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HomeMy WebLinkAbout06-17-10 (2)J 1505610101 REV-1500 Ext°"°' '$~' PA Department of Revenue Pennsylvarda OFF~IAL USE ONLY Bureau of Individual Taxes °`""`"`"" """~` County Code Year I File Number PO BOx z8o6ot. INHERITANCE TAX RETURN p y ~} Hamsburg, PA 37128-0601 RESIDENT DECEDENT ~i ~ l ~ ~ 6 ~ ( / ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death MMDDYYYY Date of Birth MMDOYYYY 203-05-2255 03/28/2010 02/03/1919 Decedents Last Name Suffix Decedent's First Name MI Smith ', Kathleen M (If Applicable) Entsr 3utviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS __ FILL INAPPROPRIATE OVALS BELOW m 1. Original Retum O 2. Supplemental Retum O 3. Remainder Re{u~ (date of death prior to 12-13-82 O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5 Federal Estate T¢x Return Re wired death afterl2-12-82) t~ 6. DerxtfeM Died Testate O 7. Detxident Maintained a Living Trust (Attach Copy of wIQ (Attach Copy of Trust) O 9. Litigatlon Proceeds Received O 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-951 • 4 ~ 8. Total Number of $ate Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MllBT BE COMPLETED. ALL CORRESPO NDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD B DIRECTED T0: Name Daytime Tekp Nu r ~ _ Keith O. Brenneman, Esq (717) 697-8 ~ ~ _ -' ' _ , ~ REGISTE USE~LY l ~ ~ ~ J 3 _ _ ~~~~ nelbaker & Brennema s Second line of address _ _ ~ --t '' _... _ _ _ __ w 44 West Main Street IV City or Post Ofrrce State ZIP Code DATH F LED i Mechanicsburg __ ___ PA 17050 ~' `.~ t;- :C y .'^ ~ ' .:~ r-r° r ~~ "-~s Correspondent's e-mail address: Under psnabiss of perjury, I declare thst I have examined this return, includirq accompanying adtedubs and statements, and to the best otjm knowledge and belief, K is true, correct end complete. DedMStton d preparer other than the personal representative is based on ell IntomiatiUon of which preparAr any knowledge. Sj~N(~TURE OF PER6QN RESPONSIBLE FOR FILING RETURN/J _ ~ h TF 308 Woodruff Way, Harrisburg PA 17112 913 Snapper Dam Road Landisville PA 17533 i1GN* F PREPARER OTHER THAN REPRESENTATIVE ADDRESS 44 West Main Street, Mechanicsburg PA 17050 PLEASIE UsE RIGINAL FORM ONLY Side 1 L 1505610101 150561010!1. J 1505610105 REV 1500 EX Decedent's Sodal Security Number t)eoeder>Ys Name: Kathleen M. Smith 203-05-2255 RECAPRULATION 1. Real Estate (Schedule A) ........................................ ..... 1. 80,000.00 2. Stocks and Bonds (Schedule B) .................................. ..... 2. 3. Cbsety Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. 2,096.67 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. 157,949.79 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 20,382.40 6. Total Gross Assets (total Lines 1 through 7) ............................. 8. 260,428.86 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. 14,071.90 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... ..... 10. ' 14,820.31 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. 28,892.21 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. 231,536.65 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an electlon to tax has not been made (Schedule J) .....', . ............. ..... 13. 14. Net Valw SubJect to Tax (Line 12 minus Line 13) ................... ..... 14. 231,536.65 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICA LE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(L2) X .0_ 15. 18. Amount of Line 14 taxable at lineal rate x .0 ~ 211,536.65 '' 16. ' ' 9,519.15 17. Amount of Line 14 taxable at sibling rate X .12 ' 17. 1 B. Amount of Line 14 taxable at cdiateral rate X .15 20,000.00 ' 18 ' 3,000.00 19. TAX DUE ..................................................... .... 19. 12,519.15 20. FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ide 2 L 1505610105 O 15056101D.~' J REV-1500 EX Pape 3 Flle Number Decedent's Comlglete Address: DECEDENTS NAME Kathleen M. Smith sTREErnDDRESS ---_. 37 Sample Bridge Road CITY Mechanicsburg STATE ;ZIP PA ~ 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments (t) 12,519.15 A. Prior Payments e. Discount 625.95 3. Interest Total Credits (A + g) (2) 625.95 (3) 4. If Line 2 is grerater than Line 1 + Line 3, enter the difference. This is the OYLRPAYMENT. Fill in oval on Page 2, LJne 20 to request a refund. (q) 5. if line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 11,893.20 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRII~TE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or kloome of the property transferred :........................................ ............................. ..................... ^ b. ruin the right to designate who shall use the Property transfen~ed or its income : ............................................ ^ ' ^x c. retain a reversionary interest; or .......................................................................................................................... ^ Q d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0 2. If death occurred after Dec. 12, 1962, did decedent transferproperiy within one year of death without receiving adequate consideretan? .............................................................................................................. Q ^ 3. Did decedent own an "in trust for" or payable•upon-death bank account or security at his or her death? .............. ^ ^Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefiaary designation? ........................................................................................................................ 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT pSl PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the 4se of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fiNng a tax return are s6~1 applicable even if the surviving spouse is the only benefirtiary. For dates of death on or after Jury 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 0 percent [72 P.S. §9116(a)(1.2)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) p2 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 12 percent [72 P.S. §9116(a)(1.~)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11-08) Pennsylvania ~iT DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NlyMBER Kathleen M. Smith 21-10-00399 All real property owned solely or as a tenant in mammon murt 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 knpw~ledge of the relevant facts. Real property that hl iointly-owned with right of survivorship murt ba disclosed on Schedule F.' Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION w. _._ _ _.. ...,~... _. ... ... ....... .,..._. 1. All that certain parcel of land improved with a residential dwelling known as 37 Sample Bridge ;Road, Mechanicsburg, Silver Spring Township, Cumberland County, Pennsylvania. Sales price _. under agreement of sale entered into March 22, 2010 (prior to death) with closing held April 20, 2010 (settlement sheet attached) 80,000.00 f'' TOTAL (Also enter on Line 1, Recapitulation.) $ 80,000.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (6-98) SCMEp~1LE E COMMONWEALTH OF PENNSYLVANIA CASI"I~ BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ' ~°" "`" "~'' ~" ""' 21-10-00399 Indude the proceeds ~ litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH -,, .... 1 = Medicare refund ~ ~~ ~~ ~ 397.80 2. ADT account refund 19.81 3. ;Verizon refund ~ ~ ~ ~~ ~ ~~ ~~ . ,. , 3.57 4. Aero Oil refund ~ 19.96 5. ~ Penn National hazard insurance refund 134.00 ,. . 6. Penn Waste refund 37.53 7. Miscellaneous personal property, yfumiture and furnishings 500.00 .__ .~~.a~... ~ . ,.~.. _ k.~ .. 8. Spring Creed, refund on account 984.00 TOTAL (Also enter on line 5, Recapitulation) ~ ', 2, 096.67 (If more space is needed, insert additional sheets of the same size) REV-1,509 EX+ (Di-1o) pennsylvarria SCM~oUL! F DEPARTMENT OFREYENUE INHERITANCETAxRETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Kathleen M. Smith 21-*10-00399 If an seat became jointly owned within one year of the deadellYs data of death, R must be reported on edule G. SURVMNG IoINT TENANT(S) NAME(S) ADDRESS RELI4TtONSHIP TO DECEDENT A. Shirley A. Kirk 308 Woodruff Way Harrisburg, PA 17112 naughter a. Celia A. Zeigler 913 Snapper Dam Road Landisville, PA 17538 Tlaughter c. - - ]OINTLY OWNED PROPERTY: TT@I NUMBEit ~~ FDR ]oUR TENANT ~~ MADE JDINr ~~ ~ ~~~ INCWDE NAME OF f'BVANCIAI BYSTIMIDN AND BANK ACCWNT NUMBER OR SIMILAR 1DBInFY[NG NUMBEII. ATTACH DEED FDR ]DINTLY HELD REAL ESTATE DATE OF DEATH 96 OECED M5 DATE OF DEATH VALUE OF I A . VALUE OF ASSET INTE DECEDENT5 INTEREST . . 7,/17/08 Wachovia Bank Certificate of De osit p $46,168.71 5p~ $23,084.36 2. A,B 7%21/89'' Members 1st F.C.U. Account #23287-00 1,609.21 3.~~ 536.40 3. A,B 2/1/01 Members 1st F.C.U. Account #23287-04 4,000.89 33.$~ 1,333.63 4. A,B ./23/09 Members 1st F.C.U. Account #23287-41 67,007.21 33'.3 22,335.74 5. A,B 5/5/08 Members 1st F.C.U. Account #23287-52 32,318.26 33:.~3~ 10,772.75 6. A,B 12/2/09-. Memberslst F.C.U. Account #23287-43 58,966.14 33.'3 19,655.38 (This account established from funds fTOm joint .account identified. in Item 2 above, which was made joint 7/21/89) 7. A 6/6/66 Citizens Bank Account #6100700526 49,665.21 501 24,832.61 8. A 2/9/90 Citizens Bank Account #6140884306 110,797.84 50~' 55,398.92 TOTAL (Also enter on Une 6, Recapitulation) I ~ 15~ , 949.79 If more space is needed, use additional sheets of paper of the same size. ~ ~ I REV-1510 EX+ (OS-09) Pennsylvania DEPARTMENT OF REVENUE lNHER1TANCE TAX RETURN ESTATE OF th This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-140tl is ves. 1:TfM DESCRIPTION OF PROPERTY NUMBER INCLUDE 711E MANE of 7tRi TRANSFEREE, THEIR REUITIDNSHIP TD DECEDENT AND THE DALE DF TRANSFER. A1TAgi A CDPY of THE DES FDR AEAL ESTATE DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST .EXCLUSION (IFi APPUCA%E TAXABLE VALU ) E 1• Members 1st F.C.U. Certificate of Deposit 23,382.40 100 3,00.00 $20,382. Account No. 232.87.-42, made joint account/ established 10/14/2009 among Decedent and daughters Shirley A. Kirk and Celia A. Zeigler 2. Members lst F.C.U. life insurance policy 2,005.18 100 ~(b0~ -0- Date of transfer 3/28/10 (date of death); Transferees: Shirley A. ,,Kirk and Celia A. Zeigler, daughters of Decedent 3. Metlife life 'insurance policy No: 942572M 3,280.98 100 1q0~ -0- Date of transfer 3/28/10 (date of death); Transferees: Shirley A. Kirk and Celia A Zeigler, daughters of Decedent If more space is needed, use additional sheets of paper of the same size. SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUl~6 R 21-10-p0399 TOTAL (Also enter on Llne 7, Recapitulation) ; 12 +0 REV-1511 EX+ (10-09) '~ Pennsylvania DEPARTMENT OF REVENUE INN8t1TANCE rAx RetuRN RESroeNr oEtEOENr ESTATE OF Kathleen M. Smith SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Decedent's debt must be reported on Schedule I. A• I FUNERAL. EXPENSES: 1. Myers Funeral Home B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Waived Street Address Gty State ZIP ___ Year(s) Commission Paid: z• AttomeyFees: Snelbaker & Brenneman, P. C. 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) gaimant Street Address qty State ZIP _ Relationship of gaimant to Decedent 4• Probate Fees: To Register of Wills S• Accountant Fees miscellaneous filing fees, reserve 6' ~9f9P3LrRr Realty transfer tax ~• Advertise grant of letters: a. Cumberland Law Journal: $ 75.00 b. The Sentinel: 219.40 $7,700.00 4,000.00 277.50 1,000.00 800.00 294.40 TOTAL (Also enter on Line 9, Recapitulation) S ~ ~ ~ If more space (s needed, use additional sheets of paper of the same size. ~ v FILE NtJM~EIt 21-10-00399 AMOUNT __ _ _._ ., _ _ REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES ~ LIENS ESTATE OF FILE NUMBER Kathleen M. Smith _ _ Repo rt debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmburpsd medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1• Millenium Pharmacy - payment on account 112.83 2. 'PA American Water - payment on account 27.76 3. PPL - payment on account 16.41 4. Real estate taxes due January 1, 2010 (prorated to settlement) 98.05 5. Silver Spring Township Authority - payment on account of sewer service 117.26 6. Dr. Alan Huff - payment on account for dental services 180.00 7. Spring Creek - payment on account of service 14,268.00 _ TOTAL (Also enter on Line 10, Recapitulation) ; 14,820.31 If more space is needed, insert additional sheets of the same size. __ _ - i REV-1513 EX+ (01-30) Pennsylvania SCHEDULE ~ DEPARTMENT OP REVENUE tNN6tITANCE TAX RETURN BENEFICIARIES RESloerr oECEDENr ESTATE OF: FI NUMBER: Kathleen M. Smith _ NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY REDo~Not List Trustee( )~ AMOOF ESTATE ARE I TAXABLE DISTR[BUTIONS [Indude ouMght spousal disMbutlons and transfers under Sec. 9116 (a) (1.2).] 1~ Shirley A. Kirk Daughter 50~ of residue 308 Woodruff Way ', Harrisburg, PA 17112 2. Celia A. Zeigler 913-Snapper Dam Road Daughter S0~ of residue Landisville, PA 17538 3. Patricia A. Miller Stepchild $10 000.00 3~4-Rich Valley Road - , Carlisle, PA 17015 4. Gerald E. Smith Stepchild $10 000 00 333 Ponderosa-Road , . Carlisle, PA 17015 ENTER DOW1R AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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: L TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ If more space is needed, use additional sheets of paper of the same size. - - __ ~ ~ MEMBERS 1't FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix 23287-00 Date Acxount Established 01 /07/1980 Principal Balance at Date of Death $1,608.85 Accrued Interest to Date of Death $.36 Total Principal and Accrued Interest $1,609.21 Name of Joint Owner Celia Zeigler / Shirley Kirk / Date Joint Ownership Established 07/21 /1989 LIFE SAVINGS ACCOUNT• Account Number/Suffix 23287-04* Date Account Established 02/01/2001 Principal Balance at Date of Death $4,000.00 Accrued Interest to Date of Death $,gg Total Principal and Accrued Interest $4,000.89 Name of Joint Owner Celia Zeigler Shirley Kirk Date Joint Ownership Established 02/01/2001 *Opened by transfer of shares from 23287-00. CERTIFICATES OF DEPOSIT• ~ l;~'f - Account Number/Suffix 23287-41 ` 23287.42 ~! J`" Date Account Established 03/23/2009* 10/14/2009 / Principal Balance at Date of Death $66,952.73 $23 359.25 ! - Accrued Interest to Date of Death $54.48 , $23.15 Total Principal and Accrued Interest $67,007.21 $23 382.40 Name of Joint Owner Celia Zeigler , Celia Zeigler Date Joint Ownership Established Shlrtey Kirk 03/23/2009 Shirley Kirk `, 10/14/2009 'Opened by transfer of funds from 23287-00. CERTIFICATES OF DEPOSIT• Account NumberJSuffix 23287-43 ~ 23287-52 Date Account Established '12102/2009• 05105/2008*" Principal Balance at Date of Death :$58,907.75 $32 234.80 Accrued Interest to Date of Death ` $58.39 , $83 46 Total Principal and Accrued Interest $58,966.14 . $32 318 26 Name of Joint Owner Celia Zeigler , . Celia Zeigler Date Joint Ownership Established Shirley Kirk 12/02/2009 Shirley Kirk 05/05/2008 'Opened by transfer of funds from '" 23287-00. rr ~~ ~~~ j ~, ~fi Rollover from certificate 23287-49, originally established 04!06/2007. ~s,. ~ 0 ~Fc 7/Z f BERS 1S7 FEDERAL REDIT UNION Danie a A. ktine Lending Insurance Support Specialist April 21, 2010 Estate of: KATHLEEN M. SMITH Dats of Death: 03/28/2010 Social Security Number. 203-05-2255 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 ww'wmemberslst.org w~,cxov~ Wachovia Bank Balance Confirmation Services P O Box 40028 Roanoke, VA 24022 Apri123, 2010 SNELBAKER & BRENNEMAN P C 44 WEST MAIN STREET MECHAIVICSBURG, PA 17055 Reference ID: 30] 8786 SUBJECT: Verification / Cortfirnlation of Account and Balance Information provided for: Customer: KATHLEEN M SMITH (SSN# XXX-XX-2255) Date of Death: March 28, 2010 Account Account TYPe Number CERTIFICATE OF XXXXXXXXXXX9098 DEPOSIT LEGAL TITLE: KATHLEEN M SM[TH SHIRLEY ANN KIRK No Safe Deposit Box found for customer. Deposit Account Information Date of Death Average Date Maturity Interest Acerul _~,Balanca_.. Balance Opened Date Rate Inter $46,146.10 • Date of death balance does rwt include accrued interest. 7/17/2008 t YTD Date. Interest Paid Closed $169.23 4/14/2010 • If date of th occurrs on a weekend or a holiday, date of death balance does not include any haiuactions that were made during that 6mje period. t ~; ~ ^ r:'~ y Graybill . Servicenter ocia[e Phone: (540)563-7323 a8. ag By accepting this infommtion, the recipient thereof represents and wartants to Wells Fargo Bank, N.A. ("Wells Fargo"), that the recipient is authorized by the customer to receive lawfully this information. The recipient agrees that it will not disclose this infomration to any third party, unless compelled to do so by legal process, and that it will lawfully use this information. The recipient acknowledges that Wells Fargo does not represent and warrant that the information is complete and accurate, The recipient further acknowledges that the infomrat~ort may not disclose the entire relationship between customer and Wells Fargo. The inforrfvtion is subject to change without notice to the recipient The recipient agrees to indemnify, defend, and Ipld Wells Fargo hamrless from and against any claim resulting from the disclosure and use of the information by the recipient or from the breach by the recipient of any agreement, representation, or rNatranty contained herein. Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A. 0000 000614 Rev 01 Page 1 of 1 Citizens Banic° April 21, 2010 KEITH O. BRENNEMAN 44 WEST MAIN STREET MECHANICSBURG PA 17055 Estate of KATHLEEN SMITH Date of Death: Mar 28, 2010 SSN: 203-OS-2255 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as ofhis/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Robert Roos Operations Services Citizens Bank.. Account Number 6100700526 Account Title Date ned KATHLEEN SMITH OR SHIRLEY ANN ' RK POA 6/6/ 1966 Account T e Checkin Princi al Balance as of DOD $49665.21 Interest from Last Postin to DOD $ .00 Account Balance as of DOD ~ $49665.21 YTD Interest to DOD $14.18 Citizens Bank° Account Number 6140884306 Account Title Date O ned KATHLEEN. SMITH OR SHIRLEY ANN 2/9/1990 POA Account T e Time De osits Princi al Balance as of DOD $110734.13 Interest from Last Postin to DOD $63.71 Account Balance as of DOD $110797.84 YTD Interest to DOD $436.38 LAST WILL AND TESTAMENT OF KATHLEEN M. SMITH I, KATHLEEN M. SMITH, of Silver Spring Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practicable after my death by my Executrices hereinafter named. 2. I give and bequeath any and all funds and accounts deposited with HAMILTON BANK, its successors and assigns, at the time of my death, at any of its branches, to my stepdaughter and stepson in the percentages as set forth below: (a) Sixty (608) percent to my stepdaughter, PATRICIA A. MILLER, absolutely; a (b) Forty (408) percent to my stepson, .GERALD E. SMITH, absolutely. ~~ 3. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my daughters, CELIA A. ZEIGLER, and SHIRLEY A. KIRK, absolutely. If either of my daughters predecease me, I direct the share such deceased daughter would have received shall pass to her issue surviving me per stirpes and if there be no such issue, then such share shall lapse. uw oFV~ces .BAKER B FLICKER 4. Should any person less than eighteen (18) years of agel share in my estate, I nominate, constitute and appoint COMMONWEALTH NATIONAL BANK, its successors and assigns, Harrisburg, Pennsylvania, as guardian of the estate of such minor child, and I authorize and direct said guardian to invest the same and to pay so much of the income arising thereon together with so much of the principal thereof as in the opinion of said guardian is necessary or desirable to be expended for the proper maintenance, support and education of such minor child, to the person having custody of such minor child, and upon such child attaining eighteen (18) years of age to pay the then remaining principal together with any undistributed income to such child. . uw oFFices 3AKER a FLICKER 5. I hereby nominate, constitute and appoint my said daughters, CELIA A. ZEIGLER and SHIRLEY A. KIRK, as Co-Executrices of this my Last Will and Testament, and I further direct that neither daughter serving as Executrix shall be required to post any bond to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on two (2) pages this /~ day of ~, C-~~ , 1 89. ~~ G~~~~`~'~-~.~ ~~ -~( SEAL ) Kathleen M.-Smith Signed, sealed, published and declared by KATHLEEN M. SMITH, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~t'~.~ti~(SEAL ) --v~--~. - ~ `J~c.-~.: ( SEAL ). - r~- -2- ~_ COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) SS. We, KATHLEEN M. SMITH, E. ROBERT ELICKER, II, and SUSAN A, McCOY, the Testatrix and the witnesses, respectively, whose name are signed to the attached or forgoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Wil] and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix ,. Witness ~ 7r~~~' Witness ,v oFV~ces CER 8 ELICKER Subscribed, sworn to and acknowledged before me by KATHLEEN M, SMITH, Testatrix, and subscribed and sworn to before me by E. tOBERT ELICKER, II and SUSAN A. McCOY, witnesses, this 1~`~ da Pf G'~t,.~° Y 1989. .~ o . -~ /~.,- Notary Public ~~ ~~~~~~P1a'.atc(~es( C,~f(:arleµ F. n si:.r<r:~ rotary PAC!(. P#4':!?5dlcx;,~i ~ k'i.,c~, G'iL!»}s~,~~N}711.4U.+fPjP ~Y E.za„,~;P~e,va ~x,:fs~F~E.27,1950 fllr~yix:, f'aa~s^_•yPt~(s r~~ac;~on of PbixPes . _____ __ ~_ r tr79Np118 tlOll10(IS 8f0 OOiUltl19 -;ynrr ntru-r ~ Look tm nmMiWNw gaF~.t a Settlement Statement U.S. Department of Housing. and Urban Developmer+e i. OFIiA 2 ~FmHA 3. OConv. Ltnins. 6. F~7e Number 7. Loan Nnoober 8. Mo-t~e Inatuance Case Numt~er This Y b yM ysu a sl4smak ssiusl ssMs~nnM oats. Amounts paW b wa ssaMmsnl apart na slwrai. C. Note: to a~ i~aYase iaa~aU~ aalo.~tsl..ls b ~ ~~ ss ~aw.r.~rall~iriaia~.aw b`~ TiU~bss setlbrr~xk 9r-~et++ D. NAME OF BORROWEsR: wil~iam R sta»aseta and shrri M. statosfielti E. NAME of SEI.L.ER: The Estate of Kathloea M. Smith F. NAlvlfi OF LENDER: G. PROPERTY ADDRESS: 37 Sample Bridge Road, Mechanicsburg, PA 1'I050 H. sET-rLEi~rrr AGEIVI': PA Real Estate Settlement Services LLC, Telephone: 717-249-6333 Fsat: 717-249-7334 SUBSTiIUTE FORM 1lIDY Yq I FR STA7E~Ii: Tha iYom~on OoMaYlad hawin it iRlpp'fant ~ inkm~bnr nd k 6i~p fWNshd b h Yrsnrl Rw~r~us BuNos.', ^~ou as nquind b As ~ ~ebrtti TaNOw earoons.re oo~as~e U.S. DEPAR'TMEN'T OF HOUSING AND URBAN DEVEIAPMENT mrm rnn,-, ~.Mro~ ror nanooooK,yw.z Fik Number: 2010-065 PAGE 2 PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT n // ~4f~ran of euvER a+o seuea ~. i aaoouK a by ma WARNRIEi R IS A CRME TO IQgWN6LY HAKE FALSE BTATE1~Ii8 TO THE 71» MUO.18Mka~wRShIaM~N wliq~ I hM pn0ard Y ~ ~oar~ asark d Ihk trraa~on. UNRED 8TAT68 ON TNIa OR MIYSM~ki,Alt FORM. PFl4N.TES UPON OONVICTION 1 AM tair~d wR aar b ~ b pe dYbaMd h M~ rils ~IMwanl. CAN MICLIlOE A FME AND ~ FOR OEi'Ak8 8EE TRLE 1a: US. CODE SECTION 1001 MID SECTION 1010. ~ ~ ~ /~ sY' ` a`Y. H TION OF BUYER AND 8ELLER I 7 b mmyy triwlMips aid OMN k b a Inr i+kw kn111~ a d S~rnart8YlaeaM. Shal M.