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11-16-09
-J REV-1500 1505607120 PA Department of Revenue ~ (~5) OFFICIAL USE-ONLY Bureau of Individual Taxes en ear .e um Po Box.2aoso~ INHERITANCE TAX RETURN Harrisburg, PA 1~12s-osol RESIDENT DECEDENT 21 0 9 0 0 3 0 7 Social Security Number Date of Death Date of Birth 207289047 02182009 06211936 Derdent's Last Name Suffix Decedent's First Name MI DSMCBAR MAXIM M (If Applicable) Enter Surviving Spouse's Irrformation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 4. Limited Estate ® g. Decedent Died Testate (Attach Copy Of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS p 2. Supplemental Return ~ qa, Future Interest Compromise (date of death after 12-12-82) 0 ], Decedent AAaintained a Living Trust (Attach Copy of Trust) 0 10. ~ P2~ Creditt(d 95of death DALE P S8IIG8ART, JR. SSQIIIRS Firm Name (If Applicable) First line of address 10 ~PSST 8I G8 STREET Second line of address City or Post Office State ZIP Code CARLISLE PA 17013 ~ 3. Remainder Retwm (date of death prior to 12-13-80 ~ 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes ~ 11. Electlon to tax vender Sec. 9113(A) (Attach Sch. O) Daytime Telephone Number 71724143'11 REGISTER S USE~iLY . r r G --,. ~ ~ r- ~~~ ~, ~ ~ _ _ "~,-~ FV r DAr~E FILED O ~ ~7 "'7 ~+~ C r c'7 .,.Y,y Correspondent's e-mail address: Under pertaltles of perjury. I declare that 1 have examined this return. IrtGudirtp aocompartylnp schedules and statements. and 1p the best pf my IvwMAedge and belief, it Is true. correr.K and complete. Declaratlort of preparer other than ifte personal representative is based tm all iMonnatlon of which P-epardr has arty Ivwwledge. usan emc a- - e ~1 /~ /~ ,~Ck~~- -rc~L.1~Mcr~.a~l.indsey R. Demchak 125 Clay Road, C isle, PA 17015 SI TURE OF ARE TH ENTATIVE DA `~ Dale F Shughart, Jr. Esquire s 10 West Hlgh St Carl le, P 17013 Side 1 1505607120 1505607120 J 1505607220 REV-1500 EX DecedenPs Social Security Number oeceaenrs r~na: D E M C H A K, M A X I M M 2 0 7 2 8 9 0 4 7 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 211 , 0 0 0 . 0 0 2. Sboc~cs and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Morkgages 8 Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. ~ 7 , 2 7 9 • 9 9 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ............. 6. 8 , 6 7 4 . 3 5 7. Inter-Vhros Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested ............. 7, 1 ~ 8 , 10 1 . 9 8 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 4 ~ 5 , 0 5 6 . 3 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. ~ 8 , 8 5 2 . 7 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 , 0 3 7 . 0 5 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11. ~ 0 , 8 8 9 . 8 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, 4 0 4 , 16 6 . 5 2 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. 4 0 4 , 16 6 . 5 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2)X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 4 0 4, 16 6. 5 2 1 g• 18 , 18 7. 4 9 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxarire at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 18 , 18 7 . 4 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Fiie Number 21 - 09 - 00307 Demchak, Maxim M 125 Clay Road Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 18,187.49 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments ~ C. Discount 900.00 3. Total Credits (A + B + C) InteresUPenalty if applicable (2) 18, 000.00 D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5} 187.49 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ $ 7 , 49 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 :.................................................................................. x b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. x d. receive the promise forlife of either payments, benefds or care? ....................................................... x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death vVithout receiving adequate consideration? ...................................................................................................................... ^ ^x 3. Did decedent own an "in trust for° or payable upon death bank account or security at his or her death?,........ ^ ^x 4. Did decedent own an Individual Refinement Account, annuity, orothernon-probate property which contains a beneficiary designation? ...................................................................................................................... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE It AS PART OF THE RETURN. For dates of deatlr on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers 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 starviving 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 disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) (72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether'by blood or adoption. CCMMDNWEALTH of PEPINSn.vAN~A INHERITANCE TA% RETURN RES~ENTDECEDENT SCHEDULE A REAL ESTATE FILE NUMBffR ESTATE OF Demchak, Maxim M 21 - 09 - 00307 All n~al property owned solely or as a tenant in common must be reported at fair market value. Fair market ~ralue is defined as the price at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Unimproved lot located at 123 Clay Road, Carlisle (West Pennsboro Township), Cumberland 57,000.00 County, PA; prior Deed reference Deed Book 252, Page 2440; Cumberland County Tax Parcel #46-08-0585. Value based upon attached appraisal of Diversified Appraisal Services, Inc. 2 Lot and single family dwelling house located at 3332 Green Street, Harrisburg, PA 17112, prior Deed reference Dauphin County Record Book 5569, Page 153. Dauphin County Tax Pardel #62-017-147. Value based upon actual sale price, copies of Deed and HUD-1 attached. 154,000.00 I TOTAL (Also enter on Line 1, Recapitulation) I 211,000.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. CO""""0N~"`TMOF~''"s"-°^"'" PERSONAL PROPERTY INf1ERTTANCE TAX RETURN RESIDENT DECEDEM FILE NUAABE ESTATE OF Demchak, Maxim M 21 - 09 - 003107 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owneld with the right of survivorship must tae disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Household goods, furniture and furnishings, value based upon gross auction sale proceeds. 5,521.00 2 Old coins, on hand, value based upon gross auction sale proceeds. 3,443.00 3 Kayak and canoe and related accessories, including 2000 Load Rite canoe trailer, value in 800.00 accordance with attached appraisal. 4 1994 Volvo 850 station wagon. Value based upon attached Kelley Blue Book valuation. 3,315.00 5 1993 Mercedes Benz convertible sedan, value based upon gross auction sale price. 6,500.00 6 1998 Redman mobile home, containing 1,064 square feet of living space. Value based upoh 12,500.00 attached appraisal of T.L. Kimball. 7 1978 Boler Camper Coachman. Value based upon gross auction sale proceeds. 3,200.00 8 2002 Worthington trailer miscromax, valued in accordance with attached appraisal. 800.00 9 1985 Crosley utility trailer with cap, valued in accordance with attached appraisal. 100.00 10 Firearm collection, value based upon gross auction sale proceeds. 1,102.50 11 Wachovia Bank checking account #101008237084 10,483.96 Principal 10,483.87 Accrued interest .09 12 Wachovia Bank savings account #3000083005427 1,244.70 Principal 1,243.76 Accrued interest .94 I TOTAL (Also enter on Line 5, Recapitulation) I 77,279.99 SCHEDULE E CASH, BANK DEPOSITS, & MISC. ~oN~oNwEN-TMO~~Sn~nNi~ PERSONAL PROPERTY MiERRANCE 7AX RETURN ~~~~®~ continued ESTATE OF Demchak, Maxim M 21 - 09 - 00307 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 13 Wachovia Bank, Certificate of Deposit #6862 25,332.37 Principal 25,283.89 Accrued interest 48.48 14 ~ U.S. Treasury, income tax refund 15 ~ Sears, credit card refund 16 ~ Comcast, refund 17 ~ GEICO, refund, insurance cancellation 18 ~ Ronald Blauch, tax and sewer proration, sale of real estate 838.00 1.31 49.99 516.53 1,531.63 Page 2 of Schedule E SCHEDULE F COMMONWEALTH OFPENNSVLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF I FILE NUMBER Demchak, Maxim M 21 - 09 - 00307 If an asset was made joint within one year of the decedent's date of death, it must lte reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELAT14NSHIP TO DECEDENT Lindsey R. Demchak A 4702 Ruth Ann treet Harrisburg, PA 17112 aughter usan Demchak-Herb B 125 ay Road Carlisle, PA 17015 aughter JVIIV 1 LY CJWNtU f'KUF'tK I Y: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT Include name o nanaal ins Ion an ban account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET ~~ OF DECD'S INtEREST DATE of DEATH VALUE OF DECEDENTS INTEREST 1 A 11/15/2006 Amerprise One Financial Account 8,546.50 50% 4,273.25 #00067322024 0 021 2 B 02/14/1991 Ameriprise Cash Management 8,802.19 50% 4,401.10 Fund-A Account #011344867533002 TOTAL (Also enter on line 6, Recapitulation ) 8.674.35 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS ~ RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Demchak, Maxim M FILE NUMBLR 21 - D9 - 00307 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD•s INTEREST EXCLUSION (IF APPLIC/~BLE) TAXABLE VALUE 1 573.733 shares Ameriprise Divers~ed Equity Income 3,476.82 100% 3,476.82 Fund A, #00143417 79859002 @$6.06 per share Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest 2 Ameriprise Cash Management Fund A, #0021 3417 25,622.59 100% 25,622.59 79854002 Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest 3 1279.049 shares Ameriprise Large Cap Value-A, 3,184.83 100% 3,184.83 #0010 1347 3106 5 002 @2.49 per share Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1!2 interest 4 1468.014 shares Ameriprise Part Select Value A, 3,934.28 100% 3,934.28 #0010 1337 8939 5 002 @$2.68 per share Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb,daughter, 1/2 interest 5 360.782 shares Ameriprise Large Cap Equity-A, 909.17 100% 909.17 #0010 1243 5463 9 002 @$2.52 per share Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest 6 692.159 shares Ameriprise OPP Fund-A, #0010 1347 5,363.29 100% 5,363.29 3106 5 002 @$7.70 per share Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest TOTAL (Also enter on line 7, Recapitulation) 158,101.98 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS ~ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF Demchak, Maxim M FILE NUMBER 21 - d9 - 00307 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY InGude the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSI N IF APPLICABLE ~ ~ TAXABLE VALUE 7 Ameriprise IRA Account #00021791330 0 021 36,942.40 100% 36,942.40 Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1 /2 interest Susan Demchak-Herb, daughter, 1/2 interest 8 Ameriprise Brokerage Account #00071558597 021 34,999.11 100% 34,999.11 Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest 9 Ameriprise Post 1985 IRA Annuity Account 43,669.49 100% 43,669.49 #93102640224 4 004 Transferred on death by beneficiary designation to: Lindsey R. Demchak, daughter, 1/2 interest Susan Demchak-Herb, daughter, 1/2 interest Page 2 of Schedule G --- ~ -r --- _.. COMMONWEALTH OF PENNSYLVnNIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCFEDIJLE H FUNERAL D~ENSES & ADN~VISTRA7IVE 00675 FIL UMB R ESTATE OF Demchak, Maxim M 21 - 09 - 00307 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Heath Funeral Home, funeral 6,977.55 2 Heath Funeral Home, headstone 475.00 3 Susan Demchak-Herb, family meal 206.82 4 Susan Demchak-Herb, miscellaneous expenses 91.43 5 Enterprise, vehicle rental 268 ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Dale Shughart/Jennifer Hipp (estimated) 17,000.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Susan Demchak-Herb 3,500.00 Street Address 125 Clay Road city Carlisle state PA Zip 17015 Relationship of Claimant to Decedent Daughter 4. Probate Fees Paid (240) owe $100 340.00 5. Acxountant's Fees 6. Tax Return Preparer's Fees Joan Henney 40.00 7. Other Administrative Costs 1 Register of Wills, Short Certificates 28.00 TOTAL (Also enter on line 9, Recapitulation) 48,852.75 Sd~ed~~ie H Fute~l E~erlses& COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN w~~ w /~.~ 1. ^DYC~IYC RESIDENT DECEDENT ESTATE OF Demchak, Maxim M FILE M R 21 - 09 - 00307 2 Cordier Antique, commission and costs on sale of all personal proeprty and coins 5,184.14 3 Cumberland Law Journal, advertise Letters 75.00 4 The Sentinel, advertise Letters 176.92 5 Postmaster, stamps 35.01 6 Hilton's, replace locks and key on safe 13.52 7 Randy Ulsh, appraisal, Green Street property 325.00 8 Office Max, photocopies 5,97 9 Postmaster, certified mail 5.00 10 Deborah Piper, county/township real estate taxes on vacant lot 69.84 11 Deborah Piper, county/township real estate taxes on mobile home 61.02 12 Susan Demchak-Herb, reimburse out of pocket expenses, mileage 168.36 13 Diversified Appraisal Service, appraisal of Clay Road property. 250.00 14 Register of Wills, filing Inheritance Tax Return and Inventory 30.00 15 Bonnie Coyle, notary fees 25.00 16 Steven Korth, yard maintenance, Green Street 660.00 17 GEICO, auto insurance 615.00 18 UGI, gas 82.09 19 PP&L, electric 126.43 20 PennDot, transfer auto titles 262.50 Page 2 of Schedule H Sd~ed~~e H Fineral Expenses & COMMONWEALTH OF PENNSYLVANI INHERITANCE TAX RETURN A, ~e RESIDENT DECEDENT ESTATE OF Demchak, Maxim M FIL NUMB 21 - 09 - 0007 21 Terry Kimball, mobile home appraisal 200.00 22 United Water 73.38 23 AEGIS Security, mobile home insurance 275.00 24 Deborah Piper, school district taxes, lot, West Pennsboro Township, Cumberland 386.52 County 25 Deborah Piper, school district taxes, mobile home, West Pennsboro Township, 337.76 Cumberland County 26 Goodwill, shredding 100.70 27 Nationwide, auto insurance 195.20 28 Susquehanna Twp, sewer 99.50 29 Fidelity, flood insurance 326.00 30 Ohio Casualty, homeowner's insurance 523.00 31 H. B. McClure, repair air conditioner 187.68 32 Susquehanna Twp, school district real estate tax, Green Street, Harrisburg, Dauphin 1,988.98 County 33 Home Depot, yard maintenance supplies 63.09 34 Wachovia Bank, service fees 19.00 35 Cordier Antiques, commission on auction sale of Green Street 4,620.00 36 Recorder of Deeds, realty transfer tax on sale of Green Street 1,540.00 37 Fine Line, detail Mercedes. 100.00 38 Susquehanna Township, Tax Certification 20.00 Page 3 of Schedule H Sd~edt~e H Funeral E~er~ses & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Demchak, Maxim M 21 - 09 - 00307 39 ~ Susquehanna Township Authority, sewer bills 40 ~ Register of Wills, reserve for account 199.00 500.00 Page 4 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE °O""'"1ON1N~TMOFn~""'" LIABILITIES & LIENS INHERITANCE TAX RETURN ~ RESIDENT DECEDENT ESTATE OF Demchak Maxim M FlLE NUMBER , 21 - 09 - 00307 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Craig Anzur, DMD, dental bill 12.36 2 United Water, water bill 22.96 3 National Telephone, telephone bill 10.89 4 AT~T, phone bill 285.80 5 UGI, gas bill 191.40 6 PP8~L, electric bill 143.98 7 American Express, credit card (254.98 paid, 285.80 debited from Wachovia) 540.60 8 Susquehanna Township Authority, sewer 104.48 9 Ameriprise Financial Services, estate planning services 500.00 10 Milton Hershey Medical Center, hospital bill 224.58 I TOTAL (Also enter on Line 10, Recapitulation) ~ 2,037.05 REV-1513 EX+ (8-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Demchak, Maxim M SCHEDULE J BENEFICIARIES ~ FILE NUMBER 21 - 09 - 00307 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Lindsey R. Demchak Daughter one-half 4702 Ruth Ann Street Harrisburg, PA 17112 2 Susan Demchak-Herb Daughter one-half 125 Clay Road Carlisle, PA 17015 Enter dollar amounts for distributions shown above on lines 1 5 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 APPRAISAL OF REAL PROPERTY LOCATED AT: 123 Clay Road Deed Book Carlisle, PA 17013 FOR: Estate of Mapm Dem'Chak AS OF: February 18, 2009 BY: Susan Burkholder, R1.-000659-L State Certfied Residential Appraiser This appraisal was completed to establish value for Estate Summary Format Fon116A1-'TO'TAL for WNidows' appraisal software by a b mode, inc. -1.800-AIAMODE LAND APPRAISAL REPORT i no ~w. w ~ way Borrowe n.a. _ Census Tract 128 Map Reference 48-08-0585-009 Property Address 123 Cla Road City Carlisle Cwrdy Cumberland State PA Zip Code 17013 Legal Desalptmn Deed Book 252 P 2440 Sale Price i n.a. Dam d Sale n.a. Loan Tenn yrs. Property Rlghm Appraised ®Fee ^ Leasehold ^ De Mklmm PUD Actual Real Estate Tams S 444.00 (Yr) Loan clstryes m be paid by sager S n.a. Other sales cnrrassbns n.a. Lender/Cier~ Estate of Maxim Dem'Chak Address Occupant Vacant Appraise Susan Burkholder Inslrecdas m Appraiser Market value Larafion Urban Suburban Rural Good Avg . l~ Poo r Built lip ^ Over 75% ®25% m 75% ~,] Under 25% Employmerd Stabgky ^ ® ^ srowth Ram ^ Fully Dev. ^ Rapid ®Steady LI slow Convenience m Enrpbynralt ^ ® ^ ~rtY yadres ^ kraeasirp ®Stable [_] DechHrp Corneriarce m Shopping ^ ® ^ DenarrdrSupply ^ Shortage ®m Balarae L~I Oversupply Comeniarce m Stdroob ^ ® ^ Marketlrp Time ^ lkrde 3 Mos. ®4.8 Mos. ^ Over B Mos. Adequacy d Pubic Transportation ^ ® ^ Present Land Use 71X61 fsrrrly _% 2-4 tartly _% Apm. _% Condo _% Commadal Recreational FaciBtles ^ ® ^ ~ ktdrtsbml 30%Vatmlt _% Charge m Presets Land Use ~ Not Likely ®LBoely ('~ ^ Taldrp Place (') Properly ~ ^ ® ^ (~Fttxn Vacant To Single famiN Promoton from DekhnarAal Candilbra ^ ® ^ ProdonYnalt Ocxupancy I~ Owror ^ TaarR 0 %Vacard Peace and pre Promotion ^ ® ^ Skrgm Family Plkx Rape = 150 m S 400.000 PredonlrlaM Vahre $ 200.000 General Appeaaae of Propertles ^ ® ^ Skrgm Pettily Age New yrs. b 250 yrs. Predanklad Age 50 yrs. Appeal m Malmt ^ ® ^ Canentmm g those facsore, favorable a unfavorable, afiectkrg maloemb(l1y (e.g, public pales, schools, view, raise): Estabfiafred residential area w ith stab ownershi ms within reasonable oommutl distance to schools laces of worshi sho i and n. Dhnenslorts 150' x 302.98' X 150 i3X 303.51' = 1.04 Sq. R a Acres Comer Ld 2alrp chdssMicatlort Residential Presets htlprovemems ®do ^ do not confam m mNtp tegrAatlons Highest and best use ®Present use Otlre Pobec Diller (Describe) OFf Sf1E NAPROVBdBVTS Tapo Sf hti rolli FJec. ® Strad Access ®Prd1Bc ^ Privam Size T loot for the area ~ ^ Surface Macadam Shape I ular Wafer ® Shared MaYtmnala ®Prabtlc ^ PrNam Vmw Avers San. Sewer ® On site ^ Stem Sewer ^ CurtdGutter Drainage ors ad uate ^ Undaprourd BBCL & Tel. Sidewalk Sft6et hLS m the property boated m a HUD Iderrtlfied SpaeW Flood Huard Area? ®Nb ^ Yea Canmatls (fawrade a urdavaabb indrM6p arty appamn advase easemams, araoalanents, a other adverse condidons): No rent adverse easements encroachments or other adverse conditions. Off-street arkin at or near sfte. The urrdxsipned has radled lhee rears sales at praperlas moo sirdlaz and pmrdmale a sub)ect and has censldaed tlrese b ere market analy~s. The desgfpbon YrcMrdes a dolor ad)osernrd retbclrp malret roaoear to thou lams of siplAcart vafallao betvnar the subject and canparable propales. e a slgNAcart lam h ere amPuable pmpsly b superbr to a mae favorable than the properly, a rtiars (•) adJrrshnera is made sxs reduGng the hrdcated vaWe of sub)ec~ g a sigrdAcaa kart b the campaahb b kdeda m ar less favorabm that the subject propaty, a pNrs (+) aljusitrrerd is made flirts ktcreasirp the irMlcaied vahre of the subject. rtFal .1 P Address 123 Clay Road Lot 2 Ritrter Highway Lot 3 RHner Highway Lot 1 Crossroad School Rd•ad Carlisle Carlisle Carlisle Carlisle 2.45 miles 2.47 miles 1.83 miles Sales n a ~~ - ~'~ ~ ~ 58 000 ,~ ~~'~ 56 000 , 7900 ~.``a Courihouae/MLS Courthouse/MLS CourthouselMLS Dam of Sob aril + - Ad ust S - + - TNtaAdjuSUrtent n.a. &13-08 &28.08 6-18-08 A Similar Similar Similar 1.04 acre 2.43 acres -7 000 2.58 acres -7 700 2.12 acres -5400 Shared well & drive None +2 000 None +2 000 None +2 000 On sHe None +5 000 None +5 000 None +5 000 Sobs a Fktattcitp l.aaasslons n.a. ~ a ' - + - 700 + 1800 krdicebed VaWe :- _. . of Subject '~ °i a. "' ~ 58 000 ~ .:~, }; . 57 300 ' . °; 500 Commetds on Market Dam: Atlhouah one or more of the corrroereb~ safes are further than one mile for the su ad the sales used aria the rrear~t available. Cammerds and COlydltlars of Appraisal: FYtal Recorta'latlar: With ustments all three corm table sales are acre table for for the direct sales rison anal is and confirm m final inbn of value. r EierearrvE 7N E M a a~ T YAWE, Atr OEFlNEO, a tauECr raoarearr ns op _ February 18 2D08 m ba S 57 D00 ~ ,{ ~ ~ XJw'WWwv~yp. Susan Burkholder. RL-000859-L ^ DId ^ Did Not PI sN~l s I t P rt rv ry y pa n rope y s Revmw a Bcable mn DlveslAed Appraisal Services Pomt LND -'TOTAL tot Wktdmes' appraisal software by a m mode, Inc. -1-800•ALAMODE Sutotolemental Addendum m.u„~M,e,,.,., Bonower/t~ieru n.a. - - - - Address 123 Cla Road Carifsle Cou Cumberland State PA L Code 17013 Lender Estate of Maxim Den'Chek Additional Comments The subject has a joint dfireway and weN agreement that are recorded in Misc. Book 686, Page 1617. The agreement waiving the restriction against placement of mobile homes on the lot, recorded in Misc.. Book 888, Page 1738. One or more of the oompareble sales are okler than six months dd. Although there are compareble properties in the subject's area, none have solo recently, therefore, sales in excess of six months old have to be used. All three comparebles used Were the best avagable. Alftwugh there are other similar home in the subject's neighborhood, none have sold recently. Therefore is was necessary to use sales further than one mile from the subject property. The sales used are the best available. Gross adjustments exceed 25% and net adjustments exceed 15% for one or more of the comparable sales. Although there are other similar homes in the area, none have sold recently. The sales used are the best available. The Intended User of this appraisal report is the Lender/Clierrt. The Intended Use is to evaluate the properly that is the sutpjed of this appraisal for a mortgage finance trensadion, subject to the stated Scope of Work, purpose of the appraisal. reportlng requirements of this appraisal report form, and Definition of Market Value. No additional Intended Users are identified by the appr~ser. Privacy Notice Pursuant to the Gremm-Leach-Billet' Ad of 1999, effective July 1, 2l)01, appraisers, abng with all providers of personal fin~ndal services are now required by federal law to intorn their clients of the policles of the firm with regard to the privacy of the dint nonpublic personal information. As professionals, we understand that your privacy is very important to you and are pleased to provide you with this information. In the course of performing appraisal, we may coiled what is known as "nompublic personal informaton" about you. This information is used to fadlitate the services that we provide to you and may include the information provided to us by you directly or received by us from others with your authorization. We do not disclose any nonpubNc personal information obtained in the course of our engagement with our clients to nonaffiliated third parties, except as necessary or as required by law. By way of example, a necessary disclosure would be to our independent contractors, and in certain sRuations, to unrelated third party consultants who need to know that information to assist us in providing appreisal services to you. All independent contractors and any third party consultants we engage are informed that any information they see as part of an appraisal is to be maintained in strict confidence within the firm. A disclosure required by law would be a disclosure by us that is ordered by a court of competent jurisdiction with regard to a legal action to which you are party. We will retain records relatlng to professional services that we have provided to you for a reasonable tlme so that we are batter able W assist you with your needs. In order to protect your nonpublic peroonal information for unauthor¢ed access by third' parties, we maintain physical, electronic and procedure) safeguards that comply with our professional standards insure the security and Integrity of your information. Sigmhxe Name Susan Burkholder Date Signed June 76. 2008 Slate CertlBcatlon ~ RL-000659-L State PA Or State Lkense ~ cry, Signature Name Date Signed _ State CertlBcatbn # Or 51ate LM,enae # State State Dfversifled Appraisal Services Form TADD2 - `TOTAL fw vVhdows' appraisal software try a la mode, Inc. -1-800-ALAMODE Location Mao n.a. 723 Cla Road C Carlisle Cou Cumberland Stye PA D Code 17013 lender Estate of AAaxim Dem'Chak >~~ 4A ' 4 ~ ~a 4r ;~~`'^ 9P :... ~ ~ ~ .I ,.. ... •• ...: I -, ox _,_ ~ ii 1 I ° ~ ~ ~ ii ~ ,1 A ~~ ~..: ,. ~ , - =- ~ - ,~ ~ r a 4? ~~~~ya I _ii 1pp~ ~( r I • il,' I __P..btre_ ..._ l i ~...4 ~.~. . - - !' - ~~.... t it I I ..'~ I~_.- i --- - ,: ~ ~ i ~~. .• ~ ~, ~----__._ ,~. I - - - - -: i ~; ,: $ _ °-" ~~. ~»~»~:~ ~I 'i frortn MAP.LOC -'TOTAL for WNrdows• appraisal software by a la erode, inc. -1-800-ALAMOOE Subject Photos BarmxrerCBent n.a. P Address i23 Cla Road Carlisb Cumberland PA Ii 17013 Lender Estate of Maram f]em'Chak Subject Front 123 Ciay Road Subject Rear Subject Street Form PICPD(.TR -'TOTAL tar Windows• appraisal soMnre by a b mode, inc. - t-800-ALAMOOE 11/09/2009 11:35 FA% 717 761 4704 ASSURED LAND TRANSFERS C~J003/010 Tax Parcel No. 62-017-147 THIS INDENTURE, MADE THE ~1•" day of ~ oyt„~bwtwo thousand nibs (2009) BETWEEN SUSAN DEMCHAK-HERB, Co-Executrix, and LINDSEY R. DEMCHAK, Co-Executrix of the Last Wall and Testament of MAXIM M. DEMCHAK, a/k/a M1~XIM DEMCHAK, late of Harrisburg, Dauphin Cbunty, Pennsylvania, parties of the first park, and RONALD B. BLAUCH and GEORGIA L. BLAUCH, hus- band and wife, of Marysville, Perry County, parties of the second part: Wfi$REAS, the said MAXIM M. DEMCHAK by his Last Will and Te~ta- ment, duly proved and recorded in the Dauphin County Register of Wills Office, Pennsylvania, in Docket Book 21-09-0307, Letters Testamentary being issued on April 1, 2009, provided, in pierti- nent part, as follows: THIRD: I hereby give, devise and bequeath all the rest, residue and remainder whether it be, real or personal, unto my daughters, SUSAN DEMCHAK and LINDSEY DEMCHAK, equally... LASTLY: I hereby nominate, constitute and appoint my daughters, SUSAN DEMCHAK and LINDSEY DEMCHAK, Co-Executrices of this my Last Wi11 and Testament. My Co-Executrices hereunder shall have the following powers, in addition to those powers conferred by law: To dispose of any asset of my estate, including real estate at private or public sale... 11/09/2009 11;35 FA% 717 761 4704 ASSURED LAND TRANSFERS f~j 004/010 NOW ISIS INDENTITRE WITNESSETB, that the said parties of the first part, by virtue of the power and authority aforesaid, in said will contained, and in consideration of the earn of One Hundred Fifty-Four Thousand and 00/100 Dollars ($154,000.00) to them paid by the said parties of the second part, at and before the ensealing and delivery of these presents, the receipt whereof is hereby acknowledged, have granted, bargained, sold and conveyed, and do hereby grant, bargain, sell and convey to the said parties of the second part, their heirs and assigns forever: ALL THAT CERTAIN lots or pieces of land situate in Susquehanna Township, Dauphin County, Pennsylvania, as laid out on Plan of "Bergner Farm", prepared by Gannett, Seelye and Fleming Engineers, Inc., in May 1928, as subsequently amended in July 1929, which said amended Plan has been recorded in the Dauphin County Recorder of Deeds Office in Plan Hook "J", Page 23, being bounded and described as follows, to wit: BEGINNING at a point on the western side of Green Street which point is 170 feet South of the southwestern corner of Green and Bergner Streets; THENCE in a westerly direction through Lot No. 54 and parallel with the northern line of Lot No. 55 a distance of 130 feet, more or less, to the eastern line of Penn Street; THENCE in a southwardly direction along the eastern line o~ Penn Street, a distance of 75 feet to a point; THENCE in an easterly direction through Lot No. 55 and parallel with the northern line of Lot No. 56 a distance of 130 feet, more or less, to the western line of Green Street; THENCE in a northwardly direction along the western line of Green Street a distance of 75 feet to the place of BEGINNING. SLING the southern 30 feet of Lot No. 54 and the northern 45 feet of Lot No. 55 in the aforesaid plan. HAVING THEREON ERECTED a single family dwelling known and numbered as 3332 Green Street, Harrisburg, Pennsylvania. BEING the same premises which Vivian Goldberg by deed dated June 23, 2004 and recorded June 30, 2004 in the Dauphin County Recorder of Deeds Office in Deed Book 5569, Page 153, granted and conveyed unto Maxim Demchak. The said Maxim Demchak having died February 18, 2009. THIS conveyance is made subject to the existing building restrictions. r _ 11/09/2009 11:35 FA% 717 761 4704 ASSURED LAND TRANSFERS C~ 005/010 UNDBR AND SIIBJECT, nevertheless, to easements, restrictions, reservations, conditions and rights-of-way of record or visible upon inspection of premises. TOaBTHER with all and singular the rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of the said MAXIM M. DEMCHAK at and immediately before the time of his decease, in law or equity or otherwise howsoever, of, in, to or out of the same: TO RAVE AffiD TO SOLD the said granted premises to the said parties of the second part, their heirs and assigns forever. AND the said parties of the first part, do covenant, promise, grant and agree, to and with the said parties of the second part, their heirs and assigns, by these presents, that the said parties of the first part, have not done, committed, or knowingly or willingly suffered to be done, any act, matter or thing whiat- soever, whereby the premises aforesaid, or any part thereof, is, are, shall or may be charged or encumbered, in title, charge or estate, or otherwise howsoever. IN WITDIESS WHEREOF, the said parties of the first part have hereunto set their hands and seals the day and year above written. Signed, Sealed and Delivered in the Preseac4 of SUSAN DEMCHAK-HERB, Co-Executrix, ~ of the Estate of MAXIM M. DEMCHAK a/k/a MAXIM DEMCHAK ~~ Ca-~cl~g . ( SEAL ) LINDSEY R. DEMCHAK, Co-Executrix, of the Estate of MAXIM M. DEMCHAK a/k/a MAXIM DEMCHAK -_ - _ 11/09/2008 11:35 FAb 717 761 4704 ASSURED LAND TRANSFERS f~j008/010 A U•S.~EPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT I. Lf FHA 2. U FFIhtA 3. LJ CONV. UNINS. 4. ^ VA 3. ^ CONV.INS. 6. FILE NUMBER: 7. LOAN NUMBER S. MORTGAGE INS. CASE NO.: C. NOTE: Thu form u LLmishod m give yon s smemeat o[actusl tettkment Doris. Armunta paid m and lry the satlaaeat sgmt are rltowa. Items marked'(p o c )' wwe t ad oubide the closh~' Nay are shown heto for iolfotmatioosl putpmw and are not iucltded io the mtsls. _ D. NAME & ADDRESS Rooold B. Blauch and Georgia L. Hlauch OF BORROWER' 1000 Mouataindale Drive M-Saville, PA 17033 E. NAME & ADDRESS The Estate of Maxim Demchak OF SELLER: F. NAME A ADDRESS CASH OF LENDER: G PROPERTY LOCATION• 3332 G~teat Stmt. Harruburg, PA 17110 _ H. SETTLEMENT AGENT: Assured Lsutd'Mnsftae, Inc. PLACE OF SETfLEMENT• 301 Mulret Street, Lemoyne, PA 17043 (717) 761-4720 I. SETTLEMENT DATE: 11/09/2009 c~~...w... ..r Qwrlww.. Twww,.aiww J. Oaa01 aII wrav 100. Greta Amoral Doa Fron Borrower: 101. Coatga sales iae 134000. ___ ___ __ _ _ _-_____ 100. Groa Amoaat Dee To 8elhtr: 401. Contract sales 134000.00 102. Perwal 402. Petrone! 103. Settlement m borrower: line 1400 3867.38 403• 104. ~ 103. ~3• Ad u For Itsaa 1v a For I Paid So1Nr v 106. C' /m+ra fixes m 406. /morn taxes m 107. Co taxes 11/09!09 m 12J3U09 171.44 407. taxes 11/09!09 m 12/31/09 171.44 108. Auernwtts m 108. Assassaean m 109. School Takes l !/098009 m 6~fl08010 1 269. 409. School Tcus 11/098009 m 6!30/2010 1 69.69 110. Sews 11/L-1131 ! 1109!1009 m II31I2A10 90.5 410. Sewer 11/1-I/3! 11/09/2009 m 1/318010 90.30 111. 411, 112. 412. 113. 413• 114. 414. 113. 413. 116. 416. 120. Groa Amoaot Dvs From Borrower. 139,399.01 420. Grose Aatoust Dee To SNler. 133,331.63 201. ' or camel 20000.0 SOI. P.xeeu see ios<rnctia:a 202. Pri amowtt of rtaw s 502. Saalwnant m seller ice 1400 7601.00 203. 1 a taken sub'ect m 503. Exi I s taken sub'ect m 204. 304. Iri La. 203. 505. P 82nd Ln. 206. 306. 207. 307. zoo. son. 209. so9. Adjatetasab For hone Unpaid By Solkr: 210. Ci lmwa tmtra m Adjtsedseab For Itewte Unpaid Hy Seller: S l0. C' lmwn tun m 211. Co taxes m S l I. Coo tun m 212. AuusmeM m 312. Aueumean m 213. 313. 214. 514. 215. 313. 216. 316. 217. 317. 21i. S1E. 219. 519. 220. Total Paid By/For ~~~: 20,000. 520. Total Bedntlioae Ia Aaouat Due Seller: 7,601.00 301. Groa amount doe S:om bmtosrer l20 139 399.01 601. Grou amoud due m teller 420 133 331.63 302. Lau amount /dor bmowcr ins 220 20 000.00 602. Lest redutxmm io amount due roller line 3 7 601.00 303. Cask (®FROM) i~l'O) Borrower: 139,399.01 603. Cash ~1'O) IOFROM) Seger: 147,930.63 Previous Edition Is Obsdete SH-1-353E-000•l Form No. 1581 1R1D-i (3-86) 3/86 D - , J - , RESPA, liB 4303.2 X ~ Pqe I of 3 X 14~4~- a~ 1.~~ daJLF Co -aLSC41~, 11/09/2009 11:38 FAZ 717 781 4704 ASSURED LAND TRANSFERS ®009/010 700. Total SalesBrokds Commission: Paid From Paid From Hated Oa Price S Borrowtsr'a SaUer's Funds Fuads At At Bettlemeat Sstdemmt 1107. Attorney's fees to Jolmsoq Dine, Stewut ~ Weidner (includes above item Numbers: } 1 30. 1108. Tide inaunna to Assured Land Tranefen, Inc. (includes above item Numbers: 1101, 1102, 1103, 1104 ) 1.013. Fonn N 1382 n~ ,~ Page 2 of 3 ~-3538.000- X 1i~~ - .~G~.r/~---~ x.d'iasr~ ~r.~iruE 6rti/ 11/09/2009 11:38 FAZ 717 781 4704 ASSURED LAND TRANSFERS ®olo/olo SELLER'S AND/OR BORROWER'S STATEMENT Escrow: 09-D0229-ALT I have carefully reviewed the HUD-1 Sealemem Statement end to the beat of my Imowledge end belief, it is a true and accurate statement of all receipts and disburaemanb made on my account or by me in thin traneatxion. l fitrther ~' that I have received a copy of the IiUD-1 Senlentent Statement. Borro//wffer~~a/`~Purch((a+//er~~s/~ /LAi~4~GGItYfi/L- ~nald B. Blauclt ~ ~ ~ rgia L. Blauch Sellers The Estate of Maxim Demcttalc The fiIID-1 5ettkotent Statement which [ have p true accurate account of Chia transaction. l have caused or wlll tattse the funds to be disbursed in accordance witlt thin Settlement Agem: ~ Date:_ ~~~/~ Stephen M. Reeves, Aastued land rwfera, Inc. WARNING: It is a crime to Imowin~ly make false b to the United Staten on this or any other similar form. Penalties upon cenviaroa can include a fine or imprisonmatt. For details see: Title I B U.S. 'on 1001 and Section 1010. Pane 3 of 3 MAY-13-2009 13:56 From: To:7172414021 P.3~3 1994 Volvo 850 - Private Party Pricing Report -Official Kelley Blue ... hup;//www.kbb.corn/KBBNsedCars/Pricin~teport.aspx?Yearld=19... -•--•---•-• advertkement --•••-•--•- BLUE 8a0K~ PRI~'~tE PdRn' VALllF 1;~~;;;4 :... .~. ~..Y ICI, •_ -3 R~~1,1 •;tJ~7:,hl~l;ii i ;L Condition Value ~ ~~" Excellent $3, ! 15 Good $2,740 ~t1r1 ~t ~ Fair $2,315 ~Vy (Selected) . Nf6! ~: .y' :s: ~I!4MI.tII^r:~ . ../IW. . YIM ~ ~~~ Vehicle Highlights Mieage; i~o,ooo 'Erglne: 5-Cyl. 2.4 l_ter ~~ Yra~srnissbn: Automatk ~Drirltrilr+: FWD • ~~~~F-.Y yi~ii?~•sr.!3:4i11':e9.~e'~110i51iut~.F;;;'::::It•Yllil/IN67:}~r".;;1G^.•L'YiIGf11->:3 JlYlx_cl!W::T"...I:CWi:dE=:IM1 Selected Equipment ~'~h0~~ ;Standard ;air Condltwnq~g AM/FM Sterna uual Front Air Bags Power Steering Cassette Algy WheEls ~~~~~ .Optbnal Power Windows Till WheRi 1 ~:athcr Power Door locks CruLse Control Fli -U Rouf ........ p ............ Blue Book Private Party Value _ Private Pally Values what a buyer can expect t0 pay when buying a used car from a private party. The Private Party Value assumes the vehicle Is sold "AS Is' and tarries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and bcal market condition8. This value may ako be used to derive Felr Market Value for Insurance and vohlpk donation purposes. Vehide Condition Ratings Excellent ~ $3,115 _ _ .. Cbse YVindow .~.---...._."_._.____ • tAOks new, is in excellent mecnanbal condition and needs rro reconditioning. • NCvCr had any paint or body work and Is free of rust. • Clean title history and wiM pass a smog and safety Inspection. • Engaie compartment is clean, with no flub leeks and is free Of any wear Or visible tlefeCts. • Complete and verifiable service records. Less than 590 of aA used vehicles fal OKO the category. 7 n~ Z 5/ I3/~009 1.49 PM Conditions of Appraisal The value stated in this Appraisal Report is based on the best judgment of the appraiser given the facts and conditions available at the date of the valuation. The use of the report is limited to the purpose of determining the value of personal property for Estate Tax purposes. Any additional research or testimony required by the client or the court will be billed at the current rates. Disclosure of the contents of the report is governed by the Standards and Practices of the Certified Appraisers Guild of the America. Certification of Report No prohibited fee was accessed for this report. David J. Cordier and Ellen E. Miller of Cordier Antiques & Auctions have successfully completed the personal property appraisal certification program with the Certified Appraisers ~'ruild of America and are members in good standing. This report. was prepared in accordance with the Uniform Standards of Professional Appraisal Practice and with the Standards and Practices of the Certified Appraisers Guild of America which has review authority of this report. David J. Cordier and/or Ellen E. Miller have personally examined the subject property. The statements of fact contained in this report are true and correct to the best knowledge land belief of the appraiser. .. ;~ ti ~~ ~id J. Cordier, C.A.G.A. By: Ellen E. Miller, C.A.G.A. Antiques & Auctions Cordier Antiques & Auctions Page: 5 of 8 Purpose of the Report The purpose of this report is to determine the value for Estate Tax purposes for The Estate of Maxim Demchak, Harrisburg, Pennsylvania. Method of Valuation The method of valuation used for this appraisal is the Fair Market Value. Definition of Value Fair Market Value Under the United States Treasury regulation 1.170-1c Fair Market value is defined as: The price at which the property would change hands between a willing buyer and a willing seller, neither being under compulsion to buy or compulsion to sell and both having reasonable knowledge. Basis of Appraisal Valuation Date The date of valuation for determining the value estimation is November 13, 2009. Date Appraisal Conducted This appraisal was conducted on November 13, 2009. Limitations of Property There were no limitations on use or disposition of this property. Description An itemized list with descriptions is in Appendix A. Page: 6 of 8 Appendix A Fair Market Value 1. $100.00 Utility trailer. 1985 Crosley model UL12. 4' x 6'. Steel with drop gate. Max load weight 1500 pounds. 2. $800.00 Custom built camper. With sleeping cabin and storage cubbies. Wired for electric. On 2002 Worthington trailer. Maximum load 'I2000 pounds. 3. $200.00 Recreational kayak. 2001 Rascal by Wilderness Systems. 9'9" x 30". Molded plastic. With paddle. 4. $200.00 Canoe. 15'. 1972 Grumman. Aluminum. 5. $400.00 Boat trailer. 2000 Load Rite Millenium Edition. $1.700.00 Total Page: 8 of 8 NUMBER 2 4 ~ 141, CERTIFICATE OF VALUE Case/File No. MANUFACTURED HOUSING 9/'ID,~ PREPARED FOR: ^ LENDER ^CLIENT ['OTHER Firm Name ~~cT,*r~, ~~ I`'lfa~,~rr nE~-'r~w~ Address #~/~~ G~ ~n # City ~~~~~ : ~O~ State Zip _ ~ 7p ~,~ Phone (7i 7 } ~~}~- ~,j'~jf9 Ordered by ~'r~,~ ~,f~tl~-, ~ „r,~~_z, •re , ~r CLIENT NAME: Address City Zip Phone LOCATION: ^ Fee Land ^ Retailer Lot ^ PUD ^ ental/lease Community -Quality ®Other (u5t> ~t/~ r~- ~ ~ Name _# State Address /,Z 3 ~ v. ~ # City G,,a,~y~,s ~~,~. State Zip j 7d ~~' Phone ( ) INSTALLATION: (a'~onventional ^ Excavated ^ HUD Foundation System ^Other (~i5t) DESCRIPTION OF SUBJECT PROPERTY: Year ~99T ,, Mfr. of Home ~,~ /y~q,L,1 Trade Name Main Floor ........................................... Size -~ x ~~cL ^ Tag-a-long ^ Expando ^Tip-out Size x Estimated Living Area /C3lc~ Sq. Ft. I.D./Serial # Not Verified OVERALL CONDITION: ^Excellent ood ^Fair ^Poor APPRAISED VALUE: Cost Guide Edition - Mo./Yr. / ~_ Yellow ChartNalue Page # ~~~~? Depreciated Replacement Value of Home.... $ ~y ~ l~~ Community In Place Location Value (IPLV) .. $ Q - Total Value of Accessories (less repairs) ...... $ eT9 yQ --~ Other (t.ist) $ Indicated Value by the Cost Approach ....... $ /(, x.58 Land Value/Other Gist) Estimated Remaining Physical Life in Years .'~7' • !~~ (RPL) ESTIMATED MARKET VALUE ...................t$ ~~_ 4Pj"~~ N.A.S. Subscriber LD. Number ~+~e`t Name (Print> ~ . J~//y{~,,~L,1,,, Phone (,71?) S[l~~Q9Q ,a~ This appraisal report dated ~ ~ is based on ^ If Repaired ~ Present Co ition ^ Completion per Plans/Specifications and complies with the NAS/US AP andards. SEE REVERSE SIDE OF THIS FORM FOR APPRAISER'S ~ G` CERTIFICATION AND STATEMENT OF LIMITATIONS. signatureofA r DesignatioNCertifiption Copyright ®2001 by National Appraisal Guides, Inc (Revised 21101 V.P.) 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N ~ =< O aC.~r tn'N~G TERRY alvn JAN KIMBALL All these factors have a negative impact on the value of this home; theref©re I would estimate that this home would sell in a reasonable amount of time, in its current location, if it were marketed at $12,500.00. If you were to move the home to a manufactured home community it would bring much closer to book value. Other options which are available to you would be to rent the home where it is. If you did that you should be able to get $750.00 per month rent. You could also sell the home where it is and rent the lot for $300.04 per month. Thank you for choosing us for your appraisal needs. If you have any questions, just give me a call at (717) 802-0902. Sincerely, ~~ ~''~ T. L. Kimball, M.H.V.,P.H.C. ~. ~ ~~ o~ A y ~ ~ ,11~ b~ C +~ "~ t'~ ~A o~oo g A . ~, . c~ ~ ~ ~ ~ ~ ~ ~ ~ °d ~ ~ ~ ~ ~ ° ~ ~ ~ ~ ~ ~ A ~ ~ ~ A a, .,,~ ~ '' ~ A o. ~ N ~ ~' ~' ~ ~ o ~ CO o ~ ~ ~ ~o ~. ~~ ~ ~~ ~ N ~ a+ ~ A ~ e-F. ~ ~ ~ `~ ~ ~ ~~ ~' ~'~~ n ~~ ~ ~`~ ~ ~ `° ~ ~ ~. ~ ~~ t~ ~ ~ ~ ~ _ ~ ~~~ ~ ~ A ~ ~ ,~ ~ ~ N. a~ "- ., TERRY AND JAN KIMBALL Board Cert~ed in Manufactured Housing Valuation May 1 I, 2009 Estate of Maxim Demchak Susan Herb, Executrix 125 Clay Rd. Cazlisle, Pa. 17015 Deaz Susan, On May 9, 2009, at your request, I inspected the manufactured home located at 123 Clay Rd., Cazlisle, Pa. The purpose of my inspection was to determine the valuue of said home. The home was built by Redman, out of their Ephrata, Pa. plant. It was built on 11 /12/97, making it a 1998 model. The home is classified as a 14 x 80, however the 80 includes the hitch. The actual floor space of the home is 14 x 76, giving it 1,064 sc~. ft. of living space. There are books which. assign value to every make, model and size of homed ever manufactured. The value of this home by the cost (book) approach is $16,558.00. This figure takes into consideration the good condition of the home itself, plus the optional equipment it has. Book value and mazket value are often different, which is the case with this home. Market value is defined as that price which an informed consumer (buyer) would play for a home such as this. It is affected by such things as its current location and its overnll desirability as well as interest rates. Generally speaking, manufactured homes sell quicker, and at a higher pricey if they are located in a manufactured home community, which this one is not. Overall desirability refers to the basic curb appeal -such things as lap siding and shingle roof, for example, which this home lacks. While interest rates have been falling for site built housing in our economy (now in the 5% range), rates for manufactured homes remain high (now in the 10 -12% range). Fax Transmittal 4/20/2009 12:16:57 PM PAGE 1/002 Fax Server ~+'1iil~HUiVIA Wachovia Bank N.A. Balancx Confirmation Services P O Hox 40028 Roanoke, VA 24027313 Apri120, 2009 DALE F SHIJGHART JR {10) ATTN: DALE F SHUGART JR 10 WEST HIGH STREET CARLISLE, PA 17013 Refaraa ID: 2718436 SUBJECT: Verification / Confirmation of Aooou~ and Balance lnibrmation provided ibr: Customer: MAXIIVI M DEMCHAK (SSN1t JC1Qt-XX-904' Date of Death: February 18, 2009 Infi Asoouot Aeoouot Date ofDeaffi Average Dde Mattuity Ia~ed AcQUed YTD Date Type Number Balaooe BaLooe~ Opened Date Rate Imemt Idemt Paid Cued CERTIEZCATEOF ?Dt}QCXX6862 525,283.89 10/11/3008 3/11/2009 548.48 578.90 DEPOSIT LEGAL TITIB: MA}IIM DEMCHAK LINDBEY DEMCHAK ~ SUSAN HERB POD CHECKING ?DD~O~X7084 LEGALTITIE: btAXDdDEMCHAK SUSAN DEbICHAK POA CLOSIIJG HALANCE: 51065.69 510,483.87 618/2001 50.09 50.72 4/1x2009 SAVIIJGB 7~DO~D5427 51,243.76 3/S/Z008 5094 58.97 4/1/2009 LEGAL TT1TE: b1AXDd DEMCHAK CLOSING BALANCE: 51410.19 r Fax Transmittal 4/20/2009 12:16:57 PM PAGE 2/002 Fax Server ~'1~.~HOlVIt1 i~ m: rna4s6 Date of death balance does not include accrued interest. • If date of death aaurn on a weekend or a holiday, date of death baLmoe does not include any transactions that were made during flat time period. 3s+~ Jennifer Straub Servieenter Associate Phone: (540)563-7323 mr, ji The Personal Advisors of Ameriprise Financial Apri121, 2009 Dale F Shughart, Jr Attorney at Law 10 West High Street Carlisle, PA 17013 Dear Mr. Shughart, Wayne A. Logue, CFP• Financial Advisor Per your request, I am enclosing date of death values for Maxim M Demchak. His various accounts are listed separately. If there is anything else you need, please call me at 717-975-0202. . Sincerely, ~~ ~~ Wayne Logue, CFP® Ameriprise Financial 342 North Front Street Wormleysburg, PA 17043 Ameriprise Financial Services, Inc. Suite 200 342 North Front Street Wormleysburg, PA 17043 Tel: 717.975.0202 Toll Free: 800.975.6680 Fax: 717.975.2700 An Ameriprise associated franchise. Ameriprise Fnancial Services, Inc. offers financial advisory services, investments, insurance and annuity products. RiverSource~"' products are offered by affiliates of Ameriprise Flnancial Services, Inc., Member NASD and SIPC. Mutual Funds Account Number Total Value # of shares Asset Value Per Share 01012435463 9 002 $909.17 360.782 2.520 01013378939 5 002 $3934.28 1468.014 2.680 01013473105 7 002 $3184.83 1279.049 2.490 010134731.06 5 002 $5363.29 692.159 7.700 01 134486753 3 002 $8802.19 8,801.510 1.00 01434177985 9 002 $3476.82 573.733 6.06Q 02134177985 4 002 $25622.59 25,620.600 1.00 Annuities -Post 1985 Account Number Total. Value # of shares Asset Vaalue Per . Share 93 102640224 4 004 $43669.49 LTC Premium Return Account Number Total Value # of shares Asset Value Per Share 91005249635 3 004 $0.00 Ameriprise Brokerage Account Account Number Total Value # of shares Asset Value Per Share 00021791330 0 021 $36942.40 Acct Name:Amer~rise Bwk~age . AMERIPRISE TRUST GOMPANY CJO MAXIM M DEMCHAK AS CUSTb FOR TIC MA3CMM fA DEMCHAK SEP IRA Acct No:00021791330 OZ1 Acct Tirol:SEP IRA 00071558597 2 021 $34999.11 Acaa~ntToh.+~ 'S3f 9420 ~ + Y Deaz WAYNE ALLEN LOGUE: Thank you for your recent inquiry regarding MAXIM M DEMCHAK's accounts. These are the values of the accounts as of 02/18/2009. Account Information Mutual Funds Account Number Ownership OT012435463 9 002 Individual - TOD 01013378939 5.002 Individual - TOD 01013473105 7 002 Individual - TOD 01013473106 5 002 Individual = TOD 01134486753 3 002 Joint Tenancy With Right Of Survivorship 01434177985 9 002 Individual - TOD 02134177985 4 002 Individual - TOD Annuities -Post 1985 Account Number Ownership 93 102640224 4 004 IRA -beneficiary designated LTC Premium Return Account Number Ownership 91005249635 3 004 Individual Ameriprise Brokerage Account Account Number Ownership 00021791330 0 02 1 IRA -beneficiary designated 00071558597 2 02 1 Individual - TOD Ameriprise ONE Financial Account Account Number Ownershiu 00052954013 0 021 Individual - TOD 00067322024 0 021 Joint Tenancy With Right Of Survivorship Ameriprise ONE Financial Account AocanlTalaL 96~.~ a,bw.oo E:: a~ .5sa.oa' .. 134,999.71 Account Number Total Value # of shares Asset Value Per Shaze 00052954013 0 021 $.OS Balance of $.OS to be transferred to cash side of SPS/ONE account 00067322024 0 021 $8546.50 Acct.Name:Ameriprise ONE F'nanaai Account, MAXiM M DEMOHAK AND LINDS~EY REGINA DEMGHAIC JT Acct No~D06T322024 021 AcctTva The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated .for any ~,ife Insurance product(s) with the insured deceased reflect the gross death benefit at date of death. and not the', cash value. Values indicated for Life Insurance Products with only the owner deceased reflect the cash value as of the date of death.. Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for brokerage products are manually calculated,. and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or l''or planning purposes should be verified by your legal and accounting advisors. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Sincerely, Judy Wiens Death Settlements Processing Team 7U 100 Ameriprise Financial Center AcwurdTntaC 38,54fi.5D Acd Name:Ameriprise Brokerage Aamuni, MAXIM M DEMCtiAK 11~D Acctlb.~71558597 021 Acct Type:Non-Q uatified AMERIPRISE FINANCIAL Fax:•717-975-2700 May 13 2009 OO:dOpm P003/003 The Personal Advisp>rs pf Whrne A. Lobo, CIFP~ Amefiprise Finenclel 5eaioes, InC. Ftnanolai Advisor Suite 200 A~~~~ ~~5~ ' • 34Z North Frorn$treet • ' : ~ Wormleysburg, >?A 17043 ~11lIR11C1~L~ ~ Tel: 717.975.0202 ' ~ Toll Free: 800.975.6680 ' ' Fex: 717.975.2700 ' May 13, 2009 Dale F Shughart, Jr Attotaey at Law ~ ~ . 10 West High Street ~ ~ . Carlisle, PA 17013 Dear Mr. Shughart, ~ .. ~ . The accounts of Maxim Demchak that he shared with his daughters, Susan and Lindsiey were started as joint accounts. ~ , ' • Account # 1134486753 3 002 was opened February 14,1991- Maxim M Demchak and Susan Demchak Herb Account # 67322024 0 021 was opened November 1 S, 2006 - Maxim M Demchak and Lindsey Regina Demchak , If you have any ether questions, please call me at 717-975.0202. Sincerely, . r Wayne Logue, CFP® Ameriprise Financial 342 North Front Street . Wormleysburg, PA 17043 M Amenprlse assoclsted frsnehrss. Amaripnss Rnsnclsl.aervias, Inc. orura flnanciel advisory ssNieea, InvestnfeMS, Insu-anw ene ennutfy proeucts. RlverSouroe• products sn: oflarad ey aflllbtes of Amedprfte Flnandsl SeMoes, Inc., Member NASD and S1PC. LAST WILL AND TESTAMENT OF MAXIM M. DEMCHAK KNOW ALL MEN BY THESE PRESENTS, that I, MAXIM M. DEMCHAK, currently of 125 Clay Road, Carlisle, Pennsylvania, 17015, being of sound and disposing mind and memory do hereby make, publish and declare this as and for my Last Will and' Testament, hereby revoking and making null and void any and all former Wills and/or Codicils heretofore by me made. FIRST: I direct my personal representative hereinafter named to play all open expenses including the expenses of my last illness and burial as soon as prackicable after my decease. I further direct that burial shall be at the Umbria Cemetery, 0$ceola Mills, Pennsylvania in a sealed, concrete vault. SECOND: I hereby give, devise and bequeath all remaining items of tangible personal property, including furniture, personal affects, jewelry, and the like to my daughters, SUSAN DEMCHAK and LINDSEY DEMCHAK, share and share alike. Any items of personal property remaining shall be sold and proceeds therefrom shill be added to the residuary of my estate. THIRD: I hereby give, devise and bequeath all the rest, residue and remainder whether it be, real or personal, unto my daughters, SUSAN DEMCHAK ANDI LINDSEY DEMCHAK, equally. Liquid assets shall be placed in separate trusts according to the instructions in section six. FOURTH: As to all provisions of my Last Will and Testament. If and in the event my daughter, SUSAN DEMCHAK, shall predecease me or fail to survive me for a period of thirty (30) days, then and in that event her interest in my estate shall lapse unto my daughter, LINDSEY DEMCHAK. If and in the event my daughter, LINDSEY DEMCHAK, shall predecease me or fail to survive me for a period of thirty (30) days, then and in that event her interest in my estate shall lapse fifty (50%) percent unto my daughter SUSAN DEMCHAK and fifty (50%) percent unto a trust as noted below for my granddaughter, DERIKA DEMCHAK. My daughter, SUSAN DEMCHAK, if surviving shall ack as Trustee according to the provisions below. If and in the event both my daughtersx LINDSEY DEMCHAK AND SUSAN DEMCHAK, predecease me or fail to survive me fob a period of thirty (30) days then and in that event, all the rest, residue and remainder o~ my estate shall be placed in a Trust for my granddaughter, DERIKA DEMCHAK, according to the provisions below. FIFTH: In the event my granddaughter, DERIKA DEMCHAK, receives the interest of my children, I direct that her interest be held INTRUST NEVERTHELESS ~y MIKKIE DEMCHAK WILLIAMS, TRUSTEE, for DERIKA'S DEMCHAK'S college expdnses or for legitimate health or welfare needs not to exceed five (5%) percent of the corpus or until my granddaughter has attained the age of twenty-five (25) years, at which time the Trustee shall immediately distribute the balance, including any earned but undistributed income or interest, to that beneficiary. If and in the event, MIKKIE DEMCHAK WILLIAMS, is unable or unwilling to as Trustee, then and in that event I appoint, DAVID R. THOMPSON, ESQUIRE, of Philipsburg, Pennsylvania, as Successor Trustee. The Trustee may receive five (5%) percent of the earnings as compensation. SIXTH: It is hereby requested that the trustee and beneficiary(ies) of my estate consult a certified financial planner, invest the monies in conservative securities (e.g utilities, GNMA, Preferred Stock) and will draw the net monthly or quarterly earnings, less 10% for growth, until age fifty-five (55) for retirement. Withdrawals from the corpus may occur for legitimate health, education, or welfare needs, not to exceed five (5%) percent. The trustee may receive five (5%) of the earnings as compensation. LASTLY: I hereby nominate, constitute and appoint my daughters, SUSAN DEMCHAK AND LINDSEY DEMCHAK, Co-Executrices of this my Last Will and Testament. My Co-Executrices hereunder shall have the following powers, in addition to those powers conferred by law: To dispose of any asset of my estate, including real estate at private or public sale at such price or prices as they shall see fit; to lease, encumber or option any portion of my estate; and to make distribution of my estate in kind, in cash, or partly in kind and in cash. No bond or other security shall be required of my Co-Executrices in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of ~-- 2008, to this my Last Will and Testament consisting of six (4) pages. `~ ~~wL-~-,-~ ~~X.. ~~C.~ ...,n c.;h'a~....- . (SEAL) Signed, sealed, published and declared by the Testator as and for his Last Will and Testament, in the presence of us, who in his presence and at his request and in the presence of each other, have hereunto subscribed our named as witnesses thereto. ,;. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~j~~.~~~ :ss: I, MAXIM M. DEMCHAK ,the Testator/Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the said instrument as my Will, that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. ~. / Sworn. to and subscribed before me, he undersigned Notary Public, by the said Testator/Testatrix, this ___ Z~_ day of , 2008. _ ~ ,. // N.P. MMONWEALTH OF PENNY y AmyJNDoran' Noss y~publi® COMMONWEALTH OF PENNSYLVANIA heater Hill Borough, ciserii•id c®u~ry COUNTY OF ~!`~~~~.~ ;gg; MYCommlaaion Expiroa IHpy fib, ZC1 ~ We,"^r1-,~r,r~ ~ ~~n and ~~t~l Cji ~. ~.~ ~~,v.~ the witnesses whose names are signed to the foregoing instrument, being qualified according to law, do depose and say that we were present and saw the Testator/Test~trix therein named sign and execute the said instrument as his/her Will, that he/she signed willingly and that he/she executed it as his/her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the said Testator/Test~trix signed the Will as witnesses; and that to the best of our knowledge the said Testatbr/Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscri ed before me, witnesses, this„ day of ~-~ 2008. the undersigned Notary Public, by the said _i COMMONWEALTH OF PENN„ 8,~~`N-= NOTARIAL SEAL, Amy J. Doran, Natery Pula~~~ Cfiester Hill Borough, ClatarilQid ~°~"' My Commisalon Explr+af M~aY 24.2Qi ~_ ti: