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Home My WebLink About03-26-10 (2)s 15056051047 06 05 REV-15 0 0 EX ( - ) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year Bureau of Individual Taxes tY File Number PO BOX 280601 INHERITANCE TAX RETURN ~ ~ ~ ~ ~`'- Harrisbur ,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI ~01~ 1 ~Y ~`1~! ~ 'T" ~ ~} (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 HE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Re urn (date of death prior to 12-13- 2) 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 f 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 nder 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 SH ULD BE DIRECTED TO: Name Daytime Telephone umber >~ ~~ ~ ~ ~~- ~' 1> 1} w i C L s ~ .~' ~ z~ 3 3S ,~ 1 Firm Name If A li bl ( pp ca e) REGISTER OF ILLS UPS-F,~ONLY First line of address ~;-~ ~ -~ ~ ~~ o ivy wE s r ~ ~ c yr s f-,q L= ~ r^ . E ~ / ` ~ - ; Second line of address ~ , ~ '~' - ~ ~~ '~ C~ ~ -~ ~. ~ ~ - City or Post Office State ZIP Code ~ _ .. .. ~ '" ~ r yt ,.~ ...~ 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 y knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepay r has any knowledge. SIGN~'iTURE OF PERSON RESPO SI64E FOR FILING RE RN E _- ~ ~ -~ ~ ~CYo ADDRESS \ ~~~ ' SI G1yATUR F EPARER O A REPRESENT TIVE • ATE ~ ~~ _ +.~-- ADDRESS , ~ v. G _ ~f C PLE SE USE ORIGINAL FORM ONLY Side 1 1505605104? 150560510 7 J J 1,5056052048 REV-1500 EX Decedent's Social Security Number ' ` " ~` ~ ~ ~ ~ ~~ Decedent s Name: RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. + 4. Mortgages 8~ Notes Receivable (Schedule D) .......................... ... 4. ~~j ~~• 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~ ~ ~ ~~/ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. ~ ~~ ~. ~ / 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~ ~ ~ .~~ 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~ ~ ~'~~ .~ G 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) ............. ... 10. ~ ~P~ . ~~ 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~G 9~ ~ • ~3 12 Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ ~ ~ .~ ~~ 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. .. ~ ~' ~ 6 • ~ ~' TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .0 _ . 16. Amount of Line 14 taxable at lineal rate X .0! ~~ ~ .~ ~ ~~ ~ 16. ~ ~ ~ ~ . ~p 17. Amount of Line 14 taxable , / / at sibling rate X .12 17. 18. Amount of Line 14 taxable • 18 • at collateral rate X .15 . 19 ~~ • 1~ ^ ~ 19. TAX DUE ...................................................... ... . / / 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1,5056052048 15056052048 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ,Q f~ - -_ - ------1~~~1--4 ~~~-_ -- --~V-~~~_ _ - --_ _ ---- STREET ADDRESS ~N~ s oRl' ~~ ~ - -- '~ __ - -_ -- --___ ---- i CITY STATE ~ ZIP ~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ~ ~ ~ ~~, 2. r C edits/Pa ments Y A. Spousal Poverty Credit -__ _ __- _ _ _ -__ ', B. Prior Payments -- - -_ C. Discount Total Credits (A + B + C) (2) ~ ~ ~ , 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI TE BLOCKS 1. Did decedent make a transfer and: Yes' No a. retain the use or income of the property transferred :.......................................................................................... ^I b. retain the right to designate who shall use the property transferred or its income : ............................................ ^I c. retain a reversionary interest; or .......................................................................................................................... ^I~I 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? .............................................................................................................. ~II ^ 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? ........................................................................................................................ ^' 1Q-1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A 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 fdr t e 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 ar for the use of the su ivi g 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 requirem nt' 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 f r t e 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. !,) 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. §91160)(1 ~3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~~ ~\~° u ~Q~ ~ ~~ ~, ~~ REV-i 507 EX+ (i -97) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RESIDENT DECEDENT RECEIVABLE ESTATE OF FILE NUMBER ~, C>o ~~N i~~R of ~~ < 8' ~~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. / G/~ ft ~~h1rC ~ ~~~C~ ~ G ~ ,mac. r~,~-, ~3 . ~ ~ ~..s' ~ v-~ c~. ~G',R~ ~...~~2 ~ a o o . Qi ~ Z~osf ~~ ~~s ~ ~ - ~- .~ 3 . ~ . ~ ~ ~ c- ~v T-~ ~ ~, s~-s ~ ~.-~ o- /o~w /~~ . ~, i i /~ OG 8 , ~~` TOTAL (Also enter on line 4, Recapitulation) ,~. $ I~ ~ ~~ S~ 'a 3 co L~ ~- ~n nw~c aNa~a w ucauCU, IIISCR dUUIUUfIdl SflBG'IS OT Tfle Same SIZe) W F- O z O y O t ~ CO 01 , N N 0 0 N O (~ O 69 ~ -~ U C M II p D. O ~ II ~+ 69 ~ ~ ~ N -D II t ti ~-. O O O '`'' ~ CJ O O LL' U N ~'C 0 0 M O O O O O O E N ~S N v O O C .a G1 U e - O N N ~ C -= ~ v- O N~ 'C ~O M i ~ cv i 1~. r 69 FA 69 ~ U ~ - ~ -O ~ ~ ~ O ` ~ ~ O ~ ~ ~ cII .-. > O w-. c0 ~ U Z ~ •~ ~ ~ ~ cV N +.. ~ i ~ ~ ~.. ~ In U rn N ~ O Q N O ~ - :~ ° ,~ ,, o o ~ :v ~ ~ ~'- c~ c N in _ cv ~ L ~ O ~ ~ c a. c0 N r ~'' Q. O Q O 'fl X O ~ X ' O !A O cv ~.- O ~ ~ ca ~ d ~ ~ CO O X ~ ~ O O . ~ ~ ~ 0 p ~ O O ~ is ~ O ~ ~ ' ~ ~ O .O , ~ ~ °- j ~ ~ o N ~ ~ _C ~ ~ 69 ~ •+ U ~ C - r W N O m O O 0 C ~ I ~i 'v REV-1508 EX+ (7-83j SCHEDULE"E" COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS AND INHERITANCE TAX RETURN MISCELLANEOUS RESIDENT DECEDENT PERSONAL PROPERTY (All property Jointly~wrts~d with th• R(pht of 8urvivonhip must b• disclosed on Sch~dul~ "F") ITEM NUMBER DESCRIPTION S L O /~~ /~~lf ~ ~~~~ ~ ~ FILE NUMB R __ l ~ (i o~~ ~ ESTATE F VALUE AT DATE OF DEATH ~i,~~ jGG, G~J TOTAL (Also enter on line 5, Recapitulation) ~ ~-f/l~ ~Q (If mor• spsc• is no.dod insert ~dditlonal shoots of :am• size) REV-1510 EX • (t-97) SCHEDULE G COMNHERIANCEDTAXERETURNANIA INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF ~~ ~ /~ ~ ~ ~ FILE NUMBER ~ ~~ ~`~ 2 0 ~ -o ~'s-~ . ~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET s y ~. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE GEED FOR REAL ESTATE . DATE OF DEATH VALUE OF AS ET % OF DECD'S INTEREST XCI_USION ' F APPLicABLE TAXABLE VALUE 1. OR ~ S 7"O~~/ i1/ ~~~1e/%, ~ c~~cw~G ~cc'Gc. ti T /p~,zy~ s ~ 3 `. - ~~• l~j~ ~oQ /g~ ~2h,1, ~~ ` . ~J~ ~ so~v ~by ~• ~j GC~X/~iL ~~'~"l2 / ~~ 2 ~ 9. ~ i ~f Z ~"~ 4 ~ , TOTAL (Also enter on line 7, Recapitulation) a ' ~ ~~ ~, G ~~~ ~~~~~~ aNa~ I~ IICCUGU, Ilwcn auunwnal sneers or one same s(zeJ `~G~~~l Orrstown Bank Stonehedge Office 427 village Drive/ Carlisle,-`PA 17019 (866) 624-4229 Br: 6 OWNERSHIP OF ACCOUNT -PERSONAL PURPOSE ^ INDIVIDUAL ^ ®JOINT -WITH SURVIVORSHIP land not as tenants in common- ^ JOINT - NO SURVIVORSHIP (as tenants in common) ^ TRUST -SEPARATE AGREEMENT: ^ REVOCABLE TRUST"DESIGNATION AS DEFINED IN THIS AGREEMENT Name and Address of Beneficiaries: Combine: N f Eyewire: OWNERSHIP OF ACCOUNT -BUSINESS PURPOSE ^ SOLE PROPRIETORSHIP ^ CORPORATION: ^ FOR PROFIT ^ NOT FOR PROFIT ^ PARTNERSHIP BUSINESS: COUNTY"& STA E OF ORGANIZATION: AUTHORIZATION DATED: ~- DATE OPENED 0912/03 BY Imelda N Stevie INITIAL DEPOSIT $ • 0 0 ^ CASH ^ CHECK ^ HOME TELEPHONE # (717) 4 8 6- 4 3 31 BUSINESS PHONE ~ DRIVER'S LICENSE #~ E-MAIL EMPLOYER RETIRED MOTHER'S MAIDEN NAME EARLY Name and address of someone who wilt always know your location: BACKUP WITHHOLDING CERTIFICATIONS TIN: 165-09-2433 ® TAXPAYER- I.D. NUMBER - The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number. ® BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. ^ EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. SIGNATURE: I certify under penalties of perjury the statenpnts checked in this seyfior~artd that},tart/ a U _S,~person (igglud~y a U.S(}esjdent alien). / ~ ®1992 Bankers Systems, tnc., St. Cloud, MN Form MPSC-LAZ-PA 4/19/2004 CIF# G000674 ACCOUNT NUMBER 106800197 50+ Interest Che¢k ng ACCOUNT OWNER(S) NAME & ADDRESS ' Martha E Gobin Richard I Gobin Joy G Burkholder 1 Longsdorf Rd Carlisle PA 17013 Revised Date: 11/27/07 `C~'" I~ ~'' Reason: CIiANG~ ACCT TYPE ^ NEW ~ IEX TING TYPE OF ^D CHECKING ^ IS ~ INGS ACCOUNT ^ MONEY MARKET ^ ICE TIFICATE OF DEPOSIT ^ NOW ^ ~ This is your (check one): ~ ® Permanent ^ Temporary ~c punt agreement. Number of signatures required for withdra~tw ~~ 1 FACSIMILE SIGNATUREIS) ALLOWEDI ^ ~'YE ®NO X SIGNATURE(S) -The undersigned agree o e terms stated on every page of this form and acknowledge recei t a completed copy. The undersigned further authorize the financi I i stitution to verify credit and employment history and/or have a redit reporting agency prepare a credit report on the undersig d, as individuals. The undersigned also acknowledge the receip o I a copy and agree to the terms of the following disclosure(s): ® Deposit Account ®Funds Availal~ili ', ®Truth in Savings ®Electronic Fund Transfers ~ Privacy ^ Substitute Checks ^ =~ (11: X artha E Gobin i ~ ~ . I.D. # 165-09-2433 p~0. '. 10/17/15 121: X . G Burkholder I.D. # 206-32-4 3 pFp, 12/17/41 (3): X ~ Richard I Gobin I.D. # 204-30-8942 p 0. 01/24/40 (4): X . I.D. # D.O. ~ ^ Authorized Signer (Individual Accounts Onlw) X I.D.# _ D.O. fpage 1 of 21 Orrstown Bank Stonehedge Office 427 Village Drive Carlisle, PA 17013 TRUTH IN SAVINGS DISCLOSURE Terms following a ®apply only if checked. We may change the interest rate on yqur ' count at that time Acct: 50+ Interest Checking and thereafter. Acct #: 10 6 8 0 019 7 Limitations on rate Chang®s ' Date: September 12, 2003 ^ The interest rate for your account Jrvill'' r~ot The interest rate and annual percentage yield stated below by more than each j are accurate as of the date printed above. If you would like more ^ The interest rate will not be less than' I o~ current rate and yield 866) 624-4229 ~ ' information please call us at ~ or more than %. This disclosure contains the rules which govern your deposit ^ The interest rate will not account. Unless it would b in n e co si n ste t to do so wor n ds a d phrases used 'in this disclosure should be construed so that the ' singular includes the plural and the plural includes the singular. the interest rate initially disclosed to yqu. We reserve the right to at any time require not less than 7 Minimum Balance Requirements ~I days notice in writing before any withdrawal from an interest ^ To o en the account Y t d li l p . ou mus epos t bearing account ( east S to open this accbu ^ FIXED RATE ^ To avoid imposition of fees. ^ The interest rate for your account is % with To avoid the imposition of the you an annual percentage yield of %. We will pay must meet ~ foll ~nring requirements: this rate ^ A of S We will not decrease this rate unless we first give you at will be imposed every ' least 30 days notice in writing. if the balance in the account falls belov~ S' ^ The interest rate and annual percentage yield for your any day of the account depend upon the applicable rate tier. We will pay ^ A o1~ S '' ', these rates will be imposed every if the average daily balance for the We will not decrease these rates unless we first give you at falls below S least 30 days notice in writing. .The average daily balance is calculated by ad ing the principal in the account for each day of the period n ® VARIABLE RATE ividing that figure by the number of days in the period. ~_, ^ The interest rate for your account is % with The period we use is an annual percentage yield of °~. Your interest To avoid the imposition of'the you rate and annual percentage yield may change. l must meet fc~llo ® The interest rate and annual percentage yield for your ^ A o~ S ing requirements: account depend upon the applicable rate tier. The interest will be imposed for rate and annual percentage yield for these tiers may change. transaction (withdrawal, check paid, au matic transfer or payment out of your account) if the t#al Determination of rate ce in the account ® At our discretion, we may change the interest rate on falls below S any d ay I _ ',f the , your account. ^ The interest rate for your account ^ A ota S ', will be imposed for ' transaction (withdrawal, check paid, ~~,au ~ matic transfer or payment out of your account) if the av~ra ~ daily balance for ^ The fixed initial rate is not determined by this rule the . ^ The initial interest rate on your account S .The average daily b falls below ante is calculated by adding the principal in the accoun f each day of the period and dividing that figure by the u er of days in the period. •The period we use is , To obtain the annual percentage yie/d ibis sed. Subsequent rates ~ You must mainUein a minimum balanc~ ' ~f g 500.00 in the acco{~nt~ ~ach day to obtain the disclosed annual percentage yield. ^ You must maintain a minimum av~ra daily balance of Frequency of rate change S to obtai t ® We may change the interest rate on your account percentage yield. The average daily ba~lan' disclosed annual is calculated by at any time adding the principal in the account fora day of the period and dividing that figure by the number f d ^ Your initial interest rate will not change sin the period. The period we use is ~ m 1992 Bankers Systems, Inc., St. Cloud, MN Form TSD 8/1 1 /2003 ' /p8ge 1 of 2J Compounding and Crediting Temporary Transaction Limitations: ® Frequency -Interest Will be ^The following withdrawal limitations app until your identity compounded monthly is verified. Once your identity has bean verified, any limits Interest will be credited monthly disclosed to you wNl apply. ® Effect of closing an account - If you close your account before interest is credited, you Will receive the accrued interest. Balance Computation Method ® Dai/y Ba/ance Method. We use the daily balance method to calculate the interest on your account. This method applies a daily periodic rate to the principal in the account each day. Additional Terms I ^ Average Dai/y Ba/ance Method. We use the average daily THE FOLLOWING TIERED RATES ', A balance method to calculate interest on your account. This method applies a periodic rate to the average daily balance in the BALv~NCE RAVE account for the period. The average daily balance is calculated $ 0. 0 0 - $ 4 9 9.9 9 .0 0 by adding the principal in the account for each day of the period $ 5 0 0 . 0 0 - $ 2 4 9 9 . 9 9 0 5 and dividing that figure by the number of days in the period. , . $2,500.00 - $9,999.99 .15'' The period we use is $10 , 0 0 0 . 0 0 & ABOVE . 2 0 Accrual of interest on noncash deposits ® Interest begins to accrue no later than the business day we r i di f h ece ve cre t or t e deposit of noncash items (for example, checks). - ^ Interest begins to accrue you deposit noncash items (for example, checks). Bonuses ^ You will as a bonus ^ You must maintain a minimum ~ ' of S ~~ to obtain the bonus. ^ To earn the bonus, Transaction Limitations ^ The minimum amount you may deposit is S ^The minimum amount you may withdraw is S ^ You may only make transfers from your account each - by checks to third parties and The minimum withdrawal is S ^ You may only make deposits into your account each statement cycle. ^ You may only make ATM your account each statement cycle. ^ You may only make preauthorized transfers your account each statement cycle. PLY TO THE ACCOUNT APY .00 .05 .15 .20 ~~ O 1992 Bankers Systems, Inc., St. Cloud, MN Form TSD 8/11/2003 I (page 2 Of 21 Oxxs~rowiv B~~K A Tradition of Excellence May 10, 2008 To: Humer & Daniels 205 Farmers Trust Building ' 1 West High Street Carlisle Pa 17013 From: Traci Shaffer Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re:. Estate of Martha Gobin Date of death January 4, 2008 -/ G -- G ~ y IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON T ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BAN . CHECKING A CCO UNT ~ ~ ~ , ~, Account # Title of Account Date opened Princi al Accrued Inter 106800197 Martha E Gobin 09/12/03. 10249.55 0.06 SA VINGS ACCOUNT Account # Title of Account Date opened Principal Accrued Inter CERTIFICATE OF DEPOSIT Account # Title of Account Date Opened Principal P.O. Box 250 • Shippensburg, PA 17257. 717.530.3530 • .717.532.4143 fax ORRSTOWNBANK `-J A ?y-adition of Excellence ' ' ,, . .!'h., fr1..~ .., ~ ... .. M ~ I t Date 1/10/08 ~ ' ? ~ ~ '~ Primary Account . ' . ~~.., . ~ ..... ..... .... ,. ~~•Enclosures , ~,, . ,......, . ~~ ~ .. _._.. - .. _ . _ ..,..:..Martha 8 Gobin __ ... . . Richard I Gobin _,_.. Joy G Burkholder `~- 1 Longsdorf Rd -- Carlisle PA 17013 ,, ~ ... ,. ,. ~; F_ ~. i . .....-., ..,... _ ........ _ .... . ~ .., ~ ~~ .. ~...,1v:...w.. .. J~w.w.i T i.,...s..,..~n..,...w • ,,.r ~.n..«.rt. ,. .... • ..rc: •~r ~ ...id•..,... ; ~1 /(~ ~i ~ T. 4 1 i 1 ~'~FY ; { ~ t t 50'+"!Interest CHec~Cing ~~°' ~:""" "~ '"'€~~~~~`~"'" "~10~800197 (Continued) < :~ Da11y~"Balsiice: ~`Informat.~on ~ .~ • Date Balance, pate . 12;794.57 12/28 ~ Balance Date. •`9;298:10'' 1'/08 .12/17 12/26 •. •..8, 851.57 1/02 ~ 9, 287 ..25 1/10 . _ , 9, 315.07 , 1/03 x/10, 2'49.55; ' Page 2 106800197 Balance 21,318.30 21,245.63 Interest . Rate . Summary , . ..:... ~ , ~ ' • 12/10 ~0.200000~ a: ; 12/17 ~ 0.15000O~C : ; ~'~ ~ ti 1/03. 0.200000~~, . , ,~ .. THANK YOU .FOR1'BANKING WITH ORRSTOWN BANK ~ , ^ ~ `''~ . N , '' ~ ~ ~Krfk~Y +`1 r+IJ•e;. ~ •rt rx~F ~..'~ .. ils ti"« i , iY s, a,. , ~~ . ~.~: ~ ~'~ Ki:i [i.• ~.~71.ril~wr 1 {35w~'+~i.7-I,J1~3.~~1.+Q.~-~-1r.7~p J~ `h3L~4`: ~H~i4'(~ ~i~kii ~;~~f~l~.~a{d~. LKi.y~ is: J ~ • ; r t, u ~ t~ . ~ ~' ' 2. '' .~ ~ + - ~ '.. .. .: ..~ A' ~ N'~•' 1L1~ ~.~~ i^a' ll-.L! 4!' ~'r:y? f. yw.45f~u3 ~ !~ fi ~ ~ pia ~ ~... L t, 1 ...+ ~cti--~i.t:J ~` ~,., / ~~i. r~~~.t; f~ •'l ~'~ 1 .. t ,. `. .~ `~ st': )T G. .. -~ . ~I ....5 .1~l. Jt .r_ ..~I. ~ .~' T~i.)u~ ~~t..s (. ~. J~~s, v ..~I. ~ .~ ... ~'' S. o~ '_ . . 1 N O et ri pO pN Q ~ Y ..t•. . t. _ `. .. 1 ~ ~ . .. 7 . REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ~ ESTATE OF FILE NUMBER G o~.~ ~ ~ 7~~ 2r08 - ys"' Z Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT- A. 1. FUNERAL EXPENSES: ~~- .~ --.~f~ r ~ .~.~~L ~rn--~ 9~ ao 9 . ~ 0 c'u~,,3 ~ ~~ss~n~.~ y2G ~~n~/ /~ ~~. 3 20 c.•~s ~ri~r- .s-.~jo, c»-c.~i~`~~, cz~.e~s' ~3~-. / C , C~~=.t.~sr/-~ Cam/--G~ ~ _~i~v~~.~_S'c,~/~- .1 l ~ ~- B. 1 ADMI~i)SJ.RAT~~S. /!'JL~.''~j4.2-r C ~ ~ ~h ~~U~~Z Perso al e resentative~ Commissio sr . p ns Name of Personal Representative(s) __ N</ Z Street Address ~ City State Zip Year(s) Commission Paid: 2. Attorney Fees /~~`JR+L/'~ A' ~G/'7/ji~~~~~" ~'7 ,,' /~ ~ 2~, ~ J 3• ~ ,.~~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) y/~ Claimant Street Address ' City State Zip __ Relationship of Claimant to Decedent 4 • Probate Fees /1~Grs ~~ ~ ~., ~" ~. 5• '~01~'~- .amt ~~r~ Accountant's Fees ~ f",y,~~ f,~~ LO/~ ~T ~ ~,~,~,~ys ~n~, ~ O, ~ ~~i C GO ~ ~ 6• Tax Return Preparer's Fees . TOTAL (Also enter on line 9, Recapitulation) ~ ~ G~~ ~ v J 'O 3 ~. %Q r 0 to rnvre space is neeaea, msert aaaitional sheets of the same size) III ~ REV~1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN DEBTS OF DECEDENT MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF ~O~/~ /~~~ T~~ ~ LE NUMBER -Q I Re port debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed m ical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH '~'~ ~ .3 ~c~o _., 2C. 8G~ ~~ i ~ + ,~~ 2y ~2o~..G,- ~` ~. c~~~ ~ ~- ~- ~' ~/ ',,x. ~ ~, 3 s TOTAL (Also enter on tine 10, Recapitulation) S i c (Ir more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF~~ ~ /~ ~~ A FILE NUMBER %~ ~~~ /l/~ y~~. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) OUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. r-.--~ ~ ` C~~ ~ Q~2U~ s~ 1~~ ~~~~ z, ~~C L~ G , ~ ~~'~~ 2 ~~~ ~ ~ ~I~~Ycti ~~ ~~ . C'~,~L is' L~~ ~/~ ~ ~-0~13 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV- 00 COVER SHEET II 1. NON-TAXABLE DISTRIBUTIONS: '~~ A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ... B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (it more space is needed, insert additional sheets of the same size) ~~~~ 1~irzsY 3~ill ttn~ C~1rsYrzmrnt ~` I, MARTHA L. GOBIN, of the Borough of Carli le, Cumberland County, Pennsylvania, declare this to be m last will ,, and revoke any will previously made by me. -I. I devise and bequeath all of my estate, of, every nature and wherever situate in equal shares to ~u.ch o my adult chi~ldren,JRICHARD I. GOBIN and JO `~~~~+ i~~~~~~` Y G. Floo~e, as shal survive m by thirty days. ~~~~~~ I. Should my son, RICHARD I."GOBIN or my d ghter, JO ~~ G. HOOKE, predecease me or die on or before the thirt th day ~~ ~, •. following my death, I devise and bequeath the share o such chip to his or her issue per stirpes living on the thirty- 'rst day following my death; and~shQuld eit er my said son, RI ARD I. ~~~ ~ ~ GOBIN, or my daughter,~JOY G. HO~KE, leave no such is e living on~ the thirty-first day following my death, I devise d ~bequeatl the share of such child to my other child or to his o her issue per stirpes living on the thirty-first day following death. III. I direct that all taxes that may be ass sed in consequence of my death, of whatever nature and-by wh ever jurisdiction imposed, shall be paid from my residuary state as part of the expense of the administration of my estate. IV. I appoint my son, RICHARD I. GOBIN, and m daughter, JOY G. HOOKE, o-executors of this my last will. Shou d both of ,, ~ "0 a. ~o~~ my said children fail to qualify or cease to. act as exe utors, I appoint THE FARMERS TRUST COMPANY, of Carlisle, Pennsyl ania as executor of this my last will. V. I direct that my executors shall not be•~r uired to give bold for the faithful performance of t~eir duties any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my h d this f ~~ day of ~~' 1990 . r MARTHA L., GOB I N, The preceding instrument, consisting of this d one other typewritten page identified by the signature of t testatrix, MARTHA L. GOBIN, was on the day and date the of signed, published and declared by MARTHA L. GOBIN, the statrix therein named, as and for her fast will, in tie presenc of us, who, at her request, in her presence, and in the presen of each other have subscri our names as witnesses hereto. ' GL~ r ~ ~ ~ ~~. ~/ ti- r~~ 3Zc~. y y~~ ~~ a~~~3~~4~~ \o ~ ~~~~ ~~ a. mow. C~1"~.z