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HomeMy WebLinkAbout04-12-10 (3)15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~,,, County Code Year File Number Po Box zsosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 - RESIDENT DECEDENT ~ / ~ y ~ ~' ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth f 9'~Q~ 1 `~Z 9 0~~~~ ~~o~ 0~-/8l 9 ~vt' Decedents Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Wr~~.i~~'? S ~,~/y~~L~ ~~ ~ Zy3 3813) Firm Name (If Applicable) ~~~ ~ ~ ~ ~~ ~ ~ ~~ ~ REGISTER OF WILLS USE ONLY N c-_~a First line of address C7~ '°' '-, _ c-~ ~:~~ Second line of address ~ _ - i-~ i .--_ .., DA7B FfttED "r'T c C't P t Office State ZIP Code -~ 'z`t ''/ ~:-_ ~` { __, _ _'.: i y or os --,-, Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~Q»,TURE OF_ PERSON RESPO~,jISIBLE FOR FIj,IN~ RETURN DATE A~~~ S . ~ 17 J~ SIGJ~H+TU1~~ PARER OTHER HA EP ESEN ATIVE ~, DATE C crc~~7~ ~ „__: .., . ~ r PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number Decedents Name: ~ ~ ~p' ~~ ~ ~~ 11 RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. ~ ~~ ~ G U '.Cl Q 2. Stocks and Bonds (Schedule B) .................................... ... 2. , 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~ ~ l ~-~ ~ 9 6. Jointly Owned Property (Schedule F} O Separate Billing Requested .... ... 6. 7 !rater-Vivos Transfers & Miscellaneous Non-Probate Property - ,Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 1 ~ ~ ~ ~ ~-. 9. ~=uneral Expenses & Administrative Costs (Schedule H) .................. ... 9. " ~ / ~ ~ / / ~ ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. „Z ~ ~~ ~ ~ ~`1 .E~ 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ~ ~ ~~ ~~ [ ~~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~7 ~ ~-~QZ 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. ~ L/ ~ / `~ s ~ ~- TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES i 5. Amount of Line 14 ±axable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0- ~ 15 16. Amount of Line 14 taxabi~ u at lineal rate X .0 ~~ ~y ~p ~-.~ . ~' ~ 16. ~ ~ ~ ~ ,,~' ~' 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxabie at collateral rate X .15 • 18 - ~'. 19. TAX DUE ........... ............................................ . 19. ~~ ~~ a J~} 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 REV-1500 EX Page 3 Decedent's Complete Address: T~tY~~R STREET ADDRESS ~ G...~~~ L ~~'i~'v C?~i2~/s'~C Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit -. B. Prior Payments C. Discount File Number ~ j~/ ~ ~~ ~ j - -- - ,~ STATE ~~ ZIP ~~ Z y Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ~ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 ± Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) ~/ 2 G O , ~ ~ (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT u PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS I. 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 : ...................................... ....... ...... ...... ^ c. retain a reversionary interest; or ............................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? ........................................................:.............................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ contains a beneficiary designation? ...................................:............................................................................. ....... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _- ~ :~ For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)J. 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)J. The statute does not exemot 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)J. 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)J. 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, _, ~..,.~ ti~ . _ _; LAST WILL AND TESTAMENT I, LAUREN LEVI TAYLOR, of Gardners, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or,payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether oY not such property passes under this will, shall be paid by the Executor or Executrix of my estate. TWO. My' Executor or Executrix may, at his or her discretion; compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and - ~•,, f-~ 1f.~.. r.. - ~ .1 ~; f/ a _ z em owered to engage in any business in which I may be engaged at my death, for such period of p time after my death as seems expedient to said Executor or Executrix. THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, Ivlildren Rice Taylor. FO_ UR. If my spouse, Mildred Rice Taylor, does not survive me by a period of at least sixty (60) days, then my estate I give, devise and bequeath, to my children, share and share alike. In the event my daughter, Jacqueline S. Taylor, predeceases me, then her share shall be divided among my remaining living children.. In the event that Nancy L. Briscoe, Sandra J. Neff or Deborrah C. Guise predecease me, then their share shall be divided among their children, per stirpes. FIVE. If my spouse, Lauren Levi Taylor, does not survive by a period of at least sixty 60 days, and if any of my grandchildren receive a portion of my estate and are under the. age of ( ) _ ears at the date of my death, then their share shall be held in trust . by .the twenty one (21) y hereinafter mentioned trustee according to the following terms and conditions: The trustee, as well as my Executor or Executrix, as the case may be, is hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The trustee shall have. the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property, to or for the use of my children, or to accumulate it in the sole discretion of the trustee. The trustee is also authorized and empowered to pay over to, or for the use and benefit of my grandchildren such portion of or all of the principal of the trust estate as in the trustee's sole discretion seems proper for their continued support, maintenance, education, medical care or general welfare. My primary object is to ensure the continued support, maintenance, education and medical care of my grandchildren until they reach the age of twenty-one (21) years. Notwithstanding the above purpose of this trust, the trustee, in the trustee's sole discretion, may distribute any portion of the income or principal of the trust estate over to any of my grandchildren who have attained the age of twenty-one (21) years prior to the ultimate distribution hereof as the trustee deems proper for the health, maintenance, education or setting up of a child in business or in a profession or for similar purposes. The trustee shall be under no duty to distribute or use the principal equally for each of my grandchildren, but may distribute or use principal unequally in its discretion. When the youngest of my grandchildren reaches the age of twenty-one (21) years, then whatever remains of income and principal of the trust estate shall be distributed to my grandchildren in equal share, the child of any deceased grandchild taking the share their parent would have taken if living, subject to the same trust provisions if any of the benficiaries are under the age of twenty-one years. SIX. I nominate and appoint my spouse, Mildred Rice Taylor, to be the Executor. of this my Last Will and Testament. If my spouse has predeceased me, failed to qualify or is not able or does not serve for whatever reason, then I appoint Sandra T. Neff to be the Substitute Executrix of my estate. In the event that Sandra T. Neff prredeceased me, failed to qualify or is unable to serve for whatever reason, then I appoint Deborrah C. Guise as the Substitute Executrix. SEVEN: , I hereby nominate and appoint Sandra J. Neff to serve as trustee of any and all trusts created herein. EIGHT. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. NINE. No Executrix, Executor, Trustee or Guardian acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 6TH day of February, 1995. i ~,. (SEAL) LAUREN LEVI TA Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ACKNOWLEDGMENT AND AFFIDAVIT WE, LAUREN LEVI TAYLOR, TERESA M. HENRY, and CHERYL L. CLELAND, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ , i LAUREN LEVI TAYL _ TERESA M. HENRY HER L. CLELAND COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND - Subscribed, sworn to and acknowledged before me by LAUREN LEVI TAYLOR, the testator herein, and subscribed ands orn to before me by TERESA M: HENRY and CHERYL L. CLELAND, witnesses, this ~ day of February,1995. o><ary Public • Notarial Seal Belzi A. Morison, Notary Pubfic Carlisle (3oro, Curnt~eriand County Nly Commission Expires Dec. 15, 1996 Member, PennsytvarnaAssoaation of Notaries 2 48500041046 ~ ~~~== /,.'~ f, REV-485 EX (05-04) ~ ,~°~~ ~~'~ ~~, ~. ~~ ~, SAFE DEPOSIT ~•,~-~' BOX INVENTORY PLEASE USE ORIGINAL FORM ONLY PA Department of Revenue Social Security or Death Certificate Number Date of Death County Code Year File Number / Suffix First Name MI Decedent's Last Name CITY: STATE: ZIP CODE. ADDRESS OF DECEDENT STREET: _ ~ ~ ~, ~ ~ ~ ~ ~ ran ~-, i~~~ ~ ~ ~Z v ..- .~; NAME AND ADDRES OF PERSO~QU„~TIN~ HE OPENING OF THE SAF/E'~D/E/~S~GOX NAME: ~'~ /~~ ~ ~C//'C: ~ ~`/~~L CITY: STATE: ZIP CODF~; STREET ADDRE S: ~~• ~~~ ~~~ C °~~`~~•J'GG f~f~- ~ ~D/ ~ NAME, ADDRESS AND RELATIONSHIP (IF ANY) T DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING RELATIONSHI/P:,,~ a. NAME: x/~y~G• ~ .~/i~GCS•Cl"~/'' STREET ADDRESS: CITY STATE ZIP CODE: ~7 b. NAME: S' ~~~w^/~~Z ~' RELATIONSHIP• ~ ~U~Z.+~/~C /' Gri u_. ~ ~ CITY: STATE: ZIP CODE: STREET ADDRESS: ~ G.~ /~5=1.S~r , S~ . 2P5 C/,~i~c~s~~ P~ 1~i3 r c. NAME:, L¢C( ~ • _ RELATIO HIP. ~ ?~~ 1(LV1G• ~~ STREET ADD//R_ --S: /~ ~ ~~ ~ / CITY: ~~ ~/ ~/~ ri~v}-s /eo < TATE: ZIP CODE: ~f~-- l ~l/'~S_ r ''C ° We f / NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ~~~ /~ y~ ~ ~_._7Y'T Lam- E T ADDRESS: CI • m ~~ : SATE: ZIP COD /~ ~ - ~~, STREE Gf /~irJe- S ~ ~ ~ G ri S NAME OF PERSON MAKING LAST ENTRY ,uI ~n~ J r"f DA E AND TIME OF LA 1UC(~ ~'k ST NTRY - ,~ Z f lJ DATE OF CONTRACT TO RENT BOX • NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REO 1~STED ~ ~ - eve G ' ~ ~ ' ~ f~J (e i AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX NAME b. NAME: / a. NAME: /' '^ ~ l (C'I ~C'C{ ~ y~L w' STREE~ ~RESS: S ~ A Z RESS: Z STATE: ~j~ ZIP CODE: CITY: jp ~~, ~~IC~ S STATE: n~ ZIP CODE: CITY: /~y~ A~ /' V /~~~) I~~G~-~ NA^~~^E AND~ITLE OF EMPLO~~,TAKING THE INVENTORY WAS A WILL IN THE BOX? ^ YES NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will NAME: CITY: STATE: ZIP CODE: STREET ADDRESS: c. Name and address of attorney, if any NAME: CITY: STATE: ZIP CODE: STREET ADDRESS: C-~rCr:~ Uzi ,~- 48500041046 48500041046 J ce~~ nFpn~~T R[~X INVENTORY Page of raw-+oo cn vi ~^ ~... .r ~..~ ^ .. -- - - INSTRUCTIONS (1) Cash: Report total only. ' (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. ' (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: fist and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE • INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION r T=i`~i~ ?~ ~:2,s~ G~C`7 ~ lO ~ - G 2 c~ ~ 3 r 2 ~i ~.r~ `~ ~ . ~C3 ,,, G?O /hi f crr..c.~/.P ~~-. L/~t~r L 7`~i Lcrt._ Z. Q/2/~ G L S' AG L Qb Z ~ ~ /l- ~ ~ X16 2 r-t' . '~/ G oGO , o0 1~reKl L . '~`~ tcz ~ • G.v.~z~,~ /~ 0 ~- ~~ ~ -^_ Lc y~ ~' ~~ tL,,'GC /~/~-' ~ ~r~~ I CERTIFY UNDER PENALTY OF PERJURY T T THE ABOVE RECORD IS ND COMPLETE TO TH BES F Y KNOWLEDGE AND BELIEF. CORRECT A PERSON RECEIVING COPY OF SAF EPOSIT BOX INVENTORY: _ SIGNA/TjJR_E ~~ /J ~/ i /C%^/.K '' -9--~ .tea /~L~XL PRINT NAME ~ ~, L ~. ~~ ~. ~ . ~./~~~~~ SIGNA E ~ RINT NAME AND HECK APPROP IATE BOX BELOW: ~,S°G,v a ~ T : ~v c- ter' --~. PRINT TITLE ~,~,~.,Y' ~l~,u~'~ ^~~ vTN~ ~ / ` ~/~ //n~,..s~-.~ ~~~ ~Q ~~81J~/J~J'tj{~,L. / ~ ~ DATE ~~2 ~ ~F6E' CHECK APPROPRIATE BOX: ,~ Executor(trix) ^ Administrator(trix) ~ Estate Representative ~ Joint owner of safe deposit box ttach additional 8'I=' x 11" sheet(s) if necessary or use duplicates of this page of form. A N OTE: The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements .._a ~,.,...~ ..,,,,,.,..,,,a„~f,o~ Ttio ~r~fo hw nrnhihitc tha CnmmonwealWS personnel from disclosing confidential tax information except for official purposes. mug i cvcim any ,wu, ,....,, ,y ...,.....~....,... ..._ . REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real property own 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 orooerty which Is Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCCRIPTION 1, i ~ • ~ ~ ~/ ~~ ~. / ~ ~ 3'~ y ~~ sal-t-- VALUE AT DATE OF DEATH J TOTAL (Also enter on line 1, Recapitulation) $ f ~ ~~i ~~ "~`'~' `~".,~. (If more space is needed, insert additional sheets of the same size) u s DEPARTMSETTLEMENT STATEMENTEVELDPMENT CORNERSTONE LAND TRANSFER, INC. 4705 East Trindle Road Mechanicsburg, PA 17050 Phone: (717) 730-9664 Fax: (717) 730-9665 U~M'3 'VC. LJUL'VCO~ TITLEPPO Laserpnnt ~B. TYPE OF LOAN 1. ( ] F,yq 2. [ ] FMHA 3. ; J WNV. U~u rva '. 4. ] ~ vA s- [ ; coNV. INS. ~. 6. FILE NUMBER: 7. LOAN NUMBER: i 70003 8. MORT. iNS. CASE NO.'. NOT_ `his `orm 's?urn shed to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items ..^tarked '(p.o c )' were paid outside the closing; they are shown here for'nformational purposes and are not included in the tctais. F. NAME AND ADDRESS OF LENCER. ~. NAt.tE ANC ACDR"eSS CF BORROWER: E. NAME ANC ADDRESS OF SELLER: Thcmas Conn Lauren L. Taylor Estate Aegis Wholesale Lester Miller Corporation One Monroeville Center Monroeville, Pa. 15146 G PROPERTY LOCATION: Gardners, PA 17324 4506 Carlisle Road Dickinson Township Cumberland County J. SUMMARY OF BORROWER': too. GROSS AMOUNT DUE FROM BORROWER tot. Contract sales price toz Personal property to7 Settlement charges to borrower (line 14 104. tos H. SETTLEMENT AGENT: CORNERSTONE LAND TRANSFER, INC. PLACE OF SETTLEMENT: Law Office of William S. Daniels '~SACTION: K. SUMMARY OF SEL 4oo.GROSS AMOUNT DUE TO SELLER 130400.00 4ot.Contractsalesprice aoz.Personal propert 15087.05 407. 404. 405. Adjustments for items paid b seller in 106. CityffOwn lax to 107. County lax to toe. Assessments to 109. SCHOOL 02 08 071006 30 07 110. ~_ IO 11i l12 t 20. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER zot Deposit or earnest mone ~ro Princioal amount of new loan(s) 204. 205. 207 Adjustments far items unpaitl z w. Ci[y(Town tax to zit Counrytaz O1 O1 071002 08 2i2. Assessments to 217. SCHOOL IO 214. 215. 216. 217. 21 B. 219. 220. TOTAL PAID BY/FOR BORROWER 700. CASH AT SETTLEMENT FROM OR TO BORR~ lot. Gross amount due from borrower (line 1. 7oz Less amount paid b /for borrower line 2 707. CASH ([$FROM) ([ ) TO) BORROWER er~ Borrowgt~s ~ignalure \~\ / ter ice Adjustments for items paid b seller in 4o6.CitylTown tax to 4ozCounty tax to aos.Assessments to 514.58 4o9.scHOOL 02 OS 07to06 30 07 410. to 411. 412. 14 6 0 01.6 3 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 1000.00 soi.Excessdeposit see instructions) 8 0 4 0 0 . 0 0 so2.Settlement char es to set er (fine 1400) so7.Existin loan(s) taken subject to so4.Payoff of First Mortgage Loan sos.Payoff of Second Mortgage Loan 506. 507. 508. 509. L SETTLEMENT DATE. 02/08/07 130400.00 ~ 14.58 I' 130914.58 034.00 items unpaid by seller to I 27.10 'r 27.10 sn.Countytax ul/ vl/ ~ rwv~.7 ~~, ., 5t2.Assessments to 517. SCHOOL t0 514. 515. Sib. 517. Ste. 519. 814 2 7.10 520.TOTAL REDUCTION AMOUNT DUE SELLER 8 0 61.1 0 CASH AT SETTLEMENT TO OR FROM SELLER 600 14 6 0 O 1 . 6 3 81427.10 . 6ot.Gross amount due to seller (line 420) 6oz Less reduction amount due seller (line 520 13 0 914.5 8 8061.10 6 4 5 7 4. 5 3 6oa.CASH ([ $TO) ([)FROM) SELLER 12 2 8 5 3. 4 8 r~ i Seller's Signature UD-i Rev. 5/86 U S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT OMB No, 2502-0265 SETTLEMENT STATEMENT ^ w^ Page z TOTAL SALES/BROKER'S COMMISSION baced on Division of Commission (line 700) as follows: ~ 6520.00 to $ to 130400.00 5 Total: $6,520 Dawn x Associates BORROWER'S SELLER'S ~,, FUNDS AT 1, FUNDS AT SETTLEMENT I SETTLEMENT 652G.00 ~c3 CaT~missionoaloatSettlement ~ 00 195.00 195 tans fee Dawn & Associates . ~c» 300 ITEMS PAYABLE IN CONNECTION WITH LOAN Americar. Advanta e Mort ai 804 • GC ' ao, ~_oan Ongrnation Fee q aozl-x~z$~~zx Yield spread° remium d to broker b lender 2512.50 ocl 903. Appraisal Fee to , Amerlcar. Advanta e Mortca 14.16' 9ca Credit Report :o CMi Collection 14C.0~' acs ~x~cx~ AT &T Co 1 i e c t i on 13 5 . 0 0 ,ace ~~t,cxagecxxx~xksxi~ex~x5eexa 0 0 ': 51 ae~ ¢coatfca®cx National kecover American Advanta e Mort a~ . 650.00! 'ace Processin Aegis Wholesale Cor orati 596.501 X909 Aam fee n t ll 214 00~ r io ec Omnium WW Co I a1o York Credit Bureau 158.00 I 911. 900. ITEMS REQUIRED BY LENDER 1 D ne rnw u. n~..a..... /day 3 5 7 . 3 9 sot lnteresttrom 02 08 07 to02 28 07 ®$ xaDCx~Pxamdaaxisxxxxxxxxx~oxta C a l va r Port Co 11 e c t i o n r r i 902 ~c~~ec m; c ~'xxxx~dxxxxxxxxxxx~xR~ Account Recover 3 0 7. 0 0 ' 903 ~ieza~I~saa;~esLac yrs. to National Recover 413.00 ' sox AFNI Collection 313.00 905. 7000 RESERVES DEPOSITED WITH LENDER FOR 19 5 . 0 0 '. ~ ~' ~~ 0o I . Hazard Insurance 3 mo. ®S 6 5 . 0 0 Imo. ~ 1002. Mortgage Insurance mo. ®$ /mo. 7003 City(f own tax r^o ®$ IR1O' 2 5 3 . 6 8 ooa. County tax 12 mo. @ $ 21.14 Imo. too;. Assessments mo.@$ /mO $$4.24 ' loos School 8 mo.®S 110.53 /mo ' @ $ Imo. oo~ mo. - 5 3 9 . 6 7 - tooa A Ad mo ®$ /mo. - ---" j 100 TITLE CHARGES Jud ement Docket 9200672 2010.00 t1c1 s,~it~~x~tx~x~x~~x Jud ement Docket 95047567 1190.00 noz A~4C§~lkRh~iNS[R4t~[ xi4x Account Recover 703.00 ,103 T~ Penn Credit 616.00 7toa T Lvnv Fundin 585.OC' ttos. Cash 25.00 15.00 ttoe Notary fees to William S. DanlelS Attorney's fees to 107 . (includes above itemsNo.:) 1101 1105 Land Transfe "'"`"'" 1013.75 Title Insurance to Cornerstone 7108. 4 10 1 103 1 2 10 No.. 1 ms ite ve bo ) es a lud Inc 0 4 0 8 e ra $ ve is co e end L 9 9 110 n to. Owner's coverage $ 13 0 4 0 0 Cornerstone Fidelit Natl 150.00 _ -` 1,tlEndts. Fidelit National Title 35.00 ,17z CSL Cornerstone Land Transfe 15.00 173. Courier 200 GOVERNMENT RECORDING AND TRANSFER CHARGES D G 1 D 3 tzo7 Recording fees: Deeds 38.50 Mortgage$ 64.50 Misc.$ . 1304.00 ~ zo2 City/county tax/stamps: Deed S 13 04.0 0 Mortgage $ ~ 13 04.0 0 I 1zo3 State tax/stamps. Deed$ 1304 • OOM t 00 I 302 ional Recover Na . 12oa Globe Home Warrant 414.00 Izos Trlarrant 300. ADDITIONAL SETTLEMENT CHARGES A ex Asset Collection 2 5 2. D G t3o7 to CBaly Creditech 250.00 to 13oz P - D.E.W. & SOns 260.00 1303 Se tic set Advance Look Buildin Ins 380.00 3oa Ins ection Cornerstone Land Transfe 25.00, 3os e-doc n, ce~ri~r,e landl(t 15087.05 8034.00 1400. TOTAL SETTLEMENT GHAR(itJ (enter on une> ivy _ ~~ ~~-. ---••-~'- - -- Parries agree Thal no liability is assumetl by Settlement Agent for the accuracy of Information furnished oy others as shown an the HUD-1 Settlement Statement. Settlement Agent hereby expressly reserves the rlgM to tleposll any amounts collected for disbursement in an Interest bearing account in a Federally insured inslilWion antl Io credit any Inieresl so earned to Its own account as additional Com pensalien for its services in this transacllpn. HUD CERTIFICATION OF BUYERS AND SELLERS I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowle o9 the HUD 10fSettlemenl Statementrate statement of all receipts and disbursements made on my account y me in this transac' n. I further certit t t I have received a copy GZ Sellei s Signature 9uya1~/t3orrower'sS n~e , Seller's New Address 6 Phone ~T Huyer s Address 8 Phon 1 /~~]„/' -~ 6/ / 1 /c/,en ^ 9 ) 1 i he i ~~`jD~ 1 Solllem and Statement wnich I have reparetl Is a 1 nd accurate account of Iris Iransach(o~n. t~h~/B cay`~u 15o ViT or~ ~sE the funds to be disnursad in accortla nce witn this Stale ~en1 ~ ~~ Date Settlement Agent connclion can include a Ilne and imprisonment. For tlet ails see _......, .. _ _ _..__ ~.. ~,,,.,.,.,,,.i„ ma4e false statements to the Unlled States on This or any similar form. Penalties upon HUD 1 Nev. 5186 REV-7508 IX ~ (1-9~ SCHEDULE E CDMMONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, 8r M~S\.r. INHERITANCE Tax RETURN PERSONAL PROPERTY RESIDENT DECEDENT l FILE NUMBER -~_/ ESTATE OF ~ ~1~ iG!% ~!'T~ O~-~ rl~ L-- r ~~~G -' ~ ~' ~ "tCj Indude the proceeds of litiga' nand the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER ,. ~~C s - /,~ / ~~ ~ ~. [~ 5.~~ 5, t, ~ I^,.~' c ,tea ~~ z, r~N ~ ~. / `~~ ~~ p~ ~C ~~/~L~/ G~ ~~~~~ 1 ;~ i ~ ) / ~ , 2-S ~~ S' ~o f~X ~~/ ~~ ~~ ,, G / ~r TOTAL (Also enter on line 5, Recapitulation) 3 ~~ T ~ ~f ~ l (If more space is needed, insert additional sheets of the same size) ~ c~r~ 'p~1,~( Erica L ` , `~~ Schlegel/Consumer/PGH/PN C 08/21 /2006 08:38 AM To Judy YawlConsumer/SCP/PNC@PNC cc bcc Subject Fw: Date of death balances ~y~y ~,~wji alawa co~r~ide~tce a~cd t.~ie c~a'P~y~~ ~ l~ ot`se~ca . ---- Forwarded by Erica LSchlegel/Consumer/PGH/PNC on 0812112006 08:38 A.M ----- ~h {~ Erica L ~ V Schlegel/Consumer/PGH/PN To Judy Yaw/Consumer/SCP/PNC C cc 08/10/2006 10:22 AM Subject Date of death balances ~ ~ ~ ~ `'_' ,~~~~~ ~i I i ~ .= 1' j /1~1 ~~ ~ ~, ~%~ ! r ~ ~ ~ ,_ ~. ~'= f" ~ G ~:L s' . i Estate of Lauren L Taylor (Deceased) SS# 197-07-1929 DOD 07-27-2006 ACCOUNT NUMBER * DATE OF DEATH BALANCE f ACCRUED INTEREST CDS #31900235166 $721.29 + $5.57 f DDA #5140192836 $2,083.70 Non interest bearing account SVG #5130320064 $677.36 + $0.01 Safe deposit box #6761ocated at the Mount Holly Branch. If you selected the balances to be sent to the "Branch" they will only be sent to The requestor by Lotus Notes. Have a great Day !!! :-) ~y ~;ade~c4`iu~fi alwcud co~s~ideace aid tl~e cvi2~.i~c ykecd to lseG~i a~iena APPRAISAL Estate of Lauren "Shorty" Taylor 4506 Carlisle Road Gardners, PA 17324 Cumberland County- Dickenson Township Sondra T. Neff, Executrix 1147 Myerstown Road Gardners, PA 17324 Phone (717) 486-5209 Personal Property: Cooking Utensils-------------------------------------------------------------------------------$ 50.00 Flatware and utensils-------------------------------------------------------------------------- 20.00 Dishes-------------------------------------------------------------------------------------------- 25.00 Sharp carousel microwave-------------------------------------------------------------------- 8.00 Frigidare refrigerator-------------------------------------------------------------------------- 55.00 Small electric kitchen appliances------------------------------------------------------------ 18.00 2 pictures -prints of elderly man & woman ---------------------------------------------- 16.00 2 bar chairs @$6.00 ea.----------------------------------------------------------------------- 12.00 9 pc. cherry dining room suite--------------------------------------------------------------- 350.00 Step stool--------------------------------------------------------------------------------------- 2.00 Singer elec. sewing machine in cabinet---------------------------------------------------- 12.00 Wall clock-battery operated------------------------------------------------------------------ 5.00 Collectable & antique dishes----------------------------------------------------------------- 35.00 Collection 19 Jim Beam Bottles------------------------------------------------------°----- 38.00 2 jugs @ $12.00 ea.---------------------------------------------------------------------------- 24.00 10 peanutbutter glasses @$5.00 ea.--------------------------------------------------------- 50.00 2 cane seat rockers @$18.00 ea.-------------------------------------------------°'----'---- 36.00 ------------------------------------------- 8.00 Trunk-------------------------------------------------- Rush seat & back rocker-----------------=---------------------------------------------------- 35.00 2 floor lamps @$8.00 ea--------------------------------------------------------------------- 16.00 Crib---------------------------------------------------------------------------------------------- 1.00 Large picture----------------------------------------------------------------------------------- 8.00 2 pc. living room suit------------------------------------------------------------------------- 20.00 Wooden child's potty chair------------------------------------------------------------------ 4.00 Thomas Kinkade picture--------------------------------------------------------------------- 7.00 Zenith 30" table model television----------------------------------------------------°°--- 25.00 Television stand------------------------------------------------------------------------------- 12.00 Microwave stand------------------------------------------------------------------------------ 8.00 Plank bottom chairs 6 @$10.00 ea.-------------------------------------------------------- 60.00 Wall mirror------------------------------------------------------------------------------------- 12.00 Walnut coffee table--------------------------------------------------------------------------- 15.00 4 table lamps @ $3.00 ea-------------------------------------------------------------------- 12.00 Gone with the Wind lamp------------------------------------------------------------------- 65.00 Modern Gone with the Wind lamp--------------------------------------------------------- 15.00 -2- Kerosene lamp-finger style-----------------------------------------------------------------$ 12.00 Modern kerosene lamp---------------------------------------------------------------------- 6.00 Westinghouse elec. table fan--------------------------------------------------------------- 6.00 ---------------------------------------------- Floor fan----------------------------------------- -------------------------- 3.00 9.00 Oak frame mirror--------------------------------------------------- -- ---------------------- 55.00 Oak library table------------------------------------------------------ ------- ------------ 00 25 Admiral elec. clothes dryer---------------------------------------------- ---------------------- . 00 5 5 --------------- GE Automatic washer-----------------------------°-° -°----°----- . 00 15 Apex 13" table model television--------------------------------°--°---'--- . 4 pc. maple bedroom suit w/box spring &mattress---------------------------------° 55.00 ------------------------------ bath items &doilies----------------------------- Bed linens 3 0.00 , 4 pc. maple painted white bedroom suit w/box spring & mattress------------------- 25.00 Cherry gateleg drop leaf table-----------------------------------°--°°--------°--"------ 250.00 4 shelf bookcase------------------------------------------------------------------------------ -°---° 5.00 00 30 Bissel & Eureka upright sweepers @$15.00 ea.------------------------------°- . 4 pc. veneer bedroom suit w/box spring &mattress---------------------------°-----° 65.00 -------------------------- Cedar chest---------------------------------------------------------- -------------------- 35.00 00 25 24" McCullough chain saw--------------------------------------------- ------------------- . 00 20 29" JC Penney television------------------------------------------------- ---------------- . 00 75 ---------- Slant front secretary/china closet--------------------------------- . ----------------------------------------- Sentry safe-------------------------------------------- ------------------------- 5.00 8.00 Sled-------------------------------------------------------------------- --------------- • 00 7 - Round table and 2 lawn chairs set-------------------------------°-°--'-- . 4 folding lawn chairs @$1.00 ea.---------------------------------------------"------------ 4.00 ---------------------- Craftsman 6 hp. lawn mower w/bagger----------------------------- 15.00 Miscellaneous items, hardware & garden items not mentioned---------------------- 100.00 TOTAL $2,055.00 APPRAISED BY: r` J. Pei r~Auct neer (PA LIC #AU-709L) 7 Clear' pring Road Biglerville, PA 17307 Phone (717)677-8086 ....-- Date ~~ ~" DEPARTMENT OF T~2ANSPORTATION • CERTIFICATE OF `TI x E FOR A VEHICLE Y ~- - ~ ' ~, ><q- ) ', 95~+S~D461flfl7389-DD1 y ~ MS©U7PAbD7DD2 ~lfi ~IE~tCURY 93 487,721G48D2 TA ;£ I£~ft~ 1 L vENll,,LE IgENTIFICATION_NUMBER I YEAR i ~~ MAKE OF VEHICLE I 1 'IT.E'vUM9ER i i" SI3N" D ( I ~ 3 SEAT GAP ~~ "DUD BODY T'iPE ~ UNLADEN WEIGHT } GVWR GCWR TITLE BRAP~DS ~~`= 3!95 2L21~l95 6!2 NJ ~ 6/23/95 I D27172 I D ' ZED I . DATE PA. TITLEp „' DATE OF ISSUE PRIOR TITLE STATE ODOM. PROGO. DATE >'; GDOM, MILES GDOnq, S TAT'JS - ~ ODOMETER STATUS ' ~ 0 ACTUAL MILEAGE ~yf - ~ ~ 1 MILEAGE EXCEEGS THE MECHANICAL €~~ ,, ~r ~w ° ^~ a~wa ~ ~-~+ i =vDr TH~'KGTIlA{,MILEAGE . '.'. ~ .._,a _~. . _ 3-NOT THE ACTUAf~ ILEAOE ODOMETER TAMPERING VERI i ~ J - / ~ ~ ` 4-EXEMPT FROM ODOMF}~ER DISCLOSURE -S I ` ~ TITLE BRANDS = ~ { REGISTE DOWNER(S) ~ n I /~ g - A- ANTIQUE VEHICLE C-CLASSIC VEHICLE - { lOR ` LAU ~N L 'TA1( ~ ~ r ;.,~. _ F - OVT OF COUNTRY . -ORIGINALLY MFGD FOR NON•~I5. I. J c n l T (t~~ _ ~SO ~ GA RLIS~~ ~RDAV ~ DISTRIBUTION HICLE ' ' ~ NERS PA 17324 GA ~.' # - AGRICULTURAL VE H L ° L~'GINO VEHICLE ' HICLE es ~ R 1 1 P - FORMERLY A POLICE VE f I I a R-RECONSTRUCTED S -STREET ROD I y I ~ j f T -RECOVERED THEFT~HICLE 3 V -VEHICLE CONTAINS IIEiSSUED VIN $ W -FLOOD VGHICLE '~ u ' ~ ~ ~ ~ECOND LIEN FAVOR OF: X - FORMERLY A TA ( ~~ FAVOR OF FIRST LI qq ~a ~ ~i~ ~ ~ / ~. ~ - ~ -:~ ~ t 1 .. ~~ I ~ ~ ~ ~t a second lienholder is listed, upon satisfaction of the first Ilan the fhst i l me ~- ~ ~ ;yenholder must forward this m and fee i l f es w th. the Title to the ~uteau of Mot'r Vehic l ~ fns 1 d FIRST U RELEASED AT . or a e ' ~ pPropr E. k I ~ f ~ . ~EGOND LIEN RELEASED ~, ~ ~ MAILING ADDRESS LAUREN L TAYLOR 450b CARLISLE ROAD GARDNERS PA 17324 z 5 F a z:rai4A's+-~ BY AUTHORIZED REPRESENTATIVE ~ ~ ;: lof the~,vehk~date of Issuee official records of the Pennsylvania DODartnTent ~ _ _.. of Tra rtatlon reflect that the rson(s) or company named herein is the Iawtulowner - ---~~; BRADLEY::` ~,`''MAt~flRY / Secretary of Tianspartation ~~~ - Illle wllh a co-owner, other than you/ spouse Check, one of When applylrp tor - - " ' ~ ! L SUBSCRIBEpAND BVARN q• ~ , n Common . these bbgka M no bock Is checked title will be slued as,'7enants ~ - I Z~ , trf , ' TO D~FpRE ME; '. DAY YEAR gges i A.,O Jomt Tenants with Right of Survivorship (on death oCpne,owner, Mle M' i ii MO j fi ~ ng owner). to the survw Y B~ O Tenants In Common (on death of one owner, interest of deceased owner t rt ' f goes to his or er heirs or estala). f{ _ SK3NATURE OF PER N ADMINIS ING OATH {LIEN IF NO LIEN a \ CHECK BOX - PATE "yam{_, . : ~: I IRST LIENHO ER, .-,f t '~~ ~JAME sr a ~s ~i Sri ' I _ J ~l l'~{IIV(D I'~Fr"CF+t." --. •.•~ ~~~ W :Iir 'STREET ,` - , . ~ t ~: _ t/1 ~ITY _ O f' I TATE ZIP :~ s~ N F EN IF NO LIEN ^ CHECK 80% u i` I ~. cribed hi l d h ~ ATE: fis e es e ve c The urWersigrled hereby makes application for Certilicale of Title to t O i rSECONO LIENHOLDER ` above, suCfect tp the encumbrances aM giher legal claims set lorth here. ~ I ~ ~ ,NAME ~~ia - I f~~ ~TREET ~ ~ril t- SIGNATURE~OF APPLICANT OR AUTHORIZED SIGNED ' ~7 3T•. ~ IT`. ~ +' ' ~~ ~ O ? TATE ZIP .. Z~ ; ~~ .. S)GNATURE OF CO APPLICANT/TITLE OF AV~HORIZED SIGNER V !. A_~ a. Nom. 0~~~~4a A. PA Tfr NL+Ml3Ef?LAS SHOWN TTACHED TITLE) '- ~ : ~ P ~ VEHICLE MOp YEAR PURCHASE PRICE ~~ ° W'. ,~ ~ / , ~ j ~ J ~,J'-~ ~ ( CCC333 / ~, ~ (See note on reverse) ; :~:; ^ ~ ^ „a , VEHIGL~ IDENT+F-!CATION NUMB R ~ ~ ~ ~ ~ CCNDITION _ LESS TRADE-IN ~ )~ l ~~ ~ ~ ~~ ° ~ 1 ~ ' ~! r ) '~~ ~ ~ y, D ^FAIR ^POOR ^ ^ t /_ f -~ f lV • L.++~~ `A (QR FULL BU INESS NAME) /FIRST NAME ( MI(pDLE INITIAL S' ~ ~ / TAXABLE AMOUNT L~---~, '--- ~~~ `` / ~ t ~ m i ~ --'- 'r"' CO-SEA ~R t. Sales Tax Due z 6% `.O6} or ~ ~ r~ ~~ (See Hole cn reverse). - ~ / ^ ^ I C i, ~ ~ `AS~'NAFt1E IOR FULL BUSINESSNAMEj / FIRST NAME MIDDLE I TAL Jp~\ I f j ~ / / • DA'f~ACQUIRED/ f'llRCH q / - ~/ 1A Exemption Reason (Qde (must be a number#mm 1 i .- ~ ~ ~ ~ ,. ~ ~ f ~ I i ~ i ~. i. I ~ CO-PURCHASER 18 First-Assignment ... ~ gnment :1B SeconD Ass -.... a I I c ST~?EET ' COUNT Y CODE - y°~ .~ ~ ~~, - n - n ; / ~ 1 /~ 2. Tdle Fee J ~ ~~, /, ATA7E % CODE / y! `~' -- ~ I i. ~ f ~ C ~ ~~ / EFER TO COUNTY-CODES USTING ON REVERSE SIDE OF PINK.COPY 3. Lien Fee - '^ -- • ~ LAST NAME (OR FULL BUSINESS NAME} "' FIRST NAME MIDD INITIAL DATE ACQUIRED/ PURCHASED 4. Registration or . processing Fee ^ ^ CO-PURCHASER Fee. Exempt Number: ~ as assigned by the z Bureau f ~ z "' ET COUNTY CODE 5. Duplicate Reg. m = STRE -- --- -'Fee-------_._..__. _ -$ o -_Q ~ No. of Cards ^ ^ ^ Z STATE ZIP CODE CITY REFER TO COUNTY CODES USTING ON REVERSE SIDE 6. Transfer Fee OF PINK DOPY ^ ^ E MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER 7. Increase Fee J ° ^ ^ Uw ° _ MODEL YEAR BODY TYPE{CP, TK, ETC.) CONDITION ,. 8'Replacement ~ ^ GOOD ^ FAIR ^ POOR Fee ^ ^ 9. 10. F. ORIGINAL PLATE / Check One ^ TRANSFER OF PREVIOUSLY ISSUED PLATE TOTAL PAID h 6 TE TO BE ISSUED BY ^ TRANSFER & RENEWAL OF PLATE (Add t I ru j ^ ^ ^ PLA ~ - d Cr S - BUREAU (PROOF OF IN- E MUST BE AT- ^ -TRANSFER & REPLACEMENT OF PLATE _ ~. - ' - - 1 t.GRAND TOTAL en te Check in ~ ~• - ~ \ - SURANG TACHED.) ^ TRANSFER OF PLATE 8 REPLACEMENT. OF STICKER (Add 9 8 10) This Amount y / ( ^ ^ EXCHANGE PLATE TO BE PLATE NO " -R EASON FOR REPLACEMENT ISSUED BY BUREAU ^LOST ^ DEFACED ^ STOLEN ¢Q Z TEMPORARY PLATE ISSUED BY FULL AGENT EXPIRES Month Year ^NEVER RECEIVED (LOST IN MAIL) NOTE: It "NEVER RECEIVED" block is checked a licant must com lete Form MV-aa z F ~ "~ pRANSFERRED FROM TITLE NO. VIN ~ o ° f ,'../`~^-~' :'r _t - ~ SIGNATURE OF PERSON FROM SIGN HERE WHOM PLATE 'IS BEING TRANS- RELATIONSHIP TO APPLICANT a c '. . . 3~j~;~iT;ra.,ar 'f~ _ .. ..: _ PERKED (IF OTHER THAN APPUCMtT) - GVWR UNLADEN WEIGHT REQ. REG. GROSS WT. REQ. REG. GROSS COMB. VEHICIF PURCHASED INCLUDING LOAD WT. (IF APPLICABLE) ' WEIGHT INFO. IF APPL.10T18LE , ~ Y~jcCTlt(E/ PD~Y ~ifPl§lAT QN--~ INSU CE G~MPA~IY N/~ME -... r PS~L H I ['l ~~",~ _J ~(~ ~ ~~ \ / "~ kT1FY THAT ON MONTH DAY Y R '' .I CE d~,,T~ ~ ) SU Rq GENj (PRINT ~ E) \ r~ / , ~ ISSUING I HAVE CHECKED TO DETERMINE THAT THE VEHICLE IS INSURED A , ' I a` AGENT INFOR- ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLICANT, IN CE WITH ALL APPLICABLE PROVISIONS OF THE VEHICLE CODE " GAG SIGNATUF~' i' I Y / TELEPHB'NEt,.N(~:^~ /~ -f'` /~ z-,_~ ; . r NATION COMPLIlW / ~ / ( a- , I , r AND DEPARTMENT REGULATIONS. ` - I/WE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETION A AT-THE INFORMATION VEN IS TRUE AND CORRECT. IF 'AN EXEMPTION G THE PURCHASER FURTHER CERTIFlES THAT HE/SHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. I/WE ACKNO E THAT I/WE MAY LOSE MY/OUR OPERATING IS CLAIMED , OR VEHICLE REGISTRATION(S) FOR FAILURE TO MAINTAIN FINANCIAL RESPONSIBILITY -ON THE CURREN REGISTERED VEHICLE FOR THE PERIOD OF EGE(S PRIVI ) L REGISTRATION. I/VJE ACKNOWLEDGE THAT I/WE MAY BE SUBJECT TO A FINE NOT EXCEEDING $5,000 AND IMP SONMENi-OE_NO_T_MORE THAN TWO YEARS FOR ANY FALSE STATEMENT THAT I/VVE MAKE ON THIS FORM. Signatu f Seller M uthorized Si Her TELEPHONE NU rst rclt~si fF~ g Si t I / t t ~~ z gna ure~ ~~i ~ 7..- 0 .tw ', ~ - ~ ~ - _ ~ -r / 1ST ( ) ~ l 7J - F ._ ''-. ... _ ~ ( - ~ - ~ Se r ~ ~ - ~ Slgnatiire oft;o ~- - ASST - Slgnah7re~Y~Co=Ptnchaser>Tltle of Authorized Signer - ~ ~ --~- ~ 1 ' ~ MENT w D Sgnature of Second Purchaser or Authorized Signer TELEPHONE NUMBER - Signature of Seller 2ND ASSIGN- MENT Sgnature of Co-Purchaser/Title of Authorized Signer ( } Si nature of Co-Seller g H NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as "Joint Tenants With . Z Right of Survivorship" (On death of one owner, title goes to surviving owner.) CHECK HERE ^. Otherwise, the title F a will be issued as "Tenants in Common" (On death of one owner, interest of deceased owner goes to_his/her heirs or F ~ a ? estate). NOTE: IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK ^ . IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-IL. ...-....~....~.~ u. ~^mco. ~ ncnl FR itSSUING AGENT ~, _ , ,~ a _ ~,.- Knouse Foods Cooperative, Inc. 800 Peach Glen - Idaville Road Peach Glen, Pennsylvania 17375-0001 Tel: (717) 677-8181 Fax: (717) 677-7069 Web Site: www.knouse.com December 4, 2006 Ms. Sondra Neff 1147 Myerstown Road Gardners, PA 17324 Re: KF#67870 -LAUREN TAYLOR Dear Sondra: Enciosed'nerewith piease find: • Check No. 60026 (payable to Lauren Taylor) in the amount of $118.64, represents redemption of 50% of Revolving Fund Certificate No. 23289, Series 1989; • Revolving Fund Certificate No. B-74789 in the amount of $118.63 represents the `• ~ ~; -, ,; _ ,-~ ... . p olving Fund Certificate No. 23289, Series 1989; an ,,, ,, - uncalled ortion of Rev • Revolving Fund Certificate No. 1721 in the a nount of $97.61 replaces No. 16691. ~:;~•° ~°~-' ~ ~ r Per our telephone conversation, to expedite settlement of your father's estate, the uncalled ~ ; ~ ; .~~ portion of the 1989 Series and the 1991 Series certificates were re-issued into your name rather than re-issuing to the Estate. Knouse Foods Cooperative, Inc., as a payer of interest and dividends, must have a signed FORM W-9 on file for all stockholders. This form, as required by the Internal Revenue Service, is a Request for Taxpayer Identification Number and Certification. It is used to certify your correct Social Security Number as well as that you are not subject to backup withholding, for tax information purposes. Please complete the enclosed FORM W-9 by signing and dating on the line so indicated. A self- addressed, postage-paid envelope is enclosed for your prompt return of the FORM W-9. Thank you, in advance, for your cooperation. Should you have any questions, please feel free to contact us. Very truly yours, KNOUSE FOODS COOPERATIVE, INC. -~~ - ~2 Mary J. My rs Assistant Secretary %mm Enclosures cc: Bill Daniels, Esquire, Humer & Daniels, 1 W. High St. #205, Carlisle, PA 17013-2951 spea3f5nn. } ~`.. lit r--` ~-+ ~-1 ~~ •~ ~~ (~~\ C O N ~-I d A ~---I N O .~ N cY'1 N O z N n M N q 1 I 1 I F =i U y F O .O tly y C ~ y ~ ~ ~ ~ vi '" o °.~': vt O ~S -d a v y a O .~ ~o a U ~ ~~ ~~ ~~ ~~ ~ ~ ~. ~. ~~ ~ a ~ .~ u, m ~ `~ U w O y ~ ~ a~ ~ U r-+ .n 1. 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U S+~' U~ q o c ~ ~-~~~ -o ~ 'v ~ o ~ b ~ F-' a> a E-' ~ E-' E-' +-~ ~ ~. w --~ N M mot' M " o ~ b ~ I ~~ -.o q ~ ., ti ~ .~i w ~ v z M W a U W i 'JrJ 7 m .~ .~ v ~ ~ W ~ O ++ N a~ ~, N '~+ O¢ ~~ REV-1511 EX+ (12-99) SCHEDULE H -~ COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ' ESTATE OF _ ~ P ~P ~~/~~ ~ / FILE NUMBER ~ ~ ~~ ~~ 'l ,, Rio Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~- // 1. ' Chi ~ ~, BOO y B. 1 2. ADMINISTRATIVE COSTS: Personal Representative's Commissions ~'' Name of Personal Representative(s) `~~ N ~~~~ ~ i ~~~~~ Social Security Number(s)/EIN Number of Personal Representatives ~ ~ ~ ~~ '~`~~ Street Address //~'G/ ~ /y1 )/ E/~.S 7'~ti'G/"~(/ City ~ ~ ~Z ~'''~L-~~ -~ State ~ Zip ~ ~~~- Year(s) Commission Paid: ~o~i' Attorney Fees ~ r / 7~.s f'+ d „~/J~/ // ~' GS . 3. Family Exemption: (If decedent's address is not the sam/e~as claimant's, attach explanation) Claimant N~~ 7 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Qes/t/`s r- n rv'. /,/.1' if al cl. 7`~ w ~,. ,~ ~. ~26 ~ y~ 7~c: 5. Accountant's Fees 6. Tax Return Preparer's Fees 1, ~- << •y, /~.rr //7.., ,( I~i~ o , ~f '~ /~.i1. /~ / `,> `"~ l'',r rl~s ~ ~ ~ / G, /, y~.~~ . J`_L/'clo. ~`/~-~. ,,,~; '~ , Cif, ~~ 2, ~~~' ~,~ ~c~, ~~ TOTAL (Also enter on line 9, Recapitulation) $ ~ ~~ G ~~, ~/ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF / FILE NUMBER Report debts inc red by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEA?H L=r~CJ - ~ ~~LG~~~ ~ ~~ ~ ~ ~ ~ ~ 3, ~=~ ~~-~- 4 ~~~, ~ ~ ~- ~~ ~- ~ Z~ ~, ~~ G, f,~ X '~- G 1 ~'^ / ' 1 ~ Z ~~ °d' ~/ ~ .~, ~ o ~ / ~ ~ „5'~c:, mac; / ~ ~E J~+ rte J S'S"~~''V I ~ , ~~G~"'~J / S, G, TOTAL (Also enter on line 10, Recapitulation) $ ~ f ~, ~' ~ ~ ~ ~~ (If more space is needed, insert additional sheets of the same size) os ice of Ce^:tral Pennsylvania 98 co,,~,-; gnola Crive ?.,,. BOX LFc Lno_a, PA _~C25 Voice: 1,-~ s2-loo0 Fax: 71--732-5348 Resident: Lauren L.laylor c/o Sondra Neff ii47 Myerstown Rd Gardners, PA 17324 CUStomeC ID: TaylorLauren Payment. Terms Net 15 Days Description esidential Care 06/16-06/22/06 no charge esidential Care 06/23-07/27/06 Invoice Invoice Number: 16~_ Invoice Date: Pale Due Date 8/15/00 - i Amount 10, 500.OOi Total Invoice Amount 10, soc . oc Check/Credit Memo No: Payment/Credit Applied TOTAL 10,5oo.cc Thank you for choosing Hospice of Central,Pennsylvania. REV-1513 EX+ cs-oo> -. SCHEDULE J w . ANIA BENEFICIARIES COMMO O TAX RETURN E TANCE RESIDENT DECEDENT FILE NUMBER ~~ ~ ~~ ESTATE OF '~ C~~~~' ~~ ~ ' .~ ~i ~G~-~ L~ ~~~G C.~ ~ " C,~ AMOUNT OR SHARE , RELATIONSHIP TO DECEDENT OF ESTATE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) NUMBER jusal distributions, and transfers under s2 jh( TAXABLE DISTRIBUTIONS (' t ) 1 t (a Sec 9116 17065 Dcbcrah Guix 308 Tichy Dr., Mt. Flolly Springs, PA vancy Taylor 403 Weldin Rd., Wilmington, DE 19803 •~~~~ /y lacquellnc Dcwalt 201 Fourth St.. Boiling Springs, PA 17007 3 ~/~GL /•~ ~ df' Sandra T. Neff l 147 Myerstown Rd., Gardners, PA 17324 f~ ~~~ ~~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MAD 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)