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HomeMy WebLinkAbout09-23-09 (3)1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes Couniy Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 5 9 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 6 2 0 4 5 7 9 0 6 0 9 2 0 0 9 0 8 2 8 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI S N Y D E R S A R A S (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 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) ® 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of VIII) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) I R W I N & M c K N I G H T P C First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E State ZIP Code P A 1 7 0 1 3 Correspondent's a-mail address: 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 ER ON RESPONSIBLE FOR (LING RETURN DAT 60 WEST Pp~MF ET STREET CARLISLE PA 17013 SIG U~ OF R OTHER THAN REPRESENTATIVE Q~ 3E/~Q l 7 REGISTER OF WILLS US(S,pNLY C7 ~--^ C ~ ~° '.D (~ - ~1 N .~ ~ w - ~ _ ~ t ,ice'-r~ - -~ ~,_._ DATE ILED (~,? ~= O GJ 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505607121 Side 1 1505607121 /~ 1505607221 REV-1500 EX Decedent's Social Security Number 1 6 6 2 .0 4 5. 7 9 Decedent's Name: S A A S• S N Y D E R RECAPITULATION 1 1 5 7 5 0 0.0 0 1. Real estate (Schedule A) ........................................ 2 1 2 2 3 1.0 4 2. Stocks and Bonds (Schedule B) ..••••••••••••••••••••••"'•""" 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) . • • • • • • • • • • • • • • • • • • • • • ~ • 4' 5 1 7 8 0 6 4. 1 5 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... . ' tl Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• • 6. Join y 7. Inter-Vivos Transfers & Miscellaneous N~Probate Property Separate Billing Requested ....... 7. 3 q 5 5 7. 8 1 (Schedule G) 3 8 7 3 5 3. 0 0 •.•••••,•. 6• Total Gross Assets (total Lines 1-7) • • • • • • • 8 . 5 0 8 6 2. 4 2 Funeral Expenses & Administrative Costs (Schedule H) . • • • • • 9 s. . 8 ? 8. 8 5 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... 10 .... 10 . . . 5 ], ? 4 1. 2 7 ............ Total Deductions (total Lines 9 & 10) 11 .... ..11. • 12. 3 3 5 6 1 1. 7 3 Net Value of Estate(Line8minusLinell) .••••••••••••••••• 12 ••••• . 13. Charitable and Governmental BequestslSec 9113 Trusts for which 13 2 6 0 6 1 1. 7 3 an election to tax has not been made (Schedule J) 7 5 0 0 0. 0 0 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 Q Q Q 15. Q' Q Q (a)(1.2) X•0 16. Amount of Line 14 taxable 0 0 0 16 0 • 0 0 at lineal rate X .045 17. Amount of Line 14 taxable Q . 0 0 17. 0 ' 0 0 at sibling rate X .12 1 1 2 5 0. 0 0 18. Amount of Line 14 taxable 7 5 0 0 0. 0 0 1 g• at collateral rate X .15 ~+ 1 2 5 0. 0 0 . 19. .... 19. Tax Due ........................................ ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~,; 1505607221 ~ Il.i.~ Side 2 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0591 DECEDENT'S NAME SARA S. SNYDER STREET ADDRESS 11 GARLAND COURT CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1 ~ Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 11, 250.00 Total Credits (A + B + C) (2) 0.00 (3) Total Interest/Penalty (D + E ) 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. 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 tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) 11,250.00 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 : ...................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................... . ................ ^ Q 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 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 (O) 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)]. 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)]. 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. (4) 0.00 (5) 11,250.00 0.00 REV-1502 EX + (6-98) • SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SARA S. SNYDER 21 09 0591 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 roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 11 GARLAND COURT, CARLISLE, PENNSYLVANIA 157,500.00 SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 1, Recapitulation) ~ $ 157 500 00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) ` SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SARA S. SNYDER 21 09 0591 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SERIES E AND EE SAVINGS BONDS -INVENTORY ATTACHED 12,231.04 TOTAL (Also enter on line 2, Recapitulation) $ 12.231.04 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) ' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENTEDECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER SARA S. SNYDER 21 09 0591 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CASH ON HAND 378.05 2. ~M&T BANK -CHECKING ACCOUNT #583456 3. ~M&T BANK -CERTIFICATE OF DEPOSIT #31003920249321 4. ~ORRSTOWN BANK -CERTIFICATE OF DEPOSIT #4000031083 5. THRIVENT FINANCIAL FOR LUTHERNS ANNUITY CONTRACT #63384854 BENEFICIARY: ESTATE OF SARA S. SNYDER 6. THRIVENT FINANCIAL FOR LUTHERNS MUTUAL FUNDS #362100318254 7. THRIVENT FINANCIAL FOR LUTHERNS MUTUAL FUNDS #181800017539 8. COINS 9. PERSONAL PROPERTY -PUBLIC SALE ASSESSMENT ATTACHED TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 14,721.25 20,580.91 30, 326.80 43,323.51 31,977.68 21,228.65 53.30 15,474.00 15 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER SARA S. SNYDER 21 09 0591 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND THE DATE OF TRANSFER ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION )IF APPLICABLE) TAXABLE VALUE 1. ALLSTATE LIFE INSURANCE COMPANY 39,557.81 100. 39,557.81 ANNUITY CONTRACT #GA18439881 BENEFICIARY: ST. STEPHANS LUTHERAN TOTAL (Also enter on line 7 Recapitulation) I $ 39 557 81 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) ' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SARA S. SNYDER 21 09 0591 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A B. FUNERAL EXPENSES: 1. HOLLINGER FUNERAL HOME 3,832.31 ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ROGER B. IRWIN, ESQUIRE 13,000.00 Street Address 60 WEST POMFRET STREET City CARLISLE State PA Zip 17013 Year(s) Commission Paid: 2. Attorney Fees IRWIN & McKNIGHT, P.C. 14,500.00 3, Family Exemption: (If decedenPs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 357.00 5 Accountants Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00 7. CLOSING COSTS FROM SALE OF REAL ESTATE 13,545.30 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 9. THE SENTINEL -ESTATE NOTICE 176.92 10. NOTARY FEES 35.00 11. HARRY DONSON -APPRAISAL ON COINS 15.00 12. ROWE'S AUCTION SERVICE -PUBLIC SALE 4,975.89 TOTAL (Also enter on line 9, Recapitulation) $ 50.862.42 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) ' ~ SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER SARA S. SNYDER 21 09 0591 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. STONEHEDGE HOMEOWNERS ASSOCIATION -HOMEOWNERS ASSOCIATION FEE 140.00 2. BOSCOV'S -CREDIT CARD 85.17 3. M8~T BANK -CREDIT CARD 518.04 4. AT&T -TELEPHONE 69.67 5. BON-TON -CREDIT CARD 64.00 6. COMCAST -CABLE UTILITY 1.97 TOTAL (Also enter on line 10, Recapitulation) $ 878 85 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SARA S SNYnFR ~~ na n~a~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outrightspousaldistributions, and transfers under Sec. 9116 (a) (1.2)j 1. DEBRA J. HESS (NIECE) Collateral 6 MEADOWVIEW DRIVE 20,000.00 SELINSGROVE, PA 17870 2. RICHARD A. ROTHERMEL (NEPHEW) Collateral 915 W. FOOTHILL BLVD., SUITE C448 20,000.00 CLAREMONT, CA 91711 3. JOHN G. ROTHERMEL (NEPHEW) Collateral 1126 POMEROY AVENUE 20,000.00 SANTA CLARA, GA 95051-4425 4. CAROLYN ARNDT (COUSIN)_ Collateral 2761 HEISTER VALLEY ROAD 5,000.00 MT. PLEASANT MILLS, PA 17853 5. FAWN ARNDT (COUSIN) Collateral 11 RR1 BOX 115 5,000.00 RICHFIELD PA 17086 6. BARBARA LEBO Collateral 41 BEECH STREET 5,000.00 CARLISLE, PA 17013 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 See Attachment Page(s) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 260 611.73 SCHEDULE J BENEFICIARIES (It more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent 'SARA S. SNYDER 21 09 0591 Decedent's Name Page 1 File Number Schedule J -Beneficiaries - 2B B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. SALVATION ARMY 5,000.00 125 SOUTH HANOVER STREET CARLISLE, PA 17013 2. HABITAT FOR HUMANITY 5,000.00 39 HEISERS LANE CARLISLE, PA 17013 3. ST. STEPHENS LUTHERN CHURCH (ALLSTATE ANNUITY) 39,557.81 30 W. MAIN STREET NEW KINGSTON, PA 17072 4. ST. STEPHENS LUTHERN CHURCH (REMAINDER) 211,053.92 30 W. MAIN STREET NEW KINGSTON, PA 17072 SUBTOTAL SCHEDULE J-2B ~ 260,611.73 LAST WILL AND TESTAMENT of SARA S. SNYDER I, SARA S. SNYDER, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executors, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executrix or Substitute Executor of my estate. 2. My Executors may, at their discretion, compromise claims, borrow money, retain property for such length of time as they may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as they may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. I authorize and empower my Executors to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Executors are authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executors. 4. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a.) The sum of Twenty Thousand ($20,000.00) Dollars to my niece, DEBRA J. HESS; (b.) The sum of Twenty Thousand Dollars ($20,000.00) to my nephew, RICHARD A. ROTHERMEL; (c.) The sum of Twenty Thousand Dollars ($20,000.00) to my nephew, JOHN G. ROTHERMEL; (d.) The sum of Five Thousand Dollars ($5,000.00) to my cousin, CAROLYN ARNDT, Mt. Pleasant Mills, PA; (e.) The sum of Five Thousand Dollars ($5,000.00) to my cousin, FAWN ARNDT, Richfield, PA; (f.) The sum of Five Thousand Dollars ($5,000.00) to the SALVATION ARMY of Carlisle, PA. (g.) The sum of Five Thousand Dollars ($5,000.00) to HABITAT FOR HUMANITY, Carlisle, PA. (h.) The sum of Five Thousand Dollars ($5,000.00) to my friend, BARBARA LEBO; and (i.) All the rest, residue and remainder to ST. STEPHENS LUTHERAN CHURCH, New Kingstown, Pennsylvania, with the request that all monies 2 received from my estate be put into The Richard and Sara Jane Snyder Fund, to be used as deemed appropriate by the Church officers for its charitable purposes. 5. I nominate and appoint ROGER B. IRWIN and MARCUS A. McKNIGHT, III to be the Executors of this my Last Will and Testament. 6. No person(s) shall benefit hereunder unless such beneficiary shall survive me by thirty (30) days. 7. No Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 8. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 3 ~ day of November, 2007. ~~.`~'~,~'`t~"J (SEAL) SARA S. SNYDER 3 Signed, sealed, published and declared by SARA S. SNYDER, the above-named Testatrix, as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. > ,Y. ~ 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, SARA S. SNYDER, KAREN S. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the 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 purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness 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. SARA S. SNYDER KAREN S. NOEL SCHWALM COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by SARA S. SNYDER, the Testatrix herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L. SCHWALM, witnesses, this l3° day of November, 2007. ~f ot~airy Public COMMOf~WE LTH OF PENNSYLVANIA Notarial Seal Roger B. Irwin, Notary Public Carlisle Born, Cumberland County My Commission Expires Oct. 3, 2008 Member, Pennsylvania Association Of Notaries OMB N0.2502.0265 . e neoe o•nueur ne un~ ~mur_ a ~ yen •u r,~..~~ ..e..~.,. 1 ' 2.~FmHA 3. UNINS. 4.rlVA s f"lcnnni we ' 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT THRUSH.J 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is famished to give yea a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '(POC]" were paid outside the closing; they era shown here for informatlonal purposes and are not included in the totals. 1.0 31eB (THRUSH.J.PPWfHRU$N.J26) D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: JANET L. THRUSH ROGER B.IRWIN Executor of the and ESTATE OF SARA S. SNYDER G. PROPERTY LOCATION: 11 GARLAND COURT CARLISLE, PA 17013 H. SETTLEMENT AGENT: 23-2402316 PURITY ABSTRACT COMPANY I. SETTLEMENT DATE: A t 18 2009 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT CENTURY 21 A BETTER WAY 398 E. HIGH ST, CARLISLE, PA ugus , J. SUMMARY OF BUYER'S TRANSACTION K SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: .400. GROSS AMOUNT DUE TO SELLER: 101. Contrail Sales Price 157,500.00 401. Contrail Sales Price 157,500.00 102. Personal Pro a 402. Personal Pro e 103. Settlement Cha es to Bu r Line 1400 3,402.62 403. 104. 404. 105. 405. Ad'usfinents For lams Paid B Sellerln advance Ad usfinents For Items Paid B Seller in advance 106. Coun >T Taxes 08/18/09 to 01/01H0 286.15 406. Coun R Taxes 08/18!09 to 01/01/10 286.15 107. Ci Tax to 407. C' Tax to 108. School Tax 08/18/09 to 07!01170 1,541.01 408. School Tax 08/18/09 to 07!01/10 1,541.01 109. ELECTRIC SERVICE 32.52 409. ELECTRIC SERVICE 32.52 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 162,762.30 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 759,359.68 201. De osit or earnest mono 1,000.00 501. Excess sk See Instructions 202. Princi al Amount of New Loans 502. Settlement Cha es to Seller Line 1400 13,150.30 203. Exlstln loan s taken sub'eil to 503. Existln loans taken sub'eil to 204. 504. Payoff of first Mortgage 205. 505. Pa of second Mo a e 206. 506. 207. 507. De osit disb. as roceeds 208. 508. 209. 509. Ad'usfinents For Items Un aid 8 Seller Ad'ustments For Items Un aid B Seller 210. Coun R Taxes to 510. Coun R Taxes to 211. Ci Tax to 511. C Tax to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. _ 515. 216. 516. 217. 517. HOME WARRANTY to AHS 395.00 218. 518. INHERITANCE TAX ESCROW to ERWIN & mCkNIGHT t 1,000.00 219. 519. 220. TOTAL PAID BY/FOR BUYER 300. CASH AT SETTLEMENT FROMRO BUYER: 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH AT SETTLEMENT TOIFROM SELLER: 24,545.30 301. Gross Amount Due From Bu r Line 120 162,762.30 601. Gross Amount Due To Seller Line 420 759,359.68 302. Less Artrount Paid BylFor Buyer (Line 220) ( 1,000.00) 602. Less Reductions Due Seller (Line 520) ( 24,545.30) 303. CASH (X FROM) ( TO) BUYER 181,762.30 803. CASH (X TO) ( FROM) SELLER 134,874.38 The undersigned hereby acknowledge receipt of a wmpleted copy of pages 182 of this statement & any attachments referted to herein. Buyer ~ ~'~ Seller ROGER . RWIN JAN .THRUSH BY: Executor of th ESTATE OF SARA S. SNYDER L. SETTLEMENT CHARGES ~. TOTAL COMMISSION Based on Price $ 157 500.00 ~ 6 0000 % 9 450 00 rao FRonn aAro FROM Drvrsion of Comm~ssron (Ime 700) as Follows: eurEas sEUerrs I. $ 4,750.00 to KELLER-WILLIAMS REALTY FuNOS ar FUNDS AT ?. $ 4,700.00 to CENTURY 21 A BETTER WAY sErn.EnneNr sernennerrr ~ o out. Loan un manon ree % ro 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lenders Inspection Fee to 806. Flood Cert Fee to 807. Tax Service Fee to 808. Document Prep Fee 809. 810. 811. ( THRUSH.J I THRUSH.J 727 PURITYABSTRACTC Y Settlement Agent Certified to be a true wpy. c ~_ fD Q O fD O • *c~i~D "~~~ Q.ooo ~ ~- o- °- a ~' vi vi ~2 N 41 y ~ ~ D n~.~.~ N ~ ~ Q S._ noon ~ mm~ o mmo . mninivn ~~y=~ ~~ fn'j O ~ ~ ~ G Gco a co aa~~ O• -• _. O N ~ ~ 7 ~ to ~ O O ~ (7 ~ ~ .. N = O CAD CSD _ ~ ~ a o~~rn~ v 3 c `~ ~' ~ ~ OS • C ~ ~ ~ O_ y 00 y 6 Q'p~ °-Zo ~•>>o~ ~ n~ a 0 0. ~ m _~`ams v O_X O O~ ~~° a m3=•~-„ ~~v ~ ~ o m c m ~,~ ~ rt = n ~ _ m o ~ Zo f1 ~ ~ ~ 7 vOi O '~ ~ a S y G O CD i 7 ~ a~ =Q s m ~ m ~ N ~ O O ~oa,~ ~ avi ~ ~. n Cr 6 a n; ~ ~ ma'v~ m ~ ~ ~ o c no a ~~ ~o~ 7 O W O 0 N N A N O O N .~• C Efl ~ N A N W O .A O CO OO V O Cn ~ W N ~ i z ! ~ ~ I rn m m m m m m m m m ~ c~ y ~ v , ~ 0 0 0 , , , , 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 o v o ~ ~ ~ ~ o o ~ N N N N N N N -~ -~ W (/~ O O O O O O O CO (0 0 ~p A ~P ~P 0 0 0 0 CJ7 C11 (~J ~ W W W W W W W N N Ul Ol W W W O O O DD W W O . 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Z ~ ~ ~ ~ N N N ~ 3 0 ~ 0 0 ~ . -- ~ O ~ y ... m -. ~ ~ -. o O O -a ~ ~ 41 N N N N ` ~ ~ N N N ~- N N N N N N N N N N ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -~ 0 -~- 0 » ~ rt V V V 00 (O CO CO O O CO ~ ~ ~ ~ ~ ~ ~ C D D D D D D D ~ ~~ n' ~p Dm N ~ O N O O ~~ O O ~~ n ~ C (D '~ (D o ~ `~ O ~~ ©M&T E~tnk ll R Millsboro DE 19966 M il C de DE 499 Mit h d MB 12 ~~~~ , c e oa , a o - - i ~~~~ ~ ~ ~~UU~ Law Offices GRWINis<It~cKNIGH~ IAW OFFICE Irwin & McKnight, P.C. West Pomfret Professional Building 60 West West Pomfret Carlisle, Pennsylvania 17013-3222 Re: Estate o~ Sara Jane Snyder Social Security: 166-20-4579 Date of Death: June 09, 2009 Phone (888) 502-4349 Fax (302) 934-2955 July 3, 2009 Dear Sir or Madam: Per your inquiry dated June 26, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccount Checking Account Account Number 583456 Ownership (Names o,~ SaraSrryder* Opening Date 12/01/80 Balance on Date of Death $14, 721.25 Accrued Interest $ 0.00 Total $14, 721.25 2. Type ofAccount Certificate of Deposit Account Number 31003920249321 Ownership (Names oj~ Sara Srryder* Opening Date 8/28/08 Balance on Date of Death $ 20, 000.00 Accrued Interest $ 580.91 Total $ 20,580.91 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Stonehedge Office # 717-240-4524. Sincerely, -. Tracie Hare Adjustment Services b/.~U/U~ Sara S Snyder 11•Garland Court Carlisle PA 17013 Has messages Current balance: Accrued interest: Penalty amount: Current cash value: Issue date: Original balance: Last payment date: Last renewal date: Last renewal balance: Date redeemed: Interest pmt freq: Interest disposition: F1=Addl functions F5=History O.RRSTOWIV$~ A Tradition of Excellence 77 East King Street P.O. Box 250 Shippensburg, PA 17257 Time Deposit Inquiry Page 1 of 5 16:55:54 CIF number: SHIRK SBA3278 Phone: (H) (717) 249-2559 Birth date: (B) (000) 000-0000 8/28/1926 Tax ID number: 166-20-4579 C/D type: I)9 36-41 Mon th Growth Account number: 4000031083 30,326.80. Certificate no: 1 of 1 65.81 1,000.78 Interest rage: APY: 3.300000` 29,391.83 C/D term: 3.350 2/06/09 30 000 00 Maturity date: 40 M 6/06/12 , . Hold amount: 00 6/06/09 Y-T-D interest: Per diem: . 326.80 2/06/09 30 000 00 Next payment. date: 2.74187 7/06/09 , . 0/00/00 Next pay amount: Value after next pmt: .00 1 M Renewable: .00 Add to balance Deposit Acct/Type: Yes F2=Image F3=Exit F6=Messages F8=Maintenance ,QO~~r /3 ...Z~-t.Ji n ~ ~ W eS ~ i~Orh {ti''e ~ S~met C~~-~~s~e, P~1 ~~~a/3 More... F4=Sweep Inquiry F24=More Keys ~~~'oV 'JUL 14 200 ~RWIN & McKNIG~' ~tN OFFICES . ~~.:.:~~::~_~~_;~ _ _ _~ i~„Iii33,Iii~,,t;,il.~If„~i ~',),1;i Ilti, i~, ~ ij, 1-~l-is,i,~-;l ii/ uy Sara S Snyder Has messages ~ 'O~riginal balance: Current balance: 1=View 6=Print T=Tset Opt Posted InputSrc 2/06/09 G 2/09/09 M 3/06/09 G 3/06/09 G 4/06/09 G 4/06/09 G 5/06/09 G 5/06/09 G 6/05/09 G 6/05/09 G 7/06/09 G 7/06/09 G 111~tC LCrV.71 ~.. 1aaYYi+.s Account number: 30,000.00 YTD interest: 30,409.06 Nex t pmt date: Control: From Rate T/C AFF Amount 3.300000 651 020 C B 30,000.00 670 D I 75.95 671 C B 75.95 670 D I 84.29 671 C B 84.29 670 D I 81.80 671 C B 81.80 670 D I 84.76 671 C B 84.76 670 D I 82.26 671 C B 82.26 4000031083 1 of 1 49.06 8/06/09 To Balance .00 30,000.00 30,000.00 30,075.95 30,075.95 30,160.24 30,160.24 30,242.04 30,326.8 3 .80 30,409.06 F4=Redisplay F7=Scan forward F8=Scan backward F17=Top F18=Bottom F20=Fold/Unfold ORRSTOWNBANK A Tradition of Excellence 77 East King Street P.O. Box 250 Shippensburg, PA 17257 Bottom F16=Sort F22=Tran Codes O~~t~ POSTgG' ~~ 7 ~~ 02 1M 0004284313 MAILED FRO{V9 ZIF 2 o~~r i3 , .,Zr yr i n ~~~~f~~® (~ v c,~~st ,uo,~ {~'e ~ s~~~ IJUL 14 ZOOS ~,/IrSle~ PA i7or3 sRWIN & Mc{SN~GIi't AW OFFICES ,,, ,,, ,~, .,,"~~w "~,;"':.; .,;i ,,. ..°... ... ~Fi llr~SS}I~l'1!!!il~~i if7ll31~~i!l~~d~!'i!!l-1 I1l1i!}l~Ffi}~}3~i~ Thrivent Finan i cal for Lutherans EC~~vE® July 6, 2009 Irwin & McKnight P.C. 60 W. Pomfret Street Carlisle, PA 17013 RE: Estate of Sara Jane Snyder IJUL 0 8 2009 ~RW~~I & McKNIGH i @JaW OFFICES Dear Roger Irwin, South Central PA Group southcentralpagroup@thrivent.com Michael P. Smith, MBA, Flc Senior Financial Consultant michael. p.smith@thrivent.com Michael P. Gallagher, Flc Financial Consultant michael. gallagher@th rivent.com 101 S. US Highway 15, Suite B Dillsburg, PA 17019 Office: 717-502-1100 To I I-free: 8 7 7-6 74-110 0 Fax: 717-502-1119 On behalf of Michael Gallagher, I am responding to your letter dated June 26, 2009 in reference to the Estate of Sara Jane Snyder. 1) Sara S. Snyder, annuity contract #63384854 issued on 3/14/2001 Sara S. Snyder, mutual funds acct #362100318254 issued on 10/5/2007 Sara S. Snyder, mutual funds acct #181800017539 issued on 7/5/1988 Sara S. Snyder, Universal Life Insurance contract #5823667 issued on 8/27/2002 2) See dates above 3) No ownership changes 4) No accounts were closed within 1 year of the date of death 5) MM #181800017539 $53.59 interest accrued in 2009 MF #362100318254 $360.84 interest accrued in 2009 Annuity $43,323.51 date of death value, Jan 15t 2009 value $42,683.33 Cost basis is $30K 6) Date of death balance: MF #181800017539 $21,228.65 MF #362100318254 $31,977.68 Annuity $43,423.51 Also enclosed is a premium refund check for the Long-term care policy that Sara had. Will you please instruct us on how to handle the claim form for the Mutual Funds? There was no beneficiary listed. Should this claim form be sent to you at this time or later when the estate is settled? Sincerely, ~~~ Kay Stone Office Professional South Central PA Group (717) 502-1100 Enclosure (1 ): Check #G337710 ashell Main Offices: Appleton, Wisconsin, and Minneapolis, Minnesota • Thrivent.com Registered representative for securities offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415-1665, 800-847-4836, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member FINRA. Member SIPC. ~~ `~ Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 July 7, 2009 Roger B. Irwin, Attorney Irwin & McKnight, P.C. 60 West Pomfret Street Carlisle, PA 17013-3222 CEI~E~ IJUL 13 ~~:: ~R~IIN & NICISIV:If~H''i LAIC OFFICES Re: Sara Snyder Contract No: GA18439881 Dear Mr. Irwin: Thank you for your correspondence to our department dated June 26, 2009. The following is a breakdown of the information you had requested on the above closed annuity claim: Title of Annuity: Sara Snyder 2~ Date of Issue: May 6, 2005 No Ownership Changes Value of the Annuity on the Date of Death: $39,557.81 Principal: $25,000.00 Accrued Interest: $14,557.81 Should you have any questions, or require further assistance, please contact our Customer Care Unit at 1- 877-499-6418. Sincerely, e ife vans Sr. Claim per ~~ A I I state U Yau`re in good hands. • ~ Annuity Number 1. Owner(s) If the owner is a trust or other non-living entity, it wills receive any death benefit due regardless of any beneficiaries designated on the contract. • ..•..nnnll.[ /1NNUtT1/ ssued by: Allstate Life Insurance Company • 3100 Sanders Road Northbrook, IL 60062 Mail ta: Allstate Life Insurance Company • 2940 S. S~r.~ Street, Lincoln, NE 68506-4142 • 800-755-5275 GA ~~ 34393~~ - Name J U.t2o. J ~~ ^M BD1996 / 02 (~ ~- ao - ys~9 ~~ _ ., ~_ '=/-=/ aoc~s ,Stt~eet Address ~ ~ CsaQ~aa~C~ ~o u12~ Soc. Sec. No.R N~ City C`a.2~ ~ s ~ e. State n~ Zip l ~ o ~ 3 phone No. ~ 1 ~ Name ^ M ^ F Birthdate Street Address Soc. Sec. No./TIN City State Zip Phane No. ~\ Are all Owner(s), Annuitant and BeneficiaryQes) U.S. Citizens? ^ Yes ^ No If no, list name and country of each in Special InstnlcUo~ 2. Owner Type ndividual Non Grantor Trust* ^ Corporate/Association ^ Tax Exempt/NonProfit Organization Minc ^ Partnership ^ Grantor Trust* ^ Custodial Account ^ CRT* ^ Other *Trustee Name(s) *Grantor Name Cf applicable) 'Grantor Date of Birth pt applicable) 3. Annuitant Name ^ M ^ F Birthdate / / Leave blank if Annuitant is the same assglerl)wner; Street Address Soc. Sec. No. - - otherwise:complete. City State Zip Relationship to Owner 4. Beneficiary(ies) Names-~.• S~e.,ohe.,.t ~--u~e.R.~~.! Relationship to Owner ~~~CC~ Include additional b f i i f i Soc. Sec. N .lTIN ~ - aU5 _ 5'10-1 ~ Birthdate / / a/c ene ic ary n ormat on under Special Instructions. ~t Address ~ O g o X of ~o to City 1~e ~ 1 ~ fo t")~tate i~ Zip ~ ~ O i Name Relationship to er Soc. Sec. No./TIN - - ~ ~ Birthdate / / Address City State Zip 5. Tax Qualified Plan ^ Yes No (Must check one - If Yes, complete the following.) ^ Traditional IRA ^ Roth IRA ^ SEP -IRA ^ IRA Rollover ^ IRA Transfer ^ 403(b) Contribution: ^ Individual ^ Employer $ Year: 6. Purchase Payment Retum of Purchase Payment Guarantee' es (accept) ^ No (waive)' Input initial purchase Note: if no selection is made, you will receive the Return of Purchase Payment Guarantee. payment and initial guarantee period(s). n [election 1: Source of Payment: ~ ,,,,, ~(" ,, „ y O j~ for "''$ ~ year(s) ^ Personal Check for year(s) ^ Wire for year(s) ^ 3rd Party Check $ for year(s) ^ Cashiers Check/Money Order (Other X035 ChG.~~^~~]Q. ~ Additions! 0.504b first year interest available only if Retum of Purchase Payment Guarantee is waived. J ':- -Replacement o-you ave any existing, annwty or i e insurance contracts? es o , Information Will this annuity replace or change any existing annuity or life insurance? [-~'S'es ^ No pf Yes, complete the following. Company 1n~2S ~-~nl Sc, ~,-~{, ~~,~} Policy No. W~ C~ 5~~~ ~ y ~ 8. Speciallnstructions I ,i~` 9. SlgnatUre(S) Owner(s) Signature Required I `represent that the information provided above is complete and true to the best of my knowledge and belief. I have read the Important Notice and'gny applicable fraud warning. for my state on the reverse side. I i _ acknowledge for Tax Qualified Mnuity contracts that all additional forms and disclosures will be sent directly to me. ~i .. Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to .me), and (2)1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b)1 have not been notfied by the Intemal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report _ `~ all interest or dividends, or (c) the (IRS) has notified me that I am no longer subject to backup withholding, [3) I am a U.S. person '~ (including U.S. resident alien). The Internal Revenue Service does not require your consent to any provisions of this document other than the certfication required to avoid backup withholding. r Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-249-2677 249-1978 697-4794 September 20, 2009 To: Roger B. Irwin 60 W. Pomfret St. Carlisle, PA 17013 From: Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 Re: Estate of Sara Jane Snyder Personal Property Auction Total Sales $15,474.00 Less Household Items @35% Commission -3875.89 Less Vehicle @ 25% Commission -1100.00 Total Due Estate $10,498.11 Rawe's Auction Service William G. Rowe