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08-12-09 (3)
-~ REV-1500 EX (D6-D5) PA Department of Revenue Bureau of Individual Tazes PO BOX 250601 Hanisbum. PA 17128-0601 15056041181 OFFICIAL USE ONLY County Code Yea File Number INHERITANCE TAX RETURN /~ ~ D~ r~C~ RESIDENT DECEDENT pL / - ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 180-09-9209 12082008 Decedent's Last Name Wright (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Wright Spouse's Social Secudty Number Date of Birth 01171916 Suffix Decedent's First Name MI Jay A Suffix Spouse's First Name MI Elizabeth M THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW QX 1.Original Retum Q 2. Supplemental Retum ~ 3. Remainder Retum (date of death pda to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of Q 5. Federal Estate lax Retum Required death after 12-12-82) 6. Decedent Died Testate 0 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 0 10. Spousal Poverty Credit (date of death ~ 11. Election to taz under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attacti Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENfVLL TAX INWRMATION SHOULD 8E DIRECTED T0: Name Daytime Telephone Number Ronald S. Kearns, CPA N 717-2633910 .~°a _,-, Finn Name (If Applicable) REGISTE ILLS US LY ~ ~ ~_ Smith Elliott Kearns & Company =;-}vr- Z n N First Ilne of address ~~ o'% 804 Wayne Ave ~.~"^ ~ ;~ y W Second line of address - ~t v --' TY City Or Post Office Sfate ZIP Code DATE FILED Chambersburg PA 17201 -.~~ }~;. !' `~r'i ~, •i C•.1 ri __ -i, ,'b ~ `r~ correspondent s e-mail address: rkearns@sek . com Untler penaMes of penury, I deUare that I have examined this return, including accompanying schedules and statements, antl ro the best of my knowledge and belief, 5 Is true, mrrect and complete. Dedareticn at preparer attar then tha personal representative is based on all inTOrmation of which preparer has any knowledge. SIGI~ATJ~RF,rOiP`R J50(RF POI~IBLE f~0 yF1~ING RETURN DATE SIGNATUR PREPgREfj OTHER 711AN RfcP$ESENTA -CL_ L//AC/~ _.OY L•Jfr!' a~n+a~_[L°~ _ 7-,3/-O 9' 804 Wayne Ave, Chambersburg, Pa 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 15U56U41181 15056041181 xxaa eavrzx-oor cos 4 1 15056042182 REV-1500 EX Decedent's Social Security Number Decedents Name: Jay A Wright 180-09-9209 RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Gosely Held Corporation, Partnership or Soie-Proprietorship (Schedule C) ... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Properly (Schedule F) OSeparote Billing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 0.00 548,203.00 0.00 0.00 0.00 130,893.00 176,154.00 855,250.00 9. Funeral Expenses 8 AdminisValive Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 11. Total DeduMlons (total Lines 9 8 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......... .................... 12. 13. Charitable and Governmental BequesWSec 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. 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.O~ 664,270.00 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 166, 743.00 1g. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Artrount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 23,873.00 364.00 24,237.00 831,013.00 0.00 831,013.00 0.00 7,503.44 0.00 0.00 7,503.44 Side 2 15~56~42182 15056042182 J ,' NK9P PAN13S-003 109 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - ~ $ - 12 5 5 DECEDENTS NAME Jay A Wright STREET ADDRESS 612 East Oran e Street CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2 floe 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) TotalCredfls(A+B+C) (2) 3. InteresUPenalty 'rf applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 4. If Line 2 is greatw than Line 1 ~ Line 3, enter the diffwence. This is the OVERPAYMENT. Fill in oval on Page 2, Llne 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the lax due. (3) (4) (5) 7, 503 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (58) 7 , 5 03 . Makt? Check PByebl@ t0: REGISTER OF WILLS, AGENT N n.. ,f'~', PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfw and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ 0 b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^ 0 c. retain a reversionary interest oc ................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. if death occurred aftw December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 0 3. Did decedent own an "in trust for' or payable upon death bank account or secudty at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly 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 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 se is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or For the use of the surviving spouse is zero (O) ercent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of as is and filing a tax return are still applicable even it the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural pa ent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiades is tour and one-half (4.5) percent, except as n ted in 72 P.S. §9116(1.2) [72 P.S. §9116(a}(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) pwcent [/2 P.S. §9116(a)(1.3)). Asibling is define ,under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. NN1P PANI]1-003 1N9 ~. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ~' ,Tav ~ Wri nht 9l -(1R-'1954 i All real property owned solely or as a tenant In wmmon must be reported at hlr market value. Fair market value is defined as the price at which property would e exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant /acts. Real propeAy which Is Joingyawned with right of survlvonhfp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 1, Recapitulation) S 0 , 0 -- _ - -- -- (n more space Is neeaea, msert aaaamnal sneer rn me same size? REV-1503 EX+ (e-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Ta.~ n wr;r,hr 21-08-1255 All oroceM iointlv-owned wiM right of survivorchlp must pe disclosed on Schedule E '~. ITEM NUMBER DESCRIPTION VALUE AT DATE ~, OF DEATH I t. Wachovia Securities, LLC AJC#4837-206037 Valuation Report Attached Security Value 544,946.10 0 Accrued Income 3,257.0 II ~i II 0 ~ TOTAL (Also enter on line 2, Recapitulation) 5 54 8 , 2 0 3 . 0 p (tt more space is neeaea, insert aoaltronat snee>s rn the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT nc SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP F11 F NIIMRFR Jay A. Wright 21-08-.1255 Schedule C-t or C-2 (including all supporting infometion) must be attached for each cbsely-held corpo2donlpartnership interest of fhe deceden4 other than a sde-propdetorship. See instnrcdons for the suppoNng infomtation to be submitted for sole-propdetorships. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DFJ~TH t. I TOTAL (Also enter on line 3, Recapitulation) $ 0 . 0 (It more space is neeoeo, insert aaaawnal sneers a the same size) REV-1505 EX+ (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSE4Y-HELD CORPORATE STOCK INFORMATION REPORT Provide all rights and restrictions pertaining to each Gass of stock. 5. Was the decedent employed by the Corporation7 ................................... ^Yes ^No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ..................................... ^Yes ^No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^Yes ^No If yes, Cash Surrender Vafue $ Net proceeds payable $ Owner of the oolicv 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 1231-82? ^Yes ^NO If yes, ^Transfer ^Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedenYS death? ... ^ Yes ^ NO If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .................................................... ^Yes ^No If yes, provide a copy of the agreement of sale, etc. t t. Was the corporation dissolved or liquidated after the decedenYS death? ................... ^Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? .............. ^Yes ^No If yes, repoR the necessary information on a separate sheet, including a Schedule Gt w C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market values. If real estate appraisals been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. P. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. REV-1506 EX+ (g-00) SCHEDULE C-2 PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Jay A Wright 21-08-1255 1. Name of Partnership Date Business Commenced Address - Business Reporting Year City State ZIP Code ~' 2. Fedeal Employer LD. Number 3. Type of Business ProductlService i 4. Decedent was a ^ General ^ Limited partner. If decedentwas a limited partner, provide initial investment $ 5. a B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ..................................... ^Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year pdor to death or within two years if the date of death prior to 12-31-82? ^Yes ^No If yes, ^Transfer ^Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ..... ^Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedents partnership interestsdd? ........................................ ^Yes ^No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissdved or liquidated after the decedent's death? ...... . ........... ^Yes ^ No If yes, provide a lxeakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ..................................... ^Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^Ye5 ^ No If yes, report the necessary information on a separate sheet, including a Schedule Gi or C-2 for each interest. A. Detailetl calculations used in the valuation of the decedents partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated Tair market value/s. If real estate appraisals h been secured, attach copies. D. Any other information relating to the valuation of the decedents partnership interest. REV-1507 EX+ (6-98) SCHEDULED COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER 7av A- Wright 21-OS-1255 i AN property jointly-owned with tight of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) S 0 . 0 wK.> vnx,:.-oos ios (If more space t5 needed, inseM1 additional sheek of the same size) REV-1508 EX+ (6-9a) ~'. SCHEDULES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ', ~ RESIDENT DECEDENT '~ ESTATE OF FILE NUhIBER i Jay A. Wright 21-08-1255 Mchrde the proceeds of I'Itigadon and the date dle proceeds were received by the estate. All properly joiMryawned with Rght of survivorship must be diulosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) E 0 . 0 ~., > ,,,,,,~ -oio cos (It more space is needed, inseR addiQOnal sheets of the same size) REV-7509 EX* (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY•OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jay A. 21-08-12 If an assetwas made joint w(thln o~wyear of the decedent's date of death, tt must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDEN A. Elizabeth M. Wright 612 East Orange Street Spouse Shippensburg, Pa 17257 B. C. JOINTLYAWNED PROPERTY: LETTER DATE DESCRIPTIONI~ PROPERTY XOF DATE OF DEATH REM FOR AIM MADE INCLUDE NMIE OF FINANC4LL 1lSTnlffgNAND BANK ACCWMNUMBER DR SNAIIAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT AIM IOEMIFYING NUMBER AITACH DEED FOR AINRY-HELD REAL ESTATE. VALUE OF ASSET INTEREST pECEOENfSINn:RE ~~ t A. 11/28/89 M&T Bank,Checking AjC#71437940 10,938.00 50.0000 5,469. 0 2 a Ol/Ol/50 Residence-612 E Orange St 0. 0 Shippensburg, Pa Parcel 32-34-2413 0. 0 207 zzB,Tae.oo 50.0000 114,074 0 3 A 08/26/08 2005 Dodge Grand Caravan-Handicapp zz,~oo.o0 50.0000 11,350. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 00 0. 00 0. 00 0. 00 0.0 0 0. 0 0. 0 0.0 0.0 TOTAL (Also enter on line 6, Recapitulation) g 13 0 , 8 93 . 0 (If more space is needed, insen additional sheets of the same size) REV-1510 EX+ (6-98) ~I SCHEDULE G ii INTER-VIVOS TRANSFERS & I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER II Ja A. Wri ht 21-08-1255 This schedule must De completed and filed g the answer W any of questions 1 through 4 on the next page of me REV-7500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLIAE THE NAME OF THETRMl6FEREE, THEIR REUTIONSHPTO DECEDEM AND DATE OF DEATH °~ OF DECD S EXCLUSION TAXABLE NUMBER THE DATE OF TRPNSFER. ATTACHA COPY OF TIE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIFAPF1JCABLE) VALUE i. Hartford Annuity #710854651 iaa,sss.oo 100.0000 144,556. 00 Beneficiaries (2)Daughters o. oo 2 Hartford Annuity #710176054 zz,ie~.oo 100.0000 2z,1B~. oo Beneficiaries (2)Daughters o. oo 3 Erie Insurance IRA#AN10020330 9,911.00 100.0000 9,4ii. oo Beneficiary Surviving Spouse o. oo o. oo o. o o. oo o. o o. o o. o o. o o. o o. o D. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. o o. oo o. oo o. oo o. oo o. oo TOTAL (Also enter on line 7 Recapitulation) S 17 6 , 154. 0 ""°' pAN1 t -°" 109 (If more space is needed, insert addiGOnel sheets of the same size) REV-1511 EX~ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES Sr INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jay A. Wright _ 21-08-1255 Dahts of decedent must he rapohed on Schedule f. ITEM NU ER DESCRIPTI(NJ AMCUNT A. FUNERAL EXPENSES: ~' Fogelsanger-Bricker Funeral Home 9,873.00 2 Mongul UB Church- Reception 100.00 3 Spring Hill Cemetery 600.00 4 Tim Wyrick-Cemetery 100.00 B. ADMINISTRATIVE COSTS'. 1. Personal Representative's Commissiore Name of Personal ReDr~entative(s) Sheet Address City State ZIP Year(s) Commission Paid. z. AttomeyFeesDavid P. Perkins, Esquire 4 800 0 . ' 3. Famiy Exemption: (If decedent's address is not the same as claimant's, attach explanation) claimant Elizabeth M. Wright sheet Address 612 East Orange Street cityShippensburg state PA zIP17257 Relafbnship of Claimantro Decedent Sl1YViV].ng Spouse 3,500. 0 4. Probate Fees 476. 0 5. AccountanCs Fees 4 , 150. 0 6. Tax Retum Prepa2fs Fees T Cumberland Law Journal-Advertising Letters 75.00 8 The Sentinel-Advertising Letters 135.00 9 Wachovia Securities LLC- Valuation Fee 50.0 10 M&T Bank-Checks for Estate Account 14.0 TOTAL (Also enter on line 9, Recapitulation) S 23 , 873 .0 (It more space is needed, insert additional sheets of the same size) vkav esuv~-ov cos REV-1572 EX* (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER '~. Jay A. Wright 21-08-1255 RapoM1 debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbureed medial expenses. ITEM NUMBER f>ESCRiPT10N VALUE AT DATE OF DEATH 2 ChaTribersburg Hospital Chambersburg Hospital 169. 195. 0 0 TOTAL (Also enter on line 10, Recapitulation) S 3 64 . 0 wk. P Pu+» ~ -m. nos (If more space is needed, insert addAional sheets of the same size) REV-1513 EX~ (9-00) ''~ I SCHEDULE] 'I COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER Ja A. Wri ht 21-08-1255 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do NM List Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS[indude ouhight spousal d'ahilwdons, and transfers under Sec. 9116 (a) (1.2)1 Vonnie K. Cressler 80 Edgehill Lane Shippensburg, Pa 17257 Daughter 83371. 0 2 Nancy B. Oyler 913 Blackthorne Drive Chesapeake, Va 23322 Daughter 83371. 0 3 Elizabeth M. Wright 612 East Orange Street Shippensburg, Pa 17257 Spouse 664270. 0 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROU GH 18, AS APPROPRIATE, ON REV- 1500 COVER SHEET II 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET E 0 . 0 ""' " """"' -"" '"' (If more space is needed, insert addNOnal sheets of the same size) REV-1514 EX+ (72.03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN ;heck Box A on REV-1500 Cover Shee ESTATE OF FILE NUMBER Jay A. Wri ht 21-08-1255 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1- 9, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in lRS Publication 1457, Actuaria{ Values, Alpha Volume for dates of death from 5-i-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other ^ Life or ^ Term of Years 3. Amount of payout per period ............................................................$ 4. Aggregate annual payment, Line 2 multiplied l7y Line 3 ..................................... 5. Annuity Factor (see instructions) Interest table rate-^31/2% ^6% ^10% ^Variable Rate 6. Adjustment Factor(see instructions) ...................................................... 7. Value of annuity - If using 3 1/2%, 6M°, 10%, or if vadable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ............................ $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 8)+ Line 3 .......................................................$ 0.00 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. WK. P ou.v,-ms .ov (If more space is needed, inseR additional sheets of the same size) REV-1647 EX. (9-W) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Ja A. Wri ht 21-08-1255 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTH Y 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate bock and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future interest ................................................................ $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also incude as part of total shown on Line 13 of Cover Sheet) ....... $ 3. Value of Line 1 passing to s use at appropriate tax rate Check One ^ 6~°. ~3%. ^ 0% ........................ $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5°f° ............................... $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ....... $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ....... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................... $ 0 . 0 xK~e vu+u ~-oi'r cos (If more space is needed, insert additwnal sheets of the same size) REV-1649 EX+ (6-98) '~ SCHEDULED ELECTION UNDER SEC.9113(A) '~' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER Ja A. Wri ht 21-08-1255 Do not complete this schedule unless the estate is making the elecdon to tax assets under Section 9113(A1 of the Inherhance & Estate Tax Act f b f l d f h e or eac Wst If me elecfbn applies to more than one tout or similar arrangement a separate orm must e i Tnis election applies to the Tlusl (marital, residual A, B, By-pass, Unload Credi[, ei . ). If a host or simiar arrangement meets the requirements of Section 9173(A), and: a. The Wstw similar anangemeM is listed on Schedule 0, and b. The value of Me trust or similar arangement is entered in while or in pad as an asset on Schedule 0, then the transferors personal representative may spedlkalty identity the bust (all w a trectlonal portion or percentage) to be inducted in the election to have such Wst o sim- ilar property treated as a taxable transfer in this estate. If less than the erldre value of the bust or similar properly is included as a taxable transfer on Schedule 0, the pe nal representative shall be considered to have made the electron onty as to a fraction of the trust or similar arangement The numerator of this traction is equal to the a nt of the trust or sirdlar arrangement inducted as a taxableasset on Schedule 0. The derwminatw is equal to the Wtal value of the trust w similar arangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to rthe dated ht's surviving spouse under a Section 9113(A) trust or similar arrangement. Description Value PartATotal $ 0.00 Part B: Enter the description and value of all interests included in Pad A for which the Section 91 t 3(A) election to tax is being. made. Description Value Pad B Total $ 0 . 0 0 ""°" """`° "'° `"' (If more space is needed, insect addihonal sheen of Ne same size) ~~i LAST WILL AND TESTAMENT [, JAY A. WRIGHT, presently of 612 Orange Street, Borough of Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all. wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECO D. I give, devise, and bequeath all of my estate, real, personal, and mixed, whatsoever and wheresoever situate, to my beloved wife, Elizabeth M. Wright. In the even4 my wife, Elizabeth M. Wright, should predecease me, or fail to survive me by thirty (30) days, 1 Then give, devise, and bequeath my estate as follows. THIRD. i give and bequeath aH of my automobiles, jewelry, clothing, furniture, vehicles and other articles of personal or household use (not including cash, stocks or other securities or general investments), including insurance on that property to my daughter, Nancy B. Oyler, provided that she survives me. FOURTH. I give and devise my real estate together with improvements erected thereon known as 612 East Orange Street, Borough of Shippensburg, Cumberland County, Pennsylvania to my daughter Nancy B. Oyler with the request that the proceeds therefrom be used for the education of my granddaughter Logan Elizabeth Oyler and my grandson Dustin Ryan Oyler. FIFTH. I give and bequeath the sum of ten thousand dollars ($10,000.00) to Mongul United Brethren Church, Mongul, Pennsylvania, five thousand dollars ($5,000.00) of which is hereby designated for the use of the church choir and five thousand dollars ($5,000.00) of which is hereby designated for general church purposes. SIXTH. I give, devise and bequeath alf of the rest, residue and remainder of my estate, real, personal, and mixed, whatsoever and wheresoever situate, in three (3) equal shares, as follows: A. One share to my daughter, NANCY B. OYLER; and B. One share to my daughter VONNIE K. CRESSLER; and n _~ ~ a , , n o , , 2 n M !t_7 :' Ui~ i "-i Q , r , / ~ r. O., ~i_ C. One share to the three (3) children of my deceased daughter, Connie B. Getz, to be divided into equal shares as follows: 1. One share to my grandson, DONALD L. YEAGER; and 2. One share to my granddaughter, MELISSA A. FOLKEMA; and 3. One share to my granddaughter, RAE E. SHARROW. SEVENTH. In the event any of my beneficiaries should predecease me or is not living on the thirtieth (30~")day following my death, leaving issue who survive me, I then give, devise and bequeath said deceased beneficiary's share to his or her issue who survive me, on a per stirpes distribution basis. EIGHTH. I direct that alt 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. NINTH. I nominate, constitute and appoint my daughter, Nancy B. Oyler, to be the Executrix of this my Last Will and Testament; and if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint my daughter, Vonnie K. Cressler, to be the Executrix of this my Last Will and Testament. TENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, JAY A. WRIGHT, have hereunto set m~ hand and heal to this my Last Will and Testament, written on two (2) pages, the first (15) page signed for identification only, this 20th day of August 2008. '~". 1 ' ~ y ~"~Ck'U_ L~(.~jz.c.F>N/1. (SEAL) C: _. _ _ _ This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. ~Jl G'• ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, JAY A. WRIGHT, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executied the instrument as my Last Will; that I signed it willingly; and that I signed it as my frde and voluntary act for the purposes therein expressed. . Sworn or affirmed to and acknowledged before me by Jay A. Wright, the Testator, this 20th day of August , 2008. /~i*fmi~ ~ ~G~~m1L COMMONWEALTH OF PENNSYLVANIA Noterlel Seel Yictorie N. PeMins, Notary PubAc SNppansbu'g Soro, CumbeAatW County My Commission E~ires Oc1.15, 2010 Mem6e~. Pennsylvan~e ssnrialion of Notedes COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS We, ~aUl d r . ~P~(CI Yl~" and ~rQY~(',lC ~e/1~'~_, the witnesses whose names are signed to the foregoing instrument, being duly gylalified ;drag tQ haw, dct depose and say that we were present and saw JAY A, WRIGHT, the l'tFSt', sign '~iti ~t+c~CUte-tlir~'1l"rstrurnertt' ~-his' Last VFllil; that he signed rniillingly arod that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator; signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~~ Q- ~~~ Sworn or affirmed ko and subscribed before me by David P. i°p~'kins and ~ Yl ~ ~ . o r''I ~~ witnesses, this 20th day of August, 2008 "LUl.~e~t~,tr. ~ Ted-,mom COMMONWEALTH OF PENNSYLVANIA Noterfel Seal Vxloria N. Perkins, Notary Public ~Pl~ensbur9 Born, CumbeAend County MY Commissbn Expires Oct. 15, 2010 Member, Pennavlva~R~ 1s~a.Yelinn of Notadea This is to terrify that this is a rrue copy of the rewrd which is on file in [he Pennsylvania Division of Vital Records in accokdance witfl Act G6, P.L. 304, approved by the General Assembly, June 29. 1953. ii i WARNING: It Is illegal to duplicate this copy by photostat or photograph. ~nuA.~ ~x~kYOo~ Military Status wm.ux IVV nau xYPEN Blb(xM a~ e 16579 No. Frank Yeropoli State Registrar DEC 1 9 Date COMMONWEALTH OF PENNBYLVANUI• DEPARTMENT OF HEALTH • VRAL RECORDS CERTIFlCATE OF DEATH 1SN 1nabYe110n8 Ma Ra11NlNe On xaVaINJ BT.T[ I.MYrotldWYIMI•.M. M.u~l -.W 1lW YV•I-'N.b, I.CW YRM[MM\MA'MI e O _ 09 _ Dec a D a.waaswsYr ur., ua.l ambar i. wrro• rMao.an "'"' °1• Nawbxirg nbP[e oxr 90 Jen. 17 1918 A ®iwsa ^ueorrw Ooox ^xroagrb,w L7w.,Vwu ~^aw-rPrV. i rwx[da.e a.minanr aor rwywmx P.ararlMwwwro.sul [. xl. or+a[wauai ®x, r.. ,.b:w..rixa.. .xbr w. RwtwFwn Ia.eM Fr nkiin Chamberebur xh Chemberebur Noe itel "O°^^"^e wO"~'b/ Mhite ~.. n. Lwa arw ra [.war Ix w.o[wra.wbw na.rordx[men WnYe. n.8wni9 Pvxe.%MmnM ~ ~ ~ vYw Il~ 1 RtlIVM INYawr/LMLI 04a 18 ^•0. 1 Y.n Ma[Fp} -a~arx/xma. Pla TWI.1~ Owner BoVlln elle ®s ^w Married lizabth M. As 1 n wbwd.wmxw.b law.4/bw aw4wwl oaw. ob0.wre 612 Eaet Oaange St .eww+snro na s"' Pennwylvanie ~r Ix.O w.wuwauax nP, . Im waa Cumberland ne.0 w. wwwbu..adx. Shi ansbur PA 17257 xe,aawa c[r/rro In PWl IYro 6xYebY.bl..a,1 e.IW IIW aNLM]Y. n.IMnw.w•1 ~, Leae Nr1 ht el lin ' N.usnwLBm Rw/PN Eabbm.Y)1YiVxliealxL+d W/ews4mua,1 Elizabeth M. Mri ht 612 Baet Oren a St. hi enabur PA 17 57 n..wraow.rw pawrw ^aaw xle.Pw awx.[w lwwwnr n~.ra[e.r~paaaawwx..r.rwwrawa na w.w iw//w. . W wM ®w•r ^ b...ar aw ar. WOr w ~ ^w^x. Dae- U 2008 z NS 1 em a Shl ens u PA 1 '257 r aww muw.xvb. xb.IbawNaw,arwa[ 112 N. King St. ' - t 1177 - el P.O. 776 PA 1725 '. o-eros.. err.yaraape ~erwawban[P.m[wamwbr.w.asw War Ppr[.wr mubw.rw [x~wb (B+bR rA w•n FNr'[a..arw rarxwb a[[psrdral ... ~. w.. Frowivrb~l,wx[prq N.TptlAr e.6Y Pgwrtq wrlWwr. ml.frl -A lr na MV~Mblb414ww,/faviNH. M.N YW CIwWYwv 1 w.wr.,w o.. rder ~. 151 o N. i - s -aoo 8 uVU watATx Mr broYUplbe. b,e.rmyw) NPabnrwwa McEwraaayl[Bee Ma[ w+wra N.x>.MLFXw[ror[aIDdt'!~[YMy,ss.YM~xtlM/orwYw4 CONJi.iYYn4,IwNM.mI,[~ut pr1b6M MM.~BLgMMw,bxgaw xM~FMI ^Yp PMLq' apWywBV.vYbrbW 4LW Y...b YBx W ^LL Vroav.wwalw. . ~Iw. " ° ° . a ..•° ~W Q u~ ..~x~~ R " Jr-~C S r. Pvwb w mal I~ --r w.rl. ^ wx w+ s p'~.y_rativ...-n. b PK NA"~Lr^st {d • r ^ awn nwblsw• at ea uesnneuu[ ^ww.puawrw.++b M ~ pablvw.a~wPwa ^/u Wprr[e rolwu a. °°^ ^ xProF.raa.r wu ]L.YbwM4y ae.xrw`Lwma,F xl . W y1lM e~wY delntwei.G4.w.l mx Mw!•b M'46uM ~ II[11YM .lbw. i.e49nM. PMVwKi MWYlbbfsdM ~ ~ / ^M ^IbMb Lb .•L m+wm ac..xarm U -/ ^b t~M ^rw ^M ^Mwr ^MaV xwaNxw wnndMF m.LMaMS[ a.xiruro.er MvlfAM) eO. mYwa Ywflav,[eb/mm.nrl ^WY ^CatlIwMCYiIi.O ^Yx ^W ^LMr.ltJxww ^P.u.nT ^M11wIA '. Pr-Md: s.wawProwwwa wir • nnM'[M.uMPMxwserwa..am.Mwa.xM+a•wx~.~.'wwnwmnwwr.xw x - n Db MaM wM,4~-rower.'wasbrLP)wbwwnxwL____________________________~___ • ' Nwwd7NSm/Y.PIyYnylysW MLwrYyMwMwgrouraero[y [.w ro[awa rb wr wa a ^ g,lyan[wgr g[yy-Va Brwb. ~[~/rr. ww w , .b . ewrgwroawxaad_________ ______ a g ~ MO ~f3L(& (p - g h!•e,V.MnwYU[nwl FwLyY[s•M uB.IY•. M www• w OUbWwwywrrww M1ML ^ . L, e~, , , M.IM. NN tl M1iMN1e C^M1YMfaiY l[nb e.nxLl ilw/PMI ~. :wdw.naRwww I ~I /I .I l l~ R.arw. (~CB• yy ~~ ZO/~~`Sw Sf C~ M a- ~ ~~ „ , ~ __. - a PbwBw r.w[w D1943ra( REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTE No . 2008- O 1255 PA No . 21- 08- 1255 Estate Of: JAVA WR/GHT (First, Mi1Eh, GsU Late Of: SHIPPENSBURG BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 180-09-9209 WHEREAS, on the 16th day of December 2008 an instrument dated August 20th 2008 was admitted to probate as the last will of JA Y A WRIGHT (First. Mitltlh, 4s0 late of SH/PPENSBURG BOROUGH, CUMBERLAND County, who died on the 8th day of December 2008 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in < for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: NANCY B OYLER 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 at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed'. the s of my office on the 16th day of December 2008. 1 **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) Fatale Vsluatioa Data of Death: 12/08/2008 katste ot: Jay A, wrig: Valnati.az Data: 12/08/2008 Report Type: Date c! Dea' Proeaseiag Date: 07/02/7009 Mmibax of Sa¢~ritien file ID: Nz1ahN8~7, Jay2060'~ 8harae Security Hesn and/or Security Div and mt Identifier or Par Description Nigh/Aak Lev/die Mjuetmmte Value ,~octvals 1) 013904305 18 ALp1TEL-LOO@Tt 89OH80RED A@ Hew York Block ErChange 17/08/3008 7,77000 7.06000 H/L 1.190000 39.42 2) 197576106 8000 CSHN 3NC 001{ ~ 'ihe 1Dz8DWQ Stock 16eiket LLC ~ 17/08/]008 11,76000 10.16000 H/L ', 10.960000 87,680.00 Mvz 0.06 Err 11/75 Aecz 11/78 Psyz 01/07/09 3) 670938100 1061 HOVaE<7 76fII1 VALVE FD ID1C ~~ OON NsY York 8toek SKChanga " 17/08(2008 8.54000 8.]7000 H/L '.. 8,455000 8,970.76 I 4) 693517106 3000 PPL OORP ~~ OOH Ne1i York Block E%ChangC 12/D8{2008 31.53000 30.44000 H/L ', 30.985000 ' Mve 0.333000 8u: 32/08 Face 17/10 Payz 01/01/09 r 0.335000 31.370000 93,960.00 '. 5) 67070A01 2000 afNEeE DN ADV 31fII9I PD 3 ~. 0.16 8H HBH Dfl' ''~ ' Amerlcaa etxk Erchange . 17(08/7008' 10.10000 9.35000 S/L '~. 9.775000 19,950.00 ~'~. 6) 707569109 9000 PBHE ~TL 0a4uHd 3NC N16 The 1a18Da0 8toek Harket L7.C 12/08/7008 27.59000 70.77000 A/L 71.430000 85,720.00 71 784413106 500 8 L I3m8 I11C Ldi Amrfcan etorJc Exchange 12/OB/7008 5.70000 5.55000 H/L 5.625000 7,817.50 B) 971121108 5323 VAH EAHPEN PA VALVE E0H II7N10! GC46 Hew YOr)c BCOC)[ ErChange 17/08/7008 8.63000 8.30000 H/L 8.465000 45,059.20 9) 105733005 75000 Sa11Hf9 HICO a TE OD NL181VH Pizunclal TSmea Interactive Daq 7xfDf 09)05/100a 74tz 03/OSj7039 5.54 17/08/2008 97.91760 Hkt 97.917600 74,479.40 Iatz 12/05/7008 to 12)08/7008 ' 10) 17789PP89 15000 CIT 8R SALT La103 C2TY OT pi.......•s.l TL9ee Interactive Dots D7'DZ 03(06/7006 74t: 03/08/7010 4.9k 12/08/2008 101.31140 Hkt 101.321900 15,198.21 Eatr 09/06/7008 to 17/08/7008 15.78 184.88 Page 1 • Please ace the final page !or IDO?OItTAN! ZAPORHATION ABOUT TH8 EBTATE VALUATION REPORT, wachwia Securities, LLC Goes sot render Car or legal advice. xt you have s~+ queelioas pleaaa cmeult with your IIlex and legal sdviaore. POtchoyia Securities, 7J.C, comber NYBE/BIPC, Bad laachovis Beeuritiee Financial Netwrk LLC, OxXnber lD18D/9IPC. Date of Death: 12/08/2008 Estate o!: Tap x. WrighlF`F Valuation Data: 17/08/1008 Report typos Data oL neatp Processing Dates 02/07/2009 Nuooher o! 9equritiea: 7 811e IDs wright4B37,Jay206031 8hsree Beeurity Kean antl/or Security niw and Eat ~~ Ideatilinr or Par Description Righ/Aek LoN/Eid Afljuatmeata Value Actrmla ~ Y 11) 3704AOTV4 25000 f~lAL MTRS AOCEP ODES " '., Piwncial Times $ttractiw Data ' DLD: 31/73/2004 late 11/35/2024 74 11/08/2008 73.93000 Mkt 13.930000 3,982.50 Eats 11/15/2008 to 12/08/2008 116.6 11) 37041fT7J9 30000 l8lZ»DtAL MTRB xCC~' CPBNRRTMBE Ainaacial Timss $tarsctiw Data DTDS 09)03/1003 tat: 09/15/2018 7.151 12/08/2008 12.90330 Mkt 12.903300 3,870.99 Eats 09/15/2008 to 17/08/1008 507.5 13) 514045ON1 25000 I.Rl7CJ18TER CN1'Y PA ROBP ADTR RE RSV RE8 8 ' Plaaneia3. Tlmea Eataractiw Data 171De 08/0!/1996 Mats 09/01/7009 5.4h ' 11/08/2008 $8.39!00 70ct I, ' -' 98.394000 24,598.50 '~. Eat: 09/01/2008 to 17/08/2008 367 .50 ~. 34) 52510ROx8 30000 LElONN CQ1D. E[ Ol71M lSnanelal TSmaa $teractiw Data D1D: 09/27/2007 tat: 09/27/2017 fi4 13/08/7008 96.71590 !Oct 96.715900 ]9,014.77 Eats 09/77/1008 to 13/08/2008 360.00 '~. 15) 70917ML41 75000 PBtIIiBYLl7S7I11 ST RIGaR]t HDL PM' EEV BUB '. Hmncial Times $tesactlw Dats 7RD: 71/al/2oo1 sat: o7/1s/1oa2 sk 11/oe/2ooe 1DB.761oo aut 108.762000 17,190.50 $t: 07/15/2008 to 11/08/2008 500.00 16) 717B80Z76 10000 PXILADID.PMIA PA 8CM DIBT O.O. HD8 Ainaacial Times $tarsctiw Data ' OIDS 11/15/1998 )ate 04/01/7027 4.75} '. 12/08/2008 101.11400 IOCt 101.114000 10,112.90 '~, Eat: 1D/01/2008 to 13/08/3008 ~, 89.72 '~. 17) 955817DA6 25000 MBT 81fORE PA AREA MOBP ADTN B REV RDe 8lnanclal TSmea $tesaeClw Data DTDI 11/01/2001 Mats O1/O1/1015 5.75h ' 12/08(2008 97.30890 Mkt ', ~ 97.308000 14,317.00 '~. $t: 07/01/2008 to 12/08/1008 630.90 '. 18) 305560104 9 FAIRPOINL OOIOIONIGTIQ78 INIC '. Q77B7 27sw York Stock lOCChange 12/08/2008 3.23000 1.96000 H/L 3.095000 27.66 19) 92343V104 570 VIDtI8011 COl810NiCAT10M8 INC GD11 lbw York 8totk >~~~•~ ',. 12/08/2008 34.90000 93.60000 H/L ' 34.250000 17,810.00 ' 20) IaQT 21141.82 1eDNRY M)O7Rl1T ISa1,ANCE 21,141.92 an xaann s ~Rt7PD_ANN~T'Y_/ 710854641 '~48'"4E3"£t ~ ~, 31) IO1MP ~35IIg_96.liARTFORD_Ala1DLTY.../.v710776054-.__~._.._.__.._.....__.~.__.~___~__.____~-`"fit ~I. Total Value: ~, ' Total Accrue!: ht ha Total: $680,193.36 k'~,y,V y~.~(~ ~a `1_.257.45 Paga 2 Plesea sae tha lisal page !or 11O?ORTlltll' ]180AMATION ARODT 79E RBTIITE VALWTIOM R1tFORT. wachsavia 9acuritiea, 1J.C does not xandar tax or legal advice. I! you lava au/ yuactiwa place ocoeult with your ax and lags! asiviaera. warnwia eecuritiee, I.LC, nmSer NYBE/87YC, sM Naehwia 9ecuritiee Fisuncial Network I.f.C, NxBD/B71YC. I I 1 I Data of Dastb: 12/08/2008 Valwtlm Date: 12/08/2008 Proceseiaq Pats: 02)0212009 Portfolio Eedootes 1MP0RTANf II7NRYATiON ASOIIf 17DS EBTATS VAiAATIWI PZ,ROAT Satate oL: J y A. I6ri 8eport Type: ~te of Da Number of 8edur1tles: PSls ID: wright483,'7,JSy206 The informatim is this Ltats Vaiwtim Rspor! (referenced below u the Report) is based on the Satate Valuer worluhaat provided to w by thn Blmaeial Rdvlsox raqu-stiag tLa Repast. Ne Lave not wed client statemeata, i~terml accounting data, or say other ruowcu to iaMpeoda:tly verify the identity or Quantity of securities held, this date of death, or the alternate valwtion data, if applicable. ID moat cues, ws we Ltate Val, a valwtioa and priciog pzogrua, Co provide Snformatim m the valor of securities on the raQwsted data. NCab Val software is pzwidsd by Setats Vslwtiaw a Pricing eystemn, Eao„ (SVP), • tW~M-pertY vendor unrelated to lsachovfa Seeuritiaa, IJ.C. The pricing and valwtioos gsoarated by SVP ere derived trm s as it believes to be reliable, but the aeeusary and cmplntewss o! this iaformatien is not guaranteed, Depending m how the Report will be wed, the pricing gawrated by SVP for some aecuritiu may wrrut additi eoasidaatim. veers may want t0 supplemsmt of adjwt the values provided for certain types of sacurltlu. M exaaple: - Szokexed Cartiflcatu of Deposit, end eartata Linda, maY poesus a dnaYL put f9ature. SPP provides a valve rh does not account for the pusib111ty tLat • suceusor weer amy bs abU to put the security back to the issuer at upm th death of the axiglnal oawz. Treasury InfLtl.m Pmtectl~-eaeuritiat_jT;P9) are,.pftea_poC .Sdgatified .as..such in.tha • ~~!-.,'. aq the intlet~m Cactos miy not De rmfleetad in the value a~ accrued interest shown. -Variable sate auCiim seCUritia may bs reported by SVP at yar, without reflecting accrued iatereat os marked cmditlasu. Otter typo of variable rate securitiu may not refiner accrued lntnrest. The datahasu wad by EVP do wt eacoopass all markets or types of 1mnatmeate, Por exude, Satate Val does t provide' valwtlm data m iavestmmts ears as anauitiu, equity optima, limited psrtnersLips, or managed futures funds among others. If the Pimnoial Tdvlsor is able to oLtaia yriciag or vslwtim data fro: other eouxas with respect t such Snvestaents, ors may iaoluda that Nta fa the Report for lntotxational end eoavaaiaaca pusposae. ors will. identi ouch inveetmenG Sa Ghe Report. Ns do not audli or Sndspmdantly verify the data provided to w, sad make m reprea tatlow u to Fife seeuraty or eoopieteaess of L:fozmatim pswided to w by others. i~ 1'hie Report dou mt Sn any way supersede tLe iafoimatim curtained So client statemeata ana trade emfiraation are the official record of aeeamt positiow sad actlviry. Ne make no raDrasentatiou that the infotmatim emtaiaad in this Report is suitable for nay particular purpose the responsibility of the chant, togetLer with Lie or ter fez end legal advisors, to Qetezedan the nppmpxiate inforea[im to 4n^l ode en a:ry fez return, inventory, or other aeeamtirtg. Page 3 Please eee the fuel page for AR70RTANl' INBDpNATION ASORf 11~ BgTATH VALD7(TIO)7 R~pRT. waehovia 9eeuriClu, 1J.C does not render tax Or legal advice. If you have a+sy quutiOw please eonault with legal advisors. Nachovia eaeuritiee, •.rn, mambas NYBR/82PC, and Narl~wia eecuritiee Pimacial Network L NaBD/BIPC, which It Se tax and _ _ ©M&TBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 David P. Perkins, Esq. Attorney At Law 4 James Circle Shippensburg, PA 17257-2165 Re: Estate of Jav A. Wright Social Security: 180-09-9209 Date ofDeath: December 08. 2008 Phone (888)502-4349 Fax (302)934-2955 May 14, 2009 Dear Sir or Madam: Per your inquiry dated Apri124, 2009, please be advised that at the time of death, the above-named decedent had on d posit with this bank the following: 1. TypeofAccount Checking Account Account Number 71437940 Ownership (Names oJJ JayA Wright• Opening Date Balance on Date ofDeath Accrued Interest Total Elizabeth MWright• 17/28/89 310,93734 3 0.37 310.93771 Please be advised, there was no safe deposit box found for the above decedent. • If upon reviewing the informatiou above, you believe there are additional accounts not referenced, please p vide us with an account number and/or name of any possible joint account holder. For any additional information o the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please rn tact our Walnut Bottom #717-532-2414. Sincerer ~~~ ~ Tracie Hare Adjustment Services ~~- __ Jun 11 2009 9:59RM Rttorney at Law [7171 532-9537 Detailed Results for Parce132-34-2413-207. in the 2004 Tax Assessment Database DistrictNo 32 Parcel ID ~ .- 32-34-2413-207. ------ MapSurfu - _ HousePlo 612 Direction E Street ORANGE STREET Ownerl -' WRIGHT, IAY A & ELI7.ABETH M ..C/O ---- ~pTrFe _~-7-_ ---------------- ~ ~ PropDesc ~ LivArea 2656 CurLandVal ..-_ 25000 -------- ----- __.-.-~- CurlmpVal 156070 -- CurTotVal 181070 CorPretVal Acreage ~.64 CIGrnStat ~TeSEx -- - I ------ SaleAmt ~ --- '-- Sa1eMo - SaleDa SaleCe ~! SaleYr DeedBkPage _ _ 00220-00742 --_-- _- - YearSl[ 1950 HF File Date LOl28/2004---` HF Approval States A ~~ ~ / zre ~ LR~ p.2 / ~'P Jun 11 2009 9:59FM f3ttorney at Law (717) 532-9537 ~ p.3 Cumberland County Tax Assessor. ent Database DISCI.AIlVIER The data contained in this database is deemed reliable but not guaranteed. This infornnatio should be used for informational use only and does not constitutc a legal document for the description of these properties. Every effort has been made to insure the accuracy of this data; however, this material may be slightly dated which would have an impact on its accuracy. The Cumberland County Assessor's Office disclaims any responsibility or liability for any direct or indirect damages resulting from the use of this data. '=' 2004 Tax Assessment Database (Updated Aprii 28, 2009 j Sort Order District Number c3 Parcel 1D j Begins_win, i ~ ' House Number 1 eegins with. ! `sit ! o r_._...__.__...__.__~ .._.__....._.__.__.~__-__..-._..____.._ . Street Name ~ Begins with Orange ~: Suhmft ' ~ NF adLr*+tZQ FOYJ ~G2AM U ,ry ww+~.ccPa...~e~~ m 1 Ia Qi a a ig i0 iN iw iry a'! o oo o~` om o `I ~ N ~ N 'A IV `~ ~-1 '~ ry ry N M p w p f ~ ~ 3 r m O tl N r w N Y w m o f m mm o r uo 0 00 ry w r w ryry H K w (v f m f f ei O O .a o w N b ir if ib if if ///u~~` mO ry. ryN ryY: ryel ry0. '',CC 00 N r1 ^ b w ry O f AI f ry ~ O w wY ~ ~o F f y~ Y O r O N ob O w oo O w om O m oN O-f O~.r Q ~~ O b b W f\N O m eiry F a f/lb m O ryf n f ryrl ~ N ryw o ryn o o- ~ O ZZ 8 .~ o 0 0 0 0 0 0 0 r 0 0 i A A ~ M M ~O 50 o w OM o ON o N Ory o 0 ON 0 0 ON ~ FIM a mr ~f !`w m b {iN N tVN NIN ry ry O O O O ~ O O O O Y 7 oD m m fA 0 ~ ~ ~ ~ 0 N g 9~ s a :° a am " - ~ ~ a ~ a~ a~ ~ c - w o~ oW ~LL 0 ~~$ K Jm ~~ ZO a~ N WV 9 ~~ s LLp d~ oo O ~Em N p S i n 3 F a y Y ~ bo 3$ W L n Q 1 uo gr O O o O ~ - ~ m O .y m O w c IL @~ S f~ ~e ««11111 o° ~ O R a~ y : ~ ~ O m 3 ~~y?y m Sx ~ a ~ ~ 0 8 ~ ~ ~~ 8 ~ r ~ ~ ~ti u ~~ ww ~ w ~w~ ~ ~N~ ~ w p~ Y a a ~ N~po p~C YS N~ u"'~wa df 0~ $ Q ^~ax UZ! ~ ~ c~s ~ ~ 'j Qmm m UNfq O~Z Qq Nm~ Z Ugq ~''$ 4pm ~~0 Z = y t~LL NUF- F ~ V ~ J ~~ a aW = Cj Cj O U ~~ UaW a N¢ ~ «MQ~JQLC 6a 3mfD f Z NOA o _._ ~~ i _ g 6~ _ 1 Q s 6p d A "e m m 1. O o ry ry A N ow w O t N ~ m o 0 [+ N Q O r * ~ ) ' w w m ~ ~ I ~' Sg ~ as ~ 0 p ~ B~ ~ •~ O '° %~ A4 1'n M M 6 ~~ (•lJ O O N ~ ~D rH ~ ~ --> . a = w ~ o s ~ ~" ~ ~~o n U a +¢ ~O Q~ '(W Q~C ~y ~W~P U~y O~~ NmQ i-~ J X W O W ~ p lJliJ- ~aZZ ~z 3~~ W W R N ~~ m ~- oSw a~~oaxJ¢°a~WC 3~n ~~ ~ ~~ 0 m Ip J a ~ 3 x JUNE X009 PENNSYLVANIA DEPARTMENT OF REVENIIE REALTY TRANSFER TAX COMMON LEVEL RATIO (CLR) REAL ESTATE VALIIATION FACTORS FOR CIIMBERLAND COUNTY The following real estate valuation factors are based on sales data compiled by the State Tax i~ Equalization Boazd. These factors aze the mathematical reciprocals of the actual common lev 1 ratios. For Pennsylvania Realty Transfer Tax purposes, these factors aze applicable for documents accepted for the periods indicated below. The date of acceptance of a document i rebuttably presumed to be its date of execution, that is, the date specified in the body of the document as the date ofthe instntment. 61 Pa. Code § 91.102 ~,,,r~~< , .. Lh y?t SS ~~ } ~ ~~ xY "'~ 3~ ~ t~! ~ L.4le. ~4 ~ 'n 3 ~r;,'3'v' 7-2-1986 7-1-1987 7-1-1988 7-1-1989 7-1-1990 H~ "~f ~_ f '~1:"~~. Y Y T 6' -l~~di}~Xk~~l ~ ~~4~~~ ~~~ ~ t~ i i Y tl.,..y ~, 6-30.1987 6-30-1988 6-30-1989 6-30-1990 6-30-1991 "~~ t x. o fjj~ y n s ~F^ ~~ i A ~~'tA~ l Y~~t ~~ It i ,~~tYtZ,.P,.a .lr 9.52 10.00 10.53 11.11 12.05 yj~~++ '" L}li ~ ^ ~~ ~ dt ~ ~~ 4 /~t~~~([~~ ~/Y~'p4•n'4a 7-1-2006 7-1-2007 7-1-2008 7-1-2009 ~~ P~'~ 4 ~' ~ .h ~/ ^~'L~s a t A ~ I}I £'tA)~~~ty }1;~~~ ~~ Y 4 ~ '~ fr,4 h~S~VW.fi yr"" 6-30-2007 6-30-2008 6-30.2009 6-30-2010 ~ Y ~ ~ > y~' )'~y,~ 1° y3Fy S l~ Y h ~4~~ ~ ~ ~ ri { ~f~Fk,.~itt ., 1.14 1.22 1.26 1.26 ~ ,~~. 7-1-1991 6-3 0-1992 123 5 7-1-1992 6-30-1993 12.50 7-1-1993 6-30-1994 12.82 7-1-1994 6-30-1995 13.33 7-1-1995 6-30-1996 13.70 7-1-1996 6-30-1997 14.29 7-1-1997 6-30-1998 14.29 7-1-1998 6-30-1999 14.71 7-1-1999 6-30-2000 15.15 7-1-2000 12-31-2000 15.63 * 1-1-2001 6-30.2001 1.00 *7-1-2001 6-30-2002 1.00 7-1-2002 6-30-2003 1.01 7-1-2003 6-30-2004 1.05 7-1-2004 12-31-2004 1.11 **1-1-2005 6-30.2005 1.00 **7-1-2005 6-30.2006 1.00 :i '° dJ~ 6Y the D of Revenue W ,eflec[ asew®wt bam chmge effective Jawary 1.2001. ~1~~ by0x Depe~tmeut of Rcvmue to'eaect a~aA base ehaoge effative January 1, 2005. O N ~ M. (~ t0 M GV ~~ 'J m Ib ~ i N r a ~ ~ ~ h N gyp' us\ F~-C.-•1 t3 6 ~Hi ~ ~ • ~ ~~~ a ~ ~~ ~j 3woa J ~"'~lV ~ J N ~ ~ W t ( i~~ Q ~ ~ Q C ~+ b5 S ° a w a s O .g '-1 V V ~~ W R S > m ~ oN D c ° c .i i o O N ~ N sn O N O~ P~ Ql P'> N ^* N (yam\\Y~ ~V O 6 O a a A --+ N u :~i 01 ~ ~ C 7 N N .~ Q~ ~D W ~ 0 ^ 0 O l!a LL7 h- O] to W g !f ',T~ W °1 j W ~ ~ ~ Np k C ~ ~ ~ J F (j LL ~ N QS ~ ?S ~ w ~ ~ Q ?p3 ~ w ~ ~ ~ x O J ~ d ~ IN 3 y ~ ~ "' ff r3 Q d Z v w z 1 lc~ o ~ w r' v W fD,y w ~ ~ c ~ ` V w w ~ ~~ N to .O p ~ 1 8 ~- ~ ~ ~ °~ J ~ O o i o ow-+ O '•r N O +Y O J ~ _ to O W O N U O N V IOW U tL7 l0 O ~ N9q ti ~ p ~y ~ ^ ^666DDD 4I ~ ~1 y ~ Issee.iesnots ~:rm~oar~:uw~e.mw•M«n:mpmsr~•~r~vrv~~e ~~aada mowro3sn Uo-~: xmrri:s-v4R iFra+l J Q W a 2'd LES6-ZES (LTL1 met Ze Fa wo~4Ff WHl1T=OT 60D~ LZ inC Ju1`27 2009 1~e1~RM Attorney at Lam (7171 532-9537 p.3 O O -P O N -p. May 19, 2009 Lrfe David P Perkins Attorney at Law 4 James Circle Shippensburg,PA ]7257-2165 Re: 13artford Annuity Contract # 710854651 Decedent: Jay. Wright Dear Ms. Oyler: Thank you fbr your correspondence regarding the above annuity contract. The death benefit payable tinder this contract is not considered "life insurance" reportable on Fonn 712, (life insurance statement). Please find the below infonrlation in response to your request. Contract Number 710854651 Dwiter Jay Wright Decedent ,Tay Wright Social Security Number XXX-XX-9209 Date of Death 12/08/2008 Cash Vatue on the dale of death $110,461.12 Death Benefit Value on the date of death* $144.555.67 'The Death Benefit Value on the date of death displayed above may include a Death Benefit Adjustment as outli ted in the Annuity Contract. This figure is being provided for illustration purposes and is not equivalent to the nal death benefit. The death benefit will be calculated on all contracts associated with [his client [he day we receive he certified death certificate. Once the death benefit is calculated, the benefit amount remains invested and is subjec to market Fluctuation until complete settlement instructions are received. If you have any questions or concerns, please feel free to contact your investrnent professional; or one of our azmuity specialists by calling ] -800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m. and Friday from 9:15 a.m. to 6 p.m., Eastern Standard Time. We will be happy " assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, Hartford Lifc Insurance l'o t Griffin Road North Windsor, C"f 06095 - L512 B Irat01] Tall Free 1 B00 862 6668 Investment Product Services Invesnnart Product Scrvicc ICS Annuity Benetit Services Team Ma;fing Address: P.o. aoz Hartford Life and Annuity Insurance Company Hartford, CT 06102-5085 online.hartfordlife.com May 19, 2009 f)avid P Perkins, Attorney at Law c!o Nancy Oyler 4 Janles Circle Shippensburg, PA 17257-21.65 Hartford Re: Hartford .4ttnuity Contract # 71 0 1 76054 Decedent: Jay Wright -. - _ -- __ _ _ _ -_ ,_ ____.~-..~-vim.'`., ~~' --- -- --- Dear Mr. Perkins: Thank you for your correspondence regarding the above annuity contract. The death beneft payable under this contract is not considered "life insurance" repotrtable on S Farm 712, (life insurance statement). Please find the below information in response to your request. Contract Numher 710176054 Owner Jay Wright Decedent Say Wright Social Securit}~ Nun:ber XXX-XX-9209 Date of Death April 16, 2009 y, Cash Value on the date of death $22,187-45 Death Benefit Yalue on the date of death* $22,187.45 ~` •The Death Benefit Valut on the date of death displayed above may include a Death Benefit Adjustment as outline m the Annuity Contract. This fi w-e is bein rovtded fort 1, B ~ 6P death benefit. The deatb benefit will be caicutated ,, ustratton pu~itoses and is nqt equivalent to the fins certified death certificate. Once the death benefit is ca cula~~~h ~"'`~`~~s ~lrt~~tltd~ay ~v~ re~Bii' f~ _, ;(,_ e benefit amount remains invested and tti subject l market fluctuation until complete settlement instructions are received. If you have any questions or conceals, please feel free to contact your investment professional, or one of our annuity specialists by calling 1-800-862-6668, Monday hrough Thursday from 8 a.m. to 7 p.m. and Friday from 9:15 a.m. to 6 p.tn., Eastern Standard Time. We will be happy to assist you. Thank you for the opportunity to help provide for yom• finaltcial needs. Sincerely, -Hartfdtd fire fnsarance corn 1 CrtitGn Rnad North Windsor, CT Oti095 - 1512 Toll Free 1 300 RSY666R K. Hlldretll Investment Product $eryices Investment Product Services ICS Anmtitv Benefit Services Teant Mailing Address; F'.O. Bex Hartford, CT 06102-i0R5 IlartfOrd L IfP, anal Aminity 1tL511CanCe ~.Onipany ~nline.har[iordlife.com 'oli ~ etail Search - 'qF. ys1Am PMed,n, ~ Oul Wlq intsrm,tlen SaWIIlmfOp 1 Oe0f0Gfdlf ~ tlOEaf I IOAMOOOLSaelOfn I Cama omDeace Agent Alartt ID) P,IIW YW111MMnIftlM AOMt Namr. STlVEN P. eaENIZE Ad,M 11 fusmm Summary OurfrK AI D/ 17/1/lOOt Aftnq: Ve12y Dets115aaKn ~dmlMatrWen V.Y NUmWr: ANIgD]D]]0 aL1lVF blvd Mp sonns Fdmtry IMUr,d: YSY A W0.10NT aMtA Dtp: 1/17/3H! Navpatbn Nep G,nOo: M ipw AEf: of Sln NaD GrOUD name: W W Nis: MCFEaltEO/NOM-TOMGCO cont. ua hyar Npna: ]AY A wR10XT allMnp AdOrep: fll ! OaANG!>R SNIPPENSaUaG, PA 171S171dA ,nadue DaaPlDlbn: fE!%ISLE PR91N1N ANNUITY Fan AmOYnt: WA %ymMe MatltoO: oN eaten, ne0p not tMlad OWII MnfM: N.61f.77 GI4!•NNk:DW: N/A Imtf Stop: PA Mwp: !mull tasty Dap: 9/x/3006 IIDdd IYalnlYm: N/A NF epdDn: GWA tplIVM: AmNaNpd Pramlun: {0.00 Day. PanONp: W Dfp SMry Oap: Apylodan Sion D.le: WW alu bER: WA Applbllpt rttaMa daoa: Wp dtl,bn Rapt N/A AasuM VYUe: Inan: =0.00 StNmNr LIMtO,: 1 teen Inlarap a.p: 0.0000 No Aagwmmant IMOrmMkn Dn DAVE, I AM SENDING YOII A COPY OF EVERTHINGI HAVE ON THIS DEATH CLAII{. AS YOII CA OF 12/08/2008. THE ACCODNT VALIIE OP #AN10020330 WAS #9,416.17 WITH RMD OF #792. ON 12/17/08. WITH FED. TA%ES WITHELD OF #79.26 NET CHECK OF ~713.34.TBIS WAS A S CONTINIIATION. THE IRA WILL REMAIN I ELIZABETH NAME TIII.SHE PASSES OR TILL SHE 0 WERE TO CHANGE IT. $age 1 of 1 SEE AS PAID IISAL THE POA TBANR YOII VERY MIICB, STEVEN P BRENIZE LDTCF