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HomeMy WebLinkAbout05-14-09 (2)1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code near File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 r ~° RESIDENT DECEDENT 2 1 0 8 12 3 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 08 26 2008 Decedent's Last Name WOOD (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Date of Birth 05 25 1914 Suffix Decedent's First Name MI RUTH K Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~~X '' 1. Original Retum ~ 2. Supplemental Return ~~ 3, Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise f~ (date of death after t2-t2-8z) L 5. Federal Estate Tax Return Required X !, 6 Decedent Died Testate I- ~ Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes --~ (Attach Copy of Will) LJ (Attach Copy of Trust) r- 9. Liti ation Proceeds Received 10. Spousal Povertyy Credit (date of death ~ g ^ between 12-31-91 and 1-1-95) ~J 11. Election to tax under Sec. 9113(A) (Attach Sch.O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD L. WEBBER JR. 717 532 7388 Firm Name (If Applicable) WEIGLE & ASSOCIATES, P. C. First line of address 126 EAST KING STREET Second line of address City or Post Office SHIPPENSBURG State ZIP Code PA 17257 Correspondent'se-mail address: rwebber@weigleassociates.com REGISTER OF WIL,L~S USE ONLY ~ ,.~ ~' _.> ,; .._ -ii ~`,~ DATE FILED"-~ fV LL1 _,~ ~i ,- _i under penalties of perfury, I tlectare 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~~ ~~~.~ ~, ~ Mary Lou Stoner 5 /^ ~' HUUR SS / ~ /~'~~/~L,`- 1277 South Colebrook Road, Manheim, PA 17545 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~~~ ~ _ ~ ~{/-~J/ Richard L. Webber, Jr. ADDRESS - ~~ ~4~ ~~~ 126 East King Street, Shippensburg, PA 17257 Side 1 15056D7120 15D5607120 J 1505607220 REV-1500 EX Decedent's Social Security Number oecedenYs Name: Ruth K. W o O d RE CAPITULATION 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. 3 9 . 8 7 7 3 1 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7 3 , 9 4 4 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. g, Total Gross Assets (total Lines 1-7) ....................................................................... g. 1 1 3, 8 2 1. 3 1 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 8 , 4 5 7 . 7 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 8 , 4 5 7 7 5 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 O 5 , 3 6 3 . 5 6 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. 1 0 5 , 3 6 3 5 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0. 0 0 15• 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 10 5, 3 6 3. 5 6 16. 4, 7 4 1. 3 6 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18• 0. 0 0 19. Tax Due ..................................................................................................................... 19. 4. 7 4 1. 3 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1231 DECEDENT'S NAME Ruth K. Wood STREET ADDRESS Green Ridge Village Nursing Home 210 Big Spring Road CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0 , 00 Total Credits (A i• B + C) (2) 3. InteresUPenalty if applicable p. Interest E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 4, 741.36 0.00 4, 741.36 4,741.36 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 ..........................'........................................................................................ ~ x d. receive the promise for life of either payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................. ......................... ~ I x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ~~ ! x 1 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which J contains a beneficia desi nation~ ...................................................................................................................... ry 9 ~.XJ 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 betore 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 disGosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries; is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+ (6-96) SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY COMMONV/~_P,LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wood, Ruth IE. 21-08-1231 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly~owned wkh the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1 1971 Eisenhower Dollar Set 1.00 2 1 1971 Eisenhower Dollar Set 1.00 3 12 1976 Series $2.00 Bills 24.00 4 Adams County National Bank #134074 -Checking Account 3,636.93 Accrued income on Item 4 through date of death 0.20 5 Adams County National Bank #1593773 -Money Market 32,013.14 Accrued income on Item 5 through date of death 7.00 6 Adams County National Bank #4991084 -Certificate of Deposit 3,000.00 Accrued income on Item 6 through date of death 7,32 7 Adams County National Bank #8990015 -Certificate of Deposit 1,000.00 Accrued income on Item 7 through date of death 22.80 8 3 Ben Franklin Dollar Set 3.00 9 Cash 7.12 10 35 Silver Dollar Liberty Coins 35.00 11 United Health Care Services -Refund 118.80 TOTAL (Also enter on Line 5, Recapitulation) I 39,877,31 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) SCHEDULE F CDMMDNVJEALTH DF PENNSYLVANIA JOfNTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wood, Ruth K. 21-08-1231 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 ADDRESS RELATIONSHIP TO DECEDENT A. Mary Lou Stoner B C 1277 South Colebrook Road Daughter Manheim, PA 17545 JOINTLY OWNED PROPERTY: 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 % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 4/21/1999 ACNE Corporation Stock Certificate 72,512.00 50.000% 36,256.00 #32294 - 4532 Shares @ $16.00/Share 2 A 211 612 0 0 0 ACNB Corporation Stock Certificate 61,632.00 50.000% 30,816.00 #32808 - 3852 Shares @ $16.00/Share 3 A 12/15/2006 ACNB Corporation Stock Certificate 6,704.00 50.000% 3,352.00 #38050 - 419 Shares @ $16.00/Share 4 A 1 211 412 0 0 7 ACNB Corporation Stock Certificate 7,040.00 50.000% 3,520.00 #40744 -440 Shares @ $16.00/Share TOTAL (Also enter on Line 6, Recapitulation) I 73,944.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Wood, Ruth K. 21-08-1231 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Eby Granite Works -Engraving 110.00 H-A Subtotal 110.00 Personal Representative Commissions 2 Mary Lou Stoner, Executrix 3,000.00 H-B1 Subtotal 3,000.00 Attorney Fees 3 Weigle 8~ Associates, P.C. 5,000.00 H-B2 Subtotal 5,000.00 Probate Fees 4 Cumberland County Law Journal -Legal Advertising 75.00 5 Cumberland County Prothonotary -Probate Fee 143.00 6 The News Chronicle -Legal Advertising 104.75 H-B4 Subtotal 322.75 Other Administrative Costs 7 Shirley Ahlers -Witness fees 25.00 H-67 Subtotal 25.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (g.00) " SCE"'EEDULE J ANIA COM ~ ~ BENEFICIARIES AX RETURN ER TANC I RESIDENT DECEDENT ESTATE OF FILE NUMBER Wood, Ruth K. 21-08-1231 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116(a)(1.2)] See attached schedule Total 31,419.56 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cover sheet ~~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE .~ The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Ruth K. Wood 08/26/2008 205-09-9475 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Keith R. Grove Grandson EightThousand Five 8.509.47 255 Strathmore Avenue Hundred Nine Dollars Oldsmar, FL 34677 and Forty-Seven Cents 2 Ed Stoner Grandson Two Thousand Six 2.618.29 1 Heidi Lane Hundred Eighteen Gardiner, NY 12525 Dollars and Twenty-Nine Cents 3 Mary Lou Stoner Daughter Eleven Thousand 11,782.33 1277 South Colebrook Road Seven Hundred Manheim, PA 17545 Eighty-Two Dollars and Thirty-Three Cents 4 Ann Wiewall Granddaughter Eight Thousand Five 8,509.47 2321 Market Street, Apt. 3 Hundred Nine Dollars Camp Hill, PA 17011 and Forty-Seven Cents Total 31.419.56 1 Ruth K. Wood Estate Pa. No 21-08-1231 SCHEDULEJ EXPLANATION FOR DISTRIBUTION The net taxable probate estate, $31,419.56, is less than the full amount needed to completely fund Paragraphs V and VI of the Will and Codicil, $40,000.00. The distribution set forth in Schedule J is therefore calculated by allocating 75% of the net estate to the Paragraph V beneficiaries and 25% to the Paragraph VI beneficiaries. There would be no distribution to the charitable beneficiaries in Paragraph VII. The Decedent had two children, Mary Lou Stoner and Joann Wiewall. The said Joann Wiewall predeceased Decedent. She was survived by two children, Keith R. Grove and Ann Wiewall, who are Decedent's grandchildren. Mary Lou Stoner, the other child of Decedent, survived Decedent. She has one child, Ed Stoner, who is a grandson of Decedent. ~~~ I ~ 11 a ~ L ~ ,~IL~ I, RUTH K. WOOD, of North Newton Township, Cumberland County, Pennsylvania, declare this to be my last will and testament, and revoke all wills and codicils which I have previously made. I _ I give and bequeath to my husband, Wayne Wood, if he shall survive me ali of my tangible personal property including automobiles. II - All the rest, residue and remainder of .my estate, real and personal, I give, devise and bequeath unto my husband, Wayne Wood, if he shall survive me, absolutely and in fee simple. III - If my husband, Wayne Wood, fails to survive me, I give and bequeath to my two daughters, Mary Lou Stoner and Joann E. Wiewall, such articles of tangible personal property, excluding automobiles as they shall amicably agree and select, I without requiring strict equality of distribution between them. Any articles not so II selected shall be sold and the proceeds added to my residuary estate. IV - If my husband, Wayne Wood, fails to survive me, I give and bequeath I my Farmers National Bank stock to my two daughters previously named in equal shares ~ if living, and if either shall be deceased to her surviving children by representation. V _ I give and bequeath the sum of Forty Thousand Dollars ($40,000.00) to ~ each of my daughters if living, otherwise to her surviving issue by representation. C~ 1 VI _ I give and bequeath the .sum of Ten Thousand. Dollars ($10,000.00) to m randchildren if living, and if deceased to his or her surviving child, each of y g S children and step-child. ~~ VII - I give and bequeath the sum of Five Thousand Dollars ($5,000.00) to the First United Presbyterian Church of Newville, One Thousand Dollars ($1,000.00) t the School of the Ozarks, Point Lookout, Missouri, and Five Thousand Dollars ($5,000.00) to the Welsh Foundation of Newville; if my estate shall be insufficient to pay all of the foregoing legacies in full, the charitable legacies in this paragraph shall first abate pro-rata. VIII - All the rest, residue and remainder of my estate, I give and bequeath in equal shares to my two daughters previously named, and if either be deceased, to her surviving issue by representation. IX - Any share of my estate which shall become distributable to a minor may be held in a savings account, certificate of deposit or similar security, in a federally insured banking or savings institution in the name of the minor and marked not to be withdrawn until the minor attains the age of 18 years, or on order of a court of competent jurisdiction. I' _ i ~ 4 i -...:_... .. z...._. ._._ _..-._ .».u.:..s.. ,_...._,w~_ a...~:_~:,__.~:.~u. _.._::~~.___ ........ .. X - All taxes becoming due because of my death, whether with respect to i property passing under this will or otherwise, shall be paid out of my est;ate as an expense of administration. XI - I appoint my husband, Wayne Wood, as Executor of this wi17., and if for any reason he shall fail to qualify or cease to act as such during they administration of my estate, I appoint my two daughters, Mary Lou Stoner a.nd Joann E Wiewall, as alternate Co-Executors of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of April, 1987. ~ .[ r .~~' ^~ ~~C i (~( ) / ~-z~L-l' ~ SEAL Signed, sealed, published and declared by Ruth K. Wood, testatrix above named, as and for her Last will and testament, written on two sheets oi' paper, in our presence, who in her presence, at her request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: ~.~~~~. C~'O 9 :{ r ~ ~ p M M ~ m ~ ~ ., z ~°x~ K ~ n z x ~ y x 9 ~n c 4 o M d ~ ~ W ~ ~ 7J ~ o s cy ~ M ~ y ~ ~,Mxo~ M H H ~ N z M x ~ K ~ n x >~,°'"[ [ r `~" z ~ ~ n c P. x ~® T~ L_. , f~ CODICIL TO LAST WILL AND TESTAMENT OF RUTH K. WOOD DATED APRIL 23, 1987 I, RUTH K. WOOD, of North Newton Township, Cumberland County, Pennsylvania, being of sound mind, memory and dispositon, having made my Last Will and Testament dated April 23, 1987, do hereby make, publish and declare this to be a Codicil to my said Last Will and Testament. FIRST, I hereby amend paragraph III and XI of my will by changing the name "Wiewall" to "Dowhower". SECOND. I hereby amend paragraph V of my will to change Forty Thousand Dollars ($40,000.00) to Thirty Thousand Dollars ($30,000.00). THIRD. I hereby amend paragraph VI of my will to change the words "child, children and step-child" to "children". FOURTH. I hereby delete paragraph IX of my will and insert in its place the following: "Any share of my estate which shall become distributable to a person less than 22 years of age shall be held in a savings account, certificate of deposit or similar security, in a federally insured banking or savings institution in the name of such person and marked not to be withdrawn until one of the following events occurs: (1) such person reaches 22 years of age, (2) such person desires to use said share or a portion thereof towards his or her post-high school education, or (3) a court of competent jurisdiction orders that said share is to be withdrawn." FIFTH. I hereby ratify and confirm my said Last Will and Testament except insofar as any part thereof is revoked or modified by this Codicil. MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 715 EAST KING STREET - SHIPPENSBURG, PA. 17257 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND . I, RUTH K. WOOD, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Codicil; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed, Sworn or affirmed to and acknowledged before me by RUTH K. WOOD, this Gc~n day of ~c,cc~~'b~.~ , 1988. ~d _ NOfAR1AL.3E/1t. Shipper mberis County My Commtasion Expiros October 28, 1989 IN WITNESS WHEREOF, I, RUTH K. WOOD, have to this, a Codicil to my Last Will and Testament dated April 23, 1987, subscribed my name and set my seal this G{~ day of December, 1988. a~ ~~ / C (ICJ ~7--~~_ ( SEAL ) Ruth K. Wood Signed, sealed, published and declared by Ruth K. Wood, the above named, as and for her Codicil, written on two sheets of paper, in our presence, who in her presence, at her request, and in the presence of each other have hereunto subscribed our names as witnesses: .~- ~ ~"~ J i COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, ~' ~- ~ and /~~~2,/,-r,.,( ~ "G~~~/~' GtiLi SG( , -~',~ the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw RUTH K. WOOD, sign and execute the instrument as her Codicil; that she 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 RUTH K. WOOD signed the will as witnesses; and that to the best of our knowledge the she was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Zip Sworn or affi d to and su s ribe.d before me., by U~c?_C.~' ~ , '~ and ~~G>„/,~~ ;~.,~ ~'~-;- ~ C ~- _~; witnesses,ythis C ~ day of ''"~ ~e~e~sc~ 1988. ~~J Nd~AR1AL SEAL David P. Parkins, Notary Public Shippensburg, PA Cumberland County My Commission Expires October 28, 7 989 MARK. WEIGLE AND PERKINS - ATTORNEYS AT LAW - 715 EAST KING STREET - SHIPPENSBURG. PA. 17257 ~1~1~/~ ~A~ ~ ~ Z~~l ~O~:J~~IY NATIONAL BA1VK March 17, 2009 Richard L. Webber, Jr., Esquire WEIGLE & ASSOCIATES, P. C. 126 East King Street Shippensburg, PA 17257 RE: Ruth K. Woodr~Estate Dear Mr. Webber: On August 26, 2008, the date of her death, Mrs. Wood was the owner of the following ACNB Corporation stock. These stmcks were registered in her name joint with Mary Lou~Stonser: Certificate 4632294 for 4532 shares issued 4/21/1999 Certificate 4632808 for 3852 shares issued 2/16/2000 Certificate 4638050 for 419 shares issued 12/15/2006 bey stock split Certificate 4640744 for 440 shares issued 12/14/2007 by stock split. The value of each share as of August 26, 2008 was $16.00. Sincerely yours, fi' ~~ <i'(,,t ~•~ Carolyn H. Kough ~'~ Executive Vice President Farmers National Bank, A Division of Adams County National Bank PO Boy 3L9, Gein~ssuuG, PA 17325 I rtio!~e 717.334.3161 ~ rou r-see 888.334.2262 ~ ~~~-.acnb.com 4850D041046 REV-485 EX (05-04) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death _ __ __ County Code Year _ File Number 2~5._0~_ 9~~75 ~~z~- 200 Decedent's Last Name Suffix First Name MI ~~ ~ ~ D I~~" ~"1-I K __ _ ©ADDRESS OF DECEDENT STREET: Zlo C3iG 5:rfttnf~ R~ ~ ~'+ CITY: fJ~~,9vIL.~.r STATE: PA __ _ _ _ _ ZIP CODE: (~~~i N REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX DDRESS OF PERSO NAME AND A n ~ C NAME: M-l RY L,QtJ` S f l~ I~C'i~ STREET ADDRESS: W ~'e~ DO ~ ~a~~ S. W ~ ~ ` CITY: '_1Ghh ~iyl'~ tad. 1"l, STATE: P.~ ZIP CODE: hs~FS. NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. NAME: ~1,~-R.~{ ~~ t.s STS ~ E'R RELATIONSHIP: . .L~q~G ~I lrt~z. , STREET ADDRESS: IaZ~ 5. C-~~GIJ~f"D~~L R~ CITY: STATE: MA,~-~~ (~ PA ZIP CODE: I~s~s b. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: A~A~S c~L~n~~~; tila°n~-.~al C3A>1~t STREET ADrDRESS ~ ~ SPRY ~ C, ~ ~~ ,W~ CITY: ~ew~I (~e STATE' P~ ZIP CODE: ~ ~a~. , NAME OF PERSON MAKING LAST ENTRY M I~ ~Y t_v ~ Sra,.i ~ DATE AND TIME OF LAST ENTRY ~'7 -1S-c~ $ DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 2-~-~`7 ~(G 1 TITLE UNDER WHICH BOX IS REQUESTED ~TtF K Waa> RIwRIC ARIn wnnOCCC AC DC CClIRI/C1 Yw\/IIJ r] wr`f`CCC TA Cf1Y '. a. NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: i CITY: b. NAME: STREET ADDRESS: STATE: ZIP CODE: ~' NAME AND TITLE OF EMPLOYEE TAKING THE INVENTOP.Y . Dovs^c.sa5 R. CI,>,1p5~y ~', X11_ dFF~«- MGG~ WAS A WILL IN THE BOX? ^ YES b. Name and address of personal reF NAME: STREET ADDRESS: c. Name and address of attorney, If any. NAME: CITY: STATE: ZIP CODE: STREET ADDRESS: 485DOD41D46 NO If yes, a. Date of will: !alive. If named in the will CITY: STATE: ZIP CODE: 48500041046 J RF\/-dR.~i FX SAFE DE~'OSIT BO)( If~VEIriTC-f~Y Page of INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found ire box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (8) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 - ITEM NO. rrEM DESCRIPTION ~ 7. ~z CASr-i 3 ©v1e_ t ISc.-,~~ we~r- 14Z I I+A~F Dul,.t.(~~ Sf= r ~' ~Nc ~ 9?~ t~S~nl~cv~e,tL N~~ D(~t-~-~~ SE i (o ~ (z ~~ ~iil(S lq~ic 5~,,-~c,S I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND C PLE TO E BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATUR SIG TURE ~> V Y PRINT NAME Dgtt~Ltgs R tnJpS. RI NAME ECK APP P ATE BOX ltil~~ ~o ~ STZ~NC'~Z. PRINT TITLE G~ R~11rL~c~ ~~ mjY DATE ~_)O-~R I CHECK APPROPRIATE BOX: ~xecutor(trix) ~Administrator(trix) ~ Estate Representative ~~ Joint owner of safe deposit box NOTE: Attach additional 8'/z" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Secudty numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the CommonwealWs personnel from disclosing confidential tax information except for official purposes. ~D1~~/IS ~oVl~ ?NATIONAL BANK December 22, 2008 Richard L. Webber Jr., Esquire WEIGLE & ASSOCIATES 126 East King Street Shippensburg, PA 17257 RE: Estate of Ruth K. Wood Date of death: August 26, 2008 Dear Mr. Webber: Mrs. Wood had the following accounts with this bank, all of which were in her name alone: Checking account 46134074.opened 3/28/1985, with a date of death balance of $3,63~i.93 plus .20~ accrued interest, Money market account 461593773 opened 12/30/1983 with a date of death balance of $32,013.14 plus $7.00 accrued interest, Certificate of deposit 464991084 opened 3/7/2001 renewed 9/7/2008 for $3,000.00 plus $7.32 accrued interest, Certificate of deposit 468990015 dated 1/16/1998 renewed 1/16/2008 for $1,000.00 plus $22.80 accrued interest. Mrs. Wood also had a safe deposit box 46406 which was opened 2/19/1969. Sincerely yours, ~~-~~ Carolyn ~ Kough ' PO Box 3 L'9, GETIYSBURG, PA 173?5 ~ PnoNe 717.334.3161 I rou FREe 888.334?262 ~ ~i~ww.acnb.com ~~ Q ~~r~ ~ w ~~' (~ .'. 1'0~ a q~ ti „~~ e ~~a ~Y S~ z U, ~ - n 'r6, ti,., ~.. ,_ _. ,~s .-...... X31 f~N n ~, ~. '' r ~~ .~ ~ ~+ ~~! {fir ~• Fri • r ~~V . , r U a vi ~'' 3 ~ w~ a~om U ;~ ~ Q H ~y4 Of Q m C ~ W~~m ~Qw a 0 \ ~ w y O ~~ ~ ~ w ~ C ~ M Oy0 V ~ ~ o aa, ai ~ j h V V~+V __~ i 7 :~. ,~ ~e _ R:4 -, ; __ _ - --) ~i ~:; ~ --~ .. JERRY A. WEIGLE Associates JOSEPH P. RUANE RICHARD L. WEBBER, JR. Of Counsel THOMAS L. BRIGHT WEIGLE & ASSOCIATES, P.C. Attorneys-at-Law 126 EAST KING STREET SHIPPENSBURG, PENNSYLVANIA 17257-1397 TELEPHONE (717) 532-7388 or (717) 776-4295 FAX (717) 532-5289 May 13, 2009 Cumberland County Register of Wills 1 Courthouse Square, Room 102 Carlisle, PA 17013 r., RE: Ruth K. Wood EstaY~-'.,_~ No. 2008-1231 ` = =4 ~ =-a - -_ Pa.No.21-08-1231 _.;-' =_ r~- Dear Ladies and Gentlemen: ~ ..,rJ ~, -A'° - `__~ ~1 - ~ I have enclosed the following items: ==? ~, ~ .; ~n 1. Inheritance Tax return, in duplicate original, with one additional copy; 2. Check in the amount of $4741.36 payable to Register of Wills, Agent, for the inheritance tax liability; 3. Check in the amount of $15.00, payable to Register of Wills, for the filing fee; and 4. Self-addressed stamped envelope. Please time-stamp the coy and return it and a receipt in the enclosed self-addressed stamped envelope. Thanks. Very truly yours, WEI,~GLE & ASSOCIATES, P.C. /i/C'/~, Richard L. Webber, Jr., Esquire RLW/paf Enclosures Cc: Mary Lou Stoner, Executrix