Loading...
HomeMy WebLinkAbout06-24-091505607120 REV- ~SOO EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 PO 60X.280601 8 1 0 1 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 30 2008 03 20 1927 Decedent's Last Name Suffix Decedent's First Name MI EICHELBERGER ROBERT L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER GF WILLS FILL IN APPROPRIATE OVALS BELOW LX ~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) n 6 Decedent Oied Testate ~~ ^^JI (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number Of Safe De OSIt BOXeS p 9. Litigation Proceeds Received i-_; ~ 1 p, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 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 MICHAEL L. BANGS 717 730 7310 ~ ~ ' Firm Name (If Applicable) -.L . ~ REGISTER ~ LS USEILY ~ - ~ ~-'' ~~~~~ ~ ~ a First line of address ~T ~ ~ ~ +~~ '"! r:#~ 4 2 9 SOUTH 1 8TH STREET r~. ~'~~ ,.~--~ c' ':~ ~-~ ~.,~ ~ ~ ~ ' ~ ~ Second tine of address C-7 ~ .~ _ --; .~ --~ , ..~..~ 1 .~ ..* :2~- ~ City or Post Office State ZIP Code DATE FILED ~ CAMP HILL PA 17011 Correspondent's a-mail address: 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 comp) e. Declaration of preparer other than the personal representative Is based on all info rmation of which preparer has any knowledge. S NATURE OF PE N R ONSIBLE FOR FI G RETURN Joyce E. Brady DATE .~ ~'''a AD ESS 12 Firehouse Road, Duncannon, PA 17020 ~ NATURE OF PREPARER OTHER THAN P ESENTATIVE ~ DATE . Michael L. Bangs ~ ~ d _ ~ ADDRESS 429 South 18th Street, amp Hill, PA 17011 Side 1 1505607120 1505607120 J REV-1500 EX oec~,rgName: Robert L. Eichelberger RECAPITULATION 95,837.28 1. Real Estate (Schedule A) .......................................................................................... 1. 66,862.68 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4. 25,305..14 5• Cash, Bank Deposits 8 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. 5 , 7 3 8 ,. 6 0 8. { ) ....................................................................... Total Gross Assets total Lines 1-7 8 1 9 3, 7 4 3 ., 7 0 14,796..39 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. 2,880..33 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 1 7, 6 7 6. 7 2 11. ( ) ...................................................................... Total Deductions total Lines 9& 10 11. 12. ( ) ............................................................. Net Value of Estate Line 8 minus Line 11 12 1 7 6, 0 6 6 9 8 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 1 7 6 , 0 6 6 . 9 8 14. 1 ( ) ................................................. Net Value Sub'ect 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 0. 0 0 15 0 0 0 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 1 7 6, 0 6 6 9 8 16 7, 9 2 3 0 1 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0. 0 0 18 0. 0 0 at collateral rate X .15 . 19. ........................................ Tax Due ............................................................................. 19. 7, 9 2 3 0 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505607220 Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1013 DECEDENT'S NAME Robert L. Eichelberger STREET ADDRESS 2 Grant Street CITY ~ STATE Enola PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 8,000.00 396.15 Total Credits (A + E + C) (1) 7,!23.01 (2) 8,:398.15 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) 473.14 (5) (5A) (5B) Make Check Payable to: REGISTER OF W/LLS, AGENT Y " f' 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 .................................................................................................................. ^ ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ C 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)]. 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 adopti~m. Rsv-1602 t:X+ (6-9ti) scHEnv~e a REAL ESTATE COM~AONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 All roal property owned solely or as a tenant in common must be roported 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 property which is jointly-owned with right of survivorship must be disclosed on schedule F. (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 A (Rev. 6-98) Rev-1606 EX+ (6-ea) SCHEDULE B STOCKS8~BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 All property Jointly-owned with right of survivorship must Ge disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE f~T DATE OF DI=ATH 1 164 shares of AT&T, Inc. 28.47 4,669.08 2 111 shares of Comcast Corporation 19.02 :2.111.22 3 Edward Jones 5~~,561.31 4 1 share of FairPoint Communications 3.14 3.14 5 21 shares of MetLife Trust Interests 34.55 725.55 6 77 shares of Qwest Communications International, 3.34 257.18 Inc. 7 77 shares of Verizon Communications, Inc. 31.52 ;2,427.04 8 96 shares of Vodafone Stock 21.96 .2,108.16 TOTAL (Also enter on Line 2, Recapitulation) 66.862.68 (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 B (Rev. 6-98) Rev-1608 EX+ (g.98) scHEO v~E E SASH, BANK DEPOSITS, & MISS: PERSONAL PROPERTY COINMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE F,T DATE OF DE=ATH 1 AT&T Dividend 65.60 2 Automobile - 2007 Chevrolet Equinox automobile (transferred to .~oyce Brady; see 15,625.00 wholesale value statement attached) 3 Citizens Bank ;1,003.33 4 Comcast Dividend 6.94 5 Fairpoint Communication Dividend 0.26 6 Fairpoint Communications Dividend 0.26 7 PNC Bank, N.A. -Account 5140111573 13,818.17 8 Qwest Communication dividend 6.16 9 Refund -Refund from Farmers Insurance Group of Companies 237.12 10 Refund -Refund from AAA Central Penn 28.35 11 Refund from Habband 10.00 12 Verizon Dividend 35.42 13 AT~T Dividend 67.24 14 Comcast dividend 6.94 15 Department of Revenue -property tax rent rebate 250.00 Total of Continuation SchedtiJle See atta<:hed page TOTAL (Also enter on Line 5, Recapitulation) 25,305.14 (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-1608 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDlJLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued __ ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 ITEM NUMBER DESCRIPTION VALUE ~~T DATE OF DE=ATH 16 Fairpoint Communication Dividend 0.26 17 Lucent Technologies -liquidation of book shares 53.25 18 Met Life trust interests dividend 15.54 19 Qwest Communication dividend 6.16 20 Verizon dividend 35.42 21 Vodafone dividend 33.72 TOTAL (Also enter on Line 5, Recapitulation) 75.305.14 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E: (Rev. 6-98) Rev-1510 EX+ (6-lib) scHEOV~E ~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COIu~AONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 This schedule must be completed and filed ff the answer to any of questions 1 through 4 on the reverse side of the REV-150() COVER SHEET is yes. ITEM NUMBER DE CRIPTI N F PR PERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST ExcwsloN (IF APPLICABLE) TA};ABLE V~~LUE 1 PNC Investments -Allstate Advantage Plus 5,738.60 5,738.60 Annuity GA16596195. This annuity was paid to the decedent's four children upon death. TOTAL (Also enter on Line ?, Recapitulation) 5,738.60 (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 G~ (Rev. 6-98) REV-1151 EX+ (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2 3. 5,228.10 8,000.00 4. Probate Fees 334.00 5. Accountant's Fees 625.00 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 609.29 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,796.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule FI (Rev. 6-98) Attorney's Fees Michael L. Bangs 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 _ SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exaenses 1 Abby Bond -Reimbursement for funeral flowers, luncheon, and various 878.10 out-of-pocket expenses 2 Sullivan Funeral Home 4,350.00 H-A Subtotal 5.228.10 Other Administrative Costs 3 Abby Bond -reimbursement for carpet removal costs 29.51 4 Cumberland Law Journal -estate advertising 75.00 5 Joyce Brady -reimbursement for luncheon 20.10 6 Pam Reitenbach -Real estate appraisal 350.00 7 The Sentinel -estate advertising 134.68 H-67 subtotal 609.29 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COIrNdONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 Include unreimbureed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Center For Kidney Disease ~ Hypertension 60.63 2 Direct pay - Privgrdoct 14.99 3 Direct pay - Privgrdsep 14.99 4 East Pennsboro Ambulance Service, Inc. 68.53 5 East Pennsboro Township -sewer/trash (OctoberlNovember/DecM1~mber 2008) 115.00 6 Glen Eichelberger -care 9/27 and 9/28/2008 199.00 7 Heritage Medical Group, LLP 56.58 8 Ian Bond -care 9127 and 9/28/2008 194.00 9 Internists of Central PA 58.33 10 PA American Water - 9112108 to 10/13/08 56.09 11 PA American Water ~ 33.77 12 PA American Water ~ 36.32 13 PA American Water -11111/08 to 12/11/08 32.37 14 PA American Water -12/11108 to 1114109 33.26 15 PA American Water -1114!09 to 2111109 31.84 16 PA American Water - 2111109 to 3112109 33.96 17 PA American Water - 3112109 to 3124109 27.21 Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 'i ~, Recapitulation) 2,880.33 (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 1(Rev. 6-98) Rev-1612 EX; (8-88) scHEOV~F ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 18 Pinnacle Health Emergency 31.97 19 Pinnacle Health Hospital 1,024.00 20 PP8r.L -11 /17108 to 12/17/08 29.02 21 PP&L -12/17108 to 1120109 30.33 22 PP~L -1120109 to 2/18/09 25.60 23 PP~L - 3/19/09 to 3125/09 5.66 24 PP~L Electric - 9/17/08 to 10/16/08 48.83 25 PP&L Electric 28.90 26 PPS~L Electric 32.53 27 PP8~L Electric - 2/18/09 to 3/19109 25.92 28 Quantum Imaging & Therapeutic Associates 42.34 29 Snoke Family Practice 11.47 30 UGI 27.32 31 UGI -12/2/08 to 12/30/08 93.21 32 UGI 156.19 33 UGI - 2/2/09 to 3/3/09 140.07 34 UGI - 3/3/09 to 3/25/09 60.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1b13 EX+ (8-00) SCHED~lLE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Eichelberger, Robert L. 21-08-1013 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SFiARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) Do Not Ust Truate s I • TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)j Abby I. Bond Daughter 351 Reigle Road Marysville, PA 17053 Joyce E. Brady Daughter 12 Firehouse Lane Duncannon, PA 17020 Robert A. Eichelberger Son 2842 Skyview Drive Camp Hill, PA 17011 Cathy D. Long Daughter 845 Hummel Avenue First Floor Lemoyne, PA 17043 Tota I Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iwte, on Rev 1500 cove ` r sheet II .P NON-TAXABLE DISTRIBUTIONS: I 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) A. Setlment Statement U.S. Department of Housing and Urban Development OMB No. 2502-0256 B. T e of Loan 1. FHA 2. FMHA 3. Conv. Unlns 6. File Number 7. Loan Number: 4. VA 5. Conv. Ins. 115-09 Mort a e Insurance Case Number: C. Note: this form is furnished to give yon a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information u oses and are not included in the totals.. D. Name/Address of Borrower: DAVID S. BRADY JR. 623 MOHAWK ROAD, NEWVILLE PA 17025 E. Name/Address of Seller: THE ESTATE OF ROBERT L. EICHELBERGER 2 GRANT STREET ENOLA F. Name/Address of Lender: FIRST NATIONAL BANK OF MARYSVILLE 1 CENTRE SQUARE MARYSVILLE, PA 17053 G. Property Location: Settlement Agent: Arthur M. Feld, Esquire 2 GRANT STREET ENOLA PA 17025 1309 Bridge St., New Cumberland, PA 17070 T) N: 23-2582769 Date of Settlement MAY 14, 2009 J. SUMMARY OF BORROWER'S TRANSACTIO N SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWE R 400. GROSS AMOUNT DUE TO SELLER 101. Contract Sales Price 103,000.00 401. Contract Sales Price 103,000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement char a to borrower Line 1400 4,529.58 403.00 104.00 404.00 105.00 405.00 Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 106. Cit /town taxes 406. Cit /town taxes 107 Count Taxes 5/7/09-12/31/09 163.62 407. Count taxes 5/7/09-12/31/09 163.62 108. School Taxes 5/7/09-6/30/09 233.24 408. School Taxes 5!1/09-6/30/09 233.24 109. Refuse & Sewer 5!7/09-6/30/09 68.04 409. Refuse ~ Sewer 5/7/09-6/30/09 68.04 110. Water 410. Water 111. Sewer 411. Sewer 112.00 412 120. GROSS AMOUNT DUE FROM BORROWER 107,994.48 420. GROSS AMOUNT DUE TO SELLER 103,464.90 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. D osit or earnest mone 500.00 501. Excess D osit see instructions 202. Princi al amount of new loans 92,700.00 502. Settlement char es to seller line 6,127.62 1400) 203. Existin loans taken subject to 503. Existin loan s taken subject to 204.00 504. Pa off of 1st Mort a e Loan 205.00 505. Pa off of 2nd Mort a e Loan 206.00 506.00 207.00 507.00 ADJUSTMENTS FOR ITEMS UNPAID BY SELLER ADJUSTMENTS FOR ITEMS UNPAID BY SELLE R 210.Cit /town taxes 510. Cit /town taxes 211. County taxes 511. Count taxes 212. Assessments 512. Assessments 213. School Taxes : 513. School Taxes 214. Refuse 514. Refuse 215. Water 515. Water 216. Sewer 516. Sewer 217 CREDIT TO BUYER FROM SELLER 1,500.00 517 CREDIT TO BUYER FROM SELLER 1 500.00 218.00 518.00 , 219.00 519.00 220. TOTAL PAID BY/FOR BORROWER ~ 94,700.00 520. TOTAL REDUCTIONS IN AMOUNT DUE 7,627.62 SELLER 300. CASH AT SETTLEMENT FROM/TO BORROWER 600. CASH AT SETTLEMENT TO/FROM SELLER 301. Gross amount due from borrower 107,994.48 601. Gross amount due io seller line 103 464 90 line 120 420 , . 302. Less amounts aid b /for borrower 94,700.00 602. Less reductions in amount due 7 627 62 line 220 seller line 520 , . 303. CASH X From TO )Borrower 13,294.48 603. CASH FROM TO X SELLER 95 837 28 , . SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is im t t t i f por an ax n ormation is being furnished to the Internal Revenue Service. If you are required to fife a return, a negligence penalty or and other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales price described on line 401 above constitutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: If this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040) You are required by law to provide Arthur M. Feld, Esquire with your correct taxpayer identification number. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law, and Under penalties of perjury. I certify that the number shown on the additional documents signed at tl set ement is my correct taxpayer identification number. Seller #1 Buyer #1 Seiter #2 R~ Ivor ~~ L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION BASED ON PRICE $ 103,000.00 PAID FROM PAID FROM AT % = BORROWER'S SELLER'S Division of Commission line 700) as follows: FUNDS AT FUNDS AT 701. $ 3090.00 to LAWYER'S REALTY SETTLEMENT SETTLEMENT 702. $ to 703. Commission paid at Settlement (Money retained by broker ap lied to commission ($3090.00 LAWYER'S REALTY 3,090.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee $ % First National Bank of Ma villa 802. Loan Discount 803. A raisal Fee $ to 1ST NATIONAL BANK OF MARYSVILLE 75.00 804. Credit Re ort to 805. Broker Fee to 806. Tax Service Fee to 1ST NATIONAL BANK OF MARYSVILLE 89.00 807. Processin Fee to 1ST NATIONAL BANK OF MARYSVILLE 100.00 808. Courier Fee to 809. Flood Cert. To 810. Yield S read to Broker 811. Admin Fee to 812 A lication Fee $ to First National Bank of Ma sville 500.00 813 Draw Ins action Fee $ to First National Bank of Ma sville 814 Tax Escrow Waiver Fee to First National Bank of Ma sville 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 5/14/09 to 6/01/09 ~ $13.84 /da 249.13 902 Mort a e Insurance to First National Bank of Ma sville 47.92 903 Hazard Insurance $600.00 POC 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance 2 months ~ $ 30.92 er month 61.84 1002. Mort a e insurance 1 months ®$ 47.90 er month 47.90 1003. Ci ro art taxes months ~ $ per month 1004. Coun ro art taxes 2 months ®$ 27.82 er month 55.64 1005. School taxes 10 months ~ $ 90.44 er month 904.40 1100. TITLE CHARGES 1101. Settlement Fee 1102..Title Examination to 1103. Document Pre aration to 1104. Nota Fees cash 10.00 10.00 1105. Attome s Fees to Arthur M. Feld 663.00 1106 Title Insurance KERWIN &KERWIN 360.75 1107. Endorsements 100/300/900 to KERWIN &KERWIN 150.00 1108. Lender's Covera e $ 1109. Owners Covera e $ 1110. Settlement X office to 1111.. Extra Co ies to 1112. Recordin to 1113 Closin Service. Letter fee to KERWIN &KERWIN 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees: Deed $50.50 ; Mort a e $ 62.50 Assi nment of M t $37.00 150.00 1202. Cit /count tax/stam s Deed $ 1030.00 Mort a e $ 1,030.00 1203. State Tax Stam s: Deed $ 1030.00 Mort a e $ 1,030.00 1204.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins action to 1303. Ovemi ht Fee 1304. Pa -off to 1305 EAST PENNSBORO TOWNSHIP SEWER AND TRASH APRIL/MAY/JUNE IN PENALTY 126.50 1306 DEBORAH A. LUPOLD, TREASURER 2009 COUNTY TAX BILL 361.12 1307 ARTHUR M FELD TAX CERTIFICATION 10.00 1308 AKENS ENGINEERING NEW SURVEY 1,500.00 1309.00 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502 4,529.58 6,127.62 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account in this transaction. I further certify that 1 have recei d a copy of the HUD-1 Settlement Statement. Borrower #1 Borrower #2 Sell Iler #2 To th st o my knowl ge, the HUD_ Settlement Statement w ich I have prepared is a true and accurate account of the f ds which were r ceived and have be be disbursed by the undersigned as part of the settlement of this transaction. ' ~1 ~ Arthur M. Feld ~/ " L ~ Settlement Agent i~ ~~ ~, ~~ 0 ~~ ~ ~ ~ ~ ~ ~ ~ v ~ ~ ~ n "" ~ n '~ ctr'i ~ ~ ~ ~ ~ ~ ~ ~ sit ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~° ~ m ~ 3 ~ ~ ~ ~ ~ as s3-' ~ ~ ~' -~~- ~ _ ~ ~' °~' ~' ~ ~'~' m ~ ~'' ~ °~. {° ~ n: ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~. ~. ~ ° ao ri a ~, $ .~. ~ ~ -- ~ " ~ ~ ct ~ ~ ~ 3 Boa a ~~ ~ ~. ~ ~_ ~' ~~ ~ ~, ~ w ~ ~ ~`' ~j ~ iC ~_ ~ ~ .w Q ~ N 1 '~ ~ 1'-? ~ ~ ctt V ir? ~ ~- ~ ~ ~ 'k ~_ ~ ~ ~ ~'' ~b ~' ~ ~ ~ ~ ~ ~ ~ o -~ ~ ~ ~ ~, ~, ~ ~~ ~~- Q~ ~ ~ ~. ~~ ~~ ~~ ~~ ~ ~ ~ ~- _~ ~ 1 Q ~. ,~ ~_ 7 ~ _~ ~~~r~~raa W W rM a ~m ~'' ~~ .~ -~ ~~ 1~ ~ m~ ~ ~ m ~ _ `~ m a c rt C ~ G4 C~ CA i d r~ W ~. ~_ ~, m ~_ p.. 0 r~ ~, ~m '~ ~ ~ ~ d ~~ ~ ~ O ~~ ~a ~~ m c. ~, ~~ ~~ 3 Q~ O ~ b O ~ ~ ja ... -~ ~ ~. ~~ ~• ~ ~Q o~ w ~' ~t 0 ~ ~. a~ ~~ a ~'. ~o ~~ a~ ~ s~ r 8~ h~ V Q. 1 d m ~~ ~m a~ ~. ~ f~ LL ~~ `c y~ ~ ao .a -~) i Gi r tJ~ .s C- i ~ i N ~ i ~1 ~ ~ tab ~J d? CJ7 ~ ~ t~7 -~ ~ G w o ~ ~ ~ C ~ o ~ ~ ~ ~ ~ ~i ~ ~ ~ ~ ~~ ~ -~ ~~ ~ ~' -s: c> c -~. ~ ;~ ~ ~ ~ . ° ~~ : ~~ O. o `` ~ ~ : ~ to ~` 0 ~+ , ~ m :~ ~~ ~~ ~~ m ~ .~ '~ '~ ~ :~ -~ r~ ~ a ~~ `3 j ~ ~ ~ ~ ; ~a ,~A .rte f~ L ~a :~ ~ ~ as ~ ~ ~ ~ w ;~! ~ o c~ a o ~ ~- i go .: w+ d ~ /~~Jy ~ 1 T !r 3~ i~ rt ~. ~. h Rf ~. ~_ _~ ~... O to ~ O ~ C i N ~~ 5 ~m ~~ ~ ~ m ~~ ~~ o. ~. ~~ ~~ s` h~ ~a ~a ~~ ~~ r« ~ _. ~~ ~'. o ~= ~ ~. o~ ~~ o ..~ _~ ~. ~ ~_~ .~ 0 ~~ ~~ ~~ ~~ .-r ~. Q Q. ~i ri ~ ~ j ..A ~„~ ~ N ~+ OD O C1~ ~ N ~• ~ • t,a m iv ~ .1 ~ N to ~.i ~ ~ t 7+ W .,11 +~ '*~ ~7 ~ ~ _ ~ Z ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ m ~ ~ Q ~ ~ ~ -~* ~ ~ ~ Q o ~° ~ ii z ~- 3 ~ ~ ~ ~ m x ~ o w ':~ ~ ~. r rn ~ ~ -~ i i ~ ~ 17 ~ ^ ~ ~II~ ~rrAw ~' '77 ~ '~ t~ }~, L~AA }~ ff~~ 'ffT ~ ~ V7 ~ FT }~, V, ~p ~I7 ~r~ VT t~ '~77 ~ ~~11II~~ i ~ ~ y ~.~. ~ 5.~ ..i tJh~ ••``AA ~/A~ r~ ~7 V7 ~ 'V7 rrl~~ ~}A~ ~!! O7 'V7 `PT YJ ~7 ~ ~T 07 ~ VT IIT ~ . fl. ^~ r'ti R71 ~_ V ~ ~ ~ a ~ .: ~ ~ m Si "~ ~. ~_ ~;. Q .-~ ..~. ~~ a'7 Rr Q N ~. o~ ~~ ,~ ~~ ~ ao ~g 'o d ~ ~ cb cp ~ ~ .-« 'C3 ~ '~ y ~~ ~~ 'n _. ~. ~ ~- S° 3 ~- ~~ m ~ ~~ --r .~ '~ O ~ ~ ~~ _~ iD O. ~ ? ~ -« ~. ~. Cj ~ _~ _~~ ~. _~ a `~ m O ~ .-+ ,a ~ ~ ~. m =- ~ ~; ~~ c- r. a~ c CD ~_ CA ~_ fl. SA ~i 'O Q ~ ~ ~ ~ ~ ~ _ _ ~ ~ 4 ~ ~ .t ~ 1"1 ~ ~ ~ ~ ~' 1~ ~ r~-F ~ ~ ~_.. ~ a. ~ ~ O. ~ of +~. ~, ~ .. t7i Cll ~ GJ ~ C ~ ~ ~ G ~ ~ ~ _ m a W j ~_ ~ ~ +~ ~ ? i' _ ~ ~ ~ ~ ' ~ O ~ , K.~ :.ti `~ ~ (~,~ ~ G? C ~ _3 ~~ C,. N ~t'D ""'' Q ~. ~ O ~ ~ '~ V! ~~ ~~ ~m _, ~~ ~~ r* C ~~ 3 .~ ~ ~ m ~ .•-. N ~ cA ~ Q ~ ~~ ~_ ~ ~ ~ ~ ~• .-•. ~ ~ ~. t~ ~ N <b ~- ~. ~; ~ ~ a~ S~ ~~ ~~ ,... ~~ ~~ ~ ~ ~~ a 1 Z ~r Q a v C ~. ~~ 4 !Q FairPoint Communications -Historical Price Lookup Fa~rFl~nt. Print Pale Stock_Quote I Stock Chart I Historical. Price Lookup I Investment Calculator Symbol: FRP (Common) Enter a Date: December ~ 22 ~: 2008. - GQ (Historical data is adjusted to reflect stock splits. ) Closing Price 3.15 Volume (000) 733,800 Day's High 3.23 Currency US Dollar Day's Low 3.05 Exchange NYSE Open 3.15 Date - Copyright. r~: 2008 MarketWatch, inc.. All rights reserved. Please see our Terms of Use. Designed and po~rrered by Dow J9n s li nt Sol~.rti~c ns Intraday data provided by Interactive Data_Real Time Services and subjer_t to the Terms of Use. Intraday data is at least 20-minutes delayed. All times are ET. Historical and current end-of-day data provided by Interactiye_Data_Pncng and Reference_Data. Page 1 of 1 Close Window http://phx.corporate-ir.net/phoenix.zhtml?c=122010&p=irol-stockLookup~f&t=HistQuote&con 12/23/2008 Historic Share Price -Vodafone Page 1 of 1 Register for news ~ Sitemap ~ Contact U:. ~ Help vo Q one Search by keyword Home About Vodafone Investor Relations Media Relations Corporate Responsibility Foundation Sponsorship Innovation Careers ~1 ~ ~ { ~ Interactive charting morn > - t't ,:.: r` ~ t~ ~~: : -~ ~ ~~- hs ~ ~~~ 4. _ t Y I,nvest oo '' ~ -l~ i~Y~~, p~~k ~. ~ C! O n;. ' ~' ` • '• d - + a ,,, t`f~~ ~ ~ t ~ + ;, x~. ~ 1 t ; ' View an interactive version of the . _~;~.' ' ,. ,~ "'; .; ~ ,, ~, x~~~ ,5,~ ~F share hart c for greater precision. ,,,~ ~ '~ `~ _~ ~ ~' .. _.. . Interactive chart Historic Share Price more > London Stock Exchange -Historic share price download Select date: In order to download the share price data in Excel format, please select the time period that you wish and select "Download". 30 ~ 09 - 2008 Start Date 20 = 05 2008 ;-` Cakx~laie End Date 20 `. 05 ~ 2009 Price on dale in GBP 1.23 Share Price Charting New York Stock Exchange -Historic share price download Download Clear data Go RIC,DATE,OPEN,CLOSE,HIGH,LOW,VOLUME 000's VOD.N,2008-09-30,21.89,22.1,22.18,21.74,747.6 Comcast Corporation ... ..:;, ;~• Change Volume (EMA,13) [_~ . _ ADD » ~ '~_ ;.`~ `.':. ADD • t--J- News f] 1 day ~ 5 days ~ 1 mo. ~ 3 mo. ~ 6 ma. ~ 1 yr. ~ 3 yr. ~ 5 yr. ~ 10 yr. ~ Max. I -~-~ '~ i I _ .. I _ _.~._ I I _ ~I I_II I_ Ti lI Link to this Chart Vii, Click and drag on the chart to zoom into a custom time frame. ;,lose Fill ^ ~ ~IIIIIIIIIIIIIII~. Llnear (Logarithmic r ~folume ~milliens) EhtA~ 13) MetLife -Investor Relations -Historical Price Lookup Historical Price Lookup Symbol MET (Common Stock) Select Date September 30 2008 Look Up Price Results Date Requested 09/30/08 Closing Price $56.00 Volume 9,453,300 Split Adjustment Factor 1:1 Open $47.52 Day's High $56.00 Day's Low $46.20 Copyright ©2008 MarketWatch, Inc. All rights reserved. Please see our Termer of lJse. Designed and powered by Dow Jones Client Solutions Intraday data provided by Interactive Da~~ Real Time__SeCVi_ces and subject to the Terms of_Use. Intraday data is at least 20-minutes delayed. All times are ET. Historical and current end-of-day data provided by Intera.~ve Data Pr~n~and. Ref~rence_Data. Page 1 of 1 Privacy Policy Lec Copyright 2003-OS Metropolitan Life Insurance Company NY, NY -All Rights Reserved PEANUTS Copyright United Feature Syndicate, Inc. http://investor.metlife.com/phoenix.zhtml?c=121171&p=irol-stocklookup__pf&t=HistQuote 2/l:Z/2009 Qwest ~ About ~ Investor Information Historical Stock Lookup: Qwest Historical Stock Lookup: Qwest Symbol Q (Common Stock) Lookup Date September' ~ 30 - 2008':.. LU'bit Up, Result Dste Requested 09/30/08 Closing Price ;3.23 Volume 25,627,280 Split Adjustment Factor 1.0000:1 Open ;3.25 Day's Niph 53.44 Day's Low 53.23 NOTE: The Losing Price, Day's Hfgh, Day's Low, and Day's Volume have been adjusted [o account for any stock splits and/or dividends which mey have occurred For this security since the date shown above. The Actual Price Is not adjusted /or splits or dividends. The Split Adjustment Factor is a cumulative factor which encapsulates all splits since the date shown above. The closing price atwve Is not necessarily indicative of future price performance ~- so : + 1 i c~,hynght ~~'~ OO7 (sweat ; Legai Notices I Privzcy Policy Page 1 of 1 http://phx.corporate-ir.net/phoenix.zhtml?c=11953 5&p=irol-stockLookup&t=HistQuote 12/23/2008 AT&T -Investor Relations -Price Look-Up Price Look-Up Quote Graph f€}iYidand H~©ricai Quotee_ Sp~llts ATBT Inc. (NYSE: T) -Common Date Requested 09/30/08 High $29.02 Low $27.92 Open $28.35 Close 527.92 Volume 45,949,200 Historic prices are adjusted for stock splits. See our Historic Stock Data page for information on splits and dividends. Price Look-Up - Select a Date 2008 ;<<~ Septembe 30 '' Update Price If you purchased ATBT stock before January 1, 1984, please .dick here for historical pricing information. NOTE: The Closing Price, Day's High, Day's Low, and Day's Volume have been adjusted to account for any stuck splits and/or dividends which may have occurred for this security since the date shown above. The Actual Price is not adjusted for splits or dividends. The Split Adjustment Factor is a cumulative factor which encapsulates all splits since the date shown above. The closing price above is not necessarily indicative of future price performance. Page 1 of 1 http:l/phx.corporate-ir.net/phoenix.zhtml?c=113088&p=irol-stockLookup&t=HistQuote 12/23/2008 Verizon ~ Investor Relations ~ Stock Information ~ Stock Price History rake i of i Stock Price History CISCLAItJIER ~lits page for more Historical Stock prices are split-adjusted; see our Stock Dec 23, 2008 10:5t~ am Investor Relations _ information. NYSI=: vz 33.68$2 Company Profile + 0.2882 Business Units The Closing Price, Day"s High, Day's Low, and Day's Volume have been adjusted to account for any stock splits andlor dividends which may have VZ Financial Order Corporate Governance occurred for this security since the date shown above. The Actual Price is not Express Literature Financial Performance adjusted for splits or dividends. The Split Adjustment Factor is a cumulative Verzon R ports Continue>d e factor which encapsulates all splits since the date shown above. All VZ prices ___ _ _ Growth inin 3Q Fixed Income have been adjusted for the spin-off of Idearc. _ Stock Information Review Q3 2008 Finarn~ials Choose the company and date you are looking for: :Earnings Webcast UVP.rVIP,W ~~ Presentation Stock ;Splits VZ (PDF 188 Kf3) Stock price History ` VL ~' 3~i . ~ Sep..... ~ 2008 ~ ~ :Quarterly Bulletin (t'DF -98 KEij Divide 7d History Tuesday, September 30, 2008 ,~ Supplemental Schedulr~ (Excel. 68 KF3) SEC Filings Close: $ 32.0900 > _No_n_-G_AAP Reconciliat on Shareowners Info High: $ 32.1500 (Eire! 65 KB) Stock Transfer Agent Low: $ 30.8900 > 2006-3Q 2008 Financi~~ls Volume: 22,794,480 Effectwe October ;_r, X008 Investor News (F.:xce!. d75 KE3) WorldCom Information Site Tools Includes the Telecom Investor Contacts Note: T17e data above is believed but not Guaranteed to be accurate. Neither ~.rUrizon Glossary and the download Gornrnunications nor its stock information providers shall be liable regardless c.= ttre cause tools you'll need to view all VzM2~il or duration, for any errors, inaccuracies. omissions or untimeliness of the Information. or investor documents. `o~ any delay cr interruption in the transmission thereof tn, the user. or for any t.~laii-ns or E-mai; Address --- Losses arislnu therefrom Password ~~ Historical data provided by EDGAR Online. Forgot your password ? Sign up for VzMail! http://investor.verizon.com/stockinfo/stock_lookup.aspx?day=30&month=09&year=2008&symb... 12/23/2008 ~~ Citizens Bank October 31, 2008 MICHAEL L BANGS Esq 429 S 18TH ST CAMP HILL PA 17011 Estate of ROBERT L EiCHELBERGER Date of Death: September 30, 2008 SSN: 195-16-3491 Dear Sir/Madam: 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his date of death. The decedent had 1 active account at the time of his death and he had no Safe Deposit Box. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Phillip Lynch Operations Services ~ Citizens Bank Account Number 6100857743 Account Title ROBERT L EICHELBERGER Date O ened 2/13/1992 Account T e Checkin Princi al Balance as of DOD $2,003.33 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $2,003.33 YTD Interest to DOD $ .00 ~~vc lEADIN9?NE WAY December 1$, 2008 Midi L Bangs Attorney at Law 429 Sau#h 18~ St Camp Hill? PA 17011 RE: Roberrt L Eichel~berge~r SSN: 195-16-3491 I~OI~: 09-30-2008 i ~ ~ I3e~r Mir, Bangs: In response to your request ft~r Date of Death (DPI)} balaa~s far tl~e cu~'tor noted alive, our records show the fvllo~wing: ~heeldng Acc~-unt Account # 514Q111573 Established: 02-01-197 R~$~ERT L EIC~£El'.BERG~.'R DAD balance: ~ 6!818.11 ~ 0.00 non interest ding ~uccount Please note that this office provides date cif death ~}ances far deposit accoants (1~As, CDs, Checlcin~g and Savings). ~Ve da aQt proce~e any fiaaa~l tr~nsactinns or provide a#ateme~. Tf you mead assist3mce vvfth sny of these items, please call 1-888-PNC-BANK ~l-SS~8-7b2-2265) or stop ~'Y Your local PI~C .~azatlc branch office. Sincerely ~atio~ Financial dices Center FNC Banl~, N.A. Member FDIC Fage 1 of I NADA Offcial Used Car Guide Saturday, October 04, 2008 Wholesale Report Region: Eastern -October 2008 Stock #: Vehicle Description: 2007 CHEVROLET TRUCK VIN: Equinox-V6 Utility 4D LT 2WD NADA CLEAN TRADE-IN Mileage Value(13,238 Miles) ---- OPTIONAL EQUIPMENT ---- Power Sunroof NADA CLEAN TRADE-IN INCLUDING OPTIONS 2CNDL63F776083743 $13,775 $1,275 $15,625 NADA assumes no responsibility or liability for any errors or omissions or any revisions or additions made by anyone on this report. All NADA values are reprinted with permission of NADA Used Car Guide, NADASC. ~ ~ ~ ~~ Allstate Life Insurance Company Telephone: 1-800-755-5275 ~" ~~~ PO Box 80469 Fax: 1-866-628-1006 ~» Lincoln NE 68501-0469 CATHY D. LONG 845 HUMMEL AVE. 1ST FLR LEMOYNE PA 17043 RE: Original Allstate, Advantage Plus #GA16596195 Your New Allstate® Advantage Plus #AC1058424C Dear Cathy D. Long: October 27, 2008 Xour Representative TIMOTHY J PARRY PNC INSURANCE SERVICES, INC 100 MT ALLEN DR MECHANICSBURG PA 17055-6171 (717)691-4091 Your claim has been processed. A check has been sent to you under separate cover and should arrive within the next seven to ten business days. The first table represents the entire benefit value under the original contract as of the date of settlement, as well as any transactions that may have occurred on that date. CONTRACT VALUE AS OF 1.0/27/0$ sJN THE ORIGINAL ANNUITY #GA16596y9S Transaction Date Transaction Type Investment Alternative Units for this Transaction Transaction Transaction Unit Value Amount 10/27/08 Total Claim ALIC FIXED ACCOUNT ONE YEAR N/A N/A $-5,738 The second table confirms the investment alternatives to which your portion of the benefit value I~as been allocated. Please review the information below. If you have any questions concerning these allocations, please contact us at ~ vl.v i vv .JL I J. :CONTRACT VALUE `AS OF X0/27/0$ ON YOUR ANNUITY. # AC7058424C Transaction Transaction Investment Units for this Transaction Transaction Date Type Alternative Transaction Unit Value Amount 10/27/08 Transfer To ALIC FIXED ACCOUNT ONE YEAR N/A N/A $1,43466 Your Total Annuity Value as of 10/27/08 $0.00 Distributions taken from non-annuitized contracts are generally considered to come from the gain in the contract first. If the contract is tax qualified, generally all withdrawals are treated as distributions of gain. Withdrawals of gain are taxed as ordinary income. 1 D068URAN.N01 awaaoozooeeuaaNOOCeuaaNOOOOo U 171-1 ~~ustate. October 27, 2008 RE: Allstate® Advantage Plus # AC1058424C The check amount of $1,434.65 represents the net proceeds of your annuity as of 10/27/08. Gross Annuity Value as of 10/27/08 $1,434.65 $1,434.65 Gross Withdrawal Amount Check Amount $1,434.65 $1,434.65 $1,434.65 Remaining Annuity Value as of 10/27/08 $0.00 As required, the taxable amount of this distribution will be reported to the Internal Revenue Service on Form 1099R. A copy of this form will be mailed to you by January 31 of the next year. If you have any questions, please contact your representative or call Allstate Life Insurance Company at 1-800-755-5275. If we can be of any service in the future, we would again welcome the opportunity to assist you in reaching your long-term financial goals. C888URBB.N01 NYLR24-1 A { ~`w7 ~~..~ ~'t1~ ~ a d~. ~~ 9 .y ~~ i~ ~~ ~_, ~' C.:".:::'T .._ ~ (ai _:C3 ~-'1 ~ ~- . ... ~. ' ~, ,~'t ....» ,= _ -- , ..~ r'-..~ - e` __ _~.a -~7 r-.-• J __~.; , . _ _ ~ I, ROBERT L. EICHELBERGER, of Enola, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my death as a part of the expense of the administration of my estate. ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, in equal shares, to those of my issue, per stirpes, as survive my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate, in equal. shares, to those of my issue, per stirpes, as survive my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution oi- attachment. 1 r ITEM V. I appoint my daughter JOYCE E. BRADY executrix of this my last will. Should Joyce E. Brady predecease me or otherwise fail to qualify cr cease to serve as executrix of this my last will, I appoint my daughter ABBY I. BOND execut~~ix of this my last will. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I Hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; t~;~ ~ to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as v my personal representatives may determine and at valuations finally to be fixed by them; to .~ invest in all forms of property, including any stock or other securities in any corporate f duciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; c,. , to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, ~~ ~~ any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate ~ ../ .,~ receipts and expenses to principal or income or partly to each as my personal representatives .~a deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Z IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~~ day of i ~ .~ ~~ , 2008. ,-~ ~ _ r ROBERT L. EICHELBERGER ' . The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testator was on the date thereof signed, published, and declared by ROBERT L. EICHELBERGER, the testator therein named, as and for his last will, in tl~e presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. ~ ,,~ -~ ~. ~ ~- 4 COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ ~ .~ .,. ROBERT L. EICHELBERGER J Sworn or affirmed to and acknowledged befcr me by the t atjpr n ed above this 1 ~ day of ~ A , 2008. ota~y Publi ` ? 1'1+~sJ~V'}/~;,i1~.T~-i U~ pENh1:iYL~I',ANt~- °t~t't^.~^rf~j i'~. r:l;~i;%;.la~J~. E+~i.)'}aF?r' 1~~ i_f~~,,,,!f''' r :~(L•is i ~t~L'!r,F;., ~..~.Af~11~.k~.lt ~'RE'~ ~.C1liR'Qi4r ~,~'V ~:'o:rrf~';rs'u;~°~1~0 ~7:+~,1;s'a:?~ ~~c~.!{ 90, 20~ ~ F''~~ ~~f~yy~rra;zi~ ,~:~;sac.iaticn a€ I~c~tart~ COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) .-- h ~ WE, \ ~~ - ~ ~ ~A ~~ ..~ and '~ ~ ~ `~ ~ ~'~ ,, e J 'J witnesses whose dames are signed tot a attached or foregoing instrument, being duly qualified accor Ong to law, do depose and say that we were present and saw the testator sign and execute the instrument as leis last will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and acknowledged before m i ~ day of . ` , 2008. ~ 1 ~ ~~t'=~s~.'I. ~~~4~ E t t~F d~E~~f~dSY'LV,~1PJlq ^`4~'Q ~ ~ ~ ~x-s~t ~n~ pfd,( 'T••r ~,.~1~.}3St7i~'.~i ~N i~qt t'"'i ~, }j~~l'(~'n3 l~,F1A ~~I!.^~rl/x'41 `~r 4 ~ f f'~r~rr~~'lv~~rtia .~~sac~~~~-. ' r~ ~t ~ ~~ ~~ 5 Sn ~~~~o-~ ~,~,d a~