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Home My WebLink About08-25-101505610143 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 ~ ~'~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 549 89 4970 02 14 2010 Decedent's Last Name PEARSALL (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Date of Birth 12 27 1985 Suffix Decedent's First Name MI KEVIN ~7' Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE PILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required 6 Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust (Attach Copy of Trust) ~ 8. Total Number of Safe De osit Boxes p 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 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 - JAMES D BOGAR 717 737 8761 a,,,~ First line of address ONE WEST MAIN STREET Second line of address City or Post Office State ZIP Code SHIREMANSTOWN pA Correspondent's a-mail address: Jbogar@bogariaw.com - _. -, -' REGISTER Q~F-~LS USE~IVLY ` -, ~--3 'v.~ f'4` I art-: ..~.~~. ~~~ ~.~. _.._ _t _.._. a-.~ DATE FILED r`=' .:.~~~ ~~~) .: ~, 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 t e, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA E OF P N RESI~O~LE FOR FILING RETURN DAT~ ~ Gregory H. Pearsall ~~ ~~ 1~ ADDRESS 4 1214 'n s Circle Mechanicsbur PA 17050 SIGN RE F PREpA R OTHER THAN REPRESENTATIVE DATE /////J James D. Bogar ~~~~~0 ADDRES One West Main Street, Shiremanstown, PA Side 1 155610143 1505610143 J J 1505610243 REV-1500 EX Decedents Name: Pearsall, Kevin J. Decedent's Social Security Number 54 9 8 9 4 97 0 RE CAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 711.58 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5- Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 3 , 2 68.73 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 4 7 6 . 5 9 7. Inter-Vivos Transfers & Miscellaneous ~.oq-Probate Property (Schedule G) u Se arate Billin R d t p g eques ............ e 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 4 , 4 5 6. 9 0 9. Funerai Expenses & Administrative Costs (Schedule H) ....................................... 9. 8,214.82 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 2,299.91 11. Total Deductions (total Lines 9 ~ 10) ................................................................... 11 1 O , 514.7 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. - 6 , 0 5 7 . $ 3 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. - 6 , 0 5 7 . $ 3 TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due .......................................................................... ....................................... 19. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1,505610243 ],505610243 0.00 0.00 0.00 0.00 0.00 J REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: DECEDENT'S NAME Pearsall, Kevin J. STREET ADDRESS 1214 Kings Circle CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits; 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (1) Totai Credits (A + B) (2) (3) (4) (5) 0.00 0.00 0.~~ 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 :............................................................................... ~~ b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... C~ d. receive the promise for life of either payments, benefits or care? ............................................................. ~I x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......................................... ~! ........................................................................ x 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 j72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) ~, SCHEDULE B ,. ~ STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Pearsall, Kevin J. _ _ 21 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Series EE U.S. Savings Bonds -Consisting of nine (9) $50.00 711.58 Bonds and one (1) $100.00 Bond. Total value per attached Savings Bond Calculator. TOTAL (Also enter on Line 2, Recapitulation) 711.58 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 02/2010 Page 1 of 1 Total Prime Tota! dlalue Total Interest l'TC~ Interest $275.00 $711.58 $436.58 $5.42 Bonds: 1-10 of 10 Serial Series L281616097EE EE L524229612EE EE L586595075EE EE L605755508EE EE L477858345EE EE L507171815EE EE L516547402EE EE L495082499EE EE L274973433EE EE C122088110EE EE C~enor~t Issue Next final Date A~€rual Maturity $50 06/1986. 0,6/2010 06/2016 $50.04/1994 04/2010 04/2024 $50 03/2000 03/2010 03/2030 $50 06/2004..03/2010. 06/2034 $50 12/ 1990.06/2010 12/2020 $50 12/1992 06/2010 12/2022 $50 12/_1993._ 05/2010 12/2,023 $ 50 12/ 1991. 06/2010 12/2021 $50 08/1986 08/2010 08/2016 $100 08/1986 08/2010 08/2016 Totals for 10 Bonds Issue Interest Interest 1~'alue €~te P~-i~e late $25.00 $.64.1.4. 4.00% $89.14 $25.00 $22.48 1.32% $47.48 $25.00 $11.10 1.64% $36.10 $25.00 $5.16 2..19% $30.16.. $25.00 $42.06 4.00% $67.06 $25.00, . $ 36.96. 4.00% $6,1.96.... $25.00 . $22.80 . 4.00% $47.80.... $2..5.00, $39.46 4.00% $64.46_. $25.00 $64.14 4.00% $89.14 $50.00.. . $128.28 4.00% $178.28,,. 275.00 $436.58 $711.58 N®tes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 8/13/2010 r _.. ~ J a- s p'y` r ~; C~ ~ n_ ~ ~.( r. 4% 7.. e 1 ~~! ~~ •+~ ~~ f ~..tti`i'..> ~ ^. ~+fK_7 ,,~ -~' _ +~ 4...r ~ ' rt . ~j ~~ ~~ _.~;:~~^~-~- ~ ~ '' E 12 2 0 ~ ~ 110 E E ,,..., . , ~~~~ ~ se00009000 ?o.^as ~`t~~~,~a Q ~ 2 ~O~~i ~ ~O~i° i _ i ~n?J6rnG;a ,r ., , e.-> ~:r-'*r:- , r r t.t-v: aRt. y.,, ~.. t .,.r a y~ e' ~. r-. ,~..r .: ~..y ,: ,e"„b~kt..~S+r4..ea_,~L. ~i~`r f+.Y.rY~ Y <~"t.'-r.,T'-!t~~'~. ~,~t 1~~vt tk ~ ..~.~: r •{ 1ozi+,~ r.} r e• r ~7r..fl, i ~Ci`-""}"t,'.!' *t_ris.aE~~:i'.!:."~GS;:Qr~~e'E. i~r.e, .r. 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Y ~ .P `+r~ ~' l .45_1J~ :0..J fh i U ^~g ~~ _ ~ ~~j~ y~ tf~~~ d~~,d%-_°j1~, X91!\y'~~1»1Fti9~ ;II`..•E~ I~3j"~l, I` ~...~~~~'~7 A ~ti•' f „~~j7 FpI~ }~ ~_ INTEREST CEASES 3D YEAftS '~a .~y+>y1 _. FRtlfA 1SSUE.DATE 095 48 8819 03 2000 f;, KEVIN PEARSALL -- - ,FRB BUf'F f,03w28-00', 1.214 KINGS C I R! 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RI O~~QJ EI-~>C ~~~ ~', .,.~ - ' IssuwG AGeNT•s 1- r S ~ r +I i ~ `~.r~ ~ ~ ~ ~ .~ G 9TA~P~ ~ ~ ~~ t ~ ', a ~11 ~ ~p - ~~~ ~' ~, ~'• PO0 #~AR~~~t~ .d ~E~R$~LL _ ~~' ~.~~_~.-i~'~. -`~r~ ~:,_ ,~ ~ L-(~-524-229-b12- c~ ---- , ~",~. °.+„ ,;, ~~ B'1 , ~..~~ 0Pi1~~._ ~~~ 718 RA ~I ;~ ~~ t~ ~,~~ I® a.000090002~00 3 ~ t~05 24 2 29~ L 2~ --.a,rD ,~ ~ ;, :, , . __ _. , .?. 4 , :....,. yt.. _~ x...J.i__ z _~ ..zv:.. a.r . ~''. +.v,~y..+.v..~.t- .. aeF•.~:x:,r_.>rc!u:1iw- •:• ~.it•:u.'>+-a++L.°~~~~...w`:2i:.~r~:isl~.u~.uiLLi4u.t'i:t~.au}ua~iluww.cr<iu<u:i.r`; }>u]_ ~-a~ilu.t -4:.:2'ruii~I yyx'.1'ui711 y ~ '` ~'~ ._.~~~.M; Q~.; ~~~C'~i5'a' ~~'~~al~~~~~u~~'"_~;~i~~~:~`'~Elr'~:~~'~C~a'~;~c~t~t''~'z\,. ~. ... .. A7 T>/E M1!ATUHIT.Y MCNEDF KILL PAY -~, '~ x ~, :~~3 ~~? fi'~f.~~ ? ~ i'~'~;~~ti s`1~.~ sky ~E~ ~Tbi ~F~SC+~T~ ,,,_ t } a9Uj7 GAGE ~~ /'~ ! - n ~.,~~~r~, ~'s~, ~s~ Z'~3 c;E I' ~:L ~ e r~i 1~' S ~3 ~ ~ r ,. :, ,,.. ~~~d .4 ~a0000 9.000 ?eo0 3 ~~;p 0 28 ~ 6 ~ 60 9 ?ua ~4.~6N~Shl~~t~+Y(el'u"SCtiAC+MI+V~~44~Jt'~'fl~_.9V,Q~t4~,+k'0.'h+.~ja~;~1.~6Xx0~~VsG~c ~XX4i4~k~ytk:~;+x.~01UAda"~Rl&C:_ ', ~ ' ' Rev-1508 EX+ (1i-98) ,, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Pearsall, Kevin J. 2~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Pioneer Investments Account -Value per statement 862.91 2 PSECU Checking Account -Value from statement 9.90 3 PSECU Regular Share Account -Value from statement 5.00 4 Apartment Refunds -Deposited into Members 1st Savings Account February 24, 2010 1,352.00 ($1,102.00 and $250.00) 5 IU Medical Group-Primary Care -Refund of overpayment 84.00 6 National Geographic Society -Refund 7.92 7 U.S. Treasury - 2009 Personal Income Tax Refund 947.00 TOTAL (Also enter on Line 5, Recapitulation) I 3,268.73 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) r 1 Lr >_v ..~ .C..~ Co~nbinecl Investments Account Stc~tejnent March 31, 2010 ~~~ Call Us 1-800-225-6292 Page 1 of 2. Retirement Accounts Call 1 -800-622-0176 Visit us on-line www.pioneerinvestments.com Your Representative PIOST444.J10772.000I45A0I fPHQ 6514DM.t-5102 3BJJ9 a5~aa ~ z 12_--_-- SMITH 08044000LABDCAR-02815 GREGORY H PEARSALL OUST FOR FIRST CDMMAND FINANCIAL PLANNING KEVIN J PEARSALL UGMA/MD 1 FIRSTCOMM PLAZA 1214 KINGS CIR FORT WORTH TX 76109-4999 MECHANICSBURG PA 17050-7673 Total Value of Yotjir Accounts _ March 31, 20.10 $86.91 B',e sure to visit the Pioneer website at us.pioneerinvestments.com.Ooce there, you'll find in-depth analyses of the markets and economic conditions by some of Pioneer's top investment experts, as well as helpful information about Pioneer's products and services. If you become a reyist~reci visitor, you alsc ~ti~il! b+? able to vie~~~ lrour account infermation and conduct transactions online. Before investing, consider the fund's investment objectives, risks, charges and expenses. Call your advisor or Pioneer Investments for a prospectus containing this information. Please read it carefully. Securities offered through Pioneer Funds Distributor, Inc., 60 State Street, Boston, MA. 02109. Underwriter of Pioneer Mutual Funds, Member SIPC Copyright, 2010 Pioneer Investments. .R`e~urar 1~ccou~2t Sun~~~2~ry 1~eet. moo. ~t~Qt4~2~6~6~ January t,~10~.Ikllarch31,2~10 Asset Category Account Fund Additions Withdrawals Change in Value Fund Name No- Nn_ Beninnine values VPar_tn.flata _ Yaar_tn.llnte ~ Vesr_tn_rlsfe _ T.....~ ~,..~.... . rowt --- PIONEER MID CAP GROWTH FUND A 00081226160-0008 PIONEER SELECT MID CAP GROWTH FUND A 00081226160-7004 $813.35 $0.00 $0.00 $795.89 X795.89 $0.00 -$17.46 $67.02 $0.00 5862.91 Year-fo-Date-Totals 581.3.35 5795.89 < 5795:89 S99.56 2:91 ® 100% U.S. Growth PIONEER MID CAP GROWTH FUND A ( PIONEER SELECT MID CAP GROWTH FUND A i Regular ~ccou7Zt C~~er~~ e~2v a~2d ~~ctZ ~Z ty January T, X10 • March 31, z0f0 'IONEER MID CAP GROWTH FUND A -Overview Account Information Account o. 00081226160 Fund No. 0008 Account Open Date 02J26/1992 Owner GREGORY H PEARSALL CUST FUR KEVIN J PEARSALL UGMA/MD 1214 KINGS CIR MECHANICSBURG PA 17050-7673 Earnings Summary Paid Year-To-Date Dividends $0.00 ShortTerm Capital Gains $0,00 Long Term Capital Gains $0,00 Distribution Options Dividends/ShortTerm Capital Gains Long-term Capital Gains REINVEST/REINVEST REINVEST .~ ,~° '~, u r~~ ~~ ;~~ ~~~ ,,;r. j~ ,., ~ ~ ~` ~ 1 I 1 1 1 1 1 P.G. Pox 6701 ? ~ 717; ~~ 4-O~~P4 ;Harrisburg) Harrisburg, ~'A 17!06-7013 x;800) 2~7-r~2~ ('Nationwide) .a GREEN IS A BEAUTIFUL THING(SM) APPLY TODAY FOR A HOME EQUITY LIME OF CREDIT 800.LOAN.555 PSECU.COMlLIFE. EQUAL HOUSING LENDER. 00015725 1 AV 0.335 '(III" 111" Iilll'IIII'111'111'1'I11'111'III'tlll'II'IIIIIIII' MR KEViN JAMES PEARSALL C/0 GREG PEARSALL 1214 KINGS CIR MECHANICSBURG PA 17050-7673 JOINT OWNER #AE.#~BEH NtJM6EA 8196 XXXXXX ss~-~a~' Karoo ter;, 040110043010 PAGE 1 P'0,91afVGF ~' EFFECTIVE >~~~ - ;. ;: `TAAkhi$~7~~ kc`,~i1R'~1A#k' .. F,4t~N'p8; Cll~p~tts>; FINANCE ~'EI"8 E1r~ TRANSAOTlON' htE4k~ t>E9E~1s CHARGE 1r/kAf~.~.4 AIa(~Elt+t7 gA4At~to~:': 04/01 ID O1 REGULAR SHARE BEGINNING BALANCE 5.00 04/12 PAYMENT: TRANSFER FROM SHARE 04 9.90 14.90 04/12 WITHDRAWAL BY CHECK 14.90- 0.00 ..p:4.~12 ~.p al R~C3uLa~ `:HARE ~~.oS ,. ~IV.~bENI~. Y.T~Ir `YEA~"...::7"Q DATE 0>, b0 , .~~I~~rr#Fi;+~~~'rSC3S Fir'S~..~r~#`rF~~~R~~t"r~w#~~~•.r~~+~r~..rrr~'Fr!r'~.r~:~"riZ"rrrr"CS:i~:~++r~+r~r'r~ .nr"G~.S.+r~i-r.~~=r:.^..~" "~' _' --~.~,~.....:;:.. 04/01 ID 04 CHECKING BEGINNING BALANCE 9.90 04/12 WITHDRAWAL TRANSFER TO SHARE O1 9.90- 0.00 04/12 ID 04 CHECKING CLOSED .. AIw~IDE~}~ ETA; YEAR ;TO DiA'FE 0.00 _^~ .... _. _ - . 0 `• 0.t~ - - - 0101 000 060 4 015725 4015725 Rev-1509 EX+ (6-98) e COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Pearsall, Kevin J. 21 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Gregory H. Pearsall 1214 Kings Circle Father Mechanicsburg, PA 17050 B. Barbara H. Pearsall 1214 Kings Circle Mother Mechanicsburg, PA 17050 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FTOENANIT DATE JOOINT 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 ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 B Members 1st Federal Credit Union -Savings 5.28 50.000% 2.64 Account -Value from Statement 2 A Navy Federal Credit Union -date of death 947.90 50.000% 473.95 value - $947.90 TOTAL (Also enter on Line 6, Recapitulation) I 476.59 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Send Inquires to: G ;;~ 1 '~"~~ 5000 Louise Drive ' `,~,'; v''~~C~ ~~~~ PO Box 40 • „~, W';,~`~~'~ ~~`~' . Mechanicsburg, PA 17055 .' ~r '~y u `~, ~ '?~~-~~, www.memberslst.org ~,.w Main Switchboard: (800) 283-2328 {~ _F '~~ EZ Call: (717) 697-4372 or (800) 283-4372 `~~~~~ h~ ~~ TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ,,~,:~- ~:_ ® TeleBranch: (800) 237-7288 MEMBERS 1St FEDERAL CREDIT UNION 12659 1 AV 0.335 12659-12659 = I.,.III~~~III~~~~I~I~II~~~I~~~I~II~~I~~~I~~II~~~~II~I~~II~I~~I -- KEVIN J PEARSALL - C/O BARBARA PEARSALL 1214 KINGS CIRCLE MECHANICSBURG PA 17050-7673 Statement cf ~a,ceounts Dec 25 , 2009 thru Mar 24 , 2010 Account Number : 208622 Balances at a Glance: Checking : 0.00 Savings: 1,357.34 Certificates : 0.00 Loans : 0.00 Money Management : 0.00 Swipe 5 YTD Reward : 0.00 Page : 1 of 1 Your aggregate balance as of March 1st is $5.28. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. We have once again partnered with Carlisle Events to provide you with a 2010 VIP Pass! Your free pass is enclosed. SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Dec 25 Ba/ance Forward 5.2g Joint Owner: BARBARA H PEARSALL Feb 24 Deposit by Check 1 ,102.00 ~~~: ~ ~ 1,107.28 Feb 24 Deposit by Check ~ 250.00 ~ ~ rt~,~~ ~ 1,357.28 Feb 28 Deposit Dividend 0.300% 0.06 1,357.34 Annua/ Percentage Yie/d Earned 0.320"/o from 02/01/2010 through 02/28/2010 Mar 24 Ending Ba/ance 1,357.34 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.06 Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. NAVY FEDERAL -~ Credit Union 4 May 2010 CDR Gregory H. Pearsall, USN (Ret.) 1214 Kings Cir Mechanicsburg, PA 17050-7673 Dear Commander Pearsall: In reply refer to: 1035342 On behalf of Navy Federal's staff and membership, I wish to extend our heartfelt sympathy to you and your family on the loss of your son. We have completed settlement of his account and I hope that the following information is of assistance to you. On 14 February 2010, your son's savings account reflected a balance of $947.90. Dividends credited to the account since that date increased the balance to $948.70 as of 19 Apri12010. As joint owner of the account, you are entitled to the savings balance. At your request, the funds have been transferred to your savings account. The account held in your son's name is now closed and the final statement will be forwarded at a later date. Should you have any questions, please call me toll-free at 1-800-883-3323, extension 47640, between 8:00 a.m. and 4:30 p.m., Eastern time, Monday through Friday. You may also reach me by fax at 1-703-255-7963. Sincerely, ~' Marlene Cha 1~' PP JP:pj ;~`. PO Box 3000 Merrifield VA ?2119-3000 REV-1151 EX+ (10-06) '~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Pearsall, Kevin J. _21 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zia Year(sl Commission said 2. Attorney's Fees Bogar & Hipp Law Offices 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. I Probate Fees 5,878.90 1,890.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 445.92 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 8,214.82 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Pearsall, Kevin J. 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex e{~nses 1 Afdersgate United Methodist Church -Funeral luncheon and hall rental 1,000.00 2 Myers Funeral Home -Funeral bill 4,165.00 3 Travel to Maine to Scatter Ashes 713.90 H-A 5,878.90 Other Administrative Costs 4 Andrews ~ Patel -Medical bill 150.00 5 Holy Spirit Hospital 250.00 6 Hoty Spirit Laboratory 30.00 7 Pulminary and Critical Care Associates -Medical bill 15.92 H-B7 445.92 Copyright (c) 2002 form software only The Lackner Group, fnc. Form PA-9500 Schedule H (Rev. 6-98) ' Rev-1512 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Pearsall, Kevin J. 2~ 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, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) P.O. BOX 918 ~,,,,~~ BROOKFIELD, WI -- For address change check this box ^ and complete form on reverse side. KEVIN PEARSALL 1214 KINGS CIRCLE MECHANICSBURG, PA 17050 ~'y(Jµaw~[ 1Cenl^ 133 Account Statement Date: 02/22/2010 Your Account #: 36 00014 47769 New Balance: $2,260.14 Payment Due: $50.00 Payment Due Date: 03/18/2010 Amount Enclosed: $ Make check payable to: MEMBERS 1ST CREDIT UNION UNIVERSITY ACCOUNTING SERVICE PO BOX 6491 CAROL STREAM, IL 60197-6491 3100030902710D0924000000000000000050000D000050003 T T PLEASE DETACH HERE. T T Account Number Bill Type Statement Date Original Draw Amount Payment Due Date 36 00014 47769 INSTALL 02/22/2010 $5,000.00 03/18/2010 Previous Balance Payments 8~ Credits Finance Charges Fees New Balance Payment Due $2,299.91 $50.00 $10.33 $0.00 $2,260.14 $50.00 CURRENT ACTIVITY Transaction Date Transaction Amount 02/02/2010 Ground Mail Payment $50.00 Thank you for your recent payment. Full payment of $50.00 is due on March 18, 2010. tf payment is received after March 31, 2010 a late fee of $2.50 will be assessed. In accorance with the Taxpayer Relief Act of 1997, UAS will provide qualified borrowers with 1098E Statements of Interest Paid on student accounts during the calendar year 2009. The 1098E form will be available at loanservice.uasecho.com beginning 1/2/2010. Documents not retrieved from the site will be mailed no later than 1/31/2010. Calendar-year interest paid will be reported to the IRS as required. For billing inquiries, please contact Customer Service at 1-800-723-2210. Direct forms/correspondence to University Accounting Service, LLC, PO Box 918, Brookfield, WI 53008-0918. For billing inquiries please contact us at 1-800-723-2210.DIRECT ALL PAYMENTS TO UAS AND NOT CREDIT UNION. FINANCE CHARGE SUMMARY Average Average Daily Average Annual Days In Finance Principal Balance * Percentage Rate Percentage Rate Billing Period Charges Current Billing Period $2,243.91 0.016438% 6.000000% 28 $10.33 Previous Billing Period $2,262.84 0.016438% 6.000000% 31 $11.53 Balance may include interest bearing fees. RATE MAY VARY Page 1 of 1 Document ID: 31 00030 90271 .._.._.__.. ,.. _-, R SCHEDULE J COMMNHERITANCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Pearsall, Kevin J. 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT Do Not List Trustee s (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 Barbara H. Pearsall Mother One-half of rest, 1214 Kings Circle residue and Mechanicsburg, PA 17050 remainder Gregory H. Pearsall Father One-half of rest, 1214 Kings Circle residue and Mechanicsburg, PA 17050 remainder Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE I I Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) LAST WILL AND TESTAMENT OF KEVIN J. PEARSALL I, Kevin J. Pearsall, having my legal residence at, 1214 Kings Circle, Mechanicsburg, Cumberland County, Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ~~ I am presently single, but live with my parents, Gregory ,~. and Barbara H. :~ Pearsall. I have no children. ,-''~ ~" ARTICLE I= PAYMENT OF EXPENSES .AND OTHER CHARGES I direct my Executor to pay the expenses of my last illness, funeral and burial (including the cost of a monument or marker over my grave) from my estate as soon as practicable after my death. ARTICLE II= PAYMENT OF TAXES All federal, state and other death taxes payable on the property forming my gross estate for those purposes, whether or not it passes under this Will, or whether it passes by reason of joint ownership thereof, such as certificates of deposit, savings bonds, etc., shall be paid out of the principal of my probate estate just a.s if they were my debts, and none of those taxes shall be charged against any beneficiary. ARTICLE III= TANGIBLE PERSONAL PROPERTY I give all personal property owned by me at my death, and all insurance policies on such property, to my parents Gregory H. and Barbara H. Pearsall. If both my parents Gregory H. and Barbara H. Pearsall fail to survive me by thirty (30) days, then I distribute my personal property to my brothers Andrew and Dethlefs-Pykosh Law Group, LLC '? l 32 Market Street . Camp Hi11, PA . 1701 1 1 7~ ~ l j-~~-~-6 Christopher equally. Any disputes concerning the allocation of my tangible personal property shall be resolved by my Executor, in my Executor's sole discretion. ARTICLE IV~ DISTRIBUTION OF NIA ESTATE I give the rest, residue, and remainder of my estate to my beloved Parents Gregory H. and Barbara H. Pearsall provided that that they survive me by thirty (30) days. In the event that they both do not survive me by thirty (30) days, I give the rest, residue and remainder of my estate to my brothers, Andrew and Christopher equally. ARTICLE V= FIDUCIARY POV~ERS I hereby grant to my Executor the continuing, absolute and discretionary power to deal with any property, real or personal, held in my estate, as freely as I might in the handling of my own affairs. My Executor shall have full authority and power to handle administration, division, management and distribution of my estate in any manner which he or she deems appropriate, necessary, or in the best interests of my estate. Such power shall be exercised independently and without the prior approval of any court or j udicial authority. Without in any way limiting. the generality of the foregoing, I hereby grant unto my Executor the following specific powers and authority, in addition to, and not in substitution of, powers conferred by law (a) To retain any or all of the assets of my estate without regard to any principal of diversification, risk or productivity. (b) To invest in all forms of property without restriction to investments authorized for any type of fiduciary. (c) To compromise any claim or controversy. (d) To loan money to or to purchase property from my probate estate. Page 2 of 6 (e) To borrow money from any person, including any Executor, and to mortgage or pledge any real or personal property. (f) To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales, exchange or leases, all for such prices and upon such terms and conditions as they deem proper. (g) To allocate receipts and expenses to principal or income or partly to each as they deem proper. (h) To repair, alter or improve any real or personal property. (i) To purchase investments at premiums and to charge premiums to income or principal or partly to each. (j) To subscribe for or to exercise options for stocks, bonds or other investments; to join in any plan or lease, mortgage, merger, consolidation, reorganization, foreclosure or voting trust and to deposit securities thereunder; and to generally exercise all the rights of security holders or employees of any corporation. (k) To register securities in the name of a nominee or in such manner that title shall pass by delivery . (1) To exercise all power, authority and discretion by this instrument after termination of any trust created herein until the same is fully distributed. (m) To commingle the assets of any trust estate created by the Will in any one or more common funds for greater convenience and flexibility. (n) To employ attorneys, accountants, engineers and other such persons, professional and otherwise, as may be necessary for the proper administration of this estate and to pay their compensation from such funds. (o) To pay off the balance of any mortgage. (p) To appoint a professional or corporate co-Executor or professional co- Trustee to provide counsel and assist in fulfilling administrative tasks, Page 3 of 6 and to pay reasonable compensation for their services, and to charge same to (or apportion the same between) income and principal as he may deem proper. (q) Whenever Trustee determines that the size of any trust does not warrant the cost of continuing it, or that its administration would be impractical for any other reason, to pay the principal without any further responsibility to the income beneficiaries in proportion to their respective interests in the income. ARTICLE VI~ EXECUTRIX I hereby appoint my father Gregory H. Pearsall to be the Executor of my Will. Upon his death, resignation or inability to act or continue to act for any reason, I appoint my mother, Barbara H. Pearsall, to be the Executrix (first alternate) of my Will. ARTICLE XI~ MISCELLANEOUS PROVISIONS A. Fiduciary Provisions No Executrix named in this will shall be required to give bond or other security in any jurisdiction in which he or his successor shall act in connection with my estate. Nor shall any guardian or property or persons be required to give bond for the faithful performance of their duties in any jurisdiction. B. Specific Items of Property Gifts of specific items of property mentioned in this will or any separate writing that is binding upon my Executor shall fail to the extent that I, or any duly authorized agent of mine, dispose of such property prior to my death. My Executor shall not substitute cash or any other assets for any such property. C. Matters of Interpretation For simplicity, I may have expressed pronouns and other terms in one Page 4 of 6 number and gender, but where appropriate to the context, these terms shall be deemed to include the other number or gender. D. Paragraph Construction Paragraph headings in this Will are for reference only and shall not affect the meaning, construction or effect of this Will. __.- 1~~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~s day of February, 2010. j ~ .i ~~ ~ / ~ ~'~ ( (SEAL) r, Kevin J. Pearsall SIGNED, sealed, published and declared by Kevin J Pearsall ,the above Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. Residence= Witness Residence Witness Page 5 of 6 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, the undersigned, whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to undersigned authority that we were present and saw the Testator sign and execute the instrument as his will, and that he had signed willingly (or willingly directed another to sign for him), and that he executed it 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 will as witness and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence and I, the said Testator, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. n ~~ ~,•,. ~ ;% ,J `. Kevin J. Pearsall Witness Witness Residence Residence Subscribed, sworn to~nd acknowledged before me by the above named witnesses this ~~~a of Februar , 2010. Y Y COMMONWEALTH OF PENNSYLVANIA Notarial Sea! Michael J. Pyfcosh, Notary Public Camp Hilt l3oro, Cumberland County My Commission F~cpires March 2T, 2010 Member, Pennsylvania Association of Notaries ;~ ~, ~ ~ ~ otary~'u lic Page 6 of 6