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Home My WebLink About10-13-101505610101 REV-1500 Ext°S_,°~ PA Department of Revenue Pennsylvania Bureau of Individual Taxes D[MNTN(Ni Df 11[V[HUF PoBOxz8o6oi INHERITANCE TAX RETURN Harrisbu PA i iz8-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social. Security Number Date of Death MMDDYYYY 179-18-5708 ' 05/11/2010 Decedent's Last Name Suffix.. Utsch ~~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name S Spouse's Social Security Number __ FILL IN APPROPRIATE OVALS BELOW dD 1. Original Return O uffix OFFICIAL USE ONLY ,- County Code Year/~ File Numb~~er- ~~ ~' ICJ ~ b.,t3G Date of Birth MMDDYYYY 02/03/1923 __. ._........ _. Decedent's First Name Carl Spouse's First Name MI 'A; THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) prior to 12-13-82) O 5. Federal Estate Tax Return Required QD 6. Decedent Died Testate (Attach Copy of Wili) O 7. Decedent Maintained a Livin Trust (Attach Copy of Trust) g 1 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name ohn M. Eakin .. _._._._..... Daytime Telephone Number _.......... ._....... _...... __ _ _ _ _ _ __ ' (717) 766-3172 _..: .........__....... _.__ __ REGISTER OF WILLS USE ONLY First line of address Market Square Building .. .___.. econd line of address __ __ _ . City or Post Office..., Mechanicsburg ~.~ c .;7 ~- ,~ ~ - :.. ~ _... _ .._ _ .._, r - _ i~ C...; State ZIP Code DATE FILED ; ; _, _ -- PA 17055-6230 ' ` - -' --~ ---- _. .. __. v _ Correspondent's a-mail address: .6- Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~IZ+NATURE F PERSO SPON ISLE FOR FI G RETURN gin„..®..~..~.i ~ ~JN 4058 Ke i Cin SIGNATUR ADDRESS Market quare ay, SC 29526 THAN REPRESENTATIVE Mechanicsburg, PA 17055 PLEASE USE ORIGIN t_,._ Side 1 1505610101 1505610101 IQ v '-; __, - ~_ ~ ,~`_~ _, t J REV-1500 EX Decedent's Name: RECAPITULATION Decedent's Social Security Number _... ___ 179-18-5708 1. Real Estate (Schedule A) ...................................... . ...... 1. 2. Stocks and Bonds (Schedule B) .... , , , , , ........................... 2. 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, 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Yvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested....... , 7. 8. Total Gross Assets (total Lines 1 through 7) .................. ........... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ............ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10).... , . , . , , W ....................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . , . , .. , 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 , an election to tax has not been made (Schedule J) ..... , .. , , , '„ ..13.` 14. Net Value SubJect to Tax (Line 12 minus Line 13) ................. . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 , 15. Amount of Line 14 taxable at the spousal tax rate, or ' transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 15. at lineal rate X .0 45 17. Amount of Line 14 taxable 16. at sibling rate X .12 18. Amount of Line 14 taxable 1 ~• at collateral rate X .15 79. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 75,000.00 2,659.52 181,255.03 258,914.55 17,889.11 268.26 18,157.37 240,757.18 240,757.18 O L Side 2 1505610105 150561D105 ,; 1505610105 _.....I REV-1500 EX Page 3 Decedent's Complete Address: File Number Carl A. Utsch, Jr. STREET ADDRESS __ 11 Birch Street ciTV Mechanicsburg _ srATE __ - - PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments (1) _ 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. Total Credits (A + B) (2) (3) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE B 1. Did decedent make a transfer and: LACKS a. retain the use or income of the property transferred :............... No Yes ..................................................................... ^ x 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? .............................................................................................................. ^ x 3. Did decedent own an "in trust for" orpayable-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? ............... 10,834.07 10, 834.07 _ ....................... ......................................... ~~ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value IT AS PART OF THE RETURN. 3 percent [72 P.S. §9116 (a) (1.1) (i)). of transfers to or for the use of the surviving spouse is 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 surv' [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 f filing a tax return are still applicable even if the surviving spouse is the only beneficiary. wing spouse is 0 percent For dates of death on or after July 1, 2000: or disclosure of assets and • 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 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 r of a natural parent, an 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 3e cent, except as noted in Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ( )( )). A sibling is defined, under ZIP 17055 REt~-502 EX~ i21-Og} Pennsylvania SCHEDULE DEPARTMENT OF REVENUE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT CCTATC n~ Carl A. Utsch, Jr. FILE NUMBER Afl real property owned solely or as a tenant in common must be reported at fair market value. Fair market value i? defin0ed0524 pr ce at would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the releva Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F, which property ITEM Attach a copy of the settlement sheet if the property has been sold, nt facts. NUMBER Include a copy of the deed showing decedent's interest if owned as tenant in common. DESCRIPTION VALUE A7 DATE 1. OF DEATH 11 Birch Street, Mechanicsburg, Pq, parcel No. 38-19-1610-019, see attached settlement sheet 75,000.00 TOTAL (Also enter on Line 1, Recapitulation,) ~ If more space is needed, insert additional sheets of the same size. 75,000.00 Previaua ad obsolete roan nuu-~ l.aoot m. ~mw.,,,,,,, .,,,,,,.~ a. ettlement Statement Prsvloua sdition%ara obsolete U.S. DEPARTMENT OF HOUSING ANn 1laaeM ncvo ne..rur tom, w~~~~_, ,..,~, _...__. _= 1 e ~ "tY WARNING: R IS A CRIME TO IWOWNdGLY MAID FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION Th° HUD-1 SedlemaM Statement which I have CAN INCLUDE A FINE AND MPRISONMENT. FOR DETAILS SEE TTRE 18: ~^°8d10n~ I have eaueed or will cause Cre fl+tda tempo baCu M h accwals accgaa o(thie U.S. CODE SECTION 1001 AND SECTION 1010. +ccordancs with Nis ~~~. SETTLEMENT AGENT: DATE: or by me h aw trmadbn. 14a0rer teddy that I have received a coPY~tlre HU0. ant StalemenL a tore and accurate ataterrieM of all receipts and disburaemante made on my accwyp REV-1503 EXi-(6-98) SCN COMMONWEALTH OF PENNSYLVANIA EDIJLE B INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT CCTAT~ .~ vInIC VP Carl A. Utsch, Jr. FILE NUMBER 79 Aft ~~... CAROL M RUHOW 4058 KERRI CIRCLE CONWAY SC Serial Number 906-13-7352 29526-5415 Series Denom Issue Date Issue Price Redemption Date: Transaction Number: Interest Earned 05/20/2010 4342140277 Redemption Value 2188010027 E $50.00 01 / 1980 $37.50 $183.74 $221.24 2188014916 E $50.00 01 / 1980 $37.50 $183.74 $221.24 2202876310 E $50.00 02 / 1980 $37.50 $183.74 $221.24 2202881432 E $50.00 02 / 1980 $37.50 $183.74 $221.24 2202899688 E $50.00 04 / 1980 $37.50 $183.74 $221.24 2202899689 E $50.00 04 / 1980 $37.50 $183.74 $221.24 2202899690 E $50.00 04 / 1980 $37.50 $183.74 $221.24 2202899691 E $50.00 04 / 1980 $37.50 $183.74 $221.24 2204598727 E $50.00 05 / 1980 $37.50 $186.00 $223.50 2204603942 E $50.00 05 / 1980 $37.50 $186.00 $223.50 2204608968 E $50.00 05 / 1980 $37.50 $186.00 $223.50 2204613469 E $50.00 06 / 1980 $37.50 $181.60 $219.10 Total Price Total Total Total number of bonds redeemed: Interest Value 12 ;~ ~ ~q z - -~ ~~ _ ~ CQ _ Carlisle Pike Office 6560 Carlisle Pike Suite 500 Mechanicsburg, PA 17050 (717) 795-1710 REV-1508 EX+. (6-gg) SCHEDULE E COMMONWEALTH Of= PENNSYLVANIA C/iS~" ~~ BANK DEPOSITS, ~ M~$C IN RN . RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF Carl A. Utsch, Jr. FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorshi ITEM 21-10-0524 p must be disclosed on Schedule F. NUMBER DESCRIPTION 1. M&T Bank Checking Account #104185 VALUE AT DATE 1, see attached OF DEATH 2. PSECU Checking Account #107596, see attached 8,465.12 3. PSECU CD #107596, see attached 17,681.72 4. PSECU Money Market Account #107596, see attached 23,213.00 5. Orrstown Bank Money Market Account #111800066, see attached 45,230.24 6. Orrstown Bank CD #4000002950, see attached 8,675.84 7. Orrstown Bank CD #4000024559, see attached 25,000.00 8. M&T Bank CD #31003912518320, see attached 32,010.52 9. Cash 10,000.00 10. Personal Property_V1A'~ S C- ~, ~ ~e~ l1 ~~ ~~ S ~l~t r~+ ~ u r2 200.00 , 11. Chevy Impala 170.00 12. Verizon -Refund 200.00 13. State Employees Retirement System 26.25 14. Prudential Life Insurance 58975150 549.42 9, 832.92 TOTAL (Also enter on line 5, Recapitulation) S (If more space is needed, insert additional sheets of the same size) 181,255.03 M&TBank ACCOUNT N0. A000UNT TYPE 1041851 N&T SELECT KITH INTEREST 00 0 04342M NM 017 CARL A UTSCH .15953 11 BIRCH ST MECHANICSBURG PA 17055-2708 INTEREST EARNED FOR STATEMENT PERIOD INTEREST PAID YEAR TO DATE 0.06 0.69 :BEGINNING :DEPOSITS & ACCOUNT SUMMARY BALANCE OTHER ADDITIONS> N0. AMOUNT CHECKS PAID SUI 8,505.27 n _ NO• AMOUNT un - o PosrING ACCOUNT ACTIVITY DATE TRANSACTION DESCRIPTION DEPOSITS,INTERES & OTHER ADDITION 04-20-10 BEGINNING BALANCE 04-20-10 KARNS PRIME 8 FANCY BOILING SPRIN 05-05-10 THE SENTINEL RENENAL 05-19-10 INTEREST PAYMENT 05-19-10 CLOSEOUT 0.07 ANNUAL PERCENTAGE YIELD EARNED = 0.00 CURRENT ENDING IONS INTEREST PD : BALANCE OUNT 8,505.34 0.07 0.00 ~.n~~R, O OTHER - SUBTRACTIONS dAILY BALANCE 58,505.27 27.23 8,478.04 12.92 8,465.12 8,465.19 0.00 50.00 AT M&T BANK, YOU HAVE A CHOICE REGARDING THE AUTHORIZATION AND PAYMENT OF OVERDRAFTS FOR ATM AND EVERYDAY DEBIT CARD TRANSACTIONS. FOR MORE INFORMATION, VISIT MTB.COM OR STOP BY AN M&T BRANCH. STATEMENT PERIOD PAGE APR.20-MAY.19,2010 1 OF 1 CARLISLE PIKE L008A (8/07) ~ 1 P.O. Box 67013 (711) 234-8484 (Harrisburg) Harrisburg, PA 17106-7013 (800) 237-7318 (Nationwide) website - http://wvvw psecu.com ~~ ' ' '' ~~ GREEN IS A BEAUTIFUL THING(SM) APPLY TODAY FOR A HOME EQUITY LINE OF CREDIT 800.LOAN.555 PSECU.COM/LIFE. EQUAL HOUSING LENDER. 00107596 1 FP 0.414 JOINT OWNER -~MSER NUMBER CARL UTSCH C/0 CAROL M RUSHOW, EXEC 0179XXXXXX 4 0 5 8 K E R R I CIRCLE s~rE~+e~r Pearc~o CONWAY SC 29526 ~'°"' 050110053110 PAGE d i~`~ _ >~FEC~w£ C)PilE 1RAN$ACTIQN U6SCRIP'f1pN ~p~ FINANCE _ ..: FEE3QR TRANSACTION 05/01 _ CHARgE _ .~.Y_v. ID Ol REGULAR SHARES BEGINNING BALANCE ~~ AMOtkfT ' NEW BALANCE __ _ _ _ 05/24 PAYMENT: DIVIDEND 23213.00 ANNUAL PERCENTAGE YIELD EARNED 0.40% FROM 05/01/ BASED ON AVERAGE D 10 THROUGH 05/31/10218 85 05/24 AILY BALANCE OF 17,~~Z.55 PAYMENT; 7RANSFEF2 FROM S '05/24 . HARE 07 PAYMENT: TR~iPiSFER FRflp1 SHARE 04 45247.34 6$y6b,lg 05/24 WITHDRAWAL BY CHECK 7.Zb57.O7 86123.26 05/24 ID O1 REGULAR SHARES CLOSED 86123.26- 0.00 DIVIDEND YTD: YEAR TO DATE _~__~~___~:~=z:=~S=====____,====T====~= 36.36 05/01' ZD 04 - CHE!GKING BEGINNING BALANCE 05/03.:.. CHECK 00;:163$ 1791525 05/07 CHECK 001637 '1;06.00- 178:0:9.25 OS/10 WITHDRAWAL DIRECT DEPOSIT VERIZON 99.00- 17710.25 TYPE: PAYMENTREC ID: 9783397101 28.53- 17681.72 C0: 'V£RL~ON 05/21 WITHDRAWAL DIRECT DEPOST~'F'AWC 05/24 TYPE : PA1flf~NT xp : 1446096660 CQ z PAWC. 2 5. 7 7 -~ 176 5 5.9 5 PAYMENT: DIVIDEND 1.12 17657.07 ANNUAL PERCENTAGE YIELD EARNED, O:lOi FROM 05/01/10 THROUGH BASED Q5/24 ON AVERAGE DAILY BALANCE OF 13,150.48 05/31/10 WITHDRAWAL TRANSFER TO SHARE dl 05/24 ID 04'CHf=CKING CLOSED 17657.07-' -0.QO DIVIDEND, YTD: YEAR TO DATE 6.19 NUMBER 001637 AMOUNT NUMBER AMOUNT NUMBER AMOUNT 99 00 NUMBER . 001638 106.00 AMOUNT U5/O1 I _____.__~.^~~...^^-.--~z~-^-=-~-a.:`-zcaz D 07.,MONEY kfARKET B1=GINNIN --- -T - zcx=^;zmz= '-;~ax~___.T....x_a .. a Q~S/24 G BALANCE _ x . PAYMENT: ;DIVIDEND 45230' 24 05/24 ANNUAL PERCENTAGE YIELD EARNED 0.601 FROM 05/01/10 WITHDRAWAL TRANSFER THROUGH105/23/10247.34 TO SHARE O1 05/24 ID 07 MONEY MARKET CLOSED 45247.34- 0.00 I-IVTDEMD YTD: YEAR TQ DATE _ __ ---- ---- ----- - 106.23 _ _ __ ;TOTAL DIVIDEND YTDa^YEAR TO DA~€E --- --- - --- --=--=------ ---- 148.78 0101 000 065 3 in~coc ~,..~~... 9/15/10 Carl A Utsch Jr Last .stmt balance: Current balance: 1=View 6=Print T=Tset Posted Check No S 3/10/10 3/26/10 I 4/09/10 I 4/11/10 4/11/10 4/26/10 I 5/07/10 I 5 10 5/26/10 I 6/03/10 6/09/10 I 6/10/10 6/10/10 Deposit Inquiry Account number: 14:12:45 111800066 9,101.29 Last stmt date: 9/12/10 9,101.29 Statement cycle: 10 T/C Control: From To 151 Debit Credit Balance 155 •60000000% 8,465.22 155 29.46 8.494.68 160 71.13 8,565.81 151 4.46 8,570.27 155 •60000000% 8,570.27 155 32.63 8,602.90 160 68.84 8.671.74 151 4.10 8,675.84 155 •60000000% 151 31.57 8,707.41 155 •50000000% 8,707.41 160 71.13 8,778.54 151 4.24 8,782.78 .50000000% 8,782,78 F4=Redsply F6=Ba1 Inq F7=Scan Fwd F8=Scan Bkwd F11=Prior bal F15=EFT F16oSort• F17=Top F18=Bottom F19=EDI F20=Unfold F22=T/C F23=Checks mmR Flrtt~ 9/15/10 Carl A Utsch Jr Orig~.nal balance: Current balance 1=View 6=Print T=Tset Opt Posted InputSrc 3/09/10 G 3/09/10 G 4/09/10 G 4/09/10 G 7 10 G G 6 09 1 G 6/09/10 G 7/09/10 G 7/09/10 G 8/09/10 G 8/09/10 G 9/09/10 G 9/09/10 G Time Deposit Inquiry Account number: 25,000.00 YTD interest: 25,000.00 Next pmt date: Control: From Rate T/C AFF 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y Amount 64.24 64.24 71.13 71.13 68.84 68.84 71.13 71.13 68.84 68.84 71.13 71.13 71.13 71.13 F4=Redisplay F7=Scan forward F8=Scan backward F17=Top F18=Bottom F20=Fold/Unfold 14:12:08 4000002950 To 628.70 10/09/10 Balance 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 25,000.00 Bottom F16=Sort F22=Tran Codes Ct~ # I 9/15/10 Carl A Utsch Jr Original balance: Current balance: 1=View 6=Print T=Tset Opt Posted InputSrc 2/26/10 G 2/26/10 G 3/26/10 G 3/26/10 G 4/26/10 G G G 5/26/10 G 6/25/10 G 6/25/10 G 7/26/10 G 7/26/10 G 8/26/10 G 8/26/10 G Time Deposit Inquiry Account number: 32,010.52 YTD interest: 32,010.52 Next pmt date: Control: From Rate T/C AFF 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y 670 D I 673 D Y Amount 32.63 32.63 29.46 29.46 32.63 32.63 31.57 31.57 32.63 32.63 31.57 31.57 32.62 32.62 F4=Redisplay F7=Scan forward F8=Scan backward F17=Top F18=Bottom F20=Fold/Unfold 14:12:20 4000024559 To 255.73 9/26/10 Balance 32,010.52 32,010.52 32,010.52 32,010.52 010.52 32,010.52 32,010.52 32,010.52 32,010.52 32,010.52 32,010.52 32,010.52 32,010.52 Bottom F16=Sort F22=Tran Codes C~ °~ '~'~ _"~"'~ ~`"`+~~ M&T Telephone Banking Center Manufacturers and Traders Trust Company DEPOSIT/PAYMENT RECEIPT (716)626.1900 outside Western NY: 1-800-724-2440 THE DEPOSIT OR PAYMENT HAS BEEN RECEIVED ON THE DATE VALIDATED BELOW AND IS SUBJECT TO THE TERMS AND C DITIONS GOVERNING YOUR ACCOUNT. CHECKS AND OTHER NON-CASH ITEMS RECEIVED FOR DEPOSIT ARE SUBJECT VERIFICATION AND COLLECTION BY M&T BANK. DEPOSITS MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRA qL DEPOSIT ^ PAYMENT ^ CHECKING ^ SAVINGS ^ LOC ^ LOAN ^ MTG THt=I Member FDIC BR-534 (3/02) OD4#DDti PRTaEp fi0,0DD.DD 43D301:21PHDSYI'T/D5 #310039125I832D MANUFACTURERS AND TRADERS TRUST COMPANY *** CERTIFICATE OF DEPOSIT *** ~3Cs~3yi251832fI DATE: 08/17/2005 OFFICE: Boiling Springs Office CARL A UTSCH 11 BIRCH ST MECHANICSBURG PA 170552708 ACCOUNT NUMBER: 31003912518320 OPENING DEPOSIT: $10,000.00 ACCOUNT TERM: 12 Months INTEREST RATE: 3.92 ANNUAL PERCENTAGE YIELD: 4.00 MATURITY DATE: 08/17/2006 Thank you for choosing M&T Bank. *'"' NOT TRANSFERABLE (AS DEFINED IN 12 CFR 204) *** **' NON-NEGOTIABLE *** LU Member FDIC 10/01f2010 09:14 9043134573 CRT IN/OUT FAX Form / ~~ I (Rev. May 2ppp) Life Insurance Statement ~PaMneM d Ms Treasury 1Memet Revenue Serw,s ~ Dacedertt--Insured {ro be read t,, ,,,~ ,,,,,:ucw rtnm rmm 706. United Slates Estate and Form 706~NA, United States Estate (and Generations - t Generotron~Skipping Transfer} Tax Retum, or Decedent's first name and middle initial 2 Decedents lasname er Tax Retum, Estate of resident not a ati2an of the United State,.) Carl A 3 Decedent's social security number 4 Date of death Name and address of insurance tympany TJt 8 ch ~ kn~) 1 ~ g _ 18 - 5 7 0 8 05/11f2010 T'hP P...,a~....__~ r_ B Type of policy --- `~` u+, vi rr`ruentC YU BOX Endowatent 8 Owners name. K decedent is not owner, attach copy of applicatton. 9 Date Issued 12 value of the policy at the 13 12 / 31, / 19 2 3 dme of assignment Amount ~ premium (see instnrc4ons} 15 18 1T 18 19 20 21 22 23 24 25 26 13.0 7 Palley number 05$875150 f 0 Assignors name. Attach assignment. SPY of 11 Date assigned 14 Name of beneficiaries ~arol Rushaw Executrix Eat Of Carl A Face amount of policy tsch Jr indemnity benefits ~ . Additionallnsurance Other benefits • Principal of any indebtedness to the oompsny that is deductible in determining net prot:eeds• interest on indebtedness {11ne 19) accrued to date of death . . Amount of arxumuiated dividends • Amount of post-mortem dividends - Amount of returned premium Amount of Pnx:eeds if payable in one sum ~ . Value of pros as ~ date of death (If not payable in one sum} ' Policy p~isions concerning deferred payments or installments. ~ ~ ~ • Note: tf other than lump-sum settlement !s atrthorizsd for a surviving spouse, attach a copy of the insurance policy. 9,495.50 27 Amount of instaAments ~~~/%~~~/ 28 Date of birth, sax, and name of any person the duratlon of whose life may measure the number of ~ Payments. 29 Amount applied by the Insurance company as a single premium reprasengng the purchase of installment benefits 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. ~ ~ 31 Were there any transfers of the policy within the three years prior to the death of the decedent? • 32 Date of assignment or transfer. ^ Yes ^ No Month OaY Year 33 Was the insured the annuitant or benetipary ~ any annuity contract issued by the company? . 34 Did the decedent have any incidents of ownership an any policies on his/her Iffe, but not owned b ^ Yes ^ No himhter at the date of death? y 35 Names of companies with which decedent carried ofher policies and amount of such policies if this information is disdose^ Yes ^ No by your records, The undersigned officer of Nte above-named Insurance com an forth true and corr8ct inforrnatlon. R Y (~ aPProprtate Federal agency or retirement system official here c ~ihl~r~,. ~OI T { ) br cues that mis statement sets Stgnewre - Vice President, rme - Customer Service Office Date ~ ~tication ~ 0 7 / 13 / 10 Cat. No. 10170v Form 712 (Rev. 5.2000) RAGE 03f 03 OMB No. i5d5-0022 OCT-i-2010 FRI 07:33AM ID: ~F~~-~sl.~ Ex+ rIO-o9, j~ Pennsylvania ~: DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FCTATC nt SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Carl A. Utsch, Jr. ITEM NUMBER A• FUNERAL EXPENSES; 1• Neil Funeral Home FILE NUMBER Decedent's debts must be reported on Schedule I. 21-10-0524 333.59 B• ADMINISTRATIVE COSTS: I• Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address - City -_- -_ ------ -_---------_--_-_--------- State_ ZIP - - ----- Year(s) Commission Paid: Z• Attorney Fees: 11,650.00 3• Family Exemption: (If decedent's address is not the same as claimant' s, attach explanation.) Claimant Street Address _ --- _ - -_ City -- - - -- ---- -- ---- -------- -- -- -- - --- _- State _ ZIP _ __ -- Relationship of Claimant to Decedent 4. Probate Fees: _ -_ - S• Accountant Fees: 327.50 6• Tax Return Preparer Fees: ~• The Sentinel, estate notice B. The Cumberland Law Journal, estate notice 19$.16 s. BBT- York Waste Dumpster for h 75.00 , ouse ~o~ Newspaper Ad for Yard Sale 399.86 ~ ~ ~ Central Penn Appriasals Real estat 25.00 , e appraisal i2 Register of Wills -Filing Fee 350.00 30.00 TOTAL (Also enter on Line 9, Recapitulation) $~~ ~ ~n ona ~ S~Q.j- If more space is needed, use additional sheets of paper of the same size. ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Carf A. Utsch, Jr. ITEM VUMBER A• FUNERAL E 1. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER Decedent's debts must be reported on Schedule I. 21-10-0524 B• ADMINISTRATIVE COSTS: 1~ Personal Representative Commissions: Name(s) of Personal Representative(s) ---_ -- -- - Street Address - - - - City -- --- -- - -- ----------- - -------_ -- --- _- _ _ _ -- State - ____ZIP ___ _ Year(s) Commission Paid: - - - - Z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address - _ - - - - -- City --. _- --- --------- -_ -_ ------------------ ---------__- --State_ ZIP __ _ _ --- _ e ationship of Claimant to Decedent 4• Probate Fees: _ - S• Accountant Fees: 6. Tax Return Preparer Fees: 7. ~ s Cost of Selling Real Estate 1 % Transfer Tax Realtor Commission 750.00 3, 750.00 TOTAL (Also enter on Line 9, Recapitulation) $ 17,889.11 If more space is needed, use additional sheets of paper of the same size. REL'-S1Z EX;- {17-G8) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~-.~~niG Vf SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS Carl A. Utsch, Jr. FILE NUMBER Report debts incurred 6v the de~edc......:__._ ~__.... 21-1n_n~~d REV-1513 EXrF (Oi-SO) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Carl A. Utsch, Jr. FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT 2 ~-~ 0-0524 I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Sec. 9116 (a) (1.2).] 1 • Carol M. Rushow 4058 Kerri Circle, Conway SC 29526 Daughter Entire Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, IS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 8. 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, use additional sheets of paper of the same size. LAST t~JILL AI~1D TESTAIiliJPdT OF CARL A. UTSCH JR. I, CARL A. UTSCH, JR., of the Township of Silver Spring, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory a.t~d understanding, do make, publish and declare this my Last t~Jill and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my ,just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give and bequeath my Two and one-half 02.50) Dollar gold piece to my granddaughter, CHRISTINA A. DATLEY, absolutely. 3• I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my daughter, CAROL AI. RUSHOW, absolutely and unconditionally. -1- t I~ • In the event that my daughter, CAROL I'I. RUSHOW, should predecease me, or should she die within thirty (30) days from the date of my death, then in either of such events, T direct the settlement a.nd distribution of my estate to be made as follows: (a) I give a.nd bequeath my Two and one-half ($2.50) Dollar gold piece to my granddaughter, CHRISTINA A. DAILEY, absolutely, (b) I give, devise and bequeath my family residence located in Silver Spring Township, Cumberland County, Pennsylvania, presently known as 11 Birch Court, Mechanicsburg, Pennsylvania, together with all the contents located therein, including, but not limited to furnishings, utensils glassware, tools, equipment and appliances, to my granddaughter, CHRISTINA A. DAILEY, absolutely, unconditionally and in fee simple, (c) T give and bequeath any automobile which I may own at the time of my death, to my granddaughter, CHRISTINA A. DATLEY, absolutely and unconditionally. (d) I give and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situate, to my granddaughter, CHRISTINA A. DAILEY and to my grandson, SIiA~IIN W. DAILEY, share and share alike, per stirpes. LASTLY, I nominate, constitute and appoint my.daughter, CAROL M RUSHOW, Executrix of this my Last Will and Testament, _2_ and in the event that my said daughter should predecease me, or should she be unable or unwilling to serve in such capacit for any reason, then in such event y I nominate, constitute and appoint my granddau titer CHRISTIAIA A. DAILEY g ' , Executrix of this my Last Will and Testament, in her place and stead, and in all instances, I direct that my said personal representatives be excused from posting bond or other security for the faithful performance of their duties in any jurisdiction. TN WITNESS WHEREOF, I have hereunto set my hand and seal this / da of December A. D. -..~._" y , 1998. ~' Carl A. Utsch, Jr---. (SEAL; w~_ Signed, sealed, published and declared by the above named, CARL A. UTSCH, JR., as and for his Last ti^Ji11 and Testam in the presence of us, who have subscribed our names beret ent, witnesses, at the request of said testator ° as in his presence and in the presence of each other. -~.- COMMONWEALTH OF PENNSXLVANIA ) SS. COUNTY OF CUMBERLAND ) I, CARL A, UTSCFi, JR, _ the testator whose na-ne is signed to the at-t-ached or.- for.egoing~inst-rument, having been duly qualified according to law, do hereby acknowledge that I signed and executed ttte instrwuent as 'my Last Will and Testament; that 1 signed it willingly; attd that I signed it as my free and volun- tary act and deed, for the purposes tfterein contained. Sworn and affirmed to and acknowledged before me bye CARL A. UTSCH. JFt the testatpr this - f~" 'day of D~ _ mbar A. ll. ~ 1998 , ~ _ ~~ ~ ~ - Car1 A. U1Jseh, J ~. ~ «,-~~ -,. ~ ~,!: ,2~ Notary Public Notarial Sea- Public Marilyn E. Wieiams, Notary Boro,Cre Novn6 2001y CUMMONWEAL'fH OF FENNSYLVANIA Mechanicsburg• My Commission Exp 5 S . Member, Pennsyiva~~ ~SOC~tton of Notaries COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFER attd SUSAN A. MCCOY the witnesses whose names are signed to ttte attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator CARL A, UTSCH JR, . cute ttte instrument as Iris/~CpC Lasl- Will and Tes- lament;st~atatheexe- said testat or CARL A. UTSCH, JR, hiss free and voluntary act for the purposes tltereinuexpressed; that each of us, iu the hearing and sight of the testator the Wt:11 as witnesses; and that to the best of our knowledge, tt1ened testatt3r was, at the titne, eighteen (18) or more years of age, of sound tnittd, and under nv constraiul-, duress or undue influence. Sworn and sub ed to befor me this / ~ day of December ~ 1998. i--- ~ ; ~.. Notarial Seal Public Marilyn E. WiHiarns, Notary Mechanicsburg Boro, Cuems Novn6, 2001ty My Commtisston Expi Member. pennsy-vas<ta Association of Notaries ~5r