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HomeMy WebLinkAbout12-16-0915056051058 REV-1500 E><c~5) ~o~Y PA Departrrre-rt of Revenue Bureau of Individual Taxes Counly Code Year Fle Number l'0 Box 280601 INHERITANCE TAX RETURN ~ 1 ~ ~ ~n O liartisbug, PA 17128-0601 RESIDENT DECEDENT ~'V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201-18-3164 03/19/2009 08/09/1924 Decedent's Last Name Suffix Decedent's First Name MI Raffensperger Sara J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW :~ 1. Original Return ~ 2. Supplemental Return r~ 3. Remainder Return (date of death prior to 12-13-82) .,._., 4. Limited Estate C~ 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) C1< 6. Decedent Died Testate 'a"~t 7. Decedent Maintained a Living Trust 1_ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) t:;::~ 9. Litigation Proceeds Received GV.°°~ 10. Spousal Poverty Credit (date of death :~;:a 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 Harold Raffensperger (703) 717-2815 Firm Name (If Applicable) REGISTER OF LLS USE toms ONQ ~ O ~ ~ T rj First line of address ,~ te- ~ t 7 f c :r ~- ~~ 14072 Gusty Knoll Lane r ~''~ ~ cn "- ~ r ~ , -i-; - ~ Second line of address ~ . C"~ C7 r] .::~ c: c' -~ J~'X7 = I -- "t'i _ D w ; ~.~rn City or Post Office State ZIP Code _ . _~~',_.. __ _ ~ 4 i ~ Leesburg VA 20176 ~ Correspondent's e~aii address: nat.rarrensperrderaLreaRnnnlc.net: Under penaltles of ury, l declare that I e retrxn, indudin9 accompanying schedules and stafemergs, and to the best of rtry knowledge and belief, it is true, correct . Deda of ottrer its the personal representatlve is based on a1 inAorrr~on of which pr~arerl has arty krwwledge. SIGNA ~F NG RETURN DATE 12/06/09 s ~ya~(z, c~,.1~, ~`~ i~a~~ ~. I cis t3~s~ ~ 2..m1~V SIGtVATURE OF PREPAR~THE THAN REPRESENTA~- T- DATE ADDRESS PLEASE USE OIRIGINAL FOfRM ONLY Side 1 15056051058 15056051'058 J 15056052059 REV-1500 EX Decedent's Social Security Number Sara J Raffenspergel' 201-18-3164 DecedenYsName: ____~.__~_.a____.__.____._ _._~.,________._._._._._.__._._.w~....__. ._._.__~_ ___.w~__ ~__.._._.__...._,_._._________..__._~___ RECAPITULATION _ . 1. Real estate (ScheduleA) ............................................. 1. 159,000.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 410.46 3. Closet' Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 3,426.29 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7. Inter-Yvce Transfers 8 MisceNaneous Non-Probate Properly (Schedule G) C°~`~7 Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 162,836.75 9. Funeral Expenses B~Administrative Costs (Schedule H) ..................... 9. 10,379.04 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Sdiedule I) ................ 10. 26,420.28 11. Total Deductions (total Lines 9 8 10) ................................... 11. 36,799.32 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 126,037.43 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. 126,037.43 ._.___ ._-__,_._______~~__.~.__~_~._.._.~.._~.._.s.~._..._.__~._w~..~_...... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _._.~.... _...._.__.~__~..__._..._.._._.._._...,...,..._._....~..._...,~._._.e.._... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .045 126,037.43 16, 5,671.68 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 5,671.68 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~° 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Comulete Address: File Number DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Sara J Raffensperger 201-18-3164 STREETADDRESS 34 North Old Stonehouse Road CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _ C. Discount Total Credits (A+ B + C) (2) (1) 5,671.68 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,671.68 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 5,671.68 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the properly transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ ^>< 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ ^x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemR 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. REV-1502 EX+ (il-OS) ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMB~'R Sara Jane Raffensperger All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is joiMlyrowncd with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) scNEOU~ s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara Jane Raffensperger ~ Pr~Y I~~-owned with right of survivorship must be disslosad on Sctreduk F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (8-98) COMMONUVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sara Jane Raffensperger Indude the proceeds of litigation and the date the proceeds were received by the estate. AN property joirdlyownsd with right of survivorship must be disdosed on Schsduk F. (ff more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCNEOtILE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara Jane Raffensperger Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT a FUNERAL EXPENSES: 1. Funeral and cxematan services (Malpeai Funeral Home; Mechanicsburg, PA} 6,254.72 2. Funeral reception 294.32 B. 1 2. 3. 4. 5. 6. 7. city Carlisle state PA _Z~p 17015 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Soaal Security Number(s)tEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is rat the same as daanant's, attach explanation) claimant Parker Raffensperger street Address 35 North Old Stonehouse Road Relationship of Claimant to Decedent Son Probate Fees Accountant's Fees Tax Ration Preparer's Fees ZP 3, 500.00 330.00 TOTAL (Also enter on line 9, Recapitulation) I $ 10,379.04 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-OS) '-• ~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES R LIENS ESTATE OF FILE NUMBER Sara Jane Raffensperger Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• Home sale settlement charges 20,361.01 2. M&T Bank Home Equity Payment (1 Month) 268.48 3.. Pension Overpayment (Public School Employees Retirement System) 112.61 4. 2008 Tax Preparation Fee 40.00 5. Home repair and preparation prior to sale 1,742.49 6. Outstanding medical taAs and fees 2,938.61 7. Home utility payments 957.08 TOTAL (Also enter on Line 10, Recapitulation) I $ I 26,420.28 If more space is needed, insert additional sheetr of the same size. KNOWN BY ALL PERSONS PRESENT, THAT: I, Sara Jane Raffensperger, of 34 Old Stonehouse Road, Carlisle, PA 17013, "Principal", execute this Durable Power of Attorney and do hereby make, constitute and appoint: Harold Henry Raffensperger, of 14072 Gusty Knoll Lane, Leesburg, VA 20176, "Agent", as my agent-in-fact TO ACT IN MY NAME, PLACE AND STEAD in any way which I myself could do as if I were personally present and to the extent that I am permitted by law to act through an agent, pursuant to the following provisions: . 1. EFFECTNENESS OF POWER OF ATTORNEY: This instrument is to be construed and interpreted as a general durable power of attorney effective immediately. This power of attorney shall not be affected by disability, incompetency, or incapacity of the Principal. 2. GRANT OF POWERS: I grant to my Agent full power and authorization to do everything necessary in exercising any of the powers herein granted by this power of attorney as fully as I might or could do if personally present. My agent shall have full power of substitution or revocation. I hereby ratify and confirm all that my Agent lawfully does or causes to be done by virtue of this power of attorney and the powers herein granted. My Agent shall have the power to exercise or perform any act, power, duty, right or obligation whatsoever that I now have or may hereinafter acquire, relating to any person, matter, transaction or property, real or personal, tangible or intangible, now owned or hereafter acquired by rr~e, including, without limitation, the following specifically enumerated powers: (a) Powers of Collection and Payment: (1) To forgive, request, demand, sue for, recover, collect, receive and hold all sums of money, accounts, annuities, bequests, bonds, certificates of deposit, checks, commercial paper, debts, deposits, devises, dividends, drafts, dues, insurance, interests, legacies, notes, pension, profit sharing, retirement, social security, stock certificates and other contractual benefits and proceeds, all documents of title, all property; real or personal, intangible or tangible, and property rights and demands whatsoever, liquidated or unliquidated, now or hereafter owned by, or due, owing, payable or belonging to, me or in which I have or may hereafter acquire an interest. (2) To have, use, and take all lawful means and equitable and legal remedies and proceedings in my name for the collection and recovery thereof, and to adjust, sell, compromise, and agree for the same, and to execute and deliver for me, on my behalf, and in my name, all endorsements, releases receipts, or other sufficient discharges for the same. -1- (b) Property Matters: (1) To acquire, purchase, exchange and sell, or grant options to sell, mortgage, pledge, lease, sell and convey real or personal property, tangible or intangible, or interests therein, on such terms and conditions as my Agent shall deem proper, with full authority to sign, endorse, execute and deliver any sales agreement, deed, bill of sale and all other instruments or documents pertaining to the sale of any of my real or personal property; and to enter into bonds, contracts, mortgages and deeds connected therewith. (2) To sell, assign, transfer, convey, exchange, deed, mortgage, pledge, lease, let, license, demise, remise, quitclaim, bargain or otherwise dispose of any or all of mzy real estate, stocks, bonds, evidences of indebtedness and other securities and other personal tangible and intangible or mixed property, or any custody, possession, interest or right therein at public or private sale, upon such terms, consideration, and conditions as my said attorney shall deem advisable and to execute, acknowledge and deliver such instruments and writings of whatsoever kind and nature as may be necessary, convenient or proper in the premises. (c) Management Powers: To maintain, repair, improve, invest, manage, insure, rent, lease, encumber, and in any manner deal with any real or personal property, tangible or intangible, or any interest therein that I now own or may hereafter acquire in my name and for my benefit, upon such terms and conditions as my Agent shall deem proper; (d) Banking_Powers: To make, receive and endorse checks and drafts, deposit sand withdraw funds, acquire and redeem certificates of deposit, in banks, savings and loan associations, and other institutions, execute or release such deeds of trust or other security agreements as may be necessary or proper in the exercise of the rights and powers herein granted; (e) Business Interests: To conduct or participate in any lawful business of whatever nature for me and in my name; to execute partnership agreements and amendments thereto; to incorporate, reorganize, merge, consolidate, recapitalize, sell, liquidate or dissolve any business; to elect or employ officers, directors and agents; to carry out the provisions of any agreement for the sale of any business interest or the stock therein; and to exercise voting rights with respect to stock, either in person or by proxy, and to exercise stock options; (f) Safe Deposit Boxes: To have access at any time or times to any safe deposit box rented by me, wheresoever located, and to remove all or part of the contents thereof, and to surrender or relinquish said safe deposit box, and any institution in which any such safe deposit box may be located shall not incur any liability to me or my estate as a result of permitting my Agent to exercise this power; (g) Power to Hold Property and Make Investments: The power to hold or acquire any property, real or personal, or securities, regardless of whether such property or securities -2- are a so-called "Legal" investment, where such course is, in the said Agent's opinion, for my best interest; (h) Power to Borrow: To borrow any sum or sums of money on such terms (including the power to borrow against the cash surrender value of any life insurance policy issued on my life), and with such security, whether real or personal property, as my Agent may think fit, and for that purpose to execute all promissory notes, bonds, mortgages, deeds of trust, security agreements, and other instruments which may be necessary or proper; (i) Disclaimer: To exercise or release powers of appointment in whole or in part and to disclaim or renounce in whole or in part any interest that I might otherwise have as a joint owner, beneficiary, heir or otherwise and in exercising such discretion, my Agent may take into account such matters as shall include but shall not be limited to any reduction in estate or inheritance taxes on my estate, and the effect of such renunciation or disclaimer upon persons interested in my estate and persons who would receive the renounced or disclaimed property; (j) Trusts: To transfer, assign and convey any property or interest in property, the legal or equitable title to which is in my name, to any trust of which I am the primary beneficiary during my lifetime and under the terms of which I expressly have the power to amend or revoke such trust, and to exercise any right of withdrawal of income and/or principal which I may have pursuant to the terms and conditions of such trust, whether such trust was created before or after the execution of this power of attorney; (k) Power to Change Beneficiaries on Any Insurance Policies on my Life: To change the beneficiaries on any insurance policies on my life; provided, however, that neither such right and power, nor any other rights and powers, shall be exercisable with respect to any policies of life insurance which may at any time be owned by me on the life of my Agent herein named. (1) Executing Government Vouchers. To execute vouchers in my behalf for any and all allowances, compensation and reimbursements properly payable to me by the Government of the United States or any agency or department thereof. (m)Depositin Money and Other Property. To deposit in my attorney's or my name, or jointly in both our names, in any banking institution, funds or property, and to withdraw any part or all of my deposits at any time made by me in my behalf. (n) Recovering Possession of Property. To eject, remove or relieve tenants or other persons from, and recover possession of, any property, real, personal or mixed in which I now or hereafter may have an interest. (o) Liti ag tion. To institute, maintain, defend, compromise, arbitrate or otherwise dispose of, any and all actions, suits, attachments or other legal proceedings for or against me. -3- (p) Tax Returns. To prepare and execute any tax returns, including,. but not limited to, Federal income tax returns, State income tax returns, Social Security tax returns, and Federal and State information and estimated returns; to execute any claims for refund, protests, applications for abatement, petitions to the United States Board of Tax Appeals or any other Board or Court, Federal or State, consents and waivers to determination and assessment of taxes and consents and waivers agreeing to a later determination and assessment of taxes than is provided by statute of limitations; to receive and endorse and collect any checks in settlement of any refund of taxes; to examine and to request and receive copies of any tax returns, reports and other information from the United States Treasury Department or any other taxing authority, Federal or State, in connection with any of the foregoing matters. (q) Automobiles. To execute and deliver to the proper persons and authority any and all documents, instruments and papers necessary to effect proper registration of any automobile in which I now or may hereafter have an interest, or the sale thereof and transfer of legal title thereto as required by law, and to collect and receipt for all monies paid in consideration of such sale and transfer. 3. MISCELLANEOUS: I grant to the Agent named herein the following additional powers of authority: (a) In the event any agent named herein should be of the opinion at any time that she or he does not have the expertise to manage all or any part of my assets, I grant to said Agent the right and power to delegate the management powers hereinabove granted over all or any part of my assets to any person(s) or firm(s), and to enter into any management or agency agreements with said person(s) or firm(s), pertaining thereto, with the right on the part of the Agent named herein to revoke and cancel any such agreement at any time upon ninety (90) days' written notice to said person(s) or firm(s). (b) I grant full and absolute authority to the Agent named herein, on a noncumulative, yearly basis, to make gifts to my children, in trust or otherwise, as well as to their spouses, and to their children, in trust or otherwise, with the amount of gifts to each such person each yeaz not to exceed that amount which is excludable from the total amount of gifts made during such year under Section 2503(b) Internal Revenue Code of 1986, as amended from time to time. (c) I further authorize and empower the Agent named herein to use and apply so much of the income and principal of the assets comprising my estate as may be necessary or desirable, in the sole discretion of said Agent, for my maintenance and support. Any provision herein to the contrary notwithstanding, the Agent shall have no power or authority to use or apply the principal to discharge any legal obligation that the agent or any other person may have to support me or any dependent or beneficiary or mine, except to the extent that there are no assets reasonably available to the person having the obligation of support to pay the same. -4- (d) I further authorize and empower my Agent to engage, employ and dismiss any agents, clerks, servants, attorneys-at-law, accountants, investment advisors, custodians, or other persons in and about the performance of these presents as my Agent shall think fit. Any decisions made by the said Agent with respect to the matters set forth hereinabove in sections 3(b), 3(c), and 3(d) shall be final, binding and conclusive upon all of the beneficiaries of my estate, and said Agent shall be released and discharged of and from all liability for any such decisions that she or he may make in good faith with respect thereto. 4. INTERPRETATION AND GOVERNING LAW: This instrument is to be construed and interpreted as a general durable power of attorney. The enumeration of specific powers herein is not intended to, nor does it, limit or restrict the general powers herein ,granted to my Agent. This instrument is executed and delivered in the State of Pennsylvania, and the laws of the State of Pennsylvania shall govern all questions as to the validity of this power and the construction of its provisions. This instrument is intended to be effective in all states of the United States and in all foreign countries. 5. INDEMNITY: I hereby bind myself to indemnify my Agent and any successor who shall sa act, against any and all claims, demands, losses, damages, actions and causes of action, including expenses, costs and reasonable attorneys' fees which my Agent at any time may sustain or incur in connection with carrying out the authority granted her or him in this power of attorney. 6. NOMINATION OF GUARDIAN OR CONSERVATOR: In the event court proceedings are hereafter commenced to appoint a guardian, conservator or other fiduciary to take charge of my person, or to manage and conserve my property, I hereby nominate and appoint my Agent above-named, as my guardian, conservator, or other fiduciary, to serve without bond unless otherwise required by a court of competent jurisdiction. 7. REVOCATION: This general durable power of attorney may be voluntarily revoked by me by written instrument signed by me and delivered to my Agent. My guardian may also revoke this instrument by written instrument signed by him or her and delivered to my Agent. Any affidavit executed by my Agent stating that she or he does not have, at the time of doing any act pursuant to this power of attorney, actual knowledge of the revocation or termination of this power of attorney, is, in the absence of fraud, conclusive proof of the nonrevocation or nontermination of the power at that time. 8. DEATH: My death shall not revoke or terminate this agency as to my Agent or any other person who, without actual knowledge of my death, acts in good faith under this power of attorney. Any action so taken, unless otherwise invalid or unenforceable, shall be binding upon me and my heirs, devises, and personal representatives. 9. SUBSTITUTE AGENT: If Harold Henry Raffensperger ceases to act as my Agent due to death, incapacity, or resignation, I appoint Charles Alfred Krone of 4033 South Rifle Court, Aurora, CO 80013, to serve as my Agent. -5- 10_ JOINT POWER: If I name two persons to serve as my Agent hereunder, it is my intent that the power granted to them shall be a joint power, which shall and must be exercised by them together as they may from time to time act on my behalf. No action or transaction requiring a signature will be effective or binding without both such persons' signatures affixed to the written instrument(s) reflecting the action or transaction. FURTHER, I do authorize my aforesaid agent to execute, acknowledge and deliver any instrument under seal or otherwise, and to do all things necessary to carry out the intent hereof, hereby granting unto my said attorney full power and authority to act in and concerning the premises as fully and effectually as I may do if personally present. PROVIDED, however, that all business transacted hereunder for me or for my account shall be transacted in my name, and that all endorsements and instruments executed by my said agent for the purpose of carrying out the foregoing powers shall contain my name, followed by that of my said agent and the designation "agent-in-fact". My agent is entitled to reasonable compensation and reimbursement for reasonable expenses for services rendered as agent under this power of attorney, if desired. TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS INSTRUMENT MAY ACT HEREUNDER, AND THAT REVOICATION OR TERMINATION HEREOF SHALL BE INEFFECTIVE AS TO SUCH THIIRD PARTY UNLESS AND UNTIL ACTUAL NOTICE OR KNOWLEDGE OF SUCH REVOCATION OR TERMINATION SHALL HAVE BEEN RECEIVED BY SUCH THIRD PARTY, AND I FOR MYSELF AND FOR MY HEIRS, EXECUTORS, LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND AGAINST ANY AND -ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD PARTY BY REASON OF SUCH THIRD PARTY HAVING RELIED ON THE PROVISIONS OF THIS INSTRUMENT. THIS DURABLE GENERAL POWER OF ATTORNEY MAY BE REVOKED BY ME AT ANY TIME. Signed this 28th day of June, 2008 -~ ignature Carlisle, Cumberland, Pennsylvania City, County, and State of Residence -6- The declarant or the person on behalf of and at the direction of declarant knowingly and voluntarily signed this writing by signatwe or mark in my presence. Witness's signature: Witness's address: Witness's signatwe: Witness's address 3a ~o u s~ /~c ~~- 3a N Did ~anc~ ~~ /~a'S % ~o/~" I, Harold Henry Raffensperger, have read the attached power of attorney and am the person identified as the agent for the principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accwate record of all actions, receipts and disbwsements on behalf of the principal. ,~„~ .. Agent Date -7- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this 28~' day of June, 2008, before me personally appeared Sara Sane Raffensperger to me known (or proved to me on basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that she executed it. I declare under penalty of perjury that the person whose name is subscribed to this instrument appears to be of sound mind and under no duress, fraud or undue influence. In witness whereof, I hereunto set my hand and official seal. o Public Printed Name: .S ~t`tJ ~ i~-k~ ~ - ~~ fiF/~l ~4 ~ My Commission Expires: COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL JUDITH D. KAUFFMAN, NOTARY PUBLIC CARLISLE BOROUQH, CUMBERLAND COUNTY MY COMMISSION EXPIRES MARCH 10, 2011 -8- iunn nuu-~ 1~~1 rn nuwoooa saw- A. Settlement Statement U.S. Department of Housing and Urban pevelopment e Host ie....l.e. 1+/ZnOnnO\ e. 1 e or oan --- ---- 1. ^F' ~ 2. ^FmfiA 3. pConv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 4. VA 5. Conv.lna. 09122 208967494 C. Note: xan. mvkw ryp.u.aY wn P b oubld. M m.r+w.iwwn Mn ror kNOrm.tlan P~.v~••.ro N na k1Uid.d in sw wlr.. TitleF~rpress Seldement System WARNING: t q . V4a.lo WnWMglr rtuk~ hH.H. WL.m.nLL W tM UNb6 61M.s on Ws a vry o1Mr flmMr 1wm. P.nY1Ms upon Printed 05/22!2009 at 14:06 KS mnvk~wn c.n kclun.. m. ra m Far aww. wr. Tlw +8 U. 8. CoG S.cMon 100+.na sawn +u+n. D. NAME OF 80RROl!VER: Jason L. Dye and Stefanie M. Dye ADDRESS: 1445 Trindle Road A A Carlisle PA 17013 E. NAME OF SELLER: Estate Of Sara J. Raffenaperger ADDRESS: 34 North Old 5tonehouse Rd. Cartisls PA 17015 F. NAME OF LENDER: Bank of America, its Subsidiaries and Affiliates ADDRESS: 6400 Lea Drive Plano TX 75024 G. PROPERTY ADDRF~S: 34 North OW Stonahouse Rd., Carlisle, PA 17015 311ver S ri Townshi H. SETTLEMENT AGENT: 1st Advantage Settlement Services Inc., Telephone: 117-591-7755 Fax: 717.591-7758 PLACE OF SETTLEMENT: 8375 Merc Drive Suke 10 Mechank.sbu PA 17050 I. TTLEMENT DATE: 05122!2009 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SE ' R'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO 'LER 101. Contract sales 159 OOO.OD 401. Conlrad sales 159 000.00 102. Personal Pro 402. Personal Pr 103. Settlement ch to borrower line 1400 3244.86 403. 104. 404. 105. ~. Ad ustmenta for items aid se8er in advance ustmenta for Ne a kf seller i n advance 1011. Ci nown taxes 4011. C' nown taxes Coun taxes 05122109to12131109 107 298.18 7. Coun Laze 05/22/091 12131/09 298.18 . 108. School taxe 05122109 to 06130109 136.34 408. Sctwd taxes 05122109 08f 30109 138.34 109. ~. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 162 879.38 420. GROSS AMOUNT DUE TO SE 'LER 159 434.52 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DU TO SELLER 201. it or earnest rtane 1000.00 501. Excess 0 sit see instnxdions 202. Prins ai amount of new Loans 18 243.D0 502. Settlement cha es to seller 6ne 1 00 44 211.01 203. Exis6 ban s taken su 'ell to 503. Exiati loa s taken su ' to 204. 504. Pa off of first M e Loan 17608.71 M 8 T Bank 205. 505. 206. ~. 207 507. Ovem' ht Delius -Pa off 25.00 1st Advents a Settlement Se i 208. ~. 209. 509. Ad ustments for items un aid b seller Ad ustmerda for ms un aid b seller 210. 'nown taxes 510. Cit nown !axes 211. Coun taxes 511. Coun taxes 212. Scholl taxes 512. School taxes 213. 513. 214. 514. 215. 515. 216. Seller Assist 516. Seller Assist 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 163 243.00 520. TOTAL REDUCTION AMOUNT UE 5ELLER 61844.78 300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO ORIFROM SELLE R 301. Gross amount due from borrower line 120 162 679.38 601. Gross amount due to seller line 420 159 434.52 302. Less amounts 'd Hor borrower tine 220 163 243.00 602. Less reduction amount due seler li a 520 61 844.78 303. CASH TO BORROWER 563.62 603. CASH TO SELLER 97 589.74 _ __ rartn nuu-~ l.vnol m nanoooaa ~aW-~ .,••.V,.-•U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 09122 PAGE 2 eeTTl CtlG~IT QTATG~ICIdT ThlnCvnmaa Sdflmm~nl Rwtcm Printatf 051/2009 at 14:06 KS L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice 5159 000.00 = 8 968.00 BORROWER'S SELLER'S Division of commission Nne 700 as follows: FUNDS AT FUNDS AT 701. 4459.00 to RalMaxlstAdvante a SETTLEMENT SETTLEMENT 4509.00 to ERA-NRT Inc. 702 . 8968.00 703. Commissar aid at Settlement 250 00 704. Transad'an Fee to Re1Max 1st Advanta a . 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Or' inatbn Fee % 802. Loan Discount % 803. A sisal Fee to Landsafe A sisal Services Inc. P.O.C. 385.00 Seller LR 75.00 Credit rt to Landsafe Cred Ina P.O.C. 35.00 B er' 804 . Lneder Fee to Bank of America LR! 805 590.00 . 808. Tax Service Fee to BAC Tax Service Co ation LR! 1~•~ 807. Flood Check Fee to Landsafe Flood Deteemtttation Inc. LR ~•~ 808. RHS Gaurantee Fee to RHS LR 3 244.86 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 0512?/2009 tD 0610112009 21.1100 Ida 10 D s LR 211.10 902. M Insurance 'um iw to 00 447 903. Hazard Insuralx;e Premium iw to Erie Insurance . 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insuranc6 3 mo. 37.25 rmo LR 111.75 1002. Mort Insurance rn0• /~ 1003. C' Pro Tax mo. Imo LR 76 158 1004. Coun Pr Tax 4 mo. 39.691mo . 32 1219 1005. Shcod taxes 12 mo. 101.61 Imo LR . 1009. A ate An sis AdUstment LR ' 0.00 •270.55 1100. TITLE GHARGES 1101. Settlertlent w CI091 fee 1102. Abstract w title search 1103. Title examination 00 35 Note Fee to Kristen D. Shave 1104 . . 1105. Document P Bon to 1st Advartta a Settlement Services Ina 1~•~ 1108. Note Fees tG Kristen D. Shhre 10.00 1707. Attwne a tees includes above items Wo: 75 1 173 t 108. Tdle Insurance tD 1st Advents a Settlement Services Ina . includes above items No: 1101.1104 1109. Lenders Pot' 16 43.00 •1 173.75 1110. er's Pol' 159 0~•~ - 150 00 1 1111. End 100 End End 900 fD 1st Advar-ta a Settlement Services Inc. . r• 1112. 1113. Closi Svd.tr tD 1st AdvartW a SetttemeM Services Inc. i 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES Record's Fees 48.50 • Mo a 76.50 • Release 125.00 1201 . 1202. C' lCoun tax/a Deed 1590.00 • Mon Y 1 ~'~ 1203. fate 7ax/stam Deed 1590.00 • Mort 1 ~•~ 1204. 1205. Se tic to Pecks Sa c Service 2~•~ 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2009 Co1T Taxes to Robert Cairns 485.88 Se to to Pecks S c Service 1302 180.00 . 1303. wre In Fee o 1st Advanta a Settlement Services Inc. 10.00 Tax Cart Fee to 1st Advan Settlement Servit~ Ina 1304 10.00 . 1305. Ovem' ht DeGv Fee-Pk l0 1st Advanta a Settlement Services lnc. 25.00 Email Pk Co Fee to 1st Advanta a Settlement Services Inc. 1308 35.00 . t307. Radon Mat 8 UV ' ht to Mike Sh Home Ins actions 1430.00 25115.00 1308. Other Disbursements 1520 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 3 244.86 44 211.01 NUO CERTIFICATION OF BUYER AND SELLER I Mw u1aful awed Ou HUD-1 S•l0amant StalsmaM and b Or WY or my kflowlstlya and WON, H I Irua anti acetate blalamalll of a0 d trY ma . I turBlw cx1Yy 1 Mw recatwd a Dopy of Ou HUD•1 SatlNmanl StatwMM. dahuragnarAa matle on my accoum WARNING: fT LS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE TM HU0.1 Settlement Slatamenl which I haw prepayad u a Yua and a~curele account of Nis UNITED STATES ON THIS OR ANY SIMnAR FORM. PENALTIES UPON CONVICTION traneattlon. 1 haw uusad or wW uuaa Ble Wnda to tae dleltuaetl N accordance wIN We atatemam. CAN INCLUDE A FINE AND IMPRISONMENT. fOR DETAILS SEE TITLE tB: U.S. CODE SECTION 1001 AND SECTION 7010. ~~~~ SETTLEMENT AGENT .f/~a DATE: rrBNWS 9GIWM ws oDWMu U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STOTEMENT roan nuu•i ~aael rar narwooac nau>~ File Number: 09122 PAGE 3 ITEMIZATION OF HUD LINE 1308 1500. SCHEDULE OF DISBURSEMENTS BUYER SELLER 1501. Home In ' n to Mike Sheel Home Ins ons ~ 605,00 1502. Home Wanan to American Home Shield 495,00 1503. Transadan Fee to ERA-NRT Inc. 165,00 1504. Inheritance Tan Escrow to 1st Advent a Settlement Services Inc. 23 850.00 1505. 1506. 1507. 1508. 1509. 1510. 1511. 1512. 1513. 1514. 1515. 1516. 1517. 1518. 1519. 1520. TOTAL HUD LINE 1308 EXPENSE: 25115.00 ' ~~ ., HENRY H RAFFENPSPERGER 194449285 14072 GUSTY KNOLL LN LESSBURG VA 20176-0000 Redemption Date: 06!10/2009 Transaction Number: 6556161158 Serial Number Series Denom Issue Issue Price interest Eamed Redemption pie Value 90482389804 EE $50.00 10 ! 1991 $25.00 $38.20 $63.20 Total number of bonds redeemed: 1 Total Total Total Price Interest Value $25-t10 $38,Zti: $63.20, Leesburg Office 345 E. Market Street • Leesburg, VA 20176 (703) 771-0400 May 28, 2009 SARA J RAFFENSPERGER Share Balances Current 34 OLD STONEHOUSE ROAD Div Reinvestment Plan p,000 CARLISLE PA 17013 Certficate(s) 0000 Direct Registration 0.000 Total Common Shares 0,000 Year-to-0ate Amounts - Comrrwn Gross Dividend Reinvested $7.32 _ ._ F~gral Tax Withheld __ -. ___ _ _._ _ __~Q.~ __ ._ __ r_._ _ ___ . _ _,_... ~ ~ . _ _ _ ____-_- _. _ Nonresident Alien Tax Witl~held $0.00 Account Value Cash Investmerrts $0.00 Market Value Date 05!27/09 Total Invested $9.52 Market Value Price -Common $31.51 Commissions Paid by Company $0.00 Account Market Value -Common $0.00 Year~o-0ate Activity Transaction or Transaction larOas Amount or Sstthnwnt Date T e T ti TaXaa Net Amount of Y Priea Shams Incrieased Total Shares yp ransac on Vithhetd Transaction per Sham or Decraassd Held in Plan ORWARD 10.683 Div Reirtv~ed $0.00 531.0000 10.799 Net Pfd Div Reinvested $0.00 $31.0000 10.835 Div Reinvested $0.00 $28.7750 10.965 Net Pfd Div Reinvested $0.00 $28.7750 11.003 Shares Sold $0.00 $31.5604 0.000 Your tra _ _ arith your req ~~~` '.,, PPL Corporation is participating in the Direct Registration System ("DRS"}. You may choose to have your Plan andlor DRS shares electronically delivered to or from your shareowner account For information coneeming authorization of electronic share marement, please ~ntad your BrokedDealer. Detach here. Forward bofllam potion b the address shovm below. Farother bansaetions see reve-ae side. Transaction Request Mall to: Shareowner Services PPL Corporation PP01 Dividend Reinvestment Plan PO i3ox 64856 St Paul MN 55164-0856 ^ Please change my address as indicated. 3097076202 SARAJRAFFENSPERGER 34 OLD STONE!-IOUSE ROAD CARLISLE PA 17013 PPL Corporation Account # 3097076202 OPTIONAL CASH PURCHASE ELECTION ^ Enclosed is a~check made payable to Shareowner Services for: $ Ataximntn 380,000.00 per year Shareowner Services will process your purchase instructions according to your Plan prospectus upon receipt of Y~r ProP~Y completed request which includes account number or SSN and reference to the PPL Plan. We will not be liable far any claim arising out of failure to purchase shares on a certain date or at a specific price. Requests submitted on this form will only affect Dividend Reinvestmetrt Plan shares. not shares held in DRS. 0 N 0 a N V .L W t~r~,~z~s o, ~ ,~ 15490041048 ~~~ REW1549 EX (02-0~ &ieauoF Y~diMdual Taxes NOTICE OF DECEDENT PO eon ~oeot ACCOUNT STATUS t~ ~isi~ ~ + DECEDENT INFORMATION: Errler data as h vrnl appear on aN doasrrard~ subnHlled to the DepaMrenl Social Sexurit~ Number Data of Death ~ ~tY _~ Last Name Suifbc First Name M' ~. ~a~- a Post omoe sRda zIP coda (_'~.r(as l~ ~i~ l 7G f5 - @n'i3i FINAIiICIAL W37TTU'fION M~'OtM1ATilON _ _ Q Flq ~ oval if name a addraas ___ _ _ _ Name of Finarx~al ir>siifutlon Address Firkandal k>sfihrtlon Bank ID Number 55~ ~r ~ I ~~~lG~ "'" ar Post Ollice stela zIP c«Ie ~I~l~n~~CS u~ ~~ I ('7GS`~ ACCOUNT INFORMATION -PLEASE ATTACH COPY OF SItaNATtAtE CARD IF AVAILABLE Fin in oval to indicaEe type of account O Joint Savings ! Join Checking O 9n Tn~t For O Joird Time Certlfiksate Account Number final Dete Acoourh was EsteWisiked wltlr Joint Survivor/Beneficiary 7~ b G2- l a s Zod 2 Acoourn Balance irxiude interest ~ data oI death) ~~ , ~d / . ~`la PLEASE FlLL IN OPAL ~ ACCOUNT WAS ESTABLISHED BY A TRANSFER OF FUND8 FROM ANOTHER ACCOUNT THAT WAS REGISTERED IN THE NAMES OF THE SAME JOINT OWNERS AND F~t?>:R THE DATE oRICNet_i Y Ar+! ~D. (RoOo~ver Account - DaUs n fstabRshed O j Title as Card or Indicate All Joint On Reverse Skin, and Worksheet, tf AppUcabk. OFFlCIAL t~ ONLY _.-,-T-,~, .~ 3RArlSAC710N COUNT ~.~~: a, PLEASE USE ORN3INiA1. FORM ONLY Side 1 15490041048 15490041048 J 15490042049 REV-1549 IX Deosderr!'s Social S ecurjl~r Nianber ~~1- I8 - ~ f i~ ~ et ~ U8T ALL JOMIT SURVIVORIBEJ 'IEFICIARY RiFORMATION BELOW OFFICIAL USE ONLY 1. Survivor's Social SewtRy Number l tl i D rt c~~ R t t l Cam/ ~` A e orrs r ecet e p o et .(,(.,( (( Percent Taxable Lam Nrene Su1Por Fist Name MI l~hs~~~r -fhn.~c ~ ~~ _ ~1 ~2Q.~e~ ~ 0 L~ ~~~ 7 ~ ~~ ~n r f .. . Tax Rate se~orrd Una of Address or Moat Office Inc ~a State ZIP Code ~~ 17c~s 2.3urvivor's Sociad Sectxity Nunbar oFFICaAL usE ONLY Rel~orlsfrp m Deoederd Last Name Suffix Fast Ptarne MI Pemer# Taxatlle f First Line Of Address Second Lhle of Address Tax Rate Cily or Past Office State ZIP Code ~ ~~ 3. Stxvivor'S Sot~al Setarrk Number OFFICIAL USE ONLY Reiatiorrsitip b Decedetlt j Last Name 1 First tine of Address of Address o~~of r Tax Rate 1 dnt qie aborts bdamstlon N true, eornct and complat.. -- NAME OF PREPA PLEASE Mf: TELEPFIOPE ttlpdBER: E-MA~ADORESS: pq Clnd~, Po/~_G7v ~ ~rl 7V~r L~Jc~ ~,vfal~ a~rx~,'~rn y J Side 2 15490042049 25490042049 Peroerd Taxable 48500041D46 REV-485 IX (05.04) SAFE DEPOSIT BOX tNVENTORl( Fi-Daparlna~taRsvel>ue n.~1sE 11SE olgfilNA~. fOR~1 ONLY sociei sealrlty ar D!eaa~ cede Number Date or Hasa, County cone Year File Nlmber a 201-18~1t34 03/19/'1009 ~ 0 Deoederri's last Name Suaioc First Name MI Raffenspenger ~ 1 Sara ; --.-._, ~AOORESS OF DECED~fr STREET CITY: STATE: 2a' CODE: rr~~ 34 Old Stare H Rd CarUsle PA 17015 NAIBe IIND ADDti~S OF PERSON REQUE8TING TFB5 OPENN3 OF T1E BJIFE DEPOErT soot Harold H Raffensperge r, Executor i sTREEr.ADDRESS: CRY: sTATE: 27P CODE: 14072 G Knd1 Ln Leesbu VA 20176 i NAME, aoDrases AND KBwTroNetitP pF arm To o~a+>: OF PERBON(Bj PREaENT aT TFiE BOrt oPENMri a. Harold H Rattertsperger ~ ~ STREET/1DORESS: CrRh STATE: ZIP CODE: + 14072 Gusty Knell Ln Leesburg VA 20176 - sTREETADORESS: cm: sraTt< zIP coDE: i a NAME: Ng.~7p ~ ~~ CrrY: . STATE: ZIP CODE e NAME AND ADDS OF FlIANCNL MIBTRIrT10N 11MBAE 7'F~ aAFE OEPOe1T BOIL 16 L+OCATID ~ NAME M&T Bank ~ 8TATE Z~ coDE: 5528 ~~ Prke PA 17050 NAME OF MAraNO LAB't EN n r TRY QaTe AND TBE OF lAaT ENTitY r ~ ricer ~ }' r - - 2a /d : ~$ flsrl ~ DATE of coNntACT T>a Retr Nurlelae of Box TrrtF iBiOER wtwcN Boot M # 03J16/1988 323 Sara ~ NAME AND ADDRES8 OF PERSON(s1 NAYNO At7CESB TO BD)t a. S Raffensaemer Elizabeth BroMm, Deputy I I 34 Old Store House Road 34 D~ Stare Horse Road tXTY. STATE: Z~ CODE: CRY: STATE: ~p CODE ~ Carlisle PA 17015 Carlisle PA 17015 ~ NAME wwo Trrue of EMPI.OIIEE TAIBNG Tt1E INYENiOR1r --f i YIU1E A rYa.r. N TrE BOICt ^ YlBf NO M yas, s. Dab at aBt b. Naha and adbaas d pawonal npe.~nbtlM. M epaMd ti a» adr NAME ~ CrTI(• STATE: ZIP CODE: a Name and addroas d aawnax K any NAME: STREETIIDDRES3: CRY: STATE Z~ COOE: L 48500D41D4b 4850D041D4b J ~ / ~3 cecc ncDnCIT RAY INVFNT~RY iNSTRUCTiONS (i) caalr: Report total only. oo (~ ~ ~ d ar ~ ' ~ ~ ~ ~ d ~ dc. a, or dc regfeeerea, .,~, ~o oe~fi~1 hwFicn ~ ~o~ e (3) abliprdorls of U.S. Govsr11nre11t Number of sear;, date of bsue, faoe value, names in wtrkh registered end type of ovwrership, - Le., joirdly held. payable on death, etc. (4) Bonds: Designate by creme. anwurrt, serial rturnber or other desigrrelion. (Bearer Bonds) (S? Bradt and Savings end L,oar1 Passboolos: State name d deporibr, rrsrd,er of book last dale appee~irg in book. name of bank and brands, and belanoe. (g) Jewshy, Coins. , Msraucrlpbs, etc; List and deso~e as tuMy as possible. Cn o..ds, Mortgages, curl.nt Inwrarlcs Poik:ba or o0rar avidarlcss of irldabMdl~: i3st and describe as tuNy as possible. (8) Ml ottl.r a~lrtaflli. (>t) Radalr compislsd form to: ew t~T. zao ttni~seuttc, w+,~,zlEOew t>~l rrer otsclttPTtoa ~~ ~jOCOt '{~ ~,~G- ~(,(OY'f' OS`CLf7.S{7+Pfi~ ' /i'O~dlt_°S~S ~ G~O~ -51~»Q f~Oc.xS-P' f~O! -~~'+ ! t~Y S n~ -- =,~YT .r C~~ ~i~rOt. ,I'..c~l t+S 2 S~G~ - ~~ y 5 ~ t o ~~ +'~-f~O.C~sz01 ~~ ~ ,x.~.~ ~ - ,~-+~-a~ o- 1 h k~ . -~- nY - "~ 3 ~o i n S C t) ~ ~Eil Y i t'~ `t~' Ef` t z~ ~ OS- - ~r~ ~~.+~ ~ ~1 E C~ C~~ (y -- 2`Ia Datla.~ id Niece ~BT '' - SO ~ t~ TY c, 1,~3L 1''1 /n - S~eQUtGY YOC~ ~ / ., r,Jh:~c X17 ~r-c( - ~ F f- ~~" 7),n~,~ ,~tJ~G~E(, !'c~nn %- G.~Di/Gtr l - f - ~-~Cc~.Lcr~ I U t ,U:~t ~^ 11 L ,,~/ / Ivit' JET "" ~ lD~ L`t[~(A '- ~~~ O~l~r1 KQ~T ~/rhP /~1i~~2/, ~~a r i(.~,n I- SC ~ - `~D ~R1ed - /~ (,f~IlQr tt~fr T~NInQ 1t~~C~l r pcn S 1 rf / t /~G is ~/a- ~~%/4rL c~ ~ Aec.2 -i`xv~r, +&~~tc 1~ ~ ,Asti- v; /CP ~ ~ ~ r l Cv ~- i CERTFY t11tDElt PBtN.IY aF PER.NJRY TiiAT'r1E ABOVE ti6COND 0 COPY CORRECT AND OOe01.ErE TO T1E at"a8T Of YY IOiOYM,~ /110 BEI.~ aeNr m~ ~.l7 i a ~ ~ o~rE /~ Q eox: / l~/ / ~ 61Me nepw~~ ^ Jdn! awr d ab d~Pdit 6aoc NOTE: Atadl addi8onal 8'/=' x 11" sheet(s) if rletxssary or use duplicates of title page of form. The Depatbwit is aul~oriaed by k1r112 U.S.G. §105 (c~(C)p), b regiie dlldoaue d Social Seoudly rrrnberr h cameclfon wih admHgednp ebb tax 4as. The DeparYnent uses the Sadal Searcy ruriber b kbnlTy the decederd and peraond repreeenbivea d M eltab. The CamarareaNh may also use ffie intamretoe h er~ga 41 tut Miamietion agreements wth Federal and bcal arAraMies. The stab law the CammarrselfPs from oartldenAel taz Momrafan br dikriel' .~i9~; ~i~~~ ~f~ ~v.4ss Ex SAFE DEPOSIT BOX ~NVENTdRY ~ ~ °f 3 /J /o ._' 1~•~ r,~.~~ .OQ .UG ;.~~ t~ '- 9 ~ a~ ~OG ~~ INSTRUCTIQNS (t) cash:, Report total only. (2) Stocks: List ~ delad every common a preferred oertlfica6e. warrant or otlrer riphls trorsrd in box. Socks are >b be designated by name of cortrparg4 oertifirabe nur+bar, dabs of oertlticaAa~ Wane fo wtid~ stodgy is registered, and nuni~er d streres and doss of stocdc. (3) ObUgatiotrs of U.t3. Gorerrumrrt Number of items, date of issue, face vakre, Hanes in which reg~ned aid hips of OMrrraship, i.e., jointly held, payable on death, ebc. {4) Bonds: Designate by rrarre, amamt, aerial nunber, ar attrer deai8rratlon. (asset sonde) (5) Bank and t3avin~ and Loan Passbooks: 3tabe Herne of de fwaibor, nrarrber of bode, leaf dale appeairg in book, rrerrre of bank ad branch. and . (B) Jewelryr, Cokrs, Stamps. Manrrscrtpts. etc: Last and desaibe ar fully as poss~le. (7J Deeds. Mortgages. Crnr+snt hrsurance Polkdss or otbsr evidences d IndeWedrras: List and desaibe as fWy as possible. (6) Ail other eonbnta. (8) Rstnrrn completed form to: DEPAR711AB~T OF REVENUE rANCE TAX DIVISION DEPT 26067D1 . ttNiW38URG, PY11712&0®01 ITEM NO. tTibtl DESCRIPTION b~ - n ~ a ~Dar~ ,- i _ ~ vaGuQ ,e~ /p coin ~' / . Cp / ~ 1 • a~ ~9y3' .S?~ /9.S-7 ~'t~o© /9.S"~ ' •.Sa r ~ •,S?~ /~~ ~- ' ~ / ' ao /Scams ~'~!•oo /q~ alt 1')d ' v - '!•~D jg(.a4 ' ~o~_c9p ! 9~7 ' ~ ~oc~ /ylp17 • /~ /`~ r~z,r,~ roils 1 ~ ~ ~i .s- t ~~ ~ %~~, ~cGSe.12 f ~~ n~ - i S - c3 f~ Ca 1c~ r9 84 1 e ~a S - ~ ~``"~ ~ ~, a o 957 •7a /9~' 8' J • /a /sS"9 ' `I. ~~ /9~ e j o 9~ ~ /gC~a- ~tr° .~~~~ - •ao /93C. ' = 3d 193? ~ '.l~.l 93 $ ~ .7a l~ ~o~ :7~ I4N~- ~ /• ~c Iy~l3 1• ao 19~~1' go ~~~15' I~~[:u. ~lrn~s - •/a /g/7~ ,iC l9a3 ~ :~te ~9ay ',io ~9~~,' .IZ i9 •~G t93(~ ' ~ . ~D t9~~3,' .~~ /ti~y~ ~ , SG /9~f ~: !• ab i Qua ' I• ~~ 193' •av t catTtFY uN°aIt Pt~IALTY OF PHi:J11R1- THAT TIC AIlO'VE RECORD a COPY OF coRRECT AID coMPl.aTta To TIE ear aF tnltr KNOMILEDOE AND BH.I~ sroNan,r~ 'inlli ~i~~~a Ct,J'/Q LQ~ i31 L ~x .r^~r ~-,~ ~ cr~ac eox: ~~(~+ I~7rtlt~~~e ~' ~I r ier- ~12~ . j( ~) ~ t~l NOTE: Attach additional 8'~' x 11' sheet(s) if rtscessary or use duplicates of this papa of form. The Deper6rrent is auiia¢ed by 10x4 42 U.S.C. §~05 (r~(CXq, b raglie rAadoaure of Sodel Beatty rsarbers in oarrrecton wlh adrrtriebrig stsbe tax laws. They Deprrtnent uses eie Sodas Sewty nuriber ~ Y tre decederi end peraorral represeriatvea of tie sews. The CommarweeMlr may sleo rare the irfomreion in errohenps d tmc inbnrnl'ion agreertbrds wilt Federal and focal autroriies. the stale law tie CarmronweeMr's ban cadiderriellert Yrfoarnlor- for alficW 9 t~ ~~ ~~. r y~cl~) page~of ceG~ nFp[~SIT BOX INVENTORY #~,~ ~a •~ / •0~ Sb ~9~ Sad REV~4tlh r.7C Vr1^ r r ~.^ . ~. ~ ... -- - - -- - INSTRUCTIONS ~,) cash: Report ktlal «rr. _ _ ~ (2, aer~la, name to which slodt rep~0ered, and d shares arWsbck name of aanparry, oerdRceb m~nber (3j Oblips~iorrs of U.S. tiorernrrwnt Wtunber of same, de6e of i6sue, face vakre, names in which regh~fered and type d ownership. i.e., jointly held. payable on death, etc. (~ Bonds: Designate by trance, amount. aerial number, or otlher desigrratlon. (Bearer Bonds) (~ Bank and Sa~krps and Loan Paasbooits: Stale rmrrre of deposibr, rrrariber of book, iaat dale appearhg in book, name of bank and branch. and balance. (~ JAY. cis. SfarrrPs+ MarMUrxlPls+ a1c List and destxibe as fusty as posss>fe. m oeeda, sAortpagss, cr.rene tn:tuartcs PoBcl.e or oAFrsr wldertoas of IndabMdrta~: List and describe as first' as possible. cal ,w oq+sr corrlsr~. pj fi,shan aotrrplead form to: Ota~r>vlexr of fiFVerota` artietralica v-u nlvlelorl DEPT. xeoeot ttnlac, w-n,zaoeo, ~+ llo. rrea oESCrePrton ~U%Gk~2/S - ~ d BOrnx inS ~Li /c /CAS' •~ I9lg ,GS /Sao , /d /~a~ I`f~ r~ tl /~' ace' ~ ~b'~ 1, 7 ` = a~ /~a~' ' . ao /9a9 ' . /o /5~3 ' 3S I93S' ' . 35 /'9 3 to ' ,aC 4 7 ' • t e 4nd a ~1 S ~n~ ~e//cQ' nn,c~s lPal/ bF ~n/li~f?s " ~-a~- ~nr~;•e3 Jul XCGr' / ¢ J~t3~ ~ 3yE /9~( /4~f/ ' a ~ /9~~ i ~ l4uy 3 ~ 1yyS - ~~ /7~L 1 ~ / 9 ~7 198 /d J / ~' / 9S'a / ¢,'/9S/ 3 ¢ ' /4s~ ~~• ~~ s¢ 3~ /9SZo ~4 ~~? /~~ 1~~~ .~~ > 1 S' 3 W mat n i e - 5?~ o~n u~lu~-~• .~' t r~rtFr ueaoel ReUL7Y of rexttatr 711A7'nlE JIaDYE tis~ is corx~cr win oorw.>=~ to ~ seer of err aloMS.eooE J11O eeaEF afAFE d ~ ~ ~ ~ d ~. +..-- Q1Sfb~e /fir fCt _ _ ,-~/ S r / ,~nC~ /~/12~ `' / ~,~r on,E ~ ~ ~ ~O ~ ~ i ~ ~~ K y ryw A.vn.r~. ^ Jour o..rr a.~. d~ eooc NOTE: Attach additiontd 8'/s' x 11' sheet(s) H necessary or use dupes of thbs pstpe of form. The DeperYrtarrt is aultaiaed by law, 42 U.S.C. §105 (cj(~(C)p), b regiie diecbpre of Social Seaasy rrmbeR ~ oota~erion wsh adsidaiedrg afee lax leae. The Depertrnet~t uses are Social Seasay camber b kienafy the deoedart and pasaui repreeenhtlres al ab ealele. Ths CarmgreaeeMt may also rme are t+iatneaer- in aadrenae of ~ iraneaan apeenet~ls wAt Fedxd and k~l auaxrsks. The ahle law e,e Carrrnaareelf~'s from car~Adentlel tax irbnnafon ibr oakiel ~ o ~ ~ ~ ~ 4. :~ `~' ~ ~ ~y `~ ~ `~ ~ W ~~. ~`` ~~ ° ~ ~ ~ a~ x ~ ~ a x ~ ~ ~ ~ w ~ ~ ~ c ~ ~ m ~ '~'~' `~ ° ~ o u, „- m -- u- ~.l ri o m ~ ~ ~~ ~ ~ ~- oa ~ ~' ~.' °~ ~~ ~_ ~; ~ = s~, ~S ~Z ~~ ~~~~ o~ ~~~ a -~ ~I ~~ ~~ ~~ ~~ ~o i i v x v c~' ~. ~. ~_ s- ~~ 0 ~ M&T Bank May 12, 2009 Sara J Raffensperger 34 N Old Stonehouse Rd Carlisle PA 17013-9773 l!tE: M&T Home Equity Line of Credit Accoant Number: 12044452674734998 Dear Sara J Raffensperger: Thank you for your request for information regarding the account listed above. The information you requested is as follows: Current Unpaid Balance: $17,547.30 Interest Accrued through 05/22/2009: $ 61.47 Insurance Accrued through 05/22/2009: $ .00 Early Termination Fees: $ .00 Closing Fees: $ .00 Total Payoff Amount: $17,608.77 Please note that the payoff amount listed above is accurate through 05/22/2009. At your request, no additional advances will be allowed to post to your account to ensure the accuracy of this payoff amount. Interest will accrue at a rate of $1.56 per day between 05/22/2009 and 6/10/2009. Final payments received between these dates must include the appropriate interest payment. Also note that these figures are subject to final verification by M&T Bank. The payoff amount may need to be adjusted if any activity occurs on the account prior to our processing of the final payment. In order to process your Home Equity Line of Credit payoff as quickly as possible, please mail your payment to: M&T Bank Attn: Home Equity Servicing Department 499 Mitchell Street Millsboro, DE 19966 Please note that in order to close your account, we must receive written notification of your intent to close (attached). A discharge of mortgage will not be completed until your account is paid in full. If you have a change in plans or wish to discuss possible options other than closing this line, we encourage you to call our Home Equity Specialists at i-888-524-2000. Sincerely, ~ ~% " Kent Taylor M&T Telephone Banking Center d A/otet Piat~ Wig ~ i1/relrewJeskrrr~, PA J 7055 Pbsrr N7=?6!i FU HOME Michatt J. Ma/pe~i, Owner Jeremy J. SJuntzer, Funeral Director STATEMENT OF TTi~~1E1tAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that: are required. ff we are required bylaw or by a cemetery or crearatory to use any items, we will explain the reason in writing below. If you selected a funeral that may require embalming, such as a funeral viewing, you may have to pay for embalming. You do not'have to'pay far embalm- ing you did not approve if you selected arrangements such as direct cremation or immediate burial. If we charged far embalming, we wilt explain why below:. For. the Service of ~ c , ? Die of lleath . ; f Name Address City State A. CHARGE F(I~ SF.BVIC>ES SEfEGTID: Other cfoching 1. PR©FESSIONAL SRNIGES Services of Funeral DirectorlStaff ....... S .. ~ Cremation um :.:..:.. . ...:.:.... $ ' Embalmetg ..................... $ _ ~ a • (Descnptton) Other preparation of body OTtIER $ _ $ " e SiIB-TOTAL OF P$OFFSS[ONAL SEHi-iCBS ..........A1 $ TOTAL ILSE SELECTED .................B $ ~. •-, ° G SPECIAL (~IARGES: 2. FACII1TlES AND SIItVICES Use of facilities and services for Fortivandirg of remains to v+~'ro$ (Visiratiariwlrake) ........ _ S ~ ,. 1 (Fumerai Home) $ Ilse of fadlities and services Receiving of remains from for funeral ceremony ............ $ $ Use of faalities nerd services for " (Funeral Home) Memorial Service .......:....... $ , -. ; :k Imrtrediate 13mial ......:.......... $ Ilse of equipment and services Direct Cremation ...............:. ~ for graveside service ........... $ . ,-, . ~ Other use of facilities SU$-TOTAL OF SPECIAL (MASGFS ...::.. . .....:..C $ II, GASH ADVA1~iCED ..........:...................$ Openir>g Grave .:....' _...:$ ...,.. SU&TOTAL OF ..:........A2 $ .:•:. € Cennetery' Equipment ...:......:... $ 3. AUTOMOTIVE EQUIPMINr Lot and Deed .. ; ......:.... : ... $ Vehicle to transfer remains to Funeral Home Newspaper NOO°I ........... $ , "--=' '" Local ............. . $ : ~., . 9 NeavspraPer Diotiees-0rrt-of-to~avn ....:. $ Hearse (Casket Coach) Telephone. & Tetegr-ams .:.......... $ Local .................. ..:.... $ Airfare ............. . ......:.. . $ Limousine CksgylMass Offering ....:..:...... $ Local ...................... Family car .. Gerufied fopies of the Deadt _ ... _ ... $ ~ Local .....---: ...........:... $ Certificate ...:.:...:........:... $ . Flower car or floral disposition Pohoe Fsant ......... . ..........$ Local :.......... . . . .. :...... $ Flowers ............... $ Lead tar/clergy car _ vault serve (:barge .............. $ ° Local ........ ....... .....:$ ~L v,.s .,,s::~~c ~'-. > ~ a ~ $ -.~;;, Car far pallbearers $ Local ........... ...... ..$ $ Curt of town tramportanor- .......... $ $ ^' $ • SUB-TOTAL OF AITfOMOTIYE ,,:: .:.......~li $ ~ SUB-TOTAL OF ADVAN(~S ........... ..... r :D $ -~..~... .... . ~ m obtammg. TOTAL OF F~OFESSIONAL SERVIE:ES, ~ ~ ~h' m~ikad-rip) . FACQlJ7ES AND AUbMOri1VE EQUIPMEKP ............................... . A $ "'" 13. CHARGE FOR b~RCHANDISE SQEClF1r SU>~I(ARY OF iSARGES ,,_ Casket.... .... ...:...:...$ A: Professional Services, Paal6iies atxl' (Description) .:, -, _ q ~` and Auttarttotive CKhet Receptacle .. ...... $ B. ~ _ $ !~ .... / C. SpecYat Chatges ...... ..._ , $ :, j • ' ~ • € ,..' ~ ."-, l~ D. Gash Advances $ ,.:.~- .........._ .. r ,~ Outer burial cmuainer ............. S _. TOTAL OF ALL SECTIONS ...... ':.........' . - - - . - 5= t.~ =L~-.:-r~„~s : PAID AT TJME OF (Bt P$tOS TO Adtrwwledgernettt cards .: ::......... $ BAIANC.E DLIE :......... , _F Re$15tef bOOk(S) ....... .......... $ .:. 1 `- )REASONI FO$. EIbBAI(~i J. Stewart Hardy, Ph_D. SENIOR PASTOR John H. Brock M.Div. ASSOCIATE PASTOR May 15, 2009 Mrs. Elizabeth Hinkle 97 Lee Ann Court Enola, PA 17025-1937 t ~~ ~~~ ~i 0 TRINITY Evangelical Lutheran Church INVOICE Charges for the Sara Raffensperger Funeral Meal: Total cost of meal Total amount due $294.32 $294.32 Nancy R Easton. M.Div. ASSISTANT PASTOR Guy S. Edmiston. J r., D.D. SUI'I'ORT PASTOR IN RESIDENCE If you have any questions about this invoice, please feel free to call me at the church. Thank you, ~~ Paul Hensel Financial Administrator 2000 Chestnut Street, Camp Hill, Pennsylvania 17011 PHONE 717.737.8635 • FAx 717.730.9297 • E-MAZE trinluth@trinitycamphill.org • wEesITE wwwtrinitycamphill.org