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HomeMy WebLinkAbout07-13-10 (2) REV-1500 EX (06-OS) PA Depedment of Revenue Bureau of IndNidual7axes Po sox zeosol Hanisburg, PA ntze-osot 15056051058 OFFICIAL USE ONLY INHERITANCE TAX RETURN C°unty Code Year Ftle Number 21 10 0101 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death _ _.. Date of Birth 203-10-0326 ! 11/26/2009 :02/07/1920 Decedent's Last Name -_ __. _ Suffix Decedent's First Name __ MI GRAHAM ~ '~ RITA J i (If Applicable) Enter Surviving Spouse's Information Below Spouse's Lasl Neme SufOx Spouse's First Name MI ',GRAHAM GARNET 'S I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW >~ 1. Original Return O 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-62) p 4. Limited Eslate O 4a. Future Interest Compromise (date of r.~ 5. Federal Estate Tex Relurn Required death after 12-12-82) t>7!,? 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust -.........._. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C~ 9. Litigation Proceeds Received t~ 10. Spousal Poverty Credit (date of death C3 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 CONFlDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name __ _ _.. __ Daytime Telephone Number THOMAS E. FLOWER ~ i (717) 737-340 ~ Firm Name (If Applicable) --- - -- - -- --- --- - ..---- ~ - - - - - REGISTER 5 USE 04}LY ~ ~: ~ ~ ~ ` SAIDIS, FLOWER LINDSAY ~~ r t~ ? L __ rr ~ ' c.~ r ` ° - . .. ~.. - ~ W -, ~tn I ..~. r-~s r 2109 MARKET ST ~ ' ~~~ 'p c~a- ~ ~; t ~ ~' i, z~ _. Second line of address t, ! ~-~~ ' v ~ .~.. _ f Y .................. ................. ........ ............... ...........__. City or Post Office State ZIP Code DATE FILED Cr2 ----- - ---- ---------- CAMP HILL ! PA i 17011 Correspondent's a-mail address: tflOWer@Sfl-Iew.CDm Under penalties of perjury, I deGare that I have examined this return, Inclutling accompanying schetlules end statements, and to the Dent of my knowledge and belief, It is true, correct and complete. Declaration of preparer other than the personal represenletlve is based on all information of which preparer has any knowledge. SIG RE OF P SO ONSIBLE FOR FILING RETURN DATE p o ~ ~ 06/18/10 S G. L , 100 F RBES RD., CARLISLE, PA 17013 51 F PREP ER 7 R THAN REPRESENTATIVE DATE / /1/AA.f 06/18/10 SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number _. Oersdent's Neme: RITA J GRAHAM ' 203-10-0326 '.; RECAPITULATION 1. Real estate (Schedule A) .............. . .............................. 1. j 147,000.00 2. Stocks and Bonds (Schedule B) 2, ', 1,601.76 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. I 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4.' 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. ' 205.38 I 6. Jointly Owned PropaAy (Schedule F) O Separate Billing Requested ..... .. 6. 8,025.83 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property j ~ ~~ (Schedule G) O Separate Billing Requested...... .. 7. I B. Total Gross Assets (total Lines t-7) ................. . ................ .. 6. j 156,832.97 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. , 25,312.27 ', 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............. .. 10. ! 60.07 ': 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. '; 25,372.34 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ', 131,460.63 13. Charitable and Governmenlai BequestslSec 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. ', TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or __ transfers under Sec. 9116 (a)(t.2) x .o_ 43,820.21: 15. ' ~~ ~-~~ 0.00 ~ ~-~ 16. Amount of Line 14 taxable ~~_-- -~Y_~"'~~~~ at lineal rate X .0 45 87,640.42 16, ' 3,943.82 17. Amount of Line 14 taxable -~-~~~~~~~~~~-~~~ ~~~~~~~ ~ ~-~ at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 ' 76. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 3,943.82 O 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Plle Number ~______-~ 21 10 (0101 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER RITA J GRAHAM 203-10-0326 STREET ADDRESS 25 STONEHEDGE DRIVE EAST CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1, Tax Due (Page 2 Line 19) (1) 3,943.82 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,943.82 A. Enter the interest on the tax due. (5A) 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 3,943.82 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or inwme 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 .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1902, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^K 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 (O) 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 benefirary. For dates of death on or after Juty 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 benefidaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-a8) SCFIEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 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 al which property would be exchanged between a willing buyer and a willing sager, neither being compeged to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE TOTAL (Also enter on line 1, Recapitulation) i 147,000.00 (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (e-08) SCNEDIJLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 TOTAL (Also enter on line 2, Recapitulation) $ 1,601.76 (If more space is needed, Insert additional sheets of the same size) REV-15e8 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASHr BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-0wned with right of aurvlvonhlp moat 6e dlaclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AVALON INSURANCE CO., REFUND OF PREMIUM 89.00- 2. PNC BANK CHECKING ACCT. #50-8054-3226 116.38 TOTAL (Also enter on line 5, Recapitulation) S 205.38 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN • RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 If an asset was made Jolnt wlthln one year of the decedents date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• GARNET S. GRAHAM ~ 1 LONGSDORF WAY, CARLISLE, PA 17013 ~ SPOUSE B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION ANO BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET X OF OECD'S INTEREST GATE OF DEATH VALUE OF DECEDENT'S INFEREST t• A• sPNC BANK CHECKING ACCT #50-8052298 16,051.66 50 8,025.83 TOTAL (Also enter on line 6, Recapitulation) I S 8,025.83 (If more space is needed, insert additional sheets of the same size) REV•1511 EX+ )12-99) SCHEDYLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 Debts of decedent must be reported on Schedub I. A. FUNERAL EXPENSES: 1 HOFFMAN-ROTH FUNERAL HOME -BALANCE OVER PREPAID AMOUNT 453.41 FUNERAL LUNCHEON 479.63 g. ADMINISTRATIVE COSTS: t. Personal Representative's Commissions 6,946.00 Name of Personal Representative(s) SUE G. LEE Social Security Number(s)IEIN Number of Personal Representative(s) 194-42-7912 Street Address 1009 FORBES ROAD City'CARLISLE State'PA ;Zip .17013. Year(s) Commission Paid:.2010 2. Attorney Fees 10,000.00' 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 369.50 5. Accountant's Fees 6. Tax Relum Preparer's Fees Z. Publish estate notices -Cumberland Law Journal 75.00 a. Publish estate notices -The Sentinel 230.02 9. Publish house for sale ads, The Sentinel and Patriot-News Classifieds 682.36 i o. Stonehedge Homeowners Association dues 870.00 t 1. WatedSewer fees 306.01 12. Continuation Sheet Total 2,900.34 TOTAL (Also enter on line 9, Recapitulation) $ 25,312.27 (If more space is needed, insert additional sheets of the same size) SCHEDULE H CONTINUATION SHEET ESTATE OF RITA J. GRAHAM 12. A. CHEM-DRY, CARPET CLEANING B. HERMAN PLUMBING C. FURNACE, A/C CLEANING D. CAVANAUGH MICHAELS, INCOME TAX PREP E. PPL F. UGI G. CENTURYLINK, PHONE BILL H. TRASH REMOVAL I. LOCALICOUNTY REAL ESTATE TAXES J. LESS TAXES RETURNED AT SETTLEMENT K. LESS HOME OWNERS ASSN. DUES RETURNED J. REALTY TRANSFER TAX TOTAL FILE NO. 21-10-0101 199.61 86.90 185.00 234.00 273.11 261.86 31.57 90.21 385.80 (259.76) (57.96) 1.470.00 2,900.34 REV-1512 EXt (12-03) SCFIEDIJLE 1 COMMONWEALTH Of PENNSYLVANIA DEBTS Of DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, 8c LIENS RESIDENT DECEDENT ra~hir: yr ~,YV ,\VTVV,\ RITA J. GRAHAM 21-10-0101 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unretmbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t COMCAST TV CABLE 60.07 TOTAL (Also enter on line 10, Recapitulation) $ 60.07 (If more space is needed, insen additional sheets of the same size) REV-1513 EX+ (9-0O) SCHEDULE J COMMONWEALTH OP PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RITA J. GRAHAM 21-10-0101 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS linclude outright spousal distdbutions, and transfers under S 9116 (a) (1 2]] 1 2 3 4 I eo JEFFREY A. GRAHAM,1249 PEGGY DR., HUMMELSTOWN, PA 17036 .DOUGLAS S. GRAHAM, 15 SIPE ROAD, CARLISLE, PA 17015 SUE G. LEE, 10D9 FORBES RD., CARLISLE, PA 17013 GARNET S. GRAHAM, 1 LDNGSDORF WAY, CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES i5 THROI NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO 1 "SON SON 'DAUGHTER "SPOUSE i IGH 18, AS APPROPRIATE, ON RE AX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~www. wn www~w„ ~-.~~rn rnrw, ~, nwi +wvwn, r n,nTtf,ol,T,l1w,[~ I~1.1 I ILIC ~~ l1C DL\/ ~G11111^!1\ILD CLICGT I[ (If more space is needed, insed additional sheets of the same size) LAST VI'i1,L AND TTSTAMENT OF RITA J. GRAHAM 1, RITA J. GRAHAM, now domiciled in Dauphin County, Pemisylvania, declare this to be my Lasi Will and Testament. I revolve all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after m}~ death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generall}~ against the principal of my residuary estate without reimbursement from any person. Tiiis provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath in accordance with any memorandum, which I have either handwritten or signed, located with my Will or with my valuable papers and found within thirty (30) days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article N I give and bequeath the sum of TWENTY THOUSAND ($20,000.00) DOLLARS to my daughter, SUE ELLEN LEE, of Cumberland County, Pennsylvania, with the request and understanding that she will use such funds to open a bank account to be used at her discretion as needed to provide for the comfort and special needs of her sister, CAROL GRAHAM, of Cumberland County, Pemisylvania. hi the event that SUE ELLEN LEE shall fail to survive me by ninety (90) days, then the sum of TWENTY THOUSAND ($20,000.00) DOLLARS to be paid to SUE ELLEN LEE on behalf of CAROL GRAHAM shall be paid to my son, JEFFREY GRAHAM, of Dauplnn County, Pem~sylvania, with the request and expectation that he will use the funds at his discretion to provide for the comfort and special needs of his sister, CAROL GRAHAM. h~ the event that JEFFREY GRAHAM shall fail to survive me by ninety (9U) days, then the sum of T~'~'ENTI' THOUSAND (520,000.00) DOLLARS to be paid to JEFFREY GRAHAM on behalf of CAROL GRAHAM shall be paid to my son, DOUGLAS GRAHAM, of Cumberland County, Pennsylvania, with the request and expectation that he wil] use the funds at his discretion to provide for the comfort and special needs of his sister; CAROL GRAHAM. -~- Article V All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, ] g ive, d evise a nd b equeath I N E QUAL S HARES t o S UE ELLEN LEE, JEFFREY GRAHAM and DOUGLAS GRAHAM. If one of my beneficiaries predeceases me or fails to survive me by thirty (3U) days, I give, devise and bequeath the share he/she would have received to my remaining benef ciary who survives me by thirty (3U) days, PER CAPITA, NOT PER STIRPES. Article VI I nominate, constitute, and appoint SUE ELLEN LEE as Executrix of my Last Will and Testament. hz the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint JEFFREY GRAHAM aiid DOUGLAS GRAHAM as successor Co-Executors of my Last Will and Testament. I direct that my Executrix or successor Co-Executors be permitted to sense without bond a11d in addition to those powers granted by law, I grant them power to distribute in cash or in hind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executrix or successor Co-Executors shall receive reasonable compensation for services rendered to my estate. Article VII hl addition to the powers conferred by law, I authorize my Executrix and successor Co- Executors, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, -3- (~) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to f le any federal income tax retun~ for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to detern7ine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, RITA J. GRAHAM, hereby set my hand to this my Last Will and Testament, on 11'lcu' c~J~~ I ~~ 2004, at-Harrisburg, Pemisylvania. ~~~~ ~~- - RITA J. GRAI~AM hz om~ presence, the above-named RITA J. GRAHAM signed this and declared this to be her Last Will and Testament and now at her reduest, in her presence, and in the presence of each other, we sign as witnesses. Name ~. (/~ / % - Address -4- I, RITA J. GRAHAM, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that 1 signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acla~owledged before me by RITA J. GRAHAM, the Testatrix on I~~1C~'Ch I c 2004. ~, „'NotaT~ Public ;v NO7ARIAL SEAL JACQUELINE A. KELLY', N07ARY PUBLIC LOWER PAXTON TWP, DAUPHIN CDUNTY MY COMMISSIO~PIRES DEC. 11, 2001 „ , RITA 3. GRAH~iM We, the undersigned witnesses vvho signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed aiTd executed it willingly as her free and voluntan~ act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that tune eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribes to m~ by -~~ and ~til~r ~lG -~L2e'~-~,/~~ witnesses, on 11~~,~'Cl~~ I ~~ , 2004. Y(~~.u~l1U' L ~ /,c~~C Witness ~~ / 1, . I". ~~itness ,~ ,, is ~ /~ /~~ r ~ i. A ~ i'i~y,U_ ~,l ,~ L~ l,'~ ~~. ~ ~L~,f~l Notary P}tblic j NOTARIAL EEAL JACQUELINE A. KELLC NOTARY PUBLIC LOWER PAXiON iWP., DAUPNIR' COUNTY MY COMMISSION EXPIRES DEC. ? 7. 2007 -5- In the Office of the Register of Wills for Cumberland County, Pennsylvania In re: Estate of Rita J. Graham, deceased No. 2010-00101 Late of South Middleton Twp. Notice of Spouse's Election Under 20 Pa. C.S. & 2201, et sea. I, Garnet S. Graham, by my agent under power of attorney, Sue G. Lee, hereby elect to claim the surviving spouse's statutory share of the estate of my late wife, Rita J. Graham. Dated: M.ts-'C~~ , 2010 Sue G Le as a er t under power of attorney Fo rn t S. r am ,ewcus etlihons are obsolete Icrm NUD-I (3861 rel Me~bppk 9305.2 A, Sett~.emellt StateITlellt U.S. Depanmenl DI HDU3irg and Urban Develapmenl n r.._...., i ...... l1Lan Annrn~el Nn rJSrMf»G5 CTNAT 1. OFHA 2. ~EmNA 3. ~[:unv. Unim. 4. VA v. 6. Fle NlYnber 7. Wkn Number a. Mertgngc Insurance Cax Number TDY Iprm ie AxnbMd N pm yeu a element q egwl wl3amam wNS. pupa p b s by the wtlbmenl eBeN xs ehown. C. NDID: name merked'Ip.p.e.)' were peb mukle the cbaeq; Ihry xe aDpwn hxe br Inbrmwbn pxpwa arN xe nd includstl b Me bleb. WARNMU:YhamvnwmkrowVply make lYw eWemeNaNMe UNbd SWes en lDb ern qhx eimYer brm. Penegba upn TIIbExpre6s Se111emeni System D. NAME or DDRROwER: Marilyn M. Finkebinder D E. NAME of SELLER: The Estate of Rita 1. Graham I(NAME DF LENDER: N/A o. rROVERTr ADDRESS: 25 Stonehedge Drive East, Carlisle, PA 17015 H. sErrLEMENT AGENT: PA Real Es[a[e Settlement Services LLC, Telephone: 717-249-6333 Fax: 717-249-7334 E E ETT T: TT M. 147 000.00 147 000.00 2 712.00 D6 18 10 12 31 10 208.22 06 18 10 12 31 10 208.22 06 18 10 O6 30 10 51.54 O6 18 10 O6 30 10 51.Sd 57.96 57.96 150 029.72 147 317.72 1 000.00 1 669.01 1 000.00 1 669.01 150 029.72 147 317.72 1 OOD.00 1 669.01 149 029.72 145 648.71 SUBSTITUTE FORM 1038 SELLER STATEMENT: TDe ireprmalbn mNebad harNn ie Vnpnam laa INmmalbn eM Y wlnB lurnYhM ip the IIwmN Reveres Sarvlce. !you ere repotted b INe a Nwrn, a nspMpems pesky pr qMi aemepn will be vnpaetl an you Y mb eem Y roWvsd to be repwd and Iw m3 dgarminw that a hw ml Dean reprNd. The CpnlrW Saba Price tlewOed pn Ibe i01 abwa mminW s Mo Oma Pmwsdv d IhY Vmwclbn You xa rxmVed Dy lee b proNtle 1hB eeal0mlep weq (Fad, Tae ID Np: 1 wi1D ~r cunacl Yapayer itlaNligVM numDar. II Yp dp nq puwtla your mnect lamapr IdenVlicNOn mmDar, yes mey Da auDpcr rp del pr a1mlMl pmkiw impsatl by bw. UM1ei pen9tdes p pwlwy, cxltly 1hN me number shown en Ihb NelamaN b my mrrrrM lupYar kNNBiplwn number. nN: /-_ SELLERISI SELLERIS) NEW IMILINB ADDRESS: SELLERIS) PHONE NUMBERS: -_. arewous etlionns ere obsolete loan NDD~113ISB) rel Ner~tlbnok 9305.2 U.S. UNPARI'ML~NT OF HGUSING AND URBAN UBVBLUPMk?NT File Nwnher: 2UIU-IUII FINAL PApE't PAID FROM PAID FROM 147 .00 ~ BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 0.00 0.00 147 000.00 Saidis Flower G Lindsa P lzmann Hu has P.C. 390.00 52.00 2 0 1 470.00 ~ 1 470.00 1 470.00 ~ 1 470.00 Re o r of Desda 1 00 Ro r Cairns Tax Collector 5.00 South Middle n T wnahi Authorit 94.01 Stonaha • Romow Aaaociation 290.00 100.00 14-- 2 HUD CERTIFK:ATKIN OF SUVEfl AND SELLEfl I here pareMlly renewetl me HUD~f 6etllvmant Salemenl antl le the Beal of my kmwMtlOe eM Oellel, II is a True and ecewele alaMnwnl of all raoelga entl tlY W reamvnM matlp pn my aLpppnl or by me in INe hvrollgwn. I IuMer ceKlly Inal I nave racaivetl a copy d the MUD-I Satllemenl Swvmenl. Marlyn M_Fnkadntler Tne EMale al floe J. Grehsm BY Sue O. leek a WggNINO: IT IS A rRIME TO KNOW WGLV MAKE FALSE STATEMENT6 TO THE Tne NUD-1 SNtlvmvM Slalanere whch I have preparetl is a Ime vM Carew ¢Ceunl of tma Iranaeclon. CLAN ENCSITIOE A fWE AND IMVRISONMENT FON DETAILS 5 E TIpTOLNE CB NVICTION I hm caused or vrill wuaa IM lurdv b Ov diWUrestl in a¢vrdance wiM Ihie clabmsN. U S. LADE SECTKN! 1001 ANO SECTION 1010. MetLife 8NY Mellon Shareowner Services P.O. Box 358420 Pittsburgh, PA 15252-8420 Account Registration: 0000190 02 !~ 0.507 ••AVTO T3 0 3359 17013-176309 COl B1MAI - 23 - 111111111111111111111111111111111111111111111111111111111t1111 SUE G LEE EX UW RITA L GRAHAM 1009 FORBES RD CARLISLE PA 17013 Date: 03/12/2010 For information concerning this statement, please call BNY Mellon Shareowner Services, MetLife, Inc.'s Transfer Agent, toll free at 1-800-649-3593 Trust Interests (Shares) 47.000D CUSIP Number 59156R1D Transaction Date D3/11/2010 Transaction Advice Number 0002421926 Investor ID 1254 0884 4559 This Transaction Advice is your record of the indicated Trust Interests being credited to an account on the books of the referenced transfer agent. The Transaction Advice should be kept with your important documents as a record of your ownership of these securities. These Trust Interests are transferable only as permitted under The MetLife Policyholder Trust. Please read the important information on the back of this form and in the Purchase and Sale Brochure. If you wish to request a purchase or sale transaction, detach coupon at the perforation and complete the applicable side of fhe form. PLEASE BE SURE THIS ADDRESS APPEARS IN THE ENVELOPE WINDOW FOR PURCHASES ONLY Purchase Instructions 1254 0884 4559 .change of Address: (See reverse side to SELL) SUE G LEE EX UW RITA L GRAHAM BNY Mellon Shareowner Services P.O. Box 382200 Pittsburgh, PA 15250-8200 Inlllllllnlllllllllllnlll/lmlllllulllnlllnlllllllnlll The MetLife Policyholder Trust ("Trust") Transfer Transaction Advice RETAIN THIS DOCUMENT FUR YOUR RECORDS Signature (if address is being chengedJ Make check in U.S. dollars, payable to' MetLife Purchase Program Amount Enclosed Minimum investment 5250 (except as described in the Purchase and Sale Brochure) 0000101 102 125408844559 5 11V New User? Sign Up !, Sign in ', Help Get Yahool Toolbar Yahoo! Mail •~•~• ~y ~~,I~OC~~,p FlNANC~ search Web Search DOw 't' 0.62% Nasdaq 't' 0.21% Tuesday, February 2, 2010, i1:OlAM ET - U.S. Markets close In 4 hours and 59 minutes. pRr pWyq'RS @ Finance Search MetLife, Inc. (MET) At 10:46AM ET: 36.02 t o.os io.zzaio~ ' Trade Mow " r11~~1111w1f~ _ ~ ~ ~ ~. k..- Historical Prices ~ Get Historical Prices for: SET DATE RANGE ~i Daily Start Date: Eg. Jan 1, Nov ' ' 23 2009 .:2003 ~ Weekly End Date:. Nov ' 30 2009 ~ Monthly Dividends Only Get Prices ; , 3~-©~' ~ First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Clod. 30-Nov-09 33.53 34.27 33.OD 34.19 7,286,700 34.19 27-Nov-09 33.34 34.01 33.10 33.28 3,255,100 33.28 25-Nov-09 34.53 34.84 34.37 34.59 4,315,400 34.59 24-Nov-09 34.42 34.74 34.09 34.42 4,115,800 34.42 23-Nov-09 34.39 34.66 34.25 34.49 6,128,700 34.49 Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last t Download To Spreadsheet Add to Portfolio ~' Set Alert 47 Email to a Friend Get Historical Prices for Another SYmbol: GO. Svmbol Lookup • Stock Screener Splits GO, http://finance.yahoo.com/q/hp?s=MET&a=10&b=23&c=2009&d=10&e=30&f=2009&g=d 2/2/2010 Interest Checking Account Statement _ For the period 11/19/2009 to 12H8/2009 For 24-hour information, sign on to PNC Bank Online Banking RITA J GRAHAM on pnc.com. Primary account number: 50-8054-3226 Page 2 of 2 PNC points is a service mark of The PNC Financial Services Group, Inc. PNC Bank reserves the right to change or terminate the PNC points program See Terms and Conditions for complete details. Interest Checking Account Summary Pota J Graham Account number: 50-8054-3226 Overdraft Protection Provided By: Contact PNC to establish Overdraft Protection Balance Summary Interest Summary As of 12/18, a total of 51.87 in interest was paid this year. Anrural Pementage Number oT days Average collected Interest Pald Yield Earned (APYE) in interest Deriod balance Tor APYE this period 0.05 30 232.94 .01 Activity Detail Deposits and Other Additions Date Amount Description 12/03 710.00 Direct Deposit - Soc Sec US Treasury 303 XXXXX0326A 12/18 .01 Interest Payment Online and Electronic Banking Deductions Date Amount Description 11/23 700.OD Online Transfer To 0000005080525298 12/D4 710.00 Direct Payment -Reversal US Treasury 3D3 XXXXX0326A Other Deductions Date Amount Description 12/18 13.00 Calculated Service Charge Type D1 Daily Balance Detail Date Balance Date Balance Date Balance 11 /19 816.38 12/03 826.38 12/18 103.39 11 /23 116.38 12/04 116.38 Beginning Deposits and Checks and other Ending balance other additions deductions balance 816.38 710.01 1,423.00 103.39 Average monthly Charges balance end tees 232.94 13.00 There were 2 Deposits and Other Additions totaling $710.01 There were 2 Online or Electronic Banking Deductions totaling $1,410.00 There was 1 Other Deduction totaling $13.00 Free Checking Account Statement For the period 1111112009 to 12111/2009 For 24-hour information, sign onto PNC Bank Online Banking GARNET S GRAHAM ~ on pnc.com. Primary account number: 50-8052-5298 Page 2 of 3 PNC points is a service mark of The PNC Financial Services Group, Inc. PNC Bank reserves the right to change or terminate the PNC points oroaram. See Terms and Conditions for complete details. Free Checking Account Summary Gamet S Graham Rita J Graham Account number: 50-8052-5298 Special Account Overdraft Protection Provided By: Contact PNC to establish Overdraft Protection Balance Summary Beginning Deposits and Ghecks and other Ending balance other additions deductions balance 10,896.66 11,328.89 5,443.92 16,781.63 Average monthly Charges balance and fees 13,258.77 .00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals Signed bansactions POS PIN transactions 7 0 0 Total ATM PNC Bank Other Bank transactions ATM trensactions ATM transactions 4 4 0 Activity Detail Deposits and Other Additions Date Amount Description 11/23 700.00 Online Transfer From 0000005080543226 11/25 8,156.85 Branch Deposit Tel 0400017602 0240 12/01 946.04 Direct Deposit - Benft Pymt Aetna Inc XXXXXXXXXXX6128 12/03 1,526.00 Direct Deposit - Soc Sec US Treasury 303 XXXXX4582A There were 4 Deposits and Other Additions totaling $11,328.89 Checks and Substitute Checks Check Date Reference Check Date Reference number Amount paid number number Amount paid number 1846 25.00 11/12 oa4os7so7 1853 60.07 12/08 Dasea242t 1848' 178.00 11/17 osst2oeo3 1855" 453.41 12!10 o93as3ao9 1850' 50.91 11/24 oesostsso 1856 112.80 12/11 084436857 1852 ' 55.10 12/08 s2za5T~ot Gap in check sequence BankinglCheck Card Withdrawals and Purchases Date Amoum Description 11/13 500.00 ATM Withdrawal 105 Noble Blvd Carlisle PA 11119 500.00 ATM Withdrawal 105 Noble Blvd Carlisle PA 12/03 500.00 ATM Withdrawal 105 Noble Blvd Carlisle PA 12/1D 500.00 ATM Withdrawal 105 Noble Blvd Carlisle PA Online and Electronic Banking Deductions Date Amount Description 11/16 2,404.23 Payment,E-Check Check Pymt Fia Cardservices 1847 11/17 43.71 Payment,E-Check Bill Pymt Embarq 1849 12/09 60.69 Payment,E-Check Util Pmt UGI Utilities 1854 There were 7 checks listed totaling $935.29 There were 4 Banking Machine withdrawals totaling $2,000.00 There were 3 Online or Electronic Banking Deductions totaling $2,508.63 Free Checking Account Statement For the period 11111!2009 to 12/1112009 For 24-hour information, sign on /o PNC Bank Online Banking GARNET S GRAHAM Primary account number: 50-8052-5298 on pnc.com. Account number: 50-8052-5298 -continued Page 3 of 3 Daily Balance Detail Date Balance Date 896.66 11/17 11111 10 Balar~e 7,745.72 Date 11/25 Balance Date Balance 16,051.66 12/09 17,847.84 , 871.66 11/19 11112 10 7,245.72 12/01 16,997.70 12/10 16,894.43 , 11!13 10,371.66 11!23 7,945.72 12103 18,023.70 12!11 16,781.63 11/16 7,967.43 11/24 7,894.81 12/08 17,908.53