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HomeMy WebLinkAbout10-20-09~ ~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 15056051058 REV-1500 EX (os-05) OFFICIAL USE ONLY PA Department of Revenue Cou Code Year File Number Bureau of IndNidual Taxes ~' PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT O~ ~ ' O ~ ' O~ 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 208-24-0456 ' 03/21/2009 '. 02/06/1933 Decedent's Last Name Suffix Decedent's First Name MI SOLLENBERGER 'MARGARET ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI __ FILL IN APPROPRIATE OVALS BELOW >.:>•::: 1. Original Return .., ,,. 2. Supplemental Retum ,. :,., 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) '.*; 6. Decedent Died Testate ::;;; ;:• 7. Decedent Maintained a Living Trust _ . 8. Total Number of Safe Deposit Boxes (Attach Copy of WIII) (Attach Copy of Trust) ..:.: 9. Litigation Proceeds ReceNed .... .;• 10. Spousal Poverty Credft (date of death .. ... 11. Electlon 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number r„~ :PAUL BRADFORD ORR I 717 258 855~ 0 ° ~~ ( ) - ~ ~} Firm Name (If Applicable) _t~ _ _ _.... - _~~... , G3 '.~ REGISTER OF tt>YI~ E O c>'S`= LAW OFFICES OF PAUL ORR ' ' ~'= r~i-i N ~;-; ;-; -, .,_._ ._, ~.J o _. ^~ ...). . `....J First line of address %'~ 50 EAST HIGH STREET r _ `-~-~" ~ -~ '^~ .. ..... Second line of address _ ---i ~ ~ .. :> ~ .-} 3 _ _ _ _ _ _ _ _ _ ~ .~ _~ -~ O v~ City or Post Office State ZIP Code _ DATE FILED CARLISLE PA :17013 __ _ __ ............................................. . Correspondent's e-mail address: paulorrcLDembargmail.com 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 Dersonal representative is based on all information of which preparer has any knowledge. SIGNATURE.OF PERSOt~I RESP SIBLE FOR FILING RETURNcr~{~~~~ ,~/J~ ~" O ~ / ~ ~~E ! d ^O~ 1~9 WALNIJ,T STREET, CARLISLE, PA 17013 iIGNAT~E OF EP/t~ER R THAN REPRESENTATIVE DATE 50 EAST HIGH STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 r 1 15056052059 REV-1500 EX Decedent's Social Security Number :.................................................................... Decedent's Name: MARGARET J SOLLENBERGER :208-24-0456 RECAPITULATION ,. ... ..... ............................................................................ 1. Real estate (Schedule A) ............................................ . 1. ' 75,000.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 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. ' 2,063.01 __ ._ 6. Jointly Owned Property (Schedule F) ':.:;~ Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property :..... ........................................................................... ; (Schedule G) ~;.~;~ Separate Billing Requested....... . T. :...... ...........................................................................: 8. ........ Total Gross Assets (total Lines 1-7) ................................... ............................................................................................................................................. . 8. ................ 77,063.01 ........................................................................... : 9. Funeral Expenses 8 Administrative Costs (Schedule H) .................... . 9. 21,352.98 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............... . 10, 6,869.01 11. Total Deductions (total Lines 9 & 10) .................................. . 11. I 28,221.99 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 48,841.02 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which " """" """""" """ " """"" "" "" " ' an election to tax has not been made (Schedule J) ....................... . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. ' 48,841.02 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate x .0 4~ ' 48,841.02 16. ' 2,197.85 17. Amount of Line 14 taxable _: at sibling rate X .12 17. 18. .....::::.:.... Amount of Line 14 taxable at collateral rate X .15 18, 19. TAX DUE ........................................................ . 19. 2,197.85 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Flle Number .................................................. Decedent's Complete Address: DECEDENTS NAME DECEDENTS SOCIAL SECURITti' NUMBER MARGARET J SOLLENBERGER 208-24-0456 STREETADDRESS 255 S. PITT STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A+ B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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 26 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2,197.85 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 :.......................................................................................... ^ ^Q 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 consideration7 .............................................................................................................. ^ 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 designaGon? ........................................................................................................................ ^ ^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-0ne 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 [!2 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. LAST WILL AND TESTAMENT ~„ _, OF ~~ ~ .. ,..~ _ MARGARET JEANSOLLENBERGER ~ __ - ' ) s;.7 , - ~`,`~ tJ '~' ~ ~ . _. l '~ I, Margaret Jean Sollenberger, also known as Peggy, of 255 South Pitt 5tr~~t`~arlis?~, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and wxc~rstandiz~g ~ :,, do hereby make, publish and declaze this as and for my Last Will and Testament, her~b~?revoking ~ other wills and codicils heretofore made by me. ~ ' FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I specifically devise and bequeath to my Granddaughter, Heidi Foreman, of 594 Mountain Road, Boiling Springs, Cumberland County, Pennsylvania, the sum of Two-thousand Dollazs ($2,000.00). THIRD: I specifically devise and bequeath to my Grandson, Deric Sollenberger, of 251 Walnut Bottom Road, Cazlisle, Cumberland County, Pennsylvania, the sun ofTwo-thousand Dollars ($2,000.00). FOURTH: I give devise and bequeath the residue of my estate, of e~rery nature and wherever situate, to my sons, Jeffrey A. Adams, of 129 Walnut Street, Carlisle, Cumberland County, Pennsylvania; and Lawrence L. Sollenberger, III, of 101 Country View Estates, Newville, Cumberland County, Pennsylvania, equally, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death, shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death, and in default of such then-living issue, such shaze shall be added to the share or shares for my other child. FIFTH: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SIXTH: I nominate, constitute and appoint my Sons, Jeffrey A. Adams and Lawrence Sollenberger, III, Co-Executors of this my Last Will and Testament. Shduld my Sons, Jeffrey A. Adams and Lawrence Sollenberger, III, fail to qualify or cease to act as Cq-Executors, I appoint my Brother, Paul L. Snyder, Executor of this my Last Will and Testament. MARGA T JEAN SOLLENBERGER Page 1 k ~ ~ 7 ~ r_ REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . PA No . 21- 09- 0301 Estate Of : MARGARET J SOLLENBERGER (First, Middle, Lastl a/k/a : PEGGY J SOLLENBERGER Late Of : CARL/SLE BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 208-24-0456 WHEREAS, on the 31st day of March 2009 an instrument dated February 26th 2009 was admitted to probate as the Iasi will of MARGARET J SOLLENBERGER /First, Midd/e, Lastl a/k/a PEGGY J SOLLENBERGER late of CARL/SLE BOROUGH, CUMBERLAND County, who died on the 21st day of March 2009 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: JEFFREYA ADAMS and LAWRENCE L SOLLENBERGER 111 who have duly qualified as EXECUTOR(R/X) and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 31st day of March 2009. c~.~ ~ ~ eguter of Wils Dep * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) 105.905 RF,V.(~/09) ~~ A Thisl is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ ~. ~-:~.e%~ Linda A. Caniglia State Registrar 4920391 M~'R ~p ~ppg /~~'~~ Date .inos.u3 REV nanoo No. nPEiPwNrm COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS such uac PEnwN~ CERTIFICATE OF DEATH (See Instrue[lone and examples on ovens) STATE FILE NUMBEp 1. Neme d Denaerl Qiq ntly, rel «ap Mar ret J . Sol lenberger 2 ~°" a sam s'°'N' "°i°" `• Gu a °«" tww, dx x"u•ll+ue.mewl tkel.r, unar, e.amaam kba,L ,,® endemr F 208 - 24 - 0456 March 21 , 1009 ~+. 6.n xur use. x Phw a u.ee tcneac Dory arl 76 m. 2/6/1933 Carlisle, PA "°'°'"` °""'° Sons Home a>.ca,uyao.rh ec.cty,mm,tYm.aOSeui eaFadAyNerrmnaYaallon,gwse6srrgmmbei ^I~9 ~~/~Q.~.asaa ^ooA ~' NuekeNom. ^rewa.nr ®ahr•spay NYperJC OapM No ^ Yw 1Q Necc Nrrrk'an IM«, neck, Wnhe, ak. Ctmtberland Carlisle Boro. 129 Walnut Street ~"''°`~'~'~ tspay7 Mrbri, Pu.m wrn, .ec.7 White n. or«rre uwr aerk eons maq a AIw Oo as MW t2 wse oepynl err k aNt ,3. Ga,bnys Eauotlor, k7na awak ,anaa anYwe ~ bdrry u.s. Armtl Faara E,enrr~ ~ (~M 01~' hlprq Peas mMasel ,a Neael a.ns AAsakd. nber NerNa, ,s.3irvNkp Spue Jrc x,h, pw meklen nerr) Her awn hairs ^ne ®Nu 11 s•~rr (o-,s7 ~•w c+~ r s.7 wkbwa, ohemr lspo3,i m °.wa.a'• wapAaa.e lsk..t ay nnwn m,.IP mal OeptlNRe PA ota uwwruidOWed - AdvY N«IaNiu 17e.91er ~5 $. Pit St i~or:npt `,~~^rr,oemr,uu.dn TeP rlisle, A j 7013 ,mGuny Ctm7berland T'd~~ ~lau+dw1tl°+ Carlisle 16 Faarfe Name Ige4 mWe, Irk ~ Ciy ~ eam I3. Mahr'a Nrr ffyq, moor, mtlaee wmrme) 2oekaae.nrer.m.nvP. PmU Sn der Martha J. Woods , Jeffre A. Adams 20b "X01"r''•"~^u^~um.•tskrtalyik.rr,.m.nP,ae.> z„wmmaorPOaAa, ^ ^ourua, zm or.a 129 Walnut St. , Carlisle, PA 1 7D13 ® Burlel ^ Rennw~ hom 5rr wa Cnneuon or Oenellon Authr,ra °A (Moe. asy, yeeQ 2,c Pru a OYPOSeso pNn~ a rewrY, aesr4y a obr P4e7 21Q LenYOn (CN ~ br4 err, by aMy ~ ^ auw-spay, byMe9oelEaebr,Orrr4 ^Y«^N. 3/25/2009 aesgn.k..a urrrrlor Westminster Cemetery Carlisle, PA Z26llrir NUlkr 27t Nerr rdAdAerdFrBN ~ FD 012633 L carcrr 21seaYyenrwaykq z3e.To amyknaerg7., eerrr«r w,. yr,,,d~i1r,at~~tle r 1 Haste .Inc., Carlisle, PA 17013 Pkymn r na wba. a Am. a are b ) _ asey.r..aa•.ul -(~-dzet.. Yr~ Lt1 'f n! ~Pnl Rnl3oo /L ~~ c~/~~2009 n.n. zaza rs, a mnprra N Anon u. tkp a ore za. Oesa (Abn,lk asy, yrr) . e,n Piaiwire orb. ~ . ~o ~ M, ~ ~ avo9 ~' ~~ Rp.n•a,p MMUI Eunik., Caon..la. Mra, OMer Pron Cr.mWOh m ~artlon9 mm 27. PN I: Ear Ar CAUSE OF DEATH (8•e Irrtructlan.na ) - rL•7" ^!o ALAiudmma-rAeeree. kl~er5rmrrpketlone_yrp r ~lPPraEnrte kaenel: Penn: Eaer WNr rosprray rreel,rwgaAr AtrEe,hi ~ aY«ayaurtl tly tl•elltWNOTeMrlrmkW •wir euai rcrdr TB.ON TebreoUPbDesAi7 ~'°~ analogy LW aYy ar uus «seai rr 'f1O~ Owt b Wai 6a ria reeJ6e h UN ueNewp rir ytin b Pen L Yr _ ~.D''?/Y1Cci ~ a~e~Me~ Orr b la u . coneepr•rne a); r ~ MaeWtlaa,Hry, h. ~ ~NOI Pr.ei.s eaNn pu yer b anus Apra an Fe e. , ^ Pnpra Y Irr d aeeth ~_ IMO~DFryAaLYrNO CNUBE Ou b (v «Y mr1«gprp pq: iNr« rrY~p~n ara~~• c. ^ Na DrepriL Oo, pr•prru xaNn 42 a.ye aN b r u e anea7unn ay: a «.e d i ^ Na nrw~rt 6W PnpwAU agnbly«r IwM Aesa ~P'~rt ~d~.y 7Ak. Ww. r P.R~, waYn tlM pq yav AMw4461S~Pnof 3,. a Deeb 93 ore a Y1MYV Ikbml a,y ywq 37A Drree Fbr k~ny OmrM ~E. Pk«~Injyu AF1mr F.m1, ~ a Gus ot\Dasafl Nebm ^ Haaaas OFa ~0. eC (Slpeay) 91re1. FrWY. ^ Y« ~Na ^ n, Ste„ ^ kdaaa ^ P.r,m~ro kM«z,u,n z~. time a iNry zz.. e~uy n wake szl. un•nyoawun k~un fspa,Yl spa Loonm a kV.n fart aN ibwk.,:ul ///YYY ~~~~~~___ ^ ems. ^ Gm Na c. Grr~a.a µ ^ n. ^ No ^ o~«i caam ^ v....a,r ^P.aarn . $ae,y,. 33e, aMr la.ac rar arl ~ 376. epnwe w ' ~Ykg PMebrn IPMsiir auayk,a aew a aesa eTen erionrr PI,Y•den hu pewaaq a«m ena mmp.ra nem 277 r To ar eer a Nry,sewrane, aeetlr epurea dr b ar erre(p em nrreerr «rA.d_..' _ _"""_' Ra~^o~~hWPM.7a«(PNraen6anPmw.ryga«m.naawykgbcawaaMml _~_________________ Thlhe wramy knPerape, aeedt oea.naru. nr.,der, ena p4«,Wawblh aree(eleM rellM,r erta~_______________ 39e. 1k«ee NwEr _ • asAN Eeemkw/Carry ^ J~ y~'_ / ~ q ay,ea (MrM, aaY. Ter) onar6.wa....kruen.na:ru~.«npua,,b,nrrolma~a«a«armarwu,n..am,.neProe~.naaw«uro ////~ ~ ~ /~~ March 23, 2009 wp)ma murrretesa_ ^ &. Name entlnmr«dPrrr, who ~ 7s.neprk.n cwk, carorrac.r+ao.rnnt.nz>ttyP.,Pnm ~ ~ ~~ (.,~f f I al C Ib I G"~'e°~°"~''y''""1 Philip D. Carey, M. D. ~ Carlisle, PA i Oleprron Penar Na. _ ~.1C.J `f"I 3 n f ~ ~ ~ ~ pennsytvania SCHEDULE A DEPARTMENT OF REVENUE INHERRANCE TAx RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET J. SOLLENBERGER 21-09-0301 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 fads. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a rnpy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' 255 SOUTH PITT STREET, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA 17013 75,000.00 __ __ __ _ __ _.. ______ _ _ __ ___ __ __ TOTAL (Also enter on Line 1, Recapitulation.) $' 75,000.00 ]f more space is needed, insert additional sheets of the same size .l Settlement Statement U.S. Department of Labor and Urban Development a, , I'. t7 Q~~' gY:.----~--f~--------- ,,..o . A. HUD-1 UNIFORM SETTLEMENT STATEMENT B. T of Loan 1. [ ]FHA 2. [ ] FmHA 3. [ ]Conv. Unins. 6. File Number. 7. Loan Number: 8. Mortgage Insurance Case Number. 4. [ j VA 5. [ ]Conv. Ins. C. NOTE: This form furnishes a statement of settlement costs. Amouts paid to and by the settlement agent are shown. Items marked "(p.o.c)" were paid outside the closing; they ere shown for informational purposes and are not included in the totals. D. Name 8 Address of Borcower: William C. Linsenbadr 47 Pennway Circle Carlisle, PA 17015 E. Name, Address and TIN of Seller: eflrey A. Adams Lawrence L. Sollenberger, III, Co-Executors of the Estate of Ma aret J. So9enbe er, Deceased F. Name & Address of Lender: Bank of Lendisburg P. O. Box 179 Landisburg, PA 17040 TIN of Seller. 61-6377430 G. Property Location: 255 South Pitt Street Borough of Carlisle Cumberland County, Pennsylvania Place of Settlement: 139 West High Street Carlisle, PA 17013 H. Settlement Agent: Keith O. Brenneman Date of Settlement: 10/2109 J. Sum of Borrowers Trensac0on K. Summa of Seller's Transaction 100. Gross Amount Dus from Borrower 400. Gross Amount Due to Seller 101. Contract sales prlce 575,000.00 401. ContreG sales rice 575,000.00 102. Personal props 402. Personal property 103. Borrower's settlement char es (line 1400 53,082.50 403 104. Mort a Payoff 404 105 405 djustments for Items paid by seller in advance Ad]usfinents for Items paid by seller In advance 108. Cityrtown taxes to 4~. C' nown taxes to 107. County taxes 10/02n)9 to 12/31/09 5104.65 407. Countytaxes 10/02/09 l0 12/31/09 5104.65 108. Assessments to 408. Assessments to 109. School Taxes 10!02/09 to 06!30/10 5694.14 409. School Taxes 10/02/09 to 06!30110 5694.14 110 410 111 411 112 412 113 413 120. Gross Amount Due From Borrower 578,881.29 420. Gross Amount Due to Seller 575,798.79 200. Amounts Paid b or in Behatl of Borcower 500. Reductions in Amount Due to Seller 201. Deposits or earnest money 51,000.00 501. Excess depoaH (ass instructions) 202. Princi al amount of new loan(s): 575,000.00 502. Settlement char es to seller (line 1400) 55,246.54 203. Draw on construction loan S70,000.00 503. Existin loans taken subject to 204. Draw for closing costs 53,080.79 504. Payoff of first m a e 205 505. Payoff of second mort a e 206 506 $0.00 207 507 208 508 209 509 Ad uatments for items unpaid by seller Ad ustmenta for Items unpaid by seller 210. CHy/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213 to 513 to 214 514 215 515 216 516 217 517 218 519 220. Total Paid Bylfor Borrower 589,080.79 520. Total Reduction of Amount Due to Seller' $5,246.54 300. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller 301. Gross amount due from borrower (line 120) $78,881.29 601. Gross amount due to seller (line 420) 575,798.79 302. Lass amounts paid by/for borrower (line 220) $89,080.79 602. Less reductions in amount due seller (line 520) $5,246.54 303. Cash (]from [x ) to Borrower $10,199:50 603. Cash X to ]from Seller E70,552.25 Substitute Form 1099 Seller Statement The Information in Blocks E, G, H, I & line 401 (or if line 401 Is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this Hem is required to be reported and the IRS determines that H has not been reported. If this real estate is your pdncipal residence, file FORM 2119, Sala or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your taxpayer kientificatlon number. If you do not provide the Settlement Agent with your taxpayer identification number, you may be subject to civil or crlminel penalties imposed by law. Under penaties of perjury, I certify that the number shown on this statement is my correct taxpayer identificetion number. L. S ttlen nt Charges 00. Total SaleslBroker's Commission: (based on price) 75,000 ~' S $3,750.00 Paid from Paid from Division of Commission (line 700) as follows: Borrowers Seller's Funds at 701. $1,850.00 to George L. Ebner 8 Associates Funds at 702. $1,900.00 to A+ Real Settlement Settlement 703. Commission paid at Settlement 3,750.00 704. TransacSon tee to A+ Realty 250.00 800. Items P ble in Connection with Loan 801. Loan Origination Fee to Bank of Landisburg 800.00 802. Loan Discount 803. Ap reisal Fee 804. Credit Report to 805. Lenders Inspedion Fee 808. Mort a e Insurance Application Fee 807. Flood Certification Fee to SOB. Tax Service Fee to 809. Document Preparation Fee 810. Plan Review to 811. Assumption Fee to 812. Bank of Landisburg -draw fee 500.00 813 814 900. Iterrrs Required by Lender to Be Paid In Advance 901. Interest from to ~ per day 0.00 902. Mortgage Insurance Premium for 903. Hazard Insurance Premium for 904 905 1000. Reserves Deposited with Lender 1001. Hazard Insurence months ~ per month 0.00 1002. Mortgage Insurance months ~ per month 1003. City property taxes months ~ per month 0.00 0.00 1004. County property taxes months ~ per month 0.00 1005. Annual assessments months (~ r month 0.00 1006. School taxes months per month 0.00 1007 1008 1009. regale Accounting Adjustment 1100. Title Charges 1101. Settlement/dosing fee 1102. Abstrad/6tle fee 1103. Title examination 1104. Title insurance binder 1105. Dowment preparation 1106. Notary fees 1107 Attorney's fees to Gerald R. Morrison, Esquire 150.00 (indudes above item numbers 1108. Title CertiOcetion to Keith O. Brenneman, Esquire 750.00 (indudes above item numbers 1101-1106) 1109. Lender's coverage: $150,000 1110 Owners coverage: $75,000 1111. Insured Closin Letter 1112. Endorsements 1113 1200. Government Recording and Transfer Charges 1201. Recording Fees: Deed: $49.00 Mortgage: 558.50 M/L Stip: 1202. City/countytax/stamps Deed: $750.00 Mortga e: 1203. State taxJstamps Deed: 5750.00 Mo a e: 107.50 750.00 50.00 1204 1205 1206 1300. Additional Settlement Charges 1301. Survey 1302. Pest Inspection to Bowers Pest Control 25.00 1303. Courier Fee to 1304. Tax Certification Fee 1305. Borough of Carlisle -water/sewer balance due 7/9-1011 1306. Attorneys fee/Deed preparation fee to Paul B. Orr, Esquire 1307. Nola fees to Robin Starner 61.54 425.00 10.00 1308 1400. Total Settlement Charges (This number transfers to Ltnes 103 S 802 Above) 3,082.50 5,248.54 Certficetfon _ _ ... _. .... _ _. __~ ._ .~_ ,.__. _~ ...... L.....uleAns enA Mlinf if is a }rIIP And ACLllrate stet@ment Of ell I have carefurly rewewea me nvrr 1 aeulclnol~. ~.a.a„~o„• o,... ,- ...- -__. _...., ....--..--~- _. _ _ - redepts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement !rte G `/`"-- Borrower /v Seller t~^^t^-mot , ~r L~-4~- =+ Seller To the est of my knowledge the HUD-t Settlement Statement which I have prepared is true and accurate account of the funds which were received andth een or will be disbursed by the undersigned as part of the settlement of this transadion. ~~ Settlement Agent Date: Keith O. Brenneman WARNING: It is a crime to knowingly make false statements to the United States on this or eny other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. ~ ~ REV-1508 EX+ (6-98) SCMEpVLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET J. SOLLENBERGER 21-09-0301 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK CHECKING ACCOUNT N0.610073-187-1 915.39 2. REFUND FROM UTILITIES 66.50 __ 3. REFUND FROM LEFFLER ENERGY 50.00 4. REFUND FROM THE SENTINEL NEWSPAPER 31.12 5. 1995 4-DOOR SATURN AUTOMOBILE 1,000.00 .. TOTAL (Also enter on line 5, Recapitulation) $ 2,063.01 (If more space is needed, insert addkional sheets of the same size) i ~ .i ._; -K; fit ...~ ..~ fn ~t :n ...~ `~,~`\ z L m i "4 ""~ S '~ my n ~ ~~ ~-- ~~, jai G'~ --~i ~ '. N C 3 ~.. m .~ 1 c N 1, m i A ~ O 7 .,~ ~ '~O A v ^~- y~ 3 0 c .~-t p~7 N J Q S SD (~p a O N A O O C m w m w a `c' N O 0 a N ~ ~~ `~ ,~, ~~ ~`~ ~, ~`: {A W T 0 3 0 c v Q a '~. ~rl ~~ '. ~, `..: r, r O Z v m m n z r t '~ ~~ Citizens Bank 711 1-888-910-4100 Call Citizens PhoneBank anytime for account information, current rates and answers to your questions. US002 BR289 PEGGY J SOLLENBERGER 255 S PITT ST CARLISLE PA 17013-3812 C~ascd G~Juv~~' ~~a~l~~ Checking Account Statement Beginning May 23, 2009 through June 22, 2009 O OF 2 Checking SUMMARY Balance Calculation Previous Balance 927.39 Checks .00 - Withdrawals 12.00 - Deposits & Additions .00 + Current Balance ~ 915.39 = TRANSACTION DETAILS Withdrawals Other Withdrawals Date Amount DesMpgon 06/22 12.00 Monthly Maintenance Fee Daily Balance Date Balance Date Balance Date Balance 06/22 9?5.39 ~ NEWS FROM CITIZENS --IMPORTANT NOTICE/ CHANGE IN TERMS Effective August 1, 2009, the handling fee for certain court orders and legal processing will be changed to E125 for each item that we process against your account. This includes court orders, garnishments, attachments, tax levies, executions, and similar types of legal process. --IMPORTANT NOTICE/ CHANGE IN TERMS Effective August 1, 2009 the Inactive Account Processing Fee for Personal & Business Deposit Accounts will be changed to f50. This fee applies to all accounts that have been inactive for 24 months or more, and is in addition to any applicable monthly dormant account fee. This fee is not imposed on New Jersey based accounts that have been charged the maximum dormant account fee. --Better online banking is on the way. The new Citizens Bank Online was designed to bring you more accounts, more information, and more capabilities to give you the power to manage your complete banking relationship - in one place. New features include viewing your pending transactions on your checking account history screen, transfer funds online to Citizens Bank customers, make transfers between accountr you own at other financial institutions and your Citizens Bank accounts, and access your Mortgage and Credit Card Accounts using Online Banking. --We offer the perfect banking package for high school and college students. Learn about our free Green Checking, online banking, Green$ense rewards and student loan options at your Member FDIC Q Equal Housing Lender PEGGYJ SOLLENBERGER Combined Checking 610073-187-1 Previous Balance 927.39 n Total Withdrawals 12.00 n Curren~nce ! 915.39,! \, f ~. - __ .~ ._ _ _ _ __ _ __ _ _ _ __ _ -~- r 1 r Checking Account ~~ Citizens Bank Statement r % 1-888-910-4100 © of 3 Call Citizens Phone6ank anytime for account information, current rates and answers to your questions. Beginning February 25, 2009 through March 23, 2009 US259 BR 289 3 1 PEGGY J SOLLENBERGER 255 S PITT ST CARLISLE PA 17013-3812 Checking SUMMARY Balance Calculation Previous Balance 11,154.88 Checks 10,033.53 - Withdrawals 100.00 - Deposits & Additions 1,000.35 + Current Balance 2,021.70 = PEGGY J SOLLENBERGER Combined Checking 610013-187-1 Previous Balance -- TRANSACTION DETAILS 11,154.88 - CheCICS' There is a break in check sequence Check q Amount Date Check i< Amount Date 1489 233.53 03/23 1491 800.00 03/18 1490 9,000.00 03/17 Total Checks 10,033.53 Withdrawals Other Withdrawals Date Amount Description 03/09 100.00 Scheduled Transfer 6245540076 Deposits & Additions Date Amount Dexription 03/02 939.39 US Treasury 312 Civil Serv 030209 F 1921732 W Csf 03/06 60.96 Western-Southern Ifs Vapymt 090305 C5w0020809013 E Daily Balance Date Balance Date Balance Date Balance 03/02 12,094.27 03/09 12,055.23 03/18 2,255.23 03/06 12,155.23 03/11 3,055.23 03/23 2,021.70 ~ NEWS FROM CITIZENS --Planning your next vacation? Get CASH BACK with your Citizens Accelerator Rewards Platinum MasterCard! 3°/o cash back on gasoline purchases at any gas station and 1% cash back on all other purchases. Earn $50 and we'll automatically send you a check right in your credit card Member FDIC 1~ Equal Housing lender Total withdrawals 100.00 Total Deposits & Additions 1,000.35 n Current Balance 2,021.70 ~ ~ We, Stacy and Tony Starner, are purchasing a 4-door 1995 Saturn, from Margaret J. Sollenberger in the amount of $1,000.00. ,~ ~, ~~~ ~ ~~~~ y ,.~ ~~`~ K r SATURN Na lreeiM -haN-Y. ~ D7e Nb/ MSAP WNW Lp Iht qS 175 2N5 2505 Sedan 40 SL2 ..:......... 2150. 27N Welton 4DSW2 .......... .. Z(JIK),5 12895 2425 Y8N Z(JM]N~ ]4290 2479. 2450 3775 35N b0 ANMumirumlNbyWheels ........ ... SO N 75 =75 Sf 011 Crutee Conird ........... .. 1 ~ 1N OI/1~eetherSesls ............. .. ... 90 75 6B~ BMPbwerpoorLodcs .. ... , 1N ~ 175 130 881 Power Sunroof ....... ....... . SO 75 N All Power Wbdows .. . 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Z(GIH)1 15385 2419 2171 Z 13305'2288 tns ; 36N 3155 1355 1l2S 2~155`Coupe3[SSC2....... 1 158852359 2225 1025 10586-2328 >I52S 2075 N5 1555 11N 18N Ssdan 40 SL (5 Spd.).. `1575 2Nf Sadan40 SL1........ . ..: 12f55'2355 18N "3175 lily- 1575 TIN 2255 Sadan4pSL2........ 1575 2175 Vfagpr 4D SW1 ...... 5 138152418 2Ma Z( 13155 242(1 1575 3060 3010 •3460 1176 1N0 23N Welton 4D SW2. Z( 15115 2K78 ,2W3 ... _..N III4AhmirrarJfdby Wheels . ~ N 6 r 75 7s _ - --lf #86t-SrITi3i+orte+4, .. 1N 125 1N BMLeaOerSeats .:.:..... .... .... .::,..._ 125 1N 125 IWPaesrsunroof ........... N 7b N AYPowerWbdows .......... 175 5sielWbutAicCardBmig... - •~7S ~#75 -175 taflet WIaAAulornatlcTrse. (Fx ZF5) . 175 1TS RIR1N IN f SEIBr Cp. M5ea5a Clue f lah. Idsnt.:lGBtModagQppW(}000001 Up. 175 1155 1525 Cape 2DSC7 ....... ~ " (FJF)1 125952338 1750 3025 575 1111 2826 Coupe 2D SC2 ....... Z Z( 1 14t155 2410 1025 5 10595 2328 1#25 °;1tN ?2025 126 775 1165 1575 Ssdan 4D SL (5 Spd.).... 1323 1775 Sedan 40SLt .......... .: .... ....Z(c~5 1'12952355 18N ::2155 A11JU8T FOR MILFJIBE JASUMY TNROUBH APRll2eN _ e,~• SATUR N -203 - ReaYe AaINe Ay. Clw aNy fri0e-In halyd rypI MNeI • .. ~r^ Mo. Ntll/ WMeM-.leap ~'~ tbs gpI(r 875 1458. 7826 Sedan 4D SL2 .. :. 3(J4( 12755 2422 1750 3025 873 .1425 19N Wagon 4D SW1 :. . Z GA4 12295 2420 t723 ~ 8 . 30N 'P 850 1525 2606 Wagon 4D SW2... .:: (J1K 14255 2482 ] t00 ' 31 N r ~ 50 AY Cnase Control ....... 75 A11 CeetherSeats ........ . 50 ... o:; ... .::: 75 A .:- 75 160 .S ,, _ 123 MM Power Sunroof ............ ....... 1125. ...:138 S ~ 50 AY PowerNUndows ........... ' ... ... 50 a 75 150 Se4re1 Wloul ar Condlbning .. 13B Ise E' 1 SO OMelt Wloul Autanetlo Trans (Fx ZF5) .. 1 S0 138 N sw~ 4 ~ ~ 1 N ~ l ~ ~- ~wO~C(at>:1 ~ ~ ~ ,8 V den t.,~ iC (M odel)QO(jVO100001Up "~ E 7s0 850 1800" 17N Coupe.2D SC1 ..: Z(EIF 1 13335 2338. 7 575 - _ iB25 t 1400 18N Coupe 2DSC2... " Z(GJFt 1 14552415 1875 2025 575 700 1075 1 SN Sedan 4D SL (5 Spd) 1225 18N Sedan 40 SLt ... .. 5 10595 2321 1$50 Z(GM~~~~5555 12435:2350 1 0 2568 ?7N 760. 1300 17N Sedan 4D SL2 ... Z(J5 13335 2419 1 7S 2t2S C 726 828 1275 1725 Wagon 4D SW1 , , 1375 - 18ffi W 4D SW2 Z(GM t3035 2420 tb75 , 2808 . . agon .. ... ... ::Z(Jd( 13B~i 2484 1858 2800 R ~ • SO AY Leather 5eab ........ S8 73 ' - :.150 A18POaier suroot ....... ~ - -.100 125 .'S ;: ;~r 123 OsretW/aitNrCoMitbning .. ...:.. 125 125 126 5a11re1 Wlaut ~ulpnetlc Tiara. (Ex ZF5) .... .125 123 S1i167M 11N 8 3518E3.4 Ch1. ' M~ q ~; f ,$: Veh. (dent.:.1G8(Model)0001 0000001 Up. 660 1125 16N Coupe 2D SC1 ... - Z[F T 12195 2312 t400 2800 ' 875 1200 1026 Coupe 2D SC2 ~ Z GM f 1 29523 1 0 460 ... 830 13N Sedan 4D SL (5 Spd) ( 3 92 47b 5 10495 2377 1245 2 1b 2975 350 B08 1038 1476 Sedan 4D SL7 1125 1SN Sedan 4D SL2 Z( 5 11395 23TI 1 0 1 ~ 23N + 800 . 1125 16N Wagon 4D SWT Z(J . 2295 2451 1 Z(~ 1t985 2488 100 Z{N Z8N 673 1200 1825 Wagon 40SW2... ... ..... (JAQB. 128952537 t175 -2875 100 AY Power.Surroof ........ ... 10f 123 76 Orilet WkutAir CoMiBOring .. 75 75 ~ 8A7711N1 7S Dd11otW/oulAubn~eBcTrans (Ex ZFS),.. "73 .. ~ .... 73 _ 1556 8 8EIE8.4 OiheOr Cla : tic I --Vehadant:7fl8~tadell(Y(lltls(I000001 t)p TM ,..... _ , -•- ' a60 526 NO 13N Coupes SC1.... 1025- 1426 Corps 2D SC2.... Z(FJF)1 /f895 z3t2 1 Z(GAi t 12985 2388 1 ia73 .2480 a= 373 X50 830 12ffi Sedan d0 SL ..... 1 ~ S Z~(( 99AS.2~3_. 5.1 222125 9 8 3N Sedan 4 b L2 .... 2' JI t ~5 2434 ~?3(tb _ .2375 450 325 880 18N Wagon 4D SWf ... 1025 1126 W o 4D SW2 Z(( l8 11885 2402 '1226 ' 2323 ~ SA7WIR ag n .:. .... - ..:: Z{JAt)8 f2898 2477 f3 __, 2450 ~ 1114 8 iEhEB ~ N~pefC ( ~ ..` Veh. Ident.: 1G8(Model)OOQRp000001 Up. =" 308 350 728 tON Coupe 2D SCt .... .... 800 11 SD Coupe.2DSC2 ......... .... Z(FJF)1 11895 2314 5{i0 ....Z(GIFI)1 121852404 1D5D 20N 2175 _ AD~RIST FOR MILEAGE ~. JIUIWR7IRROUBM AtN11L200a - ~_ ~ _, q .~' ~. ~-:: 3 s r r Page 1 of 1 Leffler Energy JPMorps Chase Beak, N.A. P.O. BOX 1457 Syracuse. NY K~0.'1 Stamford, Cr 06904 _ x" Check Date Check No Vendor Account Number: May 27, 2009 OP 00788124 lttcy-DOl2ui-amd-S~ro-Ceaes---------------------- CheekAmoani Pay •~+i~~a*•~:rre*~*50.00 F.~aCtly --------------~--------_--_--.--..---------------- ~Y PEGGY SOLLENBERGER rjzgd nature a ~ zss s PiIT sr !T'' Otdet CARLISLE, PA 17013 ~ ~ re of _-^ __~_~ !~__^_~~~~__ }OM-71111E tllii{`pMi-1yi%MGNti E~M6E11MWi G11EGM ApIIOrI[' --US P~TENT555:3.? ::'55v^J L•-:33. 6i:5i S?Ea36a 603:OJ0 ~00788124~' ~;02i309379t: 630i~,i8228509ua ~'~ .. _ ', -_ ~ G ' _ ? _ - ~Vi 30 a - - = ^ i 3 t _ ? S s • R < 7 - ; _ j { ' ' • :. m ; . .- ~~ g. -+~a,i, . ~ _ ]_ i v ~+.. a.J_ j ~ ~ ~ t t ~ V ~ ~ ~ ~ a ~ ,~ 3 ~ 9 :'? ~ i g . s ~ i * 1 _ ~ - ~ $ v/ c~•tlime =eg~r9sv~i9sv Rt'~t'arlk' ~} ~a~,o . -01 iSC+41?.O~ .. T_ - D .. . ~ ~ w fi ~ ~ U ~ .~_ ~ T , n = 1 b ti ~_ w 2 rn'. 7 _'x E~ 2 T . ~) i~ '' _~ , } ~ ~ . _ .__. ~_ I :~ ~f" ' •I Posting Date 2009 Jun 02 Posting Seq No 42349175 Account Number 6301418228509 Check Number 788124 Amount $50.00 http://wiismab00035008/inquiry/page/itemprint jsp?BEANNAME=ArchiveItemListdetails... 10/9/2009 ' Page 1 of 1 PnR- Citizens Bank Checking/MMA Deposit ~oMeel"I' ~ ZZl $ `i 2-g2~ i~ . ~ h ~ 5 u DYER s cMecRS usr cNECa oR TNe REYCRSE sioE PRINT UA1` NAME ~ I q . - Y _ " DATE ~~ v O ` SIGN HERE If CASH IIECEIVED FROM DEPOSIT 4 I.D. (SANK VSE ONLY) .i f- ~:5990En i i55~: DOLLARS CASH CENTS t E KS -usr ~ RAT Y CHE KS -TOTAL R Y R SUBTOTAL LESS CASH TOTALS ~v +(~ U Ci~ 1Z~l~ ~l 8 93/ ~ p~ ~ ) a O ~O OD V D• Vf A W N d p~ 1T'L ~ t~ { jr~'C' !" ' i ~~~~~ ~r i W N ~~l j r N ~' . ~/ 1 ~ _ ~ ~ 1 R '" 0 9t ST ILO 90 _ ~ ~ OL - I~ 1 ; o , r D N n Z H Posting Date 2009 Jun 02 Posting Seq No 42349174 Account Number 6221892825 Check Number 0 Amount $50.00 ~~ = a ~ r T ~ T A $ ~ ~ s ~~~v+ ~`~„ N T ~ m ~ zm~2 i O n sm~., m m S Q ,~ ~mg~o N cOz Ln N ~ O z m ~. ~ ~ D o a Z O 9 r ~ ~ e . r > 00' (1 m -~~~ 2 r =.y E m 2 ~ m oCo 8 ~ Y T T N Z n ~ .~1 Z http://wiismab00035008/inquiry/page/itemprint.j sp?BEANNAME=ArchiveItemListdetails... 10/9/2009 c ~ Leffler Energy P.O. BOX 1457 Stamford, CT 06904 _- : OTHER Vendor Id Check Date: May 27, 2009 RCO: Check No.: OP 00788124 Invoice Invoice Description Gross Discount Net Date Number Amount Amount Amount May 11, 660797 term move out 50.00 0.00 50.00 Total: 50. wE[1NOEw Sot • LLS. PottEM N0. 5598290, 5575608.6641183, 5785369, 5881961, 6030000 _ __ _ ___ __ _ _ _ _ _ _~ ` ' Page 1 of 1 Lee ProcwKment Solutions Co. , ~ . CA1lLISl.ti-THE SF2~17YNt7, w.... v~ ~ ».t teD : ~ ~~~~+,,,,,, . • ~s9 S/21 /2009 ' ~*i'«`*'~"«'31.12 h ~ Nom. ~ '•~AY Thirty-One and 12/200 Dollars •sr,-*a**•t+-aa•aaraasrss*t•*#rrs• ~• ,I~~f~4z9odays PBGGY J. SOLLENBSRGSRai*f*w**•trr .; ~2~ t= Z55 S PI1'P ST ~r; `. t,l1RLISLS P11 27013-3812 ~~-. a'244?0?4K' t:0?59~i603t: ~82380ifl4566~+' ITIZENS 788L9Ar43B/919 IVERSiaE P,I 96A12349 l0115G0120~ ~..- - - ~ 'l '- _Z ~ - Posting Date 2009 Jun 02 Posting Seq No 42080494 Account Number 182380184586 Check Number 2447079 Amount $31.12 Ig ~. ~~ ~ ~ Iy m ; ~ r • I~ r ~ N L O • - ggy I~ Im r ~ ' I~ = s 3 ~ x f ~~ i? ~ http://wiismabOOO35008/inquiry/page/itemprint jsp?BEANNAME=ArchiveItemListdetails... 10/9/2009 t ~ Page 1 of 1 PRINT ~~ ~}~ ~i~k~/~~Q~Q/~ ^ tl NAME ~` w~ + ~~..iiVV 11 _ ~ DATE `~' D~ Ye~ f SIGN MERE tf CASM RECEIVED IRON DEPOSIT Q I p (SANK USE ONLYt ~itiZens Bank Checking/MMA Deposit NUMlERT ~ 2 (~~ $ R ~• Y 2•/ 1! OY(R ! CNlCRS LIST CM[CRS OII TM[ RlYLRSE f10E oouARS CASH s cENrs CNE KS - usr -ARRt r I~HMCIKS ~ rorlu SUlTOTAL 1E55 CASH tt TOTALS v ~ ~ 1 Z ~: 5990 i i 5 5~: '' ~ C TIZf~lS ? ~681186/d?S/~Z ~ p~ O ~O 00 v C!• v+ A w N O t ~ ~ Q 19 w N i ~~Y Yt: y ~ roii ~ i ~ ~ p A y ~ ~ ~ ~ ~ ~ _ ~0 1 T %t %T p r %9Q 6t 0 ~ v r :o m 1 <n Posting Date 2009 Jun 02 Posting Seq No 42080493 Account Number 6221892825 Check Number 0 Amount $31.12 -+ ~ ~ .,a= r gym. m~~ a y = V1 Ia ~s~ rr an m ~ ~ m s Z v '° '" ~ o T c+ ~ ~ ~ n v N ~ T V1 ,~r p cY T ~ y SOl t r Zp m d p W y ~ !~ y po,. n ~~_~_ m ~ wc~P1 m m ~ T ~ ~ ~ ~ z http://wiismab00035008/inquiry/page/itemprint jsp?BEANNAME=ArchiveItemListdetails... 10/9/2009 REV•1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpt~LE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FlLE NUMBER MARGARET J. SOLLENBERGER 21-09-0301 Debts of decedent must be reported on Schedule L NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' 'EWING BROTHERS FUNERAL HOME, INC. 7,106.21 _. __ _ __ 2. WESTMINSTER CEMETERY 1,430.00 __ __ _ _ __ - __ _ __ s. CEMETARY MEMORIALS & ENGRAVING 1,177.80 ___ _ ___ __. __ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 4,623.78 Name of Personal Representative(s) .Jeffrey Adams & Lawrence L. Sollenberger - Social Security Number(s)IEIN Number of Personal Representative(s) .191-46-2270 '201-56-4505 street Address 129 Walnut Street cay Carlisle stete'PA zip 17013 Year(s) Commission Paid: 2009 2. Attorney Fees 6,394.41 3. Family Exemption: (B 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 337.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~~ The Sentinel -Publication 208.78 a. 'Cumberland County Law Journal -Publication 75.00 __ TOTAL (Also enter on line 9, Recapitulatian} $ 21, 352.98 (If more space is needed, insert addkional sheets of the same size) t Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 October 9, 2009 Jeffrey A. Adams 129 Walnut St. Carlisle, PA 17013 The Funeral Service for Margaret J. Sollenberger We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMO'T'IVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , $1750.00 Embalming, $750.00 Dressing, Casketing Etc. , $250.00 2. FACILITIES AND SERVICES Viewing (Visitation/Wake) , $475.00 Funeral Ceremony, $475.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $250.00 Hearse (Casket Coach) $295.00 Lead Vehicle $125.00 Service Vehicle-DeathCert. , $90.00 FUNERAL HOME SERVICE CHARGES $4460.00 SELECTED MERCHANDISE: 20G Spartan Coral-Cask/Gask. , $1210.00 #5 Regular w/Steel OBC with Set-Up , $995.00 Acknowledgement cards, $10.00 Register Book(s) $30.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $6705.00 Cash Advances Clergy/Mass Offering, $100.00 Certified Copies of the Death Certificate , $18.00 Flowers, $132.50 The Sentinel obit , $150.71 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $401.21 Total Total Cost , $7106.21 ~oa~ ~-~ ~i (~ ~ ~v ~~ Osiris Holding of Pennsylvania, Inc. ~ ~9 ~ _ _ Retail Installn-ent Contract end Security Agre,(p~ant _~[_ Comran N " '• " " Osisis Ifotlwg d Passsylvaoia LLC ("L(-C") ) F~ Wrunioster Ce:ode:Y t1.C ( LLC ) LLC ^ TriLoumY Memnial OWms LLC ( ' ' ' Osiris ?{g o~~f Pmsylvaria Sutxaaivy LLC ('Compury") I]ro6erlasd~ vaay MrunaiY O.draa ("Cemaur'7 7 WnuoWtn femuaY Subud:v)' LLC C ComWuy ~ Tri-Couoly Mm,aial 6udens SubidirY LLC CComDmy tv;-Couotr Memw;.( cram. (°Ce:odrly") wnw(mta cematry (''Cemeray ) 1911 Rkner Higkwry. Cadisk. PA 17013 740 Wyr,duoue Rod. Lewubary, PA 17339 1159 NewvBle Rwd. Carlisle. PA 17013 717-113-7511 717-93g-3433 717-U9-2029 - C maimes rclerred eo 'vely in this A tat "5 I at~retors of Cemewry. THIS AGR1sEMENT is made by aid between Seller and 4 herdtufler alld the "Purchaser". TNES TH THAT agrees m and LLC utd otters m sdl b or dai bettefiduy 4 with th tame Ilam~ the fdbwing flans m b prgvided or teed a the about choked kr:ation. DESCRIPTION OP BURIAL RIGHTS. Tk &aial Righa mvaed by the Agtetsrcm arc rdtowm by the ttalp of suck gatdavbuiWing an file in she o16tx of die CEMETERY, atd arc coos partiwkdy rksrnbed bebw. _ Buritl Righn it _ Cnvt Spaa(a) _+Mauaolenm: O Clupel O Gasden O Tudan O Side•by-Side Q,Singlt O Developed Q Premnnruction Lawa Crypt: O Double Depth ^ Sideby-Side _ Nkhe: ^ Clupel O Oardeo ^ Single O Companion O Developed O Preconatruction ^ Single ^ Developed ^ Pretonrwetion aAlatlxuw eutrrdfwwrlaiu nn: lerrDA dr -, rwdrA p', AraN 76" Ht Choke Ind Chdee 1M Choice Ind Chdee Garden Garden Building - ' Building Section Section Section Section ... Lot l.ot No.(s) . No.(a) Spau(s) Spue(s) Levd Level ON Op CHARGES LLC• Company 7• T MERCHANDISE: Y (A) B deroaed i tM. t ,bovs) Ti ^ Check tare if merehurdise is being purchased for use a atrodra cemetery. ) P Cm f Cemesery's Name: A. VAULT(S) MI. Descdption ` ( eu Cedficate Discoum t S Right of Intesmmt ~ S ) Kult(s) S ) Um(a) f al. Deseription G) M rtg/Crypt Plate f a. URN(S): NI. Dacdption 'a t S s) f sl. Deudption Imtalla6on Charge S S C. MEMORIAL INFORMATION: ~ nken S I iti f C l F I ~-~ S ~ 0 ~Og ~p Memorial Desi n: a ee or ( ) n rnamem ~ O Vue: Y / N ~ g (M)Final IntemrcnVEmombmenNnummml Fee f Bmnze Sitt X Gnnite Sitt X (N) Permanent Reeords & Fraewing Fee S 1~0 S B Location (Sation, eu.) Mn4, C + G.~ tai - Ate[ (O) Other S t (P) Sties Tax f D. MONUMENT INFORMATION: ~ 1. TOTAL CABH PURCHASE PRICE (A THRU P) S TYPt Size: x Die: x _ Bsu: z E. CASKET(S): I. Modd: _ 2. Model: Gauge: Gauge: ITEMIZATION OF THE AMOUNT FINANCED p 0 [ ~ (I) Tonl Cash Priu .......... .................... .AU ... S - '1 ° ~ - (I) A: Down Payment O Cadt Check O Credit 6d .. a1 ` ... S t B. Trde la: ....... ... S gdAgrcanrntNo.• [ 00 C. Tatsl flown Payment (IA + 2B) ................. ... S ~_ (3)_ Unpaid Balance of Cph Pdee (1 -2C) ............. ... f -~~- (4) Fiwwe Charge ................................ ... S -b (5) Tonl Unpaid Balance (3 + 1) ..................... ... S he LLC and the Company shall each remain sewrdarily liable m the other for the roles of ircms and service providd by one roomer puaumt m nis Agreement; however, Purchasn shdi not 6e rcquirea to exhaust . remedies agairot the LLC or the Company before proceeding agairut the otlra. ~. ~... - : -_ ( ' PAYMF.KT. The Purchaser shall p.y e SELLER for such rights in accotdartce ith the fdlowing disemsurc statement: FOUR PAYMENT Naymen~ Amount d Paymenn Firat Peyrrwnt Dua Dan rea. r, , a y iCHEDULE WILL BE: g O^~`,~"OQ, O MonOyy on ytac~~nL~.~'n5.` IECURf1Y: You art giving ^ security intaeu N the goads or propmy being purchrd err le put d the Arrtdspeid under rho Ag(er+nalt Geld in s kterchadise Tnut Fund. - ~ ~. . 'REPAYMENT'. If yen pay off wly, you will np love w py a pendty urd you coq be entitled w a rcfud of pan oftM F,una rOrarye. TO'fICE: Sa tits rcmrndu of this ApeurarLL (including Ckmeal Pmviaitw M the reverse side hertot) ter ddiliorW infomution about nonpaymerx, default, delinquencychute, security imeresta anY re9uucd WY::m't in full before the rchdnkd due, ad prcpsynwt rcnnds ad pcnalera. THIS AGREEMENT ARISES OUT OF A CONSUMER CREDIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVLSIONS CONTAINED ON THE REVERSE SIDE tF THIS AGREEMENT, WHICH ARE A PART OR THIS AGREEMENT. This Agteerraalt shall be binding upon the heirs, extx;u[ors, edmidsuators, successors and assigns of the pasties heruo. THIS AGREEMENT AND THE FAMII Y PROTECTION CERTCFICATE, IF APPLICABLE, CONTAIN ALL THE COVENANTS AND PROMISES BETWEEN THE PARTIES, AND 'O AGENT; SALESPERSON, OR OTHER REPRESENTATIVE OF ETTfIER PARTY HAS AUTHORITY TO MODQ''Y, ADD TO OR CHANGE ANY OF THE TERMS AND 'ONDITIONS CONTAINED IN THIS AGREEMENT AND/OR THE FAMILY PROTECTION CERTIFICATE. "OTIGE TO A CI NEES OF ~EL.LER Any holder d this consumer credit contract is subject to all claims end defenses which the debtor (Purchaser) could assert against the Seller o[ goods or services obtained pursuant hereto r wllh the proceeds hereof. Recovery hereunder by thedebtor (Purchaser) ahaB not exceed the artlounl paid by the debtor (Purchaser) hereunder. rInTTCr+ TO THE PURCHACER (1) Do not sign this Agreement before you read it or if it contains any blank spaces. (I) You are entitled to a completely filled in copy of this Agreement et the time you sign it. (3) Under the law, you have the right to pay off in advance [he full amount due and under certain conditions to obtain a partial refund of [he finance charge; to redeem the property if repossessed for a default; to require, under certain conditions, s resale of the property if repossessed. w1urHASER'S RCHT TO ~ANGIiL If this Agteermnt waa adidted at your reYdema and You do not want the goods or servka,.you, the Purchaxr, Ituy cereal fhb Agteettteat al any Urne pdor to rdddghl of Use third rasittw day aRv the date o[ thk AgreettaenL (For an explanation of this tight, see the attaehed Nona of GrtcellaUoa form ) Recovery Fund; A Real Fctere Recovery Fund exists to reimburse persons who have suffered rslatetary bas and have obtained an unmlleaiWe judgement due to fraud, misrcprcxnntion, a deceit in a sal estate transaction by a Pennsylvania licensee. For complete details c//a~~l~~l (717) 763-3658 a 1-BlXL822-2113. - N WITNESS WF~REOF, Purdtrtter hu exemted A t this yt? day of ~'~ . By esecuti this Agraesowl,~~PurcJJha--s.er adtrmsYledgn tempt of a copy of this AgreerrKnL - r 5.~ 1. Purchases 'ottnsekr: Socid Secu ' No. Date dBinh - 2. Purchata elkr by: Ad,diaed Said Beautify No. D+rc tnh - loT'ICE: AarAorfrad Rrpaenwd.e k dlgnkq w 6a if MboM LLC erd coatpeay. ~q ~ p~.a~ a . S7 01~ Addrca: 7dr Agmasaer U not swhtd aatlf slgnad by a AsdAorfud Represrsmtivc oJdu Seller. ~~ y , 2Cxy s'•a LP 'Burial Righs Cenifiaee w he prirvd m Nurre(s) othu tMn Porchawa, ram prov'We Name(s) hue: Home Phone Number: J b Ptak License Nc 1. Fmpbyer: Empbyer wttrttscaPr-Thcaxpwr~lseaer)coyy carao:w• tvNxrnPY-wrdwa~.copr TMs contract n wbl4ex to ^ semrity mterast rn `~ boor d rink Of Atrtsrrta, NA., Y mllsteral apart TM caN d yet adt as ^ yeaxy nle, r fINANCl CNAROE The doer ama1x11 Inn aedtl rra Cml fva AMOUNT FWANCEO TM Ymax a credl prorW9d b you on yaw owe 6aha11. TOTAI OF PAYNENTg TM annual You as acre pea lNet you tore ms0e Y peynrams as scneddea. TOTAL SALE PRICE TM lulu Cant d purtltaee m uedl, irclud Yp tloan pi ~~ TM Re P Are Due cot~ctYPV- t+vd~.rw•rcayr Flwne ! ~ DESIC,NERS AND BUtLDERS OF ems. M t 41 South Bedford Street ~~~ Carlisle, PA 17013 ,~ ~~ ~ F ~,~ ~ ~~ ; , , ~. 1, i ~,.~ . t k i' ,.. Carlisle Memorial Service, Inc. h -~' ' °~' '~ Carlisle, PA. Telephone 243-5480 F "~ .. 4. +- r - s~~ . e ~ 1.: ~ ~ ~. .,, Please design and build the following memorial For .i:. ~':. °~. <i J?t`~tC~~ .. .... .... .... .... Address ...... ~ .... ................... ~... . ~, ~ _ Design No.:. ~ ~ . t;-. ~.~~ r." "' ., ,~ ° ~t ~` ,. ~°:~:,- . Material : , ~ :" ~: ..i . ` ` Die ................. Base :.....`; i '.... ~' ....~~ Markers ............... Posts .. ... •'~ Price ...... ~ ~.°-~ ,~t~ i {~,~ Deposit ............ ~. f~ ': Balance Due .:"`. ~~.~ . '~".. . Family Name ........... . Inscription ............. Price .... .. .....:. Total Price ............. . ........ $.~=......i ...~.1,I.~.~•~0 ~'o}~al ~~ ~"~ a i ~ Style of Letters u~ ~-:r.~`:~. ~ `~ ~•`-'~ f .rr } 'E Foundatian to be furnished by ............ . L `. ~ ~ .:~ ..... ,~ . ~ ~ .,~. ,t_.l' l . ~ • ~•. • t ~',... ...... ' .: '...... . Material to be best selected monumental grade and to be free from imperfections and first class in every way. Work. to be finished in a workmanlike manner. z This memorial to be erected in . .... ; ..` .. . '..~ .... i.:. ~ i .:.'..r:....`: ...... ............Cemetery in or near .... .. .. .. during the month of ... . ~' ..,.? .r'rst. ~:. ... ......... . . unless unavoidably delayed by labor troubles and other contingencies beyond our control and then as soon as possible, Additional lettering and other work on this memorial in the future is not included in the Contract Price. Title and right of possession and removal of said stone, monument or appurtenances shall remain for all purposes in Carlisle Memorial Service until work and materials ordered are fully paid. by purchaser or purchasers. Inconsideration of the acceptance by Carlisle Memorial Service of this order, the undersigned (hereinafter known as the purchaser) agrees to pay Carlisle Memorial Service ............~ ........................ . ..............:....................................................................::...:. ...Dollars on or before the 15th day following the billing of the work or job upon completion thereof by Carlisle Memorial Service said billing to be notice of completion thereof, this order shall become a contract between the purchaser and Carlisle Memorial Service upon acceptance llhereof in the space below by a duly authorized representative of said Carlisle Memorial Service; it being understood that this instrument upon sucth acceptance covers all of the agreement between the purchaser and Carlisle Memorial Service and that no agent or representative of Carlisle fUlemorial Service has made any statements or agreements, verbal or written, modified or adding to the terms and conditions herein set forth. It is further understood that upon the acceptance of this order the contract so made cannot be cancelled, altered, or modified by the purchaser or by any agent of Carlisle Memorial Service or in arty manner except by agreement in writing between t:he purchaser and Carlisle Memorial Service, and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers, twenty-five per cent of the total original cost of the work or work and materials ordered, as the case may be, shall be specified correct sum as liquidated damages which purchaser shall owe Carlisle Memorial Service, less any payment on account made prior to such default, this specification of dannages to be due regardless of removal and taking possession of stone, monument or materials from purchaser or purchasers by Carlisle Memorial Service upon following such default. .......:...................:.............................:.......:.................................. ....................................................................................................iSEAL) .........................:..:: ..;...,..:...:................................................. 20.~:..1 ............................................................. ,...................................... f S E A l l Carlisle Memorial Service Approval BY - ' "• t~'. .. ... .. ... .. .:. : ..'. ..... ... ... (SEAL) White: Office Copy; Canary: Customer Copy; Pink: Salesman Copy; Gold: Office Copy ...~. ti _. t. ~, a'. ~ . __ t ~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 3/31/2009 Cumberland County - Register Of Wills Receipt Time: 08:46:11 One Courthouse S uare Receipt No.: 1056295 Carlisle, PA 1713 SOLLENBERGER MARGARET J Estate File No.: 2009-00301 Paid By Remarks: LAW OFFICES OF PAUL ORR CJ ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 32.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 2188 ---------------- $322.00 Total Received......... $322.00 r - r_ RETAIN THIS PORTION FOR YOUR RECORDS THE 38NTINBL - LEGAL PAUL BRADFORD ORR P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 367569 10 PUBLIC NOTICES carts 05/05/09 38 * 2 AD DESCRIPTION START DATE STOP DATE ESTATE NOTICE LETTERS TESTAMENTARY 04/21/09 .05/05/09 PUBLICATION INSERTIONS RATE NE7' AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 201.78 TOTAL AD CHARGE 201.78 3 PROOF OF PUBLICATION ~ O1PRF 7.00 ~~ ~ 1v DAYS RUN ORDER PAY THIS AMOUNT I 208.78 I 250.54* Est. M. Solleriberger M AETER os/04/09 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classifiedC~cumberlink.com Please send a cover letter including your name and address as an attachment PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Erica Peterson, Classified Manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13,1881, since which date THE SENTINEL has been regularly isswed in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): A~ri121, 2009, Apri128, 2009 and May 5, 2009 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/sihe is not interested in the subject matter of the aforesaid notice or advertisement, aixid that all allegations in the foregoing st~texnent as to time, place and character of publiczation are true. Sworn to and subscribed before me this 5~' ao ~arnG~r Q~n ~ Notary Public My commission expires: COMMOYVtivt.+~.a'i-I~ OF ?ENNS'YLVAN'~A NOTARIAL SEAL BAMBI ANN HECKENDORN; Notary Public Camp Hill Boro., Cumberland i;,ouatY My Commission Expires January 27, 10 ., ~ a~a8 5~`~\6 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (71 ~ 249-3188 Fax: (71 ~ 249-2883 May 8, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Paul Bradford Orr, Esquire Margaret J. Sollenberger Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: April 24, May 1, and May 8, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by __ PROOF OF PUBLICATION OF NOTICE -~ IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Culrlberland Law Journal on the following dates, viz: Apri124, May 1, and Ma 8 2009 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Coyne, Editor 8o11eaba~r, 1[as~arst J., deed. Late of Carlisle Borough. Executors: Jeffrey Adams, 129 Walnut Street, Carlisle, PA 17013 and Lawrence L. Sollenberger, III, 101 Country View Estates, New- ville, PA 17241. Attorney: Paul-Bradford Orr, Es- quire, SO East High Street, Car- lisle, PA 17013. SWORN'~0'AND SUBSCRIBED before me this 8_day of May, 2009 Notary NOTARIAL SEAL DE80RAH A COLLINS Notary Public CARLISLE BORO, CUMBERLPIND COUNIY My Commissiori Expires Apr 28. 2010 a ,.>~,:,: ~~~~~ ~ ~>;: Pennsylvania .~~ DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER MARGARET J. SOLLENBERGER 21-09-0301 Report debts incurred b~ the deadeM prior to death that romained unpaid at the date of death, including unreimbuhsed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' MET LIFE AUTO 8 HOME 132.00 2. REAL ESTATE TAXES FOR 255 SOUTH PITT STREET, CARLISLE, PA 17013 931.47 __ __ 3. REPLACEMENT OF STOVE IN ESTATE HOME (PAID IN CASH AT YARD SALE) 200.00 '' 4. G. ARTHUR CLAMAN -APPRAISAL SERVICE FOR 255 SOUTH PITT STREET, CARLISLE, PA 325.00 ` 5. VITAL CHECK DEATH CERTIFICATE FOR LAWRENCE L. SOLLENBERGER 34.00 6. SETTLEMENT CHARGES FOR SALE OF ESTATE R/E AT 255 SOUTH PITT STEET, CARLSILE, PA ' 5,246.54 NOTICE OF CANCELLATION FOR NONPAYMENT OF REQUIRED PREMI MetLife Auto & Home® URGENT: Your insurance protection will stop unless payment is ma ECONOMY PREMIER ASSURANCE COMPANY Policy Number Poli T Date and Tima Insurance will Sto Amount Past Due 4663045200 HOMEOWNERS 08/25/2009 12:01 A.M. $132.00 . _ _s n7 91 O .. fi dl ., .nv,6 ~m nwmanf waR not rACBr NOTICE ALSO SENT TO PEGGY J. SOLLENBERGER C~~0 JEFFREY A. ADAMS, CAR9L11SLEUT ST PA AS VI v•~~.rvv ,yw~wn r, vn nn,,. p,.~.. ... .. ..~.._..___' As a result, your policy will be canceled on the date and time sF>' in the box above. We hope this is not your, intent. Your policy continue without interruption only ff we receive full payment by date and time. Allow 10 days mailing time for your payment to re us. 182 This is the only NOTICE OF CANCELLATION FOR NONPAYMEI OF REQUIRED PREMIUM you wilt receive. EXEC. 17 3 ~ ~~ \' n \. IF THERE ARE ANY QUESTIONS CALL 1-717.5p6-3049. WELLS FARGO INS SER OF PA INC IMPORTANT NOTICE YOU ARE GIVEN THIS 30 DAYS NOTICE SO YOU MAY HAVE REASONABLE TIME TO MAKE OTHER ARRANGEMENTS FOR YOUR INSURANC PROTECTION. SHOULD YOU EXPERIENCE DIFFICULTY IN OBTAINING INSURANCE PROTECTION, YOU ARE POSSIBLY ELIGIBLE FOR PROPERTY INSURANCE THROUGH THE PENNSYLVANIA PROPERTY INSURANCE PLAN (FAIR PLAN). NOTICE OF RIGHT TO REQUEST REVIEW YOU HAVE THE RIGHT TO REQUEST THE PENNSYLVANIA INSURANCE COMMISSIONER TO REVIEW THIS ACTION BY METLIFE AUTO & HOME. TO DO THIS, SIGN AND SEND A COPY OF THIS FORM, WITHIN TEN DAYS, TO THE PENNSYLVANIA INSURANCE COMMISSIONER AT ONE OF THE: OFFICES. PENNSYLVANIA INSURANCE COMMISSIONER -REVIEWS PENNSYLVANIA INSURANCE COMMISSIONER -REVIEWS ROOM 1701, STATE OFFICE BUILDING ROOM 304, STATE OFFICE BUILDING 1400 BROAD AND SPRING GARDEN STREETS 300 LIBERTY AVENUE PHILADELPHIA, PENNSYLVANIA 19130 PITTSBURGH, PENNSYLVANIA 15222 TELEPHONE: (215) 560-2630 TELEPHONE: (412) 565-5020 PENNSYLVANIA INSURANCE COMMISSIONER -REVIEWS 1209 STRAWBERRY SQUARE HARRISBURG, PENNSYLVANIA 17120 TELEPHONE: (717) 787-2317 I REQUEST THE PENNSYLVANIA INSURANCE COMMISSIONER REVIEW THE (CANCELLATION) (NON-RENEWAL) OF THIS INSURANCE POLICY. INSURED SIGNATURE: DATE: MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warvvick, RI PAYABLE TO CARLISLE BOROUGH TAX ACCOUNT PO BOX 100, 53 WEST SOUTH STREET CARLISLE PA 17013 DESCRIPTION ASSESS.NO - 04000468 MAP NO: 04-21-0320-421 255 S PITT STREET ACRES .080 LAND LESS THAN 1 ACRE Residential Building RESIDENTIAL T~~A,X ,P-A,VER a~VLLCIVBERGER, LAWRENCE J JR & PEGGY J SOLLENBERGER 255 SOUTH PITT STREET CARLISLE PA 17013-3812 OFFICE HOURS fuT~R6AYFRIDAY SAM-4PM PHONE (717) 249-4422 CLOSED SAT, SUN 8~ HOLIDAYS CASH ONLY AFTER 12/15/09 TAX PAYER COPY BIII No: 5292 Control No: 004 -000466 Zone sn~e rrrera or nea r ra~we rsm ua>:e: nu I~cwa ASSesse Land Values 18,000 Homestead Exclusion Improvement 57,690 Mineral 0 Total 75,690 9 175- CJIRLIBLEAREA ~i.D. Dleeourrt Fete Rates 14.33000 SCHOOL R;3 257.94 14.33000 626.70 14.33000 2 1 06 .95 1 084.64 10 1 193.10 Homestead Credit 13 .48- 131.48- 131.48- TAX AMOUNT DUE -:> IjY>t1.47 >~a.~e ~1,OM.6! I! Raid Oa os apes Ii paid Oa or close 7 Ol 2009 8 31 2009 9 O1 2009 10 31 2009 11 01 2009 12 31 2009 IF NOT PAID BY 1?/81It>s THIS BILL tMLI; BE RETURNED TO TAX CLAIM BUREAU FOR COLLECTION. =1A0 DUPLICATE TAX BILL FEE ~/~~ ~ ~~~ ~ c~~~ ~ ~~~ NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligable homestead and/or farmstead property owner, you have n3celved tax relief through a homestead and/or farmstead exclusion which has been provided under the Pennsylvania Taxpayer Relies Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. B-H Apency Appraisal Services File No. 0300909 INVOICE .I G. Arthur Calaman 0300909 B-H Agency Appraisal Services 163 N. Hanover Street Carlisle, Pa. 17013 1 Estate of Margaret ]. Sollenberger 255 S. Pitt Street Carlisle, Pa. 17013 1 1 03/26/2009 03/21/2009 (D.O.D.) N/A N/A N/A (717) 243-1000 ext. 216 Purchaser/Borrower N/A - Property Address 255 s. Pitt street Unit No. NIA - - City Carlisle Subdivision Carlisle Bono County cumbertana State ~ Zip Code 17013 Legal Description See Attached Deed Copy from Instrument #196201445 Appraisal Fee Amount .............................................................................. $ t3zs.oo Mail or Handling Fee .......... _ ... $ Additional Charge No.1 ........ _ ... $ Additional Charge No. 2 ........ _ ... $ Additional Charge No. 3 ........ - ... $ Sales Tax ( %) ..................................................................... $ Total Amount of Irnoice $ ;3zs.oo Comments: Paid In Full by check from Attorney Paul Orr # 2202 04/17R009....Thank `foul 03/26/2009 03/21/2009 (D.O.D.) N/A N/A 0300909 '1 Fstabe of Margaret ]. Sollenberger 255 5. Pitt Street Carlisle, Pa. 17013 1 1 I I 1 r G. Arlhur Calaman B•H Agency Appraisal Services 163 N. Hanover Street Carlisle, Pa. 17013 s TEBMt - Bflena 1ue utton roalpt of Introir:e. Pkrses return tllkt pertMn ~Rk )reor pnrnleM. Thank pu! roan praeucea oy un~c systems wmvare i;ampary local seta-arzr wwx.uneeesystems.com ti &H Agency Appraisal Services File Na. 0300909 INVOICE 1 G. Arthur Calaman 0300909 B-H Agency AppraisalServirns 163 N. Hanover Street Carlisle, Pa. 17013 I Estate of Margaret ]. Shcenherger 255 5. Pit[ Street Carlisle, Pa. 17013 1 ~ i 03/26/2009 03/21/2009 (D.O.D.) N/A NJA N/A (71'7) 243-1000 ext 216 PUfCha9er/BOrrOwer JA - Property Address 255 S. Pitt Street Unit No. N/A - City Carlisle Subdivision Carlisle Born County Cuml~land State Pa Zip Code 17013 - Legal Description See Attached Deed C opy from Instrument #196201445 Appraisal Fee Amount .................. ............................................................ $ s3z5.oo Mlail or Handling Fee ....., .... _ , , , $ Additional Charge No.1 ........ _ , , , $ Additional Charge No. 2 ........ _ . , . $ Additional Charge No. 3 ........ _ ... $ Sales Tax( %) ......... ............................................................ $ Total Amount of Irnoice $ s3zs.00 Comments: Paid In FuH by check from Attorne y Paul Orr # 2202 oa/17noo9....Ttrenk youl 1 o3n6noo9 o3ninoo9 (D.O.D.) N/A N/A 0300909 ~I ~ Fite of Margaret ]. Sflllenbcrger 255 S. Pitt Street Car9sk, Pa. 17013 s 5325.00 I I I I G. Arthur Celaman B-H Agency Appraisal Services 163 N. Hanover Street Carlisle, Pa. 17013 s 1'Eflllt - glance dne epen realpt of Inlreka. tleaa return fkh prtlon witk roar garment. Tkank reu! Fam produced by Untied Systems So9ware Company (900) ~9-8727 www.unkedsystems.com V ~IChe~C Order Receipt VitalChek Order Receipt Purchase Date: Payment Method: Agency: Ship to: Shipping Method: Wednesday, May 06, 2009 Visa XX)CX XXXX XX)CX 5685 PENNSYLVANIA VITAL RECORDS Paul Orr 50 East High Street Carlisle, PA 17013 UPS Air Estimated Processing Time: 3 - 5 business days J c~-~.-~~--+' ~~'~ ~ ~~ r Order Number: 14154937 PIN: 931533 Item Record Ordered Qty Price Extra Copies Total 1 Death: Lawrence L Sollenberger 1 $9.00 $0.00 $9.00 Processing: $8.00 Shipping: $17.00 Tax: $0.00 Total: Estimated Processing Time: Page 1 of 1 ~ ~~~ 3 ~ G~~ ~? ~ l~ ~~ ~~ ~~v l ~- Of~""-~r'LV Q~~ Estimated processing time may vary according to the resources and workloads of the agency. VitalChek has no control over these variations or the amount of time an agency requires to process an order. For these reasons, we do not guarantee processing times. Shipping is not included in processing times. Order Status Information: Check the status of your order at any time by clicking on the 'My Order' tab at www.vitalchek.com, or by calling 866-203-2777 for automated order status information. Please be advised that if the order has already been transmitted to the government agency, we will not be able to cancel or make changes to the order. If you have any additional questions or would like to a-mail VitalChek about this order, please visit https:/NitalChek- solutions.custhelp.com Shipping Information: If your order is being shipped via an express service, you may receive a tracking number by a-mail once the order is processed and in transit. You may also be required to sign for the delivery of your certificate. We appreciate your business and look forward to assisting you in the future. Sincerely, VitalChek Customer Service https:/NitalChek-sol utions. custhelp. coin https://www.vitalchek.com/receipt.aspx?r=EkBXbdI3Td7DTWpgdythiA%3d%3d&i=UHHRPfxwJzE%3d 5/6/2009 D ~ ~.. '~ ~, ~~~~: 9.i~ ° tJ ~E.uu~ 1l ~\ _._ Ime 403 and 404) is important tax infonnat~ored to be reported and the The NformaOon In glodrs E, G, H, I & Tine 401 (or if line 401 is asterisked, ~ Sale or Exchange of Principal I Revenue Service. l} you are required to file a return, a sanction will be imposed on you 'rf this item rs req rincipal residence, file FORM 2119, Form 6252 andlor Ore InMma rted. it this real estate Is youi p late the applicable parts of Form 4797, ou do IRS dsterrnines that O'haa not bean repo for other transactions, pomp law R~ya~e for any gain, with your income tax return; Form 1040). ou may be subject to civil or criminal PenalOes imposed by Sel~~ O ( You are required to proede~e^`1ry s~i~reiumbe~ y (named above) with eoudentificationnu Orion number. e the $etgement Agent with Your taxpay correct taxpay not provld u I ~,~ffy that the number shown on this statement is my Under penakiea of peQ ry. Seller ~_~~e. redepts and disbursemenrs mane ~~~ ~~v a-°--~ - - Statement G ~~- y _Seller Borrower __. ~~1~.. ~ _Seller Borrower To the t of my knowledge the HUD-1 Settlement Statemert of the settlement ofrtFiis transaction ccurete account of the funds which were received end n or will be disbursed by the undersigned as pa Date: 11 Settlement Agent tr Keith O. Brenneman WARNING: It is a crime to knowingly make false statements to the United States on this or eny other similar form. Penal0es upon conviction can include a Rne and Imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. ~ '~~` Pennsylvania C .~~. DEPARTMENT DF REVEN V UE CHEDULE ~ INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF MARGARET J.SOLLENBERGER NUMBER FILE NUMBER NAME AND ADDRESS OF PERSON S R RELATIONSHIP TO DECEDENT I TAXABLE DISTRIBUTIONS [Include outright spousal~ Do Not List Tr R d~1-09-0301 AMOUNT OR SHARE ust~~s~ nbutions and ransfers under Sec. 9116 (a) (1,2],] 1 OF ESTATE . HEIDI FOREMAN 2. DERECK SOLLENBERGER GRANDDAUGHTER _: _ $2,000.00 3. JEFFREY A. ADAMS _ GRANDSON $2, 000.00 4. LAWRENCE L. SOLLENBERGER, III ' SON __ _ $22,420.51 - __ 'SON . __ __ __ _ __ _ _ $22,420.51 ` ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1 NON-TAXggLE pISTRIBUTIONS: 500 COVER SHEET AS APP A , RO . SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS PRIATE, NOT TAK ___ _ _ EN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS - - TaTAI OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV- If more space is needed, insert additional sheets of the same s ie0 COVER SHEET. ~ II 1 1