The URL can be used to link to this page

Home My WebLink About06-24-10 (3)J 1505610142 OFFiC1Al USE ONLY REV-1580 °"°'-'°' ~ PA Department of f#evenue County Code Year Fde Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~f ( ~I PO BOx 2t3060i RESIDENT DECEDENT y f ~ r' D ~ ~~ Harrisburg, PA 39i~8-o6oi ENTER DECEDENT INFORMATN)N,BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 174-20-7639 09242009 11231928 ', Decedent's Last Name ~ Suffix Decedent's First Name ~I I MI SNELL BETTIE j L (tf Applkable) Enter Surviving Spouse's Information Bslow i Spouse's Last Name Suffer Spouse's First Name ~ i MI I Spouse's Social Security Number ~ THIS RETURN MUST BE FILED iN DUPLICATE WITH THE REGISTER OF WILLS Ii FILL IN APPROPRIATE OVALS BE OW ® 1. Original Return O 2. Supplemental Return Q 3. Remainder R turn (date of death prior to 12-1 2) Q 4. Limited Estate ~ Q 4a. Future Interest Compromise (date of Q 5. Federal Estat Tax Return Required. death after 12-12-62) O 6. Decedent Died Testate . O 7. Decedent Maintained a living Trust 8. Total Number of Safe Deposit Boxes (Attadt Copy of wlg (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Eledion tot under Sec. 9113(A) ~ between 12-31-91 and 1-1-95) (Attach Sch. ) CORRESPONDENT - THIS SECTION MU BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUL TAX INFORMATION SHOW BE DIRECTED T0: Name Daytime Telephone Number PETER J. KRAMER, ESQ. (717) 728 -5502 1 N REOIST~O WILLS tl~'ONLY , .,r ' ~ ~ ,_. ,~ ~ ~ L , First line of address i ~ ~ Z c."~ ~ ~_ ~ s z i 1970 TECHNOLOGY P KWAY 4 ~ ' ~. C'S C Second line of address ~ ~-j -n 3 r~ W ~ ~... Cit P t Off State ZIP C d FILED .C' ~ < y or ice os o e MECHANICSBURG PA 17050 ill ', Corespondent's e-mail address: 1 KRAMERLAWls?COMCAST .NET U pens ~ of perjury, I declare that I examined this Tatum, including accompanying scI>edules and statements, and b the beat my luwwladge and belief, preparer other then the personal representative is based on aA Information of which has arty knovWadge. S F R R SI R FILING R URN ~ DATE 1 6/23/2010 ADDRESS 1729 GUSHING GREEN CAMP HILL, PA 17011 1 SIG RE OF PREPARER OTHER N REP SENTATIVE 1 DATE ~- 1 6/23/2010 AD ESS 4755 LINGLESTOWN R AD HARRISBURG, PA 17112 PLEASE U>3E ORI~fi1NAL FORM ONLY f 7 _~ n i Side 1 j L 150561014 1505610142 J 150561D242 REV-1500 EX Decedent's Saci~l Security Number Decedenrs Name: BETT I E', L SNELL 17 4- 2 0- 7 6 3 9 RECAPITULATION 1. Real Estate (Schedule A) ................................:............ ~ 1. • 2. Stocks and Bonds(Schedu B) ....................................... 2. • 3. Closet' Hekf Corporation, Pa rtnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes ReceiV rable (Schedule D) ........................... 4. • 5. Cash, Bank Deposits and M~ acellaneous Personal Property (Schedule E)....... 5. 12 , 717.9 2 6. Jointy Owned Property (S edule F) O Separate Billing Requested ....... 6. 7 5 , 0 0 0 . 0 0 7. Inter-V'rvos Transfers & Mis Ilaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 7 6 , 2 8 5.3 9 8. Total Gross Assets (total L nee 1 through 7) ............................. 8. 16 4 , 0 0 3.31 9. 10. 11. 12. 13. 14. Funeral Expenses and Adm Debts of Decedent, Mortg Total Deductions (total Li Net Value of Estate (Line 8 CharRable and Govemme an election to tax has not Net Value Subject to Tax ( istrative Costs (Schedule H) ................... 9. Liabilities, and Liens (Schedule I) .............. 10. s 9 and 10) ................................. 11. minus Line 11) .............................. 12. I BequestslSec 9113 Trusts for which n made (Schedule J) ........................ 13. ine 12 minus Line 13) ........................ 14. 2 7 , 814.6 9 10 , 121.4 6 ', ; 3 7 , 9 3 6.15 ~L 2 6 , 0 6 7.16 ~ 2 6 , 0 6 7.16 TAX CALCULATION -SEE IN8 RUCTIONS FOR APPLICABLE RATE8 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 18. Amount of Line 14 taxable at lineal rate X .0 4 5 12 6, 0 6 7.16 18. 5, 6 7 3. 0 2 17. Amount of Line 14 taxable at sibling rate X .12 . 17. • 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ..............~ ......................................... ..19. 5,673. 02 20. FILL IN THE OVAL IF YOU ARE REfltiESTING A REFUND OF AN OVERPAYMENT O ~i Side 2 150561024 2 1505610 42 ~'i REV-1502 EX+ (11-08) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL E6TATE INHERITANCE TAX RETURN RESIDENT DECEDENT i ESTATE OF FILE NUMBER BETTIE L. SHELL 2009-01200 All real property owned solely or as a to nt In wmmon must be reported at hir market value. Fair market value is defined a$ the price at which property would be exchanged between a willing buy r and a willing seller, neither being compelled to buy or sell, both having reasonable kno~+l$dge of the relevant facts. Real property that is foiMly-owned with right of wrvirorship must be disclosed on Schedule F. A ach a copy of the settlement sheet if the property has been sold. REM Include a c py of the deed showing decedent's interest if owned as tenant in common. ', VALUE AT DATE NUMBER OF DEATH DESCRIPTION I. TOTAL (Also enter on Line 1, Recapitulation.) If more space is needed, insert additional sheets of the same size. REV 1503 EX+ (C~98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8~ BONDS ESTATE OF FILE NUMBER REV-7504 Ex+ (mss) SCHEDULE C CLOSELY~-pHELDpC~+ORPOpRATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE'PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF FlLE NUMBER BETTIE L. SHELL 2009-01200', REV-1505 EX+{8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER BETTIE L SHELL 2009-01201b 1. Name of Corporation _ State of Incorporation Address _ Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Empbyer LD. Number Business Reporting Year 3. Type of Business Product/Service 4. Common Preferred Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Cbrporatbn? ........................................ QYes ~ No I~, If yes, Positbn Annual Salary $ Time Devoted tb Busines~ 6. Was the Corporatbn indebted to the c~eoedent? ......................................... Yes ~No If yes, provide amount of indebtedness $ ', 7. Was there life insurance payable to the corporaton upon the death of the decedent? ............ Yes If yes, Cash Surrender Value $ Net prooseds payable $ Owner of the policy 8. Did the decedent sell or transfer any titodc in this company within one year prior to death or wthin two years ', ff the date of death was prior to 12-31~-82? Yes ~No If yes,Transfer Sale Number of Shares ', Transferee or Purchaser Consideration $ Dat~ Attach a separate sheet for adddional transfers and/or sales. I, 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....... QYes ~No '~ If yes, provide a Dopy of the agreement. 10. Was the decedent's stock solo? ...................................................... Yes ~No If yes, provide a copy of the agreement of sale, etc. ', 11. VYas the corporation dissolved or liquidated after the deoedent's death? ...................... Yes ~No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporator have an interest in other corporations or partnerships? .................... ^Yes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or G2 for each interest. ', A. Detailed tabulations used in the valdation of the decedent's stock. B. Complete copies of financial statemehts or Federal Corporate Income Tax returns (Form 1120) for the year of death anti 4 preceding years. C. If the corporation owned real estate, lubmit a list showing the complete addresses and estimated fair market values. ,f real estate appraisals have been secured, attach copies. D. List of principal stodchokders at the date of death, number of shares held and their nslatonship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the Waluation of the decedent's stock. No (If more space is needed, insert additional sheets of the same sae) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER. BETTIE L SHELL 2009-012q<p 1. Name of Partnership Date Business Commenoe~l Address Business Reporting Year ~, ~tty State Zip Code 2. Federal Empbyer LD. Number I, 3. Type of Business ProducUServioe 4. Decedent was a ~ General ~ Limited partner. If decedent was a limited partner, provide initial investment $ 5. A. B. C. D. 8. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ......................................... ~ Yes ~ No H yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ............ Yes H yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years ff the d~te of death was prior to 12-31-82? Yes ~No If yes, Transfer Sale Peroentagetransferred/soki i Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. ', 10. Was there a written partnership agreement in effect at the time of the decedent's death? ......... Yes ~ No H yes, provide a copy of the agreement 11. Was the decedent's partnership interest sold? .......................................... QYes ~No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ...................... Yes ~No ff yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ........................................ ~ Yes ~ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .........:.......... Yes ~No H yes, report the necessary informaton on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership iMerost. B. Complete copies of finandal statements or Federal Partnership Income Tax returns (Form 1065) for the year of death) ajnd 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/~. ~ real estate appraisals have been secured, attach copies. No D. Any other information relating to the valuation of the decedent's partnership interest. REV 1507 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES 8~ NOTES RECEIVABLE ESTATE OF FILE NUMBER BETTIE L. SNELL 2009-01200 •11 nmme~ty InlnNv.mrrrd rdth deM nisurvhrnmhie must hs dfsrJesed en Schedule F. REV-1508 EX+(8.98) SCHEDULE E /+ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FlLE NUMBER BETTIE L. SNELL 2009-0120 Include the proceeds of ktigation and the date the proceeds were received by the estate. ', All property Jolrltly~oMrtled with right of aurvivonthip must be diecloeed on ScMduk F. REM VALUEATDATE NUMBER DESCRIPTION OF DEATH 1 SOVEREIGN BANK - INTEREST CHKNG A/C #571130062 ', 9,686.78 2 SOVEREIGN BANK - MONEY MKT A/C #571138853 ', 1,897.10 3 PSECU - CHECKING A/C #00021272 ', 634.04 4 PERSONAL EFFECTS ', 500.00 TOTAL (Also enter on line 5, Recapitulation) ~ ~ 12 , 717.9 2 (If more space is needed, insert additional sheets of the same s¢e) REV 1509 EX+ (698) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-0WNED PROPERTY ESTATE OF FILE NUMBER BETTIE L. SNELL 2009-0120 Man asset wa made joint witldn one year of the decedent's date of death, k must be ropon3ed on Schedule G. SURVIVING JOINTTENANT(S) NAME ADDRESS ELATIONSHIPTO DECEDENT A. DEBORAH S. HOOVER 1729 GUSHING GREENS DA GHTER CAMP HILL, PA 17011 ~, B. C. JIOINTLY-OYYNED PROPERTY: ITEM NUMBER LErrER FOR JONi TENANT DATE MADE ,pM DESCRIrraN of vaovErm e1CUlDE NAME OF FINMICYIL NiSRNT10NAND &Vef ACCOUNT NUMBER OR sMtAR DENTIF'fMIG NUMBER ATTACH DEED FOR JOMRLYfELD REAL ESTATE. DATE OF DEATH M4LUE OF ASSET x of DEars MITEREST DATE aF DEAT-~ 1AIUlE of DECEDENTS NTEREST 1. A. 10/31/96 1264 SUMMITVIEW COURT NEW CUMBERLAND, PA 17070 SEE ATTACHED DEED AND COMPS 150,000 50 75,000.00 TOTAL (Also enter on line t3, Rec~pihilation) 7 5 , 0 0 0.0 0 (N more space is needed, insert additional sheets of the same sae) REV 1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF BETTIE L. SNELL FILE NUMBER 2009-012 This schedule must be completed and filed 'd the answer to any of questans 1 through 4 on t he reverse side of the REV-150p COVER SHEET ~ yes. DESCRIPTION OF PROPERTY ITEM NCIUDE THE MIME OF T-f TRMISFEREE, iFER Ia:lATIONSFiP TO DECEDENT AND DATE OF DEATH 96 OF DECD'S ~ EXCLUSION TAXABLE NUMBER THE Dn1E Ov rwwSFER. n1TACH a COPT OF THE DEED FOR ~ EsrnTE. VALUE OFASSET INTEREST (IF APPLICABLE) VALUE 1. 1 MIDLAND NATIONAL LIFE - ANNUITY 12,139.43 100 'I 12,139.43 2 MIDLAND NATIONAL LIFE - ANNUITY 10,604.66 100 ! 10,604.66 3 MIDLAND NATIONAL LIFE - ANNUITY 53,541.30 100 ii 53,541.30 TOTAL (Also enter on line 7, Recapitulation), 7 6 , 2 8 5.3 9 (If more spas is needed, insect additional sheets of the same sae) REV 1511 EX+ (1t}O6) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8t ADMINISTRATIVE COSTS ESTATE OF - FILE NUMBER BETTIE L. SNELL 2009-0120 Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION ~i AMOUNT A. FUNERAL EXPENSES: ~' PARTHMORE FUNERAL HOME NEW CUMBERLAND, PA 13,617.27 2 ROLLING GREEN CEMETARY NEW CUMBERLAND, PA SITE PREP 1,345.00 3 WEST SHORE COUNTRY CLUB - RECEPTION 5,345.10 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) StreetAddresa City State ZIP Year(s) Commission Paid: 2. AftomeY Fees 3. Fatuity Exemption: (If decedent's address is not the same as claimants, attach explanatan) Claimant DOUGLAS SNELL StreetAddress 1264 SUMMITVIEW COURT CiIyNEW CUMBERLAND State PA ZIP17070 Relationship of Claimant to Decedent SON 4. Probate Fees 5. Accountant's Fees 6. Tan Retum Preparer's Fees 7, PA REV 1500 FILING 8 ADVERTISING FEES ~ 2,500.00 3,500.00 I I ~I II 293.50 i 1,000.00 i ', 15.00 198.82 TOTAL (Also enter on line 9, Rectiony ; 2 7 , 814.6 9 (K more space is needed, insert additional sheets of the same sae) REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OP DECEDENT, MORTGAGE LIABILITIES 8~ LIENS ESTATE OF _ FILE NUMBER REV-1513 EX+ (11-08) '~ i~ Pennsylvania SCHEDULE DEPARTMENT Of REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDBrT ESTATE OF FILE NINM~ER BETTIE L. SNELL 2009-0120 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) AMOUNT OR SHARE ' OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] i 1. DOUGLAS SNELL SON II 50~ 1264 SUMMITVIEW COURT ', NEW CUMBERLAND, PA 17070 2 DEBORAH S. HOOVER DAUGHTER ~I 50~ 1729 GUSHING GREENS !, i CAMP HILL, PA 17011 'i NTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 8 OF REV-1500 COVER SHEET, A I I III S APPROPRIATE. II NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE. DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SNEET. If more space is needed, insert additional sheets of the same size. REV•1514 FJ(+ (4-09) Pennsylvania DEPARTMENT OF REVENUE Bureau ~ Indivlduat Taxes PO Bac~8o6oi Harrtsiwrg PA i7~2s-o5oi scN~ou~E K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-s5oo COVER SHEET) --- ESTATE OF FILE NUMBER BETTIE L. SHELL 2009-01201) This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenwe Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from ~5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the x return. ^ Will ^ Intervivos Deed of Trust ^ her ~ 4 ( yr ~ '_ Z. J ^ Ufe pr ^ Term of Years ^ Life or ^ Term of Years ^ Ufe or ^ Term of Years ^ Ufe or ^ Term of Years ^ Ufe or ^ Term of Years 1. Value of fund from which life estate is payable .........................................$ 2. Actuarial factor per appropriate table ................................................ ~! Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate % 3. Value of life estate (Une i multiplied by Line 2) ....................................$ ^ life ' ^ Term of Years ^ Ufe o ^ Term of Years ^ Life o ^ Term of Years ^ Life o ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ VVeekty (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ II 4. Aggn3gate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% p 10% ^ Variable Rate °~ 6. Adjustment Factor (See instructions.) ................................................ . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line IS) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on hedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Unes i3 and 15 thro gh 18 of the return. If more space is needed, use additiorial sheets of the same size. REV 1644 Ex+ (s-oa) INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT INHERITANCE TAX RETURN OR INVASION OF TRUST PRINCIPAL FILE NUMBER 2!009-01200 RESIDENT DECEDENT I. ESTATE OF SNELL BETTIE L (Last Name) (First Name) (MItl01e Ir This schedule is appropriate only for esffites of decedenffi dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed urtlc~er the provisions of Section 714 of the Inheritance and Esffite Tax Act of 1961 or to report the invasion of st principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Ter of years income or Annuitant(s) of election or nnuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership .............. $ 4. Mortgages and Notes ...................... $ 5. Cash/Misc. Personal Property ............... $ 6. Total from Schedule. L-1 .................................................... $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ......................... $ 2. Unpaid Bequests ......................... $ 3. Value of UninGudable Assets ................ $ 4. Total from Schedule L-2 .................................................... $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ G. Taxable Remainder value (Line E x Line F) . , .................................... $ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annuitant(s) Date of Birth Age on date Te~ of years income corpus or nnuity is payable consumed C. Corpus consumed .......................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) .............................. $ (Also enter on Line 7, Recapitulation) REV-1847 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet FlLE NUMBER BETTIE L. SHELL 2009-0120Q This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the ~uture interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax ret~um. ^ Will ^ Trust ^ Other !, I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. ~ 3. I 4. 5. IL For decedents dying on or after July 1, 1994, if a surviving spouse exerdsed or intends to exerdSe ~ ' ht of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document im hich the surviving spouse exerdses such withdrawal right. ~, ^ Unifmited right of withdrawal ^ Limited right. of withdrawa~i III. ~ Explanation of Compromise Offer: rv 2. Value of Line 1 exempt from. tax as amount passing to charities, etc. (also indude as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to s use at appropriate tax rate Check One ^ 6%, ~3%, ^ 0% .................. $ (also indude as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ........................ $ (also indude as part of total shown on Line 16 of Cover Sheet) Summary of Compromise Offer: 1. Amount of Future Interest ...................................................... $ 5. Value of Line 1 taxable at sibling rate (12%) (also indude as part of total shown on Line 17 of Cover Sheet) .. $ 6. Value of Line 1 taxable at collateral rate (15%) (also indude as part of total shown on Line 18 of Cover Sheet) .. $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................. $ ~ (If more space is needed, inset sddilanal sheets of the same sae) -lbas rx ro2-o~~ SCHEDULE N pennsytvania SPOUSAL POVERTY CREDIT DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box~8o6o1 FOR DATES OF DEATH 01/01/92 TO 12/31/94 Han•Isbu PA ~ u8 ESTATE OF FILE NU ER BETTIE L. SHELL 2009-01'200 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sh 1 . Taxable assets total from lane 8 (cover sheet) ............................................. 1 . 2. Insurance proceeds on life of decedent .................................................. 2. ' 3. Retirement benefits ................................................................ 3. 4. Joint assets with spouse ............................................................. 4. ' 5. PA Lottery winnings ................................ 5. tia. Other nontaxable assets: List and attach schedule if necessary .. tia. 6b. tic. 6d. 6. SUBTOTAL (Lines tia, b, c, d) .......................................................... 6. 7. Total gross assets (Add Lines 1 thru 6) ................................................... 7. 8. Total actual liabilities ................................................................ 8. 9. Net value of estate (Subtract Line 8 from Line 7) ............................................ 9. ' If Line 9 is greater than;100,000 -,STOP. The estate is not eligible to claim the aedit If not, aontirfue do Pan II. Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX', : 19 a. Spouse ............ la. 2a. 3a. b. Decedent .......... lb. 2b. 3b. ' c Joint ...... .... lc. 2c. 3ci d. Tax-exempt inwme .... ld. e Other income not listed above ........ le. f. Total .............. lf. 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (if) + (2f) + (3f) _ ' (3) 4b. Average joint exemption income ........................................................ = If line 4(bI is oreater than fI0.000 -STOP. The estsGe is not eliolble M claim the vedlt If not k:ontinue to Part III. ~ i. Insert amount of taxable trensfers to spouse or #100,000, whichever is less ........................ ~ 1, 2. Multiply by credit percentage (see insb~udions) ............................................. ~ 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet . ................................. 3. 3d. 3e. ', 2f. I 13f. 4. For nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .................................................... 4. 5. Multiply Line 3 by Line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include tfiis figure in the calculation of total credits on Line 18 of the cover sheet........... 5• REV-1849 EX+ (8-98) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUM®ER BETTIE L. SHELL 2009-0120p Do not complete this sdreduk unbss the estate fs making the election to fax easels under Secton 9113tH) of the Mherimnce ~ Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election apples to the Trust (marital, residualA, ~, By-pass, Unified CredK, etc.). H a trust or simAar arrangement meets the requirernents of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement ~ entered in whole or in part as an asset on Schedub 0, ', then the banskror's personal representative may speclficalty identity the trust (aA or a fractional portion or perceniage) to be inducted in the ebcfion to halve such trust or similar property treated as a taxable transfer in this estate. N bas than the entire value of the mist or similar property is included as a taxable transfer on Sdtentrle 0, the persalal shall be considered to have made the eection arty as to a traction of the trust or ainibr arrangement. The numerator of this iractan b equal to the amount of the trust or simiar errs M included as a taxable asset on Sdbdub 0. The dsrlominator is equal to the total vakre of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to decedenFs surviving spouse under a Section 9113(A) trust or similar arrangement Desaiptlon Part A Total value Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is bei made. Value Part B Total $ ', (If more space is needed, insert additional sheets of the same siu) i LAST WILL.AND TESTAMENT OF BETTIE L. SNELL I, Bettie •L. Snell, residing at .1264 Summit View Court, New Cumberland, Cumberland County, Pennsylvania,being of sound mind and memory, do hereby make, publish and de~lare this to be my Last Will and_Testament. FIRST: I hereby revoke all Wills and Codicils thereto by me at any time heretofore made. . ~. SECOND: ~ ~ .direct that all my legal debts, expenses of my last .illness; my± funeral expenses and the costs of administration of my estate~be paid as soon as practicable after m~ death. I direct that my Executrix pay out of my estate, as a general charge thereon, all inheritarxc~, estate, succession and other taxes, together with any interest or penalty thereon assessed by reas~n of my death with regazd to~ all properties and assets subject to such taxes, whether. or not suclzpro~erty and assets.pass under this Last Will and Testament. ~ ~ ' THIRD: I give,~devise and bequeath all of my estate, real, personal or mixed,'i tangible or intangible, of whatsoever kind and ~~vheresoeyer situated,' together with any property t~ which I may have any power of disposition~or appointment and whether acquired .during or after my lifetime,. to -my beloved children, Deborah S. Hoover and: Douglas Snell, in. equal shares, provid~s~. that the shaze.of my child who predeceases me or dies on or before the sixtieth._(60th) day aftet ~iy death shall be distributed to lus or her issue per stirpeS::livin~. on the sixty=first (61st) day following my' .death, and in default of any such then living issue, such shares shall be added to the share:~r shares for my other child. FOURTH: I do hereby nominate, constitute and appoint my,beloved daughter; Deborah S. Hoover as my Executrix. My said daughter, or any successor Executor, shall have the aut~ority, in her sole discretion, to appoint another individual or a bank as an additional or successarEx~cutor, or ' to renounce her executorship in favor of another individual or. a bank. 'FIF"PH: My Executrix~shall'have the following powers in addition to those vested in her by law and by other provisions of my Last Wiil and Testament, applicable to all ~roperiy, whether principal or income, including property held for minors, exercisable without coutt approval, and effective until actual distribution of all property: i 1.. I direct that my Executrix and auy successor shall not be required to give bond for the faithful performance of her duties in any jurisdiction. 2.. My Executrix .shall receive compensation for the performance of her functions hereunder in accordance with the Pennsylvania Estates Practice standard sedule of fees in effect from time to time during the period over which his se' ces are .performed. 3. To allocate receipts. and expenses to principal or income or partly to each as~'~ he from time to time thinks proper in his sole discretion. 4. To borrow money from any person or institution.and to mortgage or pledge any ~or all .;real or personal property as my Executrix in her sole discretion shall choosey without .regard for the diapositive provisions of this instrument. 'S. To compromise any claim .or controversy. ', 6. To make distribution in cash oz ~in kind, or partly ~in cash and partly in kind, and in such manner as he may deterni~ine,.and at valuations finally to be fixed by ~er. 7.. ~ To invest in. all foims of property (including stock or ether securities. and common trust funds and mortgage investment funds), without restriction tQ .investments authorized fox Pennsylvapaa~fiduciaries,,as she deems.proper; without regard fo any principle. of diversification;ornsk. ~ . 8. To ietain.any or all of the assets of my estate, real or personal, including auy~shares of stock.or other securities I may own,.without restriction to investments authorized for Pennsylvania fiduciaries, as she deeins ,proper, without regard to. any pri~ciple of diversification.orri~k. 9,- To sell at public or private sale, to exohange, or to lease for any period of 1~ime, any real or personal property and to give options for sales, .exchanges or<leases; for such prices and upon such terms or conditions as she deems proper. 10. To exercise any law-given option to treat admintistrative expenses eitb~er a~ income tax or 'as estate tax deductions, without regard to whether the expenses vNere paid ,from principal or income.. . . .SIXTH: A11 shares of principal and income hereby given shall be' fee from anticipation, assignment, pledge or obligation of the beneficiaries and any of them, and.sh~ll not be subject to any execution, attachment, levy or sequestration or other claims of the creditors of said beneficiaries or any of them. 2 IN WITNESS WHEREOF, I, Bettie L. Snell, the above named Testatrix, have hereunto subscribed my name and affixed my seal this,1Q day of September 2009. - ~~ '' _ ~ f • ~-~,~ (Seal) Signed, sealed, published and declared by Bettie L. Snell. the above-named Testatri~k,, as and for her Last Will and Testament, in the presence of us and each of us, who, at her request aid in her - presenceand inthe presence-of each other, have hexeunto subscribed our names as witnesse~ thereto - the day and year last written above. Q - ~~ WITNESS WIT~/H' .. ADD S ~ ADDRESS ', 3 ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA , SS: COUNTY OF CUMBERLAND We, BettieL. Snell, r~z~~ Aa9•~(A,vc,mti,~~/ and ~f ~• ~GC-~~c the Testatrix and the witnesses,' respectively, whose names are signed to the attached or f regoing instrument, being first duly sworn, do hereby declare to. the undersigned authority that tha estatrix signed and executed the instrument as tier Last Will and Testament and that she signed will" gly, and that she executed it as her firee and voluntary a,ct for the purposes therein expressed, and tha each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses ~ that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, cbf sound mind and under no constraint or undue influence. ~+_i- l eStatrix J • SUBSCRIBED, sworn to and acknowledged before me by.Bettie L. Snel'1,~'i the Testatrix, and subscribed and sworn ~to before •me by Nu ~ ~-~ R • ~~ rv~ R N ~ ' and, Lb1s 7- ~~L-~.I~ ~ - ,witnesses, this:~day of September, , 009. - NQ Public (Notarial Seal) - COMMONWEALTH OF PENNSYLVANIA O AR1AL S L - Kathleen A. Sweeney, Notary Pub11c Hampden Tv+p. Cumborland•County • Commlasi<m irea June 9 2011 4 ~Ii+nPec _ _ _ _ 1-877-SOV-BANK (1-877-768.2285) www.sovereignbankcom BETTIE SNELL DOUGLAS SNELL StatemsM Psriod OiNO/Op t011N12/0Y SOVERE1t3N INTERES>rT ;CHECKING Deposit Accounts Account Number Average Daily Balance Currenyi~lap,~e SOVEREIGN INTEREST CHECKING 571130082 58,785.11 S ,686.78 MONEY ttAARKEf b71138853 51,898.29 S ,897.10 Total Deposit i1 ,ass.ea BETTIE SNEL! Account # 5~1 30062 DOUGLAS SNELL ' Balances ' Beginrrirsg Balance ' .. ~ 58,820.42. Current Balance 1 ,888.78. DeposNslCredfts + 11,788.68 Average Daily Balance E ,785.11 VVNhdrswaisl0ebib -1702.52 Interest Paid ttda Period • 10A8 Annual Percentage Yleid Eamed '~ 0.01'/0 Eemed this Period S 0.08 Paid Last Year ' 11.48 Paid Year-To•Date . - S 1.18 ' page 3 of 6 51130062 it `The interest earned and the interest paid may ddFer depending on when Interest is credited to your account. ', $@rvIC@ Fees Date # Transactions Fee ! Total l~ ~~o~~ ~ ' l~ 3 Statement and Release by Beneficiary (relationship ` / (herein called deceased), Social S~ ~- 3 a member of the PENNSYLVANIA STATE EMPLO' UNIO (herein called CREDIT UNION) and makes this statement for the purp~ Credit Union to pay over to her/him the sum of $ ~ 3 ~~ d ~ which is the standing to the credit of the deceased on the books of the Credit Union as a sl deceased) of irity Niunber ;ES CREDIT of inducing rrent balance 'e balance. I understand and agree that this balance is subject to change between the date hereo~~nd the date of closing due to payroll chargebacks, clearing of checks, etc. and I agree to accept the amount actually standing on the Credit Union's books at the time the account is closed. The deceased departed this life on the °~ ~ day of ~~ ~~ 20~: I understand that the above sum is to be paid in the following order: the spouse ~ the deceased, children of the deceased, parents of the deceased, the sisters and brothers of the d~¢eased or their children (preference being given in the order named according to the rules of succe~s~on). By signing this form, I acknowledge that I know of no one either equally or higher qualified than myself to receive said funds. I further acknowledge that funeral expenses for thle (deceased have been paid, or that arrangements satisfactory to the funeral director have been made ~f~r the payment of funeral services. NOW, THEREFORE, in consideration of the above and of the payment of the above npentioned sum to the undersigned, the undersigned hereby agrees to indemnify and hold harmless Cr~iit Union from any claim which may be made against Credit Union by reason of payment to the un~~rsigned. (~ Date SignatureofBen iary Mailing Address PSECIJ Form #7001 9/00 aaru~-0ooorn..wr~. tanntwatocnssen ~~~~ rBO<s Dt38a MADE THE ~j I sr day ~ ~~,~~ bf fife year of ow Lord oro tlauaaad nine hundred ntaety dx (J99~, HE7IVEEN !:E[VCIIMART< HOMH$, INC.. ~ Pemteytvaala Corporation, heroinaftar referred a as Graetor, and BSI'I7B L. SNEI,I,, alolte wommt, and DEBORAH 8. HOOVER. joint tsmpq whh d8dt of sarvivorahip, benbrRar referred a e tarsnteee, WITNESSETIi, that In oooeWeratioa of Oas 19rwdrsd Thlety Tlawaud Nine Huadrod aad 001100 (8130,lOOb~ DOLLARS. io head paid. the receipt whereof b 6aroby akaowled8ad, tits aW Grantor doe b.reby cent and oomroy w the aid t3rantaa, their anconsora and asslps, ALL rHAr cBRTAIN TRACT oP LAND alrvArs Ia urs 7ti~p of Lower Arias, County otCnmberlsad, sea CoaaaonwalHt olPenasylvania, nare particularly bounded and descrtbsd a tdlorrs, a wit: BBOINNIND R a poirR u the ootrhwest oonhr of Lot No. VI-14 on tAs Aasiatlbr daoribed Final Dsvebpnratt l?laa; thence aloal Lieatted Comaaa Area No. 2 Naedt ss degees 36 arimtue o2 aeoade Baat .distance or 24 feet a a point; theca contlaal~ doh Limued Comeau Ara No. 2 Sowh 34 daSrsee 23 a 31 eaonde Beet a OiRenoe of 70.00 fat a a pohtC tliaas by Limited Comeau Ara No. 2 Soath SS de8na 36 mieutea 02 axonds Wee a dWaaa of 24 feet p a pohd st carasr of Lot No. VI.14; tbeaa ab~ srlid Lat No. VI-14 Nosh 34~de1nee 23 mlmua 3! eeooede Weet a distirae of 70.00 feat a a point at laude of Limited Common Ara lVo. 2, said point flu place of BEOINNfNl7. BEINQ Lot No. VS-l3 0[ Baaooa Hilt Firm Dsvebpmm~t Plan Phase VI, Ansaded, VNItRe of Birchwood, pnperod by H. Bdward Black and Assodata cad reooeded In Cumberland County Pisa Hook 37, Pegs 23. UNDER AND SUBJBCT m a Deelaratloa of Covenants and ]teeaictioa rawrded b Cumberlsnd Cowley 1Nbcellaneoua Book 319, Page 536. AND UNDER AND SUBJECT a a Supplwtsatal Dedeatbn of Covenants and Restrictbns recorded In Cumberland County Misceilaneoua Book 355, Pale 18. ' AND UNDER AND SUHJF-CT a the By-Laws of Beacon Hiil Community Aarociatiar recorded In Cumberland County Mkcdlanaous Book 319, Pap 323. ~OCMt 151 luf1~48 ~~ ......,~ .~ ..~~ I t7 ..., •~. t ~~,,,r.. c_ coru..~ve. ernatwsmonsvm BEING apoRba of the promkba which Btucat HiU Hd~tt Developtasat Cocporttba by iq dea4 dated it[accb 21, 1996, recorded on blareh 23, 1996, in the Offles for the Recorder of Detdt of Cumberind Coutrty, Peaaaylvaals ht Dad Hook 136, Pa`e 330, {ranted tad mnvsyed ueeo Brrchmut Hoene, inc., Grantor hereia. HAVING erected thereon a dwallin~ known es 1264 Staeapkvbw Court. 7'OGLrI'HBR whh all and:ioHular the buQdin=t,lmprovemnrts, wayn, rucate, a1leYar Pte. watea, ~ orrraes, ti~hn, libatia, privflet7es, heredharaenu ~ appurtawtaa wbatrwver theratnto bekm=tai, or in any r y~perpiniaj, and the revirabaa and tentaindea, rear. laver and pm0b thereoF, and afl the eatats, curt, title. irrtdr property, cbim and demand whaftoevet of it, the aW Benchmark Homes, Inc., M 1tw, equity, or otherr kowaavar, of, !n, to or out of the nerve. TO HAVB AND TO HOLD Ws ald lot or plea of Sraaad above described, wiW the building impeovesnrtu thareoo erected, hereditaorenu tad pttimiae hereby jranad or enmtloned, sad tatetrded m m bs.'t the appuctrartcee, umo the esW Qrarraee, Weir hales and aal~ne, to and for tbs only Proper uee and behoof oy tdd Grantees, Wdr Aeice sad aaitaa, torsver. AND the acid Grantor hereby oovrwatr and gran Wat k wig warrant epaclaily the property heroby oonvgi IN Wfl'NESS VVHERFAP, the Corporate Grantor here creed Wb hrdeaeae to bs exeRVted and dnly aua by lts duly aothorfaed oRkxra and dealt cmmooa or corporate sale to be allixed We day and year lieu above wrill Sipred, Sealed and Ddivend to We Praatcs of a7rta+~r BBNCHMARK HOM0.S, INC. ~j'~Fi'i~'s. xsx~ ~ ~ (SBAL) ~~~ east 151 ruE1199 ~ ~ s ~ ~, ~s ~~~~~~3~~ :+ iss~'sslsss~s's~s~s ssr,rresasrn...~i, t»rnvw~oor+sw>z colKMOrlwsACrx ~ PBlavsnvANu courmr of C(A.mbev'1G~nd `~` Oa ihie, ehe 31sT d4 of ~2ctywloe.r 1996, before rae, dro ondae:i=aed offlou. PAY ~ppared at. ~u~:~~~i a ~. ~ • wbo admowled~ed bbneeif w be the P~Went.ot BENCHMARK Ht%iffi, I . a ostpoat sa, a that M ae ntch Preehietx, bebq anthorhatd to do eo. axeeated 1M [orepla~ lrotru,asnt for the paepoea tl,arda omudaed by d{ufag the acme of the eoiporatlon by himself a Preddaat. TN WITNESS WHEREOF, I hereunto set my hood and ofAehd aad, .. ~a..v.u~ ~-~EAL) i ~pw~p ppe~aarr ~ k' W~iN~i,tlal w I do hereby oatity riot We~ retWena a-d ron~plea poet ofRp addreu of tlu AMbfa ~ectJ Ctt,-tiilttcltLuA, P,t /7O 7G ~* ~ ~,rb=.~. DATED: l~•3/-f%ls ~I;W ,i'r~,~. ~ aoy ib ~I'a..tft{ i r . .,~C COMMONWBALTH~ OF PQNNSYLVANIA ~ tSS: CODNTY OF ~~~ REC~tD® on thb ~_ day of _ A.D., 19~, is the Recader'e otRee o[ odd Coaaty. is Deed Hook iS l1 • Voluna .Pap .Given under my haod and the ual of the Bald oifh:e, tla loos shove mrlttea. ~ `~~ ./J~jG~I.~" D~R.g:'{ ~ ~~Rj f..,.. v ~ uo ~ Recorder ~ ~~~ ._. -~ t•~ n, ;a, r,t ~, ..~3~ .V~-+.- ~ . 6, ~. ~ • _ '••~ar a ~GE~SO ~ J~ O ~ c o m z r _ ~~ ,L ,~' , ,. OK . G N n N ~ v ~~1 ` .,./ :/'^~ `t ~~ TaxDB Result Details Detailed Results for Parcel 13-25-0008-13$. in the 2004 Tax Assessment Database ~ e[~u ~?~,~„ ~.' 13-25-0008-138._._ (~ •,, ~`~, k mi'l` a P!:S fM.. T (.,, n,~ w .r l ~od~e~io „ ~ 1262 t :~. , ~:"_ ,' 4 x~;. ~^~ ~*.a.~arso SUMMIT VIEW COiJRT 31 tFQ p .., ; ' - CQBBI,ESTONE I.TD ~, r :_. ~r F,~ ~ ti X}~i.! i~ .. ... .. . . ... ~;. ~ !y y R f+~ p 1700 33000 106550 139550 ~~: - ~: y ~wa~~ -~-~, ~•;. ~. `'' :Y.: , 04 . ,j; ~ :: 5. J ~~ i ~. ~ ,.? ~ ~z:.:. ~ 1ST: _ [~ ~ ' ~~' ~ 139500 ~M k ,' 03 . ~~ ~ 28 ~. ~ 20 ,~ OS 00268-00544 ' 1988 r> ! , 01/10/2008 http://taxdb.ccpa.net/details.asp?id=13-25-0008-138.&dbselect=l Page 1 of 1 6/16/2010 ~ o~ ~ TaxDB Result Details lletailed Kesults for Parcel 13-ZS-Og08-191. in' ~~ O~ y, ~ ' 13 ,. ~ -. ~' rF .~ 2 ~ • ~~~~~ 13-25-0008-191. t~ r ,~~~; ~ ; r .. .. ~ u t iyQ ~~+~ "~ ~'` ~~ i~T~ n , ' ~ 1472 ~ , Y ~ +w a om ~Y`°^..~73.~:u t~~'.; ~s` d.:!~„i~kx.. t . 'St~t~`" 1 "'"~ ` MAPLEWQOA DRIV$ . .. ," ' , ~ ~ LENHART, JOHN P & ELEANOR J ._Y~ ~~ 3 5 ` r" R "~ a 992 _ 33000 f;; . ~~ 72580 r'* y • ~' ' 105580 ~, . _ ..... .~- - ~^ ~~. j 1 .~} 1 1. ., ~ 'r ' __. ....._ ........... .._........ ........ ._ ...... .. , ............ . ~ M ^ R' 146000 ~;<' : 04 +K : .-.,r ~< 7 29 t._.~~ . .tii3. ,~. '" ' ZO r;~ ~ 08 200813716 1996 12122/2008 v i ~.. ~__ A Page 1 of 1 :he 2004 Tax Assessment Database http://taxdb.ccpa.net/details.asp?id=13-25-0008-191.&dbselect=l 6/16/2010 II S o -F .~ a .Cr•-r Explanation of Your Benefits Midland National Life Prepared By: Donna Scharlau ?hesday, February 16, 2010 Malled to: Deborah S Hoover Claim Number: 2122649 1970 Technology Pkwy Policy: 8500147633 Mechanicsburg PA 17050 Date Paid: 2/17/2010 Insured: Bettie Snell Total Settlement: ,SI2,272.96 ~~F9 ~~ 512,139.43 Cl~lm Ieterat 2.75% S 133.53 Fed WithholdiaB S2,124.40 Taxable Amount of this settlement is: X6,069.72 ' Cash Settlement of ,54, 012.08 Paid to: Deborah S Hoover 1970 Technology Pk»y Mechunicsburg PA 17050 Annuity Service Cents * P.O.Box 79907* Des Moines, IA 50325-0907 Phone: 877-880-6367* Fax 877-586=0249 I _ _. ~. Explanation of Your Benefits Midland Natl'onal Life Prepared By: Donna Scharlau Tiuesday, February 16, 2010 Mailed to: Deborah S Hoover Claim Number: 2122651 1970 Technology Pkwy Policy:. 8500358670 Mechanicsburg PA 17050 Date Paid: 2/17/2010 Insured: Bettie Snell Total Settlement $10,721.31 Asinrity Aroerat 510,604.66 Qa1m Interest 2.75% S116.65 Fed Wit6lwldin~ 51,855.82. Taxable Amount of this settlement is: S5,302.33 Cash Settlement of a3,SO4.84 Paid to: Deborah SHoover , 1970 Technology Pkwy Mecharaicsbu~~ PA 17050 I Annuity Servicx Center * P.O.Box 79907* Des Moines, IA 50325-0907 Phone: 877-880-6367* Fax 877-586-0249 Explanation of Your Benefits Midland National Life Prepared By: Donna Seharlau Tuesday, February 16, 2010 MaBed to: Deborah S Hoover Claim Number: 2122650 1970 Technology Pkwy Policy: 8500287760 Mechanicsburg PA 17050 Date Paid: 2/17/2010 Insured: Bettie Snell Total Settlement: $54,130.25 Atiuky Mauat 553,541.30 ~, Gaim interest 2.7595 5588.95 Fed Wlthlwldinp 52,369.73 i Taxable Amount of this settlement is: 56,770.65 Cash Settlement of $24, 695.39 Paid to: Deborah S Hoover 1970 Technology Pkxy 141echanicsburg PA 17050 Annuity Service Center * P.O.Box 79907* Des Moines, IA 50325-0907 Phone: 877-880-6367* Fax 877-586-0249 !i __ _~ _~