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HomeMy WebLinkAbout01-08-10 `~O "~ M F, " J ~ ~ ~+ (.~ r--- ~ ~ '~ ~ ~~ .~ ~ j ° ~ ~ ~ ~ ~~ J ' ~ ~ ~ ~ ~ ~ M ... ~ ~ _ ~~ /~ ~ ---- ~~ ~, p ~ r~ y \` 0 ~/ ~ i Q '_ h' . ~ N m '0 I '; ~~ a' ,~'`;. ~ ~; ~~ L? ~ ~;' `~~.,7 I4 ~i I~ E ~' ~. i'~ ~s ~, s 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 2aosol 21 09 01088 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198-28-2073 10/24/2009 01 /28/1913 Decedent's Last Name Suffix Decedent's First Name MI Seitz Marlin H (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 IN APPROPRIATE OVALS BELOW +•;: 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust U . 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 TO: Name Daytime Telephone Number Vernon M. Martin, Jr. (717) 766-8156 Firm Name (If Applicable) r.,~ REGISTER ~/YILL.S USELY ,...~ t~ o ~` ~ '-7 ~ ~ C._. rr t '~ First line of address ' ~- ~-- 12 Summit Dr. ~ "~' r~~ _ ~~ ,_„ .,~ ~ Second line of address ~ ' `~'" '' _ ,. , .'~` ~ ~."'~ rv • _ i" T 1 ATE FILED ... `''~ t City or Post Office State..... ZIP Code. _. -,-~ Dillsburg PA 17019 Correspondent's a-mail address: vern@VmartlnCpa.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than perso al representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RET RN DATE ~-l- ~-~~ 2 01 /06/10 ADDRESS 12 Summit Dr., Dillsburg, PA 17019 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS Same PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 `~~~ V t 15056052059 J REV-1500 EX Decedent's Social Security Number Marlin H Seitz 198-28-2073 Decedent's Name: RECAPITULATION 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. 9 9 ( ) ............................. Mort a es & Notes Receivable Schedule D 4. 217.58 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 148,918.51 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. 149,136.09 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 15,435.76 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. ' 15,435.76 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 133,700.33 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 16 152 21 an election to tax has not been made (Schedule J) ........................ . . , 14. 1 ( ) ........................ Net Value Sub'ect to Tax Line 12 minus Line 13 14. 112,548.17 ___. TpX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 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 .0 45 112,548.17 16. 5, 064.67 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 5,064.67 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 L Side 2 ,;•~' 15056052059 1 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 01088 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Marlin H Seitz 198-28-2073 STREET ADDRESS 339 Messiah Circle STATE ZIP CITY pq 17055 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 5, 064.67 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 5,000.00 C. Discount 253.33 Total Credits (A + B + C) (2) 5, 253.33 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 188.56 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes ^ No 0 a. retain the use or income of the property transferred :.................................................................................... ...... ^ 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? ................................................................ ...... If death occurred after December 12, 1982, did decedent transfer property within one year of death 2 . 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 ....... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . 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 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. REV;1507 EX+ (1-97) ~, scwEDU~E ~r C COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER '`~^, f x,1..,1 ~. ~ . ~ C: l'".~. :Zr... ~,,. It T-.- ~ ~ ~' '~ ~ ~ Alt property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ ~ ~~ ~ ~ ~~ TOTAL (Also enter on line 4, Recapitulation) $ o'~- ~ 7 • ~ (If more space is needed, insert additional sheets of the same size) ' REV-1508 EX + (t-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY I-~ 5~~~ y FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH SE 1'M to O~(o7a0 ~'~-~~~ ~~~ ~ ,~-t- "l~~l ~ ~ U f~ ~., v. F l .a I ~,.~.~ ~ ;~ 3 . S L. I uv~ ~.~ ~ K ~~ ~~ ~'~ - ~ ~~~ 0, ~o~ ~~~ ~~~~ ~~~5 ~ ~. ~. ~. ~, ~I , ~~ ~ ~ r~ G.; P ~ ~ ~, ~~~ 3 ~f; os~ ~ . ~'~ ~ -~~ ~ a S, ~7 ~ eg,a~~ ~~~~i~~ ~ ~-(G~~~~b~~q~FS~~ C~' I L o ~r F- ` ~ f . F~ wr• ~ t~ rc (~ L~ t~ ~., ~ 2 ~. ~`~ t ~M E: ~.~~ TOTAL (Also enter on line 5, Recapitulation) a (If more space is needed, insert additional sheets of the same size) ~~ ~, ~~. ~ , ~q o . o© ~, ~S. 1 REV-1511 EX+ (10-06) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & 1\II.Irf71TAAl/'~C TAV QCTI IQAI ~n~i~ucTO eT~v~ rnCTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~'~ ~R S \` ~. ~-~ E.fi- ~~ ~ a ran C.~ ~^ ~, ~. l ~J p 7' ~, D ~7 C. ~,~~~~ S~- M rc: C-k~, R~ h~ c ~~, fa v- fG ~ J 1 C'~ ~ ~ ~ ~'' Q q 1 ~' 1 O `"Ckr ~~-- ~~-~~ ~~ ~r~ Pte- ~ ~~ C E ~t. "~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip ___ _.----___- --- Year(s) Commission Paid: _ 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip __. Relationship of Claimant to Decedent 4. Probate Fees ~ 7 ~ ~ ~ J 5. Accountant's Fees l ~~ca, .~ o 6. Tax Return Preparer's Fees 7. ~~ V E!t-~ w S F ~ G- C ~ -~ ~ c ~ ~ P ~,~ L ~ w ~~ .~ ~ u ~.~- 7 ~, ~ ~ Z5 , .S E ~~'~t i f~ E e_ TOTAL (Also enter on line 9, Recapitulation) $ ~ ~ ~ ~ ~~ ~ ~`' (If more space is needed, insert additional sheets of the same size) REV,1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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)] ~. CrC~t~ (~- 5~~~.~.. / ~ ~~ ~ (~ 3 ~ (~ ~ ~ ~ r~ IM , sC c~ ~.. ~ ~ ~.c ~ f~ ~. .~" ~ d %z N ~~ r~ 5~.~ ~~ ~ ~ v ~ ~~. E ~ '~ ~ 8 3 3 z J ~l, M R r~~ 7-~ ~ ~ ~ << ~~~ 2~.~ c1 ~ 1 ~ G- ~ ~ tzs ~ .~ ~ L ~, ~.t ~S 13 G 2 2 ~ , ~ `~ ,~ ~, I 3 . U G ~,~., ~.. (f ,~, ~7 i~ ~ ~ c`f ~-~ l~ C t~ 50 ~.c ~ ~` ~ ~ ~ ~- l f ~, 3 s` ~ ~- ~ . ~`=`' sue" ~. ~ ~. ~ ~ s ~ ,a ~. ~ ~'~~. r ~ ~ ~ ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV•1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~P ~ ~ I fib. ~''~ ~ ~ ~ ~ ~ ~ M ~ / TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Eastern•Mennonite Missions 53 W Brandt Blvd • PO Box 458 • Salunga PA 17538-0458 CHECK NO. SEIM10 MARLIN H. SEITZ ESTATE 0 5 4 3 8 3 54383 0911252758 Payout 5~..~i2~.~,.~- ~7,3~ 11/25/09 ' 31143.58 t 31143.58 0911252759 Payout ~°/14/09- (~o,~~ 11/25/09 ~ 34059.95 34059.95 0911252760 Payout ~('~S'~9 ~,~-~.c~~ 11/25/09 37925.78 37925.78 0911252761 Payout '~«~ M ~', 11/25/09: 10739.23 10739.23 3?`~,a (Acct: 001100-10-000) Check Date 11/25/09 Total 113868.54 EFORM 100472-0900 (8 ~"~ ~BA~ Your account was DEBITED for the following reason: ^ Check # posted on encoding error posted to incorrect account ® Closed account 5070099459 ^ Branch adjustment (branch name) ^ Service charge error ^ Other: Account Number File ID AMOUNT $ 4,474.93 5070099459 040 PNC Bank. National Association D i ESTATE OF MARLIN H SEITZ FOR BANK USE ONLY E 339 MESSIAH CIR Branch #/Dept. # Date B MECHANICSBURG, PA 17055-8620 I 0000112 11/23/2009 T Prepared By (PRINT Name) Authorized By DAVID R PLETCHER Customer's Advice of Charge Statement Date: Nov 25, 2009 Brethren in Christ Foundation PO Box 290 Grantham PA 17027 Mr. Marlin H. Seitz Deceased 12 Summit Dr Dillsburg PA 17019-9589 Account Number: 3505 Account Name: Mr. Marlin H. Seitz Account Type: TAP -Special Maturity Date: N/A Interest Rate: 2.47% Date Check # Type Amount 10/2/2009 Beginning Balance 26,302.78 10/31/2009 Interest 55.18 11 /25/2009 Interest 42.81 11/25/2009 2113 Withdrawal -26,400.77 Closing payout upon death .~1 „/ / ~ \\\ , 1 ~. ~ x ~s ~ Total Deposits: $0.00 Total Interest: $97.99 Unposted Interest: $0.00 Total Withdrawal: $26,400.77 Ending Balance: $0.00 C+~+cmcn+ I"lotc• I~In~i '~~". ~nno Innn.,+inr, rln+n• Cn., 7i1 ~nn~ Myers Funeral Home, Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 (717) 766-3421 Fax (717) 795-7291 A standard of excellence in Central Pennsylvania since 1910 Tuesday, October 27, 2009 Mrs. Ann Davis 2 Summit Drive Dillsburg, PA 17019 Dear Ann, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Marlin Hess Seitz SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED LESS: Credits granted LESS: Total Payments CURRENT BALANCE Credits Granted: $164.00 Early pay Discount $1,430.00 Package Price Discount If there are any questions or concerns that remain unanswered, please call me. Slncereiy ~~ $11,672.00 1,594.00 10,078.00 $0.00 HIUS.2t05 ILP.V i(~I/fl"`i LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15838888 Certification Number M1JS~143 REV 11/2006 TYPE r PRINT q4 PEfiL1ANENT BUCK qVK W h This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~~ ft(~,~I~ Q. ~ 1 v /~7 ~ 4 Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) ~tsr< <„ ~ ,,, ,,,o~p 1 Nartr d Oeceded (first, midde, most, soda) Marlin Hess Seitr 2. Sex Male 3. Social SerurMy Number 198 _ 28 _ 2073 4. Daw d Death ( daY Yew) ~c'tober 24, 2009 5. Ape (Last BiMday) tkraer 1 ar under 1 da s. Daw d Btnh Month, da . ) 7. ( and awe a ) Ba. Place d opar (C1rcM orr) 96 ~" ~` ~"` ~"'"` January 28, 1913 Fairview Township, Pa. "°`pqM~ °"'°` Yrs. kpadero ^ ER / Outpalies ^ DOA ^ f4ursirp Hans ^ Resdence ^other • Spac'dY. tb. County d Death &. City, Bono, Twp. d Death Bd. FaciMy Name Id na rleMMliork Par abeet and rxntDw) 9. Was Decedwq d Hispanic Origin4 No ^ Yes 10. Race: American Yrdian. Bwck, WtrMe, etc. Cumberland East Pennsboro Holy Spirit Hospital (qY~'~. (sv~ White Mexican, Puedo Rican, ak.) 11. Decedent's Usual Occ Knd d work d er most d We. Oo not smote reared 12. Was Oecederd ever in the 13. Deoeden's Edueagar (Specify ody hiptwst preda cortp lewd) 14. Masai SLAWS: Married Never Married t 5 Survivktq Spo up (q wile ive maiden name) Kira d Owner-~perator Knd d I a aid" U.S. Amid Forces? Ewmenwry / Secatdary (412) CoMepe -4 or 5+) ~ , , Widowed V~i~owec`~ . , g ^Yea -a 18. Decedents rYlaikrp Address Isuet, city /town, state, zip code) Decedent's pA old Decades 339 Messiah Circle ~~ va.sale tiwina t7c.~Yes,oecedeslivedin T,ep. Mechanicsburg, PA 17055 „D, ~,a„y Cumberland T0NR1el"p? ,7d ^ No, t)acerks Lived wlfwn AcYUaI LInMS d Cly r Boro 18. Fanrr'a Name (FksL middle, last, suqu) Johri 8. Seitz 'p" Mbn~~s Name (F"~' miaa.' 11idBr S1"'~1B) Elizabeth Hess 20a. Mgorrtras's Name (Type /Pmt) Ann Davis ZOb. MlortnartYs Maikrp Address (StreN, carte. ~~umm~~rive Dilisburg, PA 17019 21a. Megbd d Owposaion ^ CrertraMm ^ Donation 21D. Oaw d oiaposdion (Mongr, day, year) 21c. Place d (~~ d cenrmri aY a dhw Dom) 210. l.tx;atldn (CMy /town, aww, zp rnde) ^ Removal tram Saw ^ -ly: Wu Cremation a Dorwgon AWhorizad M.dlwlEx.nrnar/ z ^Yes^No 10-28-2009 Slate Hill Cemetery Camp Hill PA 17011 22a d furrral acanp a>~) 22b. license Number 22c. Name and Address d Fsdly - FD-012662-L Myers Funeral Home, inc. 37 East Main Street Mechanicsburg, PA 17055 Compile when rDlytrp 2 o fbe Desl krwwledpe, death axvrred ar qr Dme, dew and place sorted. (Sgnabra and qqe) 23b. Licertp Number 23c. Dew Siprrd (MorMtt, day, year) ptrysiaart w not avalabw ar krrr d dean b redly cause d deaYr. - . Moms 24-28 must De conWlewd DY person 24. Tana d th 25. Daw Prarowrced Dead (MaWt, day, yew) 26. Was Case Referred b Medical Examirrr / Cororrr br a Reason Ogrr tlran Cremakar a DorwYOn7 wro prorwux:ea deagr. ~ 2, 3 M M. O O Q I ^ Yas ~ . CAUSE OF DEATH (sw Instructlona and exsuYtpNa) r Approximar Mwrval: Pan q: Esw otlrr 28 Dd Tmacco Use CarwibW b oeWh4 Bern 27. Pan I: Eder Yr mljp rd~trgtYs -diseases. kyuries, a canpkcauons - prat dkecgy caused qr death. W N0T enter wrmkral avers arch p cardwc arrest, r gx;et b Death ba nil resulkrq n qr underlynp cwse pivan Mt Part L ^ ris ^ ProDagy rsspkalay arrest, a vesrk:ular BDriealron wMlput slwvmp the etidogy. List wrY one coup an each line. ~ r ~ ~ E C ^ fb ^ lMluawn ~f [ ^' Q / 1 I /~ /J idrYa~i T m isu hNq Y~i deaNl cksease a a VG 1 Y T 1~` / {f y ~ r'i /'S f~ QR. K ~ ? l~ m ~ ~ S r -)• I 29. q Femur: ^ Due b (a^a~s a cansequenaf d): ~ Not prepnas whin peal year aerKx:raralM Yu condigorrt, l any, b. ~ RJR ~ dr caase fsW an Yr a ^ Praprwl at tma d dealA . b for u a can nca d): IMIDEAly N10 C A I K E `e~ F N s J~ N ~ P ~ ^ Fk4 geprwe, tut pregvtrl wlM~ 4Y days ~ t ~ l~ d ~ ,e c (dasap ~ R T ~ ~+ 6 F T g A r•1 ~ H y svsnw rewN~p~r death) LAST. a death Due b (a ac a consequence d): ~ ^ Na prepare, txa papaw 43 days b 1 yew d. t 1 babre death Ildcrtowvr Y prepnas wMn qr past Year 30a Was an Adapsy 30b. Were AWOpsy Fkrdirgs 31. Mamer d Death 32a. Dab d k*qy (Morah, day: year) 32b. Describe Flow DMaY Occurred 32c. Street, Facbry, ~ &~ : Harp PedartrdY Avalabw Prior b Conpletbn d Cause d DeaM7 Natural ^ Her°icxw i 0 ^ Yas ~lb . ^ Yes. ^ No ^ Accides ^ Pen6ng Invesbpakon 32d. Tme d bjwy 32e. kyury a1 Work? 32f. q Trarrpona6on kyrxy /Spedry) 32p. Lowdon d bWY (SUex, sly /barn. rare) ^ Suicide ^ Could Nd be Dewmiined ^ Yes ^ f4o ^ Ddver / Operabr ^ Passengw ^Pedestrian M Other - Syxvcily: 33a. Grkker ( ~Y ~) 33D. arW Tide d Cedlier ' C•~YirW PDY•k~ (Physinan cerkrysg cause d death when anaher physician tars prorowx:ed death and carpwted Item 23) T OS ' TotlrbptolgryknowNdpe,rlpNoccrrtedauebUrcause(e-andnunnau.bWL________________________________^ PZ / a LIST - • PronourrcMp and arghrMq ptrysician (Physinan bath gorwwrcnp death and cemfykg b cause d death) To MM b d d k Nd d tl d d ^ 93c. licerre t4umDer 33tl. DaN Sprd lMorMh, day, Yew) e my now pe, sa l occurre N ttr me, dew, and plea, and Ow to qr coup(e) and tnararr p awwd- - - - - - - - - - - - - - - - - - • fMdical tixamirrr Y coroner M 3 6' 10 2''/ o On are basis d axarn4ragon and I a bveslipatbn, N my opinion, death occurred W qr tkrr, dW, and pea, and due b 1M cause(s) and mrurr p crated. ^ 34. Name and Addrep d Person Wta Canrpleled Carp d Death (Mom 27) Type /Pmt 3s. ~i r' ac • r - t a I ~ I a+ I ~ I ~ I 3p~.~y FMw , ~ y.aq ~ -~ iW~nl VaNora-, MD ~ 3 N ~ diet . . ~7 py aG'td A I'IQi I Disposdion Permd No. D3S 9 G / V COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ,~ estate of MARLIN H SEITZ SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 23rd day of November, Two Thousand and Nine Letters of ADMINISTRATION C. T.A. in common form were granted by the Register of said County, on the late of UPPER ALLEN TO WNSH/P (First, Middle, Lastl in said county, deceased, to VERNON M MARTIN JR (First, Middle, Lastl and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 23rd day of November Two Thousand and Nine . Fi 1 e No . 2009- D ~ 088 PA Fi 1 e No . 21- 09- ~ 088 Date of Death 10/24/2009 S . S . # 198-28-2073 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL C°~~ti~~firr~ ~; <"lh-hit~c~ WILL OF MARLIN H. SEITZ I, MARLIN H. SEITZ, currently of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. In the event that any of my children have loaned money from me during my lifetime and have not fully repaid it by the time of my death, I direct that any remaining balance shall be forgiven. IV. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath as follows: A. One-sixth (l /6) unto The Mennonite Foundation, Inc., Goshen, Indiana, to be used for the charitable purposes I intend to outline to it by separate instructions. B. Five-sixths (5/6) to be divided equally among my children, namely Ann E. Davis, Gene B. Seitz, Blair M. Seitz, Mary ,lane Melhorn, and Nancy R. Benson. If any child predeceases me, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, said share shall lapse and be added to the shares passing to my other children or their issue per stirpes. -1- ,~., x V. I appoint my daughter, Ann E. Davis, and my son, Gene B. Seitz, Executors, or the survivor of them as sole Executor, of this my Will. VI. I direct that no bond.be required of my fiduciaries for the faithful performance of their duties in any j urisdiction. IN WITNESS WHEREOF, I, MARLIN H. SEITZ, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this ~ `~~~ day of ..~~v ~.,~ , 2002. ~y ~ f ~- (SEAL) MA IN H. SEITZ Signed by MARLIN H. SEITZ, by him declared to be his Will in our presence, who have hereunto subscribed our names as witnesses in his presence and at his request, this ~j fi~ day of Tu t.. ~ , 2002. .~ ,.~,z.~-,~..~ residing at _ ,~z.~:~.-(:.'~ ~.~ r ~,~~-~-~--- ~- ~~ ~- ~-- residing at %~ . '~ ~ ~i~~" -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF 1~~1.~ `~-" "" WE, MARLIN H. SEITZ, GERALD J. BRINSER and I~~.~..Ie~~- ~- ~-L~~~~ , the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly a.ffinned, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he signed willingly {or willingly directed another to sign for him), and that he executed it as his 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 witnesses and that to the best of our knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn or affirmed and acknowledged before me by MARLIN H. SEITZ, the testator, ~ ~2.~ t_~ ~ _ C~~ ~~ s >: ~ and ~~.~ ~~ ~t,cr ,~,~ ,witnesses, this day of~~,( , 2002. Jennifer R. F~eeland Notary Public Upper Allen Twp., Cumberland County My Commission Expires Dec. 13, 2004 Marnber, Pennsylvania .gssoGiation of Notaries -3- WITNESS