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HomeMy WebLinkAbout06-23-10 1505607121 06 REV-1500 EX 05 ( - ) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 9 1 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 4 9 9 3 0 4 8 9 7 0 9 2 2 2 0 0 9 0 9 2 7 1 9 2 9 Decedent's Last Name Suffix Decedent's First Name MI B O W E N E V A N G E L I N E T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI H Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^X 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) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 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 TO: Name Daytime Telephone Number D A V I D H- S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5 r-.i Firm Name (If Applicable) ~ _ _- _ _> ?________ - `-=-~'__ ~ _ REGISTER Of llWtyS USE ONt~Y - I ; f S T O N E L A F A V E R S H E K L E T S K '' `- '~ ' ' First line of address ' 4 1 4 B R I D G E S T R E E T I ~ _ ~ _ r W ; i : Second line of address , , __, ~~• ' _' -' ~ -W , ? - ' ~ ~: :' f .._" _ _ ~ "` ~ ~ ~` 7 City or Post Office State ZIP Code DATE FILED I__ _._- ___ ___ ~_ _ N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's a-mail address: D S T O N E a~ S T O N E L A W• N E T Under penalties of perjury, I cl re th I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, co mpl e D Clara 'on of preparer other than the personal representative is b ed on all information f which preparer has any knowledge. SIGNA RE ERS O IBLE FOR FILING R N DATE std /rJ ADDRE PO BOX 664 / 14 BRIDGE ST NEW CUMBERLA D PA 17070 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1,505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Num ber Decedent's Name: EVANGELINE T• BOWEN 4 9 9 3 0 4 8 9 7 RECAPITULATION 1. Real estate (Schedule A) ...................................... 1. .. 1 7 2 0 0 0. 0 0 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. 3 2 1 1 0 6 • 0 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ..... .. 7. 8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 4 9 3 1 0 6. 0 4 9. Funeral Expenses & Administrative Costs (Schedule H) .......... ...... 9• 6 5 5 2 0 , 5 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ...... 10. 1 5 5 1 0 • 2 3 11. Total Deductions (total Lines 9 & 10) ..................... ...... 11. 8 1 D 3 0 . 7 6 12. Net Value of Estate (Line 8 minus Line 11) ................... ...... 12. 4 1 2 0 7 5 • 2 8 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. 4 1 2 D 7 5 . 2 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.0 0 D D 15. 16. Amount of Line 14 taxable at lineal rate x• 0 4 5 4 1 2 D 7 5. 2 8 16. 17. Amount of Line 14 taxable at sibling rate X .12 D 0 D 17. 18. Amount of Line 14 taxable at collateral rate X .15 D O D 1 g 19. Tax Due ............ ........................... .. ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. D 0 1 8 5 4 3. 3 9 0. 0 0 o. D 0 1 8 5 4 3. 3 9 Side 2 L 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0912 DECEDENT'S NAME EVANGELINE T. BOWEN STREET ADDRESS 717 HILLTOP DRIV - - - - CITY NEW CUMBERLAND STATE PA ZIP 17070- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 18,543.39 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 17,500.00 C. Discount 921.05 Total Credits (A + B + C) (2) 18,421.05 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. B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 122.34 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................. ..... ^ b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ 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 "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)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a){1)j. 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. (3) 0.00 (4) 0.00 (5) 122.34 (5A) REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER EVANGELINE T. BOWEN 21 09 0912 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'oinU -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ Property located at 717 Hilltop Dr New Cumberland, Cumberland County, PA 172,000.00 sold to Robert L. Brewbaker, Sr. and Jeannette E. Brewbaker, husband and wife, on June 22, 2010 TOTAL (Also enter on line 1, Recapitulation) I $ 172.000.00 (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. iNHER1TANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EVANGELINE T. BOWEN 21 09 0912 Include the proceeds of litigation and the date the proceeds were received by the estate. A{I property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 2000 Ford Taurus SE Sedan sold to Jody Clement 1,675.00 2 Fulton Bank-Checking Acct #36190-35404 4,572.72 3 Fulton Bank-line of credit refund 13.54 4 Pinnacle Health Hospital-refund 50.00 5 Susquehanna Valley Pain Managmt-Refund 10.00 6 Wells Fargo-cash acct 5.21 7 Wells Fargo-Prudential Select Annuity ##0188901 9,478.80 beneficiary is estate 8 Wells Fargo-Prudential Select Annuity #E0116215 303,272.77 beneficiary is estate 9 Erie Insurance-refund on car insurance 313.00 10 IRS-refund on decedent's 2009 income tax return 715.00 11 Miscellaneous personal property in house 1,000.00 TOTAL (Also enter on line 5, Recapitulation) I $ 321,106.04 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER EVANGELINE T. BOWEN 21 09 0912 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Parthemore Funeral Home-funeral expenses 4,435.21 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Charles AClement Jr / David H Stone Street Address PO Box 664 / 414 Bridge Street city New Cumberland State PA Z;p 17070 Year(s) Commission Paid: 2010 2 Attorney Fees Stone LaFaver & Shekletski 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent 4. ~ Probate Fees Register of Wills, Cumberland Co 5 ~ Accountant's Fees 6. I Tax Return Preparers Fees 15, 000.00 15,000.00 472.00 ~. Miriam Dickey-cleaning at property 275.00 2 Donegal Insurance-homeowners insurance 308.00 3 Erie Insurance-car insurance 192.00 4 Donegal Insurance-homeowners insurance 301.00 5 Erie Insurance-car insurance 193.00 6 Erie Insurance-car insurance 193.00 7 Cumberland Law Journal-adv grant of letters 75.00 8 The Patriot News-advertising grant of letters 148.17 9 Fred Weiand-installing hardwood floors at property 2,575.00 10 Melanie Genbauffe-Reimb for moving expenses 463.56 11 Sweet NGrow-lawn service at property 869.00 12 Pat Roth-kitchen floor installation fee 400.00 TOTAL (Also enter on line 9, Recapitulation) $ 65.520.53 Zip (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent EVANGELINE T. BOWEN 21 09 0912 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 13 Mark Whitcomb-maintenance on walls at property 500.00 14 Dan Houser-maintenance on walls at property 140.00 15 Pat Roth-gliders for closets at property 50.00 16 Affordable Property Maintenance-work done at prop 3,300.00 17 Suzanne Houser-fee for overseeing contractors 694.00 18 Lawn Care & Snow Removal Serv-serv at property 60.00 19 John L. Barrett-lawn service at property 108.00 20 Robin Gasperetti, t/c-real estate taxes on prop 1,929.42 21 Robin Gasperetti, t/c-per capita tax 11.00 22 Robin Gasperetti-real estate taxes for property 1,048.01 23 PPL-electric services at property 117.73 24 PAWC-water service at property 34.23 25 PPL-Electric service at property 113.04 26 New Cumberland Boro-sewer & trash serv at prop 106.63 27 HB McClure-oil service at property 242.00 28 Comcast Cable-service at property 56.13 29 PPL-Electric service at property 154.97 30 HB McClure-oil service at property 242.00 31 PAWC-water service at property 31.65 32 PPL-Electric services at property 33.78 33 PAWC-water service at property 28.g3 34 HB McClure-oil service at property 242.00 35 PPL-Electric service at property 29.70 36 PAWC-water service at property 30.28 37 HB McClure-oii service at property 242.00 38 PAWC-water service at property 33.72 39 PPL-Electric service at property 44.73 40 HB McClure-oil service at property 242.00 41 PAWC-water service at property 33.02 42 H B McClure-oil service at property 242.00 43 New Cumberland Boro-sewer & trash at property 101.55 44 PPL-Electric service at property 32.04 45 H B McClure-oil service at property 242.00 46 PAWC-water service at property 29.84 47 PPL-Electric service at property 28.89 48 New Cumberland Boro-sewer & trash at property 101.55 49 PPL Electric-service at property for April and May 2010 64.20 50 HB McClure-oil service at property for April and May 2010 368.94 51 PA American Water-service at property from April to June 2010 89.64 52 New Cumberland Boro-sewer & trash at property 97.55 53 Register of Wills-filing Inheritance tax return & Inventory 30.00 54 Reserve for lawn care at property 200.00 55 Settlement costs ($13,410.77) less reimb on taxes, etc ($592.35) 12,818.42 SUBTOTAL SCHEDULE H-67 24,345.59 Continuation of REV-1500 Inheritance Tax Return Resident Decedent EVANGELINE T. BOWEN 21 09 0912 Decedent's Name Page 2 File Number Schedule H -Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 56 United Mileage Plus-transfer fee 75.00 57 Reserve for closing expenses 200.00 SUBTOTAL SCHEDULE H-67 I 275.00 REV-1512 EX ~ (12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER EVANGELINE T. BOWEN 21 09 0912 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 ~ Susquehanna Valley Pain Managmt-services rendered 10.00 2 Susquehanna Valley Penn Mangmt-services rendered 10.00 3 American Express-debt of dececent 81.32 4 Fulton Bank-payment on line of credit 175.71 5 Chase Card Services-credit card debt of decedent 600.00 6 Fulton Bank-line of credit payoff 13,160.42 7 Fulton Bank-payment in full of line of credit 84.66 8 Chase Card Services-credit card debt of decedent 1,363.12 9 Lower Allen EMS-services rendered 25.00 TOTAL (Also enter on line 10, Recapitulation) I $ 15, 510.23 (If more space is needed, insert additional sheets of the same size} REV-1513 EX + (g.00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER EVANGE LINE T. BOWEN 11 uy Uy11 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 MELANIE GENBAUFFE Specific bequest Linea 1 118,018.82 10229 CHATHAM WOODS DRIVE Residue LOVELAND OH 45140- 2 STEPHANIE FLIERJANS Lineal 98,018.82 4680 QUENTIN STREET, SW CALGARY AB 3 KIMBERLY MASSAL Lineal 98,018.82 4 BOEING ROAD NEW CUMBERLAND PA 17070- 4 TAYLOR S DAVIS Lineal 49,009.41 9 SHETLAND DRIVE SHREWSBURY PA 17361- 5 SAWYER J DAVIS Lineal 49,009.41 9 SHETLAND DRIVE SHREWSBURY PA 17361- 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 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) "' ' OMB Approval NO.2502-0265 '! - A. Settlement Statement /HUD-1 ~.~ _,~ . 1. FHA 2. ^ RHS 3, Corte. • File Number ^ ^ 7. Loan Number: .Mortgage Insurance Case Number: 307958REWt3AKER 15/0067230 4. ^ VA 5. ^ l;onv. Ins. C. Nob: This form is famished to Give you a statsrttertt of actual seltbrttsM costs. Amounts paid m and by the settkrrrsnt agents aro shown leertts martced '(p.o.c)" were paid outside tits dosirt~ they are shown has for Mtortnalional purposes and are not incMdsd in the totals. D. Name b Address of Borrower: E. Name b Address of Selby. F. Name ~ Addross of Lender: Robert L Brewbaker, Sr., Jeannette E. Brewbaker Estate d Evarrgelirre T. Bowen EverBank, ISAOA 510 Terrace Drive, New Currberiartd, Pa 17070 717 HiObp Drive, New Currrberland, Pa 17070 8100 Nations Way, JadcaatviNe, FL 32256 G. Property Locatiwt H. Settlemer-t Agent: I. Settlement Date: 08r1?12010 717 Hilltop Drive Cedar Cltlf Abstract Agency, Inc. Disbursement Date: 08/22/2010 New Currtbertand, Pa 17070 Telephone: 717-n4-7435 Fax: 7177743869 New Cumberland Borough - Place of Settlerrtent: T itleEx7xess 414 fridge Street, New Cumberland, PA 17070 Printed 08/2?/2010 at 10:55 am by KAB 100. Gross Asowrt Ow tirortt Barowsr 400. Gross Asast Dw b SsNsr 1 1. sales price 1. sales price . 102. Personal 402. Personal 103. Seltlerrrertt drarges b borrower dine 1400) 7,o63.n 403. 104. 404. 105. 405. br Mess saNsr ti advsnos br Msnts ssMsr in advance 106. CiryAown taxes b 406. Ciryllown farces b 107. CourNy tortes 06/22/2010 b 12/3112010 551.28 407. County taxes 0612212010 b 12131@010 551.28 108. Assessments 06121/2010 b 0613012010 37.68 408. Assessments 062?11010 b 06/3012010 -37.68 109. 409. 110. 410. 111. 2nd qtr Trash pM 0612212010 b 06130/2010 3.39 411. 2nd qtr Trash pM 061222010 b 06/30IZ010 3.39 112. 412 120. Gross Asowtt Dtta tros 8orrowsr 17l,isi.12 420. Gross Asoatt Dw b SsNsr 172,'i2.3S 200. MtoutMs Pelid er M BsInM of Batowsr 500. t~sdtstloas ti /baaNtt Dw b SNer 1. or eameat money see 202. Principal amount d new hen(s) 82,000.00 502. Settlement charges b setler ~ 1400) 13,357.00 203. a taken b 503. s taken b 204. 504. d first loan 205. 505. d second loan 206. 506. 207. 507. 208. 508. 209. 509. for Mstas ssMr br Mnas salver 1 taxes b 51 taxes b 211. Country taxes b 511. County taxes b 212. Assessmerrb b 512. Asaessmertb b 213. 513. 214. 514. 215. 2nd qtr Sewer prin 04A12010 b 06@2/2010 53.n 515. Znd qtr Sewer prtn 04A12010 b 06222010 53.77 216. 516. 217. 517. 218. 518. 219. 519. ~• Tod Paid Bonowsr q,OS1.77 ~• ToW Reduction Asotntt Dw SaNsr 13.410.77 200. Ceeh at SeMMsMtt irosMo Bort~ower i00. CeMt et Ss1Ue^tnR toltnottt 8eMer 301. Gross amount due irom borrower (line 120) 179,656.12 601. Gras amount due b se0er (line 420) 172,592.35 302. teas amaxtls paid byllor borrower (line 220) 83,053.n 602 lass reducfions in amourn due ostler (tlne 520) 13,410.n i03. Cash ^X Fran ^ To sonvwer iR~-u 003. Cash ©To ^ Fros tiaNer 1Q0,1it.st er.~a.~w.~s.p.r..auw~rr•+eaea.r.~mw~«.. w.a.~n+rr.~..atrr.em....r~..++.n nr.rer~.erwww.«oar.~Er~-...ea..da.~.r~wa~nrr.ew.o« arbwe Neon. Previous itions arc obsolete 1 HUo-l 70Qt Tat~l Baal Eadla oroMar Faaa 1 . Paid From Paid From DMaion d oamfiaaion lure as tolowa: Borrower's Seller's 1 • i10 320.00 b Aas oaates Funds at Funds at • ~•~ ~ Settlement Settlement ' paid at settlement i er ee ~ Realty Assac;i'ates . 100. Manta in Catrtatlon wltlt Loan 801. origination charge (hiciudes Point or ) .41 (from 11) Your credit or charge (points) for the irMerest rate chosen 1,806.46 (fiorn ) . Your acted aigination charges (from GFE A) 1,216.95 • APi~ to EverBank ISAOA ( ) 75. 805. report b I Bank (from ~i) ~• ~ senioe 1o E ISAOA (from ) 74.00 807. Flood certification to from GFE #i3 808. b 100. Mara Lander b ba Paid to Advance ' interest charges b . 7 ) 1 . Ins. morrtlw ~ Homeowners i~xar>oe nrorrtha to State Farm Insrxarrce 5491.00 P.O.C. B 904. ngntlrs to from t,,FE 111 1001. IrMial deposit for your esaow aooount (from GFE fl•9) 1,719.00 1 . Homeowners irrauranoe 3 months S 40,93~~ 1 .79 1 .Mortgage Instxarroe months S O.OOJrrronth 1 ax months i o.00hnonlh . loos. Property ax s months 5 90.13hrronlh . 1 . Aasesanrenta i rrrordfrs S 143.25/nronth 1,719. 1 . Aggregate Adjustment .57 1100. The 11 1. itle aervioes and lender's title insurance (from ) 1, .75 1102. SeWerrrerrt ar cloeir-g fee ~ S 1103. Owners title insurance (from GFE 15) 466.00 1104. Lenders titb inarxarroe 5975.75 1105. Lenders tide polic~r lirtrit 58'2,000.00 Lender's Polcy 1106. Owners title policy anrit 5172,000.00 Owners Policy 1107. Agent's portion d the dotal title insixanoe premiixn 61,177.12 1108. Underwriters portion d the total title insrrranoe prerrwrm 5266.63 1109. 1200. t?owrnnrarrt and Tranabr 1201. Govenxnerrt recording drar9es (from GFE ~ 152.00 1202. Deed 562.00 590.00 Release 50.00 1203. Transfer taxes (from GFE 08) 1,720.00 1204. Ciry/Caxrty tatdstartps peed i1 720.00 50.00 1205. Stale Taxhtamps peed 51720.00 50.00 1,720.00 1 ~. Deed 50.00 50.00 1207. 1100. AddNfoml >jalranrMrt 1 1. services that you can shop ) 15. 1 tp 1303. ro 1304. 2010 County Tax to Robe 51048.01 P.O.C. ax to Robin 51718.94 P.O.C. S ax ee to Slone Lefever ~ Sheklelski nspairs b W.S. Electric • rash to New Cumberland 538.60 P.O.C. S • st Qtr b New Cumberland 558.95 P.O.C. S . Hone MraRar>hr tD Fast Mrerir•,an Home P rotection 11. Notary ea ~ Cash • b Stone Lefever d~ Sheklebki 1 1 b Etile Lender Services 1 . 'Paid outside d closing by (B)orrower, (S)eller, (L)ender, (Ikrvestor, Bro(K)er. Prtiwtous editions are obsolete ge o 4 HUD-1 Loan Twins Good FaMh EeYtaals MlO~1 3, .41 .41 -1, -1, 1,16. 1,1. i, 1, Hood Fs~t Etratsls INlD1 1 . ~5• 75.00 45. 74. 74. 1, 1, . 5 0. 468. 15. 15.50 1 .75 1, .14 - 4. Yaur HWI loan anoint is 162,000.00 Yoru ban tam is 30. years Your inilfel kMMe1t tell it 5.3750'K Maur iniwl aorddy arnonnt owed for prM+cfpsl, irlllrNt, and any ntortisps 1458.18 irrcltrdas ~~ a o Can your irrlereM rely rNs'~ QX No. ~ Yes, it can rise b a maximun d 7r.. The first change wiN be on I I and can charge again every years albr / ! . Every drange Oab, you interest rate can irraease or deaeaee by %. Over the ale d the loan, your inlereet tale is guararrleed b never be bwer than '16 or ttipher than %. Even N you nrelrs psynrarls on tinre~ can your ban bslaros riseft QX No. ^ Yes, it can rise to a maximum d i Even rf yon ndos payrsarls an wns, an your rnawrl!- antennt owed for QX No. ^ Yes, the first irxm3ase can be on 1 / and the monthly pfwrdpel, MMaeet, and malpsge irrsuranoe rtes? amount owed can rise to S The maximrxn it can ever rise b is S Does your lose IrM a PAPS t 0 ~• ^ Yes,1-~ ~~ DrePayment Ply ~ S Does your loan have a befoon peynrart? QX No. ^ Yes, you have a baNoon payment d i due b years on I I Tod nroMrly anonnt owed hcludlrg escrow aooount psyrrwrlt ^ Yau do not have a montlrly escrow payment for Nears, such as property taxes and honreowr~s baruarrce. You must pay tl>ase hems dxedly yourseti. You have an additional montidy escrow payment d 1214.31 that resuNa in a total initial monthly amount owed d 1733.49. This includes pry interest, any rtrorlgage insurance and any items drecked below: QX Property tarcee QX Homeowner's irrsuranoe ^~ ^ o a NoEa ff you have any questions about the Settlement Charges and Loan Terms N.~ed on this form, please contact your lender. Previous editions arc obsolete age HUal HUD CERTIFICATION OF BUYER AND SELLER hive c:nfulh- r~wiawad tlra HUat SattMnnrrt Sislsnrarrt and to tlra bast of my wawkdpa and trsNsf, i< is a tn,a and a«xuaAe swemsM o1 aN roaQes sea disbunenrents made on my aooount a by nra in this transaction I fixtl-sr oaNfy that I haw naiwd a Dopy of tlra HUD-1 SalfNnNM StaMnraM. dC. ~O,,n 2r~ r~i~JPtZ, A Robert L Brewbaker, Sr. Jeannette E. Brewb2ker ~~ Estate of Evangeline T. Bowen The HUD-1 Seltlerrrsrd Staesrnsnt which- prepared is a true and accurate account of this trarrsadion I have caused or wiN cause tha funds to bs disbursed in aocordanoe with this ~,-~ -, AGENT DATE WARNINCx R IS A CRIMIE TO KNdWiNGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FOR~II PENALTIES UPOP CCMNICT'ION CAN INClUOE A FINE AND IMPRISONMENT. FOR DETAILS SEE TtTIE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions arc obsolete ge 4 0 4 HUD- Nenra d Seller Robert L. Browbaker, Sr. I Estab d Evanpelins T. Bowen I 3079~iBREWBJIKER Jsannetee E. Browbaker Prspsrod 081'2?l2010 n 10:58 am noe.: This page is furnished to give you an itemi=atbn of the amounts shown on r feAid ff?~Ah`,_ ~ pMd f1~0A1 Lines 1101, 1103 and 1104 of the Settlement Statement (HUO-1). Thb page ; pig,.., ; :.~ $~+s accompanies but is not a part of the settlement statement. ff a dbcrepancy ~ FYIl~ ~-~'~~ ; ; ftM~.at ,. exists, the information shown on the Settlement Statement (HUD-1) applies. ~'" .;rte . ~ . ,~. , 1 tot. Title eerYlOee and lenders btls M1e1Kaf10e 1,0.75 a. ETF Fes s 60.00 b. Fed~ao~lwire fee S 10.00 G Fee t ffi.oo d. Tills kr-Bseic 1102 Seltlertient or fee t tai. owrbre tltls ir~,ranos s Iee.oo t too. Lender's tills ineuranos 750.75 s tl7a.7s a. Service Letler 75.00 b. ALTA Short Loan 100.00 c. End 900 50.00 1101 hrMfb #eIR 1100. OMea~r~e rs latlt t<1'l?,00084 1107.. thlerlreiaae~as i 1177f12 1101 dtArtotdlrlsi~Ntaarroa X41 1109. tiro. 1111. 1112 A~artit~n~i,ji Ini;~r!ti,~tion fni Line 1101 It}~rt~~ ~'Il ~ t tot. Ttlk e«vioee and lenders ttlls iner,ranoe ,f ~'C. v. 4 y{ KA'.:: s f^ ~ . a. ETF Fes b Sbns laisver 6 Streldelslo 50.00 50.00 b. Fed~eodwirs fee b Sbns lafavsr ~ SfreWebid 10.00 10.00 rw Fee b Cash 25.00 25.00 1104. Lender's tltls irnrafarros b Cedar Ctl(f llbelract . hrc. 975.75 975.75 }iiiw 4 .r h'i ,~;q~ 'f ,Y ,~ K`: ~Ya- m t. ¢F th ,.K "`*' .i ,.;~ 4, ~, fJ {, ~.~ ~. ESTATE OF EVANOEUNE T. BOMf EN a 6,~„0 /1'~1 ~ •• ~Jr~ Q Date 6/22/10 Robert L BroMrbaker, Sr. to 6/22J10 Jearx~etle E. Brewbeksr F'~DUCS\RE~DED1BoweaEvangeline • 717 Hilltop Drive.wpd Tax Parcel ~l: 26-24-0809-439 Address: ?t7 Hilltop Drive fYew Cumberland, PA 17070 DEED THIS INDENTURE made the O~a day of ~V~~_ , in the year 2014, between CHARLES A. CLEMENT, JR. and DAVID H. STONE, Co-Executors of the Last Will and Testament of EVANGELINE T. BOWEN, late of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, -AND- ROBERT L. BREWBAKER, SR. and JEANNETTE E. BREWBAKER, husband and wife, of the second part, hereinafter called the Grantees; WHEREAS, the said EVANGELINE T. BOWEN became in her lifetime seised, as of fee, of and in to a certain tract of land, together with the improvements thereon erected, situate in the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on September 22, 2009, having first made her Last Will and Testament in writing dated October 29, 2007, duly probated and registered in the Office of the Register of Wills of Cumberland County on September 29, 2009, wherein and whereby she appointed as Co-Executors, the said CHARLES A. CLEMENT, JR. and DAVID H. STONE, to whom Letters Testamentary were duly issued by said Register of Wills on September 29, 2009, wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register of Wills, recourse thereunto being had, appears: NOW THIS INDENTURE WITNESSETH, that the said Grantors, for and in consideration of the sum of ONE HUNDRED SEVENTY-TWO THOUSAND and NO/100 ($172,000.00) Dollars, which has -1- been paid to them by the said Grantees at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, have granted, bargained, sold, aliened, released and confirmed, and by these presents do grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THAT CERTAIN lot of land in the Borough ofNew Cumberland, County of Cumberland and Commonwealth of Pennsylvania, bounded and described as follows: Lot ZZ. Block "K": BEGINNING at a point on the northerly line of Hilltop Drive five hundred fifteen (515) feet measured northwardly and eastwardly along Hilltop Drive from the northerly line of Drexel Hills Boulevard and at the easterly line of Lot No. 22, Block "K" on the Plan of Section 4, Drexel Hills, said Plan being recorded in Plan Book 11, Page 11, Cumberland County Records; thence by the latter line northwardly one hundred fifty-six (l 56) feet to a point; thence eastwardly by the southerly lines of Lots No. 41 and 42, Block "K", ninety-seven and fifty-two hundredths (97.52) feet to a point; thence southwardly by the westerly line of Lot No. 21, Block "K", one hundred sixty-three and sixty-four hundredths (163.64) feet to a point on the northerly line of Hilltop Drive; thence by the latter line westwardly eighty-five (85) feet to the place of BEGINNING. BEING the same premises which Robert M. Troutman and Anna E. Troutman, husband and wife, by Deed dated September 20, 1960 and recorded on September 22,1960 in Cumberland County Deed Book Z., Volume 19, Page 1121, granted and conveyed unto John S. Bowen, Jr. and Evangeline T. Bowen. John S. Bowen, Jr. died on July 15,1979, thus by operation of law vesting title in Evangeline T. Bowen, deceased. HAVING THEREON ERECTED a single family dwelling house numbered as 717 Hilltop Drive New Cumberland, Pennsylvania. -2- TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, the said Evangeline T. Bowen, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. AND the said Grantors, for themselves and their respective heirs, executors and administrators, do covenant, promise and agrees to and with the said Grantees, their heirs and assigns, that she, the said Grantors, have not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set his/her hand and seal the day and year first above written. ~~~ Q--~ ~~ (SEAL) Witnes CHARLES A. CLEMENT, J , Co-Ex for of the Last Will~ur)~estament ofj~VAI~GELINE T. BOWEN 1't1Gc~ Q-&ilG~~ (SEAL) Witnes DAVI . ST E, xecutor of the bast Will and Testament of EVANGE E T. BUWEN -3- COMMONWEALTH OF PENNSYLVANIA Cu-m~'~G~ SS: COUNTY OF : On this, the aa' day of S~~ , 2010, before me a Notary Public, the undersigned officer, personally appeared CHARLES A. CLEMENT, JR., Co-Executor of the Last Will and Testament of EVANGELINE T. BOWEN, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. COMMONWEALTH OF PENNSYLVANIA ARI SAL JENNIFER A. MEARKLE, Notary Public New Cumberland Boro. Cumberland Co. Notary Public Commission Expires Ju 1, 2012 COMMONWEALTH OF PENNSYLVANIA ~1 ~ SS: COUNTY OF C-~`'r`, ~ : On this, the ~-~~d day of ~7~~"-~- , 2010, before me a Notary Public, the undersigned officer, personally appeared DAVID H. STONE, Co-Executor of the Last Will and Testament of EVANGELINE T. BOWEN, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and no 'al seal. COMMONWEALTH OF PENNSYLVANIA f NOTARIAL SEAL ~~%%` JENNIFER A. MEARKLE, Notary Public New Cumberland 9oro. Cumberland Co. Notary Public My Commission Expires Ju 7, 2012 I hereby certify that the precise address of the Grantee is ~'l l1 ~;11~1~ I/t:~~ tip,,,,C~,~~~, P~ i~~~0 DATE: Attorney for -4- 5'fONE, 1. 1F 1V EI2 rSC SHEKLET~IZI ATTQRNEYS AT LAW ala BRIDGE STREET STEW Ci1~IBERL.IJID PA 17b70 4 LAST WILL AND TESTAMENT OF EVANGELINE T. BOWEN I~, E:`~." ~1:d~.-~i~.LICTE 'I'. B(~PIEI~I, ,~,E t.h~ F3«rc,uc~~1 ~~f Nr~w (`tirnk;er.t=+~-i~~, `.,11f1!t,~_:-r 1•_iili'~ ' ~~,-llCii:l ~ ~'~'I~lri:;'~~. V~1111~~~ C~~?C'ldt'E? t:~11S ~.O ~tt~' TiI~T 1.,~~1" 6d7. 11 ~1i'i~-~ ;~<,~,~r:~: any will pravi~~usly made by me. _ ~? _ '' ~~; -. ,1t~1 n~j~ y--:.tl,- t-~tli ~ ~-1. r1[ll~ l>F'~:5~711 l .. (. '.. ~.~-.I ,. ,....i .. , t^_L: i- ~ r.,~r-~~, ~~1~1~-. p~r~:-,:~ ~.1-1-.y ~~t l i.k~ n~~iLure (i-I~~t i.I~lclta~_lin~_f ~';~~::h ~;r :~t_~c:uc it:i,,~:::'i .'~1'"l"iIr'r' T,n111"~Ii ~1;1~j ~?rl-:~f:t1lC~ ].I-lS~iY'riT1C~ t~IPL-F'OCl ~:(l fR`~ ~.1.-ill^lil,r~t~':~ ~'~:~~i~c~N?ti~ ,<<'Clts?:;'FI`[~, ~,.=iIJP.I~ D?3VIS, STFPH~1l`~7~I~ FI_,IERJI~TI;, ~~n~-1 f;719T~~~i,F~_f~Y ~~[A.~;: ,~~, -i:. ii'- ~i~~'';i it"~L1t~j~ I_~i l)C' C11V1C3E'(l %1(lll)I1~ L11t'.m ~~~~ my EY.t~(:Ur."I ~Jl' I'! ~-~11r:' li: ,.a[~'1 1:~1- 1~.(i!.'1L' ti~:.L'aC')Ll~_L ~IT'~~r~LF?I]CE_':~ 1I) d5 rlE~c?C:~-V t'C(i1~tl i~. L~-.- .., .I ?~~ +~' ~-i . '~ i~ T I `,E-tille?e1C~L tl,t~ _,;iC[l ~1t ~ 'O~ C)~O. C10 i--~-' 111 `w .I ~'.-1~(r:_ - '~~ i _ r~.i"~ I I i .. X11 C '.~'fi: ':~1~iT= CI ,'y }i~-tllSi? Zt>~-'?l~'i~~~ ,Ir ? ~ 7 il] I ~')~' ~'._ i'~'t' r, .';1 ~,~iCn,;r'.~1,-il.il~ L't'?~!1l~"1 V:3 C1.1,=t ~~ .;~JL~I aitij ~r1E` px'(,t,c,t:.l ~.:.E~Y'~l:i-C`Il; t;.. l~ 1~i~~r'ra L` ~ _~-=1":;? .~tilij ;"i~-~'1~--~1?_fl =111 ~.C: Zt)`~r.~ ! -. ,. a:~~ iCu". I it R ~~ 1.,~1, .. :* i'l:i :~~_.11 -'~ t ~-'?'' Slut1]tt' ~LI;•~ 'rl11.i_~-~lt:C ~t _ic1` =:~ ~;J'_-._ i . ..-.. ~ T. .... 1~'~ 1, i~ct.,.~,i'iiL, :~~,il~r~,~il' ,~~ ~:?111F:1 ~'~ _i~,`'/_.~r - ~ ~. .r'I ~ . ...'~ ~1 r ri.P.',~L ~°1. 1..~,._~.~ I.: .'llL ~?'v~ ;Iln. ,,'t: `_l ~ ;I~y ~~" i', L; .rl~ it-'. .. ~ ~ children predecease me, I devise and bequeath the share of such child to her issue, per stirpes; and should any such child of mine leave no such issue living following my death, I devise and bequeath the share of such child to my issue, per stirpes. ITEM V: I appoint my CHARLES A. CLEMENT, JR. and DAVID H. STONE, Co-Executors of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, EVANGELINE T. BOWEN, have hereunto set my hand and seal this '.Z~1 day of _~'c i~~~ 2007 . ' r Q~ ~ / ' EVANGE~I~NE T. BOWEN Page 2 of 4 SIGNED, SEALED, PUBLISHED and DECLARED by EVANGELINE T. BOWEN, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of eac o her, have subscribed our names as witnesses. i 414 Bridge St., New Cumberland, PA Wit Address / 414 Bridge St., New Cumberland, PA Witness _ Address COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND I, EVANGELINE T. BOWEN, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. Lam-, ~~.~ ? ~2J<~ EVANGELIN BOWEN Sworn to or affirmed to and acknowledged before me by EVANGELINE T. BOWE1`7, the Testatrix, this ~~~ day of ~-`~ 2007. .__. ~~ Notary Public ~pMMONWEAItH Of PENP~SYIV NOTARIAL SEAL Public CAROL L. TROXELL, Notary New Cumberland Boro. Cumberland Co. My Commissron Expires Oec. 27, ~ e 3 o f 4 t t COMMONWEALTH OF PENNSYLVANIA : . SS. COUNTY OF CUMBERLAND We , ~©~~ ~ ~~Cb~~.--. and ~C~..~ {.A~ Vl ~Q ( M , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. W Witness Sworn to or affirmed to and acknowledged before me by -~~~,~~ ~ - S~i~.y, _-~-.- and l `i ~ ".~,"-s=~ 1 ~'~. , witnesses, this Cz~~ day of ~~-~ r 2007 . v C~MMONWEAITH O~ PENNSriVANlA Notary Pub 1 i c NOTARIAL SEAL CAfiOI t.. TROXELL, Notary Pubttc New Cumberland Boro. Cumberland Co. My Commission Expires Dec. 27, 2(109 Page 4 of 4 ~~ Fulton Bank, h1.A. Member FDIC. Member of the Fulton Financial Family. October 12, 2009 Stone Lafaver & Shekletski 414 Bridge Street New Cumberland, Pennsylvania 17070 Dear Sir/Madam: RE: Evangeline T. Bowen, deceased September 22, 2009 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Checking # 3619-35404, open 6/30/1995, date of death balance $4,572.72 in her name only with Kimberly B. Massal as Power of Attorney. Line of Credit # 088522317, open 9/27/1999, date of death balance $13,293.35, secured by collateral mortgage, in her name only. If you require payoff information, please fax your request to our Direct Banking Center at (717) 569-6316. If you should have any further questions, please do not hesitate to contact me at (717) 291-2437. eery truly yours, ~Ak~..~ Karen D. Hillegas Credit Inquiry Processor i "y ~~~~~~D'-~ ~ ~~ This information is t;:~s~:•~' . ~ :,i:~`cr ~„ ~~.s;n;:,~ . , ~~ .^.~r;esy ~n an~~~i to ~i:::r r. 'i; ~, F v. _ :'j~. P,i ~C.:: i;n~~ sec ,,. t.. >,3 iVr~i'~4i:~F~ u~y•.. SC~. { r' v ~i'.~~ J ~_~. r ~. :: `J i..t. ., `.. 4~ti~: GC any {'` iii t r. - ~ :.' 'til _ ,~.... hE,,;n i/;,;~, ~~~s:;,,r ~a ;~ :~, i;:n rttt t r c~~ca P O Box 4887 , , ~ Lancaster, PA ~76b4 fultonbank.com ~ 1-800-FULTON-4 Wells Fargo Advisors, LLC Three Lemoyne Drive Lemoyne, PA 17043 Te1717-761-7344 Fax 717-975-8426 800-468-8685 Member FINRA/AP( October 1b, 2009 David H. Stone 414 Bridge Street New Cumberland PA 17070 RE: Estate of Evangeline Bowen uf3G y!'12i09 Dear Mr. Stone: TM Raymond G. Woods Jr., CFP Senior Vice President -Investments rav.woods~wfadvisors com Shelly A Weibley Senior Registered Client Associate shellv.weiblev~v+Fadviv+rs com Please be advised that at the time of Ms. Bowen death on 9/22/09, she maintained the following Wells Fargo Advisor account. Registration: Evangeline Bowen Acct #: 1687-2234 Acct type: Retail Individual Opened: 8/24/1990 The securities and values of the account are: Prudential Select Annuity #E0116215 cusip #74429E404 $303,272.77 Prudential Select Annuity #E0188901 cusip #74429E404 $ 9,478.8a The Estate of Evangeline Bowen is listed as the beneficiary for both annuity contracts. l have emailed the necessary forms to process the claim earlier this month. Please !et me I?now if !can ae of further assistance. Respectfully, C.CJ ,. Shelly A. Weibley Senior Registered Client Associate THE INFORMATION CONtAINED HEREIN HAS BEEN OBTAINED FROM SOURCES BELIEVED RELIABLE BUT NOT NECESSARILY COMPLETE AND CANNOT BE GUARANTEED. ?HIS REPORT IS NOT THE OFFICIAL RECORD OF YOUR ACCOUN?. YOUR WACHOVIA SECitRITiES CLIENT STATEMENT 4S THE OFFICIAL RECORD OF YOUR ACCOUNT. STONE LAFAVEI~ &SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E GERALD J. SHEKLETSKI Nsw CuMSEaLnxn. PA 17070 ELIZABETH B. STONE www.stonelawnet June 22, 2010 Register of Wills of Cumberland County 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Evangeline T. Bowen File No.: 21-09-0912 Greetings: OF COUNSEL CHARLES H. STONE JON F. LnFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 Please find enclosed two original Inheritance Tax Returns, and an original Inventory form in the above referenced estate. I am also enclosing two checks, one in the amount of $122.34 for Inheritance Taxes due, and one in the amount of $30.00 for the filing fee. Enclosed is a copy of the cover page of the Inheritance Tax Return and a copy of the Inventory form. Please time stamp those copies and return them to us in the enclosed self-addressed, stamped envelope, which I have provided for your convenience. Please note that these documents are being sent via regular United States Mail and this letter has been post marked on June 22, 2010. Thank you for your attention and assistance in this matter. Please don't hesitate to contact us should you have any questions regarding this matter. Very truly yours, STONE LaFAVER &SHEKLETSKI avid ~ ~~ ~o DHSljam ~`~-~n Enclosures ~~ ~~ `~ ~•~> .~: cc: Charles A. Clement, Jr., Co-Executor ~ " ~ ~''' - ' '~T' ~ _ _ ,r_ _ w W W W x 04. O V{ja.. m O ~? °~ W U (~ LL O S3a ~ ~ m 3~ m N~ ~~~~u a d a. W Z O i O ~ M ~ O 3 ~ ~ ,},, ~ a 0 0 ~ °~ ~ p~ .~ U C O