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07-06-09 (2)
~~.....-~ ~.. ~ 'ti ~._.~ --. C;:.~ ~~ ~r; ;: ~~1{w ._.i f Y' ~ .1 L.. i :~"; ` t... ` ~' W ~ ~ L T ~ O V J O N ~ J O ~ ~ p ~ ~ ~ ~ a~ ~ - - O N LL U I"' ~ M Q z M J~~ OU .~ - E J r - -~Owo N i CJ ~ ~ ~ U U) r ll a ~O J O "a ~ . z ~ ~ Q Q ~. W ~ I--- J ~ F- W ~ ~ -_ T ~ m ~ J cn ~ W ~UQ T w ~~ a wo _~~ .. ~ N cnocv O ~ A J ~ Q ~^_ O w W = U co ~ • CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M.HOUCK (1912-1991) July 3, 2009 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Dorothy L. Thomas No. 21-08-0883 Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Raymond E. Wall Estate as well as Check No. 165, in the amount of $4,406.24 for the Inheritance Tax due, Check No. 166, in the amount of $15.00 for the filing fee and Check No. 167 in the amount of $220.00 for additional Probate. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures ~+ r.,. ~, ~~ ~; r" ~-~f_; ~~~~ ~ ~ "~~ cr ~~ =' { t _~. ,~ ~ "3 .. `~ :~~ "i ~ ~ r-. ~ ~„ r l ..,ro s.~..~..b • ~ ' ! 1' 15056051047 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~,. County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ C> ~` O a ~ ~` 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth f S ~3to ~ y7 7 ~ S ~ Sa,©r~ ~' f +Q 0~. 1 ~ ~.~ Decedents Last Name Suffix Decedent's First Name MI Th' 0.~1~-s ~02o r~tY L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI /v/ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. supplemental Return O 3. Remainder Return (date of death ', prior to 12-13-82) O 4. Limited Estate O 4a. ~uture Interest Compromise (date of O 5. Federal Estate Tax Return Required eath after 12-12-82) ~ 6. Decedent Died Testate O 7. ecedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. pousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) efiween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLE D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name ! Daytime Telephone Number Cl~f~~~~S E SHI,E~DS i~ I 717 7 a~og: ~1 Firm Name (If Applicable) ~"~'-'~~ i REGISTER USE Y (_;".,~'j III !rte. .t.~j First line of address ~~ ~ ~~ ~'~ C~' "a ~-~ ~i C L D I„(S E IQ ,~ D /f- ~ Second line of address ~ `: -~ ~` O iu/ ,~ City or Post Office ~, State ZIP Code DATE FILED /I~E'C N~~// CS Bu ~2G1 /°/~ / 7O SS 97 3 S . I' f Correspondent's a-mail address: CC $ ~ 1 C 1~ 3 ©C ~ M C Q $ ~i h ~ Under penalties of perjury, I declare that I have examined this r turn, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other t an the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O . ERSON RESQONS~IB FOR FI RE TURN DAT jj~~// ~ ADDRESS 0 ~ ~D W ~]"-~ Q/y/~}.S 1 99 .Lon Val 1$ /?c,J westim~ n s~r, n~ ~ ~, ~ - S'$ SIGNATURE PREPAR OTH TH RES T IVE DAT ADDRESS C ~ ~.Q ~ FS E: sy~Fcps zl , ~sq~. ~D C~OLI.se/~ ~d _______ /7tee~iQnic~s~rar~. ~~ /7oSS PLEASE USE ORIGINAL FORM ONL Side 1 L 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number -- Decedent's Name: /~6~11 ~sj ~~T~y L ~ l ` v~ REC APITULATION 1. Real estate (Schedule A) . ............................................ 1. 1 I f~ ~ D ~ , ~' ~ 2. Stocks and Bonds (Schedule B) ....................................... 2. O O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • Q p 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. + D D 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. ~ ~ ~ 3 d ~ 0 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. .` ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~ S ~ 2 7 . 9 ~D 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~ ~ ~ ~ s ~ ~ 3' 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ~ ~ ! { ~ ~ / t.+ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. I ~ ` ~ ` ~ ..3 ! 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~ ~ ~j ` ~1 ' ~ S . ~7 7 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. I 7 °~ ~O 3 . `'~' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 1 D ~ an election to tax has not been made (Schedule J) ........................ 3. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ 7 ~ w 3 « ~ w TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0~ 0` D 15. d D 16. Amount of Line 14 taxable Q ~~LL ~ -1 at lineal rate X .0 ~ ! 7 ~ 6 3 T ~0 16. 3 ~ . $ b 17. Amount of Line 14 taxable at sibling rate X .12 ~ ~ 17 ! a D 18. Amount 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 O Side 2 15056052048 15056052048 J ->`2EV-1500 ~X Page 3 Decedent's Complete Address: File Number a ~ -Q ,~~- O Q DECEDENT'S NAME ~o~o TiyY ~ . L,D~~ S l T~1' STREET ADDRESS ____ CITY ~ STATE '~, ZIP _-- ,/LI~-Giy,~NICS~~I ~G P~ / 7 os-o Tax Payments and Credits: ~ o,~ 1. Tax Due (Page 2 Line 19) (1) y, ~ 7 to. O ~o 2. Credits/Payments A. Spousal Poverty Credit ~ B. Prior Payments o C. Discount p Total Credits (A + B + C) (2) ~ 3. InterestlPenalty if applicable D. Interest ~ E. Penalty ~ __ _ - -- Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) ~ 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ y, 3 7fi • ~o A. Enter the interest on the tax due. (5A) ~f , 38 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~ ~ 06. ,~~ 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 transferred :..................................... ^ ..................................................... b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 statute does not exempt a 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 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)j. 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)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~ ' RSV-1502 EX+ (6-98) SCNEiiIILE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH '. ~es i o~e~~'ial Il~ea.l ~st-at'e a~- `f I ~ ~ wn e~ ~r- vim, /,~~G~IU/YlI CS bur f ~a.~~d~v1 ~w~o, ~ Cu.w-,~-I ~ ~c, cJ ~~inns v~utx . CScc ~irue t~.n~l Cm rre,~' Cm~ Y e~ d ~eol e f Cmn v~~e a,~~ltie~~ . ~l~ ~ M.u~ - 3, zo o ~ fD ~V e s~.r lYl a rc 11en, ka a~ ~ Q ~ o v 1 R d0o oa L,u~c~m r~q M a rchenk4 der- conf~^a.~f ~,r 19 ~, doo. (~, ~~ ee ~r y ~ ~~n~l ~t~'~~~ ~heP.~` Q ff ~ ~Gt~d) . TOTAL (Also enter on line 1, Recapitulation) ! $ 1 ~ ~ Bd p, d ~ llf mnra cnara is naariarl incart arirlitinnal chaatc of tha cams ci~al forth HUD-1 (3166) ref Handbook 43 U.S. Department of Housing and Urban Development OMB A royal No. 2502-0265 ex Tres 11/30/2009 FIN! ) Number 8. Mortgage Insurance Case Number r19~fA A • ~••~~^Y~~~~ .~cureirrerll JySIE Printed 05/12/2009 at 13:36 S SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contalnetl heroin la Important tax Infortnatlon and Is being fumishetl to the Internal Revenue SerNee. If you ero roqulrotl to file a return, a negligence penalty or omer sanction will be imposed on you U this item Is roqulrsd to bs sported end the IRS detsrminsa thst It hes not Desn reported. The Contract Ssles Price desalDed on line 401 above conatilutes We Gross Proceeds of this tronaacUOn. Yau ere requlrotl by law to provde me settlement agent (Fetl. Tax ID No: 231751821) vvlttt your COfteet taxpayer identlflcetlon number. If you do not provide your cort'ect taxpayer Identiflutlon number, you may be aubjeet to civil or criminal panaltlea Imposed by law. Under penaltles of psrJury, I eertly that the number shown on this statement Ia my corroct taxpayer IoentlfinUon number. TIN: - _ / SELLER(S) SIGNATURE(S): ' SELLER(S) NEW MAILING ADDRESS: / SELLER(S) PHONE NUMBERS: (H) (W) PravioQs etlitions are obsolete A. Settlement Statement B. TVDe of I nan Previcus editions are obsolete U.S. DEPARTMENT OF HOUSING ANII I IRRenI nnrtrt ne..r-.~,• form HUD_t l3iaa~.s~s..,..__,_ ,., ~ i~! ~ r s a e o oro y omaa, one omas, ecu or WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION Tha HUD-1 Settlement Stale which I have proparod is We antl atxurote account of this CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 1B: tranaactlon. 1 hew tau twill • the funds to be el uro n rdance with this statement. U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT; DATE: ~ 3 -G~ ~ wave carer y re wetl the MUD-1 Settlement Statement antl to the beat of my knowledge and Dellsf, It la a true end accurate statement of ell retxipts antl disbursements matle on my account ` or~ ~ i~.~ hfua r tartly lost I have received a copy of the HUD-1 Settlement Stete`nant . Tax Parcel Number: THIS INDENTURE MADE THE ~ day of , in the year of our Lord two thousand and nine (2009). BETWEEN RONALD W. THOMAS, as Executor of the Estate of DOROTHY L. THOMAS, deceased, late of Mechanicsburg, Hampden Township, Cumberland County, Pennsylvania, Grantor, and NESTER MARCHENKO, and LUIDMILA MARCHENKA, a.k.a. LIUDMILA MARCHENKA, his wife, currently of Harrisburg, Dauphin County, Pennsylvania, Grantees. WHEREAS, the said Dorothy L. Thomas, was vested in her lifetime with title to the premises hereinafter described, in Hampden Township, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said Dorothy L. Thomas, departed this earthly life, testate, on the 15~' day of August, 2008, and Letters Testamentary were duly issued to the said Ronald W. Thomas, by the Register of Wills of said Cumberland County, docketed to No. 21-08-0883; and WHEREAS, the lands herein-mentioned were not specifically devised: NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Ronald W. Thomas, Executor, as aforesaid, for and in consideration of the sum of ONE HUNDRED NINETY-SIX THOUSAND and No/100ths ($196,000.00) DOLLARS, and other good and valuable considerations, to him in hand paid by the said Grantees, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in him vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Grantees, their heirs and assigns: ALL THAT CERTAIN lot or tract of land situate in Hampden Township, Cumberland County, known and designated as Lot No. 42, Block "F", of Plan No. 2 of Indian Creek as prepared by D. P. Raffensperger, Registered Surveyor, dated February 11, 1969, and filed in the Recorder of Deeds Office of Cumberland County on May 26, 1969, in Plan Book 21, Page 13. BEGINNING at a point on the East side of Pawnee Drive said point being a distance of 1,496.99 feet South of intersection of the South side of Indian Creek Drive and the East side of Pawnee Drive; thence by Lot No. 41 South 77 degrees 39 minutes 54 seconds East a distance of 178.14 feet to the land now or formerly of Realty Company of Pennsylvania; thence by the same South 25 degrees 34 minutes 15 seconds West a distance of 58.33 feet to a point at Lot No. 2, Plan No. 1; thence by the same South 67 degrees 31 minutes 30 seconds West a distance of 64.11 feet to a point at Lot No. 1 Plan No. 1; thence by the same North 72 degrees 29 minutes 45 seconds West a distance of 116.36 feet to a point on the East side of Pawnee Drive; thence by the same and a curve to the left having a radius of 920 feet an arc length of 83 feet to a point, the place of BEGINNING. HAVING THEREON ERECTED a bi-level dwelling house. BEING THE SAME PREMISES which Dorothy L. Thomas Lehman and Lee Glenn Lehman, husband and wife, of Hampton Township, by their deed dated August 24, 2001 and recorded in Deed Book 248, Page 593, granted and conveyed unto Dorothy L. Thomas, single woman. Her Estate is the Grantor herein. AND THE SAID GRANTOR, Executor, as aforesaid, his heirs and assigns does covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Ronald W. Thomas, Executor of the Estate of Dorothy L. Thomas, deceased, Grantor herein, has hereunto set his hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence of: S~ irCA S /`!~C-iv~~i! ,C ~(,~~~j j~.1, • ?dl~t.~GO (SEAL) RONALD W. THOMAS, Executor of the Estate of Dorothy L. Thomas, Deceased COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: On this, the day of , A.D. 2009, before me a notary public, in and for the Commonwealth of Pennsylvania, personally appeared RONALD W. THOMAS, known to me (or satisfactorily proven) to be the person whose name is subscribed as Executor of the Last Will and Testament of Dorothy L. Thomas, and acknowledged that he executed the same in such capacity. IN WITNESS WHEREOF, I hereunto set my hand an official seal. Notary Public My commission expires: (SEAL) CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: Attorney for Grantee REV•1508 EX ~,~1.97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER •T D/7JA-S, ?~ o ~? D T~/ y L , 02. ~ ' 01P' - ~'~3 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. l~ ~ eta y~.¢ ,~~N,K ~4 CCd u N % s a . ~ vn~s ~e~ /yo X - ~~'8 6 (sec //lllaQ/So~ ~¢ ~r a ~a cLi e ~. ~e ~nd o K ~th n 0. Viers o n al 3, ~e~ccnq~ on Gl.s, Tcasury s{, C'~cd~f /¢~ its f/~~c~s e~ Vale ~. q,~e tit ` 'A~) 's n come ~x aoo8 ~ 137.00 ~J~rscna ~ i ,rJ came ~ oZDD~ ~.3 /D , o D orb ~4l PS~~tc ~p1-r cs~~ ~ a ~~ ,i¢. L.',ru ~o g -- ~ro^ pa~'on cou.nt~ -~axc s ~ y. /3. Lint yob- SCL1oo/ ~a.Xes ~ a Da•DS { ~ 5~ ~S C . ~~ ne `fog - Sewe ~ -~ tai h ho~,~le f -~ ~al~'1'-, Po~fi cr"~ r~~wy~d XFIO. 00 6. ~r-i e ~n su.tr, , (~ turfy a~ +~~nc~ ~ 1-l v w-~eo w viGN"S ~ aZ, !o $. d D 7. ~aGhm-v; a . ~~~unnd o~ ovp,+r- p mewl' b~ Non1e ~ ~,oG,h, ~: ~' 3 ~t0 ~0~1 Dal o Ts 5 31,E f ~}S. 3b D . A ~ Q~fu/rt,G . /~ ~ ~ ~ 5 li4f S~' ~Y.ys ~' I'~on~h'a~ Gru~,,,d A-rvL 2 d . Co k.pe hn ~ le.~ 37~ q S o Cioo~f~ 'V I N I G~ N Vv t Z ~- ~ ~-}~ (0 1 8 9 7 1 3 Kc.llY 'R~ ~k U~~ Good = X7,1 `>f S . ~ ~ oo tee. = 7 588. ' ~' o° ~ S~~ ~dmtiunds Cc~.~r ~~tl~t4,~'Dr I` ray, = 0.31 .pD ~~ ~ ' ~~' ~~~ • v~ /~~son~j re;~~'nec/ dy r~a'rn~` ~ y 17y~. aQ (See va !rc a ~S vt~ /~~' Q~c~.ear~ Sc~ ~~. cS~/CG6 TOTAL (Also enter on line 5, Recapitulation) $ ~~~ ~' 3D, 87 ~~u --.---_____.. _ ~ ~~ ._ ~~ %!~a/_1~S_,.~ wiz _?--%Y_~ ~ ~. _ _.___._____._._..._____-_-___._~icE_.do_.___._.._~ho~~---~83 - _ r , ~' ~~. ~ro C eCc~S ~ ~~__.~ ~._ ~ !! . __? ~t_ ZDU ~'._._ ~7~dl,~ ht ~i(G/~ O/'1 _-_--______._._.._ ~i__~ 7/.__ 1S /...__.T ____._______..~ ~..__ ._____~. _...__ .._ ___. _-_-. _ - __L~~__ ~. ~ra ~-eerls,__e __ __. ~ rx_c _ o ._.___._ . _ __. ~. f~ /~L~~ ir•-~ ~~ Reference ID: 2642029 1~~~~.J~ Wachovia Bank N.A. Balance Confirmation Services P O Box =10028 Roanoke, VA 24022-7313 December 6, 2008 CHARLES E SHIELDS III ATTORNEY AT LA~7 6 CLOUSER ROAD CORNER OF TRINDLE AND CLOUSER ROADS MECHANICSBURG, PA 17055 SUBJECT: Verif~catian !Confirmation of Account and Balance Information provided for: Customer: D~R(3THY L TH~IVIAS (SSN# XXX-~-147Tj Date of Death: August 25, 2008 Deposit Account Information Account Account Date of Death Average Date Maturity Interest Accrued YTD Dste Type Number Balance Balance* Opened Date Rate Interest Interest Paid Closed GHECKWG ~~G~'7~'~4618 $1,601.12 3/18/1999 X0.00 50.15 8!2812008 LEGAL TITLE: DOROTHY L THOhL4S CLOSING BALANCE: 5429.07 IRA 1'~'~'Xh"t'~'3t1947 $3,491.81 8/20/2007 52.34 J $8.67 LEGAL TITLE: DOROTHY L THOMAS For Beneficiary Claim Form information, please call 1(866)7864890. IRA 3~'7~~D~DDt'~2804 X0.00 4M'I999 _----_----~ 10/712008 LEGAL TITLE: DOROTHY L THOMAS LEHMAN CLOSING HALANC'•E: $0.00 For Beneficiary C'•laim Form information, please tall 1(866)786-4890. SAVINGS ' 586 51,344.38 3/24/2006 50.01 _ 51.74 8/28/2008 LF,GAL'IZTLE: DOROTHY L THL)MAS CLOSING BALANCE: 8"1344.45 Loan Account Information Account Account Date of Death Original Date Monthly Interest Times Ird Paid Tertrs Due Type Number Balance Amount Opened Payments Rate Late Thru Date CONSLI~l~:R LOAN ' 312 564,762.93 4/28/2008 LEGAL TITLE: DOROTHY L THOMAS w.~xavz~ Reference ID: 2G42029 Revolving Credit Information Account Account Date of Death Credit Date Date Times I~gal Title Type Number Balance Limit Opened Closed Late EQUTTY LINE ~'h''7t,~.h'~:~i6515~(i.00 1/8/2004 MASTERCARD ~~'k'`L~'~4654 MBNA -Revolving credit accoutrts are no longer serviced by ui achovia Bank Please contact MBNA at 800-477-9131. VISA 4854 $0.00 11129!2007 VISA ~i`3~~~i3+~"X1488 MBNA -Revolving credit accou~ are no longer serviced by Wachovia Bank Please contact MBNA at 800-477-9131. No Safe Deposit Box found for customer. DOROTHY LTHOMAS DOROTHY L THOMAS CAP, BROKERAGE and SELF-DIRECTED IRA ACCOUNTS HAVE BEEN CONVERTED TO V~ACHO~IA SECURITIES. YOUR REQUEST HAS BEEN FORWARDED FOR PROCESSING and WII..L BE MAILED UNDER SEPARATE COVER FOR QUESTIONS REGARDING CAP, BROKERAGE, or SELF-DIRECTED IRA ACCOUNTS PLEASE C_~LL WACHOVIA SECURITIES at 1-8b~-87~-2717. * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. L~~~~ Jennifer Straub Servicenter Associate Phone: (540)~b3-7323 ~; .ls Edmunds used Pontiac Grand Am car appraisal. 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Buying & Selling • View All Styles Search Used Pontiac Listings Auto Loans as low as 5.49°/a APR • Appraise Your Car .Sell Your Car Online he t a Bad Credit Car Lpan • Prices in Your Area • Resale Values • True Co, t o wn Used Car Appraiser Vehicle Details • Available Features • Standard Warranty ~~~~ ~ R@Yi~'W 1Gt~lTtUl1{~S,COT11 ta>ricin ~~ olt't $ P • Safety True Market Values"' • Colors Pricing • Specs Multimedia 2004 Pontiac Grand Am GT 2dr Trade-In Private Party Coupe • photos National Base Price $8,227 $7,171 • Photo Archive Optional Equipment $0 $0 Ratings & Reviews Color Adiustment $-8 $ 9 Black • Model Review Regional Adiustment • Road Test Ratings for Zip Code 17055 $-39 $-45 • Road Test Reviews Mileage Adjustment • Consumer Reviews s7,95o miles $914 $914 • Awards History Condition Adiustment • Reliability Clean $0 $0 • Consumer Total 57,09A $8,031 i TRUE MARKET VALUE ___~ ._v~____.~,,.~._.. ~_~_..._~ ... ..__ < Find Out What Others Are Pavma For The Car You Want With Edmunds TMV® you get a customized C'~""'"~ puce estimate based on your Zip Code, your "111~~,~_ car, and your desired options. ~~'.OUtBUi"!"fl~!"~r! Top ~~aettted"'' Cat's SiCt"~"e SI'TE' highest with their awners? ~, ~inri acct t~.~rrwvsin~ Dea le r Retail $8,009 $0 r $-10 $-50 _.. _ .. .. TIPS & ADVICE $914 10 Steps to Buying a Used Car $0 10 Steps to Selling Your Car Confessions of a Car Salesman 58,863 Fuel Economy Center 6/12/09 3:56 PM http://www.edmunds.com/used/2004/pontiac/grandam/100307379/options.html?tmvaction=vdpresult Page 2 of 3 2004 PonLiae.6*ar~d~.,Am -Private Party Pricing Report -Kelley Blue Book 6/12/09 3:34 PM ~~~ ~ ~~ THI:7RUSTED RESCtt1RC1 .. _ _ - __ _ _ _ -adverEisement _ _ _..__ __ _ I~t°:rtr~: 64i§?~ ~.:~r~, Used Cars esaea€ ,-Pt ~: F~i:slcsr~ t~~y.„k, I~ z~r,~ie~v4r~ i~e?,a#et-s ~n~,ertttsr ~°i~:~si?ie~#~ i..a,~trs~ dr ~r~~ur-~at`:c~e Used ftar Prices ~ Search Used Car Listinys ( Certified Pre-Owned ~ Compare Vehicl es ~ Perfect Car Finder ~ Most Researched Vehicles ~ CARFAX Vehicle History Welcome Back ~ Siyn In ~ Create Account ~ My KBB ZIP Code: 17055 Recently Viewed You Might Also Like Free Dealer Price Quote Home > Used Cars > Coupes > Pontiac > Grand Am > 2004 > GT Coupe 2D ~ Sdve Vehicle Print a;al Email 6 BOOKMHRK f ~„ 2004 Pontiac Grand Am GT Coupe 2D Trade-In Value _ .. _. __ _,...._.,. .- _, .. _..- ._. _ . Private Party Value ~~.~~ ~~aK~ P~~~~T~ ~~~~ ~~~~~ r,~~ti~, ,~;:~.; ' Suggested Retail value Photo Gallery ~OndttlOn <,.~,nF, ~ x~, - - Value Compare Vehicles nrew~ Blue Book Review Excellent $7,645 Consumer Ratings GOOd $7 145 Find Your Next Car , Specifications ._ - -...... _ ... Fair $6 545 .. _ More Photos ci~a, Shopping Toois ~ ~ -~ -~; »_C ~;,.: ~ ~ ,~;~,:; Free CARFAX ReCOrd Check * Auto Loan from 5.49°rb APR Get Your Credit Score Now Free CARFAX Record Check Po wered by ~~' Get a Free Insurance Quote ~~~ Payment Calculator ,,,..~.,,,~,..,~,~„~„ Extended Warranty Quote VIN: Print For Sale Sign No VIN? No Problem! BELT A I~SED tA~ Average Consumer Rating (828 Reviews) Read Reviews On Biue Book Classifieds'" Y~, ~~~ 3.9 out of 5 Review this Vehicle Attttt~,,,_'-ti Pontiac _..___....._._..,_,._,_.~_._..__,..._~,___.__.~:_..< _ Vehicle Highlights _... Grand Am '' 25 retires or less ry Mileage: 37,950 " --" __" Engine: V6 3.4 Liter ZIP Code 17055 Transmission: Automatic Drivetrain: FWD To View Ads, Click ~15~ Y~~~ ~~ ~~~ ~~~~ Selected Equipment Change Equipment Special Package Offer! Standard t,„, , For one low price you Air Conditioning Cruise Control Traction Control ~~~~~~^` can reach millions of used car shoppers. Power Steering AM/FM Stereo Rear Spoiler Power Windows Single Compact Disc Alloy Wheels Power Door Locks Dual Front Air Bags Learn more now Tilt Wheel ABS (4-Wheel) FIND TffF R3GiiT CAR Compare Used vs. New Blue Book Private Party Value 55,000 to 510,000 '-~ private Party Value is what a buyer can expect to pay when buying a used ------•--- -- -------•, Both New and Used car from a private party. The Private Party Value assumes the vehicle is " . , -- -- --- - sold AS Is" and carries no warran ty (other than the continuing factory - ---- -----~-----, Coupe . ~ warranty). The final sale price may vary depending on the vehicle's actual _ condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. To View List. Click http://www.kbb.com/KBB/Used Cars/PricingReport.aspx?WebCategoryld...=3268%7c30806%7c17055%7c0%7c0%7c&Condition=Good&QuizConditions= Page 1 of 3 06/12/2009 11:28 4108571176 ESTATE OF DOTTiE THOMAS 418 PAWNE DR MECHANICSBURG PA 17050 (ITEM MOUNT A _ __ (DEACON BENCH _ 22.00 _ _ HAMII~TON~~GRANDMOTHER CLOCK 125.00 ~ ~ CLOTHES TREE _ ~~ ~ ~ - 2.00 _ _ _ ~ _ JEWELRY BOX ~ 15.00 -~ _ WALL PICTURE ~~ ~ 10,00 ~, ., , ~ _ (X ~( ~{~ \ ~" Y 'mil b~~-~/ k Y PAGE 05/09 06/12/2009 11:28 4108571176 PAGE 06/09 Date : 1. iT...{a~.. •c'17~t1t~ ~ww~t. haars, com f-I~IA F~' S WUCT T ©h( ~iettlemEyn~; FtO~I TI-IDMfl~ Cf4 DDTT :I F T(-IOMRS EST~ITE 11:~~ i_nRiG U~11_L1=Y RD WE~iTr(T >`ISTE R MD ~ i.1 ~L3 Farb e T•tem Aescriptaon F'rir.:e C!i:y T©t~~l. -- L..~nt Prn c, I~IQI ~ a. 2~Qi -.. 4~(e~+d pt~~-ven't 1 4,~ Q~QI __ Miracle grow 1 _ .. ~, ~~...__._ ..... lyle 1. a con•E r^v l .l t~l„ ~:J1Zt~ •-. Wes-, a t, e r •r-• l a i d i 1.. t~0 -- w~ ~ h•-•w~x 1 ~.. ~It~l - T' rJ o 1 s t ~.. 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C Tf-IOMRS ESTATE ~z ~ E W Sell.e~^~ 4ip MF1IL TO RUhI TW01~1AS ~"'~ 'l 1 ~S LCJhIG UALLCY F2D WESTM I ICI X STSR MD ~~' 11 ~6 Il;em )r?escriwphi.an_._^__..........___•-___......____.~...F'ra.cp_.~._G~tY_........___rota~.__N~_ - ~1ow1 1 at 1 c:p ~7iP~ I t e m s r, 4•S A m o pan t~ c~E," 5~ C o m m a s s i v n a~ ~+7~ a m~0"!r S4. ~,4a L.es s ad,j ~a~i; mPnt s ~ -S~4" G~ filet dice to se11Pr,~ ~.4~." 9~ www. haa.rs„ com HAAP,' S F1UC'rlahi 717-G•~G~t3~?frE, REV•1570 EX+(3.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ~. FILE NUMBER / h~0/,rl,~•S, ~ D/Zo T~i/~ ~ . oZ /+0 8 - 8~.3 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE _.. _ __ __ ATTACH A COPY OF THE DEED FOR REAL ESTATE . ,pri~c.j~a/ ~~, `19/.8/ ,~ccr..Z.zt ~,~, ly ~3~ y 9jf. /S ~~~b/e ~ l~oh~Id ~ • ~ryt,cCS, SoN ~ f' decederltj ~ ~ ~aXn~rs 71w,~rt.as, sv~ . (see ~a~uah'oh lef~cr a~f'ac/~ ~ S~• F~ a. w,~ c~o~~,~ ~~N~ /,~ ,~-~~,~o. x-~~ 7~ a) Tme Dy~osit ~Ifli I ~3. sl ~ ~ ~Kf,~,• !l, 933.~i I~r~alole ~ ~~~~ta,(d i~u. 7~ton~las, Sev+ d~' d ece~ey~t ~Valua~'oy was ~r~rn~al~-t-ed a~ca/ cQIGLLI-- u.#'ed ~~ yeas'-e,nc~ s~'eam en t s ~,~., ~, ! i ed '~ r oZ.OD ~ ~u-s e n a.rt ~ n ca Iwte ~ P~p•) ~~O~O I ~'~~ I ~/!, 933.x/ TOTAL (Also enter on line 7, Recapitulation) I ~ is; y a ~, Q 1O REV-1 X11 EX+ (12-99) ~- ~ ~~ ~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FUNERAL EXPENSES & ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF THon~~S ~o~oTNy L. FILE NUMBER a.l -08-- 8f~3 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. ~/1L1~ n-G/'1P~I"CG~ ~~I1?L' ®~ ~~(~l~IlfiYLl CSbGf )^ / ~ ~ ~ j)D. DO i C7i/2 /+i~cLi ~~'/I1o~ia~.S ~ / 'y~ctR~S~7e ~ ~ ar~'7Cd! ~ ~ti'e~1il tea, /OD• o-0 G~i-t9r•cLi ,`1/1~inoriafs, ~/~a~s~,~c , ~s~ I ~ n~~ ~ ~~ /ODD ©o , fie ~ ~ b4 rsem rapt ~v Tames i r~-~o n~as ~ Ir ~w~e-r~.! heal u~' 71,t m cc~ ~,n i csb~ ~ Ct ~b (s~ee. r~ ~i p~' a ff ~c,~.l~ed~ .~~ 7. ~I.s' B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ~ oN ~-L.D W . 71-E DAh ,~ (~ A~IYt'c'D Social Security Number(s)/EIN Number of Personal Representative(s) Street Address I I °I q ~D -Rq ~ 0. t ~ t~.y ~ n 1c( City IA1G5'rhrl t ~ S~"'~r State ~_ Zip ~. I1 Sg Year(s) Commission Paid: !V / ,f} f_ 1 2. Attorney Fees C ~utrlCS ~. Sh ~ e~clS ~ 9~ ~~(, B~ 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ,NO DIU,r~ ~G/G~/3 LE Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees ll~nd pr, q~~a,~ ~jSSl~l~ 0'F $~tt~ilrt ~QV~TI ~'ca.~'eS CJ f l ~D, as 5. Accountant's Fees Gary ~~ ttGtt"', ~ `~„~. ~~ tt.•tC~(' ~2X'S. ~ Y1G • ~ ~ 1"etu.~rnS ~ ~ Q s. 0 D 6, Tax Return Preparer's Fees ~ r I D~ I, p~' ~ (, ext . ~~ S~1m '~ ~ o~ 7eS~ OD ~. ,f~G~/e~'~ i~ i /!Q !M ~ Car~iS~e eSe/~7~i~'JC ~ /,VekCC~Oaper ~I 1 ~, ?x ~ v i9-d~e,rt ~si,n~ .~ f~c ~ ua,,her~ancl ~a~ .T~rrna~ ~ r75". DD `l. /~~ari fivna/ ~r,.h~~ ~c lb • `` ~/i~l~ eCe~ ~ /~P~ ~ ~3'/c.~ v~ Ll/~~~s ~ o 0 0 a , ¢/~;DD Csee Co,~~iitua~io,~ shy e f~ TOTAL (Also enter on line 9, Recapitulation) $ rt q~ 98/~ nr more soace is neeaea. insert atltlttlonal sheets of the same sizel ~~ ~-- • ot ~.Sra,~i~J S, ~,,~a ~~ y ~, , ~~c.~' moo. fit= a ~ -~3 /~. ~ ~~°L '~S'~f.38 /3 ~ ~ll/fl~~~? ~~.v~. ~wer' f ?l~~iJh ~ 3 ~. bS /~ ~ Tamcs but ~h ~- ~l~rwd m~~r~ f 'ail ~, ao lG. ~ ~idL ~~{!. 6 y /T / uI'c~/ /~~'Lt ~, ~/ll~/C/' T~i~al ~~%/ 7~i" / / wor -~//'~r ~GG.~ ,,~~~ ~ ~3 / ~ ~ ~ ~ 7D G~%~'N. ~ /D /~ _.... . ~I !r~ - CaGln~ ~s,l~zcf c~r~. c~, D.6>4z~nin ~G~y ~ ~C/ll/D/Y~ ~~PCC ~l 5:00 /`~, ~,~ -,diner%c~ Gc~~r- ~ 3/. ~8 ~ o. ~~° L ~ 11 9.7z oZ. ~• f /NCS L ulZ~ ~kw~j ~ cs~ir~~ /YJG:!'rJ~dQi1Le~ ~/D,~, ~ 0701. p~ ' ~lh~r! cart W o~'~r ~~ 6.9 q X73. ~_ ,/Jf'L ~~~ ~y ~`f . - ,/~Q,~ppC/G/I %u~ a.~~,r TQS`i 0' // ¢/ S ~ , Sz ~ ~ 9 a S. ~ ~ltye cswarr , ~i'X Le4t~ ~Zt ~ilt~' ~~S~D a9. ~~ -~in~,~:c~, ~ii~fer ~a 7 Is ~~- ~p~ '~ 1.39. ~s .3/. 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L~yl9a n ~s DO L.`Jict 1303 to ' :.Z. urger ~ ~/S', o0 /wens, +~s~~ ~, c~. 7oa. ~o ~ 8`- ~n n car pet ~ l~laor; n ©~ N'eu) C'u.n~- ,~a~.,~lan d , ~fy, .~~ ~e . y ~3. / sl . o v 3 9. ~a ff~~ ~u~~~ , G'/e~tn sir ~loCr~ in Corr ~t^ Sa.1e ~ a ,~ ~', ~O ' '~• ~ vCS ,~~it ~ll,l~~ ii ~j , ~i°rt 1~ ~ 9~ ,/~vr ~h4' l7a`I /~? ,~»r ~tS~l~a l~o~t fT ;/lekJ 3-~bh T'~elGf ' (~ufxp S.~~M ih i0'~ p ~r ~S~/e ~J, (ohs, d~ ~l. , ~~.in6 ~ ~'~tar/cs ~; ~S'~i • ~~ 2l ~.~ ~e,~~~ ' . lira. % n s '• ~ ~o~q~°, ~~iv~CD ~~5, -~~. f es~~ •~ ~ T ~a1, %!^% - G061/f~ /y'~iSfj"QG~ ~~iGGS 7a/' ,/SG~i%11, `~7~/ ~1° lvv,t~/L y ~ n~ lG ~r { r ~Iar~Ce/S' new ~~ ~fP. %Iw~tf~t~' ~`p Clams. ~'~~'~~ls y ~ ~ X13 S. DD ~f 3 . /~ u c.~'vn Hers w/~ih~ss~ c~, ~ ~rQars , ~a le D!~ ~ y, Z oa P' 9 98, S7~ '~ y~, ,72~1ihvtlGCt3 (.d,~i~jssiv~ to /YQarS ~a,/G OC~..~/, 2aa~ ~ . ~0 NC2581 A 6/01 - carbonless ~~~~~~adams 2 PART NC258~ `"~ ~ ® e S ~ ~I~ l~~nr 2" -~ ~ DATE r ORDER NO. NAME ADDRESS G.:~'i ~'T~' e~"~' SOLD BY 0 -CASH Q .C.O.D. `Q PAID OUT CHARGE Q MERCHANDISE RETURNED . ~ ~ - • •- ~ • ~-~. ! ~~~ ~~7.~,~ ?3 adams NC2581 SIGNATURE ALL CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL. G~I~I~RAL PURP®SE ' REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IED~JI.E 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF -7~D,`Jf ,l~.s ~o~paTHy L . FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. ~cSf cS!!O/'G ~~ QU1"~°QGf ~ a0o,~ QO.erSona~ 1 nC.~l'Y1~ ~ ~~S',DD ~, f/ T~ ~ Gtn 'versa / 1~ ~S. 90 .3. /~,'GhQ G / L.~n~Cirl, Treasurer, ~ya~a/c~ %- ~i~ .moist // ~~1t ' ~C~700/ ~wXES ~s'D/. ~o y' ~. ~/`I'C ~j•SLCr'• ~Y1S ~l/~~'1~ O?'! ~71~/yleOl,~J,/1~/"f ~~.Su,Y'. ~c~ S.~.DU ~ ,~eri zm,~ ~S', S8 6, ~~ - ,~int,~~c~ ~/~,r ~ ~8. /S 7, ~,PL ~ /o ~, B,Z ~: ~l~~ys ~ara~ ~`~ ~/ ~'. /4. ~,rh,/ja,iy~ ~iSur, ~e~~ ~~~ ~nS~rr. ~-~~~. Do ~/. lr~ac~ie as ~~,~, ~i~e .~~ u .1'- L, ~,~ ~ ,~ `~e?~ y ~ ~ ~o ~, z 9' /~ ~erizo~ ~`i ~ , z / / `~ . .~ i,~1•l LG~fz'~ ~Rw/~ ~ZG6v: n~y Ga'~'1~ /yI~~1~in.Ce. ~ 01 ~ . 00 / S. U ,/h i ~~tae~~l~C~l?~ ~~SU/'er, /~Q~~~P-.~1 lu~~- ~~ c~?S~R`~ ,~~e,~.f' - Shoo/ lax~s ~S'D/. G q /G. ~riC ?,sur. ~sfiilr~a~l~ ~, ,l~a~ea~~s -~,sur. '~ a~S~3.• DD /7. wa~lrvvq ~~t~; f~o~e ~=~ ~~i y Lin e ~ayin Gnt ~~o~, zq /8, /~~f ~,rnart C~-~. `30.00 / ~j, ,~/`i ~ ~iSl.C,h. -~yIS ~ ll/1C~~ ~ .Iyd~eoG~/,~/`S ~l'~SL[ r, ~a 5,3_ Do ao ^ ~l~e ,~~u, fy Loa h , Goa c~iov:a ~a.,z~ ~` 4/0~. 2q a~. ,%~ Smart Ord ~a ~~ ~o Csee eorr~Sn~a ~ off ~s61re1~~ TOTAL (Also enter on line 10, Recapitulation) $ I 9 ~ D ~-3 ~ .3 1 ~~. ~uantu rh e-~na ii? ~ ~a,~oea~c .~5sacs. ~ 3 = ~+/a chev:Q 13~, k, ~n~ue ~~~u. ~ Leap ~~ ~~~ ~~. ` ~°~ aynurZ card ~T. ~'~-C~o va /~~i.C~ fz~o~tc ~'~u.1~~ Loan ~~n~rt t ~~ ' ~°~` Jma~~~ C~~d1 ~ y ' ~--'awl oYia /3~ik, f~ome C u~~ ~,a~ /~~yn~~' ,. ~ / 36_ Gl~a c ~io~~ a = ~ ~/onre ~= u % Loa,,rr ~ ~~,,~- ~ ~' ~ 3/. `t/l!s`ii ~ ~u~ar (.~r~ ~7/iGes 3~. Case C'arct~ v~rv~ces ~1 ~i c~ ~YD. Z/-off' - $83 ~13~, 00 ~yo ~ Z `3 ~oZ ~, o0 ~~ ~, 3~ ~,~o. ~o ~~o~. z ~ X30, Go ~~fog, zg ~~o~, 2g ~D.ov ~~ o, vo ~~{o~, Z9 1, 3z/. 97 ' REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. 'RotU A1~ w . T~o/-~~-5 won S~ ~,~ I ~`~~ l.o~ M~ ,2r1s~ 1/all Rd., ~esfm;ns~r ~ , ,a, ~~,N~G D k1 • //~,CD/19i9~ , Qs qua r c/. ~k n e ~ ~ rwn cl Son ~S~o Z,~Cyrl~-~t' ~, %~/D/1?J~- ~~ ~1 i'S So~I, a ~h:nor ,~ 2oi~~-GO ~v • ~~i~r~ ~s~uar~i, 'a~,~ e~ r,anddau to ~ J'~ assn OG~v~~ ~- ~~~~~, ~~ s ~al~r~h~~, ~ A?~%tor- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ ~t7y~~d~«r~~c ~~ ~ ~ I, DOROTHY L. THOMAS, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and revoke any and all Wills and Codicils made by me. ITEM I: I direct that all my just debts and funeral expenses, including my grave marker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II: I give, devise and bequeath the rest, residue and remainder of my estate of every nature and wheresoever situate as follows: A. 50o in equal shares to my grandchildren, ZACHARY R. THOMAS and OLIVIA D. THOMAS, or the survivor of them. B. The balance of 50o to my son, RONALD W. THOMAS, or his issue, per stirpes. ITEM III: All Federal, state and other death taxes payable because of my death with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid out of the residue of my estate, without apportionment or right of reimbursement. ITEM IV: I direct that no executor or his successor serving hereunder be required to post bond or enter security in any jurisdiction. ITEM V: I appoint my son, RONALD W. THOMAS, Executor of this my Last Will and Testament. Should my son, RONALD W. THOMAS, fail to qualify or cease to act as Executor, I appoint RONALD E. THOMAS, Executor of this my Last Will and Testament. ITEM VI: I appoint my son, RONALD W. THOMAS, Guardian of the estate of any minor beneficiaries. Should my son, RONALD W. THOMAS, fail to qualify or cease to act as Guardian of the estate of an1T minor beneficiaries, I appoint P,.ONAL•D E. THOMAS, Guardian of the estate of any minor beneficiaries. Such. guardian shall not be required to post bond or enter security in any jurisdiction. 2 ITEM VII: Where appropriate throughout this my Last Will and Testament, all references herein to the singular or the masculine shall include the plural or the feminine, respectively. ITEM VIII: I direct. my personal representative to employ HOWARD B. KRUG as attorney for my estate. This provision is made solely at my request and without urging or suggestion by the said HOWARD B. KRUG. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ ~ da Y of d ,~}~,t~ ~ ~ , 2 0 O 1 . ? ~, ~,, / ~ a`.~.~ t.~~ ( SEAL ) DOROTHY,~L . THOMAS The preceding instrument, consisting of this and two other typewritten pages, was, on the date thereof signed, published and declared by DOROTHY L. THOMAS, the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. '~~' residing at ~ '%~f'~~~'7~. G~~ t ~" ~; _ t' ,- ~ ~ ~,~. ~~ ~ residing a t ~ .,~ ~ „ ~...~ ~ 3 COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND WE, DOROTHY L. THOMAS, ~ ~~ ~ and s the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 1~ ~~ ~~ ~' ,/~ ~~~`-' `~ DOROTHY THOMAS Witness ~~ /' , r Wi ness ~ Subscr_ ibed, sworn to and ac.irnr~w.l edged :ref ore me by DOROTHY L. THOMAS, the Testatrix, and subscribed and sworn to before me by , , ~ ~, ,~~' and ~ > , v , witnesses, this ~ ~~ day of /t~~'"~/I?,~--~ 2001 . 441l f l Notar Public '"_`~ ~, ~. y ~. IA X 'I~ ~'3f, t~ Notanai Seal ~ ~. ~,. ~ _ ry ..- Angela S. Eaton, Nota Pubii., - - - ' . " :. Hamsburg, Dauphin County- ~ . 4 My commission Expires Jan. 12, 2004 Member, Pennsylvania Association of Notaries ~ a~ ~ , ~~ r~rs"