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HomeMy WebLinkAbout07-22-09-°~.... ~,1 15056051058 REV-1500 EX (Oti-05) O ``~G~' OFFICIAL USE ONLY PA Department of Revenue County Code Year Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 21 09 Hanisburg, PA 17128-0601 RESIDENT DECEDENT File Nu 0175 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206-38-9509 02/15/2009 04/23/1923 Decedent's Last Name Suffix Decedent's First Name MI KAUFFMAN MARGARET E (If Applicable) Enter Surviving Spouse's Information Bel ow Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) •= 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death _ .: 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Lisa Marie Coyne, Esq. (717) 737-0464 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY COYNE & COYNE, P.C. ', C7 "' ,~ ~' ~ 4 .... ~} First line of address 3901 Market Street ~~ ~ zC") r " ~- ~~ `' ~ ::] ~'. f~Tl r_; t''.J t Second line of address ` -~. ~ w , ~ .,_ .. ~C7c"'7 ;;, ' , C~ V -; i ~~_ -i City or Post Office D~ Etl<ED State ZIP Code C_.) Camp Hill PA 17011-4227 ~ a-- , ~. 7 Correspondent's a-mail address: IISa@COyneandCOyne.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration~rf~reparer other than the personal representative is based on all information of which preparer has any knowledge. ~~NATURE OF P RESi'JtJt FILING RETURN xx//11 - _ _ --- ADDRESS Hadan Kauffman, 6200 Wilson Blvd., #614, Falls Church, VA 22044 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 DA E ~~~ ,`, a f/ 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name MARGARET E KAUFFMAN 206-38-9509 RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. 114,500.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 33,308.52 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 147,808.52 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 19,014.88 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 305.97 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 19,320.85 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 128,487.67 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 128,487.67 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 taxable at lineal rate X .045 128,487.67 16. 5,781.95 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g, 19. TAX DUE ....................................................... ..19. 5,781.95 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~-, 15056052059 Side 2 15056052059 A. OMB NO. 2502-0255 B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.^FHA 2.OFmHA 3. ^X CONV. UNINS. 4.OVA 5.~CONV. INS. SETTLEMENT STATEMENT 6. FILE NUMBER: 7. LOAN NUMBER: ENDERS ~ 0105703664 8. MORTGAGE INS CASE NUMBER; C. NOTE: This /orm is furnished to give you a statement of actual settlement costs. Amounts paid fo and by the settlement agent are shown. Items marked '%POCj"were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: 1~0 srea IeNOens.aro~NOeasnsl F. NAME AND ADDRESS OF LENDER: JANICE L ENDERS and ESTATE OF MARGARET E KAUFFMAN FRED ENDERS WELLS FARGO BANK NA ISAOA 111 CONTINENTIAL DR SUITE 114 NEWARK DE 19713 G. PROPERTY LOCATION: H. SETTLEMENTAGENT: 802 MARKET STREET I. SETTLEMENT DATE: LEMOYNE, PA 17043 Seasons Settlements, Inc. PLACE OF SETTLEMENT July 10, 2009 COYNE AND COYNES OFFICE 3901 MARKET ST CAMP HILL PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION inn r•_oncc ...,., ~.._ _.._ _____ K. SUMMARY nF sFi i cmc To..~~...r,,..~ 105. aua. Ad'ustments For Items Paid B Seller in advance 405. 106. Cit !town Taxes 07/10/09 fo 01/01/10 208 13 Ad ustments Forltems Paid B Se/lerin advance 107. Count Taxes to . 406. Cit !Town Taxes 07/10/09 to 01/01/10 208 13 108. School 07/10/09 to 07/01/10 109 797,10 407. Count Taxes tO 408 School . . 110. . 07/10/09 to 07/01/10 409. 797.10 111. 410. 112. 411. 120. GROSS AMOUNT DUE FROM BORROWER 412. 118,467.85 420. GROSS AMOUNT DUE TO SELLER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 115,505.23 201. De osit or earnest mone 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 202. Princi al Amount of New Loans 501. Excess De osit See Instructions 203. Exislin loans taken sub'ecl to 85,500.00 502. Settlement Char es to Seller Line 1400 204. 503. Existin loans taken sub'ect to 1,160.00 205. 504. Payoff of first Mortgage 206. 505. Pa off of second Mort a e 207. 506. 208. 507. 2pg. 508. Ad'ustments For Items Un aid B Seller ,509. ' 210. Cil !Town Taxes t0 Ad ustments For Items Un aid 8 Seller 211. Count Taxes to 510. Cil /Town Taxes to 212, School 511. Count Taxes to. 213, 1/3 RESIDUE OF THE ESTATE CRED 512. School to X14 38,166.00 513. 1/3 RESIDUE OF THE ESTATE CRED 215. 514. 38,166.00 216. 515. 217, 516. 218. 517. 119. 518. 519. ?20. TOTAL PAID BV/FOR BORROWER 123,666.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 300. GASH AT SETTLEMENT FROM/TO BORROWER: 39,326.00 301. Gross Amount Due From Borrower Line 120 ( ) 600. CASH AT SETTLEMENT TOIFROM SELLER: 302. ass Amount Paid By/FOrBorrower (Line 220) ( 118,467.85 123 666 00) 601. Gross Amount Due To Seller (Line 420 602 L 115,505.23 303. GASH ( FROM J (X TO) BORROWER , . . ess Reductions Due Seller (Line 520 ( 39,326.00 By sl+ning page 2 nl this statement, the algnetorles aoknowieAga racelpl or a l t 5,198.15 603. CASH(X TO) ( FROM) SELLER 76,179.23 comp e e d copy or page 1 0l Ihla tw o page statement. l/L~~~l'~ - -__- ~~~~~~ (ENDERSIENDERS115) .T OF RECEIPT OF SETTLEMENT STATEMENT )ERS and FRED ENDERS AARGARET E KAUFFMAN Settlement.', iO BANK NA ISAOA ements, Inc. Place of Settlement: ~OYNES OFFICE 3901 MARKET ST Cr,. a 17011 Settlement Date: July 1~,, Property Location: 802 MARKS . 'TREET LEMOYNE, PA 17043 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 oh my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. J ICE Lf ENDERS ~~ i / ESTAT OF ARGARET E KAUFFMAN BRED ENDERS To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is true and accurate account of transaction. the funds which were received and have been or will be disbursed by the ndersigned part of the settlement of this. Seasons Se men ,Inc. Settlement Agent WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (ENDERS/ENDERS/15) SCHEDULE E v' CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL P INHERITANCE TAX RETURN rt ROPL pT 1 RESIDENT DECEDENT CR ESTATE OF - - - -- ---- -----_- __ _ --- -- - - ---- ----- --- KAUFFMAN, MARGARET E. - - FILE NUMBER - - -- --- - -- - ---- 21 - 2.0.09 - -- _ _--_-Y---- ------ p- P' - _ _ _ _ _017.5 Include the proceeds of litigation and the date the proceeds were received b the estate. All ro ert survivorship must be disclosed on schedule F. y~ointly-owned with the right of ITEM - - -_---------- - -- - -- NUMBER DESCRIPTION - _ -- - ____ 1 __ VALUE AT DATE OF -__ --- M&T BANK - ---- _ DEATH ertificate of Deposit - -- 8,998.76 2 I M&T BANK Certificate of Deposit 3 I M&T BANK Certificate of Deposit 4 I M&T Bank Savings Acct. 5 I M&T Bank Checking Acct. 6 Misc. Furniture and Personal Effects See Attached Inventory 10,255.64 10,943.97 911.20 1, 764.95 434.00 TOTAL (Also enter on Line 5, Recapitulation) 33,308.52 5°QG+ 10'uQf ~~ 3Cd~p+ 2Q~GG= 5 © .~ Q :~ . , , _ _._._. ~- , ~, _-._ _ ___ .. o `} ~ ~ C U ._.. a.~ i -.~ _~ _ _ ;.. t • ~ s - ~ ~ ... __,~_- 4,.k .,, t - - _ _ v 2 a ~ ~ CT Q = ~~ ~ _ ~ ~ r -. - _~._ e_ ~ tti~ ." ~~ ~ . ~- ~ __~ ~ _ _~__~ _~. 1 ~Q~~~~ ~ _ ~__ __~~___~, ~ _~ - .~~ ~~ ~ ~ - ~ ~ f ~,. ~ :~-~- -~- m ~ ~~ ~~ _ _-_ . .~ _ _ ; ~ - ~~ ~ 4 ~~ ~~~ ~ - ~~~ ~, ~ ~- ~. ~,_. -- __ __ ~~~~~. w T , ~ ~ .~ ~. - ,_ .e __ __ - , ~ r ______ ~_ _ ._ ~ -. _ _ . v 1 ~ ~ ~ ~ ~ 1 _- . . :. ~ i . Y -.-.- T,.. , ~., '~ 10 ° ~G+ = ~ ~ _ ;~ 4 L -_.- ~ - - -~ .._ ~ _ _ ~, s ~ ~ . . . ~ ~_ .. ~- ~- .,.~ .~ m _ ,. ° Q ^ U 'i ,~;~. - f 9 i -~ -` -, _ s _.,. __-..- _ ._ .~ _. - - 5 © Q + - _..__~. ~ ; ~~_ ~_ ,~ -~ ., ~_ _ - ___ w 0 ~~ , ~ ~: ~._..... ~ ~ r y.. ..w,. ~ ..~ Lc J _._ ..... ~ 8 ~ :.._e - ., _ _ -... _. - ~ ~ - - ~ c ,. ~ ~ ti.., t., i i ' """ _ _ ~ ...n. ~ _,.. . ~-_, ~__..... - - .._ __ __ . ~. .. .. ., ~. : ~_ .. ~.._ _ ._ `_ ~, _.. __ ._ °- ..I"~ k .. t .:. _. ~. `~ ~ s- .. ~ ....., -~ __ ~ ,,...- .~ ,... { ~'~ r~ 3 ~ ~ ,~, j i y i y ~ t- V ... x .._. i i <.: .~ . .~ 1. .v _.--" -~ ~ - ~ y y ~~ /J~ I / / C ~ ~ ~ ~ ~ a ~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Coyne & Coyne, P.C. Attorneys At Law 3901 Market Street Camp Hill, Pennsylvania 17011-4227 Re: Estate of Margaret E Kau''''nan Soctal Securtty ~ 206 38 9509 Date of Death ~ February 1 S ~~no Phone (888)502-4349 Fax ;~3A~1 o'2n _'7t1cc ,~' 1 ~ ~~D ~~1j~; n ., f ffr/ E Dear Sir or Madam: Per your inqull-y dated March 2, 2009 with. this bank the followin : , please be advised that at the time of death th b g , e a ove-named decedent ha d on deposit I ~ Type ofAccount Checking Account ' Account Number 50277456 Ownership (Names o~ Margaret E Kauffman Opening Date 8/28/64 Balance on Date of Death $ 8, 998.39 Accrued Interest $ 0.37 Total __ _ -- - ---- ----- -------------------------------- $ 8, 998.76 ------------------------------------ 2• Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003913822499 Margaret E Kauf fman 7/14/00 Closed 2/20/09 ~ 10,206.27 $ 49.37 -- .. _ _--.___ $10 255.64. _.. _. _. ---_- --. SCF-IEDULE H COMMONWEALTH OF PENNSYLVANIA rvNLIV'1L ~NSES $c INHERITANCE TAX RETURN RESIDENT DECEDENT ~~N'~eTi~ /L i'~ __- -._- -- - ---- ESTATE OF - - - -- - __ __ __ __ _ - _ - -- _ _ - --_- --- KAUFFMAN, MARGARET E. ---- -_ -------- - ~ FILE NUMBER Debts of decedent must be reported on Schedule L 21 - 2009 - 0175 ITEM - - - - - --------- --- - ----------- - UMBER DESCRIPTION - --- -- - - -- - - -- - -- - - - - _ - -_ ------------ ------ ---- ----------- ---- AMOUNT A. FUNERAL EXPENSES: 1 Musslman's Funeral Home f 7,786.75 2• Reception 300.00 3 • Honorarium 100.00 4, Headstone Engraving 255.00 B• 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. Attorney's Fees Coyne & Coyne, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 5,000.00 Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees Register of Wi11s ~ 264.00 5• Accountant's Fees 6• Tax Return Preparer's Fees ~• Other Administrative Costs 1 Inheritance Tax Filing Fee 2 Postage 15.00 82.00 Total of Continuation Schedule(s) -- - ___--_ --_-- --- ----- -----------p _____ TOTAL (Also enter on line 9, Reca itulation) 5,212.13 19,014.88 Schedule H COMMONWEALTH OF PENNSYLVANIA ~ Funeral INHERITANCE TAX RETURN RESIDENT DECEDENT - - Actrunistr~tive Casts continued --- ESTATE OF - _ __ _-- - ---- __ ---- -- - FFMAN, MARGARET E. -- -- FILE NUMBER -_ _ - - - - -- -- -- --------------------------_------- ~ -2009-0175 3 Toll Calls for Executor 50.00 4 Food and Lodging for Executor 5 Mileage for Executor @ $0.52/mile 6 Landex-- Copy of Deed 7 Legal Advertisement-- Cumberland Law Journal 8 Legal Advertisement-- Patriot News 9 Don Paul Shearer-- Appraisal of Real Estate 10 Income Tax Preparation-- Larry Shoop, CPA 11 Barry Mills-- Repairs to House Required for Settlement 12 Reserves 13 Closing Costs for Sale of House 350.00 312.00 12.75 75.00 127.38 350.00 225.00 550.00 2,000.00 1,160.00 Page 2 of Schedule H ~,:: _ , REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA ,~4., __ CERTIFFCATE OF GRANT_OF LETTERS No . 2009- 00175 PA No . 21- 09- 0175 Estate Of : MARGARET E KAUFFMAN (First, Middle, Lastl Late Of : LEMOYNE BOROUGH CUMBERLAND COUNTY Deceased Social Security No : 206-38-9509 WHEREAS, on the 20th, day of February 2009 an instrument dated April 15th 2008 was admitted to probate as the last will of MARGARET E KAUFFMAN (First, Middle, Lastl late of LEMOYNEBORDUGH, CUMBERLA/~JD County, who died on the 15t~i day of February 2009 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: HADAN KAUFFMAN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to Iaw, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 20th day of February 2009. ~ w je ~ ~~,t ~fi _ ~~f 'L~GL:'~ -, RegisYe~ Wills ~~ ° n .~ d ~~~ ~ / 9 P L __ _ _. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) Will of Margaret Eve Kauffman Part 1. Personal Information 1, Margaret Eve Kauffman, a resident of the State of Pennsylvania, Cumberland, declare that this is my will. My Social Security number is 206-38-9505. Part 2. Revocation of Previous Wills ~ ~~ ~' ' L~ ''~" i revoke all wills and codicils that i have previously made. Part 3. Children I have the following children now living: Hadan E. Kauffman, Janice L Enders and Kathleen M Adams. Part 4. Grandchildren 1 have the following grandchildren now living: Avery L Adams, Haley L Adams, Kevin A Kauffman, Mark F Enders, Michael A Enders, Robert K Adams, Ron E Kauffman and Ross C Adams. Part 5. Failure to Leave Property If I do not leave property in this will to one or more of my children or grandchildren named above, my failure to do so is intentional. Part 6. Disposition of Property. All beneficiaries must survive me for 45 days to receive property under this will. Page t of 6 Initials: ~ ~ ~ Date: l.J -~O~ -~ L D~ n C n r~ c.~ U 1 T'c7 ~ LV rTi i ;1 - _, :r `: ~ :r- SSJ . r-,-~ N ( ~ ~ ~1 _ - - ~ ' 17 t Ii ~ CQ +7 Will of Margaret Eve Kauffman As used in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or debt. If I leave property to be shared by two or more beneficiaries, it shall be shared equally by them unless this will provides otherwise. If 1 leave property to be shared by two or more beneficiaries, and any of them does not survNe me, I leave his or her share to the others equally unless this will provides otherwise for that share. "Entire estate" means all property I own at my death that is subject to this will. I leave my entire estate to my children Hadan E. Kauffman, Janice L Enders and Kathleen M Adams in equal shares. Part 7. Executor I name Hadan E. Kauffman to serve as my executor. If Hadan E. Kauffman is unwilling or unable to serve as executor, I name Janice L Enders to serve instead. No executor shall be required to post bond. Page 2 of 6 Initials: ~~ r~C.,4 '1 ~ te: S U~ Will of Margaret Eve Kauffman Part 8. Executor's Powers I direct my executor to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petition in the appropriate court for the independent administration of my estate. I grant to my executor the following powers, to be exercised as he or she deems to be in the best interests of my estate: 1) To retain property without liability for loss or depreciation. 2) To dispose of property by public or private sale, or exchange, or otherwise, and receive and administer the proceeds as a part of my estate. 3) To vote stock, to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities, and to exercise ail other rights and privileges of a person owning similar property. 4) To lease any real property in my estate. 5) To abandon, adjust, arbitrate, compromise, sue on or defend and othewise deal with and settle claims in favor of or against my estate. 6) To continue or participate in any business which is a part of my estate, and Page 3 of 6 Initials: ~,~ ~~ ~~. _ Q~ Will of Margaret Eve Kauffman Part 12. Severability If any provision of this will is held invalid, that shall not affect other provisions that can be given effect without the invalid provision. Signature I, Margaret Eve Kauffman, the testator, sign my name to this instrument, this (S day of Y~n~;~ ~~ , at -~~'~-~~~1~ . I declare that I sign and execute this instrument as my last will, that I sign it willingly, and that I execute it as my free and voluntary act. I declare that I am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. Signature: ~ , ~;.~ ~°- ~ - . /nom Witnesses We, the witnesses, sign our names to this instrument, and declare that the testator willingly signed and executed this instrument as the testator's last will. !n the presence of the testator, and in the presence of each other, we sign this will as witnesses to the testator's signing. Page 5 of 6 Initials: . =.fG -`~~l- /.~- Date: 5 Will of Margaret Eve Kauffman To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is mentally competent and under no constraint or undue influence. We declare under penalty of perjury that the foregoing is true and correct, this 15~h day of r~ c77 C~ , at Witness #1: ~G%~ Residing at: 1 ~O S ~- , 'c.,E' ~ {l~r ~o r K ~~U ye/1 V%~ ~ ~ 31 Q _n „ Witness #2: Residing at: 2 ~~~~~~[.yr',~~.~ l r'r ~f 1~ i , , ~ r ~ ~~.,~2C~.~,~ ~~~~ ~~ Page 6 of 6 Initials: ~ L, K, !~'~C,/~ ~ ~ oats: l Affidavit ACKNOWLEDGMENT Commonwealth of Pennsylvania County of: C;>t.win r ~ Avld• 1, ~ ~ ~~ ~ .~ ,the testator whose name is signed to the a a ed or foreg n instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that 1 signed it willingly and as my free and voluntary act for the purposes therein expressed. Testator: ~ ~` y ~,/ ~~~ Officer: V COMMONWEALTH OF PENNSYLVANIA Notarial Seal Cathy L. Youngblood, Notary Public Lemoyne i3oro, Cumberland County My Commission Expires June 22, 2010 Member. Pennsylvania Association of Notaries Affidavit -Page 1 of 3 Affidavit AFFIDAVIT Commonwealth of Pennsylvania County of: ~wn~e~-~G.v~ r We, !(v S ~ ~ 1! C~.Ca ~ S and ~ i ~ ~~~ ~-~ ,the witnesses whose names are signed to the attached or foregoing instrument, having been duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as hisfier Last Will; that the testator signed willingly and executed it as his/her flee and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time t8 or more years of age, of sound mind and under no constraint or undue influence. Swom to or ffirmed and subscribed tory_~b_e/`fo',r~eme by ~'~55 C ~~!~~P~ti"~S and'!-!' /L/.~~ Tc~~L,P;.r<--. witnesses, this i S day of _~~~ ~~"~~""~~ ~~ ~; . ' Witness: ~ ~~ ~~~-~- Witness: ~l~ ~~G~~~~~~'Z.L~ Affidavit -Page 2 of 3 Affidavit Officer: COMMON~VEALTN OF PENNSYLVANIA Notarial Seal Cathy L. Youngblood, Notary Public Lemoyne eoro, Cumberland County My Commissbn Expires June 22, 2010 Member. Pennsylvania 4ssociation of Notaries Affidavit -- Page 3 of 3 a, t Uc1 Ul-l~ OATH OF SUBSCRIBING WITNESS(ES) n `-_~ =?, r ~ -, REGISTER OF WILLS ~~. ~ . r+~ ~~ N G ~~~'1BF~1/~IVI COUNTY PENNSYLVANIA , - ~' ~ : o ' , _ ~- ~ ~ '' c ~ - _U't ~ C!1 ~ Estate of ~// ~~~t~~ / G!" l~~' ~ ( /~F/y~/l ~ W - , , Deceased y~ n n G'~.l ~`rtit ~Elu ~ G`/Lt/~CKJ L'S l i .N /JL1Y~/ G`) /aoi-hl ~ ~„L.~,...:i.:..~ ....~__-- `- ' ~~ (Pratt Names) `" the 'Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /~ was / wer present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that sla~~/ they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other ~...~- Sig~ta e) (Su-eet Address) /~ (City. Stale. zip) Lxectcted in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills NUTS: I o be taken by Ofticer authorized to administer oaths. Ferns R4V-03 rev. 10.13.06 grsature) (Street Address) ' (City, State, Zip) ~ Executed out of Register's Office Sworn to or affirmed and subscribed before me this / 9~~'' day(1 Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Please have present the original r copy of tns ~t~,•nuta~ anon. L1NQA E t~IW~ Rib Corrrr~lsslort C OYNE & C OYNE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW FIenry F, Coyne Lisa Marie Coyne 3901 Market Street Camp Hill, Pennsylvania 17011-4227 717-737-0464 Fax: 717-737-5161 www.coyneandcoyne.com July 21, 2009 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Madam: C`> ~.~ f ~~ ~ ~ ~ '~ - -~ i r =. ~ rn Re: Estate of Margaret E. Kauffman, Deceas~,r~_ c=> ~ =- r.~ N - No. 21-09-0175 C~ ~~ ~.~ c , C~„ x~. ° .~ ~ ' - CJ --i ~ ~ ~ b ~ We represent the Estate of the Late Margaret E. Kauffman. Enclosed please find an original and two copies of the inheritance tax return for this Estate. Please docket the original and return to this office a "clocked-in" copy with the enclosed stamped envelope. Also enclosed is the $15.00 filing fee for the Inheritance Tax Return. Please issue a receipt for payment of the filing fee. Thank you for your assistance. If you have any questions, please contact me. Very truly yours, COYNE & COYNE, P.C. sa Marie Coyne c LMC/amd Enclosures Cc: Mr. Haden Kauffman, Executor, w/ends. ~, ~`C E' 4 ~ ~ I.;4a F ~ vt E .~~q,,~y. ~ t riY~ ' YC7.y; ~! 3 4f' ~ '~., ~`, L ~'ti f -=... -" --~.. ~y r. -.~ ::':... -..~ -.' ~' ~x~, ': "r , _`';s ~ ® ~ t® ~ ~. ~ C7~~ ~ ~ ~ ~ Od ~ O ~ G j ~ O C ®~ ~ en ~ n ~ ~ .ry. ~t ~x s a ` ~=aS~~?;`i ,~k ~~~, ~, µ~~ ..Y>. { x' ~ .;: sp;, ~ '~' ~~.'