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HomeMy WebLinkAbout05-27-10 (2)1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poaox2aosol INHERITANCE TAX RETURN 2 1 0 9 1 0 9 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 0 3 6 2 8 2 2 1 1 1 8 2 0 D 9 0 9 0 3 1 9 4 4 Decedent's Last Name Suffix Decedent's First Name MI M A T H N A H E R B E R T D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number J O E L R Z U L L I N G E R 7 1 7 2 6 4 6 0 2 9 Firm Name (If Applicable) Z U L L I N G E R D A V I S P C• First line of address 1 4 N O R T H M A I N S T R E E T Second line of address S U I T E 2 0 0 City or Post Office C H A M B E R S B UR G Correspondent's a-mail address: State ZIP Code REGISTEI~OF WILLS US~NLY t-~ ~ o . r ;. "C;7 f ~s• , t' 1 .~ ~ , 1~ 1 ~ ~ :~ 1 _~ i -. r'~', N - -7 r r ,.._~ ' ~ "~~ Z? {~ L a ~r7 S FILED ~ .. ~ . 1 T i _-- --_ - - - __ - c..~ -c: ~~ +~" P A 1 7 2 0 1 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, rrect and complete. Declaration of preparer other than the personal representative ~s based on all information of which preparer has any knowledge. GN RE OF PER$ON RES~P~NVSIB E FOR FILING RETURN D~E vim .-. in.~,/ ri GC ~ ~ ~,~, n,~ n 1~ /Yl/~ ~ L, -- ~ ~~ ~~ 152 KLINE ROAD " SHIPPENSBURG PA 1725? S NATURE E ER ER TiiAN REPRESENTATIVE D /E /~ A RESS NORTH, IN ST ET, SUITE 200 CHAMBERSBURG PA 7201 PLEASE USE ORIGINAL FORM ONLY 15056D7121 Side 1 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: HERBERT D• M A T H N A 1 6 0 3 6 2 8 2 2 RECAPITULATION ........................................ 1. Real estate (Schedule A) 1 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 8• 7. Inter-Vivos Transfers 8~ Miscellaneous N n-Probate Property (Schedule G) [] Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9• 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 & 10) ........................... 11. 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. 1 9 5 7. 5 4 3 7 3 9 1. 0 0 3 9 3 4 8. 5 4 1 5 5 7 9. 2 9 5 1 1 3. 3 1 2 0 6 9 2. 6 0 1 8 6 5 5. 9 4 1 8 6 5 5. 9 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable 1 8 6 5 5 9 4 at lineal rate X .045 . 1 s. 17. Amount of Line 14 taxable 0 ~ ~ at sibling rate X .12 17. 18. Amount of Line 14 taxable ~ ~ ~ at collateral rate X .15 18. 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. 0 0 8 3 9. 5 2 0. 0 0 0. 0 0 8 3 9. 5 2 Side 2 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 1093 DECEDENTS NAME HERBERT D. MATHNA STREET ADDRESS 163 Shippensburg Mobile Estates __ ___ __ CITY -- - - _ _ _ -- STATE 1 ZIP Shippensbur PA '17257 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit (1) 839.52 B. Prior Payments 641.25 C. Discount 33.75 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (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. 675.00 (3) 0.00 (4) 0.00 (5) (5A) 164.52 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 164.52 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................. ..... ^ ^X b. retain the right to designate who shall use the property transferred or its income; .......................... ..... c. retain a reversionary interest; or ........................................................................................... ..... ^ ^ 0 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? ................................................................................. ...... ^ 0 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................ ...... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transferto 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 childtwenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1,2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HERBERT D. MATHNA 21 09 1093 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 59.1045 shares common stock Orrstown Financial Services, Inc. 1,957.54 @33.12 per share TOTAL (Also enter on line 2, Recapitulation) ~ $ 1.957.54 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HERBERT D. MATHNA 21 09 1093 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Coins from decedent's lockbox appraised by Carl L. 28.10 Spidel, with copy attached 2. Benefit Now Account #50546266, with Conseco 5,810.78 Insurance 3. Refund, Embarq 12.66 4. Refund, Blue Cross/Blue Shield for ambulance 366.00 service 5. Refund, Adams Electric Cooperative 20.92 6. Refund, Blue Cross/Blue Shield 718.00 7. Refund, Blue Cross/Blue Shield 600.00 8. Medical refund 18.73 9. Proceeds from private sale of decedent's 2002 4-wheel drive Chevrolet 5,000.00 truck 10. Nationwide Insurance, refund of insurance on mobile home 17.00 11. Nationwide Insurance, refund of insurance on Chevrolet truck 254.30 12. Gross proceeds from sale of decedent's mobile home 8,500.00 which was situate on rented lot 13. Received on proration of taxes at sale of mobile home 62.75 14. Received on proration of lot rental at sale of mobile home 175.48 15. Checking Account #306258, Orrstown Bank, including interest 6,597.68 accrued to date of death 16. Savings Account#7015, Orrstown Bank, including interest accrued 9,108.52 to date of death TOTAL (Also enter on line 5, Recapitulation) S 37.391.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent HERBERT D.MATHNA 21 09 1093 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. Account #970006, Orrstown Bank, including interest accrued 100.08 to date of death SUBTOTAL SCHEDULE E 100.08 GRAND TOTAL SCHEDULE E $ 37,391.00 REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HERBERT D. MATHNA 21 09 1093 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger-Bricker, funeral services 8,731.50 2. Grave opening 450.00 B. 2. 3. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address Ciiy Year(s) Commission Paid: State Zip Attorney Fees Joel R. Zullinger Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip 4• Probate Fees Letters - 20.00; will - 15.00; short certificates - 24.00; JCP fee - 10.00; 159.00 automation fee - 5.00; additional probate fee 70.00; filing return 15.00 5 Accountants Fees 6. ~ Tax Return Preparers Fees 7. Adams Electric, utilities 48.63 8. Charge for estate checks 25.95 9. Kough's Oil Service, fuel oil for decedent's residence 429.97 10. Adams Electric, utilities 48,88 11. Shippensburg Mobile Estates, lot rental for decedent's residence 323.13 12. Melvin Mathna, work at decedent's residence 73.40 13. Snow removal at decedent's residence 40.00 14. Adams Electric, utilities 48.31 15. Shippensburg Mobile Estates, lot rental for dcedent's residence 323.36 16. Carl L. Spidel, appraisal of coins 12.50 17. Adams Electric, utilities 40.41 18. Travelers Casualty and Surety Company of America, surety bond for lost stock cert. 25.00 TOTAL (Also enter on line 9, Recapitulation) S 15.579.29 2,750.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent HERBERT D.MATHNA 21 09 1093 Decedent's Name Page 2 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - 67. ITEM NUMBER DESCRIPTION AMOUNT 19. JA/Lex Real Estate Services, LLC, commission on sale of mobile home 2,000.00 20. Barry L. Negley, Tax Collector, 2010 Co/Twp taxes on mobile home prior to sale 49.25 SUBTOTAL SCHEDULE H-B7 ~ 2,049.25 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HERBERT D. MATHNA 21 09 1093 Report debts incurred 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 DEATH 1. Franklin County Heart Center, balance due for medical services 97.04 2. Kough's Oil Service, fuel oil 3. Reese's Plumbing, balance due on account for services 4. Rehab Medicine Associates, balance due for medical services 5. Orthopaedic Associates, balance due for medical services 6. Borough of Chambersburg, ambulance transport 7. Adams Electric Cooperative, utilities due at death 8. Shippensburg Mobile Estates, lot rental due at death 9. Summit Cancer & Hematology, medical services due at death 10. Cumberland Valley Medical Services, medical services due at death 11. WSEMS-Chambersburg ALS/BLS, ambulance transport 12. Fayetteville Volunteer Fire Company, ambulance transport 13. Chambersburg Imaging, medical services due at death 14. Manor Care, nursing care services due at death 15. Chambersburg Hospital, medical services due at death TOTAL (Also enter on line 10, Recapitulation) I $ 5.113.31 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent HERBERT D.MATHNA 21 09 1093 Decedent's Name Page 3 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. Shippensburg Health Care Center, nursing care 667.50 services due at death 17. Citizens Automobile Finance, payoff of installment 1,396.27 loan used for purchase of decedent's Chevrolet truck 18. Health Network Laboratories, medical services 10.19 SUBTOTAL SCHEDULE I 2,073.96 GRAND TOTAL SCHEDULE I $ 5,113.31 REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HERBER T D. MATHNA Z1 U9 1093 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outri ht spousal distributions, and transfers under Sec. 9116 (aj (1.~ 1. Amanda K. Zimmerman Lineal 152 Kline Road one-half of residue Shippensburg, PA 17257 2. Pamela Ann Weagley Lineal 1266 Courtney Drive one-half of residue Chambersburg, PA 17201 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) LAST WILL AND TESTAMENT I, HERBERT DEAN MATHNA, of Shippensburg Mobile Estates 163, Shippensburg, Shippensburg Township, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debt and funeral expenses as soon as my be convenient after my decease. SECOND. I give, devise and bequeath all of my estate, real, personal and mixed, whatsoever and wheresoever situate as follows. A. One share of my estate to my daughter Amanda K. Zimmerman. B. One chare of my estate to my daughter Pamela Ann Weagley. THIRD. In the event either of the beneficiaries named in the paragraph SECOND should predecease me or is not living on the thirtieth (30t") day following my death, leaving issue who survive me, I then give, devise and bequeath said deceased beneficiary's share to her issue who survive, on a per stirpes distribution basis. FOURTH. In the event my daughter Amanda K. Zimmerman should predecease me or is not living on the thirtieth (30t") day following my death, and dies without leaving issue who survive me, I then give, devise and bequeath my daughter Amanda K. Zimmerman's share of my estate to her husband, Douglas L. Zimmerman, provided that he survives me and that he was legally married to my daughter Amanda K. Zimmerman at the time of her death. In the event my son-in-law Douglas L. Zimmerman should predecease me, or in the event he was divorced from my daughter Amanda K. Zimmerman at the time of her death, I then give, devise and bequeath my daughter Amanda K. Zimmerman's share of my estate. to my daughter Pamela Ann Weagley. FIFTH. In the event any beneficiary of this my Last Will and Testament is under the age of twenty-one (21) years, I then give and bequeath said beneficiary's share to and appoint as Trustee of any property which passes under this Will or otherwise, by daughters, Amanda K. Zimmerman and Pamela Ann Weagley, or the survivor thereof, AS TRUSTEES, nevertheless to invest and reinvest the same until the said beneficiary reaches the age of twenty-one (21) years, with the following powers in addition to those presently given by law: A. The power to sell any and all real estate, within the discretion of the said Trustee; B. The poser and obligation to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of twenty-one (21) years, without the necessity of a formal adjudication of the Trustee's Account in the Court of Common Please of Cumberland County, Pennsylvania or other Court of proper jurisdiction, upon the receipt of a good and valid release; C. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, not to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively. D. In the event both Amanda K. Zimmerman and Pamela Ann Weagley are unable or unwilling to serve as my Trustee, I then Nominate, constitute and appoint my son-in-law Michael L. Weagley to serve as my Trustee. SIXTH. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SEVENTH. I nominate, constitute and appoint my daughters, Amanda K. Zimmerman and Famela Ann Weagley, or the survivor thereof, to be the Executrices of this my Last Will and Testament. EIGHTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, HERBERT DEAN MATHNA, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for indentification only, this J~j-~`~lay of October, 2004. ~~ ~' ,~ jL f` r-- .~.,= J~ .r ~,'" ~ ~ :.Sea l This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other, we believing him of sound and disposing mind and memory, have hereunto subscribe our names as witnesses. / , ~ ~ ; COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, HERBERT DEAN MATHNA, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. '~~ f - ..~ .-~ ~ ~~ Sworn or affir!~e~d to and acknowledged before me by HERBERT DEAN MATHNA, the Testator, this 1~~' day of October, 2004. „~ Notarial Seal Yctarcia N. Perkins, Notary public Shippensburg Boro, Cumberland County My Comtmssion Expires Oct. 15, Zfl06 Member, Pennsylvania ASSC~ciation of Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :§ W e..~....: ~~ t '~ ~ ~ ~' ~.~~ ~ ~.S and ~nc~ N~ ~ ~ ~~ -~k a s- ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw HERBERT DEAN MATHNA, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and the he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. l Sworn or affirmed to and subscribed before me by ~ ~a`~t ~ !~ ~ ~ ~~~~ ~ ~ ~-9 and ,~°~,c~.9^e~ G''~%! ~~~,~r~-i witnesses, thi ~ ~tn day of October, 2004. ~°~ Historical Quotes: Charting Tools for Looking Up a Security's Exact Closing Price - BigC... Page 1 of 2 More r+ ~~ A x of Mekk 4. by TransUnion Hana ' Ducwtos News j Industries (Mati[aRS ~ Hlstorlcal {2uates 6~9R+Ports ( ®AdvrecedTn~ols i Prilnllurn PrclduCls This Historical Quotes tool allows you to look up a security's exact closing price. Simply type in the symbol and a historical date to view a quote and mini chart for that security. ~,~' Enter Symbol: ORRF ;Enter Date: 11/18/09 Orrstown Finl Svcs Inc Wednesday, November 1 S, 2009 Closing Price: 32.21 Open: 32.97 High: 33.10 I_ow: 32.07 Volume: 9,300 Go To Charting ~~ No Splits 2-Month Daily Chart of Orrstown Finl Svcs Inc Sponsored Links Forex Club Trade with Zero Spreads and Commission Refunds. $100 bonus. www.fxclub.wm Foreign Exchange Trading Free $50,000 Practice Account With Real-Time Charts, News & Research. www.Forex.com Hot Stock Pick - EVSO Solar Energy Investment. Evolution Solar Green Energy Solutions. www. EvolutionSolar. com Succeed with Forex Exact Entry and Exits. Profitable FX Day Trading System. Free Trial. http://www. netpicks.com/forex Take Our Free Online Seminars Charles Schwab ~..~ _ ~' ~~ ~~ -1 _S~f 33.~a ~ ~~.1~~~ http://bigcharts.marketwatch.com/historical/default.asp?detect=l &symbol=ORRF&close_d... 2/8/2010 CARL L. SPIDEL BUY * SELL * APPRAISE COINS AND OLD BOOKS 1423 Brec6bi11 Rd. Chambersburg, PA. 17201 Ph. 717-263-4257 ANA r113213 Nam ~~ ~ `" Ad ~EL ~LU/VGEn ~t~il. CiE~~-J~~' ~ /31L/2t.~St. r/`~ Zip ~ ` 1 ,~. o, D ~~-gig-o9 DaLf/t~•/~'~ .~D/D ~- A~PPt7A/~A~. ~ S 0 t.ZY~'~2. ~~'LtA /r>w~ ~2.Sv '9!'2 '- ~,,v~'?bv ~ ~~ ~ 1 ~ r/~ A s ~~ s -- ,vo rE trs`n ,t A ds- ~. , ,~' 7' _P P1~A Insurance Services#926 ~~« ~ P.O. Box 570 ` - CONSECO Rockland, MA 023'^= v,'C= ° Step up' ~~.r~~~~NO~Account® DEAN MATHNA RR 5 BOX SME LOT 163 SHIPPENSBURG PA 17257 Statement Closing Date: 11/15/2009 Account Number: 50546266 Customer Service Code 260 F+: ~CUPJT iivrCr4~Lli+iiCi'~ ~~ Balance Last Statement 0.00 Balance This Statement 5,810.78 SUMMARY + CREDITS 5,810.78 - DRAFTS and DEBITS 0.00 ENDING BALANCE 5,810.78 RATE HISTORY CURRENT INTEREST RATE 1.000°~ INTEREST CREDITED YEAR-TO-DATE 4.30 ACCOUNT TRANSACTIONS DATE DESCRIPTION 10121 DEPOSIT-CASH EFF 10-20 DEPOSIT i 1i14 CREDIT-INTERES T EFF DATE 11-15-09 Cl-'ST0~:9E4 ~~R;,'~;~E Contact Information: Insurance Services #926 P.O. Box 570 Rockland, MA 02370-0570 Website: www.bene-access.com/conseco Phones: 1-800-331-4631 8:00 AM to 8:00 PM, Eastern Time, M-F Access to your Account Information is also available 24 hours a day 7 days a week. Please have your Account Number and Customer Service Code (located above) available when calling Toll-Free. AMOUNT 5,806.48 4.30 INTRODUCING A NEW SERVICE. CHECK OUR NEW ACCOUNTHOLDER WEBSITE. WWW.BENE-ACCESS.COM/CONSECO CHECK YOUR ACCOUNT BALANCE, REORDER A DRAFTBOOK, REQUEST A DRAFT COPY, OR STOP PAY. REGISTER YOUR ACCOUNT TODAY. BALANCE 5,806.48 5,810.7° 926- 5 Page 1 _ AC _owi on o~ _ d ~ C C 8. TYPE OF LOAN: U.S~DE AP RTMENT OF HOUSING 6 URBAN DEVELOPMENT 1.~PHA 2.QFmHA 3.[]CONV. UNINS. 4. QVA 5.QCOt 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 10-0024 8. MORTGAGE INS CASE NUM6Eli: C. NOTE: This !on» is famished to give you astatement of actual settlement costs. Amounts paid to and by the Settlement agent are shown. Items marked "[POCJ" were paid outside the Closing; they ere Shown here for info-metional purposes and are not induded in the btals. to a~ee ho~ooze.PFato.oo2.r22) D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F, NAME AND ADDRESS OF LENDER: Lyndia Lynch 163 Gardner prive Pamela A. Weagley, ExewlOr Shippensburg, PA 17257 Amanda K. Zimmem-an, Facecutor Ot the Estate 0f Herbert Mathna INS. G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 20-2339545 I. SE i7LEMENT GATE: tt33 Gardner Drrye A$S7RACT AMERICA REAL ESTATE SETTLEMENT SOLUTIONS, INC. t * 1 PLACE OF SETTLEMENT March 15, 2010 128 East King Street Shippensburg, PA 17257 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM t3UYER: 400. GROSS AMOUNT DUE TO SELLER 103. Settlement Char e: t0a, 105. Ad'ustments For 106, Co/Town Taxes 107, School Taxes 108. Assessments 108. March Lol Rent 031 110. 111. f 20. GR05S AMOUNT DUE FROM BUYER Z00. AMOUNTS PAID BY OR IN BEHALF O 1 1 advance -01/11 101/11 aua. assessments to 409. March Lot Rent 03/15/10 to 04/01/10 8,922.73 I 1420. GROSS AMOUNT t)l/E TO SELLER I g; to 1 14. Taxes 218. 220. TOTAL PAID BY/FOR BUYER 300. CASH AT SETTLEMENT FRO 1C 11 For 516. 517. 518. 519. 100.OO 520. rOTALREDUCnONAMOUNTOVESELLER 2,049.25 Svc. mess nmvum rasa eyir•or nu er tune zZU) ( 100.00) 802. Less ReduGions Oue Seller (Llne 520) ( 2,049.25 303. GASH (X t=ROM) ( TO) BUYER ~- 8,822.73 603. CASH (X TO J ( FROM) SELLER 6,688.98 The undersigned hereby acKnowledge receipt of a completed copy of pages 182 of this statement 8 any attachments referred to herein. .-~ ~ ~~ Buyer.. Seller i e a A. ea I y. ~jxeculor - - '_ ~ ~~ L. SETTLEMENT Cl~j~d ~ ~ ; i, _ ,9 ~ •a >?W_a m i 1 p a n i a a a ~ .OMMISSION Basad on Price $ % 2,000.00 PAID FROM PA-D fROM ,,on of Commission line 700 as Follow: eUVER•s sEU~•s ,,000.00 to Sailhamer Real Estate, Inc, FUNDS AT FUND$ AT 3 1,000.00 to JAILex Real Estate Services, LLC SErn.EMENT SETTI.EMCcNT ,~3. Commission Paid at Settlement 2,000.OC 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. CredR Report to 805. Lenders Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. 809. 810. 811. r r ~aa rcc~rvx~car rs ~ ~nunR r u rsrs rna~ pr nuvnn~e ___ _ -- _ ` Ptom to !~ S /day ( days Y°j 1000. RESERVES DEPOSRED WITH LENOER _ __ 100'1. Hazard Insurance months (~ S Der month I T 1004. School Taxes months (~ $ per month I I 1005. Assessments - - - - - _ months (~ S __ _--- pet month -- 1006. months (~ S - - --- per month I _ _1 7007. months ~ $ per month 1008._ _ _ months (~ $ Per month 1100. TITLE CHARGES -- - _ 1.101, Settlement or Closing Fee Abstract America Real Estate Settlement Solutions to 12 5 .00 -- _ _ 110?- Abslrad_orTitle Search to I . _ I _ _ 1103. Title Examination to _ __ ___ ~ ~--~~ 1104. TRIe Insurance Binder to ~_ - _ 1105. Document Pre station to _ _ 1106. Nota Fees to -_ _ 1107. Attorney's Fees to -- - ._- moludes above item numbers: 1108. Title Insurance to Abstract America Real Estate Settlement Solutions inGudes above item numbers: __ 1109. Lenders Coverage $ -- _ 1110.Owners Go~erage s 1111, __ 1112. _ 1113. - iZ00. GOVERNMENT RECORDING AND TRA 1201, Recording Fees: Deed $ , IARGES $ Releases 3 MoRgdge 1205. I 1 - -- --- 1300. ADDITIONAL SETTLI=MENT CHARGES 1301. SurveX A to 1302. Pest Inspection to ~ ~ _ 1303. 2010 Co/Tvrp Tax to t3arrYL Ne~ley, Tax Collector ~ 1 49.2 1304. Moving Permit to eany Negle~r I 2.001_ _ __ ___ 1305. T81s Transfer Fee to Sollenbergers ~ 57.50 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K), ~ 184.50 2,049.2 .. / ~`~~° ~~ Ab'stract` Sri ep Estele ettement Solutions Settlement Ag t Cert~ed to be a true Copy. The undersigned hereby acknowledge receipt of a Completed Copy of pages 18:2 of this statement 8 any attachments referred to herein, ~4 Buyer ;•~~ ~ `~ ~~ ~ Seller dypdia.6ynsh /` Herbert Mathna Estate :' i . ~_ T ._ _~' MAy-05-2010(~IED) 15:26 P. 002/002 O~.tsTOwzvBa~x. A Tradition of Excellence 77 East King Street Shippensburg, PA 17257 May S, 2010 Zullinger Davis Professional PO Box 40 Shippensburg PA 17257 Attention: Joel Zullinger Shirley Wescott Orrstown Bank PO Box 250 Shippensburg, Pa 1.7257 Phone 717.530.251 S Re: Estate of Herbert D Mathna Date of Death: 11/18/09 TI' IS hI,EREBY CERTIFIED THAT THE ABOVE NAMED DLCCDENT, ON TII~' AI~OVB DATE, IIAD TIIE FOLLOWING ACCOUNTS WlTFI ORRS .TOWN BANK CFIF.C.KING ACCOUNT Aeeo~mt # Title of Account 306258 TTerbert D Mathna SAVINGS Account # Title of. Account 7015 Herbert D Mathna Account # Title of. Account 970006 Herbert D Mathna Best regards, Shirley Wescott Receptionist Date opened Principal Accrued l~nterest nOD 13a1 6/01/73 6597.65 .03 $6597.68 Date Oucncd Principal Accrued Interest DOD Bal 2/14/91 9107.91 .61 $9108.52 Date Ovened Principal Acerucd Interest DO:D 13a1 11 /02/83 100.00 .08 $100.08 ~! Ai.atc~mobs4e finance P.O. Box 42002 Providence, RI 02940-2002 Ihli~~~I11~~III~~IIII~I~LI,IILIJ~lILJI~IIJI~~I11J11~,1 HERBERT D MATHNA 163 SHIPPENSBURG MOBILE EST SHIPPENSBURG, PA 17257-9503 I...1II.~~I~~I~I~I~i~I~:~II~I~~~I~I:II~~~~~II~~II~~~~II~~~I~II PAYMENT DUE SUMMARY Regular Monthly Payment Amount: 263.68 Past Due Amotmt: 0.00 gees: O.CO Total Payment Amount Due: 263.68 PAYMENT DUE DATE: ACCOUNT ACTMTY Date Description I (/12/09 PAYMENT -THANK YOU December 15, 2009 ~ t1~ ©~ ~~ . • Principal 24.02 Interest Late Charge Other Amount 9.66 0.00 0.00 263.68 Should you have questions regarding your account, please call our Customer Service phone m-mber listed on this statement. Our Customer Service Representatives are available 24 hours, 7 days a week. Thank you for banking with Citizens. Did you know that you can make your payment by phone, or online for a small convenience fee? Please call our automated pay by phone system at 1-888-805-0200, or visit www.citizensbank.com/onetimepay. PLEASE DETACH AND RETURN THE PORTION BELOW WITH YOtTR CHECK PAYABLE TO CITIZENS AUTORtOBILE FINANCE, INC'. Please anz;e~ 7 days Tor m~ilfr!~ to ensure ,naymen! 3s delive.^ed br the due dn~e. ll\w71C1LL1~liJl~a yvaaa. vs.~_.Y_._,_._ [~ Equal Housing Lender Member FDIC Customer Service 1-877-265-3278 Payment Remittance Address: Citizens Automobile Finance, Inc. P.O. Box 42113 Providence, RI 02940-2113 ACCOUNT INFORMATION Account Number: Statement Date: Current Interest Rate: Current Principal Balance: *Estimated PavoffAmount Good For December 15, 2009 1,3S /.78 * Please call Customer Service ror an actual payofr amowit. 2715693392 November 25, 2009 7950% 1,387.81 LAW OFFICES OF ZULLINGER -DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Suite 200 Chambersburg, PA 17201 717-264-6029 Fax:717-264-1884 joelzullin~erna,zullingerlaw.com May 26, 2010 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Dear Register: RE: Estate of Herbert D. Mathna File No. 21-09-1093 HAMILTON C. DAVIS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg PA 17257 717-532-5713 Fax:717-530-5222 hamiltondavislawnae,comcast.net N ra a r c~ ~ ~ . -,; ~, ~ f-- _~ ~ ~ .~ ~ . -,;~-~, ~ .. -- - w . k ~ r r Enclosed for filing in your office are two copies of the PA Inheritance Tax Return for the above along with the following checks: • Register of Wills, Agent - $164.52, balance of PA Inheritance Tax due; and • Register of Wills - $85.00, additional probate fee and filing fee for the return. Register of Wills May 26, 2010 Page II If you have any questions, please contact my Chambersburg office. Thank you. Very truly yours, Y Je1R. gr ,, Encls.