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Home My WebLink About07-14-10 1505610101 REV- ~ 500 Ex (oi-io) i .iJ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY o~^^HrMf~,r~FHF~~~~E Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 28o6oi ~ 1 O ~ ( ~ / Harrisburg, PA 1128-0601 R ESIDENT DECEDENT / ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 190-22-3797 11 /27/2009 03/02/1929 Decedent's Last Name Suffix Decedent's First Name MI DRIVER DONALD E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax I~eturn Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) --- CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KATHY A SCHAEFFER (570) 374-7832 -. First line of address 1873 VERDILLA ROAD Second line of address City or Post Office PORT TREVORTON State ZIP Code PA 17864 Correspondent's a-mail address: ~:~ REGISTER OF Ut~It.~L.~S~1SE ONLY -~-~ r :~C~? i ,..., _ - .- ;` , -; ~. i --- DATE FILED (,,t~ under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI~~,TyJRE OF PERSON RESP SI LE FOR FILING RETURN _ DATE ADDRESS 1873 VERDILLA ROAD, PORT TREVORTON, PA 17864 ~iC'NA RE O~ARER OTHE A REP T~TIV __ DATE ~ ~ ~~ ADD SS 13 2 N SUSQUEHANN TRL STE 210, SELINSGROVE, PA 17870 PLEASE USE ORIGINAL FORM ONLY Side 1 15056101,01 1505610101, J ~:::~ ="i ~~ ,{ ~. ~, ; .. '~ t;;~ .; z REV-1500 DECEDENT'S NAME: DRIVER, DONALD E DECEDENT'S SOCIAL SECURITti' NUMBER 190-22-3797 ADDITIONAL SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN UNDER PENALTIES OF PERJURY, THE UNDERSIGNED DECLARES THAT SHE HAS EXAMINED THIS RETURN, INCLUDING THE ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF HER KNOWLEDGE AND BELIEF, IT IS TRUE, CURRENT AND COMPLETE. SIGNATURE NAME ADDRESS DATE BETH E SHEAFFER 10 NINES DRIVE, EAST BERLIN, PA 17316 ~/~'~/~ T-~ J 1505610105 REV-1500 EX Decedent's Social Se~~urity Number Decedent's Name: DRIVER, DONALD E 190-22-3797 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 180,000.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3 374.88 , 3. Closely 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. 40,664.77 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 179,364.94 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 181,147.26 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 584,551.85 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ....... 9. 36,466.45 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ....... 10. 232.25 11. Total Deductions (total Lines 9 and 10) .......................... ....... 11. 36,698.70 12. Net Value of Estate (Line 8 minus Line 11) ....................... ....... 12. 547,853.15 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................. ....... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................. ....... 14. 547,853.15 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15 16. Amount of Line 14 taxable at lineal rate x .0 45 547,853.15 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 1 g 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056101D5 15056101,05 24,653.39 24,653.39 J REV-1500 EX Page 3 Decedent's Complete Address: DONALD E DRIVER STREET ADDRESS 309 GLENDALE DR CITY SHIREMANSTOVVN Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ____. B. Discount 23,500.00 1.232.67 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number STATE PA (1) Total Credits (A + B } (2) (3) (4) (5) Z:I P 17011 24,653.39 24,732.67 79.28 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 income of the property transferred :.................................................................................... ...... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consitleration? ....................................................................................................... ....... ^ 0 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ....... ....... ^ fl 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use 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)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased chid 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)]. • 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) [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 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+ (01-10} ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: DRIVER, DONALD E FILE NUMBER: 21-09-1133 AH real property owned solely or as a tenant in common must be reported at fair market value, Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. apai nrnnarty that is iointlV-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size, REV-1503 EX+ (6-98) ~, SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DRIVER, DONALD E 21-0~--1133 All orooertv jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DRIVER, DONALD E 21-09-1133 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CASH ON HAND 30.39 2. PNC BANK, N.A. CHECKING ACCOUNT N0.5070079327 (PNC 01/25/10 LETTER IS ATTACHED) 22,681.88 3. 2006 TOYOTA AVALON XL SEDAN 4D (KELLEY BLUE BOOK PRICING IS ATTACHED) 13,245.00 4. COMCAST -REFUND 1.69 5. HIGHMARK -INSURANCE PREMIUMS REFUND 504.75 6. VETERANS ASSOCIATION -MEDICAL EXPENSE REIMBURSEMENT 13.65 7. STATE FARM INSURANCE COMPANY -REIMBURSEMENT AND REFUND 52.53 8, VERIZON -REFUND 10.00 9. U.S. TREASURY -REFUND OF INDIVIDUAL FEDERAL INCOME TAX 550.00 10. BENEFIT REIMBURSEMENT DUE DECEDENT 2.29 11. TYCO ELECTRONICS -PENSION 816.70 12. SCHOOL REAL ESTATE TAX - REIMBURSED AT 0512112010 SETTLEMENT 228.76 13. SEWER RENTAL FEE - REIMBURSED AT 05121/2010 SETTLEMENT 19.82 14. REFUSE FEE -REIMBURSED AT 05/21/2010 SETTLEMENT 24.31 15. MEMBERST 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT N0.352276-00 (BANK LETTER IS ATTACHED) 5.00 16. HOUSEHOLD ITEMS, FURNITURE AND OTHER PERSONAL PROPERTY (SOLD AT YARD SALE, ETC) 2,478.00 TOTAL (Also enter on line 5, Recapitulation) ~ ` 40,664.77 (If more space is needed, insert additional sheets of the same size) REV-i5og EX+ (oi-io) ~ pennsylvania DEPARTMENT OFRFVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DRIVER, DONALD E 21-09-1~t33 SCHEDULE F JOINTLY-OWNED PROPERTY if an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIC)NSHIP TO DECEDENT A• KATHY A SCHAEFFER 1873 VERDILLA ROAD PORT TREVORTON, PA 17864 DAUGHTER B' BETH E SHEAFFER C. JOINTLY OWNED PROPERTY: 10 HINES DRIVE EAST BERLIN, PA 17316 DAUGHTER ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 03/20/09 MEMBERS 1ST FEDERAL CREDIT UNION, CERTIFICATE OF B. DEPOSIT ACCOUNT N0.352276-40 (BANK LETTER, ETC. ARE ATTACHED) 50,677.58 101) 50,677.58 2. A. 03/17/09 PSECU, CERTIFICATE OF DEPOSIT ACCOUNT N0. B. 8810528730-C50 (ACCOUNT BALANCE NOTICE ATTACHED) 101,419.88 100 '101,419.88 3. A. 03/20/09 VANGUARD ENERGY FUND INVESTOR FUND ACCOUNT N0. B. 88026674131 (REPORT VALUE STATEMENT IS ATTACHED) 27,267.48 100 27,267.48 TOTAL (Also enter on Line 6, Recapitulation) I $ 179,364.94 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (U8-09) ~ pennsylvania SCH E QU LE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT -- ESTATE OF FILE NUMBER DRIVER, DONALD E 21-09-1133 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY of THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPl.1CABLE) TAXABLE VALUE i• PSECU INDIVIDUAL RETIREMENT ACCOUNT N0. 88105287301RA51 - KATHY A SCHAEFFER AND BETH E SHEAFFER, DAUGHTERS, BENEFICIARIES (SEE ATTACHED BALANCE NOTICE) 50,892.62 100 50,892.62 VANGUARD BROKERAGE SERVICES INDIVIDUAL RETIREMENT 2 ACCOUNT 43929386 - KATHY A SCHAEFFER AND BETH E SHEAFFER, DAUGHTERS, BENEFICIARIES (SEE ATTACHED VALUATION 84,618.79 100 84,618.79 STATEMENT) VANGUARD MUTUAL FUND INDIVIDUAL RETIREMENT ACCOUNT 3 09917594053 - KATHY A SCHAEFFER AND BETH E SHEAFFER, DAUGHTERS, BENEFICIARIES (SEE ATTACHED VALUATION REPORT) 45,635.85 100 45,635.85 TOTAL (Also enter on Line 7, Recapitulation) $ I 181,147.26 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE SCHEDULE H FUNERAL EXPENSES AND 4DMINISTRATIVE COSTS ESTATE OF DRIVER, DONALD E FILE NUMBER 21-09-1133 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: ~. FUNERAL MEALS 2. POSTAGE, FUNERAL BOARDS AND PICTURES 3. ORCHARD HILLS CEMETERY CO - ENGRAVING AND SETTING GRAVE MARKER B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Citv Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. 8. 9. 10. 11. 12. City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: lax Return Preparer Fees: BETH E SHEAFFER - EXECUTRIX MILEAGE, REIMB FOR SUPPLIES & GAS KATHY A SCHAEFFER - EXECUTRIX MILEAGE, REIMB FOR SUPPLIES LABOR - PREPARING HOUSE FOR SALE (BREAKDOWN IS ATTACHED) REAL ESTATE MAINTENANCE EXPENSES UNTIL SOLD (BREAKDOWN IS ATTACHED) REAL ESTATE SETTLEMENT EXPENSES (BREAKDOWN IS ATTACHED) MISCELLANEOUS EXPENSES (BREAKDOWN IS ATTACHED) 400.00 368.00 1,123.40 1,833.67 5,768.94 2,331.98 21,636.92 2,017.61 TOTAL (Also enter on Line 9, Recapitulation) I $ 3 6 , 4 6 6 .4 5 State ZIP AMOUNT 488.84 27.29 469.80 9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS SUPPLEMENTAL INFORMATION ESTATE OF FILE NUMBER DRIVER, DONALD E 21-09-1133 ITEM NO. 9 -LABOR -PREPARING HOUSE FOR SALE REMOVAL OF PERSONAL PROPERTY, REPAIRS, PAINTING, REFUSE REMOVAL, ETC.: BRANDON YODER 150.00 CATHY MALONE 595.00 DERRICK YODER 643.00 ELAINE DEWIRE 75.00 JACK SHEAFFER 295.00 MIKE DEWIRE 3,631.94 THERESA HAMILTON 90.00 DAN THE JUNK MAN 200.00 MISCELLANEOUS 89.00 TOTAL 5,768.94 ITEM NO. 10 -REAL ESTATE MAINTENANCE EXPENSES UNTIL SOLD SNOW REMOVAL, LAWN MOWING, UTILITIES: LARRY ZURICH 70.00 LOWER ALLEN SEWER AUTHORITY 215.90 PENNSYLVANIA AMERICAN WATER COMPANY 118.63 PENNSYLVANIA WATER SPECIALISTS 13.06 PPL UTILITIES CORPORATION 1,717.85 VERIZON 196.54 TOTAL 2,331.98 ITEM NO. 11 -REAL ESTATE SETTLEMENT EXPENSES REAL ESTATE BROKER SALE COMMISSION 10,152.00 ADDITIONAL BROKERAGE FEE 195.00 TRANSFER TAXES 1,800.00 TAX CERTIFICATION/PROCESSING FEE 20.00 NOTARY FEE 10.00 SELLER PAID CLOSING COSTS 9,459.92 21,636.92 ITEM NO. 12 -MISCELLANEOUS EXPENSES PATRIOT NEWS -ESTATE NOTICE 304.41 TILLERY INSPECTIONS -RADON INSPECTION 800.00 TRI-COUNTY TAG SERVICE -AUTO TRANSFER FEES 64.50 TYCO ELECTRONICS -RETURN OF PENSION 816.70 PNC BANK, N.A. -BANK FEE 2.00 CUMBERLAND COUNTY REGISTER OF WILLS -FILING FEES 30.00 2,017.61 REV•1512 EX+ (12.-~u) r pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DRIVER, DONALD E 21-09-1133 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses, If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER TIRTVFR _ T)[~NAT~T) F. 21-09-1133 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 2116 (a) (1.2).] 1. KATHY A SCHAEFFER DAUGHTER 50$ OF SCH F, 1. 1873 VERDILLA ROAD ITEMS 1, 2, 3; PORT TREVORTON, PA 17864 50$ OF SCH G, ITEMS 1, 2, 3; 1/2 OF RESIDUE 2. BETH E SHEAFFER DAUGHTER 50$ OF SCH F, 10 NINES DRIVE ITEMS 1, 2, 3; EAST BERLIN, PA 17316 50~ OF SCH G, ITEMS 1, 2, 3; 1/2 OF RESIDUE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. (~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN A. NONE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS B NONE TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ If more space is needed, insert additional sheets of the same size. 9W46A1 1.000 LAST WILL AND TESTAMENT OF DONALD E. DRIVER .ywt. ~a ~; ^~ ~~ - ~~~ ~' .: trrJ +~ . -- .~ '~~~~ rg~ :~':. I, DONALD E. DRIVER, of Shiremanstown Borough, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any and all wills and codicils heretofore -' made by me. ITEM I: My personal representative shall pay from the residuje of my estate the expenses of my last illness, funeral and burial debts duly allowed against my estate, and all death ~ taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death and incurred with `" respect to all property taxed to my estate regardless of whether such property passes by this Wiil or passes outside of this Will. ITEM II: I bequeath my automobiles, personal effects, household goods, and other tangible personal property of like nature (not including cash or securities), tiogetrier with any existing insurance thereon, if any, as set forth in a separate memorandum which I shall place with my Will to the persons therein designated. If I shall leave no separate memorandum, ~or with regard to my automobiles, personal effects, household goods, and other tangible personal property of like nature (not including cash or securities) not referenced by such memorandum, I bequeath such property to my daughters, BETH E. SHEAFFER and KATHY A. SCHAEFFER, tc- be divided among them by my Executrices with due regard for their personal preferences in as nearly equal shares as practical. ITEM III: I devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to my daughters, BETH E. SHEAFFER aid I~:ATHY A. SCHAEFFER. I do not include my beloved daughter BRENDA K. DRIVER in this distribution O 'oecause of her circurtrstances as a long-ume patient in state hospitals in Pennsylvania. Ft .is my desire that my daughters, Beth and Kathy, shall be attentive to the needs of my daughter, Brenda, and they ~ shall be generous in her support with the funds that I have provided for them here: ITEM IV: I appoint my daughters, BETH E. SHEAFFER and Ii:ATHY A. SCHAEFFER, Executrices of this my Last Will and Testament. Should either daughter fail to qualify or cease to act as Executrix, I appoint the other as Executrix of my estate. ITEM V: I direct that my Executrix and her successors shall not be required to give bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I, DONALD E. DRIVER, have hereunto set kny hand and seal to this my Last Will and Testament, consisting of four (4) printed pages, each of which bears my signature, this 18th day of October, 2007. DONALD E. DRIVER, Testator Signed, sealed, published and declared by the above-named Testator,. DC)NALD E. DRIVER, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subsc^ribeii our names as witnesses. COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) WE, DONALD E. DRIVER, TAYLOR P. ANDREWS, and RONALD E. ,]JOHNSON, the Testator and witnesses, respectively, whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as and for his Last Will and Testament anal that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the mill ~~s witnesses and that to the best of their knowledge the Testator was at the time eighteen (1$) or more years of age, of sound mind and under no constraint or undue influence. ~ a DONALD for T .Andrews, Witness onald E. Johnso i ess Subscribed, sworn to and acknowledged before me by DONALD E. DR.IV,ER, tl~e Testator, and subscribed to and sworn or affirmed to before me by TAYLOR P. ANDREWS end RONALD E. JOHNSON, witnesses, this 18`~ day of October, 2007. #'H OF PENNSYLVANfA TARIAL SEAL. _(SEAL) SHELLY SEXTON, Notary Pubac Notary Public Carlisle Bono, Cumberland County Commission Expires 'l 26, 2011 1. a FHA 2. ~ RHS 3. ~ Conv. Unins, 4, ~ VA 5. ~ Conv, Ins. 6. Flle Number: 401000441-SK 7, Loan Number: 111683663 8. Mortgage Insurance Case Number: 446-0142039-703 . NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the se:ttfement agent are shown, Items marked "(p.o.c,)" were paid outside the closing; they are shown here for Informational purposes z~nd are not included in the totals. b. Name and Address of Borrower SCOTT K, PARENT AND AMY M. PARENT 1153 BROCKTON CIRCLE NEW CUMBERLAND, PA 17070 E. Name and Address of Seller KATHY A. SCHAEi=FER, CO-EXECUTRIX AND BETH E. SHEAFFER, CO-EXECUTRIX OF ESTATE OF DONALD E, DRIVER ~ 309 GLENDALE DRIVE SHIREMANSTOWN, PA 17011 F. Name and Address of Lender NORTH AMERICAN SAVINGS BANK, FSB 12520 SOUTH 71 HIGHWAY, GRANDVIEW, MO 64030-1734 G. Property location • 309 GLENDALE DRIVE, SHIREMANSTOWN, PA 17011 H. Settlement Agent SECURED LAND TRANSFERS -MECHANICSE~URG Phone : (717} 901-8342 COUNTY: CUMBERLAND PARCEL ID: 48-24-0795-018 TOWNSHIP: LOWER ALLEN TOWNSHIP Place of Settlement Y. Settlement Date 05/Z1/2010 485 ST. JOHNS CHURCH ROAD„ SHIREMANSTOWN, PA 17011 Disbursement Date 05/21/2010 J. Summar of Borrower's Transaction K. Summa of Seller`s Transaction 100. Gross Amount pue from Borrower 400. Gross Amount Due to Seller 101. Contract Sales Price 180 000.00 401, Contract Sales Price 180 000 00' 102. Personal Pro ert 402. Personal Pro e , . 103. Settlement char es to borrower line 1400 11 706.84 443. 104. 404. • 105. 405. Ad'ustment for items aid b seller in advance Ad'ustment for items aid b seller in advance 106. Ci own Taxes 406. ~ Ci /Town Taxes ~ d GcJl~t/G ~ ~~f? iD FT 9 ~! ~'1 ao 107. Count Taxes 773.83/ r 5 21/2010 to 1/1/2011 $477,02 - 407. Count Taxes 773.83/ r 5/21/2010 to 1 1 2011 U 477 02 108. Assessments 408. Assessments , 109. School Taxes 2 036.52/ r 5/21/2010 to 7 1/2010 228.76 409. School Taxes 2 036.52/ r 5 Z1/201() to 7/1/2010 228 76 110. Sewer 44.00/ tr for 5/21/2010 to 7/1/2010 19.82 410. Sewer 44,00/ tr for 5/21 2010 to 7/1/2010 . ; 19 82 111. Refuse 53.95/ tr for 5/Z1/2010 to 7 1/2010 24.31 411. Refuse 53.95/ tr for 5/Z1/2010 to 7/1/2010 . ; 24 31 112. 412, . ; 120. Gross Amount Due from Borrower $192 456.75 420. Gross Amount Due to Seller 180 749.91 200. Amounts Paid by or in Behalf of Borrower , 500. Reductions In Amount Due to Seller 201. De osit or earnest mane $6 300.00 501. Excess De oosts Z02 Principal Laan Amount from North American $176 739 00 502. Settlement Char es to Seiler 24 32.7.00 Savin s Bank, FSB , , 503. Existin loans taken sub'ect to 203. Existin loans taken sub'ect to 504, 204, Appraisal/Credit Deposit from North American $493.50 505. Savin s Bank, FSB 506 205. . 507 206, . 508 207. ' . 509 _ 208' . Ad'ustments for items un aid b ll • 209• se er 510 Ci /Town Taxes Ad'ustments for items un aid b seller . 511 Count Taxes 210, CI /Town Taxes . 512 Assessments 211. Coun Taxes . 513 Seller Paid Closin Costs 9 212. Assessments . 514. • 459:92 213. Seller Paid Closin Costs: $9 459,92 515 214. . 516 215. . 517 216, . 518 217. . 519 218. . 520 Total Reduction Amount Due Seller 33 786 219. . .92 220. Total Paid b /far Borrower 192,992.42 300. Cash at Settlement from/to Borrower 600. Cash at Settlement to/from Se[le:r 301. Gross amount due from borrower line 120 192 456.75 601. Gross amount due to seller line 420Z 180 749 91 302. Less amounts aid b /for borrower line 220 192 992.42 ________ 602, Less reductions in amount due seller line 520 . $33 786 92 303. Cash From X To Borrower $535.67 603. Cash X To From Seller . $146,962.99 l` ~ ~~ f~ ..-- __.._ ._r _. ....J ~_.--.. .~. .. ..- ~...........,.. .., ., ,, v,,.,w s,v,. ,r v..u„,a~avu ua vv I, J11{u av~ Flvl IGJFJ VIiJG IVI VVIICI.UIIa, ICVICWI{ILJ, GIIU IC~UILli 1C~, LII@ OaLa. 17115 $9BnCy may r10T collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confid~sntiality is assured; this disclosure is mandatary. This is designed to provide the parties to a RESPA covered transaction with information during--the settlement process. ?_~_' ~ I ~ l= ~ , ~~ N /-~ ~ ~ .~ ~ ~ 9d --~ ~ -.~ ~~''`~ `f/1 ~ Initials ~- ~~- F_ /~%« ~ :~. /- U ~ - 3 ~ ~~ Cj f~lr J u 1.I~. ~ ..~i ,E~~t /110. ~~~ ~ __ r~ 11?ri 704. Additional Brokerage Fee to ERA.-NRT, LLC _ ~~ $195.00 --, 300. Itens Payable in Connection with Loan 301. Our on ination cF~ar e $995.00 from GFE # 1 ~ ~~~ 302. Your credit or char e oints for the s ecific interest rate chosen from GFE #2 ____ _ 303. Your ad usted on ination char es from GFE A 995.00 304. A raisa{ Fee to Strret Lini<s from GFE #3 475.00 305. Credit• report to Universal Credit from GFE #3 18.50 306. Tax Service from GFE #3 307. Flood Cert. Fee to First American Flood Data Services (from GFE #3 $16.00 308. i!OU, Items Required by Lender to Be iPaid' in Advance . X01. Daily interest charges from 5/Z1/2010 to 6/1/2010 @ 24.2108/day North (from 'GFE # IO} American Savin s Bank FSB $265.32 302. Mort a e Insurance Premium 1=HA Life of Ln from GFE #3 >3 039.75 a03. Homeowner's Insurance Erfe ins from GFE #11 $510.00 304, OOO.Reserves Deposited with Lender OO1.Initial de osit for our escrow account from GFE #9 ~ '2,036.52 002,~F1azard Ins. Reserve 3 Month(s) @ 42.50 per Month(s) North American $127.50 Savin s Bank, FSB 003 Mortgage Ins. Reserve 0 Month(s) @ 79.08 per Month(s) North American Savin s Bank FSB City Property Taxes 4 Month(s) @ b4.49 per Month(s) North American $ 004. Savin s Bank FSB 257.96 DOS. School Taxes 12 Month(s) @ 169.71 per Month(s) North American Savings $2,036.52 Sank, FSB 006. A re ate Accountln Ad'ustment to North American Savin s Bank FSB - 385.46 007. 100.TItie Charges 101. Title services and lender's tiffs insurance to Secured Land Transfers - (from GFE #4) Mechanicsbur $520.00 102. Settlement or ciosln fee to Secured Land Transfers -Mechanicsbur 225.00 103.Owner's title insurance to Secured Land Transfers -Mechanicsbur from GFE #5 $:1,258.75 104. Lender`s title insurance to Secured Land Transfers -Mechanicsbur 200.00 105. Lender`s title oil limit 176 739.00 106.Owner's title olic omit $180 000.00 107 Agent's portion of the total title insurance premium to Secured Land $1,317.87 Transfers -Mechanicsbur 108. Underwriter's ortion of the total title insurance remium to TRGC 140.88 109. Nota fee to Shirle Ke s Nota Public 20.00 110. Insured Closin Protection Letter tv TRGC 75.40 200.Government Recording and Transfer Charges 201. Government recordin char es from GFE #7 $142.00 202. Deed 62.00 Mort a e 80,00 Releases $ i'~ 203. Transfer taxes from GFE #8 1 800.00 L 800.00 204. Cit Count tax/stain s Deed $1800.00 Mort a e 205. State tax/stains Deed $1800,00 Mork a e $ 206. 300.Additional Settlement Charges 301. Re wired services that ou can sho for from GFE #6 302. Pest ins ectivn from Ins ect-A-Home POC Bu er 45.0000 303. Home Warrant to American Home Shield X6629,00 304. Home Ins ection to Ins ect-A-Home POC Bu er 270.00 305. Radon Test to Ins ect-A-Home POC Bu er $100.00 306. Tax Ce Processin Fee to Secured Land Transfers -Mechanicsbur 20.00 307. Nola Fee to Shirle Ke s Notar Pubiic 10.00 308. Escrow for Inheritance Tax to Secured Land Transfers -Mechanicsbur 12 150.00 309. Chimne POC Bu er $104.94 400.Tata1 Settlement Charges (enter an lines 103, Section 3 and 502, Section K) $11,;706.84 $24,327,00 you have any questions about the settlement charges and loan terms listed on this farm, please contact your lender. Settlement agent is not responsible for content of +nder's assessments on MUD. he seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorations ar~d reserves are based on gures for the preceding year or supplied by others or estimated for the current year, and in the event of any change for the current year, all necessary adjustments will be jade between borrower and seller directly. Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller. have carefully reviewed the HUD-1 Settiement Statement and to the best of my knowledge and belSef, it is true and accurate statement of ail .~ecefpts and disburs~.ments lade an my account or by me in this transaction. I further certify that I have received a copy of the HUD-'l Settlement Statement. ~UYERS cott K. Paren .my M. Parent SELLERS Estate of Donald E. Driver By: Kathy A. Sc effer, Executrix I~ FZv• Rrath F o~fFnr r`.n_Gvcn+ Vanguard December 29, 2009 KATHY SCHAEFFER 1873 VERDILLA RD PORT TREVORTON PA 17864 RE: Account Valuation Dear Ms. Schaeffer: P.O. Box 1170 Valley Forge, PA 19482-1170 www.vanguard.com Enclosed is the date of death valuation report you requested for Donald E:. Driver's brokerage accounts. You will receive a separate letter with inforrr~ation for any Vanguard fund accounts. If you have any questions, please call Vanguard Brokerage Services® at 800- 992-8327. You can reach us on business days from 8 a.m. to 10 p.m. or on Saturdays from 9 a.m. to 4 p.m., Eastern time. Sincerely, Vanguard Brokerage Services Retail Investor Group AXZ Enclosure(s): Account Valuation Report 10329302 Vanguard Brokerage Services is a division of Vanguard Marketing Corporation, Member FINRA. Vanguard Brokerage Serv~ces® A Division of Vanguard Marketing Corporation Donald E Driver 309 Glendale Dr Shiremanstown, _PA.1.7.01.1-65.14.._ .~.. Individual Brokerage Account 71629517~-~~~~~ Below is your date of death account valuation for the above referenced account `Please note that the value of your Vanguard®mutual fund accounts will be provided separately Holdings Summary Values on: 11/27/2009 Stocks Total $3,374.88 FundAccess Total ~ $C.00 Bonds Total $0.00 Total Account Value: 3,374.88 Holdings Stocks Symbol Quantity Price per Share Current Value Valero Energy Corp VLO 211.3260 $15.9700 .$3,374.8762 Total stocks $3,374.88 FundAccess Symbol Quantity Price per Share Current Value No FundAccess® securities held in the account. Total FundAccess $0.00 Fixed Income Cusip Quantity Price per Share Principal Amount Accrued Interest No fixed income securities held in the account. Total Fixed Income $0.00 Disclosure: The fair market value of the individual equity securities is calculated using the average between the highest and lowest quoted price of the securities on the valuation gate, ff the valuation date falls on a weekend or holiday, a weighted average of the highest and lowest prices on the nearest business days before and after the valuation date is used. Mutual Fund Securities are valued using the closing price of the funds on the valuation date. If the valuation date falls on a weekend a weighted average of the closing prices on the nearest business days before and after the valuation date is used. Fixed Income Security (Bonds) valuations vary by type. Please consult the VBS® Bond Desk for specific inquiries. 1 ~"r~r Via, _1~.~ ~ ~ ~~ ~ ~ ~ ~-v~- %~ ~..3 ~i~a - ~~- ~'797~ ~'~~~~~~ ~ , T~~ Page 1 of 1 i „~ ,,,~,i ,;;~~~,~~ ~, ~.~~ ~Il I`~~ rl~~ d. n . ~ ~ . ~ ~ ., ~_ ~ ~ f`. ,, ,~ ~-~ I ~ ,~ P~~ ~an~~s TxEwa~r January 25, 2010 Schaffer, Eichner & Wagner Attorneys at Law Mike Schaffer 1873 Verdilla Rd Port Trevorton, PA 17564 RE: Natne: Donald E Driver S SN: 190-22-3 797 DOD: 11-27-2009 Dear lvlr. Schaeffer: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5070079327 Established: 01-011979 DONALD E DRI"~ER DOD balance: $22.681.67 + 0.21 accrued interest Interest paid 01-01-2009 thru 11-27-2009 $3.13 YTD Please note that this o-mice provides date of death balances for deposit accounts (IRAs, CDs, Checking az-d Savings). We do not process any financial txansaction~ or prnvide statemeats. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC ~atalc branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC ~i~~~iLR, ~oN/~,~.~ ~ C~~a-~-3~97~ Page l of 1 2006 Toyota Avalon -Private Party Pricing Report -Kelley Blue Book KeiieY Blue Bank ~ I sEARC:H rlt>E7RUSrEn ii.E3ULIItCF Home New Cars lfsed Cars Research & Explore News & Reviews Dealers 8e Inventory Classifieds Loans & Insurance KBB® Green Used Car Values I Search Used Car Listings I Certified Pre-Owned I Compare Vehicles I PerteQ Car Flnder I Most Researched Vehicles I CARFAX Vehicle History Welcome Bsek I Sign In I Create Account ~ My KBB ZIP Code: 17011 2009 BUCK LACROSSE -I_ - _ ~~~ - gUIC~C~ Latest Car News ~~ Every 2008 8ulck comes with a 700,000-Mile/5-Year Pawennin ~.: ; Limited Warranty. locale a Dealer B Save Vehicle Print-, Email ;:. Bo01Q-1RRK 1' ;t1 p _ Homc > ~gd Cars > 2006 Tovo ta > Avalon > XL Sedan 4D 2006 Toyota Avalon XL Sedan 4D Trade-In Value _ _. _ _.. _ .. _ Private Party value BLUE 1300K~ PRIVATE PARTY VAIUE'r~''` Suggested Retail Value _ _. ®Estimated Payments t '" Iry„''~'' ~ ~*" •,~ { S 252 Imo ~ 4.99% APR CPO Value i~ $~ ~~~. ~.„ Condition .u~a.-..~~.:. Value Photo Gallery Compare Vehicles N~,l Excellent $13,245,, i Get aPre-Owned Loan from 61ue book Review - - Good $12,445 a.79~A APR Consumer Ratings Fair $11,345 Get Your Credit Score Now Find Your Next Car More Photos Get a Free Insurance Quote Specifications ` C SEARCH LOCAL LISTINGS N C ~~ S t L~ f C J I - advertisement ~a Shopping Tools f Free CARFAX Record Check Free CARFAX ReCOrd Check Pownred by ~~ ' Auto Loan from 4.24?u APR ---------- ----~- Get Your Credit Score Now VIN: Get a Frce Insw•ance Quote No VIN? No Problem) Payment Calculator ~ ~ - Extended Warren tY Quote Print For Sale Sign Average Consumer Rating (250 Reviews) Read Reviews BUY A USED tAR ~, {„>!`r~~ a.7 out of 5 Review this Vehicle CM Biue Book Cfassifledc"" Similar New Vehic{es ' Toyota ~ 2010 Toyota Avalon 2610 Ford Taurus Avalon ~ ...__.. .. 50 Miles r ' ; Photos Photos pricinn Review ~ Pricing ka~T _ Near ZIP 17011 ..,._, . To View Ads, Click More Results FIND THE RIGHT UR Vehicle Highlights Compare Used vs. New . ._..__ _ ... -- -- ,.... _ ._ Mileage: 55,000 f1D,DDD t°;55,000 ~ Engine: V6 3.5 titer '. Transmission: Automatic Both New and Used ~ _ __.. _ _ Drivetrain: FWD Sedan ' To View List, Click ~ Selected Equipment Change Equipment VIEW ANOTHER YFHIQE standard Selert Year... ~ Air Candltloning Cruise Control Front Side Air Bags Power Steering AM/FM Stereo A85 (4-Wheel) Select Make.. r Power Windows Cassette Power Seat "- - - " `- -' Power Door Locks Single Compact Disc Alloy Wheels SeleU: l•5odel.., ~ ~ Tilt Whed Dual Front Air Bags Or Search by Category Or Change ZIP Code _. _ , . ,. Blue Book Private Party Value Kelley Blue Book Private Party Value is the amount a buyer can expect to ~-~ ~vr r~~ ~~~v ~ ~~~~- ~- ~ ~ ~ ~ ~~~~ ~ rim r_ /l/~ ~ ~ i - ~ ~ - r/~3 T~~ ~ Page 1 of 2 http : //www. kbb. com/KBB/UsedCars/PricingReport/2006_Toyota_Avalon_ 15 77_Private ... 12/ 10!2009 U1/11/1UlU '1'LI.EJ 1.5:;11_ .h'~ 717795517tt h'i~Mi3KK5 15'1' t~C;U 1N5UKA~~C MEMBERS 1st FF~ERAL CRIDIT U~710N SAVINGS ACCOUNT: Account Number/Suffix 352276-00 ~ ; /~ , ~~ / r ~ Date Account Established 03/20/2009 ~/ ~ ~ / ~ !'7 /~-- Principal Balance at Date of Death $5.00 _.-- ~ ~~ ~~ Accxued Interest to Date of Death $.DO / . Total Principal and Accrued Interest 55.00 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account NumberiSuffoc 3522760 ~r / , C ~u ~ ~ Date Account Estab{fished 03/20/2009 i ~-~- ~7 ~" ~ PrincipaE Balance at Date of Death $50,560.53 ._ Accrued Interest to Date of Death $117.05 ~. Total Principal and Accrued Interest $50,677.58 Name of Joint Owner None ~ ~ ~ ~ ~ ~~~ ~ 1~~ ~~ ~ ~v~~T~ ~ ~.~ iv-~ ~~ ~FC~ ~~T C~R.~~Fle,4 ~ ~ ~~~-~ c.~ r7~~ E ERS 1 ~ FE ERAL DIT U .` Danielle A. Kiine Lending insurance Support Specia{ist January 12, 2010 Estate of: Donald E. Driver Dats of Death: 41/27!2009 Social Security Number. 190-22-3797 l¢~ U 01 5000 Louise Drive P.U. Box 40 Mechanicsburg, Perins~-lvan.ia 17055 (800} 283-2328 ww~Trnernberslst.org 1.~/ ~ t P v-"` S~ Send Inquires to: Main Switchboard: (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800). 283-2328 ext. 5312 ® TeleBranch: (800) 237-7288 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org MEMBERS 1St i FEDERAL CREDIT UNION 2108 1 AV 0.335 2108-2108 =-: I~~~III~~~III~~~~~~II~~~II~II~~~I~I~~~~II~I~~III~~~I~I,~~I~I~I ~~' DONALD E DRIVER ~~ 309 GLENDALE DR '~- SHIREMANSTOWN PA 17011 V ~~~ ~, _ ~~ Statement o~f Accounts Jun 25, 2009 thru Sep 24, 2009 Account Number: 352276 Balances at a Glance Checking : 0.00 Savings : 5.00 Certificates: 50,287.02 Loans: 0.00 Money Management : 0.00 Swipe 5 YTD Reward : 0.00 Page : 1 of 1 Your aggregate balance as of September 1st is $50,292.02. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. We are celebrating International Credit Union Day on October 15, 2009. Please see the enclosed insert for more details. SAVINGS ACCOUNTS 00 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Jun 25 Ba/ance Forward 5.00 Sep 24 Ending Ba/ance 5.00 CERTIFICATE ACCOUNTS 40 - 60 MONTH CERT Maturity Date -Mar 19, 2014 Date Transaction Description Additions Subtractions Balance Jun 25 Ba/ance Forward 5b , 325.65 .Joint Owner: BETH E SHEAFFER Joint Owner: KATHY A SCHAEFFER Jun 30 Deposit Dividend 3.250% 134.43 50,460.08 Annual Percentage Yie/d Eained 3.300"/0 from AS'/0>/2009 through AS/30/2009 Jul 13 Withdrawal by Check 4fi0.00- 56,010108 Jul 31 Deposit Dividend 3.250% 138.52 50,148.60 Annua/ Percentage Yie/d Famed 3.300' from 07/01/2009 through 07/31/2009 Aug 31 Deposit Dividend 3.250% 138.42 50,287.02 Annua/ Percentage Yield Famed 3.300'% from 08/01/2009 through 08/31/2009 Sep 24 Ending Balance 50 , 287.02 YTD SI~MMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 0.00 40 60 MONTH CERT 737.02 Total Year To Date Dividends Paid 737.02 NOTE : Total includes closed shares .~~'~ i~~ i~~.~ ~ ~ , ~'~/~ / ~ !~ ~ ~' ~ 7! ~~ Gtr ~a ~_.~- .~ ~ ~~-~ St MEMBERS 1st FEDERAL CREDIT UNION 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members 1 s` Certificate in the amount and term listed below. Maturity Date: 03 / 19 / 2 014 Please Print: Account #: 0000352276 Member Name: DONALD E DRIVER SSN: 190-22-3'797 Street: 309 Glendale Dr Extra Address: City: Shiremanstown State: PA Zip Code: 17011 JOINT OWNERS Last: SHEAFFER First: BETH MI: E Suffix: 1 Street: 10 NINES DR City: EAST BERLIN State: PA Zip Code: 17316 Extra Address: Date Of Birth: 03/16/1962 SSN: 205-52-9016 .Last: SCHAEFFER First: KATHY MI: A Suffix: 2 Street: 1873 VERDILLA RD City: PORT TREVORTON State: PA Zip Code: Extra Address: ~ Date Of Birth: 06/03/1956 SSN: 175-48-5291 Last: First: MI: Suffix: 3 Street: City: State: Zip Code: Extra Address: Date Of Birth: --/--/---- SS:f~: - - Last: First: MI: Sui:fix; 4 Street: City: State: Zip Cade: Extra Address: Date Of Birth: --/--/---- SSN: - - [~ Deposit Amount: $ 50 , 000.00 ^ Transfer Amount $ CERTIFICATE 1~F,TAIT.4 From Account: Share ID: Certificate Type Minimum Amount Original Deposit Amount Annual Percenta e Yield Dividend Rate Share ID 60 MONTH CERT $500 , 00 $50 ~ 000 , 00 3.30()$ ~; .250$ 40 Dividends Payment Method: By: To Share To: Account Number: Member's Signature: Share ID: ~~~, ~~ Date: 03/20/2009 This is to certify that the above named person(s) is (are) the owner(s) of a Certificate account at Members 15` Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth-in- Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. ~~ C? l~~~C,( l`.f- F -zip rY1 / ~ ~ U r' ~l i ~ C~,~ .=Z-~J ~Q PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Box zao6ol TAXPAYER RESPONSE HARRISBURG PA 1712E-0601 REV-1543 EX AFP (OB-OB) EST. OF DONALD E DRIVER SSN 190-22-3797 DATE OF DEATH 11-27-2009 COUNTY CUMBERLAND, REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 KATHY A SCHAEFFER 1873 VERDILLA RD PORT TREVORTON PA 17864-9680 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. PS E CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Connmonwealth of Pennsylvania. Please call :717: 787-8327 with questians. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8810528730-C50 Date 03-17-2009 .-Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Established $ 101,419.88 X 50.000 $ 50,709.94 X .045 $ 2,281.95 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent nine months after the date of death. PART CHECK ONE BLOCK ONLY TAXPAYER RESPONSE A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax Raid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicatin a d f ere t 9 i f n x rate , P 1 e a s e s tat e ~«;~~ ~"~~ °~r'~ ~%~`'~' ''°=a'• '`~ ~ ;°' ~_ '.~` ' •`;~~" ~:~`y`r% to ~~`'~ relationship to decedent. x;>~. '.t" ~ :•~ ,~~ ;~~ •~ .~ . ; ' J ~i ~,;:~. TAX RETURN - COMPUTATION OF TAX ::f'. .~S'» .Str ON JOINT/TRUST ACCOUNTS ~~~~'" ~~ ~ { !' . ~ qk: LINE 1. Date Established 1 ~. ~~~~~ ~s f:.l v~` $ .. ~ '~ ~ ' 2. Account Balance 2 i ~ •: ;~r.,~ v, ~;., '~.:<s: Y 3. 4. Percent Taxable 3 Amount Subject to Tax 4 X $ :;: . ~~~:J~E,~,y~~,•:, •~~ '.'~+].:'t..'} i. ,' ow~Pt ~~r'~ >: •.. 2,'. ~ '{y .ice .F`:~ 5. Debts and Deductions 5 - ~~ ~... 6. Amount Taxable 6 $ µ.v ~~ `~' 7. Tax Rate 7 X ~' .~~~;%~kY .d _ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H O M E C WORK C ) TAXPAYER RT(~NATIIRF TFI FPN(lNF NIIMRFR T1ATF FILE N0. 21 ACN 09180009 DATE 12-21-2009 TOTAL CEnter on Line 5 of Tax Computation) $ Vanguazd~ December 28, 2009 KATHY SCHAEFFER 1873 VERDILLA RD PORT TREVORTON PA 17864 Re: Estate of Donald E. Driver Dear Ms. Schaeffer: P.O. Boa: 2600 Valley Forge, PA 19482-2600 www.vanguard.com We are responding to the letter we received requesting a valuation of Donald E. Driver's Vanguard accounts on November 27, 2009. The mutual fund information requested is included on the enclosed account value reports. A letter from our brokerage department will be sent under separate cover providing a valuation of the brokerage assets. If you have any questions about a transfer or a transition of assets, please call us at 888-237-9045. Specialists are available on business days from 8 a.m. t:o 8 p.m., Eastern time. Sincerely, Ry Sikora Transition Team Enclosure(s): ** Donald E. Driver Account Value Reports 51362068 ~~ ~~~~ ~ . S~ ~~~~~ ~ ~~ ~y7 Donald E Driver & Beth E Sheaffer & Kathy Schaeffer JT TEN WROS 309 Glendale Dr Shiremanstown, PA 17011-6514 r Page > 3 of 3 ., .. ' ~:: -~~ 1~an~utatd~ F sift n rs".1' x -iti,i 'k ~~. ti yt!~~ i ~4~'YI .f d~~. r, .s. ~~~- I f "+' .. Report-for 71/27!2009 ,~ ~;~ `~ ,~~x '~ ~` . ~,z~ ry ~ . ~ } x{ ~;~ a ~ { wb ~ .. _.: ~~#1['7•v'.i~!w ~ ,_t:.-...~~ _....~.%'}~15:E ,.t •. ,....~i,.., .> z~ ~ .1.~._t ~la.~_, ~li'h[. -,_:.,.rs..,r, ,.. ~- ,.e,4 ..,i Client Services: 800-662-2739 Total report value: $72,903 ~'~ (Total report value includes any accrued dividends.) ~ r• l!q tt '.f IPA "[T Z y Nt Z J /~/~ y~ l - ~f. S`'' ~'i:. ^ 3v- a f; ~/~LVoui\t~value.summary ~;, ., ~_° ~ ~ 4 ! j l 1 Ik J k 4 tA l~ '~J`f t c ~ 1 f f4 ,( 3^ !94 4 ~ y ' 1 l \ h 'f - ' ~.. ~ k 1 l y .] ~ n V :F". ~ N- r Jr Y t1~y 'Ft k Z 1~ ry ~ f .'1 ~ ` ~ l' `~ Y~ .~ /. 'i. 1. z x..1's'z...,.,,: _.:?~. +.a.,..:,.~:J>"#lhi,.Niix..,`._~r_~'e4..,ti.: ~~~w~.5 F l ~ 1 R S.4 •.r~{u.~.t~i 1h..K~~~Y.~ vi4 ta~:aw.-.,- t . ~~ ~X. '-:..}~~. ....4 _1.1. x.. ... ._... .. .a,... ~• , : ,~...a. lit •~'. , .i: tC .. ..... i~.. 5. .~.~ a ~. 1 ~:` ._.,:., fi+l Name Fund & Account Date Price Per Accrued Number Opened Shares Share Vaiue* Dividends STAR Fund 0056-88026674131 04/08/2008 0.000 $17.56 ;$0.00 - GNMA Fund Investor Shares 0036-88026674131 04!18/2008 0.000 $10.90 ;0.00 $0.00 Prime Money Mkt Fund 0030-88026674131 04/10/2008 0.000 $1.00 :60.00 $1.69 Energy Fund Investor 0051-88026674131 04/08/2008 455.721 $59.83 $27,2Ei5.79 - Totals $27,2Ei5.79 $1.69 ~i,~~ i~/a , ~ l- 0 9- i/ ~ 3 ~Gj1f~~ ~-, 7-i~/1'I ~ 0047575428 12/2' 8/20 09 11:42:44 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BDX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 IX AFP COB'OB) FILE N0. 21 ACN 09180011 DATE 12-21-2009 TYPE OF ACCOUNT EST. OF DONALD E DRIVER ^ SAVINGS SSN 190-22-3797 ^ CHECKING DATE OF DEATH 11-27-2009 ^ TRUST COUNTY- CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: KATHY A SCHAEFFER REGISTER OF WILLS 1873 VERDILLA RD CUMBERLAND CO COURT HOUSE PORT TREVORTON PA 17864-9680 CARLISLE, PA 17013 P SE CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this a ccount. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-E327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCT"IONS Account No. 8810528730IRA51 Date 04-27-2009 To ensure proper credit to the account, two Established copies of this notice must accompany -Account $alance ,` $ 50, $92.62 Payment to the Register of Idills. Make check payable to Register of Wills, Agent . Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 25, 446.31 months of the decedent's date of death, Tax Rate ~( ~ OC~Kj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due. $ 1 , 145.08 nine months after the date of death. PART YE S ".<+. a,t, r ~' 11 ~~~Y~. : ' . fN.. : +~%.'."2.. ~ir~~: .~~. :!7~'G'"~ ¢t'. r ' ~~:~#G~~'~~~'i:.,3 . ;~,r...u+l . ~ ':'~. r llXS'ru:% j'i~"r ~+i fi~'~:,6'~k`.,kf.?i• ~~+v'.%~`i;~K.f+/`i"'y ~:~'!;#:~~r~`::`J;,;R;: :.. '~~<:i;~~`~;:~'::.~~.~rr.....'~:~;~.1:;~.~?~.::fQ~~%:~ A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance 'Tax return 0 N L Y to be filed by the estate representative. C. ^ The above information is incorrect and/or debts and deductions were paid. Complete PART 2^ and/or PART ~ below. PART `.yak.,,y`¢fit .,~`rs."r.~:.a?:~..:, ~.aiss~r~~y°"sr If indicating a different tax rate, please state x»:`~~%~ ; ~''' ~ ~ ~' ` '~;~ •~~~~ ~""'¢ , 2 relationship to decedent: >~,~>~?"~~ :,~~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ,'~E~ ~~" ~{~~ '' ry '~`•'" ~ '~' LINE 1. Date Established 1 : ' ,.f4:~.' :. ti ' : , '<''`~,~ ~ -~g~• 2. Account Balance 2 ,h .,. ~r ~~~ ~° ~ ~ < ` ~. ~... 3. Percent Taxable 3 ~ %:f s' 4. Amount Subject to Tax 4 $ '~'~`~~" ` ~ ~• ~ : : `~ 6': r ~ " 5 bt ti D d D d 5 - ~~ ~~'~ ~ t ,,,r , . e s an uc ons e • , "~ . '~ ~' ~, 6. Amount Taxable 6 $ :~f~~.~~' ~ '~~`; r ~ :. 7. Tax Rate 7 X ~ ` _:~": . w ~• j` n: :4 :... : ..... . 8 . Tax Due 8 $ °~>~:~r~.`: ~~ t N : ~ ~ •°` . d~ :~` ,. .. , r v:: k7'; nY ~~.o. ~Nf^' 'E:$:r'4.'%:tt`i`r%" ,J.~.. '.{u.'~~~p... FR:io'P :::K:::......n %..:.::~:: n.:;.,S,c:...::n.e?n .::., Yr,.s ::::.: ..:. r..:::a.::.;c:%......[. r:Zi:../`.`.:'. :.v'Y..<.: ..., :, ~.Mpt .: nYll{. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Vanguard Brokerage Services® A Division of Vanguard Marketing Corporation Donald E Driver 309 Glendale Dr S stown, PA 17011-6514 'Brokerage Account 43929 Below is your date of death account valuation for the above referenced account 'Please note that the value of your Vanguard®mutual fund accounts wUl be provided separately Holdings Summary Values on: 11/27/2009 Stocks Total $79,815.20 FundAccess Total $4,803.59.. Bonds Total $0.00 Total Account Value: $84,618.79 Holdings Stocks Symbol Quantity Price per Share Current Value Harsco Corp HSC 853.9284 $31.6000 $26,984.1374 Kimco Realty Corporation KIM 476.0452 $11.9500 $5,688.7401 (Maryland) T. Rowe Price Group Inc TROW 606.9770 $47.6700 $28,934.5936 Radiant Pharmaceuticals Corp RPC 300.0000 $0.3900 $117.0000 UGI Corp UGI 769.4907 $23.5100 $18,090.7264 Total stocks $79,815.20 FundAccess ~ Symbol Quantity Price per Share Current Value Fairholme:Fairholme FAIRX 166.3870 $28.8700 $4,803.5927 Total FundAccess $4,803.59 Fixed Income Cusip Quantity Price per Share Principal Amount Accrued Interest No fixed income securities held in the account. Total Fixed Income $0.00 Disclosure: The fair market value of the individual equity securities is cal culated using the average between the highest and lowest quoted price of the securities on the valuation date. If the valuation date falls on a weekend or holiday, a weighted average of the highest and lowest prices on the nearest business days before and after the valuation date Is used. Mutual Fund Securities are valued using the closing price of the fun ds on the valuation date: tf the valuation date falls on a weekend a weighted average of the closing prices on the nearest business days before and after the valuation date Is used. Fxed Income Security (Bonds) valuations vary by type. Please consult the V8S~1 Bond Desk for specific Inquiries. 1~u~~~a ~i9o-aa-3'797 ~1-09- i/33 ~~,~,/~~~~~ `-~, ~-~! ~~ ~, Page 1 of 1 Page>2of 3 1ran~ard Donald E Driver 309 Glendale Dr Shiremanstown, PA 17011-6514 73'}4W`~ J4hf~, k~ '.11 lcli' 1+~." ~1 °YC S 'M L' 'L .62^5 '. ?r w `e. f Report for 11127I2009~~=.~ s 3HH; ~~' ~~' ' , ~ ~ r,~3w~ ~~~ ~ ~ ~ ,~ ~:. .y '.1!, ~». .f t ~ ~'~ r s' ~ -:i: ~ ., ~ 1 ~ ; ~ v t r- . f aJ~. ~.r Client Services: 800-662-2739 Total report value: $72,9 .33 (Total report value includes any accrued dividends.} Name Fund & Account Date Price Per Accrued Number Opened Shares Share Value' Dividends / Total Int'I Stock Index J 0113-09917594053 02/01/2006 738.592 $14.47 $10,687.43 - European Stock Index Inv / 0079-09917594053 08/08/2006 249.979 $26.98 $6,744.43 - Capital Opportunity Inv ./ 0111-09917594053 07/30/1999 537.054 $28.08 $15,080.48 - Prirne Money Mkt Fund 0030-88024077015 12/05/2007 0.000 $1.00 :$0.00 $0.00 Prime Money Mkt Fund 0030-09917594053 04/17/1998 8,754.110 $1.00 $8,7;54.11 $0.81 Emerging Mkts Stk Idx lnv /~ 0533-09917594053 12/31/2003 0.000 $25.10 ;$0.00 - FTSE All-World ex-US Inv / 0770-09917594053 03/12/2007 255.473 $17.10 i'j8-~.~9- - ,Totals $45,635.04 $0.81 " Doesn't include accrued dividends _~ ~~ ~~~vF~, ~on~~ /.c~ ~ ~/9~-~~-3797 .I-i~~" it/o - ~ I -~9- //33 ~ eNF ~cl l.~ ~; Si ,~ ~J ~ 0047575428 12/28/2009 11:42:44