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Home My WebLink About07-24-09-J REV-1500 1505607120 PA Department of Revenue ~ (~ 08) OFFICL4L USE ONLY Bureau of Individual Taxes County Dade Year Fib Number PO 80X.230601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 0 8 6 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 07 18 2008 02 23 1949 Decedent's Last Name SuKx Decedent's First Name ROUKE LINDA (If Applicable) Enter Surviving Spouse's IMormation Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 7. Odginal Retum 4. Limited Eatete X^ 8. Decedent bbd Testate ^ (Anacn Copy of wllp 9. Li9ga9on Proceetle Received CORRESPONDENT - TNIS SECTION MUST BE CON Name RICHARD W. 3TEWART Firrn Name (If Applicable) JOHNSON DUFFLE Flnst line of address 301 MARKET ST. Second line of address PO BOX 109 City or Post Office LEMOYNE Correspondent's e-mail address: imeTelephons Number 17) 761 4540 REGISTER OF WILLS USE ONLY CO N b ~ n~rn- t- _Sm .;r~~ Iv ~- State ZIP Code I DATA ~j~Dn S PA 17043-0109 ~~ fV O 1 RICHARD W. STEWART 301 Market St. I_ PA 17043-0109 MI A MI =1i ~ .i Al( "1 Side 1 1505607120 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum ~ 3. Remainder Retum (tlate of death poor to 12-73-82) qa, Fulure Interest Compromise ^ (sate m deem Mar 1242-alt 5. Federal Estate Tax Retum Required 7, Decedent MalMamed a LIWip Trual (anew copy a Tmeq a. Total Number of Sefe Deposit Boxes tg'ab evean i2-31 ~~.~aat~m death ~ tt Election to tax antler Sec. 9113(A) (Attach Sch. O) 1505607120 J J 1505607220 REV-1500 EX °e~•^r'•N•^re LINDA A.ROUKE Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) ............................................... 8 9, 9 0 0 0 0 ..................................... ...... 1. . 2. Stocks and Bonds (Schedule B) .......................................................................... ..... 2. 11.3 7 0 . 7 2 3. Closety Held Corporation, Partnership or Sole-ProprtetoBhip (Schedule C)..... ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ..................................................... ..... 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Properly (Schedule E) ............ .... 5. Z 8 , 1 7 1 . 5 3 6. Jointty Owned property (Schedule F) ~ Separete Billing Requested .. 6 6 , 4 0 3 7 0 ....... 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly (Schedule G) ~ Separate Billing Re uest d .... . . 4 q e ......... .... 7. , 2 4 7 . 5 1 8. Total Gross Assets (total Lines 1-7) ................................................................... .... 8, 1 4 0, 0 9 3. 4 6 9. Funeral Expenses & Administrative Costs (Schedule H) .. 3 3 6 8 1 4 3 .............. ...................... ... 9. , . 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................ .... 10. 5 , 7 1 0 . 7 4 11. Total Deductions (total Lines 9 8 10) ............................................................ 3 9 3 9 2 1 7 ....... ... 11. , . 12. Net Value of Estate (Line 8 minus Line 11) .......................... 1 1 0 0 7 0 1 a 9 13. Charitable and Governmental Bequesta/Sec 9113 Trusts for which 2 , . an election to tax has not been made (Schedule J) ........... .................................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ ....................... .. 14 1 0 0 , 7 0 1 . 2 9 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 .o0 0. 0 0 15. 0 0 0 16. Amount of Line 14 taxable . at lineal rate X .045 0. 0 0 17. Amount of Line 14 taxable 16. 0. 0 0 at sibling rate x .12 1 0, 6 5 1. 2 1 17. 1 2 7 8 1 5 18. Amount of Line 74 taxable , . at collateral rete x .15 9 0, 0 5 0. 0 8 16. 13 , 5 0 7.51 19. Tax Due ............. ......... ........................................................................................ 19. 14, 785.66 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L Side 2 1505607220 1505607220 J REV-1500 FJ( page 3 Decedent's Complete Address: LINDA A. ROUKE 1 EAST MANOR AVENUE FIIeNumber 21_08-00866 ~ ENOLA I STATE zIP - PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credks/Payments (1) 14,785.66 A. Spousal Poverty Credit B. Prior Payments 20 000.00 r C. Discount 738.28 3. IntaresUPanaltyifapplicable TotalCredits(A +g+C) (2) 20,738.28 D. Interest -28 68 E. Penahy Total lnteresf/Penalty (D+E) (3) _28,88 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Pape 2 Line 20 to request a refund (4) 5, 9 82.30 5. If Lina 1 + Line 3 is greater than Line 2, enter the ditteronce. This is the TAX DUE. A. Enter the interest on the tax due. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) Make Check Payable to: REG/STER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a transfer and: a, retain the use or income of the property transferred :................ Yea No b. retain the right to designate who shall use the ro ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~'~~~""""""""" ~ x P party transferred or Ns income :.................................... c. retain a reversionary interest; or ........................ ......................................................................................... receive the promise for INa of eRher payments, benefits or care7 ......................... x 2. If death occurred after December 12, 1982, dkf decedent trenafer property within one year of death without x receiving adequate consideretlon7......._._. .. ........................................... 3. Did decedent own an "in trust for' or payabb upon death bank account or security at hie or her death?......... 4. Did decedent own an Individual Retirement Axount, annuity, or other non-probate properly which ^ contains a beneficiary designation7 ...................................... . ........................ x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUBT COMPLETE SCHEDULE G AND FILE R AS PART OF TH^E RETURN. For dates of death on or after Juy 1 1994 and before January 1 1995 the tax rate imposed on the net value of transfers to or for the use of the sunning spouse is three (3) percent p2 P.S. §9718 (a) (1.1) (i)]. For dates of death on or after January 7, 1995, the tax rate imposed on the net value of trensfere to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9118 (a) (1.1) (ii)]. The statute does not axemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets end filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: natural parentnan adoptive parent, lorea stepparentfof the chid aszero (0) pereentp2 PBS. §9116 (a) (1ro2,]ger at death to or for the use of a The tax rate Imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) (72 P.S. §9116 (a) (1)]. sibfng s detinedunder Sediont9102, as tan individu Iwhothas a~leest one parent nseolmmon with the(de~dern~t,nwhathesby blood or adoption. SCFIEDULE A REAL ESTATE Rw•iaea Ella (a-u) colrnoNxeM,rN or EEMwrtv~wM MNERITgNLE TAC RETURN RE810ENT DECEOEM ESTATE OF ROUKE, LINDA A. All ral Properly ownM,el,ly a u, bn,m In ecchangetl between a w1Abp Wyer,M a Rwl property rTl ITEM NUMBER teMr. neitlwr peYq oo,npyletl to EuY ar sell, DESCRIPTION v,lue Is tlesnatl FILE NUMBER 21-08-00866 vrtlicn ProPeM would be rebvem lath. 1 Real Estate - No. 1 East Manor Avenue, East Pennsboro Township, -Cumberland County, PA (Deed Book G, Volume 27, Page 284) -Sate Price Copy of Settlement Statement attached. SLUE AT DA OF DEATH 89,900.00 TOTAL (Also enter on Line 1, Recapitulation) 89 900 00 (li more apace is needed, edtlitionel pages of the same alze) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-7800 Schedule A (Rev. 8-98) ono. zs0 ' ° "•~• ~~PO, uue(II pr mpU81N8 }0286 B. Type o} Loan and Urban Development ' 1 I J FHA 2 FMHA . 1) 7. [%] ponv. nln6. 4. VA 5. ' COnv. Inn. e. Foe Number ', 7, Loan NumbeY Settlement Statement 200g0o7B ~ ~DDDDa24g9a 447 0015 Note: Thla toms is bmlRhed to give you a nbbment M t m~ ac ual setlkment ooMa Amounts pe band h0 spent ero shown. Items malketl ('POC'K were peltl oWlde the aoelnp: they ero ehOwn here for Info 0 rme on Name M eortowec Jenne L Weigher, qU Sempb Brktpe Ro d E l ' e , no a, PA 77025 Nema a/Seller: Bhirley I Keys, FxeUOr of ma Eelste M Llntle A R . OUkq, 604 Fron[ Slrset, Wegt , Falrviaw, PA 17725 TIN: Name oI Lentler: Fbal NaOonal sank of Cheapr Coumy mm qM Heme Bank DNMIan 8840 , Hampland Roetl, MounNille, PA 1]664 .Property Lowden; Esat Panne6oro Tawnahlp - i E Manor AVe., En01a. PA 77028 . 5emament Apsm: Greet RVaO Settixnanl Saniwa, 1])731-1W0 Place or eettlemant 785 Poplar Church Road, Cemp HIII PA 77071 , EeWemem Oatr. 9282008 ' Prontlm Dap:, OOq D0. Gmaa gmeYmdYe hem berrowwn 01. CoRhaa min ke 400. eroee emountdwp wllsr. e9 O2. Pereonel . 9DO.oo 4D7. comma 4abs e. eoB oD Da: SetWmem eha cab bOnewer Ilne 1400 002. Perfonel . 04. ' BBB5.e8 401. o0. ~• 408. 00. /low»le%ee 07. Colin (uea &28/2009 b 1/12010 ~ 15845 /OB, tezea {01 COU tDM De. AOwamanp . e 6282009 (o 1/12010 1 ,16 O0. School Taws 5282000 t0 7/12008 85.46 408• Aaasamenb 408. School Taws 6rz 10.. 2ntl Olt 8swsr 5/282008 b 8/30/2000 11. 24.02 (N200p f0 7!12008 470, 2rM Olr Bawer '6282008 10 8/9020118 .~ 4.02 12. 417. Ixo. Grose amoum dw from borrower: NZ %,018.48 420. Groa gnloum due td sNlsr . 80,1 .63 !01. pe wk or aemea[ mono !02. Pdna al amOMl of neW ban e) 1 000.00 601. F~maaa W k ace In One !W. EMaB Inns bbn sub sap - BB.x71.OD 60x. BetWmMt Mq • b mlbr Ilne 7100 6,2 k20 ,pA 803. ExdB bane tgken'ou 'ab E06. 804. P offlnt mo loch 208. 608. Pa M geLrond mod s loan 20] 608. OWm ht Pao s 208, caller b aba ~]' 200. Selprt Mabpnw 1950,78 608, Salbr qb eMa ~ i 1D 9,780.84 BDB. BeINro Mehpnp ~ . 3,] .84 210. C Aawn fesea x11. CVYn tewa 610. C toms 272. Maeaamenb ~ 617. Cwn pRea 217. 8eh0ol Tewq 872. Maeaamenb 214. 819. Balool TeRae 216. 514. 218 615.. ' 277. 616. 216. ~- 617. _ 618 218. . 220. Topl wla OyROr borrower: ~ 184 101 818. 8 , ,00 20. ToW redYOtlon In gmOYm due aepeY. 10 ' , .20 601, Oroaa enMUM tlW from bOrrpwwr 120 ' DO2. Lena amoum /(ot bpnoewr 2x0 87,018.48 501. Orou'errioum dw p'iillst Nne 420 80,7 b3 Ip9. CASH IXJFRDM BTD aOWlOWIR 81.401.00 602. Up ppl ntlYdbn M amoum due tulle rw 6x0 10 9 .20 gpMgTRYTq PORM fOH gM LBR RATB 2876,48 8 06. CASH QFRDM (1470 SELLER TB7 . MSM•The lnbnnaWn 40aJle M1.r.~u_~. ~.._ ~_. pmMMEM BbCkaG D.Xentl le„n,,,. n.. ur .~. ..~... ~__, .19 ,..,.pwwewMme m~bYrywdr4lu 44ernwtlen xm la __. •--.~~_•~~~~• m.W),1V0,{ 4 realm.•rwp9peaw panib orothxum5mwxl be 9nPwM an tvu H.WalpenN beND NIIWIIed tOtM !mama! lLluanua 8ervke.llyou an rpukM b• B2 r ee WBTADOTION. YtMa raN edab ww yovp4lMlMa rtdOnwa Ma binl2l~tae 9aN x B4Tnpe pl W 10.6 bb,mlma eW RRea fqt ppn ropenee. 4aua01bns,Ownpbb Aa aPp9wblesW elkam lle7, Pam a252 aIWx 8dIaGRa DIFMm 1040), 111°roM 0.eadenw, brarotMm,mm pwYwwne bR MUm; br x Yale VVeq p/Mwb pwMa Weal N4e0601ganlarll' IyOV 1 rld Ort (R 6Sa~k-'i^x-lw.n~l/$-a~~~1[e~a'a~ 5em0ee,LL1:(!1/1/61.1WDYRm Yew oOtrea la>Q>wrr lOMlpneaVdn nunber. d,-~ ( LLC (717)791-1040 vMh 1our0oneG inlalYar ManOfla6on numpr.YW mN bs suMedtb dNl orolminel palwlYea. 8hmey 1 Aeys, Ewdor Mme Ee qp of Llntlq A. ROUks ' -__-.__..__. _.-T..~_._.___. ___._ LJYy INrytl~FapgmafM EWltlq •APOW WAPMMI X h e eMS le Fnwbq/ M\e rylu ehYmege le M IIMetl tlhM M bK ae enY ^e~s q WL Imn1. M1nlpp open epMelbll un M\NI \ \ Ilm eN MMItxmM pr4h4xC1W 1q Vd CM\tleyq IMI ugyynlmLL JeMY\e1NM V~n~\ye~rwi{tleM\egemWtlM~ IMn.\npeelY\tlw\MMWnereeq Me Mq\nryyiyere nyNMpJMepeennMl4 Rwd60a EX+pAa) SCHEDULE B STOCKS & BONDS COMAONWEgL1N OF FENN8VWNIW INMFRRµOE Tq%REIURN REeIOENT OECEpEM ESTATE OF ROUKE, LINDA A. FILE NUMBER 21-08-00866 ai prow~rlaady.oemw vnen dgm a wMVeneap muse ex a.eiowd an 8en.auis F. ITEM CUSIP NUMBER NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 1 316 Shares -Mellon Financial Corporation Common - ~ 535.67 per share 11.271.72 2 72 Shares -Rite Aid Corporation Common - ~ 51.375 per share 88.00 TOTAL (Also solar on Line 2, Recapitulation) 11 370 72 (It more apace la neetled adtlitionel pages of Ne same size) Copyright (c) 2002 form sonware ony The Lackner Group, Inc. Forrn PA-1600 Schedule B (Rev. 6-98) av+sss ex+ pael SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~ o"vrekTM of rENNerwnNw INHEgpANpE TN(gETURN RE8IGENT OECEOFM ESTATE OF ROUKE, LINDA A. FILE NUMBER 21-08-00886 NI InGUtle me pmceetle of litlaelien entl Me tlMe Ule p,eceetle wale recsNetl M tlb estele. wer•M Iagsy.aw„w wle, Me rlaM or euMVOrMIp muR ee Wwloeetl on wbeule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Discover CaM -Account No. 02701516857 -overpayment refund of DEATH . 12.06 2 Highmark -decedent's final salary - 7/12/08-7125/08 884.06 3 Internal Revenue Service -refund -decedent's final form 1040 . 1.042.00 4 Kohl's Department Store -refund 8.64 5 Members 1st Federal Credit Union -Account No. 3662-00 -Date of death bala nce 21.29 6 Sovereign Bank -Checking Account No. 2561059626 -Date of death b l a ance, plus accrued interest. 2,581.46 7 I Soverertgn Bank -Savings Account No. 2564002174 -Date of death balance, plus I 10.911.33 accrued interest. 8 State Farrn -Homeowner's Insurance -refund 270.32 9 United States Treasury -Stimulus check 600.00 10 Verizon -refund 18.55 11 West Shore Tax Bureau - 2007 personal tax refund 1.82 12 2006 Buick Rendezvous Sport WG. - (Mileage - 23,000) -Sale Price 11,000.00 13 Household Goods -appraised value 819,00 TOTAL (Also enter on Line 5, Recapitulation) 28,171.53 Copyright (c) 2002 form software ony The Lackner Group nlnc.~ adoltional pages of the same size) Form PA-1500 Schedule E (Rev. 6-98) R.v.7eDY EX+p-a) COMAOHWEgLTN OF PENNBYLVANw INHERRgNCE Tq%RETURN REaDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY LINDA A. SURVIVING JOINT TENANT(S) NAME HIRLEY I. KEYS B. C. ADDRESS 694 N. FRONT ST. West Fairview, PA 17025 mup be LE NUMBER 21-08-00866 RELATIONSHIP TO DECEDENT JOINTLY OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY NUMBER FOR JOINT MADE TENANT JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEE DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE OF . D FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST DECEDENT'S INTEREST 1 114/2002 Sovereign Bank - Certificate of Deposit 1 No. 2565040066 -Date of de th b l 2,807.40 50.000% 6.403.70 a a ance, plus accrued interst. TOTAL (Also enter on Line 6, Recapitulation) 6 403 70 (M more space Is neetletl atltlltlonal pages o! Me same sas) Copynght (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule F (Rev. 8-98) Rw-1610 EXi (6Ja) COM.ggµEqLTN t)F PENNByLVgNw INNERRANCE TA%gETURN gE&pENi OEpEDEM ESTATE OF ROUKE, LINDA A. Thb eoha0ula must W mmpbtaE an0 51ee h the answer to any of questions 1 through / an the reveres aitls of me REV-1500 COVER SHEET is yea. NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %oF DECD's THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 1 Highmark 401K Investment Plan administered by 0.00 Wachovia Retirement -Services. Beneficiaries: Matthew D. Keys and Edward L. Keys, Jr. - Nephews. Date of death balance - 542,145.82, Decedent's was not 59 1/2 when she died. (Date of birth -2123/1848). Membere 1st Federal Credit Union -IRA Account 0.00 No. 3662-10 -Beneficiaries: Edward L. Keys, Jr. and Matthew D. Keys, nephews Date of death balance, plus accrued interest - 518,708.11 Decedent was not 58 1/2 when she died. (Date of Birth: 2123/1949) Members 1st Federal Credit Union -IRA 0.00 Certificate No. 3682-16 -Beneficiaries: Edward L. Keys, Jr. and Matthew D. Keys, nephews Date of death balance, plus accrued interest - 533,768.28 Decedent was not 58 1/2 when she died. (Date of Birth: 2123/1848) Citizens Bank -Checking Account No. 8,004.18 6100786667 -Linda A. Rouke and Shirley I. Keys, Sister - Jolnt as of 8/17/2008 Date of death balance - §8,004.18 Total of Continuation Schedule TOTAL (Also enter on Llne 7, Recapitulation) FILE NUMBER 21-08-00866 3,000.00 TAXABLE VALUE 0.00 0.00 0.00 3.004.18 attached page Y.C4/-'Jl SCHEDULE G INTER-VIVOS TRANSFERS $ MISC. NON-PROBATE PROPERTY ... ,,,uie space Is needeQ atld'NOnal pages of the same size) Copyright (c) 2002 form sotlware only The Leekner Group, Inc. Form PA-7500 Schedule G (Rev. 6-98) R.Y.~s~o Ex.lsasl COMAONWEALTN OF PENNEYLVANN IMIERITANCE TAA RETURN REEIpENT DECEOEN! ESTATE OF ROUKE, LINDA A. SCHEDULE 6 INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY continued LE NUMBER 79.AnJlnuCc ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTA THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTA 5 Citizens Bank -Savings Account No. 6740-185629 -Linda A. Rouke and Shirley I. Keys, Sister -Joint as of June 17, 2008 Date of death balance, plus accrued interest - 57,243.33 TOTAL (Also enter on Line 7, Recapitulation) Copyright (c) 2002 form software ony The Lackner Group, Inc. DATE OF DEATH %OF DECD'S VALUE OF ASSET INTEREST 1,243.33 TAXABLE VALUE 1,243.33 4,247.51 Fonn PA-1500 Schedule G (Rev. 6-98) Wachovia Bank, N.A. Wachovia Retirement Services XC3226 901 Marquette Avenue Suite 500 Minneapolis, MN 55402 wA+cHOVrA November 5, 2008 Johnson, Duffle, Stewart & Weidner, P.C. (( " O ~ n ~7 Attn: Cynthia Hubler ~J V 301 Market Street PO Box 209 Lemoyne, PA 17043-0109 Re: Linda A. Rouke's Account in the Highmark Investment Plan Dear Cynthia: Per your request, I am providing you with Information pertaining to Linda Rouke's 401(k) aaount within the Highmark Investment Plan. The above captioned account in the name of Linda Rouke is a 401 K account administered by Wachovia Retirement Services and maintained under 407K instruction. The balance in her account on July 18, 2008 was $$42,145.82 and the beneficiaries are Edward Keys (Nephew) and Matthew Keys (Nephew). Sincerely, Wachovia Retirement Services St MEMBERS 1°~ f1~ERALCR)~IT ONION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner IRA: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary IRA CERTIFICATE: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary 3862-00 10/18/1955 $21.29 $.OD $21.29 None 3862-10 03/13/1982 $19,655.44 $52.67 $19,708.11 Edward Keys 50% Mathew Keys 50% 3862-16 03/11/2005* $33,757.84 $10.44 $33,768.28 Edward Keys 50% Mathew Keys 50% C~OG°~~l *Purchased by transfer of funds from 3662-10. ~~y`R~S~1s,T~~FEDE~L1 . DIT~L NION Danielle A. Kli' ne Insurance Services Specialist August 28, 2008 Estate of: LINDA ROUKE Date of Death: July 18, 2008 Social Security Number: 195-38-9390 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org REV-1161 EX+(11de( COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF e~~ ~...- ....- - - SCHEDULE H FUNERAL EXPENSES $ ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSes• FILE NUMBER 21-08-00856 AMOUNT See continuation schedule(s) attached B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Johnson Duffle 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address city state Zip Relationship of Claimant to Decedent 4. ~ Probate Fees 9,789.71 4,550.00 322.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. 79,008.72 aa,oa7.4d Fonn PA-1560 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF LINDA A. LE NUMBER 21-08-00866 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Enola Sportsmen Assoc. -funeral lunch 553.75 2 Richardson Funeral Home, Inc. 6,173.90 3 Rolling Green Cemetery - Grevemarker charges. 1.668.00 4 Rolling Green Cemetery -Interment charges. 1,345.00 5 Rose Eppley -clothing purchased for decedent for burial. 59.06 H-A subtotal 9,799.71 Other Administrative Costs 6 American Radon Solutions -Radon Inspection and installation of -Radon system. 1,100.00 7 Citizens Bank -charge for Estate checks 39.33 8 Citizens Bank -service charges -Estate Account - 7131 - 5131/09 11.55 9 Comcast -cable service -1 East Manor Ave. -final charges 104.89 10 Cumberland Law Journal -Legal Advertisement 75.00 11 East Pennsboro Township - sewer/traah -1 East Manor Ave. 252.00 12 Exit Realty Group/Jack Gaughen ERA -Commission -sale of - 7 E. Manor Avenue. 4,206.00 13 Intrieri Construction -repairs required to premises prtor to settlement. -1 East Manor Ave. 4,975.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF LINDA A. iLE NUMBER 21-08-00888 ITEM NUMBER DESCRIPTION 14 PA America Water - 1 East Manor Ave. - (Sept. 08- May 09) AMOUNT 245.61 15 Pestex -Carpenter Bee treatment - 1 East Manor Ave. 127.20 16 PP&L -Electricity charges -1 East Manor Ave. - (Sept. 08 -May 09) 305.32 17 Recorder of Deeds -1% Transfer Tax - 1 East Manor Ave. 899.00 18 Register of Wills - 6 Short Certificates. 24.00 19 Register of Wills -file Inventory & Inheritance Tax Return 30.00 20 S. Brian Magaro -household goods appraisal 100.00 21 Seller Assistance to Purchaser -per Settlement Statement -1 East Manor Ave . 5,130.00 22 State Farm -Automobile Insurance 409.31 23 Sutliff Chevrolet -repairs -Buick Rendezvous -Inspection/repairs 101.02 24 The Patriot-News -Legal Advertisement 141.24 25 Wesco Engines -appraisal -Buick Rendezvous 25.00 28 West Shore Oil -oil delivery -1 East Manor Ave. 708.25 H-BT subtotal 19,009.72 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) May tl7 09 Y2:-36p Jenna ~.rr~ 717-79tl-9339 p,2 ~ro~ta~~t "°ad ~ •;o.a INTRIERt CONSTRUGTIO!N C~ OO ~° :.1559 Simpson Forty FtDed • New Gimtiea4arn7. PIl'17070 Telephone: (717) 781-9588 or (717) 7745104 PRANK INTRIERI vpOros.~.scsNm®m .. i _ r+to re - _ i j '; 7W WNE ^~Mrf JJ : QiY, SrAIE AND 7lP CDDE - 1m IOO\nOM a,Ea ba Wa cWmk _ .. C'C~.G/CAL ~- +~. d31' S .~ ~ fn.~ '' b` C LG ~~ ~ ti'c.l t/O2 • 7~(fJ fib !j '.:•Prc ,~` :. •~f~S+ / ~Q~G may! ~. ~f,cr.. ~•/ •1 ~... ~ ~/ .,/c'a'r (~JC.Y~ ~., ~'" '~•[%j`'l CG •iCdlt`.'~r CGG/`Z. C ~fi 4/!-_'r~I_~~ i~ ~~ ~ I~~`~ori i?f= %a'-tit t/' «?G~C 'n"fib "flirt'" ~ ,4%~r`/,~'-° •G'.~ /<fCLli ~. ~ `-'+`?~1,2iOG2 tit*'-xt~a'L`. ;.'~irlC, 1`'~i~.OG ~"%.L I,9LJ z ZE" ~lar ILL ~~~f?l~. -_ _„ _ ~E ~[tlpOSe hereby In famish ma[eNal and tabor - wmptete In aaoMance w3{r ihe'alwve spetlticatbns, for. the aum of•. Porrtwrt to b. male esfemuc: dotlars (# l ~ ~.S . ~'~' ) '~ritptrtatt OI ~eapafal.-tha ahw. pleas, 4+e~uo"+are eandMaix a.a saaCeRA,1' and a.a aaptad. Yaa arv eWnrlwd m de tla vo.k a NstlGed. isrnwtual bs nude es a~IList e6aro, cam' p~ Data or Acoeytance: ~Op~ Hold Harmless Agreement \~ O ~I-, I, Jenna L. Weigher, accept these checks as final paymentfidr greed upon repairs and ~ -~ hold harmless the selfar for the repairs. l F ' '~'_ ~'\~~p ` ~en~ L. Weigher ESTATE F -~ - ~ ~ SHIRt.OEY t,~KEYS FJ(RCb' Drae ... ik'A9lNQq AVE~ PnAV //////~~__ ~~[[ ENOiA; PA 75Dl34Ea' ~ ' op DgAE a'6YLYITA...: / ~.__ rL . 1055 GATE • r-aia~ao + ¢ei ---,--.1 ~ ~,3/G ~ ~ ~c Citlxens Bank 4 ~'~" ' ' 00 LL ~ ~'/Pn/M,ng(l~vania ~ ~ AR6 ..-- s 2 11, I, ~ Oq EA ---~.. ESFA7E oF'LINgA A. ~ROU'1(fi ~' SXIIZLEY.1. kEY3 EXEC ' 7 E MANOR AVa . .. ;~L6'wA~ 1Tdi6-P.IEE . DTAM Citizens Bank .•/~Jnryi„Di. F'OR. //.P.DIJ/Aa .. . ~~~ ~. u'17010 4e• _ 5 .. i:03COP6iSd~: 6214 --^~vi ~~ 1054.' DATE ~ +~/b 9• .__ . txiEOw Efl dPu ~ ,• d d`~pOLLARS a, ,t. ~ 2e• PAy TO TN! ORDEII ESTATfi OF LINbA A, ROUKE SHIRLEY 1, KEYS EXEC '. 1 E MAROR AVE.. EROLA; vA tTe!• "~ ~~- _---+~~ ~?~ ., f 056 ' GATE ,S~]Y/~7J aa~vieae ' , i!i 1 ~6~ ad •- ,~ oO LLARa ®. rc Cftlzens Bank . //P•„ns~~r~„•i. /// FOR/Aan ~ ~ ~ ~~ ~ ' I irp01056m~~;^36076i50i: 6 2 1440 14 1~n• ~- nw.~six ax+ ls.sel SCHEDULE 1 DEBTS OF DECEDENT , MORTGAGE LIABILITIES 8r LIENS ~M MONM , . IEFLTN ar rErwanvnrvu INNERnM1CE T0.C RETNRN RESIDENT pECEOENr ESTATE OF ROUKE, LINDA A. FILE NUMBER 21-08-00866 InelNas unrumeun.e m.aal.,~p.,,.... ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Comcast -cable cha es - rg 1 East Manor Ave. OF DEATH 53.33 2 Debbie Lupold, Treasurer -School District Real Estate Taxes -1 East Manor Ave . 767.21 3 Discover Card -Account No. 02701516857 -balance due 144.42 4 Holy Spirit Hospital - Co-pay balance. 50.00 5 Nester & Mathias Dental Associates -decedent's account balance 50.00 6 PA Department of Revenue -Tax due - PA 401ncome Tax Return 48.00 7 PA Water Co. -water charges -1 East Manor Ave. 41.77 8 PPBrL -electricity charges -1 East Manor Ave. 82.35 9 Sovereign Bank -Installment Loan No 8737156565 . -Automobile purchase -Date of death balance, plus interest. 4.022.22 10 State Farm Bank - Account No. 4707-8848-9916-1909 -balance due . 307.99 11 Verizon -telephone -final charges 126.83 12 West Shore Tax Bureau - 2008 income tax due. 16.62 TOTAL (Also enter on Line 10, Recapitulation) 5,710.74 Copyright (c) 2002 form software ony The Lackner Group, Ine.~ aeenlonal pages or the same size) Form PA-1500 Schedule 1(Rev. 6-98) 08/27/2008 WHD 16e 02 FAX 8109881690 60Vereign Sank -- QJ002/002 Sovereign Bank Linda ltouke 1 E Manor Ave. Eaola PA 17025-2822 Dear Linda Rouke: August 27, 2008 RE: 8737156565 ~Op~ Thank you for choosing Sovereign Bank and allowing us to assist you with your financial needs. Please be advised the date of death balance of the above referenced account effective 7/18/2008 was $4,000.21 principal and $22.01 interest. If you havo wny quootiona or arc uitcrcntc3 i~~ vtlxua yxvJawl, Null Jl.l Vlaw..i W V Vlrl.x, k1tMJV contact our Customer Service Center at 1-877-SOV-BANK (1-877-768-2265) from 7:00 a.m. to 11:00 p.m., 7 days a week. Hearing impaired customers may call I-800-428-9 ] 21 (Tl']'/TDD). Our Team Melnbets look forwazd to assisting you, Sincerely, Samantha 7NilCrams 10-421-pE2 ------~~~~`°~" ~ PO BOX IZ646,Rp.AppdG,PA I%12 Plane 100-933-0438 pc[. 801374 ~+w ~, w luau and lmlau w ~nvlro meta orsavay(q~ e.,~,,:,,,,rxa~ wmhidiuia m ~ uniro4 smNS .m om«ro~m,. REV-iN7 EX+ (gqp) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROUKE, LINDA A. NUMBER PERSON S) RECEIOV NG PROPERTY SCHEDULE J BENEFICIARIES FILE NUMBER 21-08-00866 ATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) Na ua T . ($$$) 1 EDWARD L. KEYS JR . 839 HIGH STREET Ne hew P One-half NORRISTOWN, PA 19401 Residue 2 MATTHEW D. KEYS 139 TORY CIRCLE Ne hew P One-half ENOLA, PA 17025 Residue Enter dollar amounts for distributions shown above on lines 5 throw h 18, as epproprlat Ton Rev 150 II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION BEING MADE 9113 FOR WHICH AN ELECTION T O TAX IS NOT CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE Copyright (c) 2002 form software only Tha Lackner Group, Inc. Forth PA-1$00 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT ~ O OF LINDA A. ROUKE I, LINDA A. ROUKE, single, of the Township of East Pennsboro, Cumberland County, Pennsylvania, being of sound mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils heretofore made by me. ITEM I. I direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as possible after my decease. ITEM II. All the rest, residue and remainder of my estate, real, personal or mixed, I give, devise and bequeath as follows: (A) One-half of same I give and bequeath to my nephew, Matthew D. Keys. (B) One-half of same I give and bequeath to my nephew, Edwazd L. Keys, Jr. ITEM III. My personal representative shall have the following powers in addition to those vested in her by law and by other provisions of my Will, applicable to all property, whether principal or income, exercisable without court approval and effective until actual distribution of all property: (A) To retain any or all of the assets of my estate, real or personal, without regazd to any principal of diversification, risk or productivity. (B) To sell at public or private sale any real or personal property for such prices and upon such terms or conditions as she deems proper. (C) To compromise any claim or controversy. (D) To exercise any option, right or privilege granted in insurance policies or in other investments. ITEM 1V. I appoint my sister, Shirley I. Keys, the Executrix of this my Last Will and Testament. _~ ~TNESS WHEREOF, I have hereunto set my hand and seal this ;~ ~C~~day of 1= {~~~ 2007. VEjitness: i (SEAL) Linda A. Rouke STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ SS. On this the day of ~- - ~` , 2007, before me, the undersigned officer, personally appeazed Linda A. Rouke, know to me (or satisfactorily proven) to be the person whose name is subscribed to the within Last Will and Testament and acknowledged that she executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~,~ ~-,'~ Notary Public ~M~NWEALTH OF PENNSYLVANIA C'~'^ ~+ Notary FUbflc ~Pden Twp., b1y Qommisaion E~ireg Apd 8, ~ AA+m6~l, annsyWanlm Aasxlatlon o! Notaries n (~~rr ~ i~V ., ~ k Ih~' f~: I ILI ',W Zf Y u. ,,:L+.... TO Register of Wills Office - Rm 102 Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 ECT: Estate of Linda A. No. 21-08-0866 2009 JUL 24 AM I I ~ 20 FROM JOHNSON, DUFFIE, STEWART & WEIDptF,RRK ~~ Attorneys at Law ORPHANS ~GIJRT P.O. Box 109 CU~PBrr,; ;np,~G, ~';~., PA. Lemoyne, PA 17043 (717)761-4540 Fax: 717 761-3015 DATE: July 23, 2009 Enclosed for filing in the above-captioned Estate are the following: 1. Original and copy of Inventory. 2. Original and copy of Inheritance Tax Return. 3. Check in the amount of $30.00, filing costs. If a filing receipt is issued, please forward it to me in the envelope provided. Thank you. Hubler a ~~00 N ~ ~~ N J J ~~ ~' ~~~I N~ a F.~ ~~ ~•_ _ Np ~V~VI1 00 ^~ i F [~ o 6 ~ W O ~ O C a o z q ~ ~ g0 m ~ o M ^ ~_ O: J ~ W ~ Up ~Uwn O~ M ~ ~ w W -~OUo ~~f~ ozpna ~~ . ~ a a ~ uJ 2 'F-J ~ W ~ ~ ~ m ~ J ~U.-U H