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HomeMy WebLinkAbout09-27-10I •. 1505610101 REV-1500 Ex ~°1.1°' ' enns lvania OFFICIAL USE ONLY PA Department of Revenue P Y Bureau of Individual Taxes DEPARTMENT OF REVENUE County Code Year File Number PO Box 28o6oi INHERITANCE TAX RETURN Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT a ~ ~ Q ~ Q ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY a6~ 5~ 3g 22 0 (~ o~ for o o~ z~' i 9~~ Decedent's Last Name Suffix Decedent s First Name MI ~ ~ F ~ ~ n V ~ ~T ~ ~ N ! ,~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI I'1~` Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1. Original Return O 2. Supplemental Return 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 Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C~/~RLES ~ SH lEL1~S` // l 7/7 7~~ 02-09: First line of address (, CLousF~ ~o,4-a Second line of address l I"~' City or Post Office State ZIP Code REGISTER OF WILLS ~ ONLI' C Q c --1 ~ ; ~ ; i -~~ --17 C 7 ~~ ~ t ' } _~ t~1 ~' t~? °V i_ r ~:. _. ._,, 1, ,. t~7 -~ t €`..j --r~CTAIIE FILED ~ _-~ --- /7~ 5'S973S~ ._..~ Correspondent~,.a~nail address: C GS~ 1~ ~S ~ ~ ~-C~r-' CG1 Sf• /~~° Under penalti of per' I d are that I ve a amined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, c ect a co le D clarat' n of eparer ersonal representative is based on all information of which preparer has any knowledge. SIGNAT E O P R L ILING RETURN ~ ~ ~~ D T X ~~251 ~ia ADDRESS ~-Nom~¢S ~ /°D~(JEl2S (0(003 Spr;rl4ford ?errata ~ SXNATURE QF~JR~ P~~~ O~R THA ~J~E - DATE Q/~~~D ADDRESS C"~/~-~~ ~ ~/~~~s ~ ~ f~DUSGI~ ~~0~•I /'1'lechan its bU,r ~ ~7oS5 __ _ ~~~~~~__.. _ PLEASE USE ORIGINAL FOR ONLY ~~~ ~~ ~~ Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: _ V~ tl'' 1 M I Ol ~• ~~W ~'$ ~ 0 2 ~ 'Z ~j ~ ~ Z RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. • Q ~ 2. Stocks and Bonds (Schedule B) ................................... .... 2. • D ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. • 4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. • ~ ~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. ~ 3 ~ S, ~ D 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ... .... 6. ~ s .Z $ .~. ~ T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. a oZ 7 ( ~ • D (j 8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. ` 7 3 ~" ! • 6 9. Funeral Expenses and Administrative Costs (S~hedule H) ............... .... 9. ~ (n / '7 ~ Z 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. ~ q ~ . 7 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. o~ ~ / 3 • .S ~' 12. Net Value of Estate (Line $ minus Line 11) .......................... .... 12. ~p ~ s 3 g , ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .~ an election to tax has not been made (Schedule J) .................... .... 13. ~ Q 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. ~p ~ s 3 8" • / TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 • O D 15. +r: O D 16. Amount of Line 14 taxable ' . ! ~ at lineal rate X .0.~ ~ ~ $ 3 $ 16. a 9 9 ~ . z" ~ 17. Amount of Line 14 taxable at sibling rate X .12 ~ fl 17. . O O 18. Amount of Line 14 taxable t ll t l t X 15 • ~ ~ ~: 1 ' ~ ~ a era ra e . co a 8. + 19. TAX DUE ..................................................... .... 19. oZ q f ~ • a! 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~ Side 2 L 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ ~-/(~ -- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ __ __ -_- Q --- --_--------- B. Discount ~ 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1> ~~, g45/ z/ Total Credits (A + B) (2) ~ (3) ~ (4) ~ 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 .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 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? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased 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 far the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1509 EX+?1 a7? GDMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ~0 k~PiY'S , / ~ ' h ~Q T FILE NUMBER a~ / Q I/ I 7 ~C.I _ 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 M : sc. P~rsonal~y ~' ~n ~ Nod : ~c ~(cn t ~ ~ vta~ ~ /Y1D4lc st c r'rc a m sfrt me s Q~ i1~ /I~o val ctab~c Qn/~-a~Lte s br heir/oon?s. ,~lo~e m~' her if~S ~~ ~U^Slh~~r'4 win: ~~' ~y ~ ~tn~~~~r- ~uerc ei~i~r ~unk~q~ ~r~ or aCona.~-cd ~ ~ ~a,lu~./~on /~Y-r13 !Je 6~1~'e v¢ ~e .S~lxlti~/ .1`~9'ct n~ ~r~ fcs e~Cs Q {~~ r y ~~ /~~So nab/~ valka~io" 35D. o0 ~R7S',oD TOTAL (Also enter on line 5, Recapitulation) ($ (, ,3 as". Do (If more space is needed, insert additional sheets of the same size} SCHEDULE F ~`~~ ~ JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~pt~~, Vr~inca o2~ - /t? -- N 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 A. -T}510/yII~.S ~. ~oW,~2S B. c. JOINTLY-0WNED PROPERTY: ADDRESS 6b03 Spr;n ~~d 7crr,~ta RELATIONSHIP TO DECEDENT ~pn ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointlyfield real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERE: 1. A. r~~l~!l T~~ccf v~ /anal i~x~r» /~ ~ a 4~~vB//' ~ ~ a~ kno ~ and gun, er{a,,f~d Co ~cnn ~ I /a~u beK.a~ as 1110 ~ e.rw o° d Woad, ~cin Let mss, /~f clock `%~" on ~lrt I0/a+r ~' Lo/s o~f1' /and /OQrK ~l~'lis;on, hCCOI'A~tgl ik P/a,n ~Beok ~pQ~c 9 `--i ~icmbtt /er'tc~~oan~ corals , scc. Copy ~T Otigina/~infune ¢eL'~ 4•fficolt~ ~/' Ven+~ic'a~i'or ~ 41a~ aMc~ d~fzciltcj c>,es~ripfion ~s~s. aF ~a. , ~alka~+on has ~etn b4sed on ~rorn~f adver red avnd ner~©t'; wed sale -~ T-ann ~ Ak~r#- ies~L-~d., a f-Iaurrisbur~, Anna. ~~P°~~°"- Se~ SPY o f deed ~' Con nc a anal - ~ G ~ h ` ~ p' En ' f' ' ~ ~' r' ~ ~ P~ G~ . -+on e vpt r ttita, ee IP.tY S n 7~ so0•dD J d/.+ "T 31750, 4 d . ~. ~ a/~~f 49 MP,~rv r3awk 5~ 'bus C-~.k~ n, ~~ No. o 1~ ~ ~ st3J4~3eo 1,~11.a7 orb S'8S. !vy 3. ~t. ~zJ~yl+q '8u;~k 1.eo,~d~ ~~ 1G'f HPSZCoSI'f if Sz b6S , I~r•s+ .see HR/u ~' [ ' S a t 1. Q D D , oU S~ /v ¢ 'g 9so. olc Yr o~t SeJ Js cry O~'- V r o ct d y a4 r /c ~r a fhtclr~/~ TOTAL,(Atso enter on line 6, Recapitulation) S ~S a ~ S, (~ (If more space is needed, insert additional sheets of the same size) ~~ ~' .'x ? - ~ ,~ ~ r ti n ~::-.~-:- ~ . ~1~`.'~p""y~'fy'~P",!s~~*ss,.yPr"f~~c~~''y~Anq~.`y~!.~`.~a.. ~ _ ~ ~ 3 'try " ~ ! f{'' • ~ ~ ts~ s 1'i~IS ~)I;EC3 ~~~ ~ 1~liac:; tlce -- -,I_f_.r~(~ da.~• o --- -~~z~1!~'Lc~'.-- - is t c- ~lsc ~~~ n ci~~i;;c: ar ~ r -ci ~cet~ -ccin~e ('..999). I3et ~ec;rc ~RGINIA. ~ 1. i'OtiY1h,R~, unrc-i ns~~~~~ . , : ti~ c~ ~~ _ ~; cr ~. ~ ~ l' ;i U Shc~~~woal F;oad, Ne~ti c='~c~~~che~land. (~~~unc?~~ sa ; s ~_ ~~ ~,,, t~il1~;~ ~~a, GI~, A.N~r t~ ~ - ~, r . s ; tsnC~ y • _. .. . z:: :::~ VIIi~t~GIl~~- D. P~C-~'~" E~~~~. ~e>' trernarrieci ,vi~G~~~ .:fc~r~~~~,a:: ,~~~~! 7 N-i~ tl'4~1t',~ i c. ~, P(aV'dER:S.„ her soil, a b»4rc riec mar., c;~.~rrc cat :: , :':~ q sic : r~ :: i a• ,; ~.,;. `~ - ~ .•:: Cu°nt~~rl~and, Cum~;c~.cn~_i t;'ount;~, Pr;nn~.y~~~ir.~~.. erlc t t~: ~si}s~ n ~~.~u,3_= ,}la~~~ - : ~ _ as joint tcn;.u~ts with r,,,h, ~~*'survirc:~~rshii~ ,~~~~ ~ ~~ ~: tc:, ;~~~~"~ ~~ i ~ c rzsn~~d ~n 1 - ! .. ~ _.. ~ ~ ' ~- GV1['I~:ES~"~E'CI31:, ghat in con~~~~i~l_~F~rati~>n of tti~; s~~rin c,t~ ~i ~a,~~'I~_~ K~ tid ~i:~~~](~( ~'~ I .(~Jc~}: li)r: ._ ~ ; ; =-~ aµ~ti c~tlc~r i;,~~a an~:i v;~luat+le conside:ati~~ns in hand p~>;c~i, t~~~~ ~~:c~° ~c;ii:~4 ti~~l~•.:a,~~~~E~ ~ ~.~ !ne~•c:f~:~y ~~~k:n;-w~l~a?x,e;d,~th~~~~:; :;aid Grantor da;,; he°~,~~by grant and c.c>rr.rr:~,: tic tisc ~~ai~:i c::ncan ~~;~~~,, ~~;- r~olc: " c . sl~c~xe;s c~~ _u: int: ten~~rtt:>~with right c-f ~~cr ~ ; ~~c:~r:;hip ~u~d. nc>i a~~ tc~~r~cct~~; i ~~ c~:~rrurc;;>7 th~:ar 'h~ us ~_F ~~ a~sil;n.,. !~I. ]-. 'PH~~~-T C'f:RTAIN tr~c:;t. n,i~ I~ncd sitaate in t1,~; F~~s~z:~rc7t~~ ~c c , ~I~~~'~: n t~c r:berla:nd,Cc;cmberland t~~~ur=ty, F"ennsyl~~ani:- ~~cav~Q~Aaed ~c~;~d ~1c~,;ti, •i1~~ ~~:I:~is~ Icy:' ows: 1311 G]NN)ilv1G ,;it a point on .lt.e ~ves:erly line: of ~`."a~lc'r~~,,~rt>c>d 1<:0,3.~ 1 ~~r~ lre n~.~~tlne:rly line o:f Lot Na. 13 Bieck "A" on the ir~ece.iic,cfaer x~e~r~~t.o~n~d 'i~ ci of Tots, s~~id point being toc ~iteci seen hcandred kc~c.cr ~.iacd sip t.y-r,r~u:: }1c~~ ~~xiredtl~cs (7a'1-61) feet me~~c>sc.cred westlwardly ~cn~a r~orthw;~rdl,y ~~cic»n~ ss:id. 1ir~ ~ of Sherwo<:-d Road f:-on!~ tf~e socithwest corner of` flee safrttte;rlc~ ~in:.:rsection of Sherwoodi Rc~au~ ,end Locust Street;. "I~IENC'E; sc,~wa~i:hv+r~~ ~d Ir ~ala:~~ng said. ]Lot:'Vo. 13 one h~:.znch~•ed twenty (121);)1.'iwet to a ~~,~int c:frc the ;~i~;ht-- o1-way lime of the Pennsylvania. Sta~:e Highway kno~~n as ~1 ;'1'oric- E~~cltimore; Expressway; T]IENt:~: northwestw~rrdly ,xiong :;aid l'nne, si ~.t:y (~~~I?) feet to a point; THENCE r~ortJneastwardly along; the s~:~utEcerl„y lip ,; cif rl~r,t No. 1'i, Block "A", one h~ua7dre;d twenty-nine (~1:2~!a) feast tea ,~- pi~~i.r~~~~ o;-c tic; westerly line of Sherwacxi 1~'.oad; THENC]+; sc:~ut:hwardly a:k~ng s2.i~d Iir,~; oil' Sherwood Road sixty (tiCi~) fe;~~;t to a point, the:. place: of li3 ±;GINNiI\ t„. ]3IYNG :Lot No. 14, Block "t~-"" an the Plan of Lc:~ts c>f Hi1_hlanrl F'arh; Ii;~~aension, recorded in Plam Bo«k `i, Page S9, t'~urnbe:>rland C'oun'ty ru:cArds.. 1=I,A.VING THEREON ER,E(:"TED a single dwelling hoi:rse ]cr~~~own ~~:~s ]Jr~,. (';~"10 Sherwood Road. B:I/ING'THE SAME PRE:M]SES which Bessie L. (~'rai;, single c~voi~:r~ca~r, ba~~ deed dated October 9, 1'.)7() and recorded in the Record'er's f;:-ffice. i:n ]_'~>eed Book "V", Volume 23, rage 308, granted and conveyed canto ~~~a'illi;ccc~r ;f. Powers and Virginia D. I'owc~rs, his wife. The said Williams J. Po~cwea-s dc;parted this earthly Iife c-n Oc:tober 25,-1999 whereupon fu:l1 arcd corn~cpR~~tt; tia.le: vested in the said.Vr;ginia :~. Powers, the Grantor herein, by and in accord with the law of the Commonwealth of Pennsylvania incident tea o;;nancies by the entireties. 'HIS IS A TRANSACCION BETWEEN MOTHETa .~Nl~ Sor~~1.a->\!'~:'> IS THEREFORE TRANSF'>t~'.R TAX EXEMPT 17NDER AND SUBJECT, NEVERTHELESS, to an e,~sement of` the; i?UQ?( ~j.cr iG~GE J.~;~~ ..._ xf _ q ,. ;~, ;~~llliR T ~ ~ - _- - . `` G s i ~4P - r Commonwealth-o~-~~~lxania., f~.~_highwa~.sls~~~p~goses ai~,g cn~ southwest line of said Lot. AND the said Grantor will generally warrant the property hereby conveyed. IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and sea] the day and year first above written. Signed and Sealed in the Presence of: V - V~"~~-~AL%~ RG A D. POWERS 2 ~oox 213 edct ~. COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND On this, the __1~1L day of Iv~~~t~i , A.D. 1999, before me the undersigned officer, personally appeared VIRGINIA D. POWERS, known to me, (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public CERTIFICATE OF RESIDENCE I HEREBY CERTIFY that the precise residence of the Grantees is: ~7/~ /y~ ~ .a~' /7071' 1 . _. _.._-4t~- --~ t~~ ' S^cr~tarv Attorney for Grantees Stat$ of Pennsylvania ii 86 County of CumbertandJ recorded in ttte office for the recording of Deads t. '- a ~ fo~ Vol nd Coupta>g~~ aitnegs my hand an of offi f 1~"t--i' Carlisle, PA this Y .~~~ ~ fi 3 b0(llt( ~~.~ iv~lt '1 ~q Notarial 1Serjotary Public Charles E. Shields Cumberland County ur Boro, . 2000 ~Ilechan-csbs 9 n ~xP-res June 20, MY Co~~--~--~ Tax Parcel No. THIS DEED Made the day of in the year two thousand and ten (2010). Between THOMAS D. POWERS, currently of Harrisburg, Dauphin County, Pennsylvania, Grantor, and IONNI PROPERTIES, LTD, a Pennsylvania Corporation, with a principal business office located in Harrisburg, Dauphin County, Pennsylvania, Grantee. WITNESSETH, that in consideration of the sum of EIGHTY-SEVEN THOUSAND FIVE HUNDRED and No/100ths ($87,500.00) DOLLARS, in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantee, its successors and assigns: ALL THAT CERTAIN tract of land situate in the Borough of New Cumberland, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at a point on the westerly line of Sherwood Road in the northerly line of Lot No. 13, Block "A" on the hereinafter mentioned Plan of Lots, said point being located seven hundred four and sixty-one hundredths (704.61) feet measured westwazdly and northwazdly along said line of Sherwood Road from the southwest corner of the southerly intersection of Sherwood Road and Locust Street; thence southwazdly along said Lot No. 13 one hundred twenty (120) feet to a point on the right-of--way line of the Pennsylvania State Highway known as the York-Baltimore Expressway; thence northwestwazdly along said line, sixty (60) feet to a point; thence northeastwazdly along the southerly line of Lot No. 15, Block "A", one hundred twenty-nine (129) feet to a point on the westerly line of Sherwood Road; thence southwazdly along said line of Sherwood Road sixty (60) feet to a point, the place of BEGINNING. BEING Lot No. 14, Block "A" on the Plan of Lots of Highland Pazk Extension, recorded in Plan Book 5, Page 59, Cumberland County records. HAVING THEREON ERECTED a single dwelling house known as No. 1710 Sherwood Road. BEING THE SAME PREMISES which Virginia D. Powers, unremarried widow, by deed dated December 14, 1999 and recorded in the Recorder's Office in Deed Book 213, Page 147, granted and conveyed unto Virginia D. Powers, unremarried widow, and THOMAS D. POWERS, her son, each to hold an equal share as joint tenants with right of survivorship and not as tenants in common. The said Virginia D. Powers departed this earthly life on June 1, 2010, whereupon full and complete title vested in the said Thomas D. Powers, the Grantor herein. TOGETHER with all and singular the ways, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances, whatsoever thereunto belonging, or in anywise pertaining, and the reversions, and remainders, rents issues and profits thereof, and all the estate, right title, interest, property, claim and demand whatsoever, of Grantor, in law, equity, or otherwise howsoever, of, in and to the same and every part thereof. TO HAVE AND TO HOLD the said tract of land, together with the hereditaments and premises hereby granted or mentioned and intended so to be with the appurtenances, unto the said Grantee, its successors and assigns, to and for the only proper use and behoof of the said Grantee, its successors and assigns forever. AND, the said Grantor hereby covenants and agrees that he will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, the said Grantor has hereunto set his hand and seal the day and year first above written. Signed, sealed and delivered in the presence of: s ~ ~ ~~ `~ T ~ I v, a (SEAL) T OMAS D. POWERS COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF DAUPHIN On this, the '- day of , A.D. 2010, before me the undersigned officer, personally appeared THO S D. POWERS, known to me, (or satisfactorily proven) to be the persons whose names aze subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public CERTIFICATE OF RESIDENCE I HEREBY CERTIFY that the precise residence of the Grantee is: Attorney for Grantee OMB NO. 2502-0265 A B. TYPE OF LOAN: TMENT OF HOUSING 8 URBAN DEVELOPMEN 1.QFIiA 2.QFmHA 3. QCONV. UNINS. 4. ~VA 5. []CONN. INS. U.S. DEPAR SETTLEMENT STATEMENT 6. FILE NUMBER: IONNI PROP - SHERWOO 7. LOAN NUMBER: 8. MORTGAGE iNS CASE NUMBER: C. NOTE: This form is famished to give you a stafement of actual seftlement costs. Amounts paid to and by the selflament agent are shown. Items marked (POC)" were paid outside the closing; they are shown here for informations! purposes and are not included in the totals. 1.0 3198 (IONNI PROP - SHERwWD.PFDAONM PROP - SHER1Mp0/10 D. NAME AND ADDRESS OF BORROWER: lonni Properties, ltd. 1165 Willoughby Road Harrisburg, PA 17111 E. NAME AND ADDRESS OF SELLER: Thomas D. Powers F. NAME AND ADDRESS OF LENDER: G_ PROPERTY LOCATION: 1710 Sherwood Road New Cumberland PA 17070 H. SETTLEMENT AGENT: Mid-Penn Abstract Co. I. SETTLEMENT DATE: August 27 2010 , Cumberland County, Pennsylvania PLACE OF SETTLEMENT 125 Locust Street Hamsburg, Pennsylvania 17101 . J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contrail Sales Price 87 500.00 401. Contrail Saks Price 87,500.0 102. Personal Pro 402. Personal Pr 103. Settlement Cha s to Borrower Line 1400 1,724.75 403. 104. 404. 105. 405. Ad'ustments For Items Paid B Seller in advance Ad'ustments For Items Paid B Seller in advance 106. School Taxes 08/28/10 to 07/01/11 783.25 406. School Taxes 08/28/10 to 07/01/11 783.2 107. Coun Taxes 08/28/10 to 01/01/11 203.26 407. Coun Taxes 08/28/10 to 01/01/11 203.2 108. Ci Taxes to 408. C' Taxes to 109. Quarte Trash 08/28/10 to 10/01/10 14.27 409. Quarterly Trash 08/28/10 to 10/01/10 14.2 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 90.225.53 420. GROSS AMOUNT DUE TO SELLER 88,500.7 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest move 8,750.00 501. Excess De sit See Instrudions 202. Princi al Amount of New Loans 502. Settlement Cha es to Seller Line 1400 4,095.0 203. Existin loans taken sub~ed to 503. Existin loans taken sub'ed to 204. 504. Payoff of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. De osit retained b seller 8,750.0 207. 507. 208. 508. 209. 509. Ad"ustments For Items Un aid 8 Seller Ad"ustments For Items Un aid 8 Seller 210. School Taxes to 510. School Taxes to 211. Coun Taxes to 511. Coun Taxes to 212. C' Taxes to 512. Ci Taxes to 213. Quarter/ Sewer 07!01/10 to 08/26/10 37.16 513. Quarte Sewer 07!01/10 to 08/28/10 37.1 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 8,787.16 520. TOTAL REDUCTION AMOUNT DUE SELLER 12,882.2 300. CASH AT SETTLEMENT FROMfTO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower Line 120 90,225.53 601. Gross Amount Due To Seller Line 420 88 500.7 302. Less Amount Paid B /For Borrower Line 220) ( 8,787.16) 602. Less Reductions Due Seller (Line 520) { 12,882.2 303. CASH(X FROM) ( TO) BORROWER 81,438.37 603. CASH(X TO) ( FROM) SELLER 75,618.5 The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement 8 any c nts referred to herein. Borcower lonni Prop t s, td., a Pen s lvania o oration Seller { - omas D. Powers BY: L. SETTLEMENT CHARGES T00. TOTAL COMMISSION Based on Price $ % PAID FROMPAID ROM Division of Commission line 700 as Follows: eoRROwER•s sELLER•s 701, $ t0 FUNDS AT FUNDS AT 702, $ t0 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 604. Credit Report to 805. Lenders Inspection Fee to 806. Mort a Ins. A .Fee to 807. Assumption Fee to 08. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Q $ /day ( days ~) 902. MIP Totlns. for LffeOfLoan for months to 903. Hazard Insurance Premium for 1.0 ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ r month 1002. Mort a Insurance months $ er month 1003. School Taxes months $ r month 1004. Coun Taxes months $ r month 1005. City Taxes months @ $ per month 1006. months $ er month 1007. months Q $ per month 1008. months $ r month 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Tdle Certificate to 1104. Title Insurance Binder to 1105. Deed Pre aration to 1106. Nota Fees to Ca ozzi 8 Associates, P.C. 18.00 4.0 1107. Attorney's Fees to includes above item numbers: 1108. Title Insurance to Mid-Penn Abstract Co. 768.75 includes above item numbersDwners On 1109. Lenders Coverage $ 1110. Owners Coverage $ 87,500.00 768.75 11 1. No Endorsements 1112. Closing Protection Letter 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 63.00; Mortgage $ Releases $ 63.00 1202. Ci /Coun Ta Stam s: Deed 875.00 Mort a e 875.00 1203. State Tax/Stam s: 875.00; Mort a e 875.0 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins coon to 1303. Inheritance Tax Escrow to Mid-Penn Abstract Com an 3,216.0 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K 1,724.75 4,095.0 rry s~~utg pegs i « true statemer>< ste s~gnatones sacnowawps recaps « e cbmpiete° copy « papa z « ttrs two papa atatarnern Certified to be a true copy. Mid-Penn Abstract o. Settlement Agent ( IONNI PROP - SHERWOO / IONNI PROP - SHERWOO / 70 SHAW CLEF7pN, cs~~u THE ~ A~,,~TAT ~ Ol~T AR N!X' • FOUNDED iN 1~S BY 1ML~IAMAND CATHER-NE BOOTIi ADULT RENABILITATIpN CENTERS COMMAND VEHICLE DONATION PROGRAM P.O. BOX 9t 34, BARDONIA, NY 10954-8134 d40 WEST NYACK ROiID, WEST NYACK, NY ~ 0994 TEI.EPNONE 1 (688) 989-ARAIEY FAX (570) 823-2S89 RE: PET456107 THOMAS Pow~Rs 6603 SPRII~tGFORD TERRACE HARRISBURG, PA 17111 ,luly 9, 2010 Dear Donor: Ll+WRENCE R• MORETZ '~rroau~ GcH,AN1HNDER LT. COLONa:lTIM01"h~YA. RAlNE. ARG COOMNANDER Tax Payer Icientifkation Number. 196461444 The Salvation Army thanks you for the donation of your 1995 BUICK LESABRE, VIN: 1G4HP52LOSN4826~5 on 6/2/2010. We are pleased to inform you that the gross proceeds received ftom the sate of your donated vehicle, which was conducted at arm's length by a certified auctioneer on 6!25!2010. were $1900. This is the maximum deductible amount that you may claim on your tax return. These proceeds will support The Salvation Army Adult Rehabilitation Centers in the Northeastern United States, along-term residential rehabllltation program for men and women seeking to put their lives back together_ This holistic program is provided to our residents at absolutety no cost to themselves. Instead, it relies solely on the generosity of people Pike you who donate and shop in our Family Thrift Stores. Your donation could be tax deductible, and a Copy of IRS form 8283 is enclosed for your convenience. If the value of your donation exceeds $500, the I.R.S. requires that this form be enclosed with your tax retum. Please read the instructions on the farm carefully. ' This vehicle donation program; like all Salvation Army programs, is operated at maximum efficiency. We are very proud of our record. Additionally, meticulous records are kept regarding your donation and the subsequent sale of your vehicle. If you ever have a problerrt concerning,yourdOnation, please call us immediately. By the way, we still need your useable clothing, furniture and other household items. They can be brought to one of our rnanydrop-off Donation Centers. For larger donations of furniture call us at ~-800-SA-TRUCK to arrange for a pickup. Thank you for caring and sharing. You have not just made adonation -you have made a difference. We hope you wits take a few minutes to read the enclosed pamphlet and get to know us and oar mission even better. sincerely, - • Lea A. Bednarski ' Vehicle Donation Supervisor PuEASE KEEP ALL OF TIi15 PAPERWORK, IT CONTAINS INFORMATION YOU wlLL NEED FOR YOUR TAX DEDUCTEON. THE SAfVATION ARMY ATTESTS THA71V0 GOODS OR SERVICES WERE GIVEN EN RETURN FOR THIS DONATION • THE SALVATION ARMY IS 501(c) 3CORPORATIOIy www.salvatlonarmy~lrc-org P.EV-1510 EX t (1-3~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ~ ~ FILE NUMBER ~owe~-5, V~r~,nia ~ a~-~o This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RElAT1oNSNIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IFAF'PL.IC/1BLE TAXABLE VALUE ~. 'P,r~de~fa[ fi:hanciQ~ /~nnu-~ ~on>~-ct No. ~0~65~"b~ 'den ' ' 7ho~nas ~wu^s G [ Q~'~ (1 S $~1~ f ~ 2a,~~/.o~{ /oo~o -o-- ~ ~aa,7~/.oy ~~ce ~a ~ita~on ~e 1~'~rv~ C'oh t - /fro tvn ~r~v cc~, LLC a ffa cjicd) TOTAL (Also enter on line 7, Recapitulation) $ ~~, 7'~~• ~~ (If more space is needed, insert additions{ sheets of the same size) WEALTH PRESERVATION AND FINANCIAL STRATEGIES September 7, 2010 Charles E. Shields III 6 Clouser Road Mechanicsburg, PA 17055 RE: Virginia Powers Below is the information that you requested on the Prudential contract for Virginia Powers. Contract Number- E0265568 Contract Date- 10/15/2002 Value at Contract Date- $18,334.75 Value at Death- $22,741.04 Dennis R. Browne, CMFC Managing Partner ~ 2009 Market Street, Camp Hill, Pa 17011 O Phone (71.7) 975-8800 ~ Fax (717) 975-0646 ~ Registered Representative, Securities offered through Cambridge Investment Reseazch, Inc., a Broker Dealer, Member FINRA/SIPC. Investment Advisor Representative, Cambridge Investment Reseazch Advisors, Inc., a Registered Investment Advisor. Financial Planning Services through The Conte~Browne Group, LLC, a Registered Investment Advisor. Cambridge and The Conte~Browne Group, LLC are not affiliated. I-St V- I ~ I I CJI+ 1, I L-yy,l r SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER }~ow~rs, V-rg,n~a ~, a/ ~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~.p ~ . ~alumcc ~ ~e ar,~~er pr-+~- necd ~uneral -~rusf' cnec~ ;~-b fio ~ctry heme,K. ~um~ral ~lv~ne ~ Crtitno.~ovt ~ iGes ,~-c. o~ -V~ Cwrnber~txid ~ (ooa, $~ B. ADM{NISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ~`Lp,-n Q S ~• ~ w GfiS W ~ 1 ~ F~ Social Security Number(s)/EIN Number of Personal Representative(s) • Street Ald'dress 6 ro D3 ~~/~ TGt("><'a.Ge City 7~CtX't'I 5 ~ U, try State P~ Zip ~ 7 / 1 t1 Year(s) Commission Paid: 2. Attorney Fees C ~atr'~e5 ~ ~~ ~ P~ ~~S J L ~ I 's D D b 3. Family Exemption: (If decedent's address is not the same as c-aimant's, attach explanation) Claimant NQ ON ~' ~'L~G / B ~ ~ NONE Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees ~ ' ~o~n as ~/ewers, ~ a~Gowrt fa~r1 f d~ //p~p• o~ S`D. t9~ 6. Tax Return Preparer's Fees /D~i/O~ ~~SCou#"' ~v~0~ P/¢ T~j ~• (~S/+d-.} ~. ~ ri l; n ~G ~o ~ '>rst'~.~' o~' w~ 11 s ~ ~ 15, o0 TOTAL (Also enter on line 9, Recapitulation) I $ a ` 17 8~ (If more space is needed, insert additional sheets of the same size) R'1~/ CIJ/ LCI.I. rl .I. L. L.L ! ,L / -7LU-J:JC.I.I. .1.1`1 1 Gr.71C.1. I T ur-Ir7r~ r nua_ u r r u ~ a ~ 'mot ~ r ~. grI' d~ _ ~ ~ ~ ~: S~ ,~ ~ ~~• .~+r r, .~~ ~ ~_ b~ n.l ~~ x ~!Jl~~~~l ~ .~ t. .. _. l..l r. ~~..' ~~ l: T ~ sa. .r.~` .1!. ~i r ~'~ ~ ` ..a: - a~ ,S_ T~ ~~ ..d FK , ~~ ~.~ ~rV ~A~/+.~ 71.. ~. ~ ti~ ~F S.'~et .Lw ~+ S~~ ~ ~ l ! ~ i i ~~ qty ,b ~! f IS,,,~' ~,r :.+' f 0 d~J iti July 8, 2010 ,- ~~. ; . . ..,, :, - , -- Mr. Thomas D. Powers 6603 Springford Terrace Harrisburg, PA 17111 Dear Mr. Powers; The following is an itemized listing for the services of Virginia D. Powers: Actual Cost As Funded .-~ ..:t::;~...:.~.. ., .. .. • -, . .:,.; ._ . _ _ : ,. ; • 'c...s' ~.,..' ~ ~ l . ~,r; .y ~~ r .. .~ ,~~. • . ~_: it_ Funeral Sejvice $ 3964.00 18 Gauge Steel Casket 2650.00 Memorial Folders 63.00 ~ Death Notice, Harrisburg Patriot 192-82~`~ (10) Certified Death Certificates 60.00 Clergy Nonorariurn 200.00 r Flowers, Casket Sp ay 150.00 Subtotals: ~ 7279.82 Difference: $3845•$2 Interest Earned from Trust ($1277.92 Preneed Discount $~9~`•Og) Total Due: $602.82 $ 2235.00 1199.00 -0- -0- -0- _~ -0- $3434.00 The Total Due represents only the items we paid as cash advances on your behalf that were not funded in the original contract. The Preneed Discount represents our promise to honor the original contracts for services and merchandise. Please call if you have any questions. Thank you. Sincerely, Gilbert J. "Gib" Parthemore Supervisor ~~:. REV-1512 EX+ (12-?3 SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMGNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 7d W ~~, ~~ ~ h 1 a -D . FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (~-fJt~) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ' 1~' o~.v tars, V c rg r n , a ~. ~l - ! o - RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(sj OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under 1. Sec. 9116 (a) (1.2)) ~ieA'tas .~- ~o W ers won ~ /oo ~a 6 (o 0 3 ~~ri h ,~nrt~ Try-ra,~,e d-{ arri sb wlr~, ~ 171 ~ ~ ~` ~, Mofi~e : ~ced~~ wa.s ~r~deceasQd ~- s~>ouse u~rtd b~, her Sorg, ~i ~ha nol. ~..n~s 2~. G-~w~~s ;s ~,~r soles ~~r and in h cri f yr t,~-~ ~Gr ~cc ~4'1~i5 D j~ %/l f~S r a.c.~I ate ~¢ ~/J?/17ro/~l~Q~ ~~i oV~ inn sy~/~a ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-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 $ (If more space is needed, insert additional sheets of the same size)