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HomeMy WebLinkAbout11-20-0915056041169 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau oflndividual Taxes County Code Year File Number PoBoxzsosot INHERITANCE TAX RETURN ;nl I ~-~- ~~ c Harrisburg,PA17128-0601 RESIDENT DECEDENT ~-? ~ ~ ~y,.:7 ~-~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 185-24-8376 05312009 07221931 Decedent's Last Name Suffix Decedent's First Name MI RABER THEODOSIA M. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED tN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE BOXES BELOW i. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4 Limited Estate ~ 4a. Fulure Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ~. G. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of WII) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RYA N R. GAGER Firm Name (If Applicable) SAUL EWING LLP First line of address 2 NORTH 2ND STREET Second line of address 7TH FLOOR City or Post Office HARRISBURG Correspondent's a-mail address: Sfate ZIP Code PA 17101 REGISTER,O~ WILLS USE N Y -~ .- ~ , r~.-; c~ , i -, , ri DATf'iILED ' C.,) ,- -, i Under penalties of perjury, I tleclare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING ETURN DATE p ~ y ~ /o-ao-aoQq ADDRESS 4011 EASY STREET, HARRISBURG, PA 17011 SIGNATURE OF ~EPARER OTHER7THAN REfst2ESENTATIVE DATE ADDRESS ,r' 'j' 2 NORT~# 2ND STREET, 7TH FLOOR, HARRISBURG, PA 17101 PLEASE U5E ORIGINAL FORM ONLY 15056Q41169 Side 1 15056041169 ` i REV-1500 EX Decedent's Name: THEODOS IA M . RABER RECAPITULATION 15056042160 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ........................................ 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... , . 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 - 7) ................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 & 10} .................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 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. Decedent's Social Security Number 185-24-8376 192,000.00 715.64 98,354.44 162,058.69 453,128.77 66,632.81 4,586.69 71,219.50 381,909.27 381,909.27 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 (a)(1.2) x .00 15. i6. Amount of Line 14 taxable 3 81 9 0 9 . 2 7 , at lineal rate x .04 5 16. 17. Amount of Line 14 taxable 0 at sibling rate x .12 17. 18. Amount of Line 14 taxable 0 at collateral rate x .15 18. 19. TAX DUE ...................................................... .. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 17,185.92 0.00 0.00 17,185.92 Side 2 15056042160 15056042160 REV-1500 EX Page 3 I7P_CP_['~P_nt''S Complete Address: File Number 21- 0 9- 0 5 2 2 __------- - - ---r-- -- DECEDENT'S NAME Theodosia M. Raber STREETADDRESS 418 Springhouse Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A, Spousal Poverty Credit 0 B, Prior Payments 17 0 0 0 C. Discount 0 3. InterestlPenalty if applicable D. interest E. Penalty 17.185.92 Total Credits (A + B + C) (2) Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 185.92 Make Check Payable to: REGISTER OF W1LLS, 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 : .................. .. ^ c. retain a reversionary interest; or ....................................................... .. ^ d. receive the promise for life of either payments, benefits or care? .............................. .. ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................. .. ^ X^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... .. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................ .. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116(a)(1.1.)(i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. 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. 17,000.00 0.00 185.92 _-~ ~-.~oz Ex~ ~. l-os) ~1~R~-~ti~~E,AX RETURN er_~ioer~ ~ oECEOErvr ,:r_ ~_~F==== SCHEDULE A REAL ESTATE FILE NUMBER 21-09-0522 ;II 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 ~;. ;u'~ be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. ~~ pennsylvania If more space is needed, insert additional sheets of the same size. Ei:+ ~i-58~ SCHEDULE B !`~P,1MONtNEALTH OF PENNSYLVANIA STOCKS & BONDS INriERITANCE TAX RETURN RESIDENT DECEDENT - - :.rATE OF _ _ _ - -- -_-__- _- - - FILE NUMBER 21-09-0522 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) ~~ Asa Ex~ ~;c-9a~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. ~`,rlf ~ E_`~~~ TAN~E TAX RET~RNANIA PERSONAL PROPERTY 2~SIDENT DECEDENT ----__ ';1 " CF FILE NUMBER 21-09-0522 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. i iE".9 -- P+~rF ~. 2. s. ~. DESCRIPTION Merrill Lynch No. 872-51207 Citizens Sale of personal items at auction Newish Nursing Home-Refund IComcast-Refund ',Absolute Real Estate - Refund jLiberty Mutual - Refund VALUE AT DATE OF DEATH 42,868.92 49,041.21 1,077.21 5,126.40 4.46 50.00 186.24 ";1~ EX+ (c-98) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA ~NFIERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ;'ATE OF FILE NUMBER 21-09-0522 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. --,~ '.1Bi DESCRIPTION OF PROPERTY INCLUDE THE NAP~tE 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 OFASSET % OF DECD'S INTEREST EXCLUSION iIF APPLICABLE) TAXABLE VALUE ,'Met-Life Annuity No. 9094002 9,040.33 100% _ 9,040.33 'Met-Life Annuity No. 2289422 iz2,6iz.oo 100% i22,6iz.oo Tz:ansamerica Life Annuity No. 26159595 ~I i ii i I i 30,406.36 100% i 30,~G6.~6 TOTAL (Also enter on line 7, Recapitulation) $ 16 2 , 0 5 8 . 6 9 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER 21-09-0522 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Country Club of Harrisburg-Luncheon 1,188.62 2. Brachendorf Memorials-Marker 295.00 3. Neill Funeral Home 11,216.17 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) G e o r g e Rabe r Street Address 4 011 Easy S t r e e t CityHarrisburc{ Year(s) Commission Paid: 2 0 0 9 15,000 2. Attorney Fees 14 , 0 0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress 4 5 6 ~. 8. 9. 10. 11. City State ZIP Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Sentinel-Legal Advertisement Cumberland Law Journal-legal Advertisement Short Certificate Absolute Real Estate Appraiser See Attachment 402.00 166.30 75.00 16.00 400.00 23,873.72 TOTAL (Also enter on line 9, Recapitulation) $ 6 6 , 6 3 2.81 State PA ZIP 17101 (If more space is needed, insert additional sheets of the same size) ESTATE OF THEODOSIA M. RABER SCHEDULE H ATTACHMENT 1 ~ Craters & Freighters of Central PA-ship items to beneficiary $1,293.33 2. Social Security-Reimbursement 1,930.00 3. Citizens Bank-bank charge 92.08 __ - =~. Ehrlich-Pest Control 291.50 ____- ~. __ Net Expense from sale of house 12,121.68 _ 16 ~ PPL -June 69.48 _ _ 17. _ PPL -July 77.92 __ S. PPL -August 9. ~ PPL -September 60.00 10. PPL -October 23.86 ~l 1. Ehrlich 53.00 12. _ Baker Door Company 41.29 ~'~ 13. ~ Biyan Withington -landscaping to sell house 1,318.80 _ ~ 1-t. I Emily Martinelli -lawn care 40.00 _ 1 ~. i PA American Water 35.12 _____ 16. - I Pam ieA an Water 37.23 ' ~ l 7. Liberty Mutual Insurance -homeowners insurance 101.83 _ 1 S. ~ Service Oil Company 144.89 _ ~i. C Eshenaurs Fuels 139.43 _ ~(;. - Brian Myers -exterior paint and repairs on house 1, 5 . ~ ? 1 . _ ' Citizen Bank Charges on decedents personal account 6.19 _ 22. ~ ' Lmily Martinelli -lawn care 40.00 ~23. ~ Brian Myers -power wash house 800.00 2-1. PPL 60.00 x_ 2 ~. Wire CPA -tax return 360.00 ~~ ~(. - UGI 89.33 _ C 27. Carol Raber -Cleaning House 750.00 j 28. Ehrlich 53.00 21~. Libert}~ Mutual Insurance 283.60 - ,(i. ~~ :~1. - --~ I-Iampden Township -Trash and Sewer ' UGI 138.65 105.90 -- _~~. -_ Marl< Martinelli, Lawn Care 100.00 ,, _,, Sau~ 1 Ewing -copies, telephone, postage, mileage 100.00 3~. ~ Walburn's Electrical 648.72 '~ 3 ~. Dan Thorpe -Electrical 900.00 ~I ;G. ! PA American Water 36.75 r TOTAL $23,873.72 ~,," 2 EX+ (12 08) ~ Pennsylvania SCHEDULE I .~~ ' ~ '<,,,T:,E,:T OF RE~ENDE DEBTS OF DECEDENT, ' ."`~,"''` ~E TAX RETURN MORTGAGE LIABILITIES & LIENS - - r'. S:DEGT DECEDENT = ' ~= OF FILE Nl1MBER __. _ __ _ 21-09-0522 Repor t debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. _' cER DESCRIPTION VALUE AT DATE OF DEATH Change locks-Shearer Security 209.88 Lower-valve repair 28.25 ~~dvanced Tissue-medical expense 247.94 `rampden Township-sewer and trash 138.65 ~`arrsburg Foot and Ankle-medical expense ,9.72 ~ '?r. James Harty-medical expense 243.34 ~ ~ _:osptal Telephone 24.00 F~mily Martinelli-Lawn Service 180.00 School Tax 2009-2010 1,919.34 '~~. South Central EAS-medical expense 420.00 :~. PA American Water 116.81 ;_... Principal Financial-Refund Pension 513.45 '. .. ~JGI 161.00 ~~ ~~ ~' p L 3 9. 6 6 -innacle Health - Last Illness 35.55 ". ~ I i~ir.nacle Health - Last Illness 78.73 . '~, :,outh Central EMS - Last Illness 60.00 . ~ ( ''cuth Central EMS - Last Illness 65.60 II I I~ I I~ South Central EMS - Last Illness 84.77 TOTAL (Also enter on Line 10, Recapitulation) $ 4 , 5 8 6 . 6 9 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OS) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ] BENEFICIARIES ESTATE OF FILE NUMBER 21-09-0522 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec, 9116 (a) (1.2).] 1. George T. Raber son 1/2 residue 4011 Easy Street Harrisburg, PA 2. Marjorie Hill daughter 1/2 residue 5312 Blue Cypress Lane League City, TX 3. Rodney Raber grandson 1,000.00 4011 Easy Street Harrisburg, PA 4. George T. Raber, III grandson 1,000.00 4011 Easy Street Harrisburg, PA 5. Diana Glantz-Hollenbach granddaughter 1,000.00 717 Station Avenue, Bld. O, Apt. 20 Bensalem, PA 6. Ryan Castoro grandson 1,000.00 5312 Blue Cypress Lane League City, TX ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I$ If more space is needed, insert additional sheets of the same size. ® __ tj -- - -~ Y ~ I~ " ~~° _ ~ o i ~ 1~ 1f , ~ O~ - i 1 0 -wi y ~ Q ctno ~ , ,. , m t}1 , C~ m ~ m N (Np N N ' ~i N ~ ~ ~ v ~ ~ 3 i ' m ~ o - .' m ~ . . ,. , ~ -~ v ~ ~ m (n o ~ a ~. p ~~~ oa~a ~ ~ ~ ~, , ~ ~, o ~ ° a ~ m co .~ m ~ m ~ i I ~ o ~ y, ; ~ Cn ~ O ~ ~ ~ ~ ~ y S I r '1 ~,,_. ~ ~ ~ ~ CT1 ~ ~~ N 07 V p p O N@ i i i ~ z r. r ~.1. S ."'~ _'. j ~p ~ CT Q' CA ~ .~ i ~ ~~.~ ~'. -o -»~ ~ .~ ~ ~ -^ ' ~ ~~ ~ ' . o ~wcnu,ca ~~ ~ ~ i~ ~'' z:~~~~ . N o ~ m O p= (D p O fD ~ ~ ', ~ m ~ P 1 i r ~ ~ , -~ .~ Q O (O cp N m ~, m O m~ ~ . ~ ~ ~ a z ~ r ,~ c-, y; ;- i ~ : T -a o (~ , -i :. ~ m ~ ~ ; ~ o ^ ~ _ ~ ~ ~ , 4 nit : _ -~i'Q ~ ~ ~ , r = y r D ~ ' ~k ~t ; ~ ' ` ~ ~ c ~ Z CA rn = +~ L. , 1 , ,i.. _ ~' i~~' ~ ~ i ~: nFn , ~ -, ~ m y , ~ 1~ t~~ (+ ~ 1 I ~ ~ ~ d rl-I i ~~- n ~~ , , ii ~ ~ a l t ~' ' _ y ~I; ~. a, o m O , t ~ ~{ ,~ F ~ . , t ~ ~ ~ N ~ =~,. N O t ~ j~ i:~ Ilt l I' "_ ~ ~ ^~~ o ~ ^ t 0 i ~~- it . - ~ O } ~ nm- o it W m _ ~ ~ ~ ~ 7 ~ ~i rt~ o ( ~~ .: , I ~ iGt ~ l t , ~~~ ~t~ ~~- ~ ~ ~ ~~~ ~ ~ ~ ~ t ~ ~ .~ ~ ~ ~ i t m ~ ~] (i ~, It T ~ ~I N r ~~ f i ~ .i i .i p _ ~ ~. ~y, ~ ~~ ~ ~ ~ z 3 b ~ ~ N ~{ SSA , f l i ~ ~ y ~ l I k m ~ ~ 1 ~ n N CD I ~ ~ ~ .GO .! ~ D ' ~-'~ i:;-~ w ~ i s N O ~ ,p W ~ -- p) - (D ~.: i~ ~ n) OMB NO. 2502-02fi5 '1r A B. TYPE OF LOAN. _ F HOUSING & URBAN DEVEL RTMENT P OPMENT 1.^FHA 2QFmHA 3.QCONV UNINS 4.QVA 5 [~CONV. INS. A O U.S. DE SETTLEMENT STATEMENT 6. FILE NUMBER: os-542 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE. This loan is furnished io give yrou a statement oiecfual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(POCJ" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3.99 (TINSLEY CnSEV.VFDr09~542:3) D. NAME AND ADDRESS OF BUYER: Casey J. Tinsley and Mary W. Tinsley 418 Spring House Road Camp Hill, PA 17011 E. NAME AND ADDRESS OF SELLER. Estate of Theodosia M. Raber F. NAME AND ADDRESS OF LENDER. G. PROPERTY LOCATION: 418 Spring House Road PA 17011 Camp Hill H. SETTLEMENT AGENT: 25-1857112 Midstate Abstract Company I. SETTLEMENT DATE: October 15 2009 , Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hi{I, PA 17011 , J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400, GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 192,000.00 401. Contract Sales Price 192,000.00 102. Personal Pro e ~ 402. Personal Pro err 103. Settlement Char es to eu er Line 1400 3,297.25 403. 104. 404. 105. 405. Ad'ustmenls For lfems Paid 8 seller in advance Ad"ustments Forltems Paid 8 Seller M advance 106. Cit !town Tazes to I 406. Cit !Town Taxes io 107. Count Taxes 1Df15f09 to 01/01110 119.68 407. Count Taxes 10115/09 to 01!01/70 119.68 108. School7axes 10!15109 to 07/01/10 1 389.74 408. School Taxes 10/15/09 fo 07/01!10 1,389.74 709. 4th Qtr. Sewer Proration 10!15109 to 01/01/10 I 117.55 409. 4th Qtr. Sewer Proration 10!15109 to 01/01/10 717.55 110. 410. 111. 1 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 196,924.22 420. GROSS AMOUNT DUE TO SELLER 193 626.97 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT bUE TO SELLER: 201. De osit or earnest mone 1,000.00 501. Excess De osil See Instructions 202. Princi al Amount of New Loans 502. Settlement Char es to Seller Line 1400 13 748.65 203. Existin loan s taken sub~ect to 503. Existin loans taken sub"ect to 20q. ' 504. Payoff of first Mortgage 205. 505. Pa oN of second Mort a e 206. I 506. 207 507. De osit disb. as roceeds ~ 208, I 508. ZOg 509. Ad'ustments Pot Items Un aid B Seller AdLstrnenfs For ftems Un and 8 Seller 210. Cif !Town Taxes to 510. Ci /Town Taxes to 211. Count Taxes to 511. Coun Taxes to 212. School Taxes l0 512. School Taxes to 213. 513. 214. 514, 215. 515. 216. 51fi. 217. 517. 218. 518. 219. 519. 220. TOTAL PA1D 8Y/FOR BUYER 300. CASH AT SETTLEMENT FROM/T0 BUYER: ~ 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH AT SETTLEMENT TOIFROM SELLER: 13,748.65 301. Gross Amount Due From Bu er Line 120 196 924.22 601. Gross Amount Due To Seller Line 420 193 626.97 302. Less Amount Paid B /For 8u er (Line 220) ( 1,OOD.00) 602. Less Reductions Due Seller (Line 520 ( 13,748 65 303. CASH (X FROM) ( TO) BUYER 195,924.22 603. CASH (X TO) ( FROM) SELLER 179,878.32 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Buyer Seller Casey J. Tinsley Estate of Theodosia M. Raber Mary W. Tinsley vaye L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Basetl on Price $ 192 000 00 6 0000 % t i 520 00 Pnm FROrs PP~o raoM Drvrsron o/Commission line 700 as Follows: eu~eas seueas 701..$ 11,520 00 to RE/MAX Realty Associates ouraos nr Foraos nr 702. $ to RE/MAX Realty Associates sErr~i MErar s=rr~EaFNr 703. Commission Paid at Settlement 11,520.00 704. f0 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lenders Inspection Fee to --~-- - 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. - 809. 80 811. 900. ITEMS REQUIRED BY LENDER TO 8E PAID !N ADVANCE 901. Interest From to @ $ /day ( days %) 902. M!P Totlns. for LiteO7Loan for months to 903. Hazard Insurance Premium for 1.0 ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazardlnsurance months $ er month 1002. Mod a e Insurance months $ er month 1003 Cit /Town Taxes months $ r monfh 1004. Count Tazes months ~ er month 1005. School Tazes months @ $ per month 1006. months $ er month 1007. months @ $ per month 1008. months $ er month 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102. Abstractor Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Pre to 1106. Closin Service Letter to 1107. Attorneys Fees to includes above rtem numbers' 1108. Title Insurance to MIDSTATE ABSTRACT 1 318.75 includes above item numbers.1102, 1103 8 1104 1109. Lenders Coverage $ 1110. Owners Coverage $ 192,000:00 1,318.75 1111. Endorsements 100, 30D, 8.1 1112. Notary Fee Midstate Abstract Company. 7113. Notary Fee to Rebecca Begot 15.00 ft 14. Overnight Fees 8 Handling 1115. Wire Transfer Fee to Midstate Abstract Company 10.00 1 16. Broker Fee to RE/MAX Really Associates 150.00 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 48.50; Mortgage $ Releases $ 48.50 1202, Cit /Coup Tax(Stam s: Deed 1 920.00 Mort a e 1,920.00 1203. State Tax/Stam s: Deed 1 920.00; Mort a e 1,920.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Sunre to 1302. Pest-Ins action ~ to 1303. 4th Qtr. Sewer to Ham den Townshi Munici aI Avthorit 138.65 1304. Tax Cert'rfication to Michael Lan an, Treasurer 10-19-1598-179 5.00 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103 Section J and 502, Section K 3,297.25 13,748.65 ay s~gnmg page r or Tres staiemera, Ina sgnataros acknovnetlge receipt pt a completetl copy M page 2 ar W s rwp page sfateme~f. Cert~ed to be a true copy. Midstate Abstract Company Settlement Agent ( 09-514 r 09 6a2 ~ 3 LAST WILL AND TESTAMENT OF THEODOSIA M. RABER I, THEODOSIA M. RABER, of Cumberland County, Pennsylvania, declare this to be my Will and revoke ail prior Wills. FIRST: Tangible Personal Property: I give all of my tangible personal property, including any automobiles, together with all insurance on such property, to GEORGE T. RABER, III and MARJORIE HILL, to be divided among them as they shall agree. If GEORGE T. RABER, III and MARJORIE HILL are unable to agree upon a division, each individual shall draw lots to determine the order of selection and shall alternate choice of articles until distribution is completed. My Executor shall pay, as an expense of settling my estate, the costs of packing, storage, shipping and insurance incurred in connection with the distribution of the gifts of tangible personal property made above. SECOND: Pecuniary Bequests: I make the following bequests: A. I give to my grandson, GEORGE RABER, the sum of One Thousand Dollars ($1,000.00}, if he survives me; B. I give to my grandson, RODNEY RABER, the sum of One Thousand Dollars ($1,000.00); if he survives me; C. I give to my grandson, RYAN CASTORO, the sum of One Thousand Dollars ($1,000.00); if he survives me; and D. I give to my granddaughter, DIANE GLANTZ, the sum of One Thousand Dollars ($1,000.00); if she survives me. 147255.! 12/31/08 THIRD: Residue: I give, devise and bequeath all of the residue of my estate, of whatever nature and wherever situated, to the Trustee hereinafter named, and the Trustee shall divide such residue into two equal shazes and distribute one share to GEORGE T. RABER, III and distribute one share to MARJORIE HILL. In the event that GEORGE T. RABER, III or MARJORIE HILL predecease me and have living issue, I direct that the share of such deceased individual be distributed to such deceased individual's living issue, per stirpes. To the extent that there is a failure of beneficiaries for either shaze, such shaze shall be added to other shaze for administration and distribution. FOURTH: Trust Provisions for Certain Beneficiaries: A. Any income or principal distributable to a beneficiary under the age of twenty-five or a beneficiary who, in the sole determination of the Executor or Trustee, is incapacitated, shall be held in a trust fund by the Executor during the administration of my estate and thereafter by the Trustee. The Executor or Trustee may apply such amounts of the income and principal otherwise distributable as the Executor or Trustee, in the sole discretion of the Executor or Trustee, deems proper for the support, health, education and welfaze of such beneficiary, either by direct payment of bills, or by payments to such beneficiary, his or her duly appointed guardian of the estate or person, or any person (including the parent of a beneficiary under the age of twenty-five) who has the caze or control of such beneficiary, as the Executor or Trustee selects. B. The Executor or Trustee shall distribute the balance of principal of any fund held in trust hereunder to such beneficiary when the beneficiary attains age twenty-five or, in the sole determination of the Executor or Trustee, is no longer incapacitated, whichever is 147285.1 12131 /OS later. If such beneficiary dies before attaining age twenty-five or while incapacitated, distribution shall be made to the estate of the beneficiary. C. Whenever, in the sole determination of the Executor or Trustee, any fund held in trust under this Article FOURTH is or has become too small to warrant establishing or continuing such fund in trust, or its administration is or becomes impractical for any other reason, the Executor or Trustee, in the Executor or Trustee's sole discretion, may pay such fund, outright, to the guardian of the estate or person of the beneficiary of such fund, or to any person (including the parent of a beneficiary under the age of twenty-five) who has the care or control of such beneficiary. In the case of a beneficiary under the age of twenty-five, the Executor or Trustee may pay such fund, outright, to a custodian for such beneficiary under the age of twenty- five under a Uniform Transfers to Minors Act or Uniform Gifts to Minors Act or may deposit such fund in aninterest-bearing account in a financial institution of the Executor or Trustee's choosing, payable to the beneficiary upon attaining age twenty-five. D. The Executor or Trustee .shall not be obliged to supervise or inquire into the application of any distributions of income or principal made under this article and the receipt by a payee designated hereunder shall be a complete release of the Executor or Trustee. FIFTH: Protective Provision: All principal and income shall, until actual distribution to the beneficiary, be free of the debts, contracts, alienations and anticipations of any beneficiary, and shall not be liable to any levy, attachment, execution or sequestration while in the hands of my Executor or Trustee. SIXTH: Tax Clause: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and any penalties thereon, with respect to all property owned by me at the time of my death and passing under this Will or any Codicil (the ianas.i iv3vos "Taxes"), shall be paid out of the principal of my residuary estate, as if the Taxes were administration expenses, without apportionment or right of reimbursement. The Taxes shall be paid at such time or times as my Executor may deem advisable. SEVENTH: Disinheritance: I have intentionally omitted ELIZABETH ANN GLANTZ and CAROL THORP from this my Last Will and Testament. It is my desire that ELIZABETH ANN GLANTZ and CAROL THORP not receive any benefit from my Estate. EIGHTH: Children and Adopted Persons: For the purposes of this Will, persons adopted during minority shall be considered as children of their adoptive parents, and they and their descendants shall be considered as descendants of their adoptive parents. NINTH: Powers of Executor and Trustee: In addition to the powers given by law, my Executor and Trustee, and any successors, without any order of court and in the sole discretion of the Executor and Trustee, may: a. Retain any real or personal property, as long as deemed advisable. b. Invest in any real or personal property in accordance with the prudent investor rule. c. Subscribe for stocks, bonds or other investments; join in any plan of lease, mortgage, merger, consolidation, exchange, reorganization, foreclosure or voting trust and deposit securities thereunder; and generally exercise all the rights of security holders or employees of any corporation. d. Register securities in the name of a nominee or in such manner that title will pass by delivery. e. Vote securities in person or by proxy, and in such connection delegate discretionary powers. f. Repair, alter, improve or lease, for any period of time, any real or personal property, and give options for leases. g. Sell at public or private sale, for cash or credit, with or without security, exchange or partition any real or personal property, and give options for sales or exchanges. 147285.11213 i /O8 h. Borrow money from any person, including any fiduciary, and mortgage or pledge any real or personal property. i. Disclaim any interest or power granted to me under any instrument or by operation of law. j. Employ investment and legal counsel, accountants, brokers and other specialists, and, whenever there shall be no corporate fiduciary in office, a corporate custodian, and compensate them and reimburse their expenses out of income or principal or both (in addition to fiduciary commissions), and delegate to investment counsel (including an account executive at a securities firm) discretion with respect to the investment and reinvestment of any or all of the assets held hereunder. k. Pay administration expenses, including, without limitation, interest on death taxes ("administration expenses") from principal or income, including income otherwise payable to charity; provided, however, that no allocation of administration expenses to income shall be made that would prevent any assets from otherwise qualifying for the federal estate tax charitable deduction. 1. Use administration expenses as deductions for federal estate tax purposes or fiduciary income tax purposes or partly for each, without making adjustments between principal and income in consequence of the exercise of such discretionary power. m. File joint income tax returns with my [spouse] and pay a portion of such tax, and consent to gifts made by my [spouse] and pay a portion of any gift tax thereon. n. Compromise claims. o. Divide any trust hereunder, which division may be made on a non- pro rata basis, into two or more separate and independent trusts and make any principal distributions otherwise authorized hereunder from the trusts on a non-pro rata basis. p. Add to the principal of any trust created hereby any property received from any person by Deed, Will or in any other manner. q. At any time merge any trust hereunder with any other trust held by my Executor and Trustee, whether created by me or by any other person by Will or Deed, if the terms of the trust are then substantially similar and held for the primary benefit of the same person or persons. r. Make distributions without the consent of any beneficiary, in cash or in specific property, real or personal, or an undivided interest therein, or partly in cash and partly in such property and do so, except as otherwise specifically provided elsewhere herein, without regard to the income tax basis of specific property allocated to any beneficiary (including any trust) and without making pro rata distribution of specific assets. ia~zss i iznvoa -5- s. Allocate basis pursuant to Section 1022 of the Internal Revenue Code of 1986, as amended, or successor provisions (the "Code"); provided, however, that such allocation shall be made in a fair and equitable manner among the benef curies of my estate, as my Executor, in my Executor's sole discretion, shall determine. t. Exercise all power, authority and discretion given hereby, after the termination of any trust created herein until the same is fully distributed. My Executor and Trustee may make, but shall not be required to make, any adjustment of the amount distributed to any beneficiary who would have received a greater or lesser amount if my Executor and Trustee had made a different or contrary decision in reference to any of the above matters. I exonerate my Executor and Trustee from any liability arising from any exercise or failure to exercise these powers, provided the actions (or inactions) of my Executor and Trustee are taken in good faith. TENTH: Appointment of Fiduciaries: I appoint GEORGE T. RABER, III Executor of and Trustee under this Will. Should GEORGE T. RABER, III, for any reason, fail to qualify or cease to act as such during the administration of my estate or any trust, I appoint MARJORIE HILL Executor of and Trustee under this Will. No Executor or Trustee appointed herein shall be required to give bond or furnish sureties in any jurisdiction. Each successor Executor and Trustee appointed as provided herein shall have the same duties, powers and discretion as if originally appointed. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ ~of 2008. ~uG 2/ ~" SEAL) TH IA M. RABER SIGNED, SEALED, PUBLISHED and DECLARED by the above named THEODOSIA M. RABER as and for her last Will and Testament, in the presence of us, who, at ianas ~ i~nuos -6- her request, in her presence and in the presence of each other, have hereunto subscribed our name1es a//s witnresses. WITNESS ~. WITNESS ADDRESS T ADDRESS 147285.1 12/31 /OH _7_ COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF C-~~~'` We, THEODOSIA M. RABER, the testator, and ~~~~. ~1.- S(\'~(7~ and i~'~~5~ t~ . ~~ ~~~~ ,the witnesses, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as her last Will and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of the witnesses' knowledge the testator was at that time over eighteen years of age, of sound mind and under no constraint or undue influence. .~ l~~If~~-c~(~ THEODOSIA M. RABER U. _ Wttriass Witness Subscribed, sworn to and acknowledged before me by THEODOSIA M. RABER, the testator, and subscribed and sworn to before me by ~ U~ ~ ~ ~ C ~~ and ~~i~~ G, . ~~~n~ the witnesses, thi~~day of ~-eC , , 2008. Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Kathy L. Sider, Notary Public City of Harrisburg, Dauphin County My Commission Expires March 23, 2012 Member, Pennsylvania Association of Notaries ! 47285.1 12/31!08 _ $ _ ~ai ~ zw-•~.,.~`s°.; "y-,`y_`,~" -,.st~.~,~~ *ry,`~„ti,~'~,`,~~~`'•.~~"y`+"~,~~.~.~ `~~. - - -- `'~,~8°,~,,'*.ti'`~~~~:'~'v1ti'~ ~~'~,`.~-•,,~~x~3d~;`~',~~4~~, •.. .~~r. ~ ~ :: ~ :.~ x y~;: , SALES OPFTC~ ARiIRESS. 5000 RITTER RD STE 103 nECNAk1csBUR6, Pq 17055 Liberty B•~~ ~Vlutual. 229 CiiECK 1giR19Eia -CNECiCDATE D5331729 to/zD/o9 CHECK AblOtANT BLOC( NtNR8ER *+~~9186.24 ooloss i PNONEc 804-722-5164 STATEMENT AS OF: 10!19!09 INSURED NAME: THEOAOSIA M RAKER OSN: r!}tt0101102041-001055 POLICY NUMBER: N32-281-051984-809 POSTiN6 DATE TRANSACTION BESCRIPTION EFFECTIVE DATE AMOUNT 12!23108 RENENAL PREMIUM 01/24/09 1,222.00 fll/28/09 PAYl1ENT - THANK YDU 101.83 CR 02/26/04 PAYMENT - THANK YDU 101.83 CR 03/26!09 PAYMENT - THANK YOU 101.83 CR 04/28/09 PAYMENT - THANK YOU 101.83 CR 05/27/09 PAYMENT - THANK YDU 101.83 CR 06/25/09 PAYMENT -• THANK YOU 101.83 CR 07/28/09 PAYMENT - THANK YDU 101.83 CR 08!26/09 PAYMENT - THANK YOU 101.83 CR 09/08/09 PAYMENT - TFUINK YDU 101.83 CR 04!15/09 AISNONOREA PAYMENT 08/24/09 101.83 09115!09 RETURN PAYMENT SERVICE CHARGE DS/24/09 25.00 10/01/09 PAYMENT - THANK YOU 283.60 CR 10/14/04 CANCELLATION 10/ISJD9 339.00 CR BILLING FEES TO DATE 4.00 10/19/09 CHECK AMOUNT 10/19/09 CURRENT BALANCE PAYMENT T0: TNEODOSIA M RAB£R GAAEFUILY pETACH Ct+£CK 9EFOAE DEPOSt7tNG • RETA[N STATEMENT FOA YOUR REGOAnS ' .LIBERTY HUTUAL - PMfO ~ L~tl~r~ iDD4IBERTY xAY~ Dov~R; -~H 03az1 ~LItU1~= >Fi' AY *4lIE ~FNRiAREA~E 10HTY *S Il(*DOL LARS+~TW£NTY~POUR*CENTS* 0357 1229 ~ ti32-283-051984-809 ~ 05331729 ~ 10/20/09 aavTOrnE THEC3DgSIA M RA$ER oAnexoF GEgRGE RA$ER 4Q11 EASY 5T' HARRISBURG PA 17109-4144 186.24 0.00 CIT~BANK WA,~ ~„l'Et~5; 1iA~1 NfN ~AS~'LE,,~E.-19729 , ~, PAY >t~t~rS18b.24 /~~ TWO SiGiUTURES REQUIRED iF OVER'k5,000 n'C7533172R1~' ,~O~iLQa209~: 385192511' ~ THE ORIGINAL DOCUMENT }fAS A AEFl,ECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO VIEW WFfEN CMBCKING THE ENt7URSEMENT ~ Merri[[ lynch ('~ C HAS E ~ 40 Presldentlal Ptaza Syracuse, N.Y. 13202 To The Order Of late Type Amount 08/28/2009 0 PAY $42867.76 ~'1 nr I~'008 7 20 7 6 ~ 3it' ~:0 2 L 309 3 79~: 60 18 6 70 2 fit' 15210 ABSOLUTE REAL ESTATE APPRAISALS, LLC. ~ ,~ 307 LEADERS HEIGHTS ROAD ~1~ ~ +:s ~ i ~ '. ~ YORK, PA 17402 ~`---- ~ PH. (T17) 7454277 6a-184-313 DATE 8/20/09 PAY ORDER OF ESTATE OF GEORGE & THLX7DOSIA RA5ER I $ 50.00 F~F~~pQL,L~ARS ------00/00 DOLLARS iS ~°~~•"•' Commerce •' ~~.,.M. CBank America's Mast Convenient Bank' 1-BBB•937.0004 FOA nVF.RPAYMFNT r1F APP$&T~AT - ~_ nr u'0 L 5 2 LDu' t:0 3 L 30 i846~: 5 7 0000 2 7 3n' Qffi'tce Merrill Lynch, Disbursement Account Pierce, Fenner & Smith Inc. 4804 Deer Lake Drlve East 50-937 Jacksonvllie, FL 32246 Check Number 00872 - 07613 213 Piawse Note: Your Sale Prooeeds Check is Attached ~tua ntn t 5e~n~, s BROltJ:R'g Name, Addross, ZIP Cod.. 2008 Proceeds From tBroicer ant! i~wtetr Excharpe Trmsaetbns ~°^ "~^°~ end Form 1088-B ~ Bro,®,,,f,t,1,.~ ex~h nnport fmm tr8rtsectlprte ~, COPY B FUR REGIP~NT "' ' you and bo the k-6errtai Revenue Service. 't'his form fe used to rapaf Adarat trrresta Eervioaa arPORTANT TAX NM~ OftMAT10N"' thefts proceerts ~- washtrgton eha. Ttris is tmpawd trx tr~tormWfon end is bsiny .lassy Cry. NJ 0731 D famished b Nre tdsrnai Rewwwis Serviw. r ia. Dot. of sws i b. CUSIP NuJnDp ~. -- -- you am rsquiro~d to Ire a roaXt1, a nsyifpenoe VtY2U2Wti 3915tEtt0 223367322 Pw+~r or filler atslclian r1My be trrlpoetld Oh Teisplwne: 1~-00664a~ Ya- r ttr. hpome r< teoaebb and ka tRS ~ ~. Bores eb. • FEDERA4 1NCOIdE TAX WI1HFiELD delerminrs tlrot r has not bean repatsd. i71t1.64 5200,313 TO wtito-t pA1D REPORTED ® Gwas Proved" TO IRS ^ c3,o.a Pnxwds teas aannbuon and aptbns pwmiums ----- - t3EgRCiE T RA9LR N EX tJw T. oero~i~»on - -"------- 7FIEt)p061A RAKER A~TUFE. MVC. 4tY11 EASY ST HA~~JRO PA 171gp-4114 ~'"'°ea' ~ R~Pe~t`+ Numbrr nn t:8a 1~ ococ is. - snows ms aaos awe a vie aansaaton. Far egDwpata rsportinQ, no pnl+Y wlr (9ox 1. - Shohr- hackuV wrfAtoidtrp. C3aneralfy, a payer mwt beciaip wrNwW at be p^~4- s 2696 npe r you did oat furnish your taxiwyar identrkaHon number to the payer. Box 1 b. - Far brdosr troneaatiplp~. may show iM CU91P {Cammtrae on Untlorm Seourry Ses Farm W'~• Re4~ ~ Taxpayer trfsrKlNoofbn Number and CarirtpWOn. to WsnlNioation Proosduros) number d the rem reported. NXonriatbe on baolaip wiq~oldtrg. trtcNWe fhb smoart ors your Incometax Box 2. - Shows the rst~rtr as tax wttlMpid. proceeds from transaoUons iraolvinp stocks, barxfs, other doht obilpsrars, oommodfiba, ar forward oontraeb. L.casas on fo-vvwd eorrkocb are shown Box 7. - Strows a txbf description d the ram a aervtoe for wtddr the proceeds a h pwwrlhssas. Thk boor does not (nctrrde procesets horn rapuialad frdrxes contracts. hrrteriny Nworne ~ beirKl reported. For repulatsd hdures oontrarxs and foewerd Report Hds amount on Sohsduls D (Form fWEf). t.'.spaal t3atrx and Loses. cootraots.'RFC" a odrsr epprapriats description nrry ha shw+n. a v ~1. ~.. F (f e` ~~~~~"' `c ~ i`~,~+~~. - ~ ~~/yl/ ' '~~jf/~//~~ ~a'~~ii+ f o` n}x c=iy~t ~;\ ;Er~yfy-'~li-=~:z <g~~; ill ~: ::: - .. /.... ti .....ffi~-~'~~E~.~~. aG~~+~A..'~`f .~~~S~~~~ .~~'/`~~~~iv.~~`.~~$~u'~LI"+~:F'j~V'a`~~~~~~5''~ "N,*'n~'ytt'n :.>.;•: ~f~~~ a~~ a> 3':,..'~ . ... ft~r' inquiries about your account, contact f3NY Msifon Shar+eowner 8ervicesr MetLife's Transfer Agent: Teiephone: 1-8Q4&{9-3593 U.8. Mail: E-Mail: tnetfitet~bnymellon.com MetLtfe intarrtat: www.bnymeffon.comisharttomier~sd cla BNY Mallon Shareawner Seftices PO Box 358447 Pittsburgh, PA 15252-8447 L~ , YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECit REi>RESENTS THE FULL VALUE OF YOUR ACCOUNT. J v --------- ---- (~~~ J ChECK Nl1M8ER: 719624 ~~~~e CIiBCK DATE 08127!'1009 P.fl. t30X 441 ~ 80uTH HACIffN,SACK NJ ti7908.1p1D P~tYABLE AT 1H tls. OCM_UIR; CfiECfC N11NA1liR 7tga2a THE BANK OF NEW YORK MELLON 00=1AQ 433 r'007 i98 24~ r:©t.33O i60 L~: O i i~0 i03n' " IAN+ORTAN'T TAX RETURN DOCWIr'M A1TACt~D " 0060 ~~'~.~f a Disbursement ANNUITY BENEFIT SERVICES Processin g P.O. BOX 10366 DES MOINE$,ta 5030&-0366 DATE :09/09/2009 CHECK NUMBER:89QA 090036802 ~~~6d CHECK AMOUNT:********$9,040.33 CHECK REF# :Z52-9094002 MARJORIE HILL FOR PAYMENT INFORMATION 5312 BLUE CYPRESS LN LEAQUE CITY TX 77573 0 Detach Check Detach Checl: 'ZS'? ~ y 62-20/371 FOR PAYMENT INFORMATION e'~L~f ~./ $9~A 09403682 MetLife and Annuit Cam an of Connecticut DATE: 09/09/2009 PAY **'*"**'$9,U40.33 Nine thousand forty and 33/100 Dollars Pay to the Order of: MARJORIE HILL 5312 BLUE CYPRESS LN LEAQUE CITY TX 77573 Citibank, N.A. AtrrttoatzcD slc.NnTUxs One Penn's Way Ne~,v Caste, DE ~ 972o PLEASE CASH WITIHN 60 DAYS i~'09003680 2ii' x.03 L L00 209. 38?4 L354u' Page 1 of 2 Miller, Maronetta F. __ ____ From: Hill, Rob [Rob.Hill@valero.com] Sent: Friday, September 18, 2009 8:32 AM To: Marge Hill; Miller, Maronetta F. Subject: RE: Estate Questions Follow Up Flag: Follow up Due By: Monday, September 21, 2009 12:00 AM Flag Status: Red Attachments: Scan001.pdf 1' have attached o POF file of the check from MetLife that Mar, jorie received. Thanks, Rob Hi// Director of Maintenance 1/a/ero Refining Co. Texas City Refinery 409.948.7248 . ,. ; .~~. From: Marge Hill [mailto:hillma60@hotmail.com] Sent: Thursday, September 17, 2009 8:24 PM To: Hill, Rob Subject: FW: Estate Questions Subject: Estate Questions Date: Wed, 16 Sep 2009 16:16:34 -0400 From: MMiller@saul.com To: GRaber@wohlsen.com; hi11ma60@hotmail.com 1 ~ C~eol~~7e c~nd 1VIu~~~,ry -1~id you receive you~~ check f °om 1~IctLife ~~~«~~~ the a/~2n2~ity ~ ~f so, would ~,ozf please send nee ~ copy of tivhat ~~ou ~~ccc~ived - if not, tivhcn wou do ~~eeeive it, send it to one. ~~ ~eot~~c~, slid L~oiz Deceive l~he ~~efi~nd of ~ ~0 fi°ori7 the app~c~lse~~ 9i29i?oo9 Page 2 of 2 %et.~ 3) George, anything additional bills that have been paid or any ad~~itioy~al deposits you have made - please, forti~vard to nle. ~~ ~ ~t~ould like to be able to make cr payment on account of the inheritance tax before closing, but cannot complete the calculations until 1 receive the above in, formation. A~~zy r~i~estions, let me know. Thank you! Maronetta F. Miller, Legal Assistant Saul Ewing LLP Penn National Insurance Tower 2 North Second Street, 7th Floor Harrisburg, PA 17101 direct line: 717.257.7524 direct fax: 717.257.7588 e-mail: mmillerCa~saul.com "Saul Ewing LLP <saul.com>" made the fo{lowing annotations: N N N N N N N N N N N N N N N N N N N N N N N N IRS CIRCULAR 230 DISCLOSURE: TO ENSURE COMPLIANCE WITH REQUIREMENTS IMPOSED BY THE IRS, WE INFORM YOU THAT ANY U.S. FEDERAL TAX ADVICE CONTAINED IN THIS COMMUNICATION (INCLUDING ANY ATTACHMENTS) IS NOT INTENDED OR WRITTEN TO BE USED, AND CANNOT BE USED, FOR THE PURPOSE OF (I) AVOIDING PENALTIES UNDER THE INTERNAL REVENUE CODE OR (II) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TRANSACTION OR MATTER ADDRESSED HEREIN. THIS E-MAIL MAY CONTAIN PRIVILEGED, CONFIDENTIAL, COPYRIGHTED, OR OTHER LEGALLY PROTECTED INFORMATION. 1F YOU ARE NOT THE INTENDED RECIPIENT (EVEN IF THE E-MAIL ADDRESS ABOVE IS YOURS), YOU MAY NOT USE, COPY, OR RETRANSMIT IT. IF YOU HAVE RECEIVED THIS BY MISTAKE PLEASE NOTIFY US BY RETURN E-MAIL, THEN DELETE. THANK YOU. SAUL EWING'S WEB SITE IS WWW.SAU_LCOM. Hotmail® has ever-growing storage! Don't worry about storage limits. Ch_eck_it__out. 9/29/2009 M+et~~f~ ANNUITY BENEFIT SERVICES ~.o. sc;~.,o3ca Ors mss. ~a sow-yes X95 GEORGE T RABER III 4011 EASY 5T HATtRISBURG PA 17109 Disbursement Processing DATE :09/09/2009 CHECK AFUMBER:890A 090036837 CHECK AMOUNT:*******$91,959.47 CHECK REF# :Z52-2289922 FOR PAYMENT Ii~IFORMATIOIV ,,. .' ~ ~ ~7A~: D$~~6l~0~9 ~ ~ r. , TRANSAM~RICA LIFE INSURANCE COM~' N~t De'Ferred Anr-uity IVurrtber: 2`6.15 9 5 9 5 Tax fl~€ficatit~r~~ NE}N--QU~Ir~~'`I~D r'~ Annuitant Narrrg: THEC? M 1~ABER , . Pnii~ycer~sk ,~ ,< ~C ~~ ~y ~GEQRGE " R~18ER I Z ~ Payee I~I~fTi~: f '.( ~ ,z , ~,:, f ._ f ,7c~ ' f ; ' J `, f,. ; i/"lease .sp# our lorry's sincere ~coftdot~ces o~ yaua~ re~ortt #ass. Yr~ur ret{uest fpr a . ~ di~tr'i~tf~ar`+,,1•rt~ y t~i+ #~#~'~+~' i~~ ~ ~?~ prt~~+~,s~sd.:Ya~+c: chef- is 'attach:' ~o~f~wing r ~S Nlfarr>~tlort #"$ Cl4ilf$' t8IC~11'f ~$`gtTL ' :~"` tA.xa~ o~~t ;Ct# "~lifr di~trdjuti+an , t r Groan ci'i~i.i~On. ' ~ tl , ~ ~# 6 . ~, . ; ~ ~.9ss ~~der`al ,I~c Tax jNitlthelet ~ ~ r Esss ~#~~: lrtcta~ne~~`f'~~ ~it~itl^tlsi~f~ , i5°: ~ ~ r ~~~esS dv f ~~: ~ _ . fVet Check ~['1'iCxtnt ~ ~ , 6 ~ ~ .' ~ r . i If any portion taf this disfirll~utitm~ 1S #81xab6e, thlS t~l$b'l~3lti~ltl W13f ~e r+apr~'#ecl tCD the ~~~ td ~ on ~a Farm 1~~-f~. ~,.,..__________,~~ f'lea~ `be .~Iv3s~` thafi . , release `cif ~oliCy values may'..; affect tf~e guar teed elemer~fs, t~amgiaar~ ; elements„ tie- s~mo%~t or surrer~dar value of ;the ,p~liCy fra~tn whiClZ tf~ varies ors ~eleasect ; ~" your' ~fdrtr>, stafs "regu~tic~ns ; re~qu~s insurers to nx>nitor "sported; repl~ert~er~ts of . 8xi~titl~ arlty ccxmtracts; ~d life; ia~ur~an~ polici+~ b}i our may: If #hts distrtbutiortrs inienclsd #Cl. ~J8 ~19~d tCD ptSC~C~188~ ~ t39W '11~t1iK ~rtt~r~t Dr life'-"ins~~sce pC~liC~ _ uvlt~ 011' ~i7T1yr pisase CdClt'8Cfi US ~ ' t1tNYi~;}}81' l~+alQ~v. ~',ls' re~a~mmerid you seek the adviGB cif ,yot-r> tex consultant ac~nc~ernir>g the gaper re~orfirnc~ of , ~'!~ ;l~i$'~il`}llt7E)l'l, l~nl~SS 1Ne. helve, bep17' -~tiffed of 8 'GO1ktFtlty car rt~'it~tl `prpperty inkerest ~n t91i5 `: polt~y; vue will rely, cm our hand faith belief thst nn ;such interest exists; the pcalicyowner ~grses „~q' ir~al#y at~c! f~rild t~ Ctu~any harmless from. ~ttis cansec~en~s of xcc~ting this tran~aCtion: t1~5 If .ytsu have; ~r+y C# ti3 t~"i~ ~l18$S~l Gp f ~#~C~ ~{1t,11 fQ~BI ~'$pr~301'1~$~~v~. ~1" t~18 AfN7~„tit~ ~fiS17'ibti~iOtl y p y p ! ~ ~f YI~~ ~~~ ~t 1 "" Gl V ~:'°~ ~ ~.":~ 7~ t . ~ .- r _,. r r f f r " CHECK N©. DATE Ui:IhIDUI~i IVO. PAYS IVANII= 1rH~CK AMOU~17 ' 15b48154 0~,126/20~9 AA~S~64582~ GLpRGE RARER ITI 29,699.?4 ',... r To Remove Document Fold and Tear Along This Perfaratian