HomeMy WebLinkAbout04-0024Estate of Betty J. Hershey
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS
Estate of Betty J. Hershey
also known as
, Deceased
Social Security No. 201162364
Gary R. Hershey, Brenda Kelley and Linda Wolfe
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors
[] Decedent, dated 5/6/2002 and codicil(s) dated
no exceptions
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence J
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
residence at 32 Airport Road, Shippensburg (Southampton Township), Cumberland County, PA
(list street, number and municipality)
Decedent, then 77 years of age, died December 21 ,2003 , at Carolyn Croxton Slane Residence
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $
(if not domiciled in PA) Personal property in Pennsylvania .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows:
32 Airport Road, Shippensburg, Southampton Township, Cumberland County, PA
County, Pennsylvania, with his/her last family or principal
10,000.00
80~000.00
90~000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
I //.~ /'7,,")/ I /'~ignature Typed or printed name and residence
Gary R. Hershey, 171 Chamberlin Rd., Shippensbur.ct, PA
Brenda Kelley, 1966 Park Plaza, Lancaster, PA 17601
Linda Wolfe, 420 Scott Drive, Shippensbur,cj, PA 17257
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that t~ statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Pe,~ioner(s~,arjcr t~;;fat, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate ac~r~~~
Sworn to and affirmed and subscribed
~ ' Gary R~l~hey
before me this ~ dayof
January, 2004
Brenda Kelley
Linda Wolfe
DECREE OF REGISTER CUMBERLAND COUNTY
Estate of Betty J. Hershey
Deceased
No. ~/-~)_~- ~-~
also known as
Social Security No: 201162364 Date of Death: 12/21/2003
AND NOW, January , 2004 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters I~ Testamentary I~ of Administration
(c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Gary R. Hershey, Brenda Kelley, and Linda Wolfe
in the above estate and that the instrument(s), if any, dated May 6, 20022
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ....................................
Short Certificate(s) ............... $
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages ( ) ..............$
Codicil ................................. $
JCP Fee ................................. $
Inventory & Tax Forms ............. $
Other ...................................... $
TOTAL ............................. $
RW-7A
10.00
Attorney
Attorney: Joel R. Zullinger
I.D. No: 17516
Address: 14 North Main Street, Suite 200
Chambersburg
Telephone: (717)264-6029
DATE FILED: 1/8/2004
PA 17201
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9450876
No.
~__~ocal Registrar
Date
H105.143 Rev 2/87
TYPE,'PRINT
PERMANENT
4
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
' =~E~=SUAL~U~ b. Susquehanna Twp.,Carolyn Croxton S[ane Residence b~='~=~=~"'~7 White
~:~ Shippensburg I ~ ~ ~~ ~ .~.w~. ~.~
,,~ Cook ~,m. University
,;..~ Pennsylvania o, ,~.~ ~.~ Southampton
32 Airport Road
~ Shippensburq~ PA 17257 ~) ,~.~ C~berland
,L Harold W. Yohe ,, Lyra Shoap
~..~y_~ ~ershey I~ 171 Chamberlin Road, Shippensburg, PA 17257
~ ~ ~1 I I Der&a~G uo~nty~
~'m // ~ ~ ~ ~ ],~,. 12/27/2003 J~. Spring Hill Cemetery ~,, Shippensbur PA 17257
~~, b ,
~? ~' ~ ~ 0
....... c~ ...., I //~J~'~ ~ .
..................................................................
JRZ - 5.1 hershey.2
April 4, 2002
LAST WILL AND TESTAMENT
I, Betty J. Hershey, of 32 Airport Road, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I give and bequeath those items listed on a separate unsigned
memorandum which refers to this my will by date to the individuals
named therein. In the event that no such memorandum shall be found
within thirty days following my death, this bequest shall be
considered null and void.
III.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my children, namely Gary R. Hershey,
Brenda Kelley and Linda Wolfe, in equal shares, provided that the
share of any child who predeceases me or dies on or before the
thirtieth day following my death shall be distributed to said
beneficiary's issue, per stirpes, living on the thirty-first day
following my death, and in default of any such then-living issue,
such share shall be added to the share or shares of my other
children.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
Page 2
Co
Do
mo
principle of diversification of risk.
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 they deem proper.
To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
To compromise any claim or controversy.
To distribute in cash or in kind or partly in each.
To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint my children, Gary R. Hershey, Brenda Kelley and
Linda Wolfe, as co-executors of this my will.
Page 3
VII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS W~EREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
purpose of identification this __~_--_~ day of
/
(SEAL)
Signed, sealed, published and declared by the above-named
testatrix as and for her last will and testament in our presence,
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses.
We, Betty J. Hershey,
~.~_ ~- ~~~/: , the
testatrix and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
Page 4
undersigned authority that the testatrix signed and executed the
instrument as her last will and testament and that she executed it
as her free and voluntary act for the purposes therein expressed
and that each of the witnesses, in the presence and hearing of the
said testatrix, signed the will as witnesses and to the best of
their knowledge, said signer was at that time eighteen years of age
or older, of sound mind and under no constraint or undue influence.
TeStatrix ~
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subsc~ibe~ and sworn to befor~mAme by the
above~~ ~tnesses thi~ 2~~ of
lNotarial Seal [
Nichole J. Kellert, Notary Public
Shippensburg Boro, CUmberland Coun~
My Commission Expires Aug. 18, 200,~
Page 5
Estate of Betty J. Hershey
Cumberland County Register of Wills
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Betty J. Hershey
Date of Death: 12/21/2003
Will No. 2004-00024
Admin. No. 21-04-0024
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 1/20/2004 ·
Name Address
Gary R. Hershey
Brenda Kelley
171 Chamberlin Drive
Shippensburq
1966 Park Plaza
Lancaster
PA 17257
PA 17601
Linda Wolfe
420 Scott Drive
Shippensburq
PA 17257
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
no exceptions
Date: 1/20/2004
Capacity:
Signa~j
Name: Joel R. Zullinqer
Address: 14 North Main Street, Suite 200
Chambersburg PA 17201
Telephone(264) - 6029
X
Personal Representative
Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DUPLICATE
ZULLINGER JOEL R
14 NORTH MAIN STREET,SUITE 200
CHAMBERSBURG, PA 17201
NO.
CD
REV-1162 EX(11-96)
003680
........ fold
ESTATE INFORMATION: SSN: 201-16-2364
FILE NUMBER: 2104-0024
DECEDENT NAME: HERSHEY BETTY J
DATE OF'PAYMENT: 03/16/2004
POSTMARK DATE: 03/1 5/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 12/21/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $7,267.50
RiEMARKS:
SEAL
TOTAL AMOUNT PAID:
JOEL R ZULLINGER, ESQ
CHECK//115
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$7,267.50
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
LAW OFFICES OF
ZULLINGER- DAVIS
PROFESSIONAL CORPORATION
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, PA 17201
717-264-6029
Fax: 717-264-1884
zulngrlaw~earthlink.net
Dale F. Shughart, Jr.
of counsel
HAMILTON C. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, PA 17257
717-532-5713
Fax: 717-530-5222
davish~cvn.net
March 10, 2004
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Dear Register:
RE: Estate of Betty J. Hershey
File No. 21-04-0024
Endosed is check payable to you as agent in the amount of $7,267.50, representing
prepayment on Pennsylvania Inheritance Tax for the above estate. The prepayment is based on
an estimated taxable estate of $170,000.00, taxable at 4.5% or $7,650.00, less 5% discount of
$382.50.
Enclosure
Very truly yours,
Joel R. Zullinger
14 North Main St., Suite 200
Chambersburg, PA 17201
Register o[ Wills
Cumberlahd County Courthouse
Carlisle, PA 17013
REV-I$00 EX +
Z
o
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
Hershey, Betht J.
DATE OF DEATH (MM*DD-Yea')
12/21/2003
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE Of BIRTH (MM-DD-Year)
06/07/1926
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 4 0 0 2 4
SOCIAL SECURITY NUMBER
2 0 1- 1 6-2 3 6 4
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[] 1. Odginal Return [] 2. Supplemental Return
[] 4. Limited Estate [] 4a. Futura Interast Compromise (dateoldeCh a~ 12-12-82)
[] 6. DesedentDiedTestate ~3chcopyofWill) [] 7. DecedentMaintainedaLiving TrustlA~ch,:=pyofTr~st)
[] 9. Litigation Proceeds Received [] 10. Spousal Pover~ Credit (date ofde~ be~en 12-31-91 and 1-1-95)
]3. RemainderRetum (dateof~eaffipdor~o12-13-82)
]5. Federal Estate Tax Return Requirad
0.~ 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax unper Sec. 9113(A) (At,ch Sch Oi
NAME COMPLETE MAILING ADDRESS
Joel R. 14 North Main Street
FIRM NAME (If Applicable)
P.C. Suite 200
TELEPHONE NUMBER
Chambersbur,q
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Parb~emhJp or Sole-Prapdetomhip (3)
4. Mo~ages & Notes Receivable (Schedule D) {4)
5. Cash, Bank Deposits & Miscellaneous Personal Prapedy (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
] Separate Billing Requested
7. Inter-Vivce Transfers & Miscellaneous Non-Prabate Praped7 (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
mode (Schedule J)
PA 17201
USE ONLY
1~,~0.00
1:2''229'41
62 293~)0 ~
(8)
177~022.41
(11)
18~634.98
15~844.51
34~479.49
142~542.92
0.00
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
142~542.92
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or lmnsfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxabk~ at collateral rote
19. Tax Due
0.00 x __ (15)
142,542.92 x .045 (16)
0.00 x .12 (17)
0.00 x .15 (18)
(19)
0.00
6~414.43
0.00
0.00
6~414.43
Decedent's Complete Address:
32 Airport Road
Shippensburg
I STATE PA
I ZIP 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B~ Prior Payments
C. Discount
7,267.50
382.50
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A*B +C) (2)
Total Interest/Penalty ( D + E ) (3)
If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
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. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
61414.43
7~650,00
0.00
1~235.57
0.00
0.00
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 preperty 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 cocurrred alter Decereber 12, 1982, did decedent transfer preporty 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? ................. [] []
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.
SIGNATU~j~~R FILING RETURN
IDAT~
ADDRESS (~a~ R. Hersh~ey, 1~1 Chamberlin Road, Shippensburg, PA 17257; Brenda Kelley, 1966 ~ark~laza, Lancaster,
PA 17601; Linda Wolfe, 420 Scoff Drive, Shippensburg, PA 17257
SIGNATUR~ PREPARER OTHER THAN REPRESENTATIV~ DATE
ADDRESS f14 N~h Mai~ ~t,~t~ 200 ~ '
Chambersbur~ PA 17201
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 3%
[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 survivin§ spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exemct a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax tatum 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 naturat parent, an adoptive parent,
or a stepparent of the child is 0% [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 4.5%, except as noted in 72 P.S. §9116(1.2) F2 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 12% [72 P.S. §9116(a)(1.3)], A sibling is d~ned, 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)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Hershev. Betty ,,I, 21 04 0024
All real properly owned solely or as a tenant in cororoon roust be reported at fair market value. Fair market value is defined as the p~ce at which properly would be
exchanged between a willing buyer and a willing seller, neither being corobelled to buy or sell, both having reasonable know~dge of the relevant facts.
Real propert7 which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
Tract of real estate situate at 32 Airport Road, Shippensburg,
PA, appraised by Tim L. Ausherman, with copy attached
VALUE AT DATE
OF DEATH
102,500.00
TOTAL (Also enter on line 1, Recapitulation) $ 102~500.0r)
(if more space is needed, insert addfifonal sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Hershev. Bettv J.
FILE NUMBER
21 ~4
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
2.
3.
4.
5.
6.
Checking Account #97290017, M&T Bank, including
interest accrued to date of death, with copy of
verification letter attached
Gross proceeds from sale of personal property by
Dan Hershey Auctioneering
1992 Ford Crown Victoria
Refund, Sprint
Refund, Comcast Cable
Refund, car insurance
VALUE AT DATE
OF DEATH
4,489.64
5,138.25
2,500.00
27.16
1.36
73.00
TOTAL (Also enter on line 5, Recapitulation) $ 12~229.41
(If more space is needed, insert add~onal sheets of ~he same size)
REV-1510 EX + (6-g8)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Hershev. Bettv J. 21 04 0024
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER AT~ACH A COPY OF THE DEED FOR RE~- ESTATE. VALUE OF ASSET INTEREST (IF APFt. ICABLE VALUE
1. Cash gift to Gary R. Hershey, son of decedent, on 12,304.34 100. 3,000.00 9,304.3,
11/15/2003
2. Cash gift to Linda Wolfe, daughter of decedent, on 12,304.33 100. 3,000.00 9,304.3:
1/15/2003
3. Cash gift to Brenda Kelley, daughter of decedent, on 12,304.33 100. 3,000.00 9,304.3;
11/15/2003
4. Cash gift to Gary R. Hershey, son of decedent, on 11,460.0C 100. 11,460.0(
11/28/2003
5. Cash gift to Linda Wolfe, daughter of decedent, on 11,460.0G 100. 11,460.0£
11/28/2003
6. Cash gift to Brenda Kelley, daughter of decedent, on 11,460.00 I00. 11,460.0C
11/28/2003
TOTAL (Also enter on line 7 Recapitulation) $ 62~293.
(If more space is needed, insart additional sheets of the same size)
RFV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVAN~,
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Hershev. Betty J.
ITEM
NUMBER
1.
2.
3.
4.
8.
9.
10.
12.
13.
14.
15.
16.
17.
18.
Debts of decedent must be reported on Schedule L
DESCRIPTION
FILE NUMBER
:~1 04
FUNERAL EXPENSES:
Fogelsanger-Bricker Funeral Home, funeral service
Spring Hill Cemetery/Wyrick's, grave opening
Meal after funeral service
Obituary notice in Public Opinion
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Repmsantative (s)
Social Secudty Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees Joel R. Zullinger
Family Exemption: (If decedent's address is not the same as daimenfs, attach explanation)
Claimant
Zip
Street Address
Cily State Zip
Relationship of Claimant to Decedent
Probate Fees probate petition 200.00; extra pages 12.00; short certificates 15.00;
JCP fee 10.00; filing return 28.00
Accountant's Fees
Tax Return Preparers Fees
Tim Ausherman, appraisal of real estate
Cumberland Law Journal, advertise letters
News-Chronicle, advertise letters
Dan Hershey Auctioneedng Service, commission and expenses of public sale
Penn National Car Insurance, car insurance on decedent's automobile
Penelec, utilities at decedent's residence
Sprint, telephone services at decedent's residence
Timmons Oil Company, fuel oil at decedent's residence
Timmons Oil Company, fuel oil at decedent's residence
Repair basement sump pump at decedent's residence
Repairs to decedent's automobile
Snow removal at decedent's residence
AMOUNT
6,768.80
600.00
181.00
48.00
0.00
4,500.00
0.00
265.00
0.00
0.00
250.00
75.00
134.00
1,685.50
118.00
59.61
41.28
240.73
167.16
8.00
309.00
50.00
TOTAL (Als° enter °n line 9' Recapitulati°n) I $ 18~634.9R
(If more space is needed, insert additional sheets of the same size)
Hershey, Betty J.
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
21
Page I
04 0024
File Number
Schedule H - Funeral Expenses & Administrative Costs - B7.
ITEM
NUMBER
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
DESCRIPTION
Comcast, cable service at decedent's residence
Penelec, utilities at decedent's residence
Vivan Coy, Tax Collector, county real estate taxes on decedent's residence
Cumberland Franklin Joint Municipal Authority, sewer service to residence
Penelec, utilities to residence
Timmons Oil, fuel oil to residence
Frances Marchal, preparation of decedent's final personal income tax returns
Cumberland Franklin Joint Municipal Authority, sewer service
Timmons Oil, fuel oil to residence
Penelec, utilities to residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities to residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities to residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities to residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities to residence
Cumberland Franklin Joint Municipal Authority, sewer service
Penelec, utilities to residence
Vivian Coy, Tax Collector, school real estate taxes on decedent's residence
Homeowner's insurance on decedent's residence
Home repairs and painting at decedent's residence
Replacement of fuel oil tank (leaking) at decedent'e residence
Lawn maintenance at decedent's residence
SUBTOTAL SCHEDULE H-B7
AMOUNT
41.79
48.92
231.95
26.00
39.16
102.87
140.00
26.00
113.51
37.89
26.00
36.24
26.00
27.02
26.00
30.07
26.00
30.50
26.00
33.06
1,139.93
382.00
160.79
265.00
91.20
3,133.90
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Hershev. Bettv J. 21 04 0024
Include unreimbursed medical expenses.
iTEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
5.
6.
7.
8.
9.
10.
Hospice of Central Pennsylvania, balance due for care to decedent prior to death
Sprint, telephone services due at death
Penelec, utilities due at death
Timmons Oil, fuel oil due at death
Cumberland Franklin Joint Municipal Authority, sewer services due at death
Comcast, cable services due at death
Discover Card, balance due on account at death
Internal Revenue Service, tax due on decedent's 2003 form 1040
Carlisle Regional Medical Center, balance due for medical services
South Central EMS, balance due for ambulance service
2,100.00
47.92
45.82
158.97
22.10
41.79
141.45
13,110.00
101.46
75.00
TOTAL (Also enter on line 10, Recapitulation) $ 15~844.51
(If more space is needed, inse~t eddifional sheets of the same size}
REV-1513 EX + (9~)0)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Hershev. Bettv J.
NUMBER
II.
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and ~ansfers under
Sec. 9116 (a) (1.2)]
Gary R. Hershey
171 Chamberlin Road
Shippensburg, PA 17257
Brenda Kelley
1966 Park Plaza
Lancaster, PA 17601
Linda Wolfe
420 Scott Drive
Shippensburg, PA 17257
FILE NUMBER
21 04
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
Lineal
0024
AMOUNTORSHARE
OFESTATE
ane-third of residue
ane-third of residue
one-third of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 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.O0
0.00
0.00
(if more space is needed, insert additional sheets of the same size)
JRZ 5.1 hershey.2 April 4, 2002
LAST WILL AND TESTAMENT
I, Betty J. Hershey, of 32 Airport Road, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I direct that all my just debts and funeral expenses,
including all expenses o~my last ill~ess, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I give and bequeath those items listed on a separate unsigned
memorandum which refers to this my will by date to the individuals
named therein. In the event that no such memorandum shall be found
within thirty days following my death, this bequest shall be
considered null and void.
III.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my children, namely Gary R. Hershey,
Brenda Kelley and Linda Wolfe, in equal shares, provided that the
share of any child who predeceases me or dies
thirtieth day following my death shall be distributed to said
beneficiary's issue, per stirpes, living on the thirty-first day
following my death, and in default of any such then-living issue,
such share shall be added to the share or shares of my other
children.
IV.
including
approval,
A.
Any fiduciary under this will-~hall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicaole to all property whether principal or income,
property held for minors, exercisable without Court
and effective until actual distribution of all property:
To retain any and all of the assets of my estate, real or
Bo
personal, without regard
diversification of risk.
To invest in all forms of
to any principle of
property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
Page 2
principle of diversification of risk.
C. 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 er
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. Te held property in their names without designation ef
any fiduciary capacity or in the name efa nominee er
unregistered.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint my children, Gary R. Hershey, Brenda Kelley and
Linda Wolfe, as co-executors of this my will.
Page 3
VII .
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
purpose of identification_ . t~i.~ __~/~. day of
the above -named
in our presence,
Signed, sealed, published and declared by
testatrix as and for her last will and testament
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses.
/
,'" 9-: -7~ ,/ .... , .-;, , ~ ;
' We, Betty J. Hershey, ~ .': : {' .' '-/ and
I.~ ;~[./( /~!{1 f/ the testatrix and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
Page 4
undersigned authority that the ~estatrix signed and executed the
instrument as her last will and testament and that she executed it
as her free and voluntary act for the purposes therein expressed
and that each of the witnesses, in the presence and hearing ef the
~ald test'a%~, sigT~'~d the w±~l as witrresses and to the best of
their knowledge, said signer was at that time eighteen years of age
or older, of sound mind and under no constraint or undue influence.
Tegta~rix ?
Witness ~
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subsc~ibe~ and sworn to befq~me by the
above~Q~m~4 w~tnesses this [/~ day of
Notary PubI fe / ~ ......
Page 5
Borrower Estate of Betty Hershey File No.
Address 32 Ai~
CounW Cumbertand State Pa ZipCode 17257-9402
Lender Estimate of Market Value
APPRAISAL AND REPORT IDENTIFICATION
to ~ of the following definitions:
~<~ Complete Appraisal (The act or process of estimating value, or an opinion of value, performed without invoking the Departure Rule,)
~ Limited Appraisal (The act or process of estimating value, or an opinion of value, performed under and resulting from invoking the
Departure RuJe.)
This report is ~ of the following types:
~_' Self Contained (A written report prepared under Standards Rule 2-2(a) of a Complete or Limited Appraisal performed under STANDARD 1.)
~ Summar~ (A written report prepared under Standards Rule 2-2(b) of a Compiete or Limited Appraisal performed under STANDARD 1 .)
~ Restricted (A.,v.,,ritten report prepared under Standards Rule 2-2 c) of a Complete or Limited Appra sa performed under STANDARD 1,
restricted to the sta ed ntended use by the specified client or intended user.) · ·
Comments on Standards Rule 2-3
I certify that, to the best of my knowledge and belief:
· The statements of fact contained in this report are true and correct.
· The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased
professional analyses, opinions and COnCJusJons.
· I have no (or the specified) present or prospective interest in the properly that is the subject of this report, and no (or the specified) personal interest with respect to th~
padies involved,
· I have no bias with respect tn the property that is the subject of this report or the parties involved with this assignment
· My engagement in this assignment was not contingent upon developing or repealing predetermined results
· My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the caus~
of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisa!
· My analyses, opinions and conclusions were developed and this report has been prepared, in conformity with the Unitorm Standards of Professional Appraisal Practice
· I have (or have sot) made a personal inspection of the property that is the subject of this report
· No one provided significant real property appraisal assistance to the person signing this certification. {If there are exceptions, the name of each individual providing signitican~
real property appraisal assistance must be stated.)
Comments on Appraisal and Report Identification
Note any departures from Standards Rules 1-3 and 1-4, plus any USPAP-related issues requiring disclosure:
SUMMARY OF SALIENT FEATURES
Subject Address
Legal Description
City
County
State
Zip Code
Census Tract
Map Reference
Sale Price
Cate of Sale
Borrower/Client
Lender
Size (Square Feet)
Price per Square Foot
Location
Age
Condition
Total Rooms
Baths
Appraiser
Date of Appraised Value
32 Airport Rd
Deed Book Vol.
Shippensburg
Cumberland
Pa
17257-9402
0128.00
39-33-1873-007
$ 100,000
Estate of Betty Hershey
Estimate of Market Value
1,716
$ 58.28
Average
54
Average
7
4
1
Tim L.Ausherman GAA
12-21-2003
Summa ~port
Ausherman Bros. Real Estate loc,
UNIFORM RESIDENTIAL APPRAISAL REPORT
File No.
'Address 32 Airport Rd
Deed Book Vol.
City Shippensburg
State Pa Zip Code 17257-9402
County Cumberland
Assessor's Parcel No. 39-33-1873-007
Borrower
Southampton
Date of Sale
Estimate of Market Value
Tax Year 2004 R.E. Taxes $1,177.00 Soecial Asseesm~nts $ 0.00
Current Owner Estate of Bett I Owner [7 Tenant ~ Vacant
Leasehold PUD ium (HUD/VA only) HOA $ N/A /Mo.
Map Reference 39-33-1873-007 Census TrarJ 0128.00
Descrietion and $ amount of Icao charaes/concessions t_o be oaid by s¢ier N/A
Address
Tim L.Aasherman GAA
Location Urban ~ Suburban ~ Rural
Built up 'j Over 75% [~ 25-75% [~ Under 25%
Growth rate L' Rapid ~d~ Stable [~] Slow
Property values ._1 Increasing [] Stable [.] Declining
Demand/supply ~ Shortage I~ In balance [] Over supply
Marketinqtime ! i Under3mos. ~ 3-6mos. [ ] OverBmos.
Address 229 North Second Street, Chambersbur,q, Pa 17201
Predominant I p~i~c~efamilyhousing I Present land use % I Land use change
RUE AGE ' 4
occupancy I $(000) (yrs) I One family 0 I ~NOtlikely ] Like y
~ Owner 95 ~ 50 LOW new /2'4family ] I_] In process
[]Tenant 5 [ 3~-Hiqh~50 [Multi-family ~To:
~ Vacant (0-5%) IPredOminant ] Commercial
I I Vac.(over5%) F 150 25 Vacant 60F
Note: Race and the racial composition of the neighborhood are not appraisal factors.
Neighborhood boundaries and characteristics: Bounded by Route 81 to the south, Baltimore Rd to the west, Walnut Bottom Rd to the east and Kin(
St to the nodh.
Factors that affect the marketability et the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.):
adverse factors affectinq marketability were observed.The subject property is located within an area that is a mix of scattered single_]amily
homes and land utilized for aqricuNural purposes. Overall appeal to the market is average. Employment stability within the area is averaqe with.
the current unemployment rate in the 3.5 % ran.qe.
Market conditions in the subject neighborhood (including supped for the above conclusions related to the trend cf property values, demand/supply, and marketing time
-- such as data on competitive pmperBes for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.):
General market conditions in the area are stable supply and demand appear to be in balance at present. At present there are few properties
listed for sale similar to the subject property. Marketing time is approx. 100 days according to MLS Stats.
Project Information for PUDs (If applicable)*- Is the developer/builder in control of the Home Owners' Association (HOA)? [] Yes
Approximate total number of units in the subject project Approximate total number of units for sale in the subject project
Describe common elements and recreational facilities:
~ No
Dimensions 160 x 216 x 116 x 201
Site area .67 acre double lot Corner Lot ~ Yes ,~ No
Specific zoning classification and de_s_cription None exists
Zoning compliance [-_'] Lega ~ Legal nonconforming (Grandfathered use) ~1 lilac ~ No zoning
Present use ~ Other use (explain}
Utilities Public Other Off-site Improvements Type Public Private
Electricity ~ Street Asphalt ~ ~;
Gas [] Curb/gutter nonce [ ~j
Water ~ well Sidewalk none i ~ [ ]
Sanitary sewer [] Street lights none ~ i [ ~
Storm sewer / -] j Alley None I~ [ I
Topography Level
Size Typical
Shape Irregular
Drainage Adequate
View Average_
Landscaping average
Driveway Sudace _as~ohalt
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use, etc.);
easements or encroachments were observed.
Apparent easements None
FEMA Special Flood Hazard Area [] Yes ~] No
FEMAZone X MapDate 8/4/1988
_FEMA Map ND. 4215870015B
No adverse
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION
No.o!Units 1 Foundation Concrete block Slab no
No. of Stories 2 Extedor Walls Permstone/vin Crawl Space Part
Type (Del./Att.) Detached Roof Surface asphalt Basement Part
Design (Style) Gutters & OwosptsAlumn Sump Pump yes
Existing/Proposed ¢/indowType Dbl hunq Dampness _yes
Age (Yrs.) 54 Storm/Screens yes Settlement no
20 ~lanufactured House no Infestation no
ROOMS
Finished area above qrade contains: 7 Rooms; 4 Bedroom(s);
INTERIOR Materials/Condition j HEATING Base KITCHEN EQUIP.
Floors Cpt,vin/av.q Type base Refrigerator
Wails Drywall/avg ~Fuel oil Range/Oven [] Stairs
BASEMENT
Area Sq. Ft. 920
%Finished 0
Ceiling joists
Wails block
Floor concrete
Outside Entry no
INSULATION
Roof _
Ceiling Avg
Walls Avg__
FI00r _._avg
None
Unknown~_A_vg
Rec. Rm.
Bedrooms # Baths Laundry Other _ AreaSq. Ft.
920
1
1
1,180
3 . 536
1 Bath{s); 1,716 Square Feet of Gross Livinq Area
AMENITIES CAR STORAGE: 1 car
[~] Fireplace(s)#None ['] None ~I
~/[~ [Patio~, -,,N°ne---- ~]; Gar. age #ofcars
~tlon Section
ESTIMATED SITE VALUE
ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS:
Dwelliog 1,716 Sq. Ft. @$ 58.00 = $ 99,528
920 Sq. Ft. @$ 12.00 = 11,040
Porch,deck, = 12,500
Gara(]e/Carjmd 540 S% Ft. @$ 22.00 = 11,880
Total Estimated Cost New = $ 134,948
Less Physical Functional External
Depreciation 44,9781 =$
Depreciated Value of Improvements =$
"As-is" Value of Site Improvements =$
INDICATED VALUE BY COST APPROACH
ITEM SUBJECT COMPARABLE NO. 1
UNIFORM RESIDENTIAL APPRAISAL REPORT FiloNo,
32,000 Comments on Cost Approach (such as, source of cost estimate, site value
J square foot calculation and for HUD, VA and FmHA, the estimated remaining
J economic life of the properly): Cost per sq ft was derived from
J Marshall and Swift Cost handbook and modified for local
jconditions. Estimated remaininq econnmic life 55 years.
128,970
COMPARABLE NO. 2 COMPARABLE NO. 3
32 Airport Rd
Address Shippensbc r~
Proximitv to Subiect
Sales Pdce
Price/Gross Livinq Ama
Data and/or
Verification Source
VALUE ADJUSTMENTS
Sales or Financing
Concessions
Date of Sale/Time
Location Average
Leasehold/Fee Simple Fee simple
Site .67 acre double Io
View Average
Design and Appeal Cape cod
Quality of Construction Permst vin/avg
Age 54
Condition Average
Above Grade Total iBdrmsi Baths
RoomCount 4 ! 1
Gross Uvinq Area 1,716 Sq. Et.
Basement & Finished Full
Rooms Below Grade 0
Functional UtiliN
Heatind/Co¢ind
Enerq¥ Efficient items
Garaee/Carood
Porch, Patio, Deck,
Eireolacefs), etc.
Fence, Pool, otc.
Kitchen
Net Adj. (total)
Adjusted Sales Price
of Comparable
408 Sunset Lane
2 Scrafford St
Average
Base/none
Insul Wind
1 car/shop
Pomh,deck,
None
225 Lurgan Ave
2 miles mile miles
58.28 71.78 61.77 :/ 60.78
MLS-Courthouse MLS-Courthouse MLS-Courthouse
DESCRIPTION DESCRIPTION
Cony
Concess 600
10-17-2003
Average
Fee simple
.22AJAvg
Average
Cape/avg
Alumn/avq
54
Average ;
Total ;Bdrmsl Baths~
6; 3 i 2
1 ~226 Sq. Ft.;
;
Unfinished
Average
Fha/ac
+10,000
+2,500
-3,000
+7r350
-2,00~
+1,000
+1,000
Sw,sd
1 cadworkshop
Porch
None
DESCRIPTION
Cony
No concess
5-21-2003
Average
Fee simple
.23NAvg
Average
Cape Cod/avg
Aiumn/avg
52
Average
Total iBdrmsi Baths i
4 ; 1
1~368 Sq. Ft.;
Full
Unfinished
Average
Fha/ac
Sw,sd
3 car
None
None None : None
Std Kitchen ; Std kRch
~+ I~; $ 18,85o
%
Gross: 30.5 % $ lO4,85~
Std Kitchen
+(-)$ Adjust. DESCRIPTION
Cony
NO concess
3-12-2~)03
Average
Fee simple
+ 10~000 .15 A/Avg
Average
Cape Cod/avg
+2~500 Alumn/avg
53
Average
Total :Bdrmsl Baths
6 i 4 : 2
+5,220 1,456 S_q. Et.
Full
Unfinished
Avemge
-2,000 Fha/ac
+1,000 Sw,sd
2 car
+1,000 Porch
None
None
Std kitch
17,720 ~ + i I - $
Net i~i%
102,220 Gross 264 % $
comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc,):
e within the marketplace.
+10,000
+2~_500
-3,000
+3,900
-2,000
+1,000
+1,000
Comparable sales
13,400
101,900
are over 1 mile however are the
ITEM SUSJECT COMPARABLE NO. 1 N/A COMPARABLE NO. 2 N/A COMPARABLE NO. 3
Date, Price and Data N/A
Source, for prior saws Steb-MLS Steb-MLS Steb-MLS Steb-MLS
No sa e prev 3 yr 1No sa o prev 3 yr
Analysis of any current agreement of sale, option, or listing of subject property and analysis of any pdor sales of subject and comparabWs within one year of the date of appraisal:
are closed sales.
INDICATED VALUE BY SALES COMPARISON APPROACH
$__ 102,50(
INDICATED VALUE BY INCOME APPROACH, Estimated Market Reni :~ i N~A ~ iMo. x Gross Rent Multiplier ~N_/_A = ~
This appraisal is made "as is" subject to the repairs, aiteragons, inspectioos or conditions listed below [ ~] subject to completion per plans & specifications.
Conditions of Appraisal: See attached FIRREA add and IJmRing conditions.
Supplemental Addendum
lBorrower/Client Estate of Betty Hershey
Property Address 32 Airport Rd
City Shippensburg County Cumberland
Lender Estimate c~f Market Value
File No.
State Pa Zip Code 17257.9402
Adjoining Jots when sold with a single family home typically sell at approx. 50% of retail value.
· Borrov~er/Client Estate of Betty Hershey
Property Address 32 Airport Rd
City Shippensbur~
Lender Estimate of Market Value
Building Sketch (Page - 1)
County Cumberland State Pa ZipCode 17257-9402
20,0'
38.0'
13.0'
16.0'
12.0'
Deck
Perch
12.0'
16.0'
26.0'
7,01
~orrower/Client Estate of Betty Hershey
' IProperW Address 32 Ai~ort Rd
ICity Shippensburg
ILender Estimate of Mad<et Value
Location Map
Couniy Cumberland
State Pa
Zip Code 17257-9402
?
/
MULTI-PURPOSE sUpPLEMENTAL ADDENDUM
FOR FEDERALLY RELATED TRANSACTIONS
Aosherman Bros. Real Estate Ins.
Borrower/Client Estate of Betty Hershey
Propedy Address 32 Airport Rd
{;J~J Shippensbur~ County Cumberland State Pa Zip Code 17257*9402
Lender Estimate of Market Value
This Multi-Purpose Supplemental Addendum for Federally Related Transactions was designed to provide the appraiser with a convenient way to comply with the current
appraisal standards and requirements of the Federal Deposit Insurance Corporation (FDIC), the Office of the Comptrolrer of Currency (OOC), The Office of ThriB
Supervision (OTS), the Resolution Trust Corporation (RTC), and the Federal Reserve.
This Multi-Purpose Supplemental Addendum is for use with any appraisal. Only those
statements which have been checked by the appraiser apply to the property being appraised.
~ PURPOSE & FUNCTION OF APPRAISAL
The purpose of the appraisal is to estimate the market value of the subject property as defined herein, The function of the appraisal is to assist the above-named
Lender in evaluating the subject property for lending purposes. This is a Federally related transaction.
L~ EXTENT OF APPRAISAL PROCESS
neighborhood, and selection of comparable sales within the subject market area. The odginal source of the comparables is shown in the Data Source section
of the market grid along with the source of confirmation, if available, The original source is presented first. The sources and data are considered reliable.
When conflicting information was provided, the source deemed most reliable has been used. Data believed to be unreliable was not included in the repoff nor
used as a basis for the value concJusion.
~ The Reproduction Costis based on Marshall & Swift
supplemented by the appraiser's knowledge of the local market.
[] Physical depreciation is based on the estimated elfective age of the subject prope~. Functional and/or external depreciation, it present, is specifically
addressed in the appraisal repoff or other addenda. In estimating the site value, the appraiser has relied on personal knowledge of the local market. This
knowledge is based on pdor and/or current analysis of site sales and/or abstraction of site values from sales of improved properties.
~'~ The subject property is located in an area of primarily owner-occupied single family residences and the income Approach is not considered to be meaningful.
For this reason, the Income Approach was not used.
~ The Estimated Market Rent and Gross Rent Multiplier utilized in the Income Approach are based on the appraiser,s knowledge of the subject market area.
The rental knowledge is based on prior and/or current rental rate surveys of residential properties. The Gross Rent Multiplier is based on prior and/or current
analysis of prices and market rates for residential properties.
[] For income producing properties, actual rents, vacancies and expenses have been repealed and analyzed. They have been used to project future rents,
vacancies and expenses.
[] SUBJECT PROPERTY OFFERING INFORMATION
According to MLS the subject property:
~ has not been offered for sale in the past: 'J 30 days ~ 1 year ri~ 3 years.
~'i is currently offered for sale for $
~ was offered for sa~e within the past: L~J 30days [_~ 1year [_~' 3yeare for $
~ Of~edng information was considered in the final reconciliation of value.
~! O~edng information was not considered in the final reconciliation of value.
'1 Offering information was not available. The reasons for unavailability and the steps taken by the appraiser are explained later in this addendum.
[] SALES HISTORY OF SUBJECT PROPERTY
According to Cumberland Co Courthouse the subject properly:
[~ bas net transferred in the past twelve months. [] has not transferred in the past thirty-six months.
[] b~ transferred in the past twelve months. ~ has transferred in tde past thirty-six months.
~ All pdor sales which have occurred in the past fwelve months are listed below and reconciled to the appraised value, either in the body of the report or
in the addenda.
Date Sales Price Document # Seller Buyer
~ CURRENT SALES CONTRACT
[] The subject proped7 is currently not under contract.
~ The contract and/or escrow instructions were not available for review. The unavailability of the contract is explained later ir) the addenda section,
~ The contract and/or escrow instructions were reviewS. The following summarizes the contract:
Contract Date Amendment Date Contract Price Seller
Estate of Betty Hershey
The contract indicated that personal property was not included in the sale.
The contract indicated that personal property w~s included. It consisted o1
[] Personal property was not included in the final value estimate.
i~ Personal properly was included in the tinal value estimate.
[ ~i The contract indicated no financing concessions or other incentives.
E~ The contract indicatad the followino concessions or incentives:
Estimated contributory value is $
that the final value conclusion is in compliance with the Market Value defined herein.
MARKET OVERVIEW include an explanation of current market conditions and trends,
months is considered a reasonable marketing period for the subject property based on Stats from M LS
~ ADDITIONAL CERTIFICATION
The Appraiser certifies and agrees that:
(1) The analyses, opinions and conclusions were developed, and this report was prepared, in conformity with the Uniform Standards of Protassional
Appraisal Practice ("USPAP"), except that the Depadure Provision of the USPAP does not apply.
(2) Their compensation is nut contingent upon the repealing of predetermined value or direction in value that favors the cause of the client, tde amount
of the value estimate, the attainment of a stipulated result, or the occurrence of a subsequent event.
(3) This appraisal assignment was not based on a requested minimum valuation, a speeitic valuation, ortho approval of a loan.
[] ADDITIONAL (ENVIRONMENTAL) LIMITING CONDITIONS
The value estimated is based on the assumption that the properly is not negatively affected by the existence of hazardous substances or detrimental
environmental conditions unless otherwise stated in this report. The appraiser is not an expert in the identification of hazardous substances or detdmental
environmental conditions. The appraiser's routine inspection of and inquiries about the subject property did not develop any information that indicated
any apparent significant hazardous substances or detrimental environmental conditions which wou~d affect the property negatively unless otherwise stated
in this report. It is possible that tests and inspections made by a qualified hazardous substance and environmental expert would reveal the existence of
hazardous substances or detrimental environmental conditions on er around the properly that would negatively affect its value.
L~ ADDITIONAL COMMENTS
~ APPRAISER'S SIG NATU R~,/&/LIC E NSE/C ERTIFICATiO N
Appraiser's Signature
Appraiser's Name (print) ,'~l~herman GAA
State
Pa
License' I i
~ , j Certification #
Effective Date 12-21-2003 OataPrepared 2-3-2004
Phone # _( )
Ga-OOO149-L Tax ID #
CO-SIGNING APPRAISER'S CERTIFICATION
[] The ce-signiog appraiser has oersonalIv inspectad the subject property, bnh nside and out, and has made an extoder inspoctioo of all comparable sales
listed in the report. The report was prepared by the appraiser under direct supervision of the co-signing appraiser. The co-signing appraiser accepts
responsibility for the contents of the report including the value conclusions and the limiting conditions, and confirms that the ceriifications apply
fully to the co-s~gning appraiser.
~ The co-signing appraiser bas not personally insuec ed be n e o o he subject properly and:
[] has not inspected the exterior o he subject property and all comparable sales listed in the report,
~J has insbectad the axterior of the subject properly and all comparable sales listed io the report.
b~, The repor~ was prepared by the appraiser under direct supervision of the co-signing appraiser. The co-signing appraiser accepts responsibility for the
:: ~t,e, ~, u,l,~ tihe, :eo P.O~,.,.i.n,c, I,,u.d i.n,g, ~ ! e~ ~ a..I,u,,e..,.c~,.n_c I.u.s! .o.n.s,.~a~nd_ ~!!, I!~i!ing co?itioo~s,, an! conf!rms !hat the ~:editications apply fully to the co-s gn ng
tate of Betty Hershey
Airport Rd
Lender Estimate of Market Value
Subject Photo Page
Countv Cumberland
Sta~ Pa
.Z~DCode 17257-9402
Subject Front
32 Airport Rd
Sales Price 100,000
Gross Living Area 1,716
Total Rooms 7
Total Bedrooms 4
Total Bathrooms 1
Location Average
View Average
Site .67 acre double lot
Quali[y Permst vin/avg
Age 54
Subject Rear
Subject Street
B~_qow~r/Clieot Estate of Betty Hershey
IF~IIy Address 32 Airport Rd
ICity Shippensburg
Lender Estimate of Market Value
Comparable Photo Page
County Cumberland State Pa
Zip Code 17257-9402
Comparable 1
408 Sunset Lane
Prox. to Subject 2 miles
Sale Pdce 88,000
Gross Living Area 1,226
Total Rooms 6
Total Bedrooms 3
Total Bathrooms 2
Location Average
View Average
Site .22 NAvg
Quality Alumn/avg
Age 54
Comparable 2
2 Scrafford St
Prox. to Subiect 1 mile
Sale Pdce 84,500
Gross Living Ama 1,368
Total Rooms 6
Total Bedrooms 4
Total Bathrooms 1
Location Average
View Average
Site .23 NAvg
Quality Alumn/avg
Age 52
Comparable 3
225 Lurgan Ave
Pmx. to Subject 2 miles
Sale Pdce 88,500
Gross Living Area 1,456
Total Rooms 6
Total Bedrooms 4
TotaJ Bathrooms 2
LocalJon Average
View Average
Site .15 NAvg
m M&TBank
January 28, 2004
Law Offices
Zullin§er-Davis
14 North Main Street
Suite 200
Chambersbur§, PA 17201
499 Mitchell Street, Millsboro, DE 19966
RE: Estate of Betty J. Hershey
Date of Death: December 21, 2003
Social Security Number: 201-16-2364
Dear Mr. Zullinger:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
Account T~pe ........................... Checking Account
Account Number ....................... 97290017
Ownership (Names o.0 ..............Betty J. Hershey
Opening Date ........................... 01/28/80 (account closed 01 / 16/04)
Balance on Date of Death. .........$4,489.42
Accrued Interest $ 0 ~2
Total. ...................................... $4,489.64
Sincerely,
Charlene Warrington, Records Management
1-888-502-4349
FINAL
SETTLEMENT
DATE OF SALE
PHONE,.r¥/-- '7
PROFESSIONAL FEES
AUCTIONEER
CLERK
CASHIER
$
$
$
OTHER EXPENSES
CASH $
CHECKS $
OTHER RECEIPTS
$ TOTAL RECEIPTS $ Or-/-'~o~' ~'~
$ ~ LESS TOTAL EXPENSES $ /~'~'~' ~
I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds
from the auction of my goods and property sold on the above date. I accept all responsibility for ~roviding
m~.antable title to all goods, and property sold, and for delivery of title to the purchaser, r
V .Auctioneer or Cashier's Signature ,S~/,er.s Sig~ahj~e)/~--~Da'e- / /OY
CuD~berland County Register of Wills
Estate of Betty J. Hershey
Estate of Hershey, Betty J.
also known as
INVENTORY
Deceased
No. 21 04 0024
Date of Death 12/21/2003
Social Security No. 201162364
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Persj;~lal Repres.en~t b/j~
Attorney: Joel R. Zullin,qer da Kelley~
LD. No.: 17516 Linde Wolfe
Address: 14 North Main Street Dated C~'~/~,/~I-~/
Chambersbur,q PA 17201 '/ ·
Telephone: (717)264-6029
and
Stocks & Bonds
Description
Closely-Held Corporation, Partnership or Sole-Proprietorship
Mortgages & Notes Receivable
Cash, Bank Deposits, & Misc. Personal Property
Checking Account #97290017, M&T Bank, including
interest accrued to date of death, with copy of
verification letter attached
Gross proceeds from sale of personal property by
Dan Hershey Auctioneering
(Attach Additional Sheets if necessary)
Value
4,489.64
5,138.25
rotal
114,729.41
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the tota~ of the Inventory.
RW-4
H~rshey, Betty J.
Description of Inventory
1992 Ford Crown Victoria
Description
Continuation of Inventory
Pa,qe 1
21 04 0024
Value
2,500.00
Real Estate
Tract of real estate situate at 32 Airport Road, Shippensburg,
PA, appraised by Tim L. Ausherman, with copy attached
Refund, Sprint
102,500.00
27.16
Refund, Comcast Cable
1.36
Refund, car insurance
73.00
105,101.5/
Subtotal $
Grand Total $
114,729.4
BUREAU OF INDIVIDUAL TAXES
INHERTTANCE TAX DTVTS/ON
PO BOX 280601
HARRTSBURG, PA 17128-0601
COMMONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-ZEgi7 EX AFP (09-0¢i)
JOEL R ZULLINGER
ZULLINGER DAVIS
lq N MAIN ST STE 200
CHAMBERSBURG PA 17201
DATE 11-15-200q
ESTATE OF HERSHEY BETTY
DATE OF DEATH
FILE NUMBER 21 YOq'OO2r~:
COUNTY CUI~BERLAND~'
ACN 101
Amount Remitte~
MAKE CHECK PAYABLE AND ~IT PAYMENT TO:
REGISTER OF HILLS
CUMaERLAND CO COURT,USE
CARLISLE, PA 1701~
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HERSHEY BETTY d FILE NO. 21 Oq-OO2q ACN 101 DATE 11-15-200q
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bends (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule g) (7)
8. ToteZ Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funere! Expenses/Ado. Costs/Misc. Expenses (Schedule H) (9)
ZO. Debts/Mortgage Liabilities/Liens (Schedule I) (~0}
TotaZ Deductions
Net Ve~ue of Tax Return
102~500.00
.00
.00
.00
12~229 .~1
.00
62~295.00
(s)
18,65q.98
15~8qq.51
(11)
(12)
15.
lq.
NOTE:
ASSESSMENT OF TAX:
15. Amount of Line Zq et Spouse1 rate
16. Amount of Line Zq taxable at Lineal/C~ass A rate
17. Amount of Line lq et Sibling rate
18. Amount of Line lq taxable at Collatera1/Class B rate
19. Principal Tax Due
TAX CREDITS
PAYMENT RECEIPT OISCOUNT
DATE NUMBER INTEREST/PEN PA~D (-)
O~-lS-200q CD00~680 $20.72
Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Net Value of Estate Sub,eot to Tax (lq)
If an assesseent ~as issued previously, lines 14, 15 and/or 16, 17,
reflect figures that lnclude the total of ALL returns assessed to date.
NOTE: To insure proper
credit to your account,
submit the upper portion
of th~s fore with ~our
tax payment.
177,022.~1
~.~79.~9
lq2,5q2.92
.00
lq2,5q2.92
18 and 19 will
(].;) .00 x O0 : .00
(16) lq2,5q2.92 x OqS= 6,qlq.q$
(17) . O0 x 12 = . O0
(~8) .00 x 15 = .00
(~)= 6,qlq.q$
AMOUNT PAID
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
7,267.50
TOTAL TAX CREDIT 7,588.22
BALANCE OF TAX DUEI 1,175.79CR
INTEREST AND PEN. .00
TOTAL DUE 1,17~.79CR
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred
in possession or anjoyeent to Class B (colLateral) beneficiaries of the decedent after the expiration of any estate for
lifo or for years, the Commonwealth hereby expressly reserves the right to appraise end assess transfer Inheritance Taxes
at tho laaful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act~ Act 25 of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: RESXSTER OF HILLS, AGENT
A refund of a tax credit, which wes not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax'* (REV-XS13). Applications are available
online at aww.revenue.state.pa.us, any Register of Rills or Revenue District Office, or from the Department's
Z4-hour ensearing service for forms orders: 1-800-362-2050~ services for taxpayers aith special hearing and/or
speaking needs; 1-800-447-3020 (TT only).
Any party in interest not satisfied eith the appraisment, a11oeance or disaXloaance of deductions or assessment of tax
(including discount or interest) as sheen on this Notice may object within 60 days of the date of receipt of this notice
by fixing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You may object by fixing a protest online at
www.boardofappaals.state.pa.us on or before the expiration of the sixty-day appeal period. Xn order for
an electronic protest to be valid, you must receive a confirmation number and processed date from the
Board of Appeals website. You may also send a arittan protest to PA Department of Revenue, Board of Appeals
P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxad.
B) Election to have the matter determined at the audit of the account of the personal representative.
C) Appeal to the Orphans° Court.
Factual errors discovered on this assessment should be addressed in aritin9 to: PA Department of Revenue,
Bureau of Xndividua! Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17126-0601
Phone (717) 787-6505. Sea page 5 of the booklet 'Xnstructians for inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
Xf any tax due is paid aithin three (3) calendar months after the decedent's death, a five percent (51) discount of
the tax paid is alXoaed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner end in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (61) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after
January 1, 1982 will bear interest et · rate #hich wiXX vary from calendar year to calendar year mith that rate
announced by the PA Department of Revenue. Tho applicable interest rates for 1981 through 2004 are:
Interest Da[Iv Interest Daily Xntarest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .000548 ~'8-1991 1XZ .000501 ~ 9X .000247
1983 162 .000438 1992 92 .000Z47 ZOOZ 62 .000164
1984 lXX .000301 1993-1994 7Z .00019Z 2003 5Z .000137
1985 13Z .000556 1995-1998 92 .000247 2004 4Z .000110
1986 lOX .000274 1999 7Z .000192
1987 XOZ .000Z74 ZOO0 72 .000192
--Xnterest is calculated as folXoas:
XNTEREST = BALANCE OF TAX UNPA/D X NUHBER OF DAYS DELXNQUENT X DALLY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on tho
Notice, additional interest must ba calculated.
BUREAU OF INDIVlIilp.Q;l~~S ni:i:iI:~ nf
INHERITANCE TAX DIVIS~~:' " ..,-' '. . '.,1<1-11':,
PO BOX Z8060l h' : '-,
HARRISBURG, PA 171Z8-06n1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV.U07 EX AFP (09-04)
7~]C; '."! 1[-, D,e", '., 3: L,.O
... t' .} '" ...,,'1. ~ -
CLfTr< 0::
ORF'H;\\1'~',
JOEL R ilUliCINGER'
ZULLINGER DAVIS
14 N MAIN ST STE 200
CHAMBERSBURG PA 17201
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-13-2004
HERSHEY
12-21-2003
21 04-0024
CUMBERLAND
101
BETTY
J
Allount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account} submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
~~:r&~,r.!5r.A'~..r51~.6!1.......i;.."fA~!~e1r"f~5r.~~"r!A1nrr.b1r.~~l:DO~...j(i.....................
ESTATE OF HERSHEY BETTY J FILE NO.21 04-0024 ACN 101 DATE 12-13-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-15-2004
PRINCIPAL TAX DUE:.
6,414.43
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-15-2004 CD003680 320.72 ~ 7,267.50
11-24-2004 REFUND .00 1,173.79-
TOTAL TAX CREDIT 6,414.43
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, see REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
~~K