Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
07-30-10
1505610101 REV-1500 °`t01-1°' ~ PA Department of Revenue pennsylverda OFFICIAL USE ONLY ~~TM~xr«~« County Code Year File Number Bureau of Individual Taxes - PO BOx 213o6os INHERITANCE TAX RETURN Harrisburg. NA s~s28-o6oi RESIDENT DECEDENT q ENTER DECEDENT INFORMAQ'iON-BELOW Soda) Security Number Date of Death MMDDYYYY ~ 9 7 ~~ ro t: g o `~ Decedents Last Name suffix u R C~_0 DatTTof~~Bi--rth MMDDYYYY .Decedent's First Name MI ~~ ~~~ ~ (MApplicable) EMsr Survivlrtp Spouss's IMonnation Below Spouse's Last Name Suffix Spouse's First Name MI ^m r~~~~~ -r~-~-r-r~ o spouse's s«>fal Securtty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ tli 8. Decedent Died Testate O ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of tNll) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number L F S S / // / 7/ 7 7 6 ©~® REGISTER OF WILLS.USE ONLY n r First line of address C! ~~~ ~ ~~~+ L U S ~:z~~rn r ,_,a , ~„ ~ ~' ~ 0 r V Second line of address `' :7 . City or Post Office State ZIP Code ` ATE FI ~_ •• : e c u ~~o q~3 ~ -.~ o ~ ' ~ Omeasf: /1e~' 153 ® c' Ces~i!L' cornsp rtder t a e.-raaaU addr esa: . - Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. NATURE OF PERSON RES ONSI E FOR FILING RET RN DATE .//~.rl ~ ~ CrGf~~~ 7~?L fio ADDRESS 1'ltlt'jlAM S. CRI4WFOICD ~I+f ltJ. Silltf7son Sr'. mocha„ i csbu !tit , iP~ l joss SIG RE RER ;~ ~ ~ F.SENTATIVE R F~ DOTE I~~~~-/~ ~ ~~ ~ ~ ~ // 7.?(s o •••-•-• _•• - --+ ~•. ~~lilllGt~slsr ~~ /7vSS PLEASE USE ORIGI ORM ONLY Side 1 L 1505610101 1505610101 J 1505610105 REV 1500 EX Decedent's name: ~i/'I Q/A ~• o~(~~C/S Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) .........................:................... 1. ~ ( ~ Q ~ , ~ 'O 2. stocks and Bonds (Schedule B) ............:.......................... 2. .D l b 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~ O 4. Mortgages and Notes Reoeivabte (Schedule D) ........................... 4. ~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~. 6. Jointly Owned Property (Schedule F) O Separate Bi1Gng Requested ....... 6. D O 7. Inter-Vn-~ Transfers 8 MisceNaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Asssts (total Lines 1 through 7) ............................. 8. 6 9 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~? O Q 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. Q 3 7 11. Total Dsduations {total Lines 9 and 10) ................................. 11. 3 9 0 3 12. Net Value of Estate (Line 8 maws Line 11) .............................. 12. "] ~ ;if 13. Charitable and GQVemmental BequestsJSec 9113 Trusts for whigh an electior- totax has not been made (Schedule J) .................`...:.... 13. ,_ : ~ O 14. Net Yalue Subject to Tax (Line 12 minus Line 13) ........................ 14. 9 TAX CALCULATION -SEE INSTRUCTI~IS FOR APPLICABLE RATES " 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a~1.2) X .0_ 18. Amount of Une 14 taxable at lineal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable:; at collateral rate X .15 15. 16. 17. i 18. 19. TAX DUE ..........................'......'..........:....:....:..:.19.{ 20. FILL IN THE OVAL IF YOU ARE REWJESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 J REV 1500 EX Page 3 Decedent's Complete Address: File Number ~, ~ - p C; _. ~2 DECEDENTS NAME A9 i r'%Qm ~ . ~oud~ STREET ADDRESS 23 ~% /a~•d ~firG CITY - , c~.~,~ H,~~ STATE ~~- ZIP ~ ~o~~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. creditslPa ~ ~a 9 j 9 ~ S• DO B. Dismount I , 5 7S• 0O 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, enter the dilFerer>oe. This is the OVERPAYMENT. FiN ~ oval on Page 2, Lie 29 to request a refund. (1) ~ 32, 8~7. 9S Total Credits (A + B } (2) ~ 3 /~ Soo • 0 0 (s) ~ 9. ~~ (4) O 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~~ ~ (~ 7, (e~i Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSYVER 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 incorrle 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 Dec. 12, 1982, did decedent transfer properly within one year of death without receiving adequate oorrsideration? .............................................................................................................. ~ ^ 3. Did decedent own an "in -trust for" or payat~e-upon-death bank account or security at his or her death? .............. ^ 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 f~lESTtONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after Juty 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 172 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed tm the net value of transfers to or for the use of the surviving spouse is 0 percent p2 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 spore is the onty beneficiary. For dates of death on or after Jury 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the c~lild 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. §911ti(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents slMings 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. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0801 RECEIVED FROM: CRAWFORD MIRIAM S 44 W SIMPSON STREET MECHANICSBUG, PA 17055 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT /~Q~ ~ REW-1162 EX111-961 N0. CD b1 1761 ACN ASSESSMENT AIV~OUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 209-07-3565 FILE NUMBER: 2109-0592 DECEDENT NAME: SOUDERS MIRIAM D DATE OF PAYMENT: 09/18/2009 POSTMARK DATE: 09/ 18/2009 COUNTY: CUMBERLAND DATE OF DEATH: 06/18/2009 101 ~ 529,925.00 TOTAL AMOUNT PAID: REMARKS: RECEIPT GIVEN TO ATTY 529~~925.00 CHECK# 107 INITIALS: JN SEAL RECEIVED BY: GLENDA EARNER STRA~BAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (8-98) ' SCNEpULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SouD~25, 11'11R~~Frv- ~. -2~-09- S9.Z All real property owned solely or ~ 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 wiling buyer and a willing sager, neither being compelled to buy or sell, both having reasonable knowledge of }he relevant fans. RBI property which Is jointly-owned with right of survivorship must be disclosed on Schsduk F. ITEM ~ VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. /1// vY~ C~er/trin /otr~e/ .~ /~~/ i~x/.~reru! 6y a res:r/u~t- ia/ a~k~C//%1y ~te!(u ~i: Liwtr ,~i//ty Tosv/Asl,~`v ~ C~ic.,.ltr/a~ C'ott~, l'~il~ISywasu4~ ~4v.n~ an add~tss s~ ~3 !1.' /.,r~/ ''' ,Ori re, C'4~Ir~ Hi%/, PA /70// ~ ,~i„~ /1zohC ~rrfi~a/self, deSC/'i6~cc/ is 7~~ cc~f~i%n dcc~ ~~ Nov i!3, / 4s3, awl r~r~ca/ k; ~e ewlw ba 14.rtd Cro w+~y I ~~ua a~{~c ~t L~ha'- aura( E/i Zt,dC%1~ T, L~!,Ega~oh, h~S kli d~C~ ~i-~[~,~1 ~ cenv~e~ ~i 5etie! pnrn~iSeS ~' /l7iri~t/x d (/~uderx 1~cc Q~%tGC~tilt ~lrtti~. set ~ .ltia~ sreeeo/ a,i7~tc~ir~J ~, p+*opu'rJ, c~~s field ~ .?ason I¢• l~o~;tit an Du,/7,Zun9 ~tr p ri ~c ~ ~l a d, ~ . ®o • CSe¢. Co p~ s f seff/cn~~ ~~ a,p ~p o ~iee~ ~c~cc/~ '', ~ TOTAL (Also enter on line 1, Recapftulation) I S !' Z ~ Q~©' ~ (K more space is needed, insert additional sheets of the same size) 201-CT-~Varranc DaW. Store Form, Ace o[ [i0Y 8~aq Hall, La, ~aa, Ya. ~fji~ ~eeb, ~QaE tkJE 13th day of Novembeti: i.n the year of our Lord one thoacsand nine hundred and fifty-three. ~etlueen PAUL K. LEBARON and ELIZABETH J. LEBON, his wife, of Lower Allen Township, Cumberland County, Pennsylva a, hereinafter called the 'r ~ (~r(atotor s , and MIRIAM I~. $OUDERS, of Monroe TownehilL ~Cuml~erland County, Pennsylvania, hereinafter called the .. Girantee , ~ftne$~tet~j, that. in oonsideration of Fourteen THqusan Three Hundred (~ 14; 300.00) .Dollars, in hand paid, the reoeipt whereof is hereby.aeknowledge , the:said grantor s do hereby grant and convey to the said grantee ALL THAT CERTAIN piece or parcel of land, situate in the Township of Lowed Allen, County of Cumberland and State of Pennsylvania, more particularly bounded and described as follows, to wit: ` BEGINNING at a point on the .eastern side of ] dividing line between Lots Nos. 11 and 12 on the herein. Lots; thence in an easterly direction along said dividing twenty and nine-tenths (120.9) feet to a point; thence nog two (52). minutes east one hundred thirty-eight (138) feel Plan; thence in a southwesterly direction along the divid Nos. 12 and 13 on said Plan, one hundred sixty-eight ar. feet to Highland Drive; thence along the curve of Highlal direction sixty (b0) feet to Lot No. 11, the place of Begi ighland Drive, at the fter mentioned Plan of line one hundred th no (0) degrees fifty- to Lot No. 13 on said ag line between Lots i nine-tenths (168.9) d Drive in a southerly BEII~~.r dot N4. 12 in the Plan of Highland Village as recorded in the Cumberland County Recorder's Office in Plan Book 3, page 98, and having thereon erected a single brick dwelling house known and numbered as 23 High- land Drive. BEING the same premises which Wllbi~t,~jom s, Itte. by deed dated September 8, 1947 and recorded in the Recorder's Offic of Cumberland County, Pennsylvania, in Decd Book "P", Vol. 13, Pag 296, granted and conveyed to Paul K. Lebaron cad Elizabeth J. Lebaron, grantors herein. _ _ __._ _. ~.na the said grantor s , do hereby covenant that ~eY will N~'J1RIZANT generally the property hereby conveyed. Sri 76~tfrit8g ~~trtOf, said grantors have hereunto seals the day and year flr8t above writ wpa.Dt, Saalsl ..a ~eltneceD as epe ~au,ue .t a T J. their hand s a.nd on u~ s State of Pennsylvania ss. County of Cumberland On this, the 13th day of Novembers , 19 53 ,before me, the undersigned ofJleer, personally appeared Paul K. LeBaron and Elizabeth J. LeBaron known tome (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged hat ~eY executed the same for the purposes therein contained. ~a ~ttneBS ~tltteaf, I hereunto s and and o cial seal.- ss'~ai. NOiAlY 6LC~~': Mllr ~ Ftb. ~, ~~_.i Ti le of Ofjlcer. G Or o~. C'`{ ~./ d0 hereby Certify that the ~r'eCilB TElidE/-tele~O~f ~~LC. Wtthift n4med DYQJttee id V'a . /~f1rv, /3 t9 S 3 ` ~ (/ '. Attorney Jow'-- - -----------------------____---- .d 0 r OF 1NE v 'l.T£K OF,CG'~I p F ._ ~ ~ rt ~ ~` '~~aOfR ~ ~ ' ~ ~ J /rI RQ P} ~ D M ~ ~~ , •. i ~ j~~ 'T 0 ~_ ___.. 1A~ ... ,. ~~Itl ~Y . . ~ .._ . A AN W CU F~'~ a W a~ ~ o ~ z~a aw ~ a~a COMMONWEALTIq OF P1CNN$YLVANIA ~. • county o/ _ S dtMAESANQ RECORDED on this _ i}_TH .._._._.. day IOJ __~~~M~B.._____~__._ A. D. 19$.3,_, ix the Reeorder'so~ke of the said Cou~.ty, in Deed Book M VoL ___~.5i.; ._ _--, Pape _.1k? e said mice, tlae date above written. th Given under my ha„d and the aealof ~ / /~~e62r~~v~L~~~.~. Recorder. ` ~~~°-~- MADE THE ~,! ~/lday of two thousand and nine (2009). NIIRIAM S. CRAWFORD, as Executriz of the Estate ofbl~[~RIAM D. SOUDERS, deed, late of Lower Allen Township; C±um nand County, ..- Pennsylvania, Grantcsr, j !, and JASON A. VOIGHT, single man, ourrentty of Brooklyn, Kin~s County, New York, Grantee. ~ Lord WHEREAS, the said Miriam D. Souders, was vested in~her li tune with title to the premises hereinafter described, in Lower Allen Township, County of ~unberland and Commonwealth of Pennsylvania; and WHEREAS, the said Miriam D. Souders, departed this earthly life, testate, on the 18"' day of June, 2009, and Letters Testamentary were duly issued to the d Miriam S. Crawford, by the Register of Wills of said Cumberland County, docketed to No. 21- 9-0592; and WHEREAS, the lands herein-mentioned were not specifically evised: NOW, THEREFORE, THIS INDENTURE WITNESSETH that the said Miriam ~S. Crawford, Executrix, as aforesaid, for and in consideration of the sum f ONE HUNDRED TWENTY THOUSAND.snd No/104ths (5120,000.00) DOLLARS, d other good and valuable considerations, to her in hand paid by the said Grantce at and ore tlu ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has grant bargained, sold, ,. aliened, released, and confirmed, and by these presents, by of power and authority in ~~ her vested by the Fiduoiaries Aet of the Commonwealth of P~yly .does gn~nt, bargain, sell, alien, release, and confirm unto the said Grantee, his heirs and assi All THAT CERTAIN piece or parcel of land, situate i~ the To 'p of Lower Allen, County of Cumberland and Mate of Pennsylvania, more particularly bo ed and described as follows, to wit: f BEGIIYNING at a point oa the eastern side of Highland Drive, t the dividing line between Lots No's. 11 and 12 on the hereinafter mentioned Plan' of Lots• thence in an easterly ~. direction along said dividing line one hundred twenty and nine-tenths (120.9) feet to a point; thence north no )degrees fifty two (52) minutes east one hundred -eight (138) feet to Lqt No. 13 on said P~a; thence in a southwesterly direction along the divi ' line between Lots Nos. 12 and 13 on said Plan, one hundred siacty-eight and nine tenths (1 8.9) feet to Higbland Drive; thence eleit-g the curve of Highland Drive in a southerly directio sixty (60) feet to Lot No. 11, the placx~of Beginning. BEING Lot No. 12 in the Plan of Highland Village as: recorded the Cumberland County Recorder's Office~in Plaa Book3, Page 98, and having thereon ected,a single brick. dwelling house known and numbered as 23 Highland Drive. ~ .. I', L____ BETWEEN BEING the same premises which Paul IC. Lebanon end E ' J. Lebamn, his wife, by their deed dated November 13, 1953 and retarded in the Recorder's ce of Cumberland ~. County, Pennsylvania, in Deed Book "M", Volume 15, Page 47, gran d and conveyed to Miriam D. Souders. Her said Estate is the Grantor herein. TO HAVE AND TO HOLD the said messuage or tenement tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, ur}'to the said Greats, his heirs and assigns, to d for the only propeF use and behoof of the said: Grantee, his heirs and assigns, forcYer. AND THE SAID GRANTOR, Executrix, as aforesaid, her rs and assigns does covenant, promise and agree to and with the said Grantee, his heirs ands assigns, by these presents, that the Grantor has not done, committed. any act, matter or whatsoever whereby.. the premises hereby granted;. or any part thereof; is, are, shall ormay bd impeached, charged or . encumbered in title, or otheryvise howsoever. '~ IN WTI'NESS WHEREOF, the said Executrix of the Estate of D. Souders, deceased, Grantor herein, has hereunto set her hand and seal theday an year first above written. Signed, Sealed and Delivered in the Presence of .-~. ._ 7'~° :a MIRIAM S. CRAWN~ Estate of NIIRIAM D. ~/ (SEAL; trig of the Deceased COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND On this, the i / r~ day of /o~~+tt~ , A.D. 2 ,before me a notary , public, in and for the Commonwealth of Pennsylvania, personally MIRIAM S. CRAWFORD; known to me (or satisfactorily Proven) to be the person ose name is subscribed as Executrix of the Last Will end Testament of Miriam D. S ,and acknowledged that she executed the same in such capacity. IN WITNTSS WI~REOF,1 hereunto set my hand an official seal. ~oww o p~snv~u- ~npdm7iwp.. ~r9lq,9Ato gp~~inlon p~ydohdN ~pw,p~„~iyiwe. - My commission exposes: (SEAL.) vreha'a o0lUOlii w oWObb A. Settlement Statement B. Tvoe of Loan form NU0.1 (SIRE) of NRnooook X303.2 U.S. Department of Houskp and Urban Development OMB Albroval No. 2502-0285 texoires 11130120091 FINAL 1. DFHA 2. ^FmHA 3. DConv. Unira. 4. VA 5. 6. Fib Number C 7. Loan Nulr~er 8. Mortgage Insurance Case Ntxr~er C.Note: tbrrrmtlw'(poer wrR pboWlaR Rb ~wRlrw7tb,NbrtNRrnuaon PIRORRIM RnR~notYMIMWNRr IOWA WARNYiG R k ~ alnb b RnwYply aWM ItlRR b Rb tRNbN 81Rbs on RN Or Rn~ ONIRf RMri1Rf lane. PorlRltlas upon oonMaan eRn Rw#ae• a an. anR Far OMMR RRK 7tM 7R U. S. CaOR eRCYm 1007 RM SRatlan 1010. TitleExpress Settlemal715yatem i2tlnted 12119 ~ 13:x.1 .~ D. NAME OF BORROWER: Jason A Voight ADDRESS: E. NAME OF SELLER Miriam S. Crawford as Executrbt of the Estate of Miriam D. Souders ADDRESS: F. NAME OF LENDER: Miriam S. Crawford as Exatt-trht of ttt4 Est ADDRESS: G. PROPERTY ADDRESS: 23 Hightsnd DrNe, Camp Hiq, PA 17011 Lower Atlen TowrKlti H. SETTLEMENT AGENT: Cornerstone land Transfer, inc., Teispttone: 717.730.9684 Fax: 717-730.9665 CE OF 5 MENT: 4705 E. Trindle Mechani PA 17050 I. SE7TLFJr1EWT TE: 12N J. UM Y RAN CON: 100. GROSS AMOUNT DUE FROM BORROYYER 400. GROSS AMOUNT DIN: TO SELLER 101. Contract sales 120000.00 t. tract 120000.00 102. Personal 402. t Settlen7eM Ch Do 1 351.25 t04. 404. 105. 405. rda for items id ss8er i n advance tiStrrlenta for dams std se8er k7 advance 106. Ibwl7taxes 408. 107.. Coun taxes 12H7108to12131/09 32:15 12h7109 12131!09 32.15 t taxes 12117109 06130110 798.56 12117!09 OQJ30110 798.56 109. 409. 1t0 Sewer 12117109to12/31109 6.19 41. 12117109 12131109 6.19 ttt. ltehlse 12/17109b12131i'08 9.45 411. 12M7108b12/31109 9.45 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 123197.60 420. GROSS AMOUNT DUE TO SELLER 120 846.35 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS 1N AMOUNT DUE TO SELLER 201. ' a eamast 501. 202. amount of rlew loans Settlsrt7ent line 1 1225.00 203. Ex' ' b s taken to Ex' . 204. of FNSt loan 205. 206. 207. Loan 6om Seler to 120 000.00 Loan 6om SeAar to bu 120 000.00 ~. 209. taor itnns setler tabttsrds for trams tHl seller 210. taxes 510. 211. 11. 2t2. School taxes 12. 213. 13. 214. 14. 215. 15. 216. 16. 217. 7, 218. 1 . 219. 220. TOTAL PAID BY/FOR BORROWER 300. CASH AT SETTLEMENT FROM OR TO BORR 120 000.00 OMfER 1 , .TOTAL KNI AMOUNT DUE SELLER 800. CASH AT TO OR FROM SELLE 121 .00 R Sot. Grasa due from 1 123197.60 t. lino 4 120 846.35 302. Grte 220 120 000.00 ' n ` S ~; 121225.00 103. CASH FROM BORROWER 197.60 603. CASH FROM SELLER 378.65 RlaaTrIUTE FORM tORR SELLER aTA7EMEN~F. 71rRMarbdar, oala~II1W lbninbblPMOrltibr blannRRan and b tMMna R,rrNMbQb IIb lnbr/IN Rwwlfrr RMNeo. Nrpl M rogtirM b IM ~ rWn, I. rrMM ar oMr rlraanra lb tngeNa m Her, NMb tMm b rRgliW b W npwbR rIa tM IRS RRbntIRlp Rbt R lbs RaJ RRRrt fRPRlb4 llb Cannel BRbs hb WwON n .. n. RRew aorMlY0M 71M 0>rwo AooRRa aw. r.(f..m~ ,~Ir~w m~ir Wlwgwb~aaYnYbIPwINr MgagO A'Iw.26UnOV7S2~t~R~ oanr~~rlarlWk~Nm nunRr. N7oa oe not paN0o7prmmN WrWRaRNaI pRr)Iry, l Lwwy Yw tlr rn~nRRr rbwn on NN ~IRhmRrM b my aolrErt WlpRrr~Na~Nan rrnrwr. ~ _.. / __ SEl1ER(S) SgNAILRE(SG / SELLER(S) NEW M~R1NG ADDRESS: bLLER(yy PHONE tN111eER5: IN) _. _. flNt Pr•ylout •d?dt. d• a,.aw .. - +om+lKlD-1 {3!!6) of Nrf69etlt 4906.1 u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Fde Numbe-:; CL09207 FlNAL PAGE 2 SETTLEMENT STATEMENT rdle Settlement s ~ 1 at 1 :55 L. SETTLEMENT CHARGES PRID FROM PAID FROM 700, TOTAL SALES/BROKER'S COMMISSION bas8d on 5120 000.00 = BORROWER'S 'SELLER'S Divaion Ot Pale 700 es toNows: FUNDS AT FUNDS AT 701 = t, SETTLEMENT SETTLEMENT 702 70Ci. Cormm~stioll paid at S - - vn~ r n. wnuurM+nu weraali nwu 1 801.•Loanv .~ Fee- __ ---%- - -- -- B02 Loan D'ISOOUM 9G _ 803. Fee 804. Cred'd 805. Lenders ~ Fee ' Fee 807. Fee 808. 809. 810. A1L ' eao cEw+IF+cAnon of aur6le AND t>s~ Ir.. MI ru ~ •Ilr b 01.OM+~a la'"-io-+ saxun.rrssuw rw korw ar«..~i a w r«rw •nu aww..mrws mw. m mr wea.r.~ YWRINNQ R IeA CRME TO IOIgNMgLY W~1pKgE~FAIRE MA7EMElITe TO T11E G~tt~NC1i1 GF EA AlE AIO~MMRNONM®R. F')R DET/YL6 i~ 7TRE 1 us. eooE sECrwN +06+ Arw 6Eenou +ox n.INJO.) Inw.fw0 NM•Yu• a.,aw.was.. a•waon.I nu.•rv •MN~Na •a vMIh MY MawawK sErnelwEnr oAr~Z17->~i REV-'1503 Ex+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scN~ov~ s STOCKS & BONDS ESTATE OF FILE NUMBER Sou~~~?S, M1+2r~M ~. 02/-oq-S9z Ait Property jofntyr-owned rrith right of survivorship must be disclosed on Schedule F. ITEM NUMBER ! VALUE AT DATE DESCRIPTION OF DEATH ,. u. s. Jav;q~s $~nds w+ soli han-e diF /h;ri~n- D. Sokd~s +~-+ d enom i Nations ~{ '~StaO. ~ ~ ~/, DDD, vc '' ~a~ i{tM:za~ va/k~t~Svn Meet ~~x~~) ~~ "S14, P~f/, ~f D ~. U. S, Sav,~.r~ bd~-ds %., wh•'cti d eccd cn t was a Jo; ht '' owner' Gui/6i r-1ar~ara~ p. 41a:r~ sts~'Cr of d~ee.edenf. rns. 81air prcdace.aseAl decedent '~n or about t~ '; '/Gar 19gs, Ner esfa~ weer ha»dte~ by Aflrbrn~ Tohn ~, ~.rtS, ,Tr !-Ic MaGntaintd ot~{ces act lol 5ou.~ SecA~ol St'., Cieaur~i'ehl, P~ 16~3o acrd a# 122z F`~nn 5 ~ vaata ~--'~., NtSS ~ Ids. ~ 5w-~ 201, ~Ty rant, P/F ~~6Pb. T~ ll. S. /~ors/s ®~ ~i /%sf a~~d h t~fn wire repor~'ed en Sehed. F o~ ~, ~,,1-+~r~~« '' tt-ord;~ To ?~ lQehtrh {'/t~ ~ipr pis. ~C3/~r.r ~t ~, ~ , ehrnrrnd,~pN {at,nd Qnton~at decedent's Pap~u-s. ,~ .50, 8B3v0 3. U. S, ~SViiJps ,~i+~s iit p-/j.'cLi decedc.~' tiaad a ~o%~tf' ' ''' otcr~atr wif~ /jlt~J. C'. o~rcc~et~if, sft~o- al~cK tiler e{ ~ decede~~ /yisr C. ~u~ltrs ~ancdeeeased ~eccE~ /n %17 s~' /95~, fiEr ESt~cr~ Gv~s mid/u/ 6 ~fifl~-r~ ~ ~ ~ [. s~-~.~y . fk //~igf4.nea/ Gr~`CeS st 39 taest lV/~ . /r~a:n St, /1te~ltanics6a,+~, P/~ ~7ass Ti4~ (~. s, ~elcdr ~ (id. u~ r~~~ted on S in ~'Yt /%s1`' Qlf~x~lav~ ~e~O w ~~ / ~ / F ~~ ~ldt .~lrfl`Lr~~NCL ~/ri° /['CT>rt/"N G~I/jiGli ~d di/~4/ /~~ lk CIC/N ~i6rl~ to WK~ ~ ~it~f /YO. ~/-g8 -376. qO p 3 ! I ~t. a~ , `~~ Vwrt ,(~a~r~-~n //,5h S/;e/d ~wncf -,4 x8'/66 Dss o a r76 ~` ~ ago. ~G Cset Sr4t>~A-tnf Q1~ete/r«/~ TOTAL (Also enter on line 2, Recapitulation) $ f ~ ~~ ~ 0 ~ ~ L ~, (tt more space is needed, insert additional sheets of the same size) Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 06/2009 Total Price Total Vaiue Total Interest YTD Interest 1l 750.00 0 841.40 29 091.40 797.40 ~' Bonds: 1-26 of 26 Serial # Series Denom Issue Next Final Date Accrual Maturity Issue Price . Interest Inter. Rats M639ti3989EE ... EE .. „ ~ 1,000 ~02f 1991,08f 2009* 02(2021 ~ _ _ _ _ _500.00 a. _ _ _ _ _789, 20 µ _ _4.0( M(i39ti3990EE ; EE v ~ ~ 1,000 ; 02/1991: 08/2009 ; 02/2021; _ X500.00 ; ~789s 20 ^ 4:0( M63963978EE _ EE _ _ r $1,000 ~ 08j 1986 08/2009 ; 08/2016 _ _ _ _ _500.00 ; _ _ _ _ _ _~ 1,213.60 ~ _ 4.0( M63963982EE ; EE _ _ µ ~ 1,000 T07/ 1986 µ07/2009 ; 07%201(1; _ _ _ _ _500: 00 ~ _ _ ~ 11213: 60 ~ _ 4.0( M63963977EE ; _ EE _ µ X1,000 µ07/1986µ07/2009T 07/2016 ; _ _ _ _ _500:00 ~ $11213:60' _ 4.0( M63963985EE : _ EE _ _ ^ $1,000 x06/1986 ;12/2009 ; 06/2016 ; _ _ _ _ _500.00 T _ _ _ _11248:00 ; _ 4.0( M63963981EE ; _ EE _ $1,000 µO6/1986 ;12/2009 ; 06/2016 ; _ _ $500.00 µ $11248.00 ; 4.01 M63963980EE _ EE $1,000 ; O6/1986µ12/2009 ; 06/2016 ; _ _ _ _ _500.00 T _ ~ 11248.00 ~ 4.01 M63963984EE : EE _ : $1,000 µO5/1986 ;11/2009 ; 05/2016 , _ _ _ . _ _ _ _$500.00 T _ _ $11248.00 ; 4.0( M63963986EE ; EE µ ~ 1,000 µO4%1986 ~ lOf 2009T 04(2016 r _ _ _ _ _ _500.00 ; _ ~ 11248:00 ~ 4.0( M63963987EE EE. _~$1,000~0411986mm10%2009T04~201(i; _ _..___~500.00! _ _ ~11248.00z 4 Ot M63963983EE F _ _ EE _ ~ ~ 1,000 µ()411986µl.0%2009' 04/2016 ~ _ _ _ _ _ ..500.00 T ___ . _ _ ~ 11248.00 _ 4 0( M63963991EE EE . _ ~ ~ 1,000 µ04f 1986;,10 f 2009,, _04/2016 r _ _ _ _ _500.00 r _ W _ ~ 1,248:00 ~ _ 4.Ot M63963988EE' EE ~ ~ 1,000 ' 04/1986 ;10/2009 ; 04/2016 ; _ _ _ X500.00 ~ _ $11248.00 µ 4At M63963974EE r _ EE _ _ ~ 1,000 ; 05/1985 ;11/2009 ; 05/2015 ; _ _ X500.00 T _ ~ 1,318.80 µ ~ 4.Ot M63963973EE ; EE _ t X1,000 X05/1985'11/2009 ; 05/2015 ~ _ _ _ _ _ _500.00 µ _ _ _ _ $11318:80 µ 4 Ot M63963972EE ; _ EE _ _ r $1,000 rU3/1985 ; 09/2009 ; 03/2015 ; _ _ _$500_ UO v _ _ ~ 11318.80 r 4 Ot M63963992EE ; _ EE _ _ ¢ $1,000 x02/1985 ; 08/2009 ~ 02/2015 ~ _ _ _ _ _ _ _500:00 µ _ _ $11318:80 ; 4.01 M63963976EE ; _ _EE _ ; $1,000 T02/1985 T08/2009 ; 02/2015 ; ~ _ _ X500.00 ~ _ _ 11318.80 µ 4.01 M63936975EE ; EE _' $1,000 µO1/1985 ; 07/2009; 01/2015 ; _ _ _ _ _ _ _ _ _500.00 T _ $11318~ 80 : 4.01 M63963979EE; _EE $1,000'01/1985{07/2009T01/2015; _ ~500.00T _ _ $11318.80; 4.0( D46330563EE EE _ , _ $500 µ05f 1986µ11f 2009 ; 05[2016 ~ ___ _ _ _ _ _ _250.00 ; _ _ _ _ _624:00 µ 4.0! D46330564EE ; EE _ ~ ; $500 ; 04f 1985 ;10f 2009 ; 04(2015 ; _ _ _ _ _250.00 ~ _ _ _ 659.40 4 0t _ D46330565EE ; EE _ ~ _ $500 #03f 1985T09f 2009 ; 03/2015 ; _ . _ _250 00 ; _ _ _ 659.40 P 4.Ot D46330566EE _ EE ..__-a-----_-~ ----- , _ $500 ; 0211985 T08f 2009 ~ 02/2015 ; _-. ----~-- ----- .. ..... ... .. . 250.00 ;~ _ _ _ _ _ 659:40 ~ 4:01 D46330562E_ E : _ EE _ ... - . . ~ _ $500 ; 04/1983 ~ 10/2009: 04/2013 ; _ _ _ _ . ...-----~- _ _ _ _ _250:00 ~ _ _ _ _ _ _ _806:40 ^ 2.9~ Totals for 26 Bonds ; _ _ _ _ X11,750.00 ;129,091.40 ; Notes NI E Not Issued _ _ _ NE 'Not eligible_for_payment _ _ _ _ _ . ~ _ ~ . PSIncludes 3_month intere_s_t penalt~r _ ~MA ~Matured „and not earnin interest 9/4/09 4:29 PM Value Note ~/o ' # 11289 20 ; _ . ~oT . , _ _$1171360` _ ~o; . _. . 11713.130; '/o ; $1174$ 00 ; . _ _ . '/o ; _ $11748.00 ~ . '/o; _ _ _ $11748.00 ~ --_... '/6 ; _11748 00 . '/oT _ X1/748.00,., . . ?/o ` . _ $11748_00 ; '/o:. . _ _ 11748 00„ ?/o ; .. _. $11748 00 : ~' _ _ __~isi8_so '/o T _ 811818 80 ; '16E ~t1818;80r '/o ; _ ___ 11818 80 ; '~6 $11818.80: '/0; _ _$1181880. ~ '/o ; __ _ ..8874.00 ; _ '_/? ^ .. . . _ _ _909 40 : './D Y _ _ ,. _909 4C ~ . . 'r6 ~ .. . . - _8909 40 .., , , _ ~/o ' _ ~ 11056 _40 : . ; 540,841.40 E http://www.treuurydirect.gov/BC/SBCPrice Page 1 of Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) ~'~iAc, u ax~c -}~ sel~ su.wi vo r rids ~'{cr d ea~ltt e~ Jt. Tcaant /l1ar+~a ~' ~: [31a; r Calculator Results for Redemption Date 06/2009 Total Price Total Value Total Interest YTD Interest 14 425.00 50 883.00 36 458.00 988.44 Bonds: 1-15 of 15 9/4/09 4:45 PM Issue Next Final Seriai # Series Denom Date Accrual Maturity Issue Price Intesit Interest Ra est e Value Note X497233EE ~ EE ~ ~10~000~03j1986~09j2009; 03/2016 4 __._ _s X5,000.00 ~ $12,480.00 ~ 4.0 %; #17,480.00 ~ _ X497232EE ^ _ _EE _ _ ~~10~000~0311986~09f 2009T 03(2016 ~ _ _ _ _ _ 5,000.00 ; $12,48D: 00 ; 4.0 _ _ _ % ; #171480 00 14530417EE EE ~ $1000 ~ 03j 1986 ~ 09j2009 ~ 032016 ~ ~ _ - _ _ _ _ _500.00 ~ _ - r _ ~ 1,248: 00 ~ - --- _ 4:0 ---- % ; _ X11748.00 _M14530415EE _EE__~_$is000~03f1986T09j2009~03/2016~ _____~500A0~ 1,248,00, 4.0 %~ $i1T48.00~ M14530416EE; EE ~_$1~000~03j1986;09j2009; 03[2016 _ ~500.00'_ _ __~1,248:00' _ _ 4.0 %' _ _ _ X11748 00~____ _ M9233287EE ~ EE _ $1,000704/1985 ~ 10/2009, 04/2015 ~ $500.00 ~ $1,318.80 ~ 4_0 % ~ $1818.80 ~ M9233286EE : _ EE _ _ r _ $1000 ~ 04/1985 T10f 2009; 04/2015. _ _ _ _ _ _ _ _ _ _500.00 ~ _ _ _ _1,318.80 ~ _ _ _4.0 _ _%r _ _ _ _11818.80 ; _ _ M9233285EE~ EE _~_$1~000T04j1985;1Oj2009'04~2015~ _____~500:00~_ ~1,318.80r _ 4.0 % ,~1181880~ . M9233288EE~ _EE __$1,000704/1985'10/2009g04/2015~ _ ~500:00~ X1,318.80; 4.0 %y $11818.80' D 11468470EE T _ _ EE ~ _ $500 ; 03/ 1986709/2009 ~ 03/2016 ~ ____ _ _ _ _ _250.00 ~ _ _ _ _ _ _624.00 r _ _ 4.0 %R ~8T4 00 D5450085EE . EE F $500.03/1984 ~ 09/2009 ~ ,03/2014; ~ ~ _ _ _250.00 ~ X709.00 ~ 2.9 %' 959 00 r D2707429EE : EE _ _ _ $ 500703/1984709/2009 ~ 03/2014 ~ 250.00 ~ $709.00 ^ _ 2.9 % . _ X959.00 R029208232EE ~ _ EE _ ~ _ $200703j1986~09/2009; 032016 ~ _ _ _ _ _ _ _ _ _ _ _100.00 ; _ _ _ _ _ _ X249.60 ^ _ _ 4.0 _ % ~_ _ _. _ _ _349 60 C111295996EE , EE ~ , $100703f 1986709f 2009 03/2016 r _ X50 00 ~ _124 80 ~ 4.0 % ~ _ ~1T4 80 ~ _ . _ _ L259663625EE,__EE _, ___ $5003/1986.09/2009~03/2016~ ______$25.00~ $62 40x 4.0 %' $87.40x Totals for 15 Bonds : _ 14 425.00 ~ ____ . 36 458.00 ; _ ~ ___ _ _ 50 883.00 ; Notes NI 'Not Issued ----.. NE ~ Not eligible for payment _ _ _ _ _ P5 :Includes 3_ m_onth_ interest penalty_ _ _ _ _ _ _ _ MA ;Matured and not earnin interest http: //www.treasu rydirect.gov/BC/SBCPrice Page 1 of Calculated Value of Your Paper Savings Bond(s) 9/4/09 5:05 PM Calculated Value of Your Paper Savings Bond(s) fond s i-e/d w . huir~ C• ~ou.c~ u~s 2S rY'f . Tua ~' Calculator Results for Redemption Date 06/2009 Total Price Total Value Total Interest YTD Interest 14 300.00 43 996.80 29 696.80 862.32 Bonds: i-32 of 32 Serial # Series Denam Issue Next Final Issue Price Interest Intel Date Accrual Maturity Ra~ M22365362EE~ EE ,~~1 000~04j1987=10j2009~ 04[2017a_____~500.00~,___~11010,40~_ 4:C -- --- ----- ----- ----- _M22365361EE__ EE_ r$1,00004/1987T10%200904/2017;_____~500.00r__$11010.40; 4.C M22365360EE . EE 4 X1,000 ~ 04/1987 T10j2009 ; 04/2017 ; _ _ _ _500:00 ~ _ X1,010.40' _ 4.C M22365359EEY EE ~~1,000:04j1987;10j2009:04/2017; X500.00; __~11010.40~_ 4.C M22365358EE ; EE ~ ; ~ 1,000 ~ 04~ 1987 T10 j2009 04/2017 ~ _ _ _ _ _500: 00 ~ _ _ _~ 11010:40 ~ _ 4:C M22365357EE ~ _ EE _ r $1,000 x04/ 1987 P10%2009 ; 04%2017 ; _ _ _ _ _500.00 ; _ _ $1,010.40 ; _ 4.C _ M22365356EE, EE P~1,000'04/1987T10j200904/2017;_____~500.00~___$11010.40T__4.C _ M20861792EE; EE ~~1,000T04/1987;1Of2009~ 04/2017; __ _~500:00;___~11010.40p 4:C . M20861791EE ~ _ EE T X1,000 ~04j19871012009 ; 0412017 ` _ _ _ _~SUO:OO Y _ _11010:40' _ 4:( M20861789EE, _~EE+ F$1,000~04/1987r10%2009, 04/2017; ___ ~500.00r__ $11010.40; 4.C _ M20861790EE, EE ~~1,00004/1987,_10/2009; 04/2017'_____500.00,__ $11010.40'__4.C M22365372EE~ EE_ F~1,000t04/1987~10j2009;04/2017;__ __~500.00'___~11010:40r 4.C .M22365371EE~;_ EE M1~1~000T04j1987T10j2009~04~2017~_____~500,00~ __~11010,40r 4^C M22365370EE m _ EE T ~ 1,000 ; 04%1987 CIO%20C19; 04/2017 ~ _ _ _ _500.00 r _ ~ 11010.40 T _ _4.C M22365369EET EE ;~1,000~04/1987T10/2009y04/2017; ___~500.00~_ ~11010.40w_ 4.C M22365367EE ~ EE _ T X1,000 ; 04j1987 ;1Oj20094 04/2017 ; _500 00 ; _ X11010.40 ^ 4:C . M22365366EE ; EE ; X1,000 ; 04j1987~10~2009 ; 0412017 ~ _500.00 ; _ _~11010~40 P _ 4:C _..___.__.._v_._s.~..__._,,. - ____..._ ...._.._. ----___-.. __ M22365365EE _ EE T$1,000~04/1987~i0j2009T 04/2017, _____~SOO.OOr___~11010.40~_ 4.C __ M22365364EE; _ EE__~~1,000'04/1987_1012009T 04%2017;_____500.00; ___~11010.40~_ 4.C M22365363EE ; EE @ X1,000 ; 04j1987 1Oj2009 ; 04/2017 ; _ _500.00 ; X11010.40 ~ _ 4.C _ M_20861785EET__EE_ ;~1,000T04/1987T10/2009T04/2017; _ _500.00;__ ~11010.40~_ 4.C M22365375EE; EE__~1,000;04/1987_10/2009;04/2017;__ _~500.00;__~11010.40 4.C M22365374EE' EE , X1,000 T04/1987r10/2009, 04/2017: _ _ _500:00 ; _ _1,010,40 __ _ 4 C M22365373EET EE__~1,000T04/1987;1Oj200904[2017~ ___ ~500;00;___~11010.40~_ 4.C M20861786EE . V EE $1,000.04/1987~10/2009T 04/2017 ; _ _ _ _500.00 p $1,010.40' _ 4_C M24713325EEY ~ EE _ ~ ~ 1,000 x04/1987 ;10/2009T 04/2017 ' _ _500 00 ; _ _ _11010.40 r _ 4.C M20861787EE _ EE__. ~1,000'04j1987~10j2009~ 04/2017; _ _ ~500.00,___~1,010:40~_ 4.C M20861788EE' _ EE ~ X1,000 T04/1987 ' 1012009, 04/2017: _ _500.00 ~ _ _ _11010.40 T _ 4.C _ C2106161844E~ _ _ E _ _ _ r _ $100 05/ 1980 ~ 11/2009 T 05/2010 ~ _ _ _ _ X75.00 ~ _ _ _ _$354.64 x _ 4. C C2106157206E ; E_ t _ _ $100 ; 04/ 1980 X10/2009 ; 04~20I0 ; _ _ _ _ _ _ X75.00 ; _ _ _ _350.32 r _ 4.C C21069152797ET_ E _ ;__$100 ~04/1980~1Oj2009;04(2010~___ __~75.00~_____~350:32~_4.C _ C2101430714E ~ _ _Ew _ ; M_ X100 ; 02/ 1980 ~08j2009_ 0212010 ; _ _ _ _ X75,00 ~ _350.32 T 4_C _. ....____~.~....--~..._ ~~ - ~_- -Totals for 32 Bonds;$14,300.00;$29,696.80; Notes NI ~ Not Issued .4. ,. .. ....».~.. ,. ,. ...>.... .. .. ... ..... ..... .. _NE °~ Not eliglble_for_payment _ _ _ _ _ _ _ _ _ P5 'Includes 3 month interest penalty _ _ _ _ _ MA :Matured and not eamin interest Value Note 1%; $11510.40 1%; _ ___ . _$11510.40: _ _ , %~ _~11510:40 . _ R .. )%' 11510.40 ; %= _11510.40; )%~ ...._ _~1151040~V __ %~ 11510 40 %; _1151.040: %p _ _ X11510 40 1%T _ _ X11510.40' )% ; ___ 11510 40 %; X11510.40; : 1%~ .,... _ X1151© 40 %, .__. _~1151040~__... %~ . ,- _ X1,510.40' 1%T --- _ _ X11510 40. 1%. „_. _ X11510.40; 1°k. __11510 40' 1%~ .. _ $1,510 40 ~ ~ )% _ _ _$1151040 _ %~ _ _-- 11510.40 1% ~ _ _ _ _$429.64 •. _ _ . 1°!0 ' 25.32 . )%_ : 425 32 _ . , ~~A7 AA! eA~. http://www.treasurydirect.gov/BC/SBCPrice Page 1 of SNVfiSTMENTS ~1~11111~~11•I~.~II~I~ill~l~~~lll~~~ll~.~~1111111~~1~11.1t1.1~111 MII2IAM SOUDERS 44 W SIMPSON ST oo2z~ MECHANICSBURG PA 17055-6324 Confirmation ' Statement & Check OCtObef ~, ~ Financial Advisor Access tour ACCOUnt ~' On the Web Mary J Holtz Read NEXT FINANCIAL G 322 FRANKSTOWN ALTOONA PA 1660 X800)647-2424 vankampen.com Set Up Your Online Transaction Privileges. If you haven't established your online purchase and redemption privileges, don't worry -you can enroll online. Visit vankampen.com to register and learn more. High Yield Fund - A Fund/Account Number 28/6605502176 Account Owner Miriam Souders Trods Tnassotioo Dslhr DsM Dsseri~tion Msouat 10/30/2009 Income Div Cash 558.02 Ending Yalue as of 10/308009 58.28D.46 We make it easy foryon to manage your Van Kampen mutual fiord investor by visiting venkampen.com. INC Page 1 of 1 S-sro SlunsThis ToW • Prico = Trsntnatien Simons SO.D000 0.000 893.253 893.253 eats with our Direct Deposit plan - sign I online today Thank you for choosing Van Kamprn Invesanents. Your satisfac~on is important to us. If you identify srry inaccauacy or discrepancy on your stattment, it is your responsibility to notify us promptly but no later than 10 business days foDowing receipt ~ your initial confirmation. To fiuther protect your rights as a customer, oral communication shook] be reconfirmed in writing. This is the only confirm that you wiIl be receiving for this transaction. Please gain this statement for you# records. i _ REV-150EIX.Jt-/7) COMMOt~MIEALTH of PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF s D k D ~ ~S, im 1121 ll-M "p. FILE NUMBER Indude the prooeeds of Ndgation and the date the proceeds were receHed by ttie estate. AA property johwy~wned with the right of wrvirorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DE&CRIPTION OF DEATH 1. E/trrisbpr-T ion- /V~, -~~.obs~i+iby' /Pe~rrres~l f /07, ~S ~• ~eyno/ds ,Esrili ~ ~-.btt ~ :~2 49 3 QiYi~Rlr /~i~Jft'yiE~ ~'~K T ~ valt /S~j1~71N afS ~ f.~ O7 y. .Tn/w,~-sry of housr,,~lold ~irnish~n~s, ~. ~`s87, GS CStC i~C~lliZtA~ /;S7~ii1 a~cltt~) s- L'•~'z ~8a,.,rk L~Ilce~.' . No 6z~ /od 3/ w,s ~ A~ 49 '~ 3I, /7/, c/ 6 . Z.~t. ~ror/ /*sf ~vsh:l~ ~-" d...d rrou~ t'SG~ ~'.Pl~rt~io~ ~e.~`t•~ a~sclrta'~ 7 I~iVC ~a~ ~(' , C/r s ck: ~tq ~: Nc• Sid 0/6 8'S 2 9 a ~7, /s y~ ~y 8• 7. ~'.~t. accr. on Ifr~, f (Sce rtVaa ~ii~t ~GJf `u^ a~ittlrt•/~ O. 73 ~. - .LEIS Of ~~~~, f oh fYcble oT ~eai' ~S ~dle ~' ~~'~c+ruwt ~~ L;n,~ ~f~' ~ pro-naf~t ra~a+b.~oan~y Tars ~3a /S ~'ne ~ P: P~-~ ~~t16_ S~l,.e/ T•~es '~ 79B. 5K ~;nc ~F/o: ~~ ~ • / 9 L;Ift 5~//= ~rese f 9. ~s /o. Reid /11;//en;am ~/~Qrn~ aey ~Sys~Gms, .Z c. f/6 , oz i4.~ ~I N. M ~'-~I ~~ w i f{- horn ~ Wl a r ked Gorba) ~ rrrta~de, dama,~ t~+n d -tiell" Saleable - p ~- ~.) T~ufnrl~t) , Gn~bcl W~ Cu-rna~ Suxct /!1 usic ,x# ~ 810, Q(arna~ caHid ho}' saleable - p .- C~) Hu.mrnal 1^~9urinc 1 ``pl~,~y Love'' TrnK~ ~ pia. 99 U.) V,'nt'a~e Nummcl aol 2/o Rt;tnart ~o Sa~ ~f" T// VBF.~' '~3~•99 TOTAL (Also enter on line 5, Recapitulation) I S ~ ~~ / 3 p', ZZ more space is needed, insert add'dional sheets of the same size) r_ ~ . 2 ~'Cf1Er~. E, Con tad ~s~i. ~~ so~o~2s ~ir~r•~itt ~_ F'~ c.E- w~. a i-o 9- s~: 2,1 F !~ siA/~ r~•n a~ / 6/e -- o -- Jks es h~ --- a~ 9 ~, s~ ~ ~~ ~ ~ ~ r~ ~ ~J ~~ 1~ tuY~t x/6,00 t3. pp QG 11~r-c~ U S. ~-'~tSUr U S I ~ 4n ~ ot~ ' ¢ 83.00 I ~i. P~;~t ~e~,~,nd S ~.M. ty 4 a, o0 MIRIAM D. SOUDERS ESTATE -SCHEDULE E LIVING ROOM Small wooden composite material table $ 3.50 TV -not updated to digital $ 5.00 Small clock $ 1•~ 41ong drawer drop leaf desk $ 55.00 Small lamp table $ 2.00 Glass based table lamp $ 1.00 Assorted misc. knack-knacks $ 2.25 Upholstered chair $ 4.00 Small wooden arm chair-pillow cushion seat $ 4.50 Small floor chest $ 3.00 Small oval coffee table $ 3.25 3 seat couch $ 21.00 Small plastic knack-knack table $ 1.00 Round lamp table $ 2.75 White vase lamp $ 1.30 Upholstered chair with foot rest extension $ 6.00 Wall mirror $ 3.00 Wall pictures $ 2.25 Small drop leaf table $ 14.00 Small ladder back chair $ 3.00 Small ladder back chair with arms 3.50 SUBTOTAL $142.30 KITCHEN Assorted hand held & small appliances $ 5.00 Assorted pots, pans $ 6.00 Assorted plates, dishes, etc. $ 3.00 Assorted kitchen utensils 2.00 SUBTOTAL $ 16.00 PATIO ROOM Assorted Reader's Digest Condensed Books, Book Club Books $ 8.50 Couch $ 15.00 Old upholstered chair $ 4.00 Small table & lamp $ 2.25 Wicker basket $ 1.00 Small fold up tray $ 0.25 Small stool $ 1.00 Fire place set & basket $ 14.50 Coffee table $ 3.50 Assorted knack knack $ 2.75 2 old small ladder chairs $ 5.00 Table clock 6 small Hummel figurines (3 1/2 inches tall) SUBTOTAL OPEN SCREEN PORCH 3 Pieces old lawn fiu~niture Small round table Assorted knack knacks Old wooden knack knack shelf Plastic waste can Small lamp Small table Magazine rack SUBTOTAL GARAGE Assorted garden tools (no lawn mower) Old short aluminum ladders SUBTOTAL HALF BASEMENT Washer/Dryer & ironing board Assorted small cabinets Standup wooden cabinet Old wooden table 2 plastic buckets, mops, etc. SUBTOTAL FRONT BEDROOM Dresser & mirror unit 2 small wooden chairs Chest of drawers Small desk Small table & lamp Small head board Clock SUBTOTAL BACK BEDROOM Metal head board Dresser & mirror unit Table lamp Low chest with drawers Small upholstered chair SUBTOTAL $ 3.00 S ce ,p~p,,,w,tt V~t~ u •. hen d a~a $ 60.75 $ 6.50 $ 1.75 $ 2.00 $ 1.75 $ 0.10 $ 0.75 $ 1.00 0.50 $ 14.35 $ 7.75 3.00 $ 10.75 $ 22.00 $ 6.50 $ 7.00 $ 3.00 3.00 $ 41.50 $ 38.00 $ 6.25 $ 11.75 $ 18.00 $ 3.25 $ 4.75 0.75 $ 82.75 $ 15.00 $ 33.50 $ 1.00 $ 7.75 3.75 $ 61.00 2 BATHROOM Plastic waste can 0.25 SUBTOTAL $ 0.25 TOP FLOOR BEDROOM Headboard $ 35.00 Chest of drawers & Mirror $ 55.00 Small stand & lamp $ 4.00 2 Small wooden chairs $ 6.25 Chest of drawers $ 21.00 Captains folding chair $ 2.75 Small wooden chair with pillow seat $ 4.50 Small luggage set $ 4.00 Small round stand $ 1.75 Old chest $ 5.00 Old sewing machine $ 6.25 Old white painted chest 2.50 SUBTOTAL $148.00 SMALL ATTIC Old accumulated and assorted materials of no substantial value 10.00 SUBTOTAL $ 10.00 TOTAL $ 587 ~ 3 Citizens Bank- October 6, 2009 CHARLES E SHIELDS III 6 CLOUSER ROAD MECHAIJICSBURG PA 17055 Estate of MIRIAM D DODDERS Date of Death: Jun 18, 2009 SSN: 209-07-3565 Dear Sir/Madam: ,t,~.ei~ ~m/~J/,~-. ~~ ~ 525 William Penn Place Suite 153-2618 Pittsburgh,PA 15219 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Barbara Richards Operations Services ,~", Cltize~sBank• Account Number 6221033199 Account Title MIRIAM D SOUDERS Date ed 3/11/2008 Account T Checkin Princi al Balance as of DOD $31171.61 Interest from Last Postin to DOD Account Balance as of DOD $31171.61 YTD Interest to DOD $118.17 Sep. 1B. 1UU9 1U:14AM PNC BANK 411-IU5-Z 141 L,F.AQlNG TFl~ WAY September 18, 2009 Charles ]; Shields 111 Attorney at Law 4' Clouser Rd Mechanicsburg, PA 17455 RE: Miriam D Souders SSN: 209-07-3565 DOD: OCr18 2009 Dear Mr. Shields: No. 9375 P. 1/1 In response to your request £or Date of Death (DOD) balances for the customer noted above, our records show the following: Check Account Account # S 140168529 .Established: 05.12-198? MIRIAM D SOUDERS DOD balance: $ 27,154.44 + 0.73 aecruod interest Interest paid OI-O1-2009 thru 06-18.2009 . Im-es#ment Account The decedent maintained Investment ,A,ccouat ?8868546. For further information, you spay call the Brokerage Departonent at 1-800-762-6111. ' Please cote that tMs office provides date of death balancxs for deposit aocoums (IItAs, CDs, Ch~clcing and Savings). R+e do aot pmce.+s say fiaucfal traataetioaa or provkk sfiatemeats. ffyou need $ssistaace with any of these items, please call 1-888 PNC-BANK (i-88&762 2265) or stop by your local PNC ~+nnic branch office. sincerely, National Financial Services Center PNC Bank, NA. Member FDIC Page 1 of 1 _ _ ,_ ltvltlll•itiL LV 1 •y111111V1~1M 1'lvVl~ilvl,' LV1t1t~G1! IJVI_'.L-~L al^.l~G1Vt11J~ - Cl3ily ill... Yage 1 OI L ~~ ~~` ~ weed Buy 8e11 My eBay ! Community !Help ~i~:~kl~ Sign out You'ro Invited! Join eeay Bucks. Site Map Categories • ~ Motors Stores ~ Daily Deal Back m Searth ResuRs I Listed In uos9ory: CoOactlbles > Decomtlve Collettlbles > Detoretlve Colkctlbk Brandt > Hummel, Goebel > Pi9urines Bidding has ended on this item. Rem: IIUMMEL BOY 1MTH HORN Fl(3URINE MARKED OOEBEL SERENADE Recommendations for you Goebel HunerNl Rpurlne W.Gemwiry ... ;288.89 Sh 42m RUNNEL GOES -EARLY FR'sURINE OF A ... Si99.00 ld 16h ,~ s ,~ GoebM Hummel HUMS SSIENADE Boy ... 560.00 3d oh i I I Goebel M.I. Hummel 217 nouru» Boy ... 5188.86 4d 4h More from the same seller GONONSBURG WILD CLOVER DMLED I~SCa DTSH Saes 9h 31m ii BLACK AMETHYST VASE BUBBLE DESIGN 59.ee 10h 31m ^ i ~ GOEBEL Hurtrriel BOY Wltli Gwbel Hummel Rpurlne- Hummel Goeb11 tSOY AOur1M AccoRDIAN ... BoY wNh ... Bsro ... :14.86 59.00 548.88 ld 15h Sd Bh 24d 3h i 1 ~ I i ~ ~' ~ ~ ! .~_~ Hummel Goebel #Sa Mumrewi BE MINE Goelfel A GREAT F11 G0~9. Pleymabs (Boy ... F9purbie ... FIGURINE' ... 546.00 560.90 548.88 4e eh 70 13h 1od 13h -~ VIriT~.E WATT 1940 ARCS MARTIN LB40Gt5 FRANCE MCCOY CJWYgN MES4 COVERED CASSEROLE WYLIE NEW ... STONEWARE VII ... 59.89 Sees 514.86 id 10h 30h 41m 4d lih RUNNEL BOY WITH HORN FIGURINE MARKED OOEBEL SERENADE ` Item conddion: - ~ ~`+~~ `~~~ Ended: Oct 18, 2009 18:30:52 PDT Bid history: 5 bids ~\~-~~~.~ C ~~~` L•.. Winning bid: US =27.66 Shipping: 58.86 US Postal Service Prbrily Mal sw ap deta9s 6tbeahd delNery vdtl,ln 12-13 business days Returns: No Returlre Accepted Coverage: Pey with PMyPM! and your ful purchase prbe is covered ~ See arms Seiler info nt~(~ak) 10096 Podl6ve ~edtrack ehk eeNer ~~ i Ofher Item info } Item number: 250613188002 Item locat~on: TueldtarNlDCk, Pe~ttyhle~ United Stag Ship>;f to: Unbd States Payments: PayPsl see datetls __ Share I~PriM http://cgi.ebay.co -BOY-WITH-HORN-FIGURINE MARKED-GOEBEL-5... 1Q/31/2009 zeoni lnlerpe _. UVriLSl".L W/lTD1t1V1t1LV Y -7 W IiI.1 1V1U~Jll. fh/OV ^' t1UlV1iV1t.L ' GDQy l1LGllt LOV~F11 / /77... rtl.~'jG 1 V1 G o fi «' nom' Buy !Sell My ef3ay ~ CommunRy Hsip Sign out You're Invkedl Jdn eBay Bucks. Ske MaP Categories • f Motors i Stores ~ Dairy Deai ~ r-~ ~ - - ~ .nrr~oer.aor., Beck oD Search Rewles i LbAed In category: Cdlactlblas > Decoratlve Colactlblas > Decoratlve Collectible !trends > Hummtl, GoebN > Flpurlnas Bidding has ended on this Rem. Rem: CiOEBEL WK3ERMANY SWEET MUSIC #786 -RUNNEL i Recommendations for you .7 ~ MUSIC ... 549.89 3d 13h Free ShiPP~e i . - -I i I ! i Goebel HumnNl Stwet Musk '~ 186 TMK3 ... s119.9a ild lOh a .. 1 ~, ~ RUNNEL GOE6a 'SWEET MUSIC" MARK 5 ... 5176.00 9h 2m Free ShlPPlne r ; f i i i Goebel Humnel'SWEEr MUSIC e186 ... 5110.00 23d 17h Pree'-~PPIne 1 More from the same seller i I RUNNEL GOEBB-,Germany ... Sts9.9s ~d 3h 11 Nj,'h •~./ Hummel ~ iB6 "Banat Music' Ftpun ... 5186.00 27d 6h i~ -_~ Vintage Goebel Hummel 5' Tab ... 524.98 2d 4h ii • Goebel Hummel 5' SWEET MUSIC Boy/ ... 5110.00 13d 13h 512s.oo 2d 2h 1 i ~_ -~ YNISIC rN/MAEL FIG iili~ «1 Goebel: Hummel: (Sweat Music No. 186 CE '. Ss9.fio 7d 13h j TRAVEL INfO CENIER SIGN ADORABLE SET OF 3 DOGS ADORABLE SET BLACK 2 VINTAGE FL]HT -..: VINTAGE WOOD ----- METAL ON ... VNrTAGE ... POODLE SALT a ... STAHi1.E55 U.S.A.... Hl1NW.E IOiB°E ... 59.99 54.99 54.8! 523.76 54.9Y Bh 53m eh 58m 9h lm lOh lOh Im i. j GOEBEL W/GERMANY SWEET MUSIC X786 -- ~ Top-rated seller RUNNEL "~ ~~~Q~C~ ~ #4L~tsqu'"atya' (1332 Item condkion: - ~ i~e ~7~ ~- 99.49b Posf~Ne feedbeoit Ended: Oct 25, 2009 08:19:50 PDT ~~ ~^ ~ ~ndv ncdva highest yen' ratings Bid history: 5 bids `N ~j ~~ ,~~-~,;~ l ships rounF qukkiv ~~ ~~~ ~.~~-~\ '\ V )it "des earned a track raeord of Winning bid: US S28.Q0 I exceBentskake i Ask a questlo~ ~ Ssve this sal Shipping: 57.66 US Postal Service Peroel s« othw Post Sa more awltes . ~ Sw aN datslls Estaeated daWary wlthN 7-1~ busbess days Returns: No Returns Accepted Goverage: Pay wkh PaYPar and your fuN purchase price is covered (s« ems _ ZOOIn F.nlerga f j Other iterKt Info ij http://cgi.ebay.corn/GOEBEL-W-GERMANY-SWEET-MUSIC-786-I-~ WOQQi.. 10/31/20Q9 nuivuvlci., rlvutcuv~ i r urr Y Lv V 1/_ 11Ylli b - essay (liem L /U4 /V'fbJLJy erict ume ... rage 1 of 1 ~ c'"s- Adreetea ~~':~~ ~ seereh Buy ;Self My eBay CommunNy ~ Help Sign out You'ro Invited) Jokl eBay Bucks. She Map Categories • I Motors I Stores ~ Daily Deal Back oo Search Results I Listed In caospory: ColNctlbles > Datontlva CoNectlWas > Decwetlve Cdlectlda Brands > Hummel, Goebel > RpuHnes - Bidding has ended on this Item. Item: RUNNEL FlOURII~ 1 "PUPPY LOVE" TMK 6 Reconr>tendations for you . ~ _ i ' I ~ , ~ j ~ I i ~ ~ i ! ~ i i ~ - ' i Goebel HU~N7E1.16/1 LITTLE HU4M~EL GOEBEL FIGURINE Humnfal STORMY WEATHER GwbN RUNNEL 136/1 Hummel a Sansitlve 1 HnQ3t ... -WAYSIDE ... Gwbel ... FlpuyMt ... Hunter ... ' ;88.89 ;36.OD ;235.86 '1;89.88 ;18.89 22d 13h id lOb 2d Oh 22d lOh Sd 6h i i { I i j ~ i I ~ ~ l f i f ' ~ I ~ i i i L ~ ._ Flunlnel 12/1 Apple TnN RUNNEL FIGURINE •71 M.1. tlurtsnel Npurhla 8129 N11b~ HummN APPLE HUMMB ' GIRL" Boy 6' TMK ... STORMY WEAT1iElt ... 'Bend ... TREE GIRL ... FIGURtNE - ... ;88.96 X3.60 ;148.88 ;t68.88 ;176.00 3d 6h py~ ghlPpbw 13h 20m Bd 13h 19d 23h 20d 6h i More from the same seller ': .~ '.. RUNNEL FIGURINE 59 Goebel Rpurinas 3a9 (plrl ... RUNNEL FIGURINE S3 'SkNr' TMK 6 "1oYrul' TMK S ;14.80 ;14.80 ;14.80 Sd 8h 7h 25m Sd 9h i RUNNEL FIGURINE 1 "PUPPY LOVE" TMK 6 ~ seller ia7lfo ' Nem condition: - ~ i ityak-198Q (57 Ended: Oct 22, 2009 00:50:43 PDT 100% PosNfve feedback j Bid history: 10 bids i ~ a y~ n ------^-- , Save tl+lk sejNer i ' Sae otltar aMn Winning bid: U$ X42.89 -------------------- Shipping: ;7.46 US Posist 8egtrfoe PriorNy Maq ~ Other 1t~rt1 IMo I Sw aN datatls Item number: 27047086259 Esteeatea OeiNery wahln a-5 business days ~' Item location: YVarmkTater, Returns: 7~da~y e~xckhenge, buyer pays rattan shipping I PA, Unllsd States Coverage: Pay with PJq/AL/ and your tut purchase piii:e ~ Ship>„ to: Worldwide k eoverod I sae Dams ~, j Paymehts: PayPal ~ Zoom E"larya See dwlu ®~ ® ~ ~ ! share {~1Prfnt http://cgi.ebay.com/HUM1v~L-FIGURINE-I-PUPPY-LOVE-TMK-6 WOQQitemZ2704,.. 10/31/2009 V liv i A17~ riU1V1M~L .LU i L/U 1CL l .tC~A 1 1 V JAt' L 1 Y 4" l A1..L V ti~~ - ebay (iteril 1~... Yage 1 oI 'l s Aa"""d Bu 'Sall ; M eea ~ Commun ~ He starch Y ; y y ; Ily j IP ~~: Sign out You're invitedi Join esay Bucks. Site Map Categories • I Motors I Stores ~ Dally Deal I ~~ Beck t" Search Results I Ustad In ca0epory: Collecrabks > DecarotWe CoNactsbks > l>ocoratlve Collectsbk Brenda > Hummel, Goebel > FlpuAms Bidding has ended on this Item. hem: VINTAGE HIIMMEL 201 2/D RETREAT TO SAFETY 4" TALL VBEE Recommendations for you --- -~ Humnwl Goebel W Germany 1 198 ... :'18.96 '; 6d 13h I -R,MMa. GoEeEL FIGURIh1E 201 n ... 51as.oo `, led lsn RUNNEL ti0E8Et. FIGURINE 201 RETREAT ... =80.00 2d 3h ,_ J M 1 RUNNEL GOt~ RETREAT Tk) SAFETY ... 684.96 Sd 3h aMsroe ®~ ~~ RetrMt to Safety - N201 HummN ... ;388.00 1d 2oh 1 Goebel Hummel FIpw1M Retreat to ... =9.89 3d 12h r , i l MI Mumnwl RETREAT To sAFten ... 586.00 21d SSh VINTAf3E RUNNEL 201 Z10 RETREAT TO SAFETY 4" TALL VBEE Item k:ond'Rial: Ended: Oct 27, 2009 15:61:46 PDT Bid history: 3 bids Winning bid: U$ :32.99 Seller itNfo bridalwreilth (1025 97.4eK PositNs feedback 1 ----- ~ i Ask a quesNbn i Sava tlik seller See otMr Rams -----....__..T_ __-------- ---... ~! Other helm Info i L Item numHer: 230391268807 Item bcatihn: Bridgewater, NS, Canada Ships',t0: VYorldwide Payments: PayPal ~ Sae doves Share fQiPrint ~ Report Rsrrl Shipping: Read Nem descdptlon or contact aelbr for deteYs. I se. s0 awns rstlmated delhery runt rarles I Returns: 7 day money book, buyer pays rotum shippkrg ~ Rand dwib Coverage: Pay with Pf/SFM/ and your tuN purchase price N covered (see terms ', DescHptlon Shipping and payments Item speafics Type: Figurine Brand d< Maker. Hummel Original or Reprodudlon: OAgklal Theme: COLLECTIBLES, DECORATIVE, Hummals Materiel: (isrman Porcelain http://cgi. ebay.com/VINTAGE-RUNNEL-201-2-0-RETREAT-TO-SAFETY-4-TALL-... 10/31/2009 VINTAGE RUNNEL RETREAT To sarEry ... 546.00 3d 7Fi 1 hurrenel poebd 201 retreat t" ssrety ... 547.97 ilh im l"aebel Hummel' R~estTo sir' ... ;276.00 3d 3h Wayside Harmony 73 under completed listings Listed from $14.99 to $99.99 Sold from $19.99 to $75 Most fold $20-$35 ~ P -n~aC~l• (~ ,~~-~~ ~~ ~~ r S Just Resting 79 under completed listings Listed from $10 to $189 Sold from $10.50 to $215 Book value $300-350 Most sold $30-$45 ~, vG . ='3 7, s~ Two sold listed together ... $33 -$65 ~ NEW150BIX+(471 SCHEDULE F COAedONWfJ1LTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RE NT DECEDENT ESTATE OF 50U OEI~S~ Mll2//~ M ~. FILE NU~ER Z~,' 0 9 _ S?.2 Man asset was made joint rriNrin one year of the decedent's date of death, it must be reported on Schedule G. -- --- SURVIVING JOINT TENANT(S) NAIAE ADDRESS ~fY w. s-nt vsoa sT mecN~tNlcs ~ k/t~, P/f !-7osS' A• M 1 KrA-m 5. CRRW FoiZD B. C. JOINTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDENT ~/~ucN-r~e ITEM NUh6ER LETTER FOR JOeR TENANT DATE WIDE JONT DESCRIPTION OF PROPERTY kldude mane d finenrtal insbtWion and bank aoooun- hurter or similar idenliyinp number. Allach deed for jainlly-held real estate. DATE of DEATH VALUE OF ASSET %OF ~ DECD'S ST DATE OF DEATH VALUE of DECEDENPS M~TEREST 1. A. f2)14 u.S. SA-v/NdS Soiv05~ SERIES HH ' as~b r~ loci ~-7 z HH ,, o00 . oo S~7o Soo, ao a~~ m bog sr~ ~ HH eoo.oo ~l ~~D ~SAO.OD y ~ s I 8~ .2 O H 1y , ¢5-, off, oo ISb~, fa, Soo. o0 TOTAL,(Also enter on line 6, Recapitulation} IT 3~ .r00. e o (If rrrore space is needed, insert additions sheets of the same size} i REW1510IX•(i8n COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VNOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ~ouDE-2S, I'M1~21,~M "D• e~/-o4-34~. This schedule must be completed and filed if the answer to arty of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY "~10En~""'E°FTME'a•TM~e"a""°~wT°°EC~oart""°'"E°"r~°F~ws~a ~rr~ACarroFn+EOEEnwrtnFxEar~h. DATE OF DEATH VALUE OF ASSET % OF DECDS INTEREST E~CLUSION e TAXABLE VALUE t. ~¢//~it~ L~~ ~iis~tr, Lei. ~A,iA•r~~, ~o~lSt~tcf' ~lv. G.9~ f~.~d`o7~6 ~.Z.?3, 3~ /~90 - jo ' ~~ 3sZ y. ,~!~/SCi,~~y •' /11ii'iHl ~- ~~ttfsvtr~ ~f~G~llr~~• ~CCCq~G>P'~ ~seeva/~ian /~`~ a~fxclr~a~) a, '~ ,/ " y f lZ o7 P360 /yletL. " /Tn/1K~ t(o/)TT'itG ~2a, ~7~.a1 /o0 90 ~ o - ~ a~, a~a. a ,Qt»e~iuary : /~)iritaJ S. Cr~cw~d, tau ti1~i' el' d~crd~nt ~se~ Va/ualS'on ~(efl~r Q1}Q~l~a) 3• Lincoln ~.nanc.a/ ~nnuit oo~ 013 Poll y, No. 3~~ X36, D53 ss /0090 -moo -- ~,36,os3 sS /~~ /~. ~y BU7e~jGl~l-~' ~ /,/~t/Q/r1.S. C./`~IdTD/~~j ~~/>I(EI" (sce Yalua~'en /erfi/- Q/fa coed ~RI!.S/~/11l/'/GQ L. ~i ~shlY. ~ . ~'~8 ~09 X02 /~Olrp .'`D - ~~/gj 10y, G2 /~n~u, y yo. a~ ! pis !2 ~C/ir'/SCiary.' ~I7iriR/11- S. ~/Yw~r~W; ~~~ / ( ~tG I~QII~IQ/~Oh ~C~Ci" A~tt~> l+kstt~n Na,~out/ ~,k ~risur. ~. lA/~~ J~, 3/9 9~ !o0 90 --o -- /5~, 3/9, 9s ~'1C/iua.ry: /~'!//'/4A! S G'hQlt/t~vrAl/ %bs' ~v- fuG U~Si¢ ~h~u>: y y L,~ ~i/sr~+r. Co• X46, 204. /0090 -o -- 9~, ~ 8 No. C ~ ~ ~S9 ~- C9 (s Is'x1te~Gi 47~y .' ~i a/~ S. C'raiv~r~, d~l7er TOTAL (Also elrter on line 7, Recapitulation) I s ' ~ /.+ ~. ~ 17, 4 3 /lf mnrP cnar.R k navrk•+~t incart arlrtitinnal chaatc 1ha. aamP Rt7P.i . `/- [v~u y-.v: jlrM ~,oisi2oos s:se:~.e ArI PAaE 2ioo2 Fa~No. 825~er P. 2 Agst:te Lift btsu~xnce Gompamy P.o. sox 94212 II, 600944212 Telephone: (87'7) 499-b418 Fscaimit7~e: (866) 635-4523 ~~~~ You're in gaud ts: October 5.2009 Todd Amold Perry PNC 4242 C.orlisb Pike Camp AiQ PA I70I I Re: I~iriu®D. Sanders Comex No: C}A29380746 Dew Mt. Percy: VIA FACSIIui11;E We ~eocived : request to IItS Form 7l2 for 8~e aboHe t~renced contract. The purpose of ~orm 7I2 is to provide an 4strde m donor with the value of a life iasm~mce contract or its proceeds se of a cepctyuin drte (uaaally the owner's dste of death or date of tiansfar of the eontrad). Because this ca~act is ~n mpauuty, it ib not reportable on IILS Potm 7I2 I can, however. provide the foUowiab iafo:m~ion for estate proposes: Date of Death: Jame 18, 2009 Am,~cy Value as of Date of Death: S 223,352.45 Cost Basis S 133.096.12 Named Bez~6c~up: Harbin S. Crawford '~'1'Le anal aaaotmR paid map di$er due to 1-darber Valve Adjustments and/or nay applicable S Charges. If you bane airy gnestiaos, please contact me at 1-877-499-6418 F_xt. 48371. Siacer+dy, Robin nay c~a ~~ 17C{.L1ZC MelL1~B investors USA P.O. Sac 1593 Des Manes IA 50306-3593 MetLife December 14, 2009 CHARLES SHIELDS NI (717) 795-7473 (FAQ RE: METLIFE INVESTORS USA MISURANCE COM~ANY CONTRACT 11075360 OWNER MIRIAM SOUDERS BENEFICIARY MIRIAM CRAWFORD Dear Mr. Shields: We are song to learn of the death of Ms. Souders. The fdlowing informaion will be helpful in settling the daim on this annuity contract In accordance with the policy's death benefits, the benefidary may choose one of the fdlowing options to settle the funds still acctimulating: 1. Request a lump sum payment of the cash surrender value. This value is paid in one lump sum, and it would indude all applicable surrender fees. This settlement must be made within 5 years from the date of the partiapanYs death. 2. Request that income begin immetiately from any of the annuity income options described ah the endased list Tttis chdce maximizes the benefits of the poky since 100°~ if the annuity value is applied to produce periocic armuity income. The guaranteed period of any option seleded cannot exceed the benefidarys antidpated life expectancy. Proof of the benefiaarys date of birth is required if a life option is chosen. Benefit payments must start within one year from the date of death. Because the policy is a legal document, certain forms need to be canpleted and returned before settlement of the daim can be processed. Listed below are the requirements to settle this daim. 1. The original poacy must be returned for lump sum settlement If it cannot be located, section G on the daim faun must be completed and signed. 2. The Poky Claims Settlement Form. Please complete sedion A. A settlement option must be selected as well as an election regarcing Federal Income Tax withhdding.. Please note thad sedicn F does not apply to the settlement of this daim. The value of the policy on June 18, 2009 was 522,272.21. If you have any questions, please contact your representative or call our Customer Service Center at 1-800-2844536 Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, 1L/ 14/ LVU`J' L : V'f : 4J Yl7 YHVC L/ VV / l7CLLl2E3 Mid~ael Irving Sr. Annuity Representa5ve -Post Issue Processing MetLife Annuity Operations and Services Cl Lincoln Financial Group® March 6, 2010 CHARLES E SHIELDS III ATTORNEY AT LAW 6 CLOUSER ROAD MECHANICSBURG PA 17055 2ND REQUEST RE: Miriam D. Souders The Lincoln National Life Insurance Company, Contract/Policy Number 382002013 Claim Number 643621. Dear Mr. Sheilds: ~~ ~ We have received notification of the death of Miriam D. Souders. On behalf of Lincohu Financial Group, we wish to express our condolences. Please submit the following items: 1. Claimant's Statement completed and signed by Miriam Souders Voight the beneficiary. If her name has changed to Miriam S. Crawford, we will need proof of that change. 2. A Certified Death Certificate of Miriam D. Souders, indicating the find cause end manner of death. 3. The return of the original policy. The value as of the date of death, June 18, 2009, is $36,053.55, the cost basis amount i~ $19,600.00 and the taxable amount is $16,453.55. Please call toll free (800) 487-1485, ext. 8584, or write to me at the above address if ydu have any questions. Sincerely, ' V ~~ • ~ ~t Karen I Russell Claims Examiner Greensboro Claims Department Enc. cc: THOMAS RICE CO HCB CHICAGO 53 W JACKSON BLVD #1101 CHICAGO IL 60604 ~I~tAN~AMF~tICA • LIFE INSURANCE C0IQPANY November 11, 2009 Estate of Miriam D Souders c/o Charles E Shields III 6 Clouser Road Mechanicsburg PA 17055 RE: Aaauity Number(s) ~614151Z Dear Estate of Miriam D Souders: ,, _ _ _ ___ .c~crG ~~ i d/ u y ~~ i~ r Transamerica Life Inanrance Company 4333 I.daeuvood Road NE PO Boz 3183 Cedar Rapids, Iowa 52406-3183 Our office has received your request concerning the above listed non- qualified tax deferred annuity. The above listed policy is 'not a variable annuity. The above listed annuity is a fixed annui y with an interest rate of 3.1~. The value as of June 18,.2009 was $4'8,909.62 with 12,581.98 of that being taxable interest. Any additional questions regarding this annuity can be directted to the Annuity Service Center at 1-800-238-4311. A Transamerica Life Insurance Company representative will gladly assist you with' any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, V(,UV1 Amanda Vavra Claims Transamerica Life Insurance Company Member of the ` '~. C~onp • ~r r~ . e REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEpuLE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF S p U DERS ~ I'1'1l Jpl A' M ~. FILE NUMBER ~ !" pq_ s~ ~- Dents of decedent must be reported on Schedub I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. />~rtcr C/'cA1R~i/) ,~rviCCs of ~4rrisOk,-~~ ~/1' Qer'~ bf f~4S aelAi ~• Re/!i~ Greer ~emt~ Co. o f Cana p Hit!, p,4~ ~bsl~~. B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 111112f/~/19 $~ C~.~W ~~ l~J~f y~ Social Security Number(sUEIN Number of Personal Representative(s) street Address Yy ~v. SI n~t,os oN S'~' ~,, /Y-ECN11A/~t"..Sd~lip,G~ ~ state .~ rrp / 7o,S~ Year(s) Co/m~m/fission/Paid: ,ss~• 2. Attorney Fees 1. ~[RrrCS E o~ti~G~q~S yx t ~6~ /D0~ pO 3. Family Exemption: (If decedent's address is not the same as claimant s, attach exploration) Claimant /VeNE E'G/~/~iLE' NONE Street Address City State Zip Relationship of Claimant to Decedent 4. pp Probate Fees ~ e~ia i ~ isi ML eI" Sltsrt Ctrti f~i~tq,}td ~~ ~ ~, ~ 5. Aa~untant's Fees CrY~tal off: Of'11Gr try, CP~4 f ~ 6. PKP• eJt~se ortf Info, O~ ~fo, toil, P~ yl, f~• ~tsK~.1 Tax Return Preparer's Fees so.oo ~. /~~/e'i~i'von/ ~~ Cer~inCQ1~ ~!?.00 R'• ~rtutisi n~ - ~'tr~sk Sent%nc/ ~ ~ y S ~b Q tt 14dvert~s~~ - Cumdf:/'~ano~ ~-M,- cl0Krrla~ ~ ~7S.o0 /o• ~~prsia..l /ra,/f'ens, ~r'G~ ~eh!'~ta.ler deg oLpp~~titct~ o~ re+~1 es>~ • ~3 00. vo I (. ~,1~/:>~J o~ / ~re 6,~ t Feces {~ IP s ffr .f ldi//s ~ ~ o o. 00 !2 ~%ir F~ t ~'e ~ski• ~ !•v%I~s ~Ee Ceab~. shccf~ /~'.oo TOTAL (Also enter on line 9, Recapitulation} S 39, 30D,'70 (If more space is needed, insert additional sheets of the same size) EsT a~ SoalDE7QS /11/~Q/~h1Y ~. fiic~- yy. .Z/-o9 S~ l3 ~SSO/'ftA~ ~4 o~~C /1~ oS`jtc ~ ~! Q~ZlG etc' ~E~~irt' L:rye //Di6 NoT F ~s ~ %S. aiD ,(.'mac !Zn ~eQ %t ! ~ Loo.eo ~d ~ i~DP/~ KG ~ L,iae /3oS~ T.crc C'u~f,%r ~ Trd,Yt Sd~I^ o_ mo ~/ ~eint 6u/^SeA /y ~~~~s ~ c~~~:~Sl~' ~r ''~~~-'~-e-~-~-- o~ e cer~ ~e~ ~l~i~/~ ,s e7~ . ~Gs~in+. ~ ~9 6 , Sb /,$. /IYlQil70/l0~ Oil/Q ~~I'r'i I"iGa/Z ~~7• ~D 6, t~m to Charles E• 5h. Q,Ivls 3 ?.ea / 44a~mbarae~ne~t ~ ;~~a~n s. CrcwF~rn~ {wr Cosls and bus a~ r~ ~ ; ~,~~~ Q~~~~ ~~s~~~~ _ /Y. /~vyto;e /1!i /er a~ Csll r /~•b T '~j, ~f59. ~ / , /CAL, Alec Scry;cc _ _ ~3a- 7/ ~o. u GZ G.fi 1: kcs, f y'f• 3S d t. kortlis f3 1-'la;nf: L,tw Tr ct tpo, o0 ~.~ T "M~u~an /urnb:n f ht~+. -- it o~ furnace rnr sJe. ~`14q, o0 3, i #.T~ ~ o ~~ /Sor~- s 13! IrI .~. ~ 7S. 00 ,ZS, ~'fcrrfr mac. 1~ Cfn. :r ~ dale fi odp, ov ~~. UcI k~ili~'~s ~ 9/. Bo a7, Ler~ ~,ll ~' 'ina S~wcr' ~9G, o0 GI' 30.7f~ a . ~Pt '`~~.9~ 30. o r. • ~ Kr. ~SSaZ. 00 3 ~ is /hoof o~, o~ ~ y oao. eo 31, U Gz ~.fil'~~-cs ~ ~ i. o0 p.3 SC~e~ N., Ce~~d ~~ o~ A Fit.F ivo. -o 33 PPc ~`,Z si Pa /~. ~cr Xi3, ~ 35 ~Iw~wb~ ~ Hca~+' ~ecen~i' urirt rCt~ t~. ~r Sit o{~ {~v .off ~~' ~ r ~~ FS7atL -Sa ~~DO, 00 3 Ppt ~9. qs ~ ~ ~ IM~ ~.G~ur~'1 t,~t. ~~OS, DD 37- ~ ~ lv~,- ~1 z.53 rsE~a Est. mot. w; .~,~ ~ ~~ Xl~. ~ o _. __ ~ ..~ 30.E O a~s~c ~.~~~ - ~~tR~ .. ~.~ ~ ~I ~I~i•~ c,{~~ ~~, t2C PPt~12.1~ ~~~ 2, 5r, o . oc7 ~~~ZQ ~M~~i.~_ .... t S1. Z~ -t ~q ~~ u~~tJ~vM ~P~ t ~ ,~, ~ l 9 _ vc~ ~ _ __ .. _ __ _. ~ --~Q ~ .~ ~, . . __ _ ~ ~# 4 ©. ~ 8 -~ ~ Zo ~ Sit-moo: . w . g~ a,t - _-~. .. . a ,-.t. v:f~ • ~ ~~ J7- '~" Glenda Famer Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, IEsq ' solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE ~:D360?6 L'SDf, ~6 C 1:555 ~ 2481' 1370 ~~. Checks should be made payable to the Register of Wills. Terms: Net 30. Please xet:uxn one copy of this invoice with pour payment. Thank you. __ i-7 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARMER STRASBAUGH Receipt Date: 6/24/2009 Cumberland County - Register Of Wills Receipt Time: 12:20:47 One Courthouse Sqquuare Receipt No.: 1057263 Carlisle, PA 17Q13 SOUDERS MIRIAM D Estate File No.: 2009-00592 Paid By Remarks: CHARLES SHIELDS III WZ ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 60.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY '.. GENERAL FUN SHORT CERTIFICATE 32.00 CUMBERLAND COUNTY ' GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN --- Check# 1328 ------------- $122.00 Total Received......... $122.00 ttC I/111V 11'lIJ P'ViC I IVIV f'lJR ~ VVR RGVVI\/J ~ THS SLNTINBL - LLGAL CHARLES SHIELDS P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 374465 10 PUBLIC NOTICES kamok 09/24/09 26 * 2 AD DESCRIPTION START DATE SOP DATE EXECUTRIX'S NOTICE LETTERS TESTAME 09/10/09 09/24/09 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 138.06 TOTAL AD CHARGE 138.06 3 PROOF OF PUBLICATION OlPRF 7.00 PAY THIS AMOUNT Est Miriam Souders MESSAGE: Thank y Deadlin , 5 p.m, ~ ~ Thursd is wedrl ~ - ~~~~ _ If you Classic Fax yo ~ ~~'~~~~ You c Please t __ . -_. _~- 145.06 174.07* DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL -LEGAL Est Miriam Souders P n RAX 1?S'(1 r4Ri ISI F PO ~7fM~ AD NUMBER CLA SO START ATE STO A 374465 PUBLIC NOTICES .09/10/09 09/24/09 AD DESCRIPTION ILLING DATE TELE ON NUMBE EXECUTRIX'S NOTICE LETTERS TESTAME 09/24/09 717-766-0209 CHARLES SHIELDS 6 CLOUSER ROAD MECHANICSBURG, PA 17055 In~Illn~lilnnl~lu~~lu~l~l~ GROSS AMOUNT OF 174.07 DUE AFTER 10/24/09 TOTAL AMOUNT DUE 145.06 ENTER AMOUNT ENCLOSED 20200000003744650000000000000001740700000145067 CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHAMCSBURG, PA 17055 GEORGE M.HOUCK (1912-1991) September 4, 2009 Ms. Becky H. Morgenthal Cumberland Law Journal 32 South Bedford Street Cazlisle, PA 17013-3302 Re: Estate of Miriam D. Souders File No. 21-09-0592 Deaz Ms. Morgenthal: TELEPHONE (7I7) 766-0209 FAX (717) 795-7473 Enclosed please fmd the Executor's Notice for the above estate to be advertised in your journal three times. I am enclosing a check in the amount of $75.00 to cover the costa Please forwazd proof of publication to me at the above address. Thank you for your kind attention to this matter. very truly yours, Chazles E. Shields, III Attorney-At-Law CES/mjj Enclosure renns~nvan~a c~,~~ / For-.,~~ ~-_""- ,~ C. x:0360?6 ~50~: 6 2 1555 i 248~~' 1368 )~ ', REV-1512 EX+ (12-03) coMMDNwEALTH ~ PENNSnvANw INHERRANCE TAX RETURN RESIDENT DECEDENT SCHED~iLE 1 DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & LIENS ESTATE OF C D u D~s' rn' ~' ~~ ~ . ~~ILE NUMBER d ~v-o9- s9z Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unroimbursed mledicai expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Re;w~bursemenf Te Pe~n~t. ~~t,l'e ~'ntployett Retireritcnt Sys. I, ~ -~r over pla,~ntC„t ~~ o(arYS e~ Jrtine /9 f~r•4~l- Jicnt ~D, ZOO9 .756.70 .?. lower l~ller- TwP•~ $cwer ~ Trash "96.00 j, Yeriton , /Jlsoat 6:// f/5/. 99 ~• ~ /r/!lCI'~GtM W~' i Gva1.cr kraice f.ZG. ~0 5; K.rt1~i"s 8/da• /11a;nt., L+cwa Care '`Go.oo TOTAL (Also enter on line 10, Recapitulation) ; I s'f~~,37 (If more space is needed, insert additional sheets of the same size) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of TYindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) Linda Dolan, Administrative Assistant Commonwealth of Pennsylvania State Employees' Retirement System 30 North Third Street, Room 319 Harrisburg, PA 17101 August 24, 2009 TELEPHONE (717) 766-0209 FAX (717) 795-7473 In Re: Estate of Miriam D. Souders, Deceased SSN: 209-07-3565 Invoice No.: 21235 Deaz Ms. Dolan: Please fmd enclosed the following items: A) Check No. Ol -0007 in the amount of $256.70 in reimbursement for the overpayment to Ms. Souders for the period of 6/19/09 - 6/30/09. B) Copy of your correspondence dated July 9, 2009 and August 17, 2009 for your ready reference and convenience. C) Death Certificate. Thank you for your kind attention to this matter. Very truly yours, ~0 ~~~~ ~ Charles E. Shields, III Attorney-At-Law CES/mjj Enclosure COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM HARRISBURG REGIONAL COUNSELING CENTER 30 NORTH THIRD STREET, ROOM 319 HARRISBURG, PA 17101 TELEPHONE: (717) 783-9065 FAX: (717) 783-9599 TOLLFREE: 1-800-633-5461 www.sers.state.pa.us July 9, 2009 Estate of Miriam Souders C/O Charles Shields Esquire 6 Clouser Road Mechanicsburg PA 17055 Dear Mr. Shields: Invoice # 21235 RE: Miriam Souders SS#: 209-07-3565 We have recently been informed of the death of Miriam Souders, a retired member of this System. We wish to extend our condolences to you at this time. Since Ms. Souders died 6/18/09 and the June check was not returned to our office, this account has been overpaid in the amount of $256.70 for the period from 6/19/09 6/30/09. It will therefore be necessary for our office to be reimbursed for $256.70 to liquidate this overpayment. The reimbursement should be made payable to The State Employees' Retirement System, and mailed with the enclosed copy of this letter to the address shown above. We also need a certified copy or an original death certificate for onr file. Upon receipt of the reimbursement, this account will be closed. There are no further benefits to be paid from this System. Should you have any questions concerning this matter, please do not hesitate to contact me at the above address or by telephone at (717) 783-9065 or 1-800-633-54b1. Thank you for your cooperation. Sincerely, . ~ri~JIGt1 ~ Linda Dolan, Administrative Assist>~nt Harrisburg Regional Counseling Cehter Enclosure i T REV-1513.EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE J BENEFICIARIES ESTATE OF FlLE NUMBER $ 0 U DEIQS, /Y1 J R I A• M 17 . o~ l- D 4- S Q .~. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not Uat TrusNs(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (t.2)) 1' MIRI/~D1 S. CI~ZIlNl~'oi2fl , ~»rnltr~y ~nouM at ~/}1161~~T~Q /OD 90 mra,~m S. VoI~NT y4 w• sin~~soN sT. rnE cH~N IcsBaa~, pA Ross' ~'/1VFo N,T~ A1- eA~RacyN souQE77S p'ee~~gstd fP~ de~crJcnfi hcr~in ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON R~11-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (li more space is needed, insert additional sheets of the same size) ___ _.. LAST WILL AND TESTAMENT OF MIRLAM D. SOUDEH:z- _ I, MIRIAM D. SOUDERS, 23 Highland Drive, Camp Hill, Pennsyl- vania, being of sound and disposir-g mind, memory and understanding, hereby deolare this as and for my bast Will and T~'atament, hereby revoking arty Wills heretofore by me made. rmEM ONE: I give, devise and bequeath my entire Estate, real, personal or mixed, whatsoever in kind, or wheresoever situate, to my daughters, MIHIAM S. VOIGHT, Camp Hill, Pennsylvania, and M. CAfiOLYN SOUDERS, Camp Hill, Pennsylvania, in equal one-half shares sash, share and share alike. Should either of th~km fail to survive me then the survivor of them shall be entitled to'!my entire Estate. ,~„TEM TWO: I nominate and appoint my daughters, MIRIAM S. VOIGHT and M. CAROLYN SOUD:ERS, to be Co-Executrices of this my Iasi Will and Testament, with a further proeiso that t11ey, nor neither of them, shall be obliged to either post bond or aGSk leave of Court, in this or any other jurisdiction in which they many be obliged to act hereunder, in the discharge of their duties hereunder. IN WITNESS WHEREOF, I have hereunto set my hand and seal this Sf day of ~~~ , 1973• ~. SEAL) • i ism Souders Signed, sealed, published and declared by MIRIAM D. SOUDEHS, the above named Testratrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence, and in the presence of each other, all being present at 1She same time, have hereunto subscribed our names as witnesses. .-~ / ) i ~,z~l~('~~, ~ 4~f address // ~ Q ~~ ~ ~' C~~1rc;=.L. ~r~. ~:u~ address ~~ S~ C_`~• ~.~~a~aZ`~t.~ ~.~~' f4