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HomeMy WebLinkAbout08-27-09J 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code veer File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.28oso1 2 1 0 9 0 3 5 0 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168 36 3033 04 03 2009 11 08 1913 Decedent's Last Name Suffix Decedent's First Name MI BRENNEMAN LOUETTA E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X~ 1. Odginal Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ qa. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (tlete or tleath soar 12-12-a2) g, Decatlenl Dietl Tastele ~ T Decedent Malntainetl a LiWng Trust (Attach Copy of wily (Attach Copy m Trust) 0 8. Total Number of Sa(e Deposit Boxes 9. Litigation Proceetls Received ~ 10. Spousal Poverty Cretlit !date of tleath ~ 11. Election to tax antler Sec. 9113(A) aetween 12-31-91 and 1-1A5) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D. FLOWER, JR. ESQ 717 243 6222 Firm Name (If Applicable) SAIDIS, FLOWER & LINDSAY First line of address 26 WEST HIGH STREET Second line of address City or Post Office CARLISLE Correspondent's a-mall address: State ZIP Code PA 17013 N 0 REGISTER -W~.LS USE~t1LY -~ {r rn-v ~ I r1Zn G7 `= 3 7 J °crr;K ~(i1T ~ ~~~ N ~~ DAT~ILED ~ 5 7 ii -'ri :i Under penalties of perjury, I tleclare that I have examined this return, including eccompanying schedules and statements, and to the best of my knowledge and belief, it is tme, correct and complete. Declaretion o(preparer other than the perspna representatlve Is based on all information of which preoarer has env knowledpe. 10 Dogwood Drive, Newville, PA 17241 Robert A. Brenneman IGN TURE OF PREPARER OTHER THA REPRESENTATNE D TE James D. Flower, Jr. Esq ~ ~ ~ g A 5 2 West High Street, Carlis A 17013 Side 1 L 1505607120 150560712 PA Inheritance Tax Return Signature of Additional Fiduciaries EBrenneman, Louetta E. 21 09 03 OBER 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 of preparer other than the personal representative is based on all Information of which preparer has any knowledge. Signature #2 Name Addressl Addressl City, State, Zip Donna L. Brenneman 75 Northview Drive PA 17050 Date J 1505607220 REV-1500 EX oeceaem•:Name: Louetta E. Brenneman Decedent's Social Security Number 168 36 3033 RECAPITULATION 1. Real Estate (Schedule A) .................................................................................. .... 1. 2. Stocks and Bonds (Schedule e) ............................._.......................................... .. 2. 2 8 8, 0 2 0. 9 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... ... 3. 4. Mortgages 8 Notes Receivable (Schedule D) .............................-.................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............ .... 5. 3 8 , 9 0 8 . 1 7 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ........... .. 6. 7. Inter•Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate B Iling Requested ........... .. 7. 6. Total Gross Assets (total Lines 1-7) .............................~...........................-.... .. 8. - 3 2 6, 9 2 9. 0 7 9. Funeral Expenses & Administrative Costs (Schedule H) .................................... .. 9. 1 6 , 7 5 6 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... ..... 10. 11 , 3 2 6 . 7 3 11. Total Deduetlons (total Lines 9 8 10) ............................._................................ .. 11, 2 8, 0 8 2. 7 3 12. Net Value of Estate (Line 8 minus Line 11) .............................-...................... .... 12. 2 9 8 . 8 4 6 . 3 4 13. Chadtable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................ .. 13. 5 , 9 7 6 . 9 2 14. Net Value Subjeet to Tax (Line 12 minus Line 13) ............................................ .. 14. 2 9 2 , 8 6 9 . 4 2 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 .00 0 . 0 0 15. 16. Amount of Line 14 taxable 16 at lineal rate X .045 2 9 2, 8 6 9. 4 2 . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ................................................ ............................................................. .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 13,179.12 0.00 0.00 13,179.12 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0350 DECEDENT'S NAME Louetta E. Brenneman STREET ADDRESS 801 North Hanover Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresVPenalty if applicable p. Interest E. Penalty 12,000.00 631.58 Total Credits (A + g + C) (1) 13,179.12 Total InteresVPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Cheek box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is thdTAX DUE q. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is theBALANCE DUE (2> 12,631.58 (3) (4) (5) 547.54 (5A) (58) 547.54 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property trensferced :............................................................................. ^ ^x b. retain the right to designate who shall use the property transferred or Its income :................................ ^x c. retain a reversionary interest, or ............................................................................................................ d. receive the promise for life of either payments, benefits or care? ........................................................... 2. If death occurred after December 12, 1982, did decedent Vansfer properly within one year of death without receiving adequate consideration? ................................................................................................................. ^ ^x 3. Did decedent own an °in trust for' or payable upon death bank account or security at his or her death?......... ~ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................ ^ ^x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (II)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even If the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The fax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under SecOon 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-7585 EX+ )B-88) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSTLVANU INHERITANCE TR%RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Brenneman, Louetta E. 21-09-0350 All property )olnth/•ownetl wIN rlBht o! survlvonhlp must be dlscloeatl on 8chetlule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 030371108 400 shares of American Vanguard Corp -Com 13.27 5,308.00 2 0442ostoa 660 shares of Ashland Inc. New 13.65 9,009.00 3 os5szztoa 100 shares of BP P L C -Sponsored Adr 41.33 4,133.00 4 tsat6zto3 100 shares of Colgate Palmolive Co -Com 60.44 6,044.00 5 zso5a3to3 100 shares of Dow Chemical Ca -Com 11.00 1,100.00 6 zstotttoa 100 shares of Emerson Electric Co -Com 31.96 3,196.00 7 az7assfoe 400 shares of Hershey Foods Corp -Com 38.14 14,456.00 g a2az36to3 100 shares of Hewlett Packard Co -Com 34.15 3.415.00 g so2azatoa 100 shares of L-3 Communications Holdings Inc -Com 88.73 6,873.00 1p Saoazatoa 100 shares of Loews Corp -Com 23.49 2,349.00 11 565849186 312 shares of Marathon Oil Corp -Com 29.07 9,069.84 12 586278101 200 shares of Middleby Corp -Com 34.78 6,956.00 13 H5a33N183 100 shares of Noble Corporation -Com 28.10 2,610.00 14 754212108 300 shares of Raven Industries Inc -Com 21.93 6,579.00 15 775oa3to2 500 shares of Rofin Sinar Technologies Inc -Com 18.90 9,450.00 18 878155100 100 shares of Team Inc -Com 12.92 1,292.00 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 2, Recapitulation) 288,020.90 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-86) Rev-15°3 EXi (°-°°) COMMONWEATH OF PENNSYLVMIIA INHERITANCE TIU( RETiMN RE°IOENT OECfOENi SCHEDULE B STOCKS & BONDS continued ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 17 88706M103 400 shares of Tim Hortons, Inc. -Com 26.64 10,656.00 1g e22g3ts1o 474.092 shares of Vanguard Fixed Income Securities 8.47 3,987.11 Fund - Intrm Invgrdad 19 922031836 1,344.012 shares of Vanguard Fixed Income Securities 9.73 13,077.24 Fund - Strm Invgra AD y0 922031869 818.157 shares of Vanguard Fixed Income Securities 11.98 9,801.52 Fund -Intl Protection Securities 21 s2zo153oa 102.607 shares of Vanguard Windsor Fund Inc - lifund 31.08 3,189.03 Adml Shares 22 z5a6sT1os 200 shares of Walt Disney Co -Com Disney 20.00 4,000.00 y3 3133XFAX4 $10,000 Federal Home Loan Banks - 5.4% 4128/11 100.281 10,028.10 24 3133XL1JW3 $50,000 Federal Home Loan Banks - 4% 9/2812015 102.594 51,297.00 25 31428Q101 Federated Total Return Series -Total Ret Institutional 10.17 57,865.06 26 3133T2BR0 $7,086.71 FHLMC - 6.5% 11/15/23 106.862 7,573.00 Federal 27 36sszGxse $25,000 General Elec Cap Corp MTN BE - MTNF 98.828 24,707.00 5.875% 2/15112 I TOTAL (Also enter on Line 2, Recapitulation) 288.020.90 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) SCHEDULE E CASH, BANK DEPOSITS, 8t MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSriVANU INHERITANCE TA%RfTURN RESIDENT OfCEDEM ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 Inclutle the procaetls of litigation antl the tlale the proceetls ware receivetl by the estate. All property jointly-ownetl with the Nghl of survlvorehip must be tllecloaed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Money Market Obligations Trust -Premium Cash Institutional 23,270.60 2 Orrstown Bank -Checking Account #108005476 1.217.51 3 Church of God Home -Refund 13,636.34 4 Church of God Home -Refund from personal account 262.00 5 Refund from Capital Blue Cross 314.52 6 Refund from Church of God -Personal Expenses Account 207.20 TOTAL (Also enter on Line 5, Recapitulation) I 38,908.17 (If more space is nestled, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 5-98) REV-1151 EXa (1299) COM INHERITANCE TAX RETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 1,420.87 B. ADMINISTRATIVE COSTS: 1. 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 Saidis, Flower & Lindsay 14,500.00 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 402.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 433.13 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,756.00 Copyright (c) 2002 form sottware only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Carlisle Memorial Service, Inc. -Head Stone 770.00 2 Hoffman-Roth Funeral Home & Crematory, Inc. -Balance of funeral bill 850.87 H-A Subtotal 1,420.87 Other Administrative Costs 3 Cumberland Law Journal -Advertise Estate Notice 75.00 4 Orrstown Bank -Check Charge 13.15 5 Register of Wills -Record Inventory and Inheritance Tax Return 30.00 6 The Sentinel -Advertise the Estate Notice 314.98 H-e7 subtotal 433.13 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev'ISiY Exi (8-981 I SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 Inclutle unrelmbureetl metlical expanses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Carlisle Borough Tax Account - 2009 Personal Taxes 4.90 2 Church of God Home -Amount out of investment account on 4/20/2009 7,192.88 3 Continuing Care RX -Account #100046686 2,303.75 4 Continuing Care RX -Account #100046686 23.24 5 Continuing Care RX -Account #100046686 23.24 6 Middlesex United Methodist Church -Quarterly donation 300.00 7 Orrstown Bank -Tax preparation fees 2008 300.00 8 Orrstown Bank Fiduciary Fees -Trust Department Fee for quarter ended 3131/2009 541.86 9 Orrstown Bank Fiduciary Fees -Trust Department Fee 541.86 10 PA Department of Revenue -Bureau of Imageing & Document Management 95.00 2009 PA-40ES TOTAL (Also enter on Line 10, Recapitulation) I 11,326.73 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-0510 EX~ IB-00) SCHEDULE J COM NHERRANCETA%RENRNpNIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-08-0350 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not Llet Trustee I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)) See attached schedule Total 292,869.42 Enter dollar amounts for distributions shown above on lines 1 5 through 16, as appropr iate, on Rev 1500 cov er sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 5,976.92 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 5,976.92 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J me BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Louetta E. Brenneman 04/03/2009 168-36-3033 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Allen Brenneman Grandson Five percent (5%) of 14,942.32 5011 Seneca Drive the residue. Mechanicsburg, PA 17050 2 Donna L. Brenneman Daughter Forty-nine percent 146,434.71 75 Northview Drive (49%) of the residue. Mechanicsburg, PA 17050 3 Robert A. Brenneman Son Thirty-nine percent 116.550.07 10 Dogwood Drive (39%) of the residue. Newville, PA 17241 4 Jan Lalomia Granddaughter Five percent (5%) of 14,942.32 8607 Polly Hill Court the residue. Windsor Mill, MD 21244 Total 292,869.42 1 SCHEDULE J-IIB CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued ESTATE OF FILE NUMBER Brenneman, Louetta E. 21-09-0350 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-IIB (Rev. 6-98) ~~~x i11 ~zn~ C7~ g~~~xrrt~rtt OF LOUETTA E. BRENNEMAN I, LOUETTA E. BRENNEMAN, of 825 North Hanover Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: 1 hereby order and direct my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: All the rest, residue and remainder of my estate, be it real, personal or mixed, of whatsoever kind and wheresoever situate, I hereby give, devise and bequeath as follows: A. Forty-nine (49%) percent to my daughter, DONNA L. BRENNEMAN; B. Thirty-nine (39%) percent to my son, ROBERT A. BRENNEMAN; C. Five (5%) percent to my grandson, ALLEN BRENNEMAN; D. Five (5%) percent to my granddaughter, JAN LaLOMIA; E. One (1%) percent to the CHURCH OF GOD HOME, to be applied to the FOREVER CARING FUND. f. One (1%) percent to the MIDDLESEX UNfTED METHODIST CHURCH, to be applied to the ENDOWMENT FUND. LASTLY: I nominate, constitute and appoint my son, ROBERT A. BRENNEMAN and my daughter, DONNA L. BRENNEMAN, to be the Co-Executors of this my Last Will and Testament. In the event that either my said son or my daughter shall predecease me or be unable to serve as Executor for any reason, the survivor sha11 act as Executor hereof. No executor shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this S f day of d 1997. Louetta E. Brenneman SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss I, LOUETTA E. BRENNEMAN, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by LOUETTA E. BRENNEMAN, the Testatrix, this /`z~ day of ~ a:~,l 7997. `` Louetta E. Brenneman, Testatrix 'rERE6A J. 6URKHOLOBFl, Pblsry Pudic CsrNere, Cumb~AMM Courrty, PA My Commission Eamkes FeC. 21,1000 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss ~I~/e,James D. Flower, Jr. and Merlene Marhevka the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that LOUET7A E. BRENNEMAN signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in ttie hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by James D. Flower, and Merlene Marhevka this /~ day o ~' 1997. Witness /{v Witness Notary fj'ublic TERE6A J. 6URICHOLDER. Notary PubNc CeMOVe, Cumbariantl County. PA rAV Commiowon EwoNOS Fob. 21, 20W ~i Reporl Date: AUri11Q 21111) ORRSTO WN BANK Time Preparetl: lIO:SJ:79 AM Requested By: B/tf1D GlRLACf/ Includes Accnnnt: 5(I 0(/ 0578 /1 (/7 LOUETTiI E. I1kGNNEMi1 N Account Holdings as of 413/2009 Cusip No. Security Name Shares /Par Investment Unit Price Market Value Price Dale 030371106 AM VANGUARD CORP 400.0000 4,932.45 13.27 5,308.00 04/03/2009 044209104 ASHLAND INC NEW 660.0000 1.177.26 13.65 9,009.00 04/03/2009 055622104 BP AMOCO PLC 100.0000 4,504.00 41.33 4,133.00 04/03/2009 194162103 COLLATE-PALMOLIVE 100.0000 6,401.79 60.44 6,044.00 04/03/2009 254687106 WALT DISNEY COMPANY 200.0000 6,642.00 20.00 4,000.00 04/03/2009 260543103 DOW CHEM CO 100.0000 2,009.00 11.00 1,100.00 04/03/2009 291011104 EMERSON ELEC CO 100.0000 3,769.56 31.96 3,196.00 04/03/2009 3133T2BR0 FHLMC 6.5% 11/15/23 7,086.7100 7,086.71 106.862 7,573.00 03/31/2009 ~ 3133XFAX4 FHLB 5.4% 4/28/11 10,000.0000 10,000.00 100.261 10,028.10 04!03!2009 3133XOJW3 FHLB 4%9/28/2015 50,000.0000 50,000.00 102.594 51,297.00 04/03/2009 314280101 FED TOTAL RETURN BD 5,689.7800 60,326.55 10.17 57,865.06 04103!2009 36962GXSB GE 5.8752/15/12 25,000.0000 24,715.94 98.828 24,707.00 04/03/2009 427866108 HERSHEY FOODS 400.0000 0.67 36.14 14,456.00 04/03/2009 428236103 HEWLETT-PACKARD 100.0000 4,156.90 34.15 3,415.00 04/03/2009 502424104 L3 COMMUNICATIONS 100.0000 6,545.00 68.73 6,873.00 04/03/2009 540424108 LOEWS CORP 100.0000 2,731.00 23.49 2,349.00 04/03/2009 565849106 MARATHON OIL CORP 312.0000 721.46 29.07 9,069.84 04/03/2009 596278101 MIDDLEBY CORP 200.0000 1,850.25 34.78 6,956.00 04/03/2009 6D934N625 FED MONEY MKT-PRI 16.323.3600 16,323,36 1.00 16,323.36 04/03/2009 60934N621 FED MONEY MKT-INC 6,947.2400 6,947.24 1.00 6,947.24 04/03/2009 7542121 D8 RAVEN INDS INC 300.0000 3,822.85 21.93 6,579.00 04/03/2009 775043102 ROFIN-SINAR 500.0000 7,954.51 18.90 9,450.00 04!03(2009 878155100 TEAM INC 100.0000 1.562.50 12.92 1,292.00 04/03/2009 86706M103 TIM HORTONS INC 400.0000 7,941.59 26.64 10,656.00 04!0312009 922018304 VG WINDSOR II AD 573 102.6070 5,118.86 31.08 3,189.03 04/03/2009 922031810 VG IT INVESTGRD ADM 474.0920 4,911.59 8.41 3,987.11 04!03/2009 922031836 VG ST INVESTGRD ADM 1,344.0120 14.457.62 9.73 13,077.24 04/03!2009 922031869 YANG INFLATION#119 818.1570 10,000.00 11.98 9,801.52 04/03/2009 H5833N103 NOBLE CORPORATION 100.0000 5,109.36 26.10 2,610.00 04/03/2009 Total Securities 128.057.9580 281.720.02 311,291.50 Income Cash 0.110 0.00 Principal Cash 0.00 0.00 Account Total 281,720.02 511.291.60 Page 1 ~RRSTOpWN ~~ A Tradition of Excellence April 16, 2009 To: Saidis, Flower and Lindsay 2109 Market Street Camp Hill, Pa 170] 1 From: Traci Yohe Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Louetta E Brenneman Date of death Apri] 3, 2009 APR 2 0 appg IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK.• CHECKING ACCOUNT Account # Title of Account Date opened Principal Accrued Interest 108005476 Louetta E Brenneman 09/01/00 1217.51 0.00 Orrstown Finacial Advisors SAVINGS ACCO UNT Account # Title of Account Date opened Principal Accrued Interest CERTIFICATE OF DEPOSIT Account # Title of Account Date Opened Principal Accrued Interest PO. Box 250 • Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax <,~""' . ~ THE CHURCH OF GOQ HON2E, INC. "~"` Cld'JHCH BUi IJ. HAIJOVER ST Of GOD CARLISLE, PA 17013 ©~1~E 'G~mmui,o ~.. Cmm (717) 299-532? SAY Thirteen Thousand Sir Huntlsed Thirty-Si>: antl 39/100----- 'O THE ORDER oP ESTF.TE OF LOUETTA BRENNEMAIV 75 NORTHVIEW DRIVE INECHANICSBURG, FH 17050 V~"eo-uusslz ~•~. CHECY. DATE CONTROL IJUMBER 5/6/2005 613878 AMOUNIT C / 0 2 U. S. Dol lass i. D UVER $'3000.06 ``' „.. i - / LJ u'Dk387811' d:D3i3~5D36F: l06 1i05i4u' HE CHURCH OF GOD HOME, INC. 13 8 7 B UR REF. NO. YOUR INVOICE NO. INVOICE DATE INVOICE AMOUNT AMOUNT PAID DISCOUNT TAKEN NET CHECK AMOUNT 708601 EFUND 9/30/200 13,636.3 13,636.3 O. DO 13,636.39