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HomeMy WebLinkAbout07-16-10J 1505610143 ~~ ~ ~~ Ex (01-10) OFF~IAL USE ONLY PA Department of Revenue pennsyhrania CcxxMy Cods „r Fire Nwnbsr Bureau of Individual Taxes ~**~- Po i~x.2ao6o1 INHERITANCE TAX RETURit! 21 I v Harristwrg, PA 17128-0601 RE8#~3ENT DECEDEM'1' ~ ~.Q c~ t ENTER DECEDI~NT IMI'rORIYIATlOI'1 BELOW Social Security Number Date of Death Date of Birtfi 193 is Ss97 03 20 2010 10 28 1923 Decedent's Last Name SALITIS Suffix Decedent's. First Name JOHN (if Appiicable- Enbr Surviving 8pouse's Information Bslow Spouse's Last Name Suffix Spouse's Sotaal Security Number FILL IN APPROPRIATE OVALS BELOW Spouse's First Name THIS RETURN MUST 8E FILED iN DUPL~ATE WITH THE RE~~~T~R of ~L,s Mt C Mt x^ 1. Original Retum ^ 2. Supplemental Retum ^ 3. ndZr1 (date pf death ~ ^ 4. Limited Estate ^ 4a. Fut~ tnt~ Cam ~ (date d death attar 12x2-t32) ^ 5. Federal Estate Tax Retum Requirod ® g, Deoedsrrt Died Testate (Attach Copy of WNq ^ ~, pp a living Truit (l~toMpy ~) 8. Total Number Of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. ~~~~~5~ death ^ 11. EIeCpOn to tax under Sec. 9113(A) (Attadt Sch. O) CORRESPONDENT -TMs SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIQENTIAL TAX INFORMATION sHOUE.D BE DIRECTED O: Name Daytime Telephone Numlrer AARON C JACKSON ESQ 717 234 4121 First line of addr+ses 111 NORTH FRONT STREET Second Iine of address PO BOX 889 City or Poet O~ HARRI3AURG State ZIP Code PA Correspondent's a-mal! adc~ss: >~iCKSOnfIiCK@Nt;1W.COi'n REt3tSTER O~ALLS USE IY c°~~ ~ n ,~ ~ ~ ~ ~: r .r .., ,~ ~, 4. ~~=4 r....! ~• ~:,k ~,. w DA FLED __,. ;" ~.~ _ ~ .~~ n~der P ~ , , "and"' n°doaw~r ~, #te '~ ~ is ' 'of~wn ~pRSp~ia+er~h"~ ~~,y ~, belief, S ~r ETURN DATE) John M. Salitis ~' 12 jln stt~rA 111 North Front PA Aaron C. Jackson. Esq. Side 1 L, 1505630143 REPRESENTATNE DATE 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number °~~'_ "~~ S~alitis, John C. 193 16 85 97 RECAPfTU1.ATiON 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Heki Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedu~ F) ^ Separate Billing Requested............ 6. 2 3 , 5 90.61 T. Inter-Vivos Transfers & Miscellaneous -Probate Property (Schedul arat G) ~ Se Billi R t d p e e ng eques e ............ 7, 8. Tote! Gross Assts (total lines ~-7) ..................................................................... g, 23 , 5 90.61 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 12,031.77 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I 10. 6 7 4.6 6 11. Tote! Deductions (total Lines 9 810) ................................................................... 11, 12 , 7 0 6.4 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 1Y, 10 , 8 8 4.18 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Sut~ct to Tax (Line 12 minus Line 13) ............................................... 14, 10 , 8 8 4.18 TAX COMPUTATION -SEE Mi3TRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or tranafens under Sec. 9116 (a)(1.2) X .00 15. 0.00 16. Amount of Line 14 taxable 10 8 8 4.18 at lineal rate X .045 r 16. 4 8 9.7 9 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 0.0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. Tax Due .................................................................................................................. 19. 4 8 9. 7 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. D Sidi 2 1505610243 1505630243 J _. REV-1500 EX Page 3 DecsdenNs Ca~tll~te Address: File Number 21 ----- DECEDENTS NAME Saii#is, John C. STREET ApORESS Faitwsy Drive CITY Camp HiN STATE PA ZIP 17011 Tax Payments and Gredits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 8. Discount (1) 489.78 475.00 24.49 Total Credits (A + B) (2) 499.419 (3) (4) 9.710 (5) 3. interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on PaOe 2 Line- 20 to roquest a rotund 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Make ~tt~dc Payable to PLEASE AW$'M11ER THE FOLLOWING QUESTIONS BY PLACING AN "ll~" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. rotain the use or income of the property transferred :............................................................................... b. rotain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... x d. roceive the promise far life of either payments, benefits or caro? ............................................................ 2. if death occxJrred after December 12, 1982, 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?....... ^ 4. Did decedent own. an Individual Retirement Axount, annuity, or other non-probatie property which contains a benefidary designation? .................................................................................................................. ^ iF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE ti ANO FIi.E IT AS PART OF THE For dates of death on ar after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surv'nring' spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For darts 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 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax rotum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: . The tax rate imposed an 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, 8n adoptive paren{, or a stepparent otthe child is 0 percent [72 P.S. §9116 (a) (1.2)). • The tax refs 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) [72 P.S. §9116 (a) (1)]. • The tax cabs imposed on the net value of transfers to or for the use of ~e decedent's sibNngs is 12 percent [72 P.S. §9116 (a) (1.3) . A sibling is defined under Sedion 9102, as an individual who has at least one parent in common with the decedent, whether by b or adoption. Rw-160! EX+ (6A6- coMMOrs~A~m of rtvANU- uess:n'A~ rAx REao~r oea~n ESTATE OF FILE NLER Sa~it~. John C. 21 M Mn asNt wras m.a. jMnt wNhM as >n~ of aa~ d~dsnt'a dom. or d~Mh, n nNrst a. npaad on D. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. ~l01iWTLY OMI?NIE~ PROi~RTY: ITEM - NUMBER LETTER FOR JOt TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FiNANCWI IN8TIT11'riON AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUNISER. ATTACH GEED FOR JOINTLY-HELD REAL ESTATE. ~~~ ~ DEATH ' ALOE OF ASS o~ OF DECD`S INTER€ST DATE OF OIE~TH VALUE OF DECEDENTS iNTER~5T 1 Bonds -Bonds held jointly with son John M. 2,262.72 50.04D'16 1,131.6 Salitls. See atblched list. 2 2/24/2006 Certificate of Deposit -Certificate of deposit 1.0,073.77 54.000'Ye 5,036.8 held jointly with son, John M. Salitls. {see Valuation from iYIBT Bank). 3 4/28/1888 IN~T Bank -Checking account # xxxx3716 34.844.72 ;it1.000ti6 17,422.316 held jointly with son, John M. Salitls (See Valuatlon from MBT Bank). ~~ JOINTLY-OWNED PROPERTY TOTAL 1AIso enter on Line 6. Recapitulatlon) l 23.880.61 (If more spans is needed, additional popes of the same size) Copyright (c) 20t?2 form software only The Lackner Group, Inc. Fomn PA-1500 Schedule F (Rev. 6-9$) REV-t ~ s~ Ex+ lu-.oa~ coM-fki~4~.~~-Y,wu ~~~~~ FUNERAL EXPENSES ~ ESTATE OF FILE NUN~ER Sallt~, John C. 21 Debts of decedent must be roporbsd on Schedule t. ITEM DESCRiPTiON AMOUNT A, FUNERAL EXPEN8E3: ~e continuation schedule(s) attached 8,248.Q0 B. AD11118N18TRATiVE COSTS: 1. Personal Representative's Commissions Name of Pentonal Representative(s) Street Address Cry State ~ Zio Year(sl Commission paid 2, Attomev's Fees Tucker Arensbeirg, P.C. 3,499.88 3. Family Exemption: (tf decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Cry Stater Zio Relationshio of Claimant to Decedent a. Probate Fines 5. Accountant's Fees 6. Tax Retum Proparer'a Fees 7. Other Administrative Costs 283.78 See cor>rttnuation schedule(s) attached TOTAL Also enter on fins 8, Racspitulation) 12,031.7'1' Copyright (c) 2049 form software only Tire Lackner Group, Inc. Form PA-1600 Schedub H (Rev. 10-OI6) SCi-~i~Ut.! N FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUA~3ER Sa~tb John C. 21 ITEM DESCRIPTION AMOUNT NUMBER ~-u~~3-Eartsas 1 Richardson Funeral Home, inc. -Funeral expenses g~7'~•~ 2 Santis, John M. -Reimbursement for opening of grave site, food for ftuneral service and food 1,500.40 for out-of~own relatives staying at dececk~nt's home. H-A 8,248.b0 3 Cumberland County Law Journal -Legal advertisement notice. 7g•p4 4 Sentinel, The -Legal advertisement notice 208.78 H-B7 283.x'8 Copyright (c) 2002 form soltwar+e only The Lackner C3roup, Inc. Form PA-16©E'! Sc~edub H (Rev. 6-98) Rw-1612 EX;112-06f cw.n+oR~-~wsnvAHU- INNIERITANCE TAX RH'~LJRN REiIOIENT 01T ~~~~ DEBTS OF DECEDENT, MORTGAGE LIA~~LITIES, ~ LIENS ESTATE OF FILE NtJER Saallitis John C. Z1 R.~oee d.ba a,e:urnd by th. d~csdsnt prior to d..a, thst r.n..a,.d unpaw act d~a a d..a-, i~au~np unnimbues~dawdlcai . ITEM VALUE AT DATA NUMBER DESCRIPTION OF DEATH 1 Messiah Village -Final bill for Emergency Call Lease and Monitoring 22.6 2 Messiah Village -Payment for emergency phone service and home health aides. 2S2.a0 3 Salitis, Trudy -Home medical care for 4 days at 1100.00 per day. ~•~ TOTAL (Abo enter on Line 10, Recapitulation) ~ 674.616 (K rrwre apace is needed, additlional pages ~ the same size) Copyright (c) 2009 form software only The Lackner Group, inc. Form PA-100 Schedule 1(Rev. 12-018) ~v-~s~s ac+l~~-oel ~~LE J COMA ""'" ~EhiEFIC1~4R1ES ESTATE OF 3atkis. J'~hn C. FILE NUMBER ~~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (VUarcia) (~) I TAXABLE DISTRtBUTIONS ~~duds outright al distributions, andfers under Sec. 9118 a 1.2 Kathleen R, Bowers Daughter one-haN of net 65 l~ortlt Conley n~sidus Ethers, PA 17318 John M. Salltia Son one-hall of nst 88 Fairvwy Drive residue Camp Hiii, PA 17011 Total E for utlona sh n above on lines 1 5th 18 on Rev 50 0 cover stet ~ . II NON~TAX,ASt.E DISTRfiBUT14MS: . A. SPOUSAL DisTRiBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTII~N TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TtaTA ii. ~ iR1~RT M - I~tT'EFi TOTAL. NpN-TAX/~IBLE DISTRIBUTIONS ON lIPtE 13 4F' RE1/ 'I504 CQVER StME~ Copyright (c) 2009 form soRwere only The Lackner Gawp, Inc. Form PA-1!li80 Sc~euiuie J (Rev. 11-0~) Estate of John C. Santis, deceased Estate No. 21-10-0631 Re: PA Inheritance Tax Return List t~€ ~~~ts A. Death Certificate B. Last Wil! & Testament of the Decx~dent dated January 25, 2010 C. Bond valuations D. Certificate of Deposit and Checking account valuations from M&T Bank HBt3DB:114266-1 026113-146647 EXHIBIT A ios.sos xEV coiro~~ LOCAL REGI~T~RAR'S CERTIFICATION OF DEATH WARNING: It is illegal ~o duplicate this copy by photostat or photograph. EXHIBIT B Will for Adult with Children Do aat jest Bill is and sigma this form. To be legally valid, you must use a typewriter or computer to prepare a fresh copy of your will, without any handwriting except in the signature portion. You cannot just fill in the blanks of this form and try to use it as your will. r~ I -~~ s~ _ Will of ~ ~ ~ 1 I, Jb~ ~ ~ ~ ~~ (~7 ~ , a resident of State of ~~~~ ~4~~i`~., ,declare that this is my will. 1. Revocation. I rev all wills that I have previously made. 2. Marital Statas. I am 0 marriedsingle. ~~~~), 3. Children. I have the following natural and legally adopted child(ren): Name Date of Birth J~ I~- ~ ~;. s .. + ~ If I do not leave property to one or more of the children whom I have identified above, my failure to do so is intentional 4. Specific Gifts. I make the following specific gifts: -- - ~ - to or, if heJshe/they do/does not survive. me, to Ileave ~ to or, if he/she/they do/does not survive me, to I leave . to or, if he/sheJthey dodoes not survive me, to [repeat as needed] 5. Reaidaary Estate. I leave my residuary estate, that is, the rest of my not oth y _sad va~d- /~(1dTi~'= ~~~ ~~lC /~'71/Ifitl~alll' 1/1lCI,Y/ t,~/,~ /9 ~i~p ~~,~:1~~Ia~~~1'IG~v~'i~D "~ D ~~ S ~ ~ . I its 4~ ~'~r j ~t~*f' ~ ~AG 0~ p~a~ ~ a~' y ,~,.~,ob,~, il~tl for ui# Childr+erl to or, if he/she/they do/does not suxv3ve me, to (i~~ f ` ~ S ~ l~~Q., I leave ~~~ rQ-.(~,,i r i 1 n~ i~~ r1 ~ 1y disposed of by this will including lapsed or failed gifts to N or, if he/she/they do/does not survive me, to 6. Beneficiary Provisions. The following teams and conditions apply to the beneficiary clauses of this will. A. 45-Day Snrvivorshig Period. As used in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. Any beneficiary, except any a1tE;rnate residuary beneficiary, mwst survive me to take properly under this will. B. Shared Gib. If I leave property to be shared by two or more beneficiaries, it shall be shared equally by them unless this will provides otherwise. If any beneficiary of a shared specific gift left in a single paragraph of the 'Specific Gifts clause, above, does not survive me, the gift shall be given to the surviving beneficiaries in•equal shares. If any beneficiary of a shared residuary gift does not survive me, the residue shall be given to the surviving residue ary beneficiaries in equal shares. C. Encumbrances. All~roperty that I Ieave by this will shall passsubject to any encumbrances or liens on the property. 7. Ezecntor. I name J b~i~ C~.~j~,,,' ~ ~ t ~ as executor, to serve with- out bond. If he/she does not ~, or ceases to serve, I name ~~ as executor, also to serve without bond. U I direct that my executor take all actions legally permissible to probate this will, including filing a petition in the appropriate court for the independent administration of my estate. I grant to my executor the following powers, to be exercised as the executer deems to be in the best interests of my estate: A. To retain property, without liability for loss or depreciation resulting from such retention. B. To sell, lease, or exchange properly. and to receive or Adn,in~~~ the proceeds as a part of my estate. C. To vote stock; convert bonds, notes, stocks, or other securities belonging to my estate into other securities; and . exercise all other rights and privileges of a person owning similar property D. To deal with and settle claims in favor of or against my estate. E. To continue, maintain, operate, or participaxe in any business which is a peat of my estate, and to incorporate, dis- solve, or otherwise change the form of organization of the business. F. To pay all debts and taxes that may be assessed against my estate, as provided under state law G. To do all other acts which in the executor's judgment maybe necessary or appropriate for the proper and adv~nt~- genus management, investment, and distribution of my estate. The powers, authority, and discretion are in addition to the powers, authority, and discretion vested in as executor by operation of law and maybe exercised as often as deemed necessary, without approval by any court in any jurisdiction. 8. Personal Guardian. If at my death any of my children are minors and a personal guat~disn is needed, I nominate to be appointed personal guardian of my minor children. he/she/they cannot serve as personal guardian, I nominate to be appointed. personal guardian. I direct that no bond be required of any personal guardian. 9. Property Guardian. If at my death any of my children are minors and a pn~periy guardian is needed, I appoint as the property guardian of my minor children. he/she~/they cannot serve as property guardian, I appoint prapcrty guardian- I direct that no bond be required of any property~guaraian. 0. Gifts Under the Uniform 1~ranafers to Minors Act. (name of minor) shall be given to All property left by this will to 9~ (name of custodian) as custodian for (name of nninor) under the Uniform 'I~ansfers to Minors Act of (your state). If (name of custodian) cannot serve as custodian, (name of successor custodian) shall serve as custodian.. If (your state) allows testators to choose the age at which the custodianship ends, I choose the oldest age allowed by my state's Uniform Transfers to Minors Act. ( repeat as needed) Signature I subscnbe my name to this will this a.~ day of ,1 A~~AJ~iY ~ 0I4 , ax ~~'xt,~dwn (county), State of Y . I declare that it is my will, that ~ sign it willingly, that I execute it as my free and vol act for the purposes expressed, and that I am of tlhe age of majority or otherwise legally empowered to make a will and under no constraint or undue in$uence. .. ~ ~ ,~• Signatrue ~. Witnesses On this +~~ day of ~ ~ /Q ,the testator, ~IJ ~ • /~ / T ,declared to us, the undersigned, that this instrument was his ^ her will and requested u to act as witnesses to it:. The testator signed this will in our presence, all of us being present at the same time. We now, at the testator's .request, in the testator's presence and in thie presence of each other, subscribe our names as witnesses and each declare that we are of sound mind and of proper age to witness a will. We finther declare that we understand this to be the tostator's will and thax to the best of our knowl- edge the testator is of the age of majority, or is otherwise legally empowered to make a will, and appears to be of sound. mind under no constraint or undue in$uence. We declare under penalty of perjury that the foregoing is true and connect, this oZ~ ~ day of ~/ a. d ~'1 , at ~~ ~/~,~i(/) (county), State of Witness s' ~. '/ Typed or printed name 70 ~//t ~y ~R.. Residmg et city, state, ~ Witness 3 .t S' '~' l,~t Typed or name ~'..~/ 1~/gST' 4 X//~~ Residing at ~~~ t~~~~. P~ l~i~/ Witness signatuiz Typed or printed nay C~-m~ ~~It ,~~ 17411 city, static, zip r"7~ 17~ '~ ~ f~- l y y f Thed«' Noti~y Aril Peirale~ ~arvloss Besty K. Tr~dar', J.D. 561 Wad Drive I~risburg, Pa 17111. 717.696-1T32 city, State, .zip ~ - ~ ~~7- ~~~ - ~~3~ n~~~ ~~jy WIII for A~It wNh Children t~WVi~Ai. AGKNt~-WLED~'~MEHT St~ielCommonwealth of ~S~LI~~~!/I~1 ss. County of , f~~~ ~~~1 t Aeil~? On this the ~1.~ day of ~0/0 ,before pay ~' oath Year me, 1ll~J~y ,~. ~L~ ,the undersigned Notary Name ofi Notary Public Public, personalty appeared ,raNiil L. fE/~~ / Tact , Name(s) of Signer(s) ^ personalty known to me - OR - w'n~R Mor o n+~a g~rr~w- aagMn.r+~ ~ .tl1u~ Place Notary Seal and/or Any Stamp Above roved to me on the basis of satis#actory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they executed the same for the purposes therein stated. WITNESS hah and official seal. Sig otherRequired hfom~liori , elc.) 5511N~t Ham, Prat i?i i 1 7176-1732 OPTIONAL Although the lnfomtation in ibis section is not n~quirr3ai by law, it may prove vr3luable b persons reJyifng on the document and caould prevent fraudulent n~mova/ and reattachment of ibis fern b another documeni DescripRion of Attact~d Document Trtfe or Type of Document: J~I~L ~~ Jf,Ak,~T k/tTk G /~ 11 f~~ Document Date: ~ ~ Number of Pages: Signer(s) Other Than Named Above: ~?AJ~ n- 02002 National Notary Association •9350 De Soto Ave., P.O. Box 2402 • ClTatsworth, CA 91313-2402 • www NalionalNotaryorg Item No. 5936 Reorder. Calf Tott-Free 1-800 US NOTARY (1-800-876-8827 ,~o~ y ~~ ~ EXHIBIT C •Jun-O7-Z010 O1':Z6wi FrarPA DEPT 4F HEALTH SCE +T17TTZ8151 G~ICU1at~q v~~ue or xour raper ~av~ngs ~sona~s~ C~Iculator Resufts fd~ Red~mp~on _D~te ~~/~O~.t~ Total Price Total Vafue Total =nterest 51.450.00 52,262,72. 5$12.72 Bonds: 1-~9 of 29 T-OSO P.OOZ/009 F-51Z 1lTD Ynterest 512.96 6triaf # Is~CU~ N®xt i;in61 Series C-®nom a>~~ Accrtiai Maturity beaus ~ Price ~nt+ereat Irttet'e.~a't Rye itaf~e Note C860191855EE : EE.. . , $.100 ObI?009. 04/210 06/2039 , .. $0.00 $0.16 0.7090 $80.16 NE C855135462E~ EE . 10/7008 042010 10(2038 $-100 $50.00 $0.84 1.40aYo 30.84 PS' C8489375f~$EE EE • ~ $100 02/2008 OA~/2010 02/2038 $50.00 $2.80 3.OO~Yo $2.80 • 1~5 '' G$4Z031924EE • ~ EE $100 06/2007 04/2010 Ofi/2037 $50.00 $4.40. 3.404Ya $54.40 P5 C8356254$eEE EE $100 10/2006 04/2010 10/2036 $50.00 $b,15 3.70°~v $Bd,S.B PS'~. C827519788EE ~ ~EE . $100 OZ/2006 04/2010 02/2036 $50.00 $6.48- 3.20aXo $6-8.48 PS ' c810624972EE • EE .$100 x6/2005 04,2010 ~ 06/2035 . ...... .... . X50.00. • $8.44: 3.SO~b • $l,GS.44 P5 . .................... C802943847EE , . • • .. .. EE . , $1Q0. 10/2004 04/2010 ~ l4/Z034 .. . $50.00: . $14.0!4 = 1..64~3b *BEf.04 C790260838EE EE $100 02/2004 04/2Q10:02/2034 ~ $50.00 $10.96 ~ • 2.1996 $~!.lild C777355892EE EE 04/Z010 : o~J2033 •$100' 06/2003 $50.00 ~ $12.04 • 2.199~a ~l82.04 C762983917EE • EE _ • $100 10/2002 04/2ta10. 10/2032 $50..00 $13.84 1.6496 X132.84 C74853709ZEE EE $100 02%2002 04/2010 , 02/2032 $50.00 ; $15.28 ' 2.19°x6 ~i65.28 G73 ii36633EE EE $100.05/2001 04/2010 ~ 06/2031 $50.00. $17.04 .2.19°x6 ~67.OA. • C71568235ZEE EE $100 10/2000 04/Z010 10/2030 $50.00 $20.44 . 1.64°x6: $y0.44 C701291444EE EE $100. 02/2000 04/201Q ; 02/2034. $50..00. . ;$22.44 • • ~.19!~6• • $72.44 C678238278EE EE; $100 Ofi~i999 04%2010••ofi/2029 $50.00 • $24.32 2.1946 • $7'4.1 Cfi49Z09963EE _ EE.. 04/2010. 10/2028 • • $100.10/1998 • $50.00 X27.44 • 1.5446 , $77.44 C63784~-342EE EE , 02/ 1998 04/2010 02/2028 • • $I00 $50.00 $29.76 ; 2.199/0 $79.76 Cfi1b546954EE EE , . $100.Of~/X997 04/2010 06/2027 $50.00 $32.40: 2.19°ib x.82.40 C604109541EE EE $100 10/1996.04/2010,. 10/ZOZ6 $50.00 $31.52 ~ 1.55°~b $BY.SZ G571693056EE EE ,. $100 02/1996 08/2010 OZ/Z02f • $50.00 $34.00 • 2.06°h~ $84.00 C544346958EE • EE ~ •$100.06/1995.06/2010.06/aQ25 $50.00: $36.28; 2.06~i1o $86.28 G466062Z36fE • EE . $X.00 06/1994 05/2010 06/2024 • • . .. .. . . .. .. .. . $50..00 • . • $43.68 4.OOa9~6 $93.68 ................. C502006654EE . ........ ........ EE ...... . $i1~0 ' 02/ 1995 0612010 02/2025 . ....... ... . . ... $50.00 . . $41.52 4.006 $91.52 . C437493782EE EE $100 3.0/1993 04/2010 10/2023 $50.00 $47.08 1.5701a $97.08 C39361753EE . EE • h •$100 02/1993 08/2010 OZjZ023 • $50.00. $73.92 4.00% $123.92 DC3584fi5298EE' EE • ~ $100.Ofi/1992 06/2010 Obi/Z022 $50.00 $76.A~0 ~ 4.00°k $126.40 C312672039EE' EE $100 10/199! 04/2010' 10/2QZ1 $50.00 $78.92 4.00% $1.213.92 C288141831EE Lir $100 02/1991 08/2010 02/2021 $50.00 $84.12 4.00°1+6 $134.x.2 • Tot~ls'for 29 Bonds 1 4Si3.g0 812.72 as2.72 Motes MI 'Not Issued _ N8 : Nvt eliglble• for payment Ps Yncludes 3 month Interest penalty. MA Nfatvr®d~and not aarnin• interest .-~`'./ 03-23-10 400.00 ~ 14.IR 03-?2-10 2~500.00~ _ ;1,08,0 03-31-10 EXHIBIT D Q M~TSank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Sen+ices Phone 888-502-4349 F ax (302) 934-2955 June 18, 2010 Dawn Heil>sl<an Estate of 3~hn C Salitzs 111 N Front Street Harrisburg, PA 17141 Re: Estate of John C Salitis Social Security: 193-16-8597 Date of Death: March 20, 2010 Dear Sir or Madam: Per your inquiry on June 11, 2010, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. ~ of Account Checking Account Account Number 71433716 Ownership (Names o, fl John C Salitis John M Salitis ~~ Date 04,28/89 _ ..7 Balance on Dote of Death $34,844.72 Accrued Interest $ .1S Total 2. Type of Account Account Number Ownership (Names o, fl 8 Dam Balance on Date of Death Acc»,eed Interest Total s• ly, Susanne M Kimble Adjustment Services $34,844 ~-------_. Certificate of Deposit 31003916495912 John C Salitis John M Salitis 0224~g6 $10,073.77 $ 3.95 $10,077.72