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HomeMy WebLinkAbout01-27-10c_ 15056051058 06 05 REV-1500 EX PA Department of Revenue ( - ) OFFICIAL USE ONLY Bureau of Individual Taxes Count Code Year File Number Y INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 .0141 ', ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 202-42-6328 ' 01/30/2009 06/04/1960 Decedent's Last Name Suffix Decedent's First Name MI SHOFF 'TIMOTHY L __ . (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 i,: 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) c,*; 6. Decedent Died Testate ;;;;;;• 7. Decedent Malntalned a Living Trust _. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ..:.: 9. Litigation Proceeds ReceNed .....;• 10. Spousal Poverty Credit (date of death ..... 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number i PAUL BRADFORD ORR ', (717) 258-8558 __ Firm Name (If Applicable) REGI$I,ER OF WILLS ~ ONLY LAW OFFICES OF PAUL ORR ~ o ~ ~" First line of address ~~ ,. !°fl .ice c :~ _~ -'- 50 EAST HIGH STREET t ~ rn tv cr7 ~ ~ "` Second line of address ~ "L~ _-, C.3 ~ . j City or Post Office ~, TE FILED-- State ZIP Code -~ ,.- __. ... .... ;e CARLISLE PA :17013 N ~` Correspondent's a-mail address: paulorr@embargmail.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. Declaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~U~,E,OF PERSON ESPONSI E FOR FILING RETURN DATE ADDRESS 54 West I S eet arlisle, A 17013 SIGNATURE OF EP ER H HAN REPRESENTATIVE ATE / ` 1 /) /~dE ~+TyF 1 ADDRESS ~D ~. I'T `g/J ~T • („ a~S~e') /'~7 ~ (O ~~ V PLEA8E U8E ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number :..................................................................... Decedent's Name: TIMOTHY L SHOFF 202-42$328 _... RECAPITULATION ...... ............................................................................ 1. Real estate (Schedule A) . .......................................... .. 1. ' 123,000.00 i 2. Stocks and Bonds (Schedule B) ..................................... .. 2.' ', _....... 3. Closely 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. ' 23,821.11 6. Jointly Owned Property (Schedule F) ~~,:::~% Separate Billing Requested ..... .. 6. ', 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ', (Schedule G) ~;;;;; Separate Billing Requested...... .. 7. 8. ....... Total Gross Assets (total Lines 1-7) .................................. ........................................................................................................................................... .. 8. .............:..... 146,821.11 ' ...........................................................................: 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................... .. 9. I 8,821.19 ', 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ' 137,458.62 11. Total Deductions (total Lines 9 8 10) .................................. .. 11. 146,279.81 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ', 541.30 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. 541.30 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0. 16. 17. Amount of Line 14 taxable ' 96 64 at sibling rate X .12 17. . _...: 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ...................................................... ...19. 64.96 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 Complete Addres File Number :::. s: 21 09 .0141 DECEDENTS NAME TIMOTHY L SHOFF DECEDEN TS SOCIAL SECURITY NUMBER STREET ADDRESS 202-42-6328 805 SANDBANK ROAD CITY MT. HOLLY SPRINGS STATE ZIP PA 17065 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) Z. Credits/Payments (1) 64.96 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable Total Credits (A + B + C) (2) D. Interest E. Penalty Total InterestlPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0 74 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) 64.96 A. Enter the interest on the tax due. (5A) 0.74 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE . (5B) 65.70 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :........................................................................... ............... ^ b. retain the right to designate who shall use the property transferred or its income : .............................. .............. ^ Q 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? .............. ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......................................................................................................... .............. 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,, ... or ates 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. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2009- 00141 PA No . 21- 09- 014 ~ Estate Of: TIMOTHYL SHOFF (First, Middle, Last) Late Of : DICKINSON TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 202-42-6328 WHEREAS, on the 9th day of February 2009 an instrument dated January 29th 2009 was admitted to probate as the last will of TIMOTHY L SHOFF /First, Middle, Last! l a t e of D/CKINSON TO WNSH/P, CUMBERLAND County, who died on the 30th day of January 2009 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: ESTHER G ARMSTRONG who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 9th day of February 2009. eg/ster o ill i - .~ eputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) i LAST WILL AND TESTAMENT OF TIMOTHYL. SHOFF I, T~~MOTHY L. SHOFF, of 803 Sandbank Road, Dickinson Township, Mt. Holly Springs, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declaze this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave mazker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: A. I give devise and specifically bequeath my 1972 Plymouth Barracuda, and all miscellaneous parts that aze associated thereto to my Brother, Jesse L. Showers, of Cazlisle, Pennsylvania, if still owned by me at the time of my death; B. I give devise and specifically bequeath my 1978 Dodge Power Wagon 4 Wheel Drive Truck to my Brother, Scott A. Showers, of Cazlisle, Pennsylvania, if still owned by me at the time of my death; C. I give devise and specifically bequeath my 1972 Plymouth Duster to my Nephew, Donald P. Showers, of Carlisle, Pennsylvania, if it is still owned by me at the time of my death; D. I give devise and specifically bequeath my 1996 Dodge Ram D- 150 Pick-up Truck to my Father-in-law, George E. Armstrong, of Cazlisle, Pennsylvania, if still owned by me at the time of my death; E. I give devise and specifically bequeath any of my Boy Scout of America Memorabilia, to my Brother, Jesse L. Showers, of Cazlisle, Pennsylvania, if still owned by me at the time of my death; F. I give devise and specifically bequeath my old antique desk that has a secret compartment, to my Nephew, Donald P. Showers, of Cazlisle, Pennsylvania, if still owned by me at the time of my death; G. I give devise and specifically bequeath my antique china. closet, with any china only, to my Sister, Wanda K. Showers, of Mt. Holly Springs, Pennsylvania, if still owned by me at the time of my death; Page 1 H. I give devise and specifically bequeath one shotgun to Andy Hostetter, of Newville, Pennsylvania, to be eventually handed down to his Son, Eathan, if still owned by me at the time of my death; I. I give devise and specifically bequeath any remaining weapons/long azm from my gun cabinet, to Andy Hostetter, of Newville, Pennsylvania, if still owned by me at the time of my death; J. I give devise and specifically bequeath any other remaining single weapon or long azm to Mike McQuillen, of Landisburg, Pennsylvania, if still owned by me at the time of my death; THIRD: In the event I still own Real Property located at 803 Sandbank Road, My Holly Springs, Dickinson Township, Pennsylvania existing of improvements and approximately one (1) acre at the time of my death, my dear friend, and Real Estate Agent, Valerie Clouse is to be given. right of first refusal in the listing and marketing of said property, if still owned by me at the time of my death. FOURTH: I give devise and bequeath the residue of my estate, of every nature and wherever situate, to my siblings, Jesse L. Showers, of Cazlisle, Pennsylvania, and Scott A. Showers, of Carlisle, Pennsylvania, and Wanda K. Showers, of Mt. Holly Springs, Pennsylvania, equally, provided that they survive me by thirty (30) days. In the event that any of my siblings predecease me, their shaze shall revert to the surviving siblings. FIFTH: I give, devise, and bequeath specifically, my love and affection and One ($1.00) dollaz only to my Biological Father and any unknown children that may arise. At this time I do not know the where about of my Biological Father or if there aze any offspring. In the event any of these said possible children or Biological Father would challenge the sufficiency of this Last Will and Testament, all expenses thereto shall not be an expense of my Estate. Rather, they haze any and all expense of such proceeding. Finally, if none of my children or my Biological Father can be located, as there whereabouts aze unknown to me; their specific bequest listed above shall lapse into my Residue Estate. SIXTH: I nominate, constitute and appoint my Mother, Esther G. Armstrong, of Cazlisle, Pennsylvania, Executrix of this my Last Will and Testament. Should my Mother, Esther G. Armstrong, fail to qualify or cease to act as Executrix, I appoint my Father-in-law, George E. Armstrong, of Cazlisle, Pennsylvania, Executor of this my Last Will and Testament. SEVENTH: I direct my Executrix and her successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. Page 2 3?I.V-15x2 F:<-~ ~ ~.•C8} ~ °~ Pennsylvania SCHEDULE A ~~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER TIMOTHY L SHOFF 21-09-0141 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 jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a cepy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' 805 SANDBANK ROAD, DICKINSON TOWNSHIP, MT. HOLLY SPRINGS, PA 17065 123,000.00 TOTAL (Also enter on Line 1, Recapitulation.) ; 123,000.00 If more space is needed, insert additional sheets of the same size. ProMOUt e5itlmt are awleb ' form HUD-1 (3/85) ref HanEbook 4305.2 'A' ~' Ett1eT1'~CTIt Statclnent U.S. Department of Housing and Urban Development nteo enn.nvol fJn 9r.MJ+9ii5 /avniroe 11Cin/7nn91 tl. I Oi LOafl 1. pFHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 4. VA 5. Conv.lns. 08153 : is pve you a t an an s oun P e a msn open are TftleExpress Settlement System C. Note: Ibme markeo'(p.o.c.)' were polo Dotes Rro doeinp; they ere Mown hen for inlormeuon purpoms aM are not induoeo m etc totals. WMNING: tt n a crime b kmwkpy make falp stNemantt b ma Urebd Stabs m tfiie ar anY Derr eimtlar form. Pmetties upon mnNeuon an induas a reu one kn sorvnant For Eabtts sea: TiSa +5 u. s. coos Ssaom +oo+ end seam to+o. Printed 07/2912008 at 15:56 CH D. NAME OF BORROWER: Timothy L. Shoff ADDRESS: 15 Sha bark Lane Carlisle PA 17013 E. NAME OF SELLER: Sylvia M. Hom ADDRESS: 805 Sandbank Road Mount Hol S rin s PA 17065 F. NAME OF LENDER: Sovereign Bank andlor Mortgage Electronic Registration Systems, Inc., solely as Nominee for the Lender, ISAOAIATIMA ADDRESS: 1130 Berkshire BNd. misain PA 19610 G. PROPERTY ADDRESS: 805 Sandbank Road, Mount Holly Springs, PA 17065 Dickinson Townshi H. SETTLEMENT AGENT: 1st Advantage Settlement Services Inc., Telephone: 717-591.7755 Fax: 717-591.7756 PLACE OF SETTLEMENT: 6375 Mercu Drive Suite 102 Mechanicabur PA 17050 I. SETTLEMENT DATE: 0713012008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contrail sales rice 123 000.00 401. Contrail sales rice 123 000.00 102. Personal Pro en 402. Personal Pro 103. Settlement char es to borrower line 1400 4 091.31 403. 104. 404. 105. 405. Ad'ustments for items aid seller i n advance Ad'ustments for items aid b seller i n advance 106. Ci Aown taxes 406. Cif /town taxes 107. Coun taxes 07130108to12131108 67.35 407. Coun taxes 07130108to12131108 67.35 108. School taxes 07130108to06130109 686.25 408.. School taxes 07130108to06130109 686.25 109. 409. 110. 410. 111. 41 L 112. 120. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR ON BEHALF OF BOR 127 844.91 ROWER 412. 420. GROSS AMOUNT DUE TO SELLER 123 753.60 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. osit or earnest mono 4 000.00 501. Excess De sit see instructions 202. Princi al amount of new loans 116 850.00 502. Settlement char es to seller line 1400 9 510.38 203. Existin loan s taken sub~ed to 503. Existin loan s taken sub'ed to 204 504. Pa off of First Mort a e Loan 47133.59 Suntrust Mort a e 205. 505. 206. 506. 207 507. Ovemi ht Delive -Pa off 25.00 1st Advanta a Settlement Servi 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'uatments for items un aid b seller 210. Ci /town taxes 510. Cit Mown taxes 211. Coun taxes 511. Coun taxes 212. School taxes 512. School taxes 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 120 850.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 56 668.97 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 127 844.91 601. Gross amount due to seller line 420 123 753.60 302. Less amounts aid b Ifor borrower line 220 120 850.00 602. Less reduction amount due seller line 520 56 668.97 303. CASH FROM BORROWER 6 994.91 603. CASH TO SELLER 6T 084.63 Provbus etlitbna sss obeolste `'- U:S. ~EPAgTMENT OF HOUSING AND URBAN DEVELOPMENT ' `SETTLEMENT STATEMENT farm MUD-1 (JIBS) ref Hantlbook 4305.2 File Number: 08153 PAGE 2 TitleExoress Settlemenf Svetam Prinlari n7/~QM(k1A ~t 1 r,•5R ( H L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESBROKER'S COMMISSION based on rice $123 000.00 = 7 380.00 BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. 3665.00 to ReiMaxlstAdvanta a SETTLEMENT SETTLEMENT 702. 3 715.00 to Geor a L. Ebener & Associates 703. Commission id at Settlement 7 380.00 704. Transac8on Fee to Re1Max 1stAdvanta a 295.00 800. REMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount % 803. A raisal Fee to Steve Barrett LR 325.00 804. Credit Re rt to CBC Com anies LR 26.00 805. Flood CertficaGon Fee to FIS Flood Service LR T.50 806. Mort e A lication Fee to Soverei n Bank LR 299.00 807. Document Relive Fee to Soverei n Bank LR 3.50 808. Document Pre to Soverei n Bank LR 200.00 809. Tax Service Fee to Soverei n Bank LR 69.00 810. MERS istration Fee to MERS LR .4.95 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 0713012008 to 0810112008 23.5322 Ida 2 D s 47.06 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for fo 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. 32.92 !mo 101.76 1002. Mort a Insurance na. Imo 1003. C' Pro Tax mo. Imo 1004. Coun Pro rt Tax 6 mo. 12.99 Imo 77.94 1005. School taxes 2 mo. 60.88 Imo 121.76 1009. A ate Anal sis Ad'ustrnent to Soverei n Bank •85.91 0.00 1100. TITLE CHARGES 1101. Settlement or cbsin fee 1102. Abstract or title search 1103. Title examination 1104. Titte insurance binder 1105. Dowment Pre ration-Deed to Humer 8 Daniels 125.00 1106. Note Fees to Carol Hinman 35.00 5.00 1 t 07. Attome s fees incudes above items No: 1108. Title Insurance to 1st Advartta a Settlement Services Inc. 973.75 includes above items No: 1109. lender's Poli -106860954 116 850.00 1 t 10. Owner's Pcti -106765398 123 000.00 •973.75 1111. End 100 End 300 End 900 to 1st Advarlta a Settlement Services Inc. 150.00 1112. 1113. Cbsi SvcLtr to 1st Advanta Settlement Services Inc. 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recerdi Fees Deed 38.50 • Mo a e 66.50 • Release 105.00 1202. Ci /Coun tax/sfam s Deed 1 230.00 • Mort a e 1 230.00 1203. State Taxlstam Deed 1 230.00 Mort a e 1230.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2008-09 School RE Taxes to Caro n R. McQuiilen 730.58 1302. Water Bill6120 - 7130 to Boro of Mt. Holt S rin s 34.80 1303. Wire In Fee to 1st Advarrta Settlement Services Inc. 10.00 1304. Tax Cert Fee to 1st Advanta Settlement Services Inc. 5.00 1305. Ovemi M Deliv Fee-Pk to 1st Advents a Settlement Services Inc. 25.00 1306. Email Pk Doc Co Fee to 1st Advanta a Settlement Services Inc. 35.00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 4 091.31 9 510.38 HUD CERTIFICATION OF BUYER AND SELLER I haw ursNly roMewetl Me HUD-1 Settlement Statement antl W Ne best of my knovAetlge antl belief, a is a true and aowrole statement of alt receipts antl Otabursements metle on my acwunt or by ma in thi,~~tr/a/nJs_a~ction~. I NrM~er ceNy thH I haw ivetl a mpy of the HUD-1 Seelement Slatelrront. IT-mothTS~ll `, ywa / WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement whits I haw proparatl b • true antl aewrole account of mia UNITED STATES ON TNIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION banaagion. I haw wuaetl or will cause Me funtla to be tlisbursetl in accaMance wits this statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT. DATE:'I~ REV-1508 EX+ (6-98) SCNEpVLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER TIMOTHY L. SHOFF 21-09-0141 Include the proceeds of litigation and the date the proceeds were received;by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. BANK ACCOUNT No. 11,500.00 2. PAYCHECK FROM EMPLOYER NESTLE ENDING DATE 2/8/09 1,713.66 3. .REFUND OF FEDERAL & STATE TAXES FROM EMPLOYER NESTLE 708 97 4. .UNITED STATES TREASURY -FEDERAL TAX REFUND 2,200.00 5. REFUND FROM VERIZON WIRELESS 102.97 6. FOUR (4) GUNS (SEE ATTACHED DESCRIPTIONS) 1,125.00 7.' 1972 PLYMOUTH BARRACUDA 500.00 8. 1978 DODGE POWERWAGON 4 WHEEL DRIVE TRUCK 300.00 9. 1974 PLYMOUTH DUSTER 400.00 10. 1996 DODGE RAM D-150 PICK-UP TRUCK 3,000.00 11. .ANTIQUE DESK 125.00 12. CHINA CLOSET 100.00 13. TOOLS & MOWER 345.00 14. MONUMENTAL LIFE REFUND/OVERPAYMENTS 356.00 15. MONUMENTAL LIFE ROOM 8~ BOARD PAYMENT 520.00 16. MONUMENTAL LIFE DISABILITY PAYMENT 410.00 17. MONUMENTAL LIFE DISABILITY PAYMENT 310.00 18. CARLISLE PROPANE REFUND 104.51 TOTAL (Also enter on line 5. Recaoitulationl $ 23,821.11 (If more space is needed, insert addftional sheets of the same size) 8 :~ AFIn Z' ~i 'C --~ Tr ~ r~ < ~ ^5 i :~ iL CU ~ J + ~ •Sn• 4i m rY ~ ~' ~' m x ~: ,..• ~• ~. m o~ +-~ .r~ ~, i i to ~ r,f ~ m +~ • ~+ r_n o ¢' u~ ~ .. ~ ~,. cn na •• re. a ~ ~ .~ ~ ~~ Cn FJ to V KJ7 m µ o ~ n a ' e f r cc x. ~ S ~~~ V ~. 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Dr D A D. 7 W W (T W (T O V A c -1 O O ,"' O Q° r 'R~. -i - h' 'O O Oo 0 ~ (T (T O O OD V7 V O O O n- ~: N to 10 N ~ f " O~ 0' "CJ _ ~ O ~ >~ ~ ~ 3 e O N aT e-' m ~ fD -1 ~ O O A N ~ 7 f D m:. D O W ,--, 2 Z O D ~~ o: 7~1D n ~ Gj ~ ~ C~_ ~ A ~_ O ~ O d O r O r A -~ 3 N 01 fD A m 7 a >2. i n v p o O a ~ .~. 7 ~ G ~ . 7 A N ~ n C < d N - O O C D m . ~ _N r N B ~ f *1~ o A ~~. `* N W c ~0 3 t-' 3 A Vl d Q n O~ r r d 7' ~ ~- d K 10 fD (D ~ d CJ1 A N O J 7 N f't r ~- f D A 7 ~ N C C A (n O~ V r Ol r V 0OD ~ ~ 'O 'O •O T -/1 D DD tD O' • ~ C C OO NO N goo cNi~ c~r+ p ~ o o r m m m D m o D °o j E f f f o m m m J ~c ,__. rn 3 J~c~3tn s~ z~ n _ '-' o n o v»~ o ~~ .., ~~ ~ 3 ~ m -~ ~ -~ -i n w- ~ m. _ . N a 7 a a c a ~ -~ fl... ~ 0. ~ X f'' X X s X : .N_ ~ 7 _ C W ~ " ' -~ ~ m , i a_ --~ °" ~ r •L m Oo ~: ~ tAnrrnrA--~tVT D 'dG ata0 -~ ;(p - wv:oocn O O N (T A O O .~ voo O, d d 7 rf O O - ~ e'' K K T N (D .. A ~: 0 0 0 N N N N :: D d \ ~ \ r o 0 N d D N -G r N Q• N N N O 0 :~:.-. \ \ \ N N N --{ (lt N N N t0 W ~ ~ O O O O O W N W r r o 0 .~ ' ~ ao0 aO0 O O A N ~O r ~ju Z1 r T -._~ '..r' ~ H G ... J ~ '~' . . YJ i ` T ~ . . n. Jy T ~. R ~ ~ ~"' ny 'Y u t .'~, . to ~~ ~n ~ *~w rt 47 ~C o-a. ~, +',~ ~_ ~' ~. ~ ~ . ,~ ~ ~( N ~ n a a ~ ~ = J ,o v~F ~~ ""~ ~ O ~ n-~ r.~ m ~ ~ ~ . ~ ~ 6 ~ - " + ~ C1J ~ y~J ~-. ro- C.a ~ ~ fi -tr .C. .L 4 .A rJy Cs '~C1 C? W .. ~ C.J O+ V i~~~ V ~ 7 l 1 D ~ Z 7 "i") a~~ d 3 N ~~ i m n m i -a . T~~S t5 ~ 2tFu~~ ot= T~uE F~Dr~L -~ S~~ I~AUE3 -T~-tGtT tt.~laQ~ t_,z-5.'c~.i!-tt~4~ ~-/~c~l '~"i d1~t ~S L.J~-`j T C N ~ZIC . ~~`~ 5 ~ csi.s~. ~ u 6r ~-wu r= a Z~.t ~~~ ~~~( c~vF3 ttb~5 , St22t ~kow~ ~'~v~ -L- Nestle Purina PetCare ComP~Y Pay Area: U6 US Wkly Hrly Mon/Thu Beg Date: 02/23/2009 ~'y 1 Checkerboard Square EE Subgr: US Hourly NE Prod End Date: 03/01/2009 St. Louis, MO 63164 Pay Rate: 24.7200 Hourly Pay Date: 03/05/2009 Timothy L Mr Shoff Empl Id :01620120 TAX filing Status Allarance5 AddT Amt. . 803 Sandbank Rd. Bus Unit: Nestle Puri na.PA.Mechanics FED Single 00 0.00 Mount Holly Springs PA 17065 Org Unit: NPPC Mechanicsburg Naintene PA Single 00 0.00 Position: Integration: default posi Check No: 3000141085 ----- - ---Current---------'- ---=----YTD------- ,. , __ _.. ___ , Wren Ives nus ar s Vacation/PTO Payout 114.00 _ , 2.831. . ing ax FED EE Social Securi - 253.11 Regular Earnings 1.371. FED EE Medicare Tax 59.19 Imp Inc Employee Life 6. PA Withholding Tax 91.92- 33.40 PA EE Unemployment 2.54 PAUO Withholding Tax 65.30 PAUO Local Services T 5.00 BEFORE-TAX DEDr~CTi0N5 Current. YTD i,FTER-TAX CEDUC71OtiS Current YTD EMPLOYER-PAID BENEFIT$.Cttrrent YTD Ica re- ax rt erm oan n ri ut ion Dental Pre-Tax 4.60 401k Long Term Loan 28.04 196.28 Vision Pre-tax 2.30 AD&D 10.95 Life Insurance PreTax 11.55 LTD 7.25 401K EE Before-tax US 83.47 Auto/Home Insurance 44.37 115.46 Current YTD' NET PAY DISTRIBUTdON i Balance: Total Gross 4.222.40 Check 708.97 Total Taxes 812.63- 510:14 Total Deductions 103.66 778.7 NET PAY 708.97 2.933.55 ~ ~ ~~ D ~~ ` c ~ da d x 3 ~ 1;. T ~• - - r[. _ ~--~ rL~ In 94• Ifl L ~'t r_;t ri •'tt• ~:'~ ~~ :~~ .-+• # ,~~ ~. w: 0.1 1'1 UI 3 "'••a Its r. Cri u-•.• ~i ~ Il: +,~ - rt .. ~. xl ~. . a. 1~ ~ .. Iro c ~ ~ 7 ~•., rt• ix~ .~ -~ `~ +rs ~ «~• ,fi ~ ~n C _ Y.i 4•.! ~ /~ v y v ~ U? ~ y •~ r•.~ •~G c.a rt~ ,Yr• ~ P r .u. C A CD • C ~"1• ~ ryy ~ Cr- Q V v; ~ 3 n m n ~i ~., >; ~ ~ W r ru r to .O .: O w r r O 0 r ti W tt:iiJRE SEf JHI,Y .Liii!t +...vJhL St CL~1:l"~ ,....r.e. +..._Jer_. O ~ ~~ ~ $~C ~ ~o Om=~ D nNi3o m~m0 ~ NC)N ~Da O ~~ _ ~ ~ ~ m w ~00~ _ O°w= ~ ZyO ~ ~ _ ~ -~ 4 OZO o ~ ~ '~ °- ~ v ~, ti ~ D ~ Z ~ v ~~ D to d ~ s V m ~ ~ ~ m ~ to O z ~o i D f O (O O_ J O ~ Ol ~ s SIN ~' A A n J p W x Q ~ p 0 ~ n N ` m n `(_ ~ ~ ~ Z <O ~ G n ~ S x ~ D N c _ ~ N m C m C7 C `,~ O z ~_ tT9 A "~ Z ~mcc.: o > a!r: r: ?. uRn ;a, 3Rm.•a .... ARYI•; a nunvs avg.^. N :~ c0 ' Z m A z N ~ o d. o `o; o' 0 0 o ~ a. -~ o N 0o z o: z n m z c T.. m z t 0 n m O m m v m ° c g v O O Z m r! H m ~_ O 7 y .J m ~ ~ '~ O N CA ~ O N r t0 ~ ~ v N _ A O O N C ~ ~ C ~ ~ O ~ N C T~ N V ~ m V ~5S NC2587 SIGNATURE ~~L ~~ ~ `4~ ALL CLAfMS AND RET ~ / V GENERAL 0 _ 240 Lincoln Street Carlisle, PR 17013 (717) 243-5252 Fax (717) 240-6670 4005 Philadelphia Ave S Chambersburg, PA 17202 A s S-e Phone: (717)267-1953 / ~ Fax: (717)267-0743 www. sunsetautosa les. com E-Mail: salesC~sunsetautosales.com March 19.2009 I Timothy W Kyner of Sunset Auto Sales, Inc. appraise the follow vehicles: C ~4-^~~l~a J 1972 Plymouth Mileage TMU VIN BS23H2B269958 $500.00 1978 Dodge Powerwagon VIN W 113BE8J514965 $300.00 1974 Plymouth Duster VIN VL29c4B340978 $400.00 1996 Dodge Truck Mileage 135,000 VIN 3B7HF13Y3TG158714 $3,000.00 Trailer $200.00 Sunset Auto Sales, Inc.\ .r u / Timoth yner ~', r a ~u G G 'S "2 :~ n' 2t w' ~~ ~ m r+• . .~ ~ m ~, a ~ ~ ~• ~ ~ ~ ;. # 4 ~! W ~ .p. 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Y o ° D ~ ~ p -< 2 2 -i m ~ ~ ~ m Z m c ~' ~. ~ m D ~ ~ ~P ~ v r o v c: o ~: , ° ~ ~ ~ ~ N r D O O ~ ° ° O O T r D D z 0 D m m a x d b H x y yyH Cb z H 9 PQ 3 3 ° ~-3 CzOw~ y[nH O~~ ~~o ~~~ ro ?d H Gz] m r v O rn r r ° a 2a T ~•~. '~ O n -I W ~ N m~3~"i~aiz '~ O ~ 37 ~ -1 ~ ~ ~mm~DC~m cDi~~`ZmoD~ (7 ~ 3Z~D C H m~ N_ N N r -i ~~ ~ m N 37 m z ?~ ,$ m - ~ mz tntb7r ~C ~ x.~ D H O Z ~,° m rn O w p r °0 ~ `~ ° < O Z 7v 0 A 70 'v 0 ~ ~ m D 2 m D O ~A!nO~m~n 'mvN ZO~z~ -i ~zcz D 3~ .. ~m~W .. .- 70 Hoor$$y~a.t7 H~w~PCrJHOD$', N O`~ ~ o~Ot~~P 0 0 a+t=1Hrntn o a+ K'a ~ rn`U«xCo~oo ~ N ~ w r O ~ ~ O r ~ ~ ~ N ~~ W CO 0 rn c ~ ~} 0 (V N • -~ o 0 _~ =! ~ c z ~ ~ =._ - m W ~ o _= ~~ ~~ N _ }r c V ~ = . _ V W'n x o~~ d}a jON N=~ J~~ Q~~ v :~ 3.=~ a a c a a r M H O is ~ ~ N ~ W ~~a ~ N CA ~ G7 ~ H H E ~ . rl H ~~ ~ o LW~nU W W N O ... c0 .~ c!1 N cll rft O ~n ~n ti tJ1 PHONE ?17-249-3112 FAX ?17-249-0156 CARLISLE PROPANE COMPANY Dependable Gas Service P.O. Box 577 CARLISLE, PA 17013 t, a . Date M ~ . ,.~. R.~.. / s{:r { Gallons of P%~a ~' ~. ~' Service Leak Test Penna. Sales Tax .. .. _~~~ Paid ~e 13nk Number $eturoed Regulator Material THIS IS YOUR INVOICE -.~~ inataltca ' ~ ~ br _ ~..~, Re~'d by ~l~ia/rdC ~~ G/ ~ ~ 17~~ ? ~,~f~.~tr P -- -- -------- RE`.%-7.57 a F.X-r ~QF.-C9;~ ~ ~ Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER TIMOTHY L. SHOFF This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is ves. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A CDPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1~ NESTLE 401(k) RETIREMENT PLAN TRANSFERED TO ESTH G ' ARMSTRONG, MOTHER OF DECEDENT TRANSFERED ON @~_. 14,540.75 100'. 14,540.75 ' 0.0( TOTAL (Also enter on Line 7, Recapitulation) ~ I 0..00 If more space is needed, use additional sheets of paper of the same size. ~~ ~ 51~ 1Vestle ~~I (k) Savings Plan Boston, MA t~2os _____ Statement Period October 1, 21108 -December 31, 2008 DOMlll TIMOTHY L SHOFF 803 3ANDBANR RD. M017NT HOLLY SPRINGS, PA 17065 T t lA t Val Y our ue o a ccoun Opening Value On October 1,2008 $17,142.12 + Employee Contributions $301.69 + EmployerContributions $201.13 + Other Credits!Payments(a) $830.06 + Investmern Gain (Loss) $3,934.25 - DistribudonsJDebits(b) $0.00 ~1 e~ Vai~e t~1'i ~llk~ l'ef~ie~ ~'~,' 208 ~+'~'~ ~17' ~3 r~ 'f~i,~li~llr~rinr+4alltreartf~t#Aa period , ~-~,1~1.37 3.~ ~ ~ ~~~tr~t ~ ,~,'~ ..,y .< ~ ~ t - z ~ ~ ~2` ~ ~ .. 9t1'~ ~ iR~ <Z .a..~.~a.. NeStI@ Questions? Automated 24-hour Help Line (1,877-637-2255) ~ Participant Services Representatnresars available Monday through Friday, 7:30 A.M. to 11:00 P.M. ET Internet Access at: - httpJ/nestle.ingplans.com Participant Prole Plan Entry Date/Status 03101/1999/Active Account Balance History Beneficiary Designation Notice Our records indicate that you currently have beneficiary elections on file. Please note that you should periodically review your benefiaary elections to ensure they are kept wrrent, especially at mapr life events: Beneficiary Information Name Date of Birth Relationship Designation Percentage ESTHER G. ARMSTRONG 09104/19: Mother Primary 100.009'0 Page 1 of 4 compsisoi,a,ra,rprevkws,rear-erwooc~ opMnywwrvs. values at ING elodne valor TIMOTHY L SHOFF Nestle 401(k) Savings Plan ~~~ 803 SANDBANK RD. MOiJNT HOLLY SPRINGS, PA 17065 Statement Period October 1, 2008- December3l, 2008 Pre 1987 /Post 1986 Contributions Total Pre-1987 After-Tax Contributbns ~•~ Post-1986 After-Tax Contributions $1 OB8 ~ ConMbution Type Your Contribution & Current Period. Yeer•To-Da~ Contributions Contributions Before-Tax Account $301.69 $2,854.68 Attar-Tax Account $O.Op ~•~ EmployerContributions $201.13 $190304 Total x5.702,82 54,757 T2 Vesting Summary TotalMarket Value x as d 12r3120p8 Vaatad a Vested Mrket Value Percent as d 12131/lDDB $4,835.61 100°/a $4,835.61 $1,513.93 100% 51,513.93 $8,19121 100% $8,19121 $14,540.75 $14,540.75 YourAccount Activity Summary The fdbwing is a summary of your transactions during this peHod. For a detailed history of your daily transactions, visit your. plan's web site at httpPubestle.ingplans,com or call (1-87737-2255), - Ihbncion Contributions/ Loan• Distributions! Fund Nerve CradNs(a) ~ Otltar ~ GeiMLoss Tmnslere Other Debits(b) Core International StodcFund 1_ :tl! $125.71 $207.60 $-878.60 $0 00 . . Alive Large Cap Value Fund ~~ $75.41 $124.55 $-564 31 $0 00 $0.00 . . . Alive Large Cap Growth Fund ' ~'~, $125.72 $207.43 $-1 07020 $0 00 $0.00 , ~ . , . Antiwe Intl Stock Fund $4,3'!lt.~5 $125.70 $207.48 $-969.14.. $0 00 $0.00 , ~ ~~ . Alive Mid Cap Fund ~, $5028 $83.00 $-452.00 $0 _. _ . . 00. $0.00 ~; t~~ `~: . ..._ . Total Portfolio Value `; . , y.. $502.82 5830.06 $-3,934.25 50 _ .~, 00 $0.00 . ,, '- °~ .. . $OJ00 Your Loan Summar y Totes Amount Loan Payment Payoff Losn Balance .~ ~~' Borrowed P•kt }.'~"inatfiti~Etit"~'M t+~ijpl~ Stabs Amount Dale LosngaMnce Acausd6r t an tOgt/2008 7Yislparied 1771! perio! ~ T/W $6,500.00 Active $31.25 0923/2011 $4 300 27 on 12/91<1008 h-sa This Period , . $14,414.42 Active $28.04 05J19JZ023 $14,241.92 f,•tB3 7x $~~ ~ :968.02 $0.00 • 3D2.tS8 Total $14,078.20 $0.00 518,542.19. _ 518,044.22 Ir>terest will continue to aaxue on the outstarxling amount of your loan if scheduled repayments are not received )n a your loan, the outstanding amount of your k7an volt be reported as a taxable distribution. Ater the loan is manr-er• rimed as a tax t ble ban a ain Pl In the event that you default on s Your g a event. an aooount, wip continue to aaxue interest, and wiN count as an outstandin ban for bans you may take. Accrued interest is in additan to 9 purposes of determining the Maur remaining ban balance and must be paid to satisfy the Bari. it w8t continue as an outstanding amount and number of future (a) Credits include forteRures and Tn~t to Trust transfers, rtapplicable. (b l>abits include new bens. fees. and forteltures, N applicabe. (c Personal Imreshnent Pedortnence PIP) is a measurement of the peAortrrarrce of YOUR entire account fondle time you were invested in the plan durtng the statement rind, PIP is cabulflted based on the performance of your invesenentsduring perbd. tekfnpj nto ac~unt your activity among I~al rrvestmant ~p~rma~ce~latin9 performance is used by tha financial servio~ss industry. Other metlrods d Caiaulating your PIP may yield dlRerem results. Call (1.877.637-2255 fa more information on • Pkaae read this statement carefully. Any error must bs reported within 80 days, Page 3 of 4 »<~>::> ~ ~<; ~ Pennsylvania ~ lIRR~~RRff ^EPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER TIMOTHY L. SHOFF 21-09-0141 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. _ _ __ HOLLINGER FUNERAL HOME 2,318.00 2. WESMINISTER CEMETARY 669.00 s. WESMINISTER CEMETARY 780.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 1,468.47 Name(s) of Personal Representative(s) ESTER G. ARMSTRONG street Address 54 W. I Street city Carlisle state PA zIP 17013 Year(s) Commission Paid: 2009 2. Attorney Fees: 2, 936.94 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: 365.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. THE SENTINEL. _ _ _ _ _ __ 208.78 8. CUMBERLAND LAW JOURNAL 75.00 TOTAL (Also enter on Line 9, Recapitulation) I;' 8,821.19 If more space is needed, use additional sheets of paper of the same size. ~~~~ ~ ~ /~~~ „~ .: m. ~•• ~,- ~~ Hollinger Funeral Home & Crematory,~Inc. Eric L. Hotiinger, Supervisor f February 27, 2009 Esther G. Armstrong 54 West I Street Carlisle, PA _ 1'1013 The Funeral Service for Timothy L. Shoff: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Cremation Package E -Direct Cremation with memorial service $2615.00 Sanitary Care for Private Family Vievying 345.00 Merchandise Dodge Parquet Grecian Marble Urn $395.00 Memorial Package -Register Book, Memorial Folders Acknowledgement Cards, Bookmarks 175.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN_ACCOMMODATION_ THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Newspaper Notices -Sentinel Newspaper Notices -Patriot Certified Copies of Death Certificate (15 @ $6} Cumberland County Coroners Authorization Flowers - Mache and Bud Vase Rev. Richard Reese $162.80 307.20 90.00 25.00 103.00 100.00 Total Charges less: .Received 1/31/2009 Received from Eagles Aerie #1299 Current Balance: $4318.00 $1500.00 500.00 2318.00 501 NORTH BALTIMORE AVENllE • MOllNT'HOLLY SPRINGS. PENNSYLVANIA 17065 • (717) 486-3433 • FAX (717) 4s6-3215 _. - _ f_ _ f.. ~ .. 1...... lL ~.~ .. ..._.~.. - ,assn ~ ' Osiris Holding of Pennsylvania, Inc. t Zg - ~- ~syj ,Z Retail Installment Contract and Security Ag moot ~~ " Osiris Holdkg of Pennsylvania I.I.C ("[LC") " ' ^ Tri-Couary Memorial Gardens I.I.C ("W.C'3 Tn-County Memaid Gadma Subsidiary LI.C ('Company ~ ) 9'~imnnster Cemetery I.LC ("I.I.C Westmiosta Cemdery Subsidiary I.LC ("Campny'7 ' Compmy ) Osirk Holding of Pe,msylvania Subsidiary IlC ( CumbrWd Valley Merrrodal Garden ('Cemdery") Td-CouolY Memodal Garden ("Cemrwy'") 740 Wydamex Rod.I.ewisbarry. PA.17339 ) Wesuninster Cemetery C'Cenxtery 1159 NeavOk Rod. Caniak, PA 17013 1921 Rimer Highway. 6rasle, PA 17013 717-938-34J5 717-7A9-2029 717-243-3541 in tMs Agreement ss "Seler') ere ownns and operators of the Cemetery. THIS AGREEMENT is made by and 6etwem Shcer and d dx "Pu baser.. ITNESSETH THAT Purchaxr agrees a buy and LLC and CodtQatdy egxes b sdl a PtaclmK, t DESCRIPTION OP BURIAL RIGHTS. The Burial Rights coveted by the Agreerrtatt aR sh Bnrial Righu in: _ Gnve Space(s) Lawn Crypt: ^ Double Depth ^ Side-bySide ^ Single O Developed O Preconstruceion 1st Chofee 2nd Chdee Garden Garden $Klloll SKt10i1 Lot ~ Spxe(s) Sptaa) MERCHANDISE: O Check here if mnchandix u being prchased for ux at another ttmetery. Ccmdery's Name: A. VAULT(S) pl. Description N2. Description B. URN(S): al. Dexnption a2. Deacriptim heranafier all rc . deaigtastd beneficiary uraccerdatKe vvlllt the tens ht7eof, the tbllowaig ikrsa a be provided or tied K the above checked kxation. M tlx map of arch garderulwdding m fik in the o1Ree of the CEMECERY, and are mac prdnrlarly dexribed bekw. _ +Mamoleam: O CMpel ^ Gudm O Tandem O Side-by-Side O Single O Dcvelaped ^ Preconstruction _ Nlehe: ~ ^ Chapel O Garden O Single O Companion O Devekryed O Prewnatmction ~Ma,iinwa m,he dfnwn,iov aw: leglh dt ", wrNh IP". hsiaM7e' - 1st Cholte 2nd Choice C. MEMORIAL INFORMATION: Memorial Design: Vast' Y / N Bronze Siu X ~ / Granite Size X /' ~ 19 7 .~ I ° " Lauion ($Ktlon, etc.) ~ - r D. AfONUMENT INFORMATION: T GvatSS /11d..(ce/ YPe color: SG~1r Q~ Size: Z '-' O x I -- O x ~'L-.~- P Die: x x P Bsse: _ x x. P - E. CASKET(S): i. Model: _ 2 Model' Gauge: Gauge: Building Section No.(s) Level Building Section No.(s) Level ITEMIZATION OF CHARGES LLC• Company' (A) Burial Righb (. draroca o, M. t dwva) S (B) PeryeNd Care S (C) Less Certifiale Discount f (D) Semtd Right of Interment S (E) Vault(s) S L imtn~ U S glerypv4Dat- )#foawlorw et (G S ~ (H) MemodaVMenummt (q Greniu Base(s) s ~ - - S g (1) Insullatim charge (K) Caskets - - S (L) Initial Fee for Imanxm S (M)Firul Intament/EntombmenVltxtmmmt Fee ~~^ s 7S ~dc PrRcesssrgg Fee f (N) Permanem R 1 fC aOC f Z33 ' (p)OtryeySw (P) Sala Tu S 2f-~c~ , TOTAL CASH PURCHASE PRICE (A THRU P) f J 338 ITEMIZATION OF THE AMOUNT FINANCED 1338 (1) Toul Cuh Price .................... .......... d [~it G ... S -~7~ S ~- .. r (2) A: Down Payment O Cash O Check ... ~ B. Trade In: ....... ... S Old Agreement No. ' 69 C. Tool Down Payment (2A+ 2B) ................. --- ... S -~ L ~ (3) Unpid Balance ot.Cssh Price (1 -2C) ............. --- - .... S O (4) Finarx:e Charge ................:............... ... S /56q (5) Toul Unpid Belmee (3 + 4) ..................... .. . The LLC and the Comprry shall each remain secotdanly liable w the other far the aalaof itetru and services provided by, trot another pursuant ro this Agxemem; howevK, Purchssu shall not be required ro exhaust any remedtea igamt the t1e m t1,eCordpidy 1,e2re Poceedie8 ago-mittfie o,her. 5. PAYMENT. TM Purchaxr shall py the SELLER for such rights in accordance with the following disclosure smummc ArN ENT13[ aT! EIHAtlDL-tJ.t~Sit ANWNT FkUNCED TOTAL OF PAYMENTS TOTAL SALE PRICE rotcaady~ur aedlnavery rk. The dolor amanlMCedtwa mnyou TM amae:tdaM prmMedkyou TM anxud you wahM paB dMr you the Ida mgdpuniwa~ an your own beret. nave maM M paymsto ss edtedaed. aq down paymed d S ~ x s D s 669 s X69 s 1338 YOUR PAYMENT Number of Peymenb Amount of PeymenN Frst Payment Duo Date Thereafter, Paymenb Ara Due SCHEDULE WILL BE: ~ g fvJ 6 ~I Maw 2 2609 en me , S - Dv UpoN Rwr/4~ SECURITY: You arc giving a raurity intern in the goads a proputy being pxhssd or in put of dx funds paid udar thu Agreranent held in a Merchadix Trust Fud. PREPAYMEM1rf: If you pY oR edy, Yon wiR na have to pY a pemltY ad Yor: nay ~ model to • refuel of part of tlx FinarxeChuga red ment in full befox the i NOTICE: See the rcmaidu of this Agreemrn (irtduding Gerterd Proviaone m the mere aide dxrpo0 fK ddidmd information about ixnpYmenl, defaul4 delinquency charg0. security intexan, my regal py schd led dak ad prepymcm refunds ud pemlbu eccucarr d vrccC nnT nF A (YINSIIMER CREDIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVLSIONS CONTAINED ON THE REVERSE SIDE OF THIS AGREEMENT, WHICH ARE A PART OF THLS AGREEMENT. This Agreetrxm shall be binding upon the heirs; executors, administrators, succeswrs and assigns of the parties bettor. THIS AGREEMENT AND THE FAMILY PROTECTION CERTIFICATE, IF APPLICABLE, CONTAIN ALL THE COVENANTS AND PROMISES BETWEEN THE PARTIES, AND NO AGENT, SALESPERSON, OR OTHER REPRESENTATIVE OF EITHER PARTY HAS AUTHORITY TO MODIFY, ADD TO OR CHANGE ANY OF THE TERMS AND CONDITIONS CONTAINED 1N THIS AGREEMENT AND/OR THE FAMD Y PROTECTION CERTIFICATE. N..•na~ •rvx • CCxr_niV~FC ~C CFi 1 FF Any hdder of this consumer credit wntnet is subject to all daims and defences which the debtor (Purchaser) could assert against the Seller of goods or services obtained purwant hereto or with the proceeds hereof. Recovery hereunder by the debtor (Purchaser) shall-not exceed the amount paid by the debtor (Purchaser) hereunder. NOTICE TO THE PURCHASER (l) Do not sign this Agreement before you read it or if it contains any blank spaces. (2) You are entitled to a completely filled in copy of this Agreement at the time you sign it. (3) Under the law, you have the tight to pay off in advance the full amount due and under certain wnditions to obtain a phial refund of the finmce charge; to redeem the property if repossessed for a default; to require, under certain conditions, a resale of the property if repossessed. PitRCHACFR'S RICHT TO CANCEI• It dais Agreement was sdirited st your residence and you do not~wanl the goods or services you, the Purchaser, may canceldlis Agreement at azry time prior to midnight of the third business dap'after the date o[ dtia Agreement (For an explanation of this right, see the attached Nodce of Cencelladon form.) Recovery Fund: A Real Estate Recovery Fund exists to reimburse persons dho have suffered monetary loss and have obtained an uncollecdblejudgementctue to fraud, misrepresentation, or deceit in a real estate transaction by a Pennsylvania licensee. For complete details call (717) 783-3038 or t-800-822-2113. ecc ocvcoec g[DE F sO-R~ADDITIONAL TERgMS AND CONDITIONS IN W ITNESS WHEREOF, Purchaxr has executed this ent this ~ day ot-Iro ~yuq :~~~Yexecuting~toh/i~s7Agreement, Ppu~rcjhax/r a//~]~cnowledg~e/s rec~ei]ptyoCa copy oC this Agreement. 1. Purchaxr ~ '" - ~• • J ^' '~ ~u " Counxlor: X ~ qa - _4~ -~ aK,~S~E! _~ Social SKUrity No. Date of Binh 2. Purchaser Seller by: Awlwn,ed Rep n ~ Social SKUrity No. ~~ ~ ~ /) Dare of Bin NOTICE: Adhorfud Rrprrseruartvr is signurgan t» {rot both LLC ami Company. Address: ~ °~-/ W ~ ? ~ S~ // A/ /if/E /t X70/ 7hir Agrceatenr it na amid umfl rigntd gy an AaflroriLad ReprererdNivr of the Seller, y -~ Suu 2,p If Burial RiaMs Cenificae to be pdntd in Nsme(s) orbs then Purchaxr, then provide Name(s) hex: Home Phone Number: ~ ~~~ ~ y3 --~ ~~ 1. Employer: Phone 2. Employer: one Srax Licenx Nc wNRE COPY-M Cwryanj,latlb)Capy YEILOW COPY-Record, Co,pwere PINK COPY-Purdmvl Copy GOID COPY-Pun:luwr's Copy This wntratt K wb}ett to a seventy Interest m favor of Bank of Amerrta, N.A., as mlleteral agent Osiris Holding of Pennsylvania, Inc. ~ 9_3 - 35 - L Retail Installment Contract and Security Agreett}gnt Comnsd # " " :ids Holding of Peoosylvania I.I.C ("LLC") ins Holdin` M PeMfylvMia Subeidivy LLC ("company") ^ 7ti-Coum Memaid Gudens 1.I.C C'LLC") Y Tn-Coruay Merswnd Gardens SuMidiary LLC ("Company'? LLC ) r~estminstc Canetery LLC ( WesMimta Cemetery Subaidiuy LLC C'Company") " " . , Berland talky Memorial Oudens ("Cemetery") 17013 P Tri-County Memorial Gudem ('Cemetery") I7339 Lewisbeny, PA 740 Wyndamert Road Cemeery ) Westmins[a CMretery ( 1159 Newvi[e Raced, Carlisle, PA 17013 A 1921 Rimer Highway, Carlisle, 717-243-3341 . , 717-938-3433 717.149-2029 and Cangny (sometimes rcfemd to collectively in this Agremsmt u "Seller") arc owMrs :Stye i. G . ~}.- e.rTe~oa,~-'~o r, T'vl, VFSSETH THAT Purchaser ogres m dry and LLC and Corrsprry agn:n b sdl b Purchaser, a ESCRIP'nON OF BURIAL RIGHTS. The Burial Rightl covered by the Agteanest arc sh[ _ BurIN Righb In: _ Grave Space(s) _ Lawn Crypt: f] Double Depth O Side-by-Side O Single O Developed O Psernnstruction 1st Choice tad Choice Garden Garden Section Section Lot Lot spxaa> Spas) MERCHANDISE: ^ Check here if merchandix is being pmchaxd fm ux at aMdser cemetery. Cemdery's Name: A. VAULT(S) #I. Description #2. Description B. URN(S): #1. Description #2. pexription of the Cemetery. THIS AGREEMENT tl made by and between Sella and y y G S[~ e~' hercinaRer aanea the °Parchaxr •. tigsated 6esse6ckry inatxordmce with dse terrra hereof, the tdkswmg tMSa b be provxkd or used a[ the above clssked ktntion. the rrep of such gardersMsikgng on 81e in the ol&e of the CEMETERY, and arc more particularly dexnTsed below. +Mamoleam: O Chapel ^ Gerdrn ^ Tandem O Sideby-Side ^ Single O Developed ^ Preconstruction Nlehe: ~ O Chapel O Gerdrn ~ Single O Companion O Developed ^ Preconatruction .M 'Horn cmkn diwrviw art: ImpAa1 ", widrAlP", heiaAr T4" 1st Cho{ce 2nd Choke C. MEMORIAL INFORMATION: Memorial Design: Vsse: Y / N Bronze Size X ~L Gnrsile Size X Location (Section, etc.) M O N~~ P hT R ~ g 7 '~~~ D. MONUMENT INFORMATION: TYPr Color: Size: z x P Die: x z P Base: x _ E. CASKET(S): I. Model: 2. Model: Gauge: Gauge: Building Building Section Section No.(s) No.(s) Level I-evel 3. ITEMIZATION OF CHARGES - LLC• Company (A) Burial Rightl (a dermTed a ea. s .Hour) S (B) Perpetual Cm S (C) Less CerUEute Dixount f - 1 S (D) Second Right of Ntmnent (E) Vault(s) S (~ Um(s) S (G) Mausoleum Ldtedng/Crypt Plate f (H) Mmsorial/Monument S (q Gremx Base(q -__. S (1) Installation Chorge -. S S (K) Cuken Z S i l F f I ~ Z~ S raemsmt (L) Init ee or a ~ S6 (M)Final IntermMUEntombmrntMurnment Fee S (N) Permanent Records & Processing Fee S '~'~ S (G) Gtlser S _ (P) Saln Taz S 4. TOTAL CASH PURCHASE PRICE (A THRU P) ~qf S , /~O ITEMIZATION OF THE AMOUNT FINANCED '7 O ' (1) Total Cash Prior ..................j. .......... ....5 (2) A: Down Payment O Gah O Cheek C3Credit Grd . .... S ~~ B. Trade In: ...... .... S Old Agreerrsem No. '7Qn - C. Told Down PrymeM (2A + 28) ................ .... S A (3) Unpaid Balarsee of Gsh Price (1 - 2L~ ............ .... S O (4) Finance Charge ............................... ....f ~ (5) Toal Utspaid Bdusc# (3 + 4) .................... . .. .. f fhe LLC and the Company shalt each remain secondarily liable m the odser for Ilse sales of items and xrvices provsded by one another purswnt to this Agreemem; however, Purchaser shell Mt be required to exhaust ry remedies agaimt the LLC or the Company ticfore proteedissg against the other: ~- -. PAYMENT: The Purchaser shall pay ne SELLER for such rights in accordance vith the following discbsurc statement: YOUR PAYMENT ~~mbar of Payments SCHEDULE WILL BE: /(/Q v+ C AYRULL P yC[RTIOE RAT[ AMOUNT FIRANCED TOTAL OF PAYYENfB TOTAL SI1LE PRICE TM coal d yaa aaM a a yearly orb. TM doge aitsaau Ba aeM M wd you. the errant d-pad8 provided b Yar on yau~oM behx. The unaW yW suT haw paid Mier you Haw nude! paymuas as sdadded. Tha bW ma d padMa m aedi bduo Yg dam paymed d S D ~ ~ o g o >< : A ihs Amo nt of Payments g ~e a Fuss Payment Due Data Thertsafler, Payments,y,re a Non Q O MonlMy on ate N° n SECURRY: You arc giving a xcunty inuren in the goads a properly being purchased or in pert of the funds paid under this Agrament held in a Merchandise Tmn Fund. PREPAYMEM: If you pay oR ady. ywwill nor have to pay a penalty avid you may be en0lkd to a rctund of put of the Finmu Charge. ''yy NOTICE: Sx are rcllralrldef of thu Agreement (including General Proviuona on the reverse side herpoO for tldiuond information about r,onpaYment, defaul4 delinquency charge, sauritY inlercsn. ary required peynienrin NII 7Abre the xhedukd due and prepsymmt refunds aM peodtia THIS AGREEMENT ARISES OUT OF A CONSUMER CREDIT SALE AND IS SUBJECT TO THE ADDTTIONAL GENERAL PROVISIONS CONTAINED ON THE REVERSE SIDE JF THIS AGREEMENT, WHICH ARE A PART OF THIS AGREEMENT: This AgratneM shall be binding upon the heirs, executors, administrators, successors and assigns of the pattiu hereto. THIS AGREEMENT AND THE FAMILY PROTECTION CERTIFICATE, IF APPLICABLE, CONTAIN ALL THE COVENANTS AND PROMISES BETWEEN THE PARITES, AND VO AGENT, SALESPERSON, OR OTHER REPRESENTATIVE OF EITHER PARTY HAS AUTHORITY TO MODIFY, ADD TO OR CHANGE ANY OF THE TERMS AND CONDITIONS CONTADNED IN THIS AGREEMENT AND/OR THE FAMILY PROTECTION CERTIFICATE. - i'01TCP TO ASAtiGNEES OFS .t1_i•~R _ Any hdder of this consumer credit rnntract is subject to ell ciaima and defertsd wNch the debtor (Purchaxr) could amen against the Seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor (Purchaser) shall not exceed the amount paid by the debtor (Purchaser) hereunder. NOTICE TO THE PURCHASER (I) Ib not sign this Agreement before you read it or if it contains any blank spaces. (2) You are entitled to a completely filled in copy of this Agreement at the time you sign it. (3) Under the law, you have the right to pay off in advance the full amount due and ursder certain conditions to obtain a partial refund of the finance charge; to redeem the properly if repossessed for a default, to require, under certain conditions, a resale of the property if repossessed. PURCH_ASER'S RGHT TO CANCEL If this Agreement was aditited at your residence and you do not want the goods or services, you, the Purchaser, may cancel.ihis Agreement at any lime prior to midnight of the third business day aRer the date of this Agreement (For an explanation of this fight, see the attached Naace of Cancellation form. ) Recovery Fund: A Real Estate Recovery Fund exists to reimburx persons who have suffered trionetary loss and have obtained an uncollectible judgement due to fraud, misrepresentation, ordeceit in a real estate transaction by a Pennsylvania licensee. For complete details call (7l7) 783-3658 or 1-80(1-822-2113. Gcc Hevener g[DE FOR ADDITIONAL TEgRMS AND CONDITIONS Z 2~dD executin this A cement, Purchaser ackno led es recei t of a co of this A reement. W WITNESS WHEREOF, Parch r has executed this A mans this _ day o[ ~,~ Y B gr y~~ PY R 1. Purchaser ~ ~ ~'~ii~ 4 Counselor signs Social Security No. Date of Binh 2. Purchaser Seller by: AvihodzN Regru °r Social Security No. ~/ /1 Date of Binh NOT/CE: Aar/mrized Repres¢nlnrive is signing on belmff of bo(h (dC and Cornppny. Address:X.S`I W S ST L -~~~~° ~ ~~D~ Thu Agreement is not amid undJ signed by an AWMrrud Repretentarive of the SrUer. - tiry suu 2.p Ir BariJ Righu Cenifiwe ro be pdnred in Norta(S) aher sun Purchases, aan provide Name(s) here: Horne Phone Number: >( 7~7 _ 2u3-.3/ ~~ 1. Employer: i'hone 2. Employer: Sate Licenx No. - WXrrECOPY-ile CongnY's (aNkr)CopY YELIAW COPY-Farads Carpwau PINR COPY-Pacbuv'sCWY r+Ot-D COPY- ParcMw'r Copy Phoce This wntract is subject to a security mterast m favor of hank o/ Anttmce, N.A., as mltaurelagent P~ ~" ,~ " ,, y^ _.. ,~ ~,,: T ! y_ r, ~ ~ a, CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (71 Ti 249,9188 Fax: (71 Ti 249-2885 March 20, 2009 ~~~~~~~D MAR 2 ~I 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Paul Bradford Orr, Esquire RE: Timothy L. Shoff Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. ------------------------------------------------------------------ ------------------------------------------------------------------ Advertisement inserted on the following dates: March 6, March 13, and March 20, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA : COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, vlz: March 6 March 13 and March 20 2009 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. 8}wll, 'lYmoth~ L., deed. Late of Dickinson Township. Executrix: Ether G. Armstrong, 54 "I" Street, Carlisle, PA 17013. Attorney: Paul Radford Orr, Es- quire. 50 East kiigh Street, Car- lisle, PA 17013. Lisa arie Coyne, Editor SWORN TO AND SUBSCRIBED before me this 20 day of March. 2009 Notary ----_.~ NOTARIAL SEAL DEBORAH A COLLINS Notvry Public CARLISLE BORO, CGMSERLAND COUNTY My Cornmisslon Ex~fres Apr 28, 20k 0 RETAIN THIS PORTION FOR YOUR RECORDS THE SENTINEL - LEGAL vPAUL BRADFORD ORR P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 365151 10 PUBLIC NOTICES robik 03/13/09 38 * 2 AD DESCRIPTION START DATE STOP DATE ESTATE NOTICE LETTERS TESTAMENTARY 02/27/09 03/13/09 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 201.78 TOTAL AD CHARGE 201.78 PROOF OF PUBLICATION O1PRF 7.00 0 ~~~ ~~!'. MAR 1 2009 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT 208.78 250. 54* Est. Timothy Shoff • AFTER 04/12/09 MESSAGE: c~~ Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classifiedC~curnberlink.com Please send a cover letter including your name and address as an attachment PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Erica Peterson, Classified Manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): February 27, 2009, March 6, 2009 and March 13, 2009 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~. Sworn to and subscribed before me this I.~d a . ~~,rn.~, stn ~~~~d~~ Notary Public My commission expires: ~; NWEALTH OF PENMSYLVANI NOTARIAL SEAL t3AM81 ANN HECKENDORN; NOM~IIy PUbNC Camp Hill 8oro., Cumberland County My Commission Expires January 27, 26u~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SHOFF TIMOTHY L Estate File No.: 2009-00141 Paid By Remarks: ESTHER G ARMSTRONG CJ ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 1595 Total Received......... Receipt Date: 2/09/2009 Receipt Time: 15:16:11 Receipt No.: 1055674 Receipt Distribution ------ ------- -------- --- Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 60.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- 350.00 350.00 •t• f S '>'~~~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, l~~~IRRR INHERITANCE TAl( RETURN MARTGAGE LIABILITIES $ LIENS ESTATE OF FILE NUMBER TIMOTHY L. SHOFF 21-09-0141 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• ' MET-ED ELECTRIC (VIA ELECTRONIC CHECK) 2/09 -11/09 179.13 2' '. CAPITAL ONE (VIA ELECTRONIC CHECK) 92.00 3. WASTE MANAGEMENT219 -11/09 156.46 4.' ANDREWS & PATEL ASSOCIATES, P.C. 304.20 5.' COMCAST CABLE 29.70 6. BOROUGH OF MT. HOLLY SPRINGS 57.66 7. 'AMERICAN GENERAL FINANCE 85.00 8. CASH OIL 329.85 9. CARLISLE PROPANE 93.53 10.' SOVERIGN BANK -MORTGAGE PYMNTS ON DECEDENT'S PROPERTY LOAN N0.0106201482 19,836.38 11. SOVERIGN BANK -MORTGAGE OUTSTANDING AT TIME OF DEATH 116,294.71 TOTAL (Also enter on Line 10, Recapitulation) ; 137,458.62 If more space is needed, insert additional sheets of the same size. sovereign Bank. STATEMENT OF ACCOUNT`. Statemerrt Period 0?M1/89 to 03M1A9 1-8n-SOV-BANK t1~na68-2265) wwM-.soveref9nbank.com SOVEREK~1 FREE CHECKING ESTATE OF TIMOTHY L SHOFF ESTHER G ARMSTRONG EXEC # 761124675 Balances . ' .. _ _ ~~~~ + 513,922.63 Average Daily Balance 511,586.43 i Checks Posted '~ Checks Date Paid ~~ # 504` 02/24 585.00 978679035 ~; •~ Check # Date Paid AmourMt Reference s i 506- 02124 - =329.5 978552880 ~,- 5 Check(s) Posted =;2.410.01 An asterisk t") indicates a skip in sequential check numbers which maybe caused by ors of the f~krwirrg: • A check not yet ret~itred ,.__~ - ~A dterJc thetw~ eta e2toniC trantsaction~which w~l_be lis6eti in the "Eletxrarric Checks Posted" _-- _ sectiat below. ff no c~redrs were etectronicaly converted, this section wiH not appear. Electronic Checks Posted checks Date Paid Amamt Payee ~` . ' ~' 502 02!24 574.00 CAPITAL ON 3 Check(s) Pasted Electrortk~Ny=1124.00 Please note: Checks Date Paid Amou>ttt Payee s~4 y n` °; j ,c `> l.d'~. iT~~iMWCi+'~f .'. k 1 _ The merchant you void has oonverled these cheats imo an etecborric transaaion. t3ecarrse we did rwt receive the original check or a cony of the r~reck. we cannot pro+ride the check with this sfalernerrt- M the cheat ntxnber is aero, it matins the meraiaM did rat provide the dreclc number in the proper format Please refer to ttre'Aooorx~t Adivily' section tow W the chedr number in the trarroaction desraiptior-. Account Activity "~ ~ .Additions ~ ~ Balarxoe 02-11 ~ Ba~nnkyp Balance 10.00 «, 02-12 CHECK 101 ,, ~ ~ ~. ~ 5981.85 510,518.15 02-18 CHECK BOOK FEE ~ ~ ;20.65 512,211.18 02-24 CHE {... 50d ~ ,. ~. '` _ ~ ~ ~' 511,796.31 ~:,. ~_ i9overeign Bank STATEMENT OF ACCOUNT Stabenrerrc Period osn21v9 to aI12ro9 -877-sov.~BArnc c,-877-7sa-r165) ,Mwu-.so~ereignbank.can sovEREK~I'~FREE CFIECIONG ESTAT E OF TIMOTHY L SHOFF ESTHER G ARMSTRONG EXEC i3a18nC@s # 761124675 ~ S;~G' ~ f.T ~ N 3 .. ~~'~'' Ygs, ~; , F . sly _ ,. z-~ - t)eposils/Credds + 51,388.75 Average Daly Balance 59,396.85 , ~ ,. r Asa ',~ g". .c Checks Posted Check # Date Paid Amount Reference # ^? ~ V ~ err ~ ~~ ~ _ r, 5pg 03/19 129.70 6.90317120 5'fG ,, 2b Check # Date Paid Amount Reference # 511 0326 ;208.78. 987916065 515' 04/01 177.17 990074375 6 Check(s) Posted =13.012.85 An asterisk (') indicates a skip in sequential ctteclc numbers which maybe caused by one of the foNowin9: _ aA_ _ ._ _ _ ~ ~. _. • A check that was corwerted to an electronic trartsaGion, which wig be r~ in tfie 'Electronic Checks f'osied" section below, ff no checks wen: electronically cwrverted, this section will Trot appear. Elecbonic Checks Posted Check # Date Paid Amount Payee Check # Date Paid Amount Payee 513 ~ ~r_ .'.~~"rE'''~ ~ "~" '~.~ ` ,~ 1 Check(s) Posted Electronically=120.97 Please nobs: The rtrerc~rant you paid has carnrerted these dredcs krto an electronic transaction. Because we did not receive the orighral check or a Dopy of the ct-eck, vve carxrot provide the clrec9c with this statement M the check nurr~er is Hero, it means the mercirarrt did not provide the check rsxnber ~ the proper liorrnat. Please refer to the 'Account Activity' section bek>Mr to locate the check number in the transaction description. Account Activity Dabs Description Additlons ~ Subtractlorts Balance y0~3-1y2y Beginning Balance 03-19 ~ ~ CHECK 509 ~' {, / \~ `,` = ^~ ` 1`~~ .N X .70 ±~ S9'020.27I ., 03-30 - - - - ~ 03-31 METED BILL PYMT ~ 120.97 Sti,411.32 090330 513 _..6 ,. ~ .. ~ _... C - ~_ ;~ i i=ce ~_ s ; iiS `~ iSovereign Bank STATEMENT OF ACCOUNTS 1-s77-stiv-6At~lc 11-877-768-265) ww~-•savenei9nbantc:com SOYEREI~+1 FltEE Ct~CKiNG Checks Pasted check ~ Date Palo 1Un~+urrt Re[enenos ~ check # Date Paid AmourlR nr~ e (~ ,~,., g ~' F + 3~. ~ • l 517 05106: 5669.00 620813710 3 Check(s) Posted = i1,T44.38 An asterisk {7 ~dicates a skip. kr sequential cheek numbers which maybe caused. by one of the folbwing: ~ A chede not yet reoenred ~ A check that was converted to an eiaetronic Uansadion, which will be nsted in the "Efeatronic Checks Posted" sedan bebw. If no disdrs were elec3ronicaly converted, this section win not appear. _ .__:_ _~ _- _ __ Electronic Checks Posted check d Date Paid Amouirt Rayee Ghedr i Gabe Pa>d~ Amount Payee .,may :; .i -- ~~ ~~ 1 Checks} Poked Electronk~ 118.23 ...~ Please nobs: ....~. The merchant you said nas converted lases d-ecics irHo an eleibonic iraraaeiien. Because we did not: reoeire the original check or a copy o! the dslck. we carwiot Provide the check wild this staterr+ent M the check number ~ zero,. it rneeans Cie mert~ant atd not pmvidellis d~clc nurnber' in tae proper format.. Please refer ~ to the'Account Adivily' aeQion belo~w4o ~aical~Cre ciretic nurnbe(in the Vansacfion desaiptlon. ~ Account Acthihy Date Description Additia>ns 8t'btrSCirt°ns Bad 0413 Beginning Balance - - _ - -- r~..,~~~~.~t .M. ... ,~.~..~.,a,._>,~~*Y. ~-~Aa®n.' _ t na¢e 3 of 4 761124675 ~i(~V'~~'~1g1~. ~a11~. STATEMENT OF ACCOUNTS statement Period t15M Z~9 TO 06{91/09 1-877-SOV-BANK (1-877 768-2265) www.sovereignbank.com SOVEREIGN FREE CHECKING ESTATE ©F TIiNOTNY L SMOFF fiCCOUni ~ i o ~ ~ coo i ~ ESTHER G ARMSTRONG E3CEC Balatnces Beginning i~ianee ~7;96q.~9 ' GurronfBa~rate , $8.262.34 ~~~ + $2,302.97 Average Daily Balance $9,200.35 Vi~tltd~ - 52A00.9~ Checks P~ted Check 8 Date Paid Amount Reference 9 Check g Date Paid Atnourtt Reference g 518: f15113 `.~18.2t1 $75529714 523' 06109 5.98L85 6717743880 ..521` 05113 5981.85 671652060.. 3 Checks}Posted = 19,879.90 An aster~tc'{'~ indicates a skip in sequential ctredc numbers which may be caused by one of the fallowing:. .A check not-yet ret~eived " • A cttecit that was oomerted to an electronic transaction, whicfi will be listed in the "Electronic Checks Posted __ section below. H no ci-edcs were eledroncatty conrrerted, this sediori wilt not appear. Electronic Checks Posted Check 9 Elate Paid Amount Payee Check # Date Paid Amour-t Payee 522 Q6109 52~~ MET-ED BN_ --- 9 Chetdc(s) Posted Electronically=121.02 - Please nobec 7tte rrrerr~nt you paid has converted these ctrectcs irno an electronic transaction. Because vve did not receive the original check or a copy of the d~edc. we canner Provkle tt+e dtedc wi~+ this staten~nt. = - - ff the check number ~ taro, it m~r-s the. rtierdrarri did not provide the check rximber in the proper format. t~lease refer M the'ACCOUnt Activity' section below to kx~ie the Bieck number in the transaaior- desaiptlon. Account Activity Date Description - Additions Subtractions Balance tk"i-12 Ba+~inning Balance E _„ ~ > ` ° 52 $7.960.29 "$!0,283.26 , O's-12 ~7 1)5-13 CHECK 521 $981.85 $.9,281.41 ti5-'t3 Cti 'i ' _:. , • ~0 .20 ' ~ -: 513,265.21 $981.85 06-09 CHECK 523 $8,283.36 ~~ 521.02.- 58,262.34 1)606018 522 58,262.34 06-11 Ending Balance 761724675 nerve 3 of4 °~ 8overeignBank STATEMENT OF ACCOUNTS Statement Period 07/13109 TO 08!11!09 1-877-SOV-BANK (1-877-768-2265} www.sovereignbank.com SOVEREIGN FREE CHECKING. ESTATE OF TlM07HY L SHOFF A(iCOUl1i~ # 761124675 ES7HER G ARMSTRONG EXEC Balances. r: .: ,. ~ _ 13eginnirxj Balancee' _1:$,160:58 Current 8aianoe ' $6,306.7.1 peposits/Credits + $257.59 Average Daily Balance $7,271.64 WiQtdravra~ebiFs - 32,1(1:47 Checks Posted Check 8 Date Paid Amount. Reference # Check # Date Paid Amount Reference # 529 08110 $981.85 66550587(3 1 Check(s) Posted = X1.85 An asterisk ('~ indicates a skip in sequential check `numbers which may be caused by one of the #oNOwing: • A check not yet received • A check that w~' converted to an electronic transaction, which will he Nsted in the "Electronic Checks Posted" section bek„iv. ff no checks were elertron'rcally converted, this section will not appear. Electronic Checks Boated Check fk Date Paid Amount Payee Check fE _Date Paid Amount Payee 526 ` ~ 07!14 $981.$5 SOVEREIGN 527 08/03. 522.58 MET-ED 131E 2 Checks} Posted Electronically=11,004.43 ' .~ Please note: ~..~~ The merdta~t you paid has these checks irrrto an electronic transadior-. Because we did not receive the original check or a copy of the clrec~, wre cannot provide the check wish this sta~rrienf. •..• ~~ ff the check nurnbe` is zero, it rnea~ the rrrerdrant did not provide the diedc number in the proper Torrnat: Please refer the 'Account Activity' section below hr kx;ate the check numbs( in the transaction description....... ~- Account Activity Date Description Additions- Subtractions Balance 07-13 Beginning Salsnce 58.160.59 ' 07-'l3 t7EpOSlT X167.59 ... :38,:148.18'.. 07-13 DEPOSIT ~ $70.00 $8,418.18 ~~ 071 'tNTHDR `. _, - ; - ..: . 3fi :19 ~ ~ 58.292.99 $981.85 '~~7-14 SOVEREIGN BANK 57,311 14 ~~ MTG PYMT 090714 0526 08-03 ; MET-isD t311L _ _ ; ,288.56 '.09(1231527 08-10 CHECK 529. $981.85 56,306.71 -••••• 08-11 Ending Balance 36,306.71 -"••• ~~ page 3 of 4 761114675 ~., ~ Sovereign. Bank STATEMENT OF ACCOUNTS Statement Period 08H21r9 TO Otl/'!3/09 1-877-SO~f-BANK (1-877-768-2265) www.sovereigntranlc.com SOYEItEiGN FREE CHECIONG ESTATE OF TIMOTHY L SHOFF ACCOU/tt # 761124675 ES7NFJ4 G ARMSTRONG EXEC Balances Beginning Balance $6,306.71 Current Balance $5,285.76 Deposifs/Credits + $0.00 Average Daily Balance $6,166.23 Withdrawrals/Debits - $1 A20.95 Checks Posted Check # Date Paid Amourrt Reference # Check # Date Paid Amount Reference # 528 08!12 $10.00 696604640 1 Check(s) Posted = 510.00 An asterisk (*) indicates a skip in sequential check numbers which may be caused try one of the following: • A check not yet FBCeived • A check that waS converted m an elec6rcuric transaction, which will be listed in the "Electronic Checks Posted" sedlon below. If no ti>edcs were electronicaNy converted, this section wiltnot appear.. Electronic Checks Pasted Check # DatePaid Amount Payse Chetdc # Date'Paid Amount Payee 530 08/28 $20.16 MET-ED BIL 531 09/10.. $990.79. SOVEREIGN 2 Check(s) Posted Electronically= s1A10.95 Please note' The merchant you paid has corn+eited these ct,edcs ueo an electronic transaction. Because we did not receive tl,e ori®ir~al check or a copy of the ct>ack, we carrot provide tt-e check vrith this staterrnerrt. .~.~ ff rile check number iS nero, K means the M did not provide the check number in the proper format. Please n3fer ~ to ihe'Accamt Aotivily section bekrw to locate the ct-eck number in the traruaction description. A6COUt1t ACtlVlti/ `~ Date Description Additions Subtractions Balance '~'- 08-12 Beginning t3alance $8,306.71 08.12 CHECK 528 310.00 $6.296.71 08-28. METED BILL PYMi` 320.16: $6,276.55 .~ 090827 530 • 09-10 SOVEREIGN BANK 3990.79 ;5,285.76 MTG PYNIT 0909100531 09-13 Ending Balance.. 35,285.76 __ _ ___ page 3 of 4 761124675 SOVEl"el~l B~1I~ STATEMENT OF ACCOUNTS 1-877-SOV-BANK {1-877-768-2265) wyva,r.sovenei9nt3ank.com SOVERE1t3N FREE'CHECKiI~ ESTAi'E OF TIMOTHY ~ SHOFF rtccvu-re rr i ar r cvw a ESTHER G ARMSTRONG EXEC Balances ,Beginning balance 35,265.76 Gufrerrt Balance ~ 55.180.t#'i DepositslCredits +$0.00 Average Daily Balance 35,262.97 WithdraNr8ls![~eR~s -.:3105.75 ; Checks Posted Check. ~ Date Paid Amount Reference# Check 11` Date Paid Amount Reference # 533. 10fOT Y79.29 991996175 1 Check(s) Posted =179.29 An asterisk {'~ irMicates a eke in sequential dreck numtlers which maybe caused by one of the folbwing: A check not yet received " A check that was converted to an electronic transacdort, which will be listed in the °Eledronic Checks Posted section below.. tf no checks were electronically converted, this section will not appear. Electtronc Checks Pasted ._._ -- Check ~ Date Paid Amount Payee Check # Date Paid Amount Payee 10106 `526.46 METED BIL: 1 Check(s) Pasted Electronicaity=;'16.46 Please nobs: The merdiantyou paid has t~rwerted these ct+ecics itrki an etechonic transaction. t3ecause we did not recce the original - check or a copy of the diecic, we canrwt provide tt~e check with this statement tr the c~ecic number is hero. d means the merdiaM did not provide the t~eclc numbs( in the proper format Pl~se Teter to the'Accour-t AcUvily sectior- below to locate ~e cFiecic number in the transaction descxiption. _ _ Account Actnrity Date Description Additions subtractions Balance 55,285.76 ~ _ 09-14 Beginning Balance 5~8:~i6 ~5;259.3tt t0-06 Mf=1''-~ k. F'Y#+tT ; - 091{105 532 --__-_ - 379.29 55.180.01 10-07 t„HECK 533 55,1 .01 _~ 10-12 Ending Balance 761124675 page 3 oj4 SOV8TP.1gIIBRIlk STATEMENT OF ACCOUNTS Statement Perkid 10/131D9 TO1fN1t09 1-877-SO1/ BANK (1-877-768-2265) vrww.sovereigflbank.c~rtr SOVEREKaN FREE GHECKiNG ESTATE OF TIMOTHY L SHOFF ACCOUnt # 761124675 ESTHER G ARMSTRONG EXEC Balancers Begrttnirg Balance 55,1$El.01 Cumarrt Balance ~ ,"53;180:72 Deposits/Credits + $0.00 Average Daily Balance 53,985.75 = 51,999:29 Electronic Checks Posted Check d Date. Palo Amount Payne Ghecie# Date Paid Amount Payee 534 10/14 $990.79 SOVEFiEiOrl 538 11-05 5990:79 3bVEftEtGN 536 11!'03. 517.71... MET-ED BIL 3 Check{sl PoslSed Electr~on(ca~ 51,599.29. Please mite: The rnerchar-t you Paid has converted these checks an electronic hansacGon. Because we did not receive the original.. "i3radC or a copy otthe cheek. we cerrnot provide the r~tech vritA the staten>ent. - ~ __ ._ ff the check rxxnber is zero, it means the merc~rau+t did -not provide the ched~'number in the IX~ format Please :refer to the 'AOOOUM Activity' sectlon below to kxxbe the check numtret m the iransacdorr descriptiort. Account Activity Date Description Additions Subtractions Balance ~~ ~~ 10-13 Beginning Balance. 55,180.01 ~ 10-14 3t}1JEREI~N BANK' S~i:79 `54,'189.22' ~~ lulT'G hYMT 0910t~4;-0534 - 11-03 MET-ED BILL. PYMT St7.71 54,171.51 - ~~ 091102 536 11-05 SOVE BANK _ 7$ 72 MTG PY11AT 091.1050538 ~~ 11-11 Entling Balam~e 53,180.72 ~~ ~~ ~~ ~~ ..~.~ ~~ page 3 of 3 761124675 _ __ __ _ _ _ __ __ p~ 1 of 4 _ _ _.. - ~ Accaxit Number: 10 00 75 7922 2 4 M66 ~~ March 10, 2009 Bill for: TIMOTHY SCHOFF ,A~,~,~ca~,oe~r 803 SANDBANK RD MOUNT HOLLY SPRINGS PA 17065 Billing Period: Feb 05 to Mar 09, 2009 for 33 days Next Reading Dalbe: On or about Apr 07, 2009 Bill Based On: Actual Meter Reading Standard Residential C~.fill ~" Your previous bill was Total paymentstarljustments Balance at billing on March 10, 2009 Current Basic Charges Met-Ed - Cons~npbon To avoid a 1.50X L,~e Paytrrent being added to your bill, -32.00 0.00 _.,,...-a..- pay~by t _ 0.Q0 _ Biii Essdued by: Customer Service 1-800-545-7741 ~ ~ Coll tionsOutage ReporUn9 1-800-962-4848n ® PO Box 16001 ^`'~`""yGbips" Reading PA 19612-6001 visit us on-line ~ vvww.flr;~energ~P•COm tv AeV~N~14!'R Me.~~±~ Your current PRICE TO COMPARE for generation and transrrwssion from Met-Ed is listed oerow. rvr yw -~ ~~, a suppliers price must be lower- 6.6 cells per kWh Standard Residential -0002088587 Customer reserves the right to shop for an electric supplier. o ~ ~ ~ ~~3 . 3 a~ WASH MpNp~3EMEN'T WASTE MANAGEMENT OF CENTRAL PA - 61 4300 INDUSTRIAL PARK RD CAMP HILL PA 17011 (717) 232-0878 (8pp) 642-8850 (215) 269-1671 FAX ~~a...,_- -- Total Credits and Adjustmen Tota{ Payments Received. Total Current Charges Total Amount Due Total Amount Past Due INVOICE ~~a~~~,~. ~~~ Page 1 of 2 TIMOTHY SHOFF Customer: 611-0149267-~1-9 Account Number: 04/01/2009 Invoice Date: 3671088-0061-9 Invoice Number: Due Upon Receipt DUe Date: WM spay Aceount ID: 00014-78547-82000 Current Irnro~ce amount Total Amount Due 77.17 ~7a17 / Please pay total amorx~t cue. Ttrardc You for Y twsir~ess. Qty Amount pate DesonPtiOn 1 v.w 1.00 Bin service rel rcy 1 69.00 1 00 96 Gal toter rel 1 ___._ 8_17 1 00 FUeI/environmental charge 77 ~? Total Currertt~ ~ ~ receivee ~~ ~ d~ ~ ~ ~~ date, you If fuN paYn-ent a mom ~ of 1.5% of the unpad amount. wdh a minimum morrtMy late fee atawed tcable law. regulation a ~~ , or such lesser urxfer a ~-~~g equal to the maxim For each retixned ~hedc. a fee wiN be asset °n Y~ amount permdted bl- state taw Want to pay this bit an-b^e? Go to www•wm•c~~~ more atxwt WMezPay aril rn~e a conveni~, payment. ANDREWS 8 PATEL ASSOCIATES, P.C. 3912 TRINDLE RD. CAMP HILL, PA 17011 PHONE: (717) 761-8740 ~~ 02/27/09 TIMOTHY L. SHOFF • 803 SANDBANK ROAD 29080 (1) MT. HOLLY SPRINGS PA 17065 comcast® Page z Service Charges Detail Date Description Amount ~~ Previous Balance $148.69 /?i 3~~~~~ y O t,omcast Cable Television 02/01 - 03101 Basic Gable 19.95 cr Limited Basic 02/01 - 03101 Basic Cable 38.05 cr Expanded Basic 02/01 - 03/01 Digital Cable 16.95 cr Digital Classes wiOn Demand Total Comcast Cable Television $74.95 cr ® Comcast High Speed q~temet - 02/01 - 03101 Internet Service 42.95 cr - Performance _ _ __ -___ --- _ _ -- - Totat Comcast High Speed Mtemet $42.95 cr Taxes, Surcharges & Fees 02/01 - 03/01 Sales Tax 1.02 cr 02101 03101 FCC Reg Fes 0.07 cr Total Taxes, Surcharges & Fees 1 • c Total Due ~•~ C Sovereign. Mail Code 10-6438-CS5 601 Penn Street Reading, PA 19601 **AUTO**ALL FOR AADC 170 TIMOTHY C SHOFF 803 SANDBANK RD MOUNT HOLLY SPRINGS PA 17065-1107 I~t~ill~~~llit~~~ll~t~l~l~~~~ll~t~llll~~~l~~~lil~~~~~iltltit~l MGRTGAGE SiLLING STATEMENT Page 1 of 1 Q Customer Service 800-232-5200 o Visit our website ^~ ~f3~_-its}fL ~q~rv.sovereictnbank.cora.~n;,i~,~ _ AAi f~l~+~°s,4~~ANK RD Ses~ f?'~3~ J-:! }~ ~ A~t1NI0UNT Hl~3.Y~RINGS PA 17065 Statement Date Loan Number. 02116/09 0106201482 ~Y--- ----,...~..--._ _.._.r...... Q,. .. Current Principal Balance $116 294.71 Current Interest Rate X1.250% Escrow Balance $862.29 .- Current Principal 8~ Interest Due $797.13 Current Escrow Due $184.72 Current Optional Insurance Due $0.00 CURRENT AMOUNT DUE $981.85 ' ~'~' ' ' ` Current Fees Due 0.00 Payments Past Due 0.00 Interest Paid $1,406.93 Unpaid Late Charges 0.00 Taxes Paid $0.00 PAST DUE AMOUNT $0.00 PAYMENT DUE DATE 03/01/09 TOTAL PAYMENTS DUE $981.85 s s TRAN DESCRIPTION IRAN PRINCIPAL INTEREST ESCROW LATE OTHER END PRINCIPAL DATE AMOUNT PAID PAID PAID CHARGE PAID BALANCE 02-0B-(f9 Escrow t)igbrsim-t 578.93 SfJ:00 $f1.0U $78.93 SO.UO $0.00 5416.388.66 02-11-09 iNtg Payment 5981.85 $93:95 5703.16 $184.72 Sf}.00 50.00 t116,294.Tt Additional Traneactlons -Please Conttct our Customer Service ~ 1-f100.232.54D0 YOUR LOAN NUMBER IS YOt/R IDEPfrFfCATiON and must be stated when calling ar writgg for nforrnatgn on your loan. We consider your loan conf+denfiet and we reserve the right to decline to di~xa8 your loan details without the loan ideniifigNon ranger. Did you know you can access your mortgage infomtation on line? Call 877-Sov Bank (877-768-2265) choose a language, then press 1, 4 and follow the prompts or go to our website at www.SovereianBank.com for more information on atxessing your mortgage account through the intemet. Additional information is provided on the back of statement. PE`J-7.57.3 F.X-~ ;.-Cg? ,.,.~ . ~ ~;> pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES FILE NUMBER ESTATE OF 21-09-0141 TIMOTHY L. SHOFF RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116{a) (1.2) ] 1. JESSE L. SHOWERS, 806 Fairview Road, Carlisle, PA 17013 'Brother $1,225.00+1/3residu 2. SCOTT A. SHOWERS, 46 Cave Hill Drive, Carlisle, PA 17013 'Brother $300.00+1/3residue ` 426 S Baltimore Ave, Mt Holly Springs, PA 17065 SHOWERS WANDA K 'Sister $100.00+1/3residue 3. , . 4. DONALD P. SHOWERS,152 W. Penn St., #A, Carlisle, PA 17013 Nephew $525.00 5. GEORGE E. ARMSTRONG, 54 W. "I" St. Carlisle, PA 17013 Father-in-law $3,000.00 6. ANDY HOSTETTER, 341 Kernsville Rd., Carlisle, PA 17013 Friend $1,000.00 7. MIKE McQUILLEN, 6196 Waggoners Gap Rd., Landisburg, PA 17040 '.Friend $125.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN A. SPOUSAL 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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.