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Home My WebLink About01-20-10J 1505607120 RE1 /-1500 EX (Oti-05) OFFICIAL USE ONLY PADepartmentofRevenue County Code near File Number BureauoflndividualTaxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 12 8 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 01. 2008 03 05 1921 Decedent'sLastName Suffix DecedenYsFirstName MI SMITH FRANCES G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social SecurityNumber FILL IN APPROPRIATE OVALS BELOW X~ 1. Original Return 4. Limited Estate X^ g. Decedent Died Testate (Attach Copyaf WIII) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum ~ 3, Remainder Retum (date of death prior to 12-13-82) 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (date of tleath after 12-12-92) 7, Decedent Maintained a Living Trust Q 8. Total Number of Safe De osit Boxes (Attach Copy of Trust) p 9. Litigation Proceeds Received ~ 1 p, Spousal Povertyy Credit (date or death 11. Election to tax under Sec. 9113 A between 12-31-91 and 1-1-95) ~ (Attach Sch. O) ( ) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number n~ SUZANNE H. GRIEST ESO. 717 R4(g"~ Rf2R~ '~~ Firm Name (If Applicable) GRIEST, HIMES, HERROLD, First line of address 129 EAST MARKET STREET Second line of address City or Post Office YORK SCHAUMANN, FER State 21P Code PA 17401 Correspondent'se-mail address: SgrieSt~ghhS18W.C0111 `-_~ C~ REGISTER OF:iI4LC9USE pittLY r---- - . . i-: ~ Fv i'7 O ,. ,~;~ ~ ~ - .:'s ~ _1::1 c~ --~ (~ DATE FILED _..~ z _~ `~J _.7 :._; rt ~..., -..4 ) Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, tt is true, correct and complete. D daration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNAT RE OF PERSON RE NSI LE R FILI DATE Laura J. Bartlett /~- ~ - ~~ 120 Vyijfl Horse Court, Monro~¢T 06468 129 E~~qE Market Street, York, PA 17401 Suzanne H. Griest Esq. Side 1 1505607120 1505607120 b J 1505607220 REV-1500 EX oecedenes Name: Frances G. S m i t h RECAPITULATION 1. Real Estate (Schedule A) ........................................................................................... 1. 2. Stocks and Bonds (Schedule B) ................................................................................. 2. Decedent's Social Security N umber 3. Closely Held Corporation,PartnershiporSole-Proprietorship(ScheduleC) .............. 3. 4. Mortgages&NotesReceivable(ScheduleD) ............................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .................... 5. 14 9 , 9 5 7 . 5 9 6. Jointly Owned Property(Schedule F) ~ SeparateBillingRequested .............. 6. 7. Inter-VivosTransfers & Miscellaneous Non-Probate Property (Schedule G) [~ SeparateBillingRequested .............. 7, 1 1 1, 9 0 7. 6 1 8. Total Gross Assets (total Lines 1-7) ........................................................................ 8, 2 6 1, 8 6 5. 2 0 9. Funeral.Expenses&AdministrativeCosts(ScheduleH) ............................................ 9. 2 2, 6 2 7$ 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................... 10. 1, 0 6 0 . 9 5 11. Total Deductions (total Lines 9& 10) .........................................:............................. 1 ~, 2 3, 6 8 8. 8 1 12. Net Value of Estate (Line 8 minus Line 11) .............................................................. 12, 2 3 8 , 17 6 . 3 9 13. Charitable and Governmental Bequests/Sec9113Trustsforwhich an election to tax has not been made (Schedule J) .................................................... 13, 6 , 3 13.4 4 14. Net Value Sub ect to Tax Line 12 minus Line 13 ........................ 1 ( ) ........................... 1a. 231, 862.95 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. AmountofLinel4taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X .00 0. 0 0 15• 0. 0 0 16. Amount of Line14taxable atiineairatex .045 2 2 5, 5 4 9.51 16• 10 , 14 9. 7 3 17. AmountofLine14taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable atcoliateralrateX .15 6, 313.4 4 18• 9 4 7. 0 2 19. Tax Due ..................................................................................................................... 19. 1 1. 0 9 6. 7 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1285 DECEDENT'S NAME Frances G. Smith STREET ADDRESS 54 Bullock Circle CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 11,096.75 2. Credits/Payments A. Spousal PovertyCredit B. PriorPayments 10 , 0 0 0.0 0 C. Discount 526.32 3. Total Credits (A + B +C) Interest/Pena Ityifa ppiicabie (2) 10, 526.32 D. Interest E. Penalty Total lnterest/Penalty(D+E) (3) 4, If line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Llne 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enterthe difference. This is the TAX DUE. (5) 570.43 A, Entertheinterestonthetaxdue. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) rJ 7 ~ . 43 Make Check Payable to: REGISTER OF WILLS, AGENT rR{y~~Y, ~..~K ;f4 ^=~[~~} a fi~ ~;.~~'~ Nib ~ ~ ~ "'~: M1HM~4•^Y'1: ~~ ~K~]A ~ 'w.., .4~: ~ ~v 4 .'i ~ne~~Yfa$~S~Y4$!~ 1FG+R4FlWT.WYK `~3. ~~~1'iI~~YCII-°{1kr*~ ~ ~ " }~5ut ` 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 useorincomeofthepropertytrahsferred :......................................:.............................................. ^ b, retain the rightto designate who shall use the property transferred or its income :......................................... ^ c. retainareversionaryinterest;or ..................................................................................................................... d. receive the promiseforlifeofeitherpayments,benefitsorcare? .................................................................. ^ 2. if death occun'ed after December 12, 1982, did decedent transfer property within one year of death without receivingadequateconsideration? .......................................................................................................................... ^ ^ 3. Did decedentown an "intrust for" or payable upon death bank account orsecurityat his or her death? ............... ^ ^ 4. DiddecedentownanlndividualRetirementAccount,annuity,orothernon-probatepropertywhich containsabeneficiarydesignation? ........................................................................................................................ ^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. y ,,.,1~t,.zYr:~.wt:~ ~.. , 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)]. Fordates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to orfor the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does notexemot 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 childtwenty-one years of age or younger at death to or forthe 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 netvalue 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 orfor the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under5ection 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev1508 EX+ (6-98) COMMONWEALTHOFPENNSYLVANIA INHERfTANCETAXRETURN RESIDENTDECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Smith, Frances G. 21-08-1285 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolMlyrowned with the rlgM of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 AARP Insurance Refund 147.50 2 AARP Member Refund 13.48 3 Cumberland Crossings -estimated amount due for interest in cottage pursuant to 144,288.00 contract 4 Donegal Insurance -Refund 85.00 5 Internal Revenue Service -Tax Refund 100.00 6 Sovereign Bank- decedent's checking account #170102561 5.302.82 7 UGI Refund 20.79 TOTAL (Also enter on Line 5, Recapitulation) I 149,957.59 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA•1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6.98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONW EALTNOf PENNSriVANIA MHERITANCETAXRETURN RESIDENTDECEOENT ESTATE OF (FILE NUMBER Smith, Frances G. 21.08-12$5 This schedule rtwsl be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV•1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION IF APPLICABLE) TAXABLE VALUE 1 Ameriprise 111,907.61 111,907.61 TOTAL (Also enter on Line 7, Recapitulation) ~ 111,907.61 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software onlyThe Lackner Group, Inc. Form PA-1500 Schedule G (Rev.6-98) REV-1151 EX+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scHEOV~E H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smith, Frances G. 21-08-1285 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative'sCom m fissions Social Security Number(s) / EIN Number of Personal Representative(s): StreetAddress City State Zip Year(s) Commission paid 2. Attorney's Fees Griest, Himes, Herrold, Schaumann, Ferro LLP 3, Family Exemption: (if decedent's address is not the same as Gaimant's, attach explanation) Claimant StreetAddress City State Zip Relationship ofClaimantto Decedent 4. ProbateFees See continuation schedule{s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 5,197.38 4,500.00 356.00 7. OtherAdministrativeGosts 12,574.48 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 22,627.86 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smith, Frances G. 21-08-1285 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Auer Cremation Services of PA 2.665.12 2 Back Woods Florist 37.10 3 Baughman Memorial Works -headstone engraving 277.00 4 Bonnie Whittier -Minister for funeral 250.00 5 Cremer Flowers 568.16 6 Emig Funeral Home 350.00 T Kahunya Wario -travel assistance to funeral 250.00 8 Red Run Cemetary Association -burial 300.00 9 St. Paul's RR Church -funeral luncheon 500.00 H-A Subtotal 5,197.38 Probate Fees 10 Register of Wills Other Administrative Costs 11 American Red Ball -moving expense 356.00 H-B4 subtotal 356.00 4,804.49 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Smith, Frances G. 21-08-1285 ______ ITEM NUMBER DESCRIPTION AMOUNT 12 Anita Smith -travel expenses to help clean out cottage 13 Applebee's -post funeral family dinner 14 Clerk of Orphans' Court -family settlement agreement 15 Cumberland Crossings -December maintenance 16 Cumberland Crossings -fee to stay and clean out cottage 17 Cumberland Crossings -final maintenance 18 Cumberland Law Journal -advertising of estate 19 Elinor Smally gift 20 Laura J. Bartlett -reimbursement for expenses 21 Norman Rodger -travel expenses to help clean out cottage 22 Register of Wilis -filing fee for inventory & inheritance tax return 23 St. Pau's RR Church -strawberry festival donation 24 The Sentinel -advertising of estate 25 Trash hauling 26 Traveling expenses for executrix in order to administer estate 27 UPS -shipping fee for specific bequests 108.00 230.06 30.00 1,297.17 100.00 710.05 75.00 219.90 2,000.00 407.00 20.00 265.00 134.68 100.00 1,549.88 523.25 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Smith, Frances G. 21-08-1285 ITEM NUMBER DESCRIPTION AMOUNT H-B7 Subtotal 12,574.48 Copyright (c) 2002 form software onlyThe Lackner Group, Inc. Form PA-1500 Schedule H (Rev.6-98) Rev-1512 EX+ (6.98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTHOFPENNSYLUANIA WHERRANCETAXRETIIRN RESIDENTDECEDENT FILE NUMBER ESTATE OF Smith, Frances G. 21-08-1285 Include unrelmbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 Checks cleared after date of_ death 246.18 2 Family CFO -2008 Tax Return Preparation 185.00 96.85 3 Guideposts 4 PA Department of Revenue -tax payment 480.00 5 Pennsylvania Bureau of Individual Taxes -tax payment 8.96 6 Reader's Digest 43.96 TOTAL {Also enter on Line 10, Recapitulation) I 1,060.95 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software onlyThe Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev.6-98) REV-1513 EX+ (9-0Oj COMMONWEALTH OF PENNSYLVANIA IN RES DENT DECEDENT N SCHEDULE J BENEFICIARIES ESTATE OF Smith, Frances G. NAME AND ADDRESS OF NUMBER PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [includeoutrightspousal I. distributions, and transfe under Sec. 9116(a)(1.2)] Laura J. Bartlett 120 Wild Horse Court Monroe, CT 06468 Simon W. Kahunya Box 2816 Nakuru Kenya, East Afric Anita K. Smith 1700 West Huron Street Chicago, iL 60622 11. FILE NUMBER 21-08-1285 RELATIONSHIP TO SHARE OF ESTATE AMOI DECEDENT - (Words) Daughter Friend Daughter 45% of residuary estate 5% of residuary estate 45% of residuary estate I I Total Enterdollar amounts fordistribuGons shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 St. Paul's Red Run United Church of Christ TATAI OF PART II -ENTER TOTAL NON-TAXABLE. DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET f OF ESTATE ($$$) 6,313.44 R Form YA-7,UU Jc:nCUUro .+ ~ncv. ~-o~~ Copyright (c) 2002 form software onlyThe Lackner Group, Inc. T . LAST WILL AND TESTAMENT OF FRANCES G. SMITH I, FRANCES G. SMITH, as resident of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking, annulling and making void any and all Wills by me at any time heretofore made. ITEM 1. I direct the payment of the expenses of my last illness and funeral from my estate as soon after my death as conveniently maybe done. ITEM 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatever kind and wheresoever situate, which I may own or have the right to dispose of at the time of my death, as follows: a. I give, devise and bequeath five (5%) percent of this my residuary estate unto ST. PAUL'S "RED RUN" UNITED CHURCH OF CHRIST, absolutely. This bequest is unrestricted and the Board of Trustees. or other governing body may use and expend the same for the benefit of such organization in any manner it deems appropriate. ~~ :TEST, ATAtes, Hexxoco, SCNAUAIANN ur ~~~11~ ~~rG+r ~' w^ ATTORNEYS AT LAW 129 EAST Iv~ARKE1'$TREEf FRANCES G. SMIT YORK, PENNSriYANIA 17401 TE~rlloue (717) 846-8856 1 't b. I give, devise and bequeath five (5%) percent of this my residuary estate unto REVEREND SIMON W. KAHUNYA of Nakuru, Kenya, East Africa, to be his absolutely. c. I give, devise and bequeath the remaining ninety (90%) percent of this my residuary estate unto my daughters, ANITA K. SMITH and LAURA J. BARTLETT, or the survivor of them, in equal shares. ITEM 4: I direct that no Trustee, Executor or other fiduciary named, nominated or appointed in this, my Last Will and Testament, shall be required to post bond or give any security of any type for any purpose whatsoever, any law or rule of Court of the Commonwealth of Pennsylvania'or any other jurisdiction to the contrary notwithstanding. ITEM 5: I direct that any and all inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. ITEM 6: I hereby nominate, constitute and appoint my daughter, LAURA J. :IESf. HiM64. HRRROI.D. ScxAUtAANN LIJ ATTORNEYS AT LAW I2S EAST MARKET STREET YORK, PENN$Yi.VAMA 17401 TELET'HONE (717) 64(:8856 BARTLETT, Executrix of this my Last Will and Testament. In the even of renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate ANITA K. SMITH Alternate Executrix of this., my Last Will and Testament. -~Jif.241-~J FRANCES G. SMITH 2 IN WITNESS WHEREOF, I, FRANCES G. SMITH, the above-named, have to this, my Last Will and Testament, signed my name at the bottom of pages one through two for the purposes of identification and at the end hereof, on page three, have set my ~lj ~ day of , 2007. hand and seal this as witnesses hereto. r' TJ> ~ ,~°~~~rn,~•~t~ (SEAL) FRANCES G. SMITH Signed, sealed, published and declared by FRANCES G. SMITH, the above- named Testatrix, as and for her Last Will and Testament, in the presence of we who, in her presence and in the presence of each other, have at her request subscribed our names a~ ~ p~ :IF3~, HIMES, HERXOLO, SCNAUMANN LLP ATIURNEYS AT LAW 129 EAST MAXXET $TItEET YOXX, PENNSYLVANIA 17401 7'¢ErxoNE (717) 8468856 3 COMMONWELATH OF PENNSYLVANIA : COUNTY OF YORK SS: We, FRANCES G. SMITH, i~ ~~'l/Gp and i1ETI. HIM6S. HERROLD, SpiAUMANN I.L ATTORNEYS AT LAW 129 EAST MARKET STREET PORK, PENNSriYANU 1741 TdEPNONE (7l7) 846-8856 ~a~Pi>~ Z• ,~Cy~j, the Testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she signed willingly or willingly directed another to sign for her, that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses, and that, to the best of their knowledge, the Testatrix was at that time eighteen (18) yeaxs of age, of sound mind, and under no constraint or undue influence. Subscribed, sworn to, and acknowledged before me by FRANCES G. SMITH, the ' and subscribed and sworn to before me by the aforenamed witnesses, this ~i~ Testatrix, day of , 2007. N A Y UBLIC COMMONWEALTH OF PBNNSYI_VANIA NOTARfAI SEAL KELLY A. LAUER, Notary Public r} City of York, York County My Commission Expires February 2, 2010 ~~~y~~ ,h FRANCES G. SMI'T'H, Testatrix > ° ~ ~ d' ~ o . u~ rn' C %. 8 ° q . • ~ ~ ~n ~ ~ m N '~ w w w w. .O . . ~ ~, N ~, ~ ~ Y C . o a . o, ~• ~ ~ ~ ~ `° ~ ..a 4 LC i~a' W Z' ~ ~ . ., ~ .~ ~~ R'N N N ' O GI . O O N w y I'. 'C ro dR _ ~ . ~ ~ qQ a ~ N . Z .. Y: C N .. i. . O u' ~ ~ ~ ' E4~ Y3 G O ~ 0~~ C~ N ~~ TL ~ d ~41 ~ O Cpl H m tcC~~ ~~pp d ~ ~ '' 3 O . .L2 ~ ~ ' ui ~+ i. ., a L m .. cy = .V> > .~ S. 8 ~ . ~ ~ .'~ R. a c V O g~ N ~ av o ~ ~ ~3 ~ . ~ 2. N .H C ¢l ~ C J~, O M y~ . 'O ~ N uS~ ° '?y ~~ t{'di ~ ue ' o ° '' E$~ ~~ Q 8Z S' W ~~ rr~~ o N 0 75 d ro ~ ~~ o -. C M N .C. ~ d Q t~V C1 ~. ~ ~ U C N C Y~.. ~j .~. ry Y CO ,~ ~ to a ~ aoi . . m t° ~ ~ i• ~. 3m~.. ~$ ~ 3 ~ ~~ off ~~ ~ _~ Q ~. a~ ~ v 4 C7 ~ ~ ~ ~ ~ ~ c ~ ~ d p [L W d u~i ' ~ Li. ~ LL. ~ ~p W ~ m ~ ~ ~ G~ ~y ~ N ~ t7' U y ~ ~ ~ ~ 01 pp~~, db~: ~ icy, N o M ~ , • v~ o cD .. t"I O N b~A 4 ~~Sovereign Bank. page 3 of 3 STATEMENT OF ACCOUNTS page "I of 3 >SOVeI'el~]] BAIIk STATEMENT OF ACCOUNTS CU1v~BERLAND CROSSINGS A DIAKON LUTHERAN SENIOR LIVING COMMUNITY August,25; 200.9 Ms. Laura Bartlett -~ American Association of Advertising Agencies 405 Lexington Avenue New York NY 10174. Re. Refund for Frances Smith -Cottage #54 Dear Laura: ~~ I am writing in response to your email of August 24, requesting information about the amount of the refund which can be expected by the estate of Frances Smith. According to the terms of her contract with Cumberland Crossings, Mrs. Smith's estate will receive a refund of 90% of her entrance. The following are the particulars in this case: Refund Option 90% Entrance Fee $159,750.00 Improvements $ 570.00 . Total eligible for refund $160,320.00 When a new occupant takes possession of cottage #54 and pays his or her entrance fee in full, Diakon will issue a check for 90% of this amount. Refund amount $144,288.00 I will contact you as soon as I get a 10% deposit on the cottage. This is no guarantee of a move, but it is always a good sign that the cottage has found a new occupant. Please call me if you have any additional questions. I am at your service, Oliver hazano@diakon.org Oliver Hazan Marketing and Sales Director Cumberland Crossings Phone Line /Marketing Office 717.240.6013 Cell Phone 717.215.1730 Fax 717.243.2054 1 Longsdorf Way Carlisle, PA 17015 Phone 717.245.9941 Fax 717.240.6017 Toll Free 800.722.0267 www diakon.org