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HomeMy WebLinkAbout03-15-10 (2)--~ REV-'t 5~~ 1505607120 PA Department of Revenue ~ (06-OS) OFFICIAL U$E ONLY Buresu of Individual Taxes ~ow+r cod. .. Fr Nunoor Po Box.ztw6o~ INHERITANCE TAX RETURN 2 1 0 9 117 7 Hanhburg, PA 17728-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 209208530 09212009 .10231926 Decedents Last Name Suffix Decedent's First Name BUZIIIR MI ELEANOR V (N Applipbie) Enbr Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRUITE OVALS BELOW ® 1. OriyMlal Retum ^ 4. Limited Estate ® g. D~n0rl1 Obd TagHa (AttaM copy a vw/ ^ 9. Litipatbn Proceeds Received THIS RETURN MUST BE FILED IN DUPLI¢ATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Relum ^ 4a. Fulurs Inlentl ConpraNw (Wb derlh a11Y tbt4.eP) ® ), (A~ d~ aaTMNd; I.ivkq Trust ^ 10. tY-77• t w~id f.t~a d~aln AARON C. JACKSON ESQ. Firm Name (If Applicable) JACKSON LAW FIRM First line of address 4076 MARKET STREST, SUITE 206 Second Ilna of address City or Post ONiu CAMP HILL CortespondenYs e-mail addnas: Stab ZIP Code PA 17011 ^ 3. Remalnbar Retum (date of death prior to 2-13•a2) ^ 5. Federal` Estate Tax Retum Requ O S. Total lumber of Sale Deposit 8oxe ^ 11. Election to tax under Sec. Bt 73(A (AMarJj Sch. O) NTIAL TAX INFO I NATION SHOULD BE [ Daytime T~lephone Number 7177613535 fired s OF WILLS USE ONLY n o O =-z~ c`s ;gT- ,;-- rv ~ ~ r.~l ,_, , r- IT `- -e -- ; -.TS --Y ~- - -T-~~ ~ , , ,.^i A. ~:' c ~! - ~.7 .. x-i ~ t17 '~ ~~ an + ~,q'"'"n.Y~~`a„rat "O~°~"„4°_t!+r^~~~^0 ~WnYirq sGtadulss arld sfatemaMS, arW tot Ithe best of my WioMAedpe aM belief, (y~,~-°~ 9-~~__~~"'°','""' Personal yeprasenlatlve is based on dl intortnatbn of which preParar has anY knowAedpe. Anthony Buziuk 1823 Red Spruce Lane, Mechanicsburg, PA 17050 Aaron C. Jackson Esq. ~iyi 4076 Market Strew; Suite 206, Camp Hill, PA 17011 Side 1 1505607120 15D5607120 J U~j J 1505607220 REV-1500 EX °i~°""'+~ BUZIUK, ELEANOR V Decedent's Social Security Number 2 0 9 2 0 8 5 3 0 RECAPITULATION 1. Real Estate (Schedule A) ......................................................................................... . 1. 2. Stocks and Bonds (Schedub B) .............................................................................. . 2. 3. Closet' Held Corporation, Partnership or Sole-Proprbtonzhip (Schedule C)......... . 3. 4. Mortgages & Notes Receivable (Schedule D) ....... .................................................. . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedub E) ................ 5. 1 1 , 5 9 0 . 6 8 8. Jointly Awned Property (Schedule F) ^ Separate Billing Requested ....... 8 ...... 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) . ^ Separate Billing Requested ............. 7, 4 9 2, 6 8 1. 6 3 8. Tohl Oross Assets (total Lines 1-7) ............................... ........................................ e. 5 0 4, 2 7 2. 3 1 9. Funeral Expenses 8 Administrative Costs (Schedub H) ............... .......................... 9. 4 7, 3 4 0. 6 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (schedule I) ................................ 10. 6 9 6 . 0 2 11. Total Deduetlons (total Lines 9& 10) ................................................ 4 8 0 3 6 6 3 ...................... 11. , . 72. Net Valus of Estate (line 8 minus Line 11) ............................................................. 1P 4 5 6 , 2 3 5 . 6 8 13. Charitable and Governmental Bequesta/Sec 9113 Trusts for which , an eketion to tax hea not been made (Schedule J) ................................................. 13. 1 , 0 0 0 . 0 0 14. Net Value Subjsct to Tax (Line 12 minus Line 73) ........................ ......................... 14. 4 5 5 , 2 3 5 . 6 8 TAX 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 4 5 5, 2 3 5. 6 8 18. 2 0, 4 8 5. 6 1 17. Amount of Line 74 taxable at sibling rate X ,t2 17 18. Amount of Line 14 taxable at collateral rate X .15 18 ts. Tax Due ..................................................................................................................... 1s. 2 0 , 4 8 5.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L. Side 2 1505607220 15D5607220 J REV-1500 EX Page 3 Decedent's Complete Address: Buziuk, Eleanor V 1545 Inverness Drive Fus Number 21 _ 09 - 1177 Mechanicsburg STATE zIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Peyments (1) 20,485.61 A. Spousal Poverty Credit B. PriorPsyments 18,775.10 C. Discount 988.16 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) 18, 763.26 D. Interest E. Penally Total Interest/Penalty (D + E) (3) 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page 2 Line 20 to rogwst a rotund (4) 5. If Line 1 + Line 3 is groater than Line 2, enter the difference. This is the TAX DUE. (5> 722.35 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (s6> 722.35 Make Check Payable to: REG/STER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. rotain the use or income of the ro Yea No P Party trans(erred :............................................................... x b. retain the right to designate who shall use the r ~~~~~~~~~~~~~~~~~~~ P operty transferred or its income :................:............. e. retain a reversionary interest or ............................................ ...... x d. receive the promise for life of either a ...................................................................... x P yments, benefds or care? .......................... x 2. If death oceumed after December 12, 1862, did decadent transfer ro ~~~~~~~~~~~~~~~~~~~ receivin a P Party within one year of death without g dequate considerslion? ......................... ^ 0 ....................................... ....................................................... 3. Did decedent own an "in trust for or payable upon death bank account or security at his or her death?......... 4. Did decadent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefleiary designation7 ...................................... O ^ ....................................................... . ........................ 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 survmng spouse is three (3) percent p2 P.S. §9116 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, the tax refs 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)J. Tha statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosuro of assets and filing a tax return are still applicable even 'rf 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 yeah of age or younger at death to or for the use of a nature) parent, an adoptive paronL or a stepparent of the child is zero (0) percent (72 P.S. §9116 (a) (1.2)). The tax rota imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is tour 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)). A sibling is defined under Sedion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. ..~...~.~~.,~, i ~°~"`~""°"°`°~`"""" PERSONAL PROPERTY ~ ~e~.~,. ESTATE OF BUZIUk, Eleanor V FILE UMBER 21 - 0 -1177 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Joint -owned with the right of survivorship must be disetosed on schedule F. ITEM NUMBER DESCRIPTION 1 2006 KIA Rio VIN KNgDE12346616577 2 Malpezzi Funeral Home Mechanicsburg PA prepaid Funeral Account TOTAL (Also enter on Une 5, VALUE AT DATE OF DEATH 5,185.00 6,405.68 11,590.68 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS 8~ RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Buziuk, Eleanor V FILE NUMBER 21-09-1177 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Irtdutle dte "°'"' a tlw transrerea, °'°r'°I.°°"a^IP t° °°°wam and tha dale d transfer. Attedl a copy d the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 The Hartford -Annuity, Hartford CT 62,629.18 100% 62 629 18 Eleanor V. Buziuk Trust , . Policy #310162958 2 Baker Hughes Inc. Common Stock r12~} SI~0.xt;S 5,410.12 100% 5 410.12 Eleanor V. Buziuk Trust , CUSIP 001 753 05722410 3 1545 Iverness Drive, Mechanicsburg PA 284,700.00 100% 284 700 00 Eleanor V. Buziuk Trust , . TAX ID # 10-15-1281-043 4 M & T Bank Checking 14,163.19 100% 14 163.19 Eleanor V. Buziuk Trust , Acct# 3740882117 5 David Learner Assoc. Inc. 56,900.85 100% 56 900.85 Eleanor V. Buziuk Trust , Securities Account 6 M & T Certificate of Deposit 5,582.87 100% 5,582.87 Eleanor V. Buziuk Trust Account#31003915001132 7 M & T Certificate of Deposit 5,667.55 100% 5,667.55 Eleanor V. Buziuk Trust Account#31003915001140 8 M 8 T Certificate of Deposit 5,512.48 100% 5,512.48 Eleanor V. Buziuk Trust Account#31003915001158 9 M & T Savings Account 40,236.12 100% 40 236.12 Eleanor V. Buziuk Trust , Account#15004205864926 TOTAL (Also enter on line 7, Recapitulation) I 492,681.63 COMLIONYVEAtTN of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Buziuk, Eleanor V FILE NUMBER 21-09-1177 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 21a yes. ITEM DESCRIPTION OF PROPERTY NUMBER 11di0i "" "'"' w ~ ~... thHr rNtlion.Mp to a.cswm °A~ °F °EATM DECD s Excwslo" TAXABLE VALUE ad ~ GM °f UrfMs, AMSGI a °oPY of the d~W for nN a~letr VALUE OF ASSET INTEREST (IF APPLICABLE) 10 Baker Hughes Incorp 18.60 100% Eleanor V. Buziuk Trust 18.60 Stock Dividend 11 Lincoln National Annuity Eleanor V. Buziuk Trust 10,660.80 100% 10,660.80 Account #.1P5189835 12 AAA Membership Refund 36.48 100% 36.48 13 Verizon Credit Refund Phone Bill 39.34 100% 39.34 14 M & T Bank FIA Credit Card 42.00 100% 42.00 Refund overpayment 15 David LemerAssoc . Dividends 1,067.78 100% 1,067.78 16 Secureline Banking Services 7.65 100% 7.65 Refund overpayment 17 Comcast Refund 6.62 100% 6.62 Page 2 of Schedule G SC.I-EDUI.E H cwwoMweKnr os vawevw~wu ~t wrearw~ r~x nenMw ~ryr~•~T~ ~,T~ n[soerroro®@IT /1Lw~~~7 ESTATE OF Buziuk, Eleanor V FILE NUMBER 21-09-1177 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Malpezzi Funeral Home 7,808.52 Mechanicbsburg PA B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Addross COY State Zip Year(s) Commission paid 2. Attorneys Fees Jackson Law Firm 3. Famiy Exemption: (If decedent's addross is not the same as Gaimant's, attach explanation) Claimant Street Addroas CAN State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees estimate 2009 7. Other Administrative Costa 1 The Sentinal and Cumberland Law Journal Advertising 14,007.71 200.00 251.92 TOTAL (Also enter on line 9, Reeapltulation) 47,340.61 ~+MOawe,LLn±oF rEw+srw~w~ Sd~eclule H Ftneral E>~er>ISes & ~~~ ESTATE OF Buziuk, Eleanor V 2 Transfer Tax on Sale of Real Property per agreement of sale 3 Realtors Commission on Sale of Real Property per agreement of sale 4 Frank Buziuk -Reimbursement for Expenses for Sale of Real Property 5 Classic Interiors -New Carpeting Expense for Sale of Real Property 6 GELCO -Carpet Cleaning Expense for Sale of Real Property 7 UGI Utilities Gas Bill 8 Verizon Phone Bill 9 PPL Utilities Electric Bill 10 Pennsylvania American Water Utilities Water Bill 11 Sellers Assistance to Buyer for Sale of Real Property 12 Transaction Fes -Keller Williams for Sale of Real Property 13 Resale Cert. Fairwinds HOA for Sale of Real Property 14 County Taxes for Sale of Real Property 21 - 09 - 1177 2,847.00 17,082.00 440.00 3,151.00 249.05 66.74 96.12 88.09 114.01 500.00 225.00 100.00 37.41 Page 2 of Schedule H G ...S.~d~Ce~d,.lri~e,H~~ COMbgNrVEgLnI OF PENNSYWANU ~ ~a ~^f'" ~'~ un~wr~ r~x n~uaN ~ r108t4 OOI11~ri1Bd r~s~o~rt oeceoenrt ESTATE OF Buziuk, Eleanor V FILE NUMBER 21-09-1177 15 Postage 76.04 Page 3 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE j "°"'°'"'~"'"°'°"""~"""" nfanerroecmwr LIABILITIES, & LIENS ESTATE OF BUZIUk, Eleanor V FILE UMBER 21 - 0 - 1177 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inGuding u reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 AMOUNT 1 PPL Electric 48 27 Electric Bill ' I . 2 Pennsylvania American Water 44.77 Water Bill i 3 Verizon ~ 92.20 Phone Bill 4 Comcast 67 77 Television Bill 5 M & T Bank 107.70 FIA Credit Card 6 UGI 19.21 Gas Bill 7 Sewer Trash 138.65 Hampton Township. 8 Fairwinds Home Owners Association Fee 50.00 9 West Shore EMS 103.54 Final Medical 10 Debra L. Boshinski, OD 15.00 Final Medical TOTAL (Also enter on Lina 10, ReCapitr~lation) 696.02 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE ~M01N~ALM°"b1N6n"""" LIABILITIES, & LIENS MIWrM6[TA%RllY1M1 "°°°rt°~' continued ESTATE OF BUZIUk, Eleanor V FILE UMBER 21-0I~-1177 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inGuding unreimbursed medical expenses. ITEM NUMBER DESCRIPTION ~~ AMOUNT 11 Sanford and Roumm Rheumatology ~ 8.91 Final Medical Page 2 of Schedule I REV-0617 E7N (11-0Q + ~s ~ i SCHEDULE J COMM°NVYEALTN OF PENNSYLVANIA INFIERITANCE TA7( RETURN BENEFICIARIES ~ ~ RESIOENr oECEDENr ESTATE OF 13uziuk, Eleanor V I FILE UMBER 21-09-1177 NUMBER NAME AND ADDRESS OF PERSONS () RELATIONSHIP TO SHARE F ESTATE AMOUNT OF ESTATE RECEIVING PROPERTY oo~auu~nw ql ( °~s) (SSE) I, TAXABLE DISTRIBUTIONS [include outright spousal distn'tiutiona and transfers under See. X118 (a) (1.2)) 1 Eleanor T. Mace Daughter 1/4 of re idue 9 Gore Road Wamer, NH 03278 2 Ellen Leibson Granddaughter ~ 5 000 00 30 Vanhom Drive , . Glenville, WV 26351 3 Ryan Leibson Great Grandson ~ 5 000 00 30 Vanhom Drive ~ , . Glenville, WV 26351 i Enter dollar amounts for dlatributions shown atwve on lines 1 5 through 18 on Rev 1500 cover sheet, as a propriate. II. NONTAXABLE DISTRIBUTIONS: ~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TA~CEN 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 St. Joseph's Church 410 East Simpson Street Mechanicsburg, PA 17050 I 1,000.00 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1,000.00 RTV•1H7 EX~ p.00I a ~ a SCHEDULE J cowo~lwFiLLn~ of PEw1mvANU~ ~Rr<„{~T~„~,uR~,, BENEFICIARIES continued ~ r~ESro~Nr oECEOeNr ESTATE OF Buziuk, Eleanor V FILE UMBER 21-09-1177 NUMBER NAME AND ADDRESS OF PERSONS RECEIV () RELATIONSHIP TO D E C E D nM SHARE F ESTATE ob°) AMOUNT OF ESTATE (SSS) ING PROPERTY c, - w i LIs t T Wq I, TAXABLE DISTRIBUTIONS (Mldude oulripht usal dbtributions and~nsters under Sec. li116 (a) (1.2)j 4 Laura Morley Granddaughter ~ 5 000 00 3 Hemlock Hollow ~ , . Bek:hertown, Mass. 01007 i i 5 Alex Morley Great Grandson 5 000 00 3 Hemlock Hollow , . Bek~tertown, MA 01007 6 Sara Morley Great-granddaughter i 5 000.00 3 Hemlock Hollow ~~ , Belchertown, MA 01007 7 Therese Corburn Granddaughter 5,000.00 841 Anne Lane ~ Endicott, NY 13760 8 Bernadine Monaco Daughter 1/4 of re~idue 30752 Shadetree Lane San Juan Capistrano, CA 92675 ' 9 Jason T. Monaco Grandson ~ 5,000.00 24358 Azal Ct ~ Laguna Niguel, CA 92677 10 Frank Buziuk Son 1/4 of residue • 112 Tuscany Way ~ Danville, CA 94506 11 Frank J. Buziuk Grandson I 5,000.00 112 Tuscany Way Danville, CA 94506 12 Stephen Buziuk Grandson ' 5 000.00 112 Tuscany Way , Danville, CA 94506 13 Anthony R. Buziuk Son I 1/4 of residue 1823 Red Spruce Lane Mechanicsburg, PA 17050 Page 2 of Schedule J rtEV.u~a «. gaol . '~ . SCHEDULE) ~°~ Win""" BENEFICIARIES continued aess~roECeoENr ~ ES TATE OF Buziuk, Eleanor V FILE UMBER 1-09-1177 NUMBER NAME AND ADDRESS OF PERSONS () RELATIONSHIP TO DECEDENT SHARE ESTATE AMOUNT OF ESTATE RECEIVING PROPERTY 0o Met ua rN.bgs- ~) (~) j, TAXABLE DISTRIBUTIONSpndude outright spousal distributbns and transfers under See. 116 (a) (1.2)) 14 Anthony Buziuk Grandson ~ 5 000 00 1823 Red Spruce Lane ~ , . Mechanicsburg, PA 17050 ', I i i I i Page 3 of Schedule J Last Will of ELEANOR V. BUZIUK I, ELEANOR V. BUZIUK, of Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am not now married. The names of my children are: ELEANOR T. MACE BERNADINE M. MONACO FRANK BUZIUK ANTHONY R. BUZIUK All references to my children in my will are to these children, as well as any children subsequently born to me, or legally adopted by me. Page I Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: ELEANOR V. BUZIUK, sole Trustee, or her successors in trust, under the ELEANOR V. BUZIUK LIVING TRUST, dated October 14, 2003, and any amendments thereto. Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the teens of my revocable living trust as if it were in full force and effect on the date of my death. Article Three Powers of My Personal Representative My personal representative shall have the power to perform all acts reasonably necessary to administer my estate, as well as any powem set forth in the statutes in the State of Pennsylvania relating to the powers of $duciaries. Page 2 Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust 1 direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative, in its sole and absolute discretion, may elect to have all, none, or part of the property comprising my estate for federal estate tax purposes qualify for the federal estate tax marital deduction as qualified terminable interest property under Section 2056(b)(7) of the Internal Revenue Code. My personal represe~atative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property .passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses .and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for fezlEral estate tax purposes, shall be chargeable against the persons receiving such property. Page 3 Article Five Appointment of My Personal Representative I appoint the following to be my personal representatives: ANTHONY R. BUZIUK, or if ANTHONY R. BUZIUK is unwilling or unable to serve, I appoint FRANK BUZIUK. I direct that my personal representatives not be required to furnish bond, surety, or other security. I have signed this Will on September 27, 2006. ~~ ELEANOR V. BUZIUK ~ The foregoing Will was, on the day and year written above, published and declared by ELEANOR V. BUZIUK in our presence to be her Will. We, in her presence and at her request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses and have initialed each page. We declare that at the time of our attes~tion of this WiII, ELEANOR V. BUZIUK was, according to our best lmowletige and belief, of sound mind and memory and under no undue duress or constraint. Page 4 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, ELEANOR V. BUZIUK, L~1111ZJ4 J ~ a ~~ ~~c ~E J - /~/ 1 E ctS~ ~V and the Testatrix and the witnesses, respectively, whose names are signed to the foregoing Will, having been sworn, declared to the undersigned officer that the Testatrix, in the presence of the witnesses, signed the instrument as her last Will, that she signed, and that each of the witnesses, in the presence of the Testatrix and in the presence of each other, signed the Will as a witness. v ELEANOR V. BUZIUK 5ubs~ribed and stworn before me by ELEANOR//~~V. BUZIIJK, the Testatrix, and by pvn,q .l • ~.,~ ~ >9 c-k and /~EC,L/ E lr/)E CfEiV the witnesses, on September 27, 2006. ' ' ~.~ N TARY PUBLIC My commission expires: MONI.: L FR N YLVMpA ~Nb'F' A41;~ J ~ ,~ , ,Public `..~, ", ; Page 5 I~n~t~rt~~~~~~~i~n~n Article{~ne ....: ....... .....c............Cf~eatian-of l~i~. 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Fr~n~~~+~~~~`~I"~iti~l ~y~~~ ` 4-3 ,ri K i .',i 1 N i ~.~ o rt li ~ i~1i ~ ~~ 2 ~ t k >1 S~; ~~ y~~.,~ < q c , ~~~~ ~~ ~tat~n ~~` ' ~ s~ ~ ,max. i } „ n r ly ~ ~L;,., 1~. ~, ~ ~,i, Wr ,a. ~, a,~~ )' .~i~~° ~~~yy~1^J`~jj~1;'NC, jr~~~~! ~~~/ y Ri'l~4~'+{1lV ,~Kt'K4f,'~Y~{'~,"df~'+~PS r i~~r` ' ~'~t ~~ ~,'~t~v *3~A~+T~{'~'A ~iMl~ ~iW~LW ~ iq~''i`` 1 ~ ''!S 1{ L {'t ~a~ ~'/ t< ~ 'a~~,ii ? v iw, r A7 V.~ ~ ' S ~ ! _ ;~~~t"~~t ~~,'u~,im~-i'~}~~ Eb~Si~~~?~ ;~ ~'~te~`~"h1i'~~1R1~'~t+~~D1!~16`t~1(~Cl'b~ o~' in~+~~tg'~~~#~S ~b~?~t: a. lw~~~~ S 4l tsrr 64i 11'1 H 1 t5 3i+~. \i~* i r yq l l~'ll er 1 > r p r a~~~ 'nn a jd, ~ f~~~ ~[~~y ~ ~'(, y~ ~k YY k. ~S}iJ•SB f r ~ ~ ,,,5 ) 1 ~i } ~` L r ~11'S ~77.~f~ _ 4{~i1~jl~li, b r i a ~~M~T~ .V ~ / t~ t n \... ~ n~ pY t~ b i i s6 y}yy-1~ 11~~y~`((y~l s t S t . s ~ 1 ~ tI t.#1Y~'q,~ ) 1 s r P,;" d a ro- r ~u s i °~ i - 1~~'7 fi ~7 r 1 I i U4 ~f S ~„ FE( 1} G ~f> tjQ,((~~f ~t V ~~1`"~,. 1 i i Yf k't/~, y~ its ~ ~ b5 ,ir + i ~. °i C~ t.~ ~37 d ~~j191 j4A~ li pp l i~ r~ ~i ~6 ~ ~ tl t it ` ~'~ t '~~~ "~~) 1 C tJinrt FJ ~~ t Y . iq S f 7' 4 Yti a' ~~ A' i `~ 1 i P i !, '' ~ it F r i +y r~l j 7~ i~ i G~ i ~~9 ~73sa ~~;3~ K t p ~ ~ y' E ~ ~ti~i e~ ~ I f r~~'.~ ~ ! ~1 ~1' ~ \ } f1 ~`~;y, ,~ t ~ l,J r ~ k S ~~ ~ c ~4 i~ ~ l} s ~ f ~~(~ rqi ~~~~ c~~i3}i~~f~14 1 ~a~ 1 irf x y%4 {t, Y il,.x ~ i dt ~ far tv4~ fiR l.~ltj it lr>> I i,ti~ y t 1 a ~ ~'y~ 31~{aS z( ~[itiei ~<& ~Si ~17~~~ 1iy a.. ~~ l~~i ~ ( 1 ~ ~ i b}~~a yi~ ~ t ~y ~ i ~ r1~ t~V k1 ~. ~.. ~t ~ i~ii~~PS ~ ~ttl ~ u~ i yL~r~. a~ a i x ~ rZ~, ~ i ~ ~ }"+Nrh 3i ~ bat tr ~~f~,yr{ ,,w a41it~` ~vww~`) ?,Nj ~ }Ri f ~ r ~~~ ~~~Jjl s i ~ f i -, if ~ n a ~~ Y i Xff ~ 7< i5 ~ I t-0 ~ ti "~3~° ~~Sr~:: f > S qy Ae`! d {..{~ vW I} nJi i e„i ~ 1 t f3i'M~f . I i t ,~ 1~,' ,xl~ , .~ 5-1 S+~~t~~~,'~~., ;~~~~~~. l~~aa~tah Q" utstttnt~~,e ii+Ed~s, tct~~h~t~t~pl;~~, ~td~,~'ti~~~ `~~a + `"~`~`~~-~s~ i~5~ohsi~ ov~3~d by or p~ytt~~~ ~d°a1'ly #'~is. a. ~~1~!~t~ot~, bf 'Ian~u~~ri~ae `~'i+oc~e~§ ` ~~~=:':~tili'~ir, i~btii>r~ti~~ta~~'t ~ant1~ ~'~b~as yy~yp~ Ri'W~ti~i ~~ ~ tlJ lu S r h {e a ~Sa } }s{a s}ra nG i °7 S x Y"'i~ 1 t ~f X15, n\ TK, Sf f ~ ~ ~~~+ ~ ~t~~~1)~~~51~~~ ~j ~~.1~'. ~~. ~,}~~ ~~yy N J~ Y v~ t~Y 1yy)y~~,~)F y~ /yr E i f ~'I~( ~,.y~r~,yS,~L ~~±.o~, yy~ ~~\ ~'4~ )S ~.~.. ~k>?!h}~~t1 ~' FF.i W{?t'tr i tY ~y;`r~1v+'k~ a~l+V' Yi~,`l~r ~~ Hilt'' ~Gf+t }~ ~f~IQI~y l iry)A, r I ice t}+YS Npa Way, lr rRIM~i ~.~MT~f:R~~ ~~Vj•IV;~~~~~W ~~~~~~Yj{l~~l~l'Li f ~~ ~~ c epyy(r ,jay a q T_4 ~~~~ r ~~~ ~` Z! I ~ j ~ I+ ~ ~ ~ y~ i~~ 4[) l t~ F ~ ~; ~i x4 i lTi ~ / t !~ F"'°'i 4ilV4 ~ ~~ ~r7 ~~S I~' ~1~ W ; S ~ r s~ fc rite tc~Ya > a t{iyS r~ ~~~it - '.~ 1C% ~ I ~~~ S ks 4+'y~7 ~~ I ~ K s ~ - tlljsa 'y +; ~.YF ~ ~<7 ~ ~Pk~ r{s ~ ; + 's a~ ~~~ nt iiT~``~ ,, ~ ~Y~~}~ ~~~ WLs d i j ~ ap.,ca ~ f Dpi y'1~i ty~y~ r ~L 7 y~.r y~}~~~y.~ '~44} ~j~{j~~ \t~h 9~(,\~} ~'ti ~S} I ~~~~t~~YS~M~iVi'~~~1~~~~ ~~""'/~ ~11 ~'t~iYAl ~ a. ~ \a I k; I ~~ 1 ~ -. ~s~y~r~st ?F ~< a7s "~'`~pp~~''Ar +.i~O~LL~~'i '~~1~~ ~ 71s ~•~~'Y~.~~~ 1~'` ~;{ 1'4~fV'^~ .~l~+~Y4~~1KM1 `~... ~{ ~; Mfr , i ~ ~ '. E j tv 1 es ~ ¢ s i,.~ s p~ { t3 "r r sv}r §~tiii .~ xv I ti <<? ^e,vtaai 0x91} V t (G/~s ~Ia`~ (1 I ~ n ~ tj~ ~' ~ ~ i'.t ~ c i s~ fr,~ ilr ~ti~ ii I ~i dal ~ f~ h, 'Y ^ ~A~S ~~ # '~i~Pt~< 4 i Sa ~~ dry r a t ~ ~ YS t~y ~t~rs 'S~'!'fi~tr, i?(M~1 \\ V I ~ d., ~ ~~~~~ s ~ , i i i ii "dM4e~"~ ~ ~ , 4 ~ / ~~} Xu s w1 is ~1c y~ e xhNM~ ~ I ~ Y a ~ z l~~§1 )ct Y} a} {i 1(fl./; \ ~ tail ~ is U ~t r e~~~ }' of t ~ J., 4a y ~ 1 '. 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I~ Y I I ( ~ a ~~~ r w ~ ++~~ ~ 4 - nn i an i j ?#'~ ~~aaa , I' , ~ ~~jr ,a~y(;' a~~ ~ 7 ~ ,x a^s t ~~~ ~~i r ~~ pp ~ ~~ ~ ( P} t frt i t ~ Ira ~ tai ~} a ~' v jp ~a i 1 ~ T 1 ~~~ t~ .,~~ll~~ " r ~t .~ 'a ( S t Y~nt~`s~ a ~~ r ~ ~ ~ti~ >' h tQ~ ~ a r a ~x ?~ f} t ~ r a ~ > a;'t 7`}f r t a 1} A n I `` '~ fi :: a `, ,, ,~ ,.. „t ~ _. 5`2 j`~'fi'4~~~~~ ~~ ~~ 1 ~r3~_ ~~f~~~~. ~'1" ~ i~(~.. 4 +"~ ~'I~`111~t}3 ~~,5> ~(i~-lil~(~;;t~ `._ 1~~ ~} I Spi ny< 3 y~~~ !~~ 5) ~ 1 4 i~t of hey 3yi~'d b' ~Int ~ ~ P> ~ 1IF~~t; ~ fL f '~~;j~Ai4 V4y~"'rC~~~~.~ ~'.b~i~S~st~~~':l~df~l".' +p Sir 7W~~ ~~~~~, ~~~ ~~! $~~~ L~gaid~'ei~nr~~~~~~,oY~~i4ai~ ~~"~~tst~jrf~~;;bk'~i~y,,~~~aa~e, ~~~~ms~sLx~t~3t'~'~i~`t~;1~i'~t; " t, , 'a~i~`~~ti~~atua~'?~y, ~st~t~. f }~ ti", i r e a t o- r r i f71 °~ ~?,~ i ~, ~~ i`~'~""~;+~,'?~i xs n,r~` ~ ;,', ~~~,~^~`~ ,'111W1S,~ ,,li +}~,~~' ~'S'tld`~~' '' ~'~6, AI e1T~~ ~t~`~tr~~~~~i h` ~~ , c , ``°~r< ~... ~`~~~oi`~+,~`o~st~d91 ' ~„~~'~''~',~~!i~~" ~~~~~~~ar~~; ` ' r"' ' ~~'ui~1~+'~~i''i~~r~s. f l ~ ~ ~l t, + Y L ~ ~ ~ f ~~rk31 E ~ ~ s~ x.! v ~ ~ti~i ° ~ inn j i A ~. ! r ~4~ + 8 t 'f ~ r i i ~f a if y ~ y >Y' ~§tt) s t gL~kpa~t ,m~ Cv y~ ~ « tii ~`y 'dl ~ ~ ~ +,//.)) ! ~ ~ ~ '~nJ dY*jil~Kjyy,`~I~~~F~~~yj ~~ 'W~~` ~1~1 vi~tj 1v3ih'9 ~ 41ti lhs ~ ~i!rry ~lt~ ~~r ,+., ~~t„ S~b? T,Y ~,~~1' ~~~ It ~ ~ ) fE f i t S 1 . ~ ,. ,: r (~ Yi ~ f~' tb i 1 ~i` if 3 ~ ~ ~ < li T r t ~~ h Yi 1 1 if, ~i~~~ ) 1 ' I 5 1~ ' b7~ san,1 ~ c i~ ~ ~ y ~ TS pµW~ ~ d ~ ~ ! ~~ "~Y 1'M ~~ t ~!j~ ~1ig { ' h `~ L~~ ~.c a t ~ ~ -!'i ~o~~ f ~ ar ~~1 '~^~ , it r.. ~4 '~ W ~ l ~ v ` ~' ` fhr; /y}~J ~r {~t ''J ~ S 1~.J ~ ~t.r s~ ~l~ ^>ry`„)S ~ljii s, r~ t~1~ !e,^~+ i 1~. '. ~ Y'fJ! ~ ~ U 1 1f ll! ~~ ~ ~ ~ A ~il.lj : „. 1~ f ~ i i~i I ~~ ~ ~ ~~r i` ~ ~f~ ~ ~ ~ ~l i ` th ~fi )!' It f', i~~s~i ~ ,. ~~', t ptt ref ~ i la ~ r ,, r.,, ~. ,.~ ~~' i ~n ~ ~ ~~ i ~n i e , ~ iYi i ~ s ~ ~ 4 i t tk ~ i ~ ~ ~ Gi tl ~ ~ ~ ~ 1 ~~~u ri~~' ~ 1~° p, ~~? A4 ~ 2" ~~j ~ ~,'~' , ~ ~ ,4 ~ ~ i ~st t«A'~n i. in S~rtt ''¢'. e ~i~ I~q to rt z~ 7 V ',! l~{r r a ~4i 55 t t/r< n q ~ i~ ~ if }~`f r'%~n4, ,rr ~b~5tic {rr r{ref 3q~7~`Y i' o.'~;'~nu a~tt ,'.1 >, ,~1 n. ~ o 1 v i 1 ~i 71 n .r n ~ ~ ~. r b y~'~~~! ~ ~, C vxi s W u? ~ , u ,,, ~ ,.. B ,:., ~ . ,. r-; .~', ~~1 ~. T#us ~~s~#~r~ s~~x,,,t~ t~~~x~+~ ~Y ~P~~i' `mvYai~~'~~~~e~e ~~ ~~,~!1$9G;~t~, t~t~'e= ~~ri~t~tibn~ betv~!ee~'.fi~te b~~~,'~h~~t4x"~~ '~'~e~~~'?~rtYi;`s,ct fib ~:aiay of - t ~iy ~d~~t~. a. 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' ~ ~n _ . y, pi~tt~i~+~~i~'ec~~ t~~'1+~ 1s ,'~e~~d~s~ce` ~f c ~;F i ~, ''~i~~~1~~~e~b'I4~~~~~~1~~+,ftrc~er~~ie~~~~i~fi'i~~~~~a~vs-©f ~: a~ .~; ~ ~j ~t{4~ 5 ti '~~'y ,.~~ 'y~ v1 " @~i r Syr. t',t~n~ ~i. 7l~er'~';f ~ , ~1~ ~~~ ~13 `~~' 1 [ k)~j .: t l}1~4 ~ ~. . ~~. ~ ~"~,'F5~~1~~ t~ i ~t~- 4 1~1~ °< ~ fti ~y ~ S S ~~,5 S+ > "a ni ~sw ,.i~ i 1 ~tl ~ , h~~, r, f Se ~'~ ~ ' r 1 fr r 1 ..~J 4 j } 1 1 ~~ ~ ~~ 1 F ~~~ , ~ t ' *, ~ )f ~ / ~lz r~y ~~ 4~`y ° ~~ ~ kk Yuji s ~ i'iir u1~~~`i 1 r Ltiifb i f 9 5 ,Ij1v ' ~ ~'}~~. ~ tti ii}~'~{~~s ~~~~~+~~~ T' ~'' v 'dF.~ ~ b it~.11 ~ rt ~ ^ e ~ rT ~1y~ ~ ",,. 49 r ~:.~ ~ n n 1si~ '4 ",i i ~ a ~ ~ r It of { ~~ t t~~~xz ! ht " ~$~~ir7 ~ I A ~4 ° '~ U a~;h ~(FiY i.. Fl ' ~.... ~; I~:. ~,:C ~ .::\~,. 5 ~~'I 11 ~ I t K~~(C~$f~\~ylt~ej7~~~ Selo 11 i ~~ ~ ~ i }i}t ~ ~~~ nuo un ocn~axc !~ A. S. TYPE OF LOAN: U S DEPARTMENT OF NOUSINO a URBAN DEVELOPMENT 1.QFHA 2.QFmHA 3. X CONV. UNINS. 1. QVA 5. QCONV. INS. . . SETTLEMENT STATEMENT 8. FILE NUMBER: ~~ 7. LOAN NUMBER: 33332593 8. MORTGAGE INS CASE NUMBER: C. NOTE: TNf brm h AatYflwd b 9n'a you a a4brrrarN of acfwl rsWMifrnerd cosh. Amounts psid b and by 0re sff6emsM apeM are Hawn. Rana nwkd 7PGC/' were Pell ouhlda nra ebalrq; Bray are anown here brMRxms6onel purpops ad aro not inckrdfd in 0ra bfals. 1.0 L9a OOrlWN1.W:/wEL.PFntlfbltl D. NAME AND ADDRESS OF BORROWER: MiduN Danwan and MgNa I. Donovan 15/5lmromeff DrM MeeMniaburp, PA 17050 E. NAME AND A0DRE65 OF SELLER: Eshte M Eleanor V. Buziuk f. NAME AND ADDRESS OF LENDER: Metro Bank 3507 Parton Strost Hartkburp, PA 17117 G. PROPERTY LOCATION: 15451nvernsa DriW Mschaniabury, PA 17050 H. SETTLEMENT AGENT: 68-0510958 Community Land Tranaler, LLC I. SETTLEMENT DATE: JaWfry 20, 2010 Cumbeaand Counts PeralfyNtNS ................. PLACE OF SETTLEMENT 2331 Market Strosl . Gamp,HB,AA..17011 J. S K. UMMARY OF FLIER'S TION 100. AMOUNT Ol1E FROM BORROWER: 100. GROSS AMOUNT DUE TO BELLER: 101. Sala Prba 281700.00 101. CoMracl Sales Pdee 281700.00 102. 102. ParaonalP 103. Ch b Borrower Lkte U00 10821.32 403. 1a. 101. 1os. 1os. Fa 6eme Pard SNarh advance For Burrs Pa1d 8 Ss6arh adwras 108. C own Taxes b 108. C own Taxef b 107. Tars b 106. School Taw 01Tm110 b 07p7/10 108. FIOA Dup 012N70 to 70107/70 1123.81 34.79 407. Coun Tarp b 408. School Taxes 01/20/10 b 07/01/70 189. HOA Ouas 01!20110 to 70101/10 1123.51 31.79 710. 1f1 O6. O1B0/10 bOW1/70 133.31 I r 1 1 1 3. 711. 111. 712. 112. 120. GROSS AMOUNT OUE FROM BORROWER 296,615.99 420. GROSS AMOUNT DUE N SELLER 265,981.67 200. AMOUNTS PAN BY OR M BEHALF ~ BORROWER: SW. REOUCTNNS IN AMOUNT OUE TO SELLER: 201. or axnpi 202. P Anaunl of New f 203. ExM left f ifkp • l0 5000.00 213 328.00 801. Ezcesa Sp InWudbna 802. SealemeM W SB6sr lJne 1400 603. loa f Wren W b 20 254.00 204. 801. oIMN 205. o feeond 208. 506. 207. 507. 8 dhD. of s 206:_ 209. SeOer NaNl Far Orrna 8 Saaar .. 500.00 ...,506: SOB. S1Nx ASShI For pamf U B SsINr 500.00 270. C own Taxes l0 277. Cou axp 01N7/10 b OtRW10 212. School Taxp b 37.41 510. C own Ta»f to 511. CWn Takp 01/01!10 ro 0120/70 512. School Takes b 37.11 213. 573. 271. 511. 215. 575. 216. 518. 217. 577. Efuow Inhsraanca Taxes to Re r a Adbr PC 5000.00 278. 518. 218. 519. 220. TOTAL PAID BY/F0R BORROWER 300. CASH AT S FROMRO BORROWER: 301, Groa Dua Fmm Bortower Lino 1 302. Lps Anwum Paid ar Bortapr 228 903. CASH (X FROM) ( TO) BORROWER 279,062.11 298 818.99 ( 218,082A7 77,553.58 520. TOTAL REDUCTION AMOUNT WESELLER 600. CASH AT SETTLEMENT TOIFROM SELLER: 801. Groff Amount To SeINr kw 420 802. Lsfs Reductbp Ow SNkx Lins 520 B03. CASH (X 7D J ( FROM J SELLER 25,791.41 285 891.67 25,791.11 280,200.28 Thor undsngned hereby aeknowktd0s reeeka of a compbted copy of Dapas tat of thk atatemenl d arty adachmenh referred to Asrsin. ~rt~r ~G~ %~~F~' iyys--. Seller Eslaler uxiuk Mkhaal Donovan L. SETTLEMENT CHARGES 700. TOTAL COYIB651ON lrW on Prka i % 17.082.00 vuo Faau vuo Faau Sas sE N 1 Ice pA eoaaavExs Furxn AT U FuN06 AT 7 b P, 9aTiLEUEM BETTlPJ1ENT W 701. b FbrnsWed OUp, Inc. 900. ITEMS PAYAlIE NI CONI/ECT1ON YYITH LOAN 801. Loan klNOrt FN 1.0000 % b Metro Bank 802. Loan Dhcorrrd % b 2 135.25 N b lad a b ax a :L1 . N b bs. . FN b b b n l 18.00 809, b n inanelal I :l 1 . Admi N b o nk 315.00 1. 900. IfEi18 R@QUWED BY LENDER TO BE PAID 01 ADVANCE 801. InNroN From D//20/10 b OZN1/10 i 38.553100/da ( 12 da %) 182.41 rang b 903. Ha2aN Insurance Premium ror 1.D an b Enden Inwrana POC:8554.00 901. 905. 1000. RESERVFJi DEPOSITED YR7}i LENDER 1001. Halurd kgrxartu 3.000 months S 18.17 r month 138.51 1002. Msuratba months i r month 1003. C own TaxN monMs S r month 1001. TaxN 13.000 months S 511.89 r month 1005. Sdbd TaxN 8.000 rrwMha S 208.73 par month 762.97 1,853.81 1 months r r 1008, ah months r monm ~16.W 1100. TITLE CNAROEB 1101. SatlMmeM or FN b 1102. ANkatl or TIIN Seardi ro 1103. to 1101. Tkla kuurnl0e Bindm ro 1105. EMcponk DOWrrnrN b Common' Land Trenatar LLC 1108. Cbs Service Leger to Common Land Tramisr LLC 50.00 75.00 1107. A9omays FaN b irorrl numl»rs: 11 n NITY D RAN F a aeae Gam numoan1102 1103 8 1101 17 .75 11 a 213,525. 111. a 1,78.75 1 .1 1 b and rasa , LL N to nns 10. 111. N mun nns r 1 ~ eN to n • raps r, 15.00 1 1200. GOVERNMENT RECOROWG AND TRANBFER CHARGES 1201. Re FsN: Dsed i 81.00; Mo ^ S 98.00; RekasN i 182.00 1 o ~ DesA 2&17.00: 1203. SINa TaxSta 288.00 1201. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Su b 1302. PNt 1 n to 1303. 1301. Tnnsadbn FN to KaWr WlWams of Cenlrol PA 225.00 1305. RNW CM. b Fakwlnds FIOA 100.00 1100. TOTAL SETTLEMENT CHARGES Eller on LMN 103 SaUbn J and 602, Sactlon K 10,824.32 20,251.00 =r.P.qFy..u.~~.~...~.y,~e~au.~y..o~,u. mrv~amvr uF.y.iu...un y.y..r~„wa Fl Commun9y Land Tnnafer,~LLC SettbmeM Agent CenMW b Da ^ Ina copy. I OaN7/Oa{a711) © ••~,a November 2. 2009 Jackson Law b7rm Aaron C Jackson 4076 Market Street Suite 206 Camp Hill, PA 17011 499 Mitchell Street. Millsboro, DE 19966 RE: Estate of: Eleaaor V Huztuk Date of Death; Septe:aber 21, 2009 ~oEial-:Ste~+~,.'~r:.:.~209~~08tS30 Dear Mr. Jackson: In response to your request. please be advised that at the time of death, the above- named decedent had on deposit with this bank the following ac~unts. 1 • Account Type ........................... Checking Mcouat Aoc~oetnt NuTnber ....................... 3740882117 O[o-ie-'shlp (Names o„f) .............. Eleanor V BuT1uk, Grantor Anthonty R Buziuk. Trustee ~n9 ~ ...........................05/25/99 Balance on Date oJDeath......... $14.163.19 Accrued Interest S 050 Total ........................................ 514,163.69 2. Aconu~tt Type ........................... Savin~a Accoamt Ao`ount Number ....................... 15004205864926 OuaiersFtip (Names on .............. Eleanor V Buziuk ~~~•••••-•••••••••••..........10/07/03 closed 10/14/09 Balance on Date oJD~eat1,.......... 540.234.24 A~r~ed Inte-pst S 1$$ Total ....................................... $40.236.12 • Page 2 3. Account 1~ype ........................... CerttBcate of Deposit Account Amowtt Number :...................... 31003915001132 Ouxze-ship (Names o,~ .............. Eleanor V Buziuk ~~B' Date• • •• .......................09/22/06 closed 10/Ol /09 Balance on Dale ojDeath......... 55.582.87 Accrued Interest S 0 91 Ta taL ....................................... 55.581.78 November 2, 2009 4. __ a4CC01/t2t 2jype.._........_ .............:.C.al~cate of'1~eposit Account Account Number ....................... 31003915001140 Ouxiership (Names o,~ .............. Eleanor V Buzluk ~~ ...........................09/22/06 closed 10/O1 /09 Balance on Date of D~eatlt......... 55.667.55 Amired Interest S 0 93 Total ....................................... 55.668.48 5. Account Type ........................... CerkiScate of Deposit Account Account Nur-iber ....................... 31003915001158 OumerslUp (Names o,~ .............. Eleanor V Buzluk ~+~9Date•••• .......................09/22/O6closed 10/01/09 Balance on Date oJDeath......... 55,512.48 Accrued Interest $ 050 Total ....................................... 55.512.98 The above named decedent did not have a safe deposit box. • ff upon reviewing the infonmation above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible point account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our Carlisle Pike Branch at 6560Carlisle Pike Sutte 500. Mechanicsburg, PA 17050, or # 717-795-1710. Sin , N Sears, jus t Services 888-502-4349 __ ~ ooozioooz h H O M, ~ Q M 1 F1 Y ~ M rVFF ~ " -~ .. 1 ~ 11 1 w o ~' ~ r 1 b ~; ~ ~ ~ W ~ .. ~M M • • 1 C 1 1"~ ~ ~ ~ ~ M M 1 M 6 1 A Y 1 yq p OJ N yl 1 ?j 51 . 1 C p O Q 1 O O O ~ \ Ip~`lij• O O W W G 1 1!y/1 y N 1 q ~„Lr AaAa ay ~ ~~ ` ~~~ $8qW~ O~pWTi 8eeM rt b~ O 07777111 i (tly J ( N u I r F~ y yy 1~ y O 1~ y~ 1~ O 1 Q jJ ~ • K O fd ~ O O N ~1 r ~ (j ~~8 c go r~$ ~ 1°, ~ h yo1 ~ ~ °u ~ w i »~ p N N 1 jM ~ J R O 1 ~ M N W el 1 p j r r q UO yWjp ~ ~ A Oro •7} .f O Pp yyy p ~ O j O O O 1 7 r ~ O O O O ~ q pq! O N O p 1~ p ~ X ~ ~ b 1MA r r .., A r N N ~ ; .. ~ r ~* • ~ {~~ C~ 1 I R m N r l M pMM W p ~ Z A W N 1 Q b O W m a b j 10 b r J 1 1 W N • O 1 R 1 J p 0; Q a 1 1 1 I u u i f• i Q a A l p W 1 1 ~ O 1 q l N b O 1 ~O W ; F,. J : 1 N m u O i b o a i ~' 1 1 1 1 dtl''' 11l~J~ W i 1 ~'1$ v l ~ p b ~ S CpCpCp W 1 O 'O 1 YI 1 W J ~ ; q 1 1 1 I ' • r _._ _ _ _. r Oct 2B Z889 18:31:19 Via Fex -> 7177613559 The Hartfo~ faxT Page BBZ Of 882 October 2R, 2t~9 Aaron C Jackson F A..X 717 751 3554 Hartford Life Re: Hartford A[tnuity Contracx # 310162958 '~~ Decedent: Eleanor V Buziuk ~~ Dear Mr. Jackson; 'Thank you far your correspondence regarding tl[e above annuityl'codtract. +' ,. -:: .: ::. , ' he death benefit payable under this contract is not considered "life in~ui•altce":.~ " ` ' %' '~J~~_._.,,. reponable oti.I1LS ~~.':::..:.:.. Form 712, (liFe insurance statement) pl f : . ease ind the re below information in res}itiii~e:io,your`- : >;::7~ `', ~ ` • ., .° quest. >~: C.'ontract Number - ~' ~~ , ' : ; Owner 3101 62958 ~ ..: ~: -.::~;;. ' •:::: - Decedent 1=leaner VBuziuk:-;~ ~,>'-::+:.:~;~' :.°: ': r.:: : ,- ,...:::. .Soclnl.S'ecuri[y Number Eleatta'' v Buziuk :: ;. !: ; Date ojDeutlt XX.7C-XX-8530 :::. ; ' ' Cash Value on [fee date u death September 21. 2009;x::;:;.... :~.; :: ::: ;,`.: ,;; .: ' '~ ~ :~,.;~: Death .Benefit Vabee on the date of death's '` ~% :~ 562,629. } 8 'r *Thc De[uh BCnePit Val ; ....-:'.:::'::"-':' ::::~.::;•.:.,.. ~:~. ,..:,::;, :. u. re of death chsplstycd outlined in the Annuity Contract. This figure is being prW~id~ final death lx~tefil. 'Tl~e dcallt lxncGl Kill be a-(COtafi'd:on receive [he anificd death ccrli6cate. Once the dcatlt b¢dcft:'i is tu~bjocl to m~[rktt tlitctuation tuttil comoletd siatt~.,,w„~ :...n: Ifyou have any yucst.ioos or cot one of our annuity specialists by to 7 p.nt. and Friday Front 9:15 t ,you. Thank you for t}te apportut Sincerely, !F ~ .. letise feol`frec`to ccintr~ir'~; B )~Atan Investment -raduct Services IC'S Mnuity Benefit Services Team Hartford life Insurance Company. ; :.:_;"~;. ,: .. . , a .. ..., :. -~., ved . •,...: -~ o:' . p;prtSvt r3forybttf-financialiii3eds::~:`:,,:;'-,;~:':::~-~:::~~„~::::::•:~: ,: ,. ., :'l ~ :.~~' . /:. '%~ - - Line® Certificate of Confirm atlon INSURED: Eleanor V Buziuk BENEFICIARY/ACCOUNT HOLDER: Eleanor Buziuk Liv Trst ACCOUNT NUMBER: 9591921255 OPENING DATE: 12/4!2009 CURRENT RATE OF INTEREST: 1.58"/0 (Subject to change monthly) CLAIM NUMBER: 0000637216 POLICY NUMBER(S): JP5189835 BENEFITS: Benefit Amount: 10,680.80 Annuity Interest: Death Claim Interest: Dividend Amount: Paid Up Additions: Excess Premiums: Premium Refund: Loan Interest Refund: Coupons: Miscellaneous Benefds: Total Benefiffi: 510,680.80 DEDUCTIONS: Loan: Lien: Premium Due: Tax Withholding: 277 97 State VYdhhokling: Actuarial Discount: Administrative Expenses: Miscellaneous Deductions: Total Deductlons: 6277.97 Net Death Benefits: 610,382.83 Opening Balance: 610,382.83 Lli1CO~I1 Financial Group• Lincoln Financial Group is the marketing name for Lincoln National Corporation and it affiliates. 04/07 Rev a~ O 0 N .t'' ~ U ~ 3 ~ O A ~ 0 X LL m ~~ ~ U N r w~ ,, ~ ~~ ^ .r ~i ~~ ~ ~ ~ • .~ ~, ~ ~ " a o O a U w x ~ 1~ ~ ~ ~ U o ~ ~ ~ ~ *-~ U ~ AS tJ1. •1~1 ~ V] A, ~ R xa w Q a~'~a a a °' C~ ~ ~ va i `~ ~ Q ~+a U1 ~i ~ H id ~ r O O ~ ~ 1~1 ' In . Yi N 0 O ~ ~ ~i M U O ~ x a U N h rl ~O l0 M N r-1 ~1 a ~ o a rl O 0 o m N r~ t Ai N O Q1 H O O N