HomeMy WebLinkAbout10-22-10 (3)1505610143
REV-1500 Ex `°'-'°' ~,
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 80X.280601 INHERITANCE TAX RETURN 21 10 0339
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
177 16 0909 03 09 2010 08 27 1922
Decedent's Last Name Suffix Decedent's First Name MI
MCDERMOND HELEN F
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED 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 ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
[ v ~
n ~ 6 Decedent Died Testate ~] ~ Attach CoMaiof T sd a giving Trust
PY ) ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received ~ 10. between P2 31 ~J1 andit1(dat~e5~f death ~~ 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
GEORGE F DOUGLAS III ESQ 717 2`4g =' 633~.~~;
First line of address
354 ALEXANDER SPRING RO
Second line of address
City or Post Office State ZIP Code
CARLISLE PA
REGISTER OF-WILLS U~~'ONLY
c°.„~4
-,
may.
DATE FILED
Correspondent's a-mail address: 9douglas@salzmannhughes.com
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.
SIGNATURE PERSON R PONSIB E FOR F ING RETURN DATE
,,~2~ ~ ~ Q/ Lynnette C. Lewis '%i ~
AD S ,
28 East Yellow Breeches Road, Carlisle, PA 17015
SIGNATURE OF PREPARER OTHER THAN REPRESENTA IVE DATE
George F Douglas, III Esq. f c / I ~ ~'
ADDRESS r 1 ~
354 Alexander Spring Road, Suite 1, Carlisle, PA
Side 1
1505610143 1505610143
j+~LI W
7'~~
J
150561D2U3
REV-1500 EX
Decedent's Social Security Number
Decedents Name: McDermond, Helen F. 17 7 16 0 90 9
RECAPITULATION
149,300.00
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 & Notes Receivable (Schedule D) ....................................................... 4.
48,430.16
5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8~ Miscellaneous I~q Probate Property
4 8
94 8.81
(Schedule G) ^~ Separate Billing Requested............ 7, ,
g,
Total Gross Assets (total Lines 1-7) .....................................................................
g. 246 678.97
~
29,527.37
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ...................................... 9.
3,433.87
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10.
11. Total Deductions (total Lines 9 & 10) ................................................................... 11.
32,961.24
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 213 , 717.7 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.
213,717.73
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15
0 . 0 0
(a)(1.2) X .00 .
16. Amount of Line 14 taxable 213
717.7 3 16. 9 , 617.3 0
,
at lineal rate X .045
17. Amount of Line 14 taxable
0
0 0
17
0. 0 0
.
at sibling rate X .12 .
18. Amount of Line 14 taxable
0
0 0
18
0. 0 0
.
at collateral rate X .15 .
19. Tax Due .................................................................................................................. 19. 9 , 617.3 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-10-0339
DECEDENT'S NAME
McDermond, Helen F.
STREET ADDRESS
2189 Newville Road
CITY
Carlisle STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 9,617.30
2. Credits/Payments
A. Prior Payments 8,850.92
B. Discount 465.84
Total Credits (A + g) (2) 9,316.76
3. Interest (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 3QQ.rJ4
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 :............................................................................... ^ ^x
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x
c. retain a reversionary interest; or ............................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .................................................................................................................... ^ 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. 0 ^
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 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-1502 EX+ (11-08)
SCHEDI)LE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
(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 A (Rev. 11-08)
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
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
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATN
1 Members 1st Federal Credit Union, Certificate of Deposit No. 43403-0042 8,660.69
Accrued income on Item 1 through date of death 4.19
2 Members 1st Federal Credit Union, Certificate of Deposit No. 43403-0048 6,770.21
Accrued income on Item 2 through date of death 3.84
3 Members 1st Federal Credit Union, Certificate of Deposit No. 43403-0052 10,632.07
Accrued income on Item 3 through date of death 8.12
4 AXA Equitable -April 1, 2010 check 123.92
5 Members 1st Federal Credit Union,Checking Account No. 43403-0011 9,393.09
Accrued interest on Item 5 through date of death 0.18
6 Members 1st Federal Credit Union Savings Account No. 43403-0000 8,471.46
Accrued interest on Item 6 through date of death 0.49
7 Household Goods 3,594.50
8 Commonwealth of Pennsylvania -property tax rebate 250.00
9 Erie Insurance -refund of unused premium due to cancellation 204.00
10 Erie Insurance Group -refund of unused automobile insurance premium due to cancellation 276.00
11 United Healthcare Services -refund 37.40
TOTAL (Also enter on Line 5, Recapitulation)
48,430.16
(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)
Rev-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
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
THE DATE OF TRANSFERSATTACIi A COPY OF T~E DEIED FOOREREAL ESTATE. DATE OF DEATH
VALUE OF ASSET °i° OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Allstate -Annuity Contract No. GA0751887, 16,122.26 100.000% 16,122.26
Beneficiaries are Lynnette Lewis, daughter, Lauri
Sheriff, granddaughter and Jamie Kelly,
granddaughter
2 Allstate -Annuity Contract No. GA0752466, 18,809.30 100.000% 18,809.30
Beneficiaries are Shawna Kelly, Sidney Erin Kelly,
Kylie Shannon Kelly and Carlee Elizabeth Hahn, great
granddaughters, Brady Patrick Kelly and Cory William
Hahn, great grandsons
3 Western 8~ Southern Life -Annuity Contract No. 14,017.25 100.000% 14,017.25
W0020598895; Beneficiaries are Lynnette Lewis,
daughter, Lauri Sheriff, granddaughter and Jamie
Kelly, granddaughter
TOTAL (Also enter on Line 7, Recapitulation) I 48,948.81
(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 G (Rev. 6-98)
REV-1151 EX+ (10-06)
SCHEDULE N
COMMONWRR~E~ALTCCH OF PENNSUUYLVANIA FUNERAL EXPENSES &
IN RESIDENTEDE'cEDENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
L~GY~J VI VGVGV Gt1~ IIIMJ6 VG 1GlJVI LGW V11 VVIIGMIdIG 1.
ITEM DESCRIPTION AMOUNT
N MBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
2,352.13
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Lynnette C. Lewis
Street Address 28 East Yellow Breeches Road
city Carlisle state PA zip 17015
Year(s) Commission paid 8,900.00
2. Attorney's Fees Salzmann Hughes, P.C. 5,000.00
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 345.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 12,929.74
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 29,527.37
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
McDermond, Helen F. 21-10-0339
ITEM
NUMBER
DESCRIPTION
AMOUNT
Funeral Ex e
1 Barbara Finkenbinder -funeral services 50.00
2 Betty Hockensmith -funeral services 50.00
3 Carlisle Memorial Service, Inc. -grave marker 1,134.50
4 CGWM -funeral luncheon 250.00
5 Hoffman-Roth Funeral Home -balance due for funeral services 867.63
H-A 2,352.13
Other Administrative Costs
6 Advanced Septic -pump septic tank to sell real estate in order to administer the estate 235.00
7 CenturyLink -phone service 20.30
8 Charles C. Mattias -seller assistance paid to sell real estate in order to administer the estate 5,520.00
9 Charles C. Mattias -seller credit paid to sell real estate in order to administer the estate 980.00
10 Cornerstone Land Transfer, Inc. -tax certification fee paid to sell real estate in order to 5.00
administer the estate
11 Kevin M. Wickard -expenses to sell household goods 822.48
12 Kough's Oil Service - 3/13/10 oil delivery 152.36
13 Kough's Oil Service 134.39
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCH~D~JLlE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
ITEM
NUMBER DESCRIPTION AMOUNT
14 PPL Electric Utilities -electric service
15 PPL Electric Utilities -electric service
16 PPL Electric Utilities -electric service
17 PPL Electric Utilities -electric service
18 PPL Electric Utilities -electric service
19 PPL Electric Utilities -electric service
20 Re/Max Central State -commission paid to sell real estate in order to administer the estate
21 Re/Max Central State -transaction fee paid to sell real estate in order to administer the estate
22 Recorder of Deeds - 1% realty transfer tax paid to sell real estate in order to administer the
estate
23 Salzmann Hughes, P.C. -reimbursement for payment to Cumberland Law Journal for
publishing the Estate notice
24 The Sentinel-Legal -Legal advertising
H-B7
48.18
59.88
70.28
75.77
47.94
17.00
2,800.00
175.00
1,493.00
75.00
198.16
12,929.74
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCI~E®ULE 1
, DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANfA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McDermond, Helen F. 21-10-0339
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 AARP MedicareRX Preferred -balance due on account 37.40
2 AXA Equitable -reimbursement for April benefit not earned 123.92
3 Carlisle HMA -balance due for medical services 93.56
4 Comcast -cable service 10.00
5 Cumberland Goodwill EMS -balance due on account 51.50
6 Deborah W. Piper, Tax Collector - 2010 County real estate tax 324.90
7 Deborah W. Piper, Tax Collector - 2010 real estate tax 1,653.12
8 Forest Park -personal care 62.14
9 Forest Park Health Center -balance due on account 492.00
10 Guardian Long-Term Care Pharmacy -balance due on account 11.54
11 Internal Revenue Service - 2009 1040 income tax due 388.00
12 Marston's Tax Service -preparation of income tax returns for the year 2009 65.00
13 PA Department of Revenue - 2009 PA40 income tax due 73.00
14 PPL Electric Utilities -electric service form 2/18110 to 3119/10 47.79
TOTAL (Also enter on Line 10, Recapitulation) I 3,433.87
(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)
REV-1513 EX+ (11-08)
SCHEDULE J
COMMNHERITANCE~ ~ RETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McDermond. Helen F. 21-10-0339
NAME AND ADDRESS OF RELATIONSHIP TO
SHARE OF ESTATE
AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY D
ECg DEN e (Words) ($$$)
~
S
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
See attached schedule
Total 213,717.73
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Helen F. McDermond 03/09/2010 177-16-0909
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
1 Carlee E. Hahn Great-granddaughter SchG 116th Item 2 23,731.00
325 McCulloch Rd. 12.5% residue as per
Shippensburg, PA 17257 Item 4. (c) of the Will
2 Cory W. Hahn Great-grandson SchG 1/6th Item 2 23,731.00
325 McCulloch Rd. 12.5% residue as per
Shippensburg, PA 17257 Item 4. (c) of the Will
3 Brady P. Kelly Great-grandson SchG 1/6th Item 2 13,432.94
1971 Londontowne Dr. 6.25% residue as per
Hagerstown, MD 21740 Item 4. (d) of the Will
4 Jamie L. Kelly Granddaughter SchG 1/3rd 183 37,507.99
1971 Londontowne Dr. 16.6667% residue as
Hagerstown, MD 21740 per Item 4. (b) of the
Will
5 Kylie S. Kelly Great-granddaughter SchG 1/6th Item 2 13,432.94
1971 Londontowne Dr. 6.25% residue as per
Hagerstown, MD 21740 Item 4. (d) of the Will
6 Shawna B. Kelly Great-granddaughter SchG 116th Item 2 13,432.94
1971 Londontowne Dr. 6.25% residue as per
Hagerstown, MD 21740 Item 4. (d) of the Will
7 Sidney E. Kelly Great-granddaughter SchG 1/6th Item 2 13,432.94
1971 Londontowne Dr. 6.25% residue as per
Hagerstown, MD 21740 Item 4. (d) of the Will
8 Lynnette C. Lewis Daughter SchG 1/3rd 183 37,507.99
28 E. Yellow Breeches Rd. 16.6667% under Item 4.
Carlisle, PA 17015 (b) of the Will
1
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Helen F. McDermond 03/09/2010 177-16-0909
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
9 Lauri A. Sheriff Granddaughter SchG 113rd 1 &3 37,507.99
325 McCulloch Rd. 16.6667% residue as
Shippensburg, PA 17257 per Item 4. (b) of the
Will
Total 213.717.73
2
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 20 ~ 0- 00339 PA No . 2 ~ - ~ D- 0339
Estate Of : HELEN F MCDERMOND
(First, Middle, Last)
Late Of : WEST PENNSBORO TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No : ~ 77- ~ 6-0909
WHEREAS, on the 1st day of April 2010 an instrument dated
August 13th 2002 was admitted to pz-obate as the last will of
HEL EN F MCDERMOND
(First, Middle, Last)
1 a to of WEST PENNSBORO TOWNSHIP, CUMBERLAND County,
who died on the 9th day of March 2 010 and,
WHEREAS, a true copy of the will as probated i s annexed hereto .
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
L YNNET TE C L EWIS
who has duly qualified as EXECUTOR(R/Xl
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY CDURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the Est day of April 2070.
,~
Registet{of Wills
~ ~`
~ ( \ 3
~! f S ~~~1 J { k..
,~ ~ v~ Deput~i
~~
* * NnT~* * ALL NAMES ABOVE APPEAR (FIRST, r7IDDLE, LAST)
I, I~ELEN F. ~IcI~~Ri~I~ND, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executor to pay all of my debts, funeral and administrative expenses as
soon as maybe done conveniently after my decease.
2. I authorize and empower my executor to sell any realty owned by me at my death,
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to my
husband, CARL S. McDER1VIOND, providing he shall survive me by sixty days.
r~,~jr~ too (ten ~{- ;n P'a"'7 ~^,h1"t ~T~^ r~~~ 4pi~a t~ r~ f iat~l cam; r ~ ~
~. Shl+a.a~u t~tL gill. ~ u. t.~i... fii• 1`i ... - Lui1v ~.Slt. t. ~, I Ua.~v 1Jv ana dequeatri all o my
estate of every nature and wherever situate as follows:
(a) I give certain items of personal property according to a list left with
my substitute executrix.
(b) 50% of the residue is to be divided equally between LYNNETTE C.
LE~ti IS, LAURI Ati`i~T SHERIFF and JAtiIIE L. KELLY, share and share
alike. If LYNETTE predeceases me, her share shall go to LAURI ANN
and JAMIE. If either LAURI ANN or JAMIE predecease me, their share
shall go to their children, share and share alike.
(c) 2~% of the residue is to be divided equally between CARLEE
HAHN and CORY HAHN, share and share alike, but to be held in Trust
by MANUFACTURERS AND TRADERS TRUST COMPANY, of
Carlisle, Pennsylvania.
(d) 2~% of the residue is to be divided equally between SHAUNA
KELLY, BRADY KELLY, SIDNEY ERIN KELLY and KYLIE KELLY,
share ar~d share alike, but to beheld in Trust by MANUFACTURERS
• AND TRADERS TRUST COMPANY of Carlisle, Pennsylvania, until
they reach the age of eighteen (18) years and then the funds are to be
used for their education, and any remainder is to be distributed to them
upon completion of their education.
5. I nominate and appoint CARL S. McDERI~~IOND to be the executor of this my Last
Will and Testament; he is to serve as such without bond. Should he die before my death,
renounce or refuse to serve for an reason, or die leaving any of my estate unadministered, I
2
nominate and appoint LYNETTE C. LE~VIS as substitute executrix, also to serve as such .
without bond, with the same powers as are given herein to my executor.
b. I hereby suggest that my personal representative retain the services of Irwin, McKnight
& Hughes as attorneys in the settlement of my estate
IN FITNESS ~IFIEI~OF, I have hereunto set my hand and seal this ' ~~ day of
August, 2002.
r -,
r~, _.
__ ~ ~,; ~ , ~- -- .,.(SELL)
-~ HELEN F. McI~EF.~~'I~ND ~.; ~_ ;~ <
Signed, sealed, published and declared by HELEN F. l~IcDERiVI~'+TD, the testatrix
above-rained, as and for leer Last Will and Testament, in the presence of us, who, at her request,
in her presence and in the presence of each other have subscribed our names as witnesses hereto.
~,
J
tiVE, I~ELE1~t F. ~IeDER~IO`v'D, I~IARTI~A L. NOEL and JACQUELINE L.
DRA`VBALTGIJ, the testatrix and witnesses respectij~~ely, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testatrix signed ar~d executed the instrument as her last will and that she had signed willingly,
and that she executed it as her free and voluntary act for the purpose herein expressed, and that
each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and
that to the best of their knowledge the testatrix was, at thai time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
_. _
HELEN F. NIcDER'~IOND
~L AR~'I-3A U1Y~EL
r~ ,. ~, a a
J~CQUE~I~i`E L. DRAWBA'UOII
COIV~MONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OE CUMBERLAND
Subscribed, sworn to and acknowledged before me by I3ELEN ~'. l~IcDERNIOND, the
testatrix, and subscribed and sworn to before me by MARTI-IA L. NOEL and JACQUELINE
L. DRAWBAUG~, witnesses, this ~ s ~~^ day of August, 2002.
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No~ary Public
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l:o~~r S. 1r~.vi,l, T4o~:r; P~abii{.:
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7~'~'':;~{'~~ lJr; ~liJ~iyC~f:~t~' f}`~lll.ic;ti~i{~..',~~i1t11~ia3
~'`'~ OMB Approval No. 2502-0255
%~,~II~-p ~ A. Settlement Statement (HUD-7 )
~, II~II~II FINAL
~"`
.- . ..
^Conv. Unins.
^ RHS 3
^ FHA 2
1 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
.
.
. CL10126 1000028500
4. X^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
"(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
Charles C. Mattias The Estates of Helen McDermond by her Executrix Walker Jackson Mortgage Corporation
3 Mandy Lane, Dillsburg, Pa. 17019 Lynette C. Lewis 14501 George Carter Way #300, Chantilly,
Virginia 20151
G. Property Location: H. Settlement Agent: I. Settlement Date: 08/31/2010
2189 Newville Road Cornerstone Land Transfer, Inc. Disbursement Date: 08l3V2010
Carlisle, PA 17015 Telephone: 717-730-9664 Fax: 717-730-9665
West Pennsboro Township
Place of Settlement: TitleExpress
4705 E. Trindle Road, Mechanicsburg, PA 17050 Printed 08/31/2010 at 11:49 am
by VS
100. Gross Amount Due from Borrower
101. Contract sales price 149,300.00
102. Personal ro rt
103. Settlement charges to borrower (line 1400) 10,483.52
104.
105.
Ad'ustments for items aid b seller in advance
106. City/town taxes 08!3112010 to 12/31/2010 111.72
107. County taxes to
108. Assessments 08/31/2010 to 06/30/2011 1,405.02
109.
110.
111.
112.
120. Gross Amount Due from Borrower 161,300.26
200. Amounts Paid b or in Behalf of Borrower
201. Deposit or earnest money 1,000.00
202. Principal amount of new loan(s) 154,226.00
203. Existin loa s taken sub'ect to
204.
205.
206.
207. Sellers Assistance 5,520.00
208. Seller credit for VA Non-allowable Adm & Process fat 980.00
209.
Ad'ustments for items un aid b seller
210. City/town taxes to
211. County taxes to
212. Assessments to
213.
214.
215.
216.
217.
218.
219.
220• Total Paid b Ifor Borrower 161,726.00
300. Cash at Settlement fromito Borrower
301. Gross amount due from borrower (line 120) 161,300.26
302. Less amounts paid by/for borrower (line 220) 161,726.00
303. Cash ^ From ^X To Borrower 425.74
400. Gross Amount Due to Seller
401. Contract sales price 149,300.00
402. Personal ro art
403.
404.
405.
Ad'ustments for items aid b seller in advance
406. City/town taxes 08/31/2010 to 12/31/2010 111.72
407. County taxes to
408. Assessments 08/31/2010 to 06!30/2011 1,405.02
409.
410.
411.
412.
420. Gross Amount Due to Seller 150,816.74
500. Reductions In Amount Due to Seller
501. Excess deposit (see instructions) ~
502. Settlement charges to seller (line 1400) 4,708.00
503. Existin loa s taken sub'ect to
504. Pa off of first mort a e loan
505. Payoff of second mortgage loan
506.
507. Sellers Assistance 5,520.00
508. Seller credit for VA Non-allowable Adm & Process fel 980.00
509.
Ad'ustments for items un aid b seller
510. City/town taxes to
511. County taxes to
512. Assessments to
513.
514.
515.
516.
517.
518.
519.
520. Total Reduction Amount Due Setter (a •-1-1,,Z08.Q0
600. Cash at Settlement totfrom Seller
601. Gross amount due to seller (line 420) 150,816.74
602. Less reductions in amount due seller (line 520) a~ '+-~00
603.
repo mg Cash X^ To ^ From Seller
e a a is agency may no rA a rs in ortna ion a you era n requue 439;69634
o wm e e
this form, unless It displays a currently valid OMB control number. No confidentiality Is assured; this disdosure is rnantlalary. This is designed to provitle the padles to a RESPA covered transaction with inlortnation during the r;
sedlement process. I? ~~ ~ O y i~l t j
Previous editions are obsolete Page 1 of 4 HUD-1
__,. ,
L ent C
700. Total Real Estate Broker Fees $ 2,800.00 Paid From Pald From
Division of commission Tine 700 as follows: Borrower's Seller's
701. $2,800.00 to RelMax Central State Funds at Funds at
702. $0.00 to Settlement Settlement
703. Commission paid at settlement 2,800.00
704. Transaction fee to RelMax Central State 175.00
800. Items Pa able in Connection with Loan
801. Our origination charge (Includes Origination Point % or $0.00) $4,711.88 (from GFE #1)
802. Your credit or charge (points) for the specific interest rate chosen $-3,864.90 (from GFE #2)
803. Your adjusted origination charges (from GFE A) 846.98
804. Appraisal fee to Cod Financial Mort a e Services, Inc. (from GFE #3) 375.00
805. Credit report to Cod Financial Mort a e Services, Inc. (from GFE #3) 50.00
806. Tax service to from GFE #3
807. Flood certification to from GFE #3
808. VA Funding fee to Veterans Administration (from GFE #3) 4,926.90
900. Items Required b Lender to be Paid in Advance
901. Daily interest charges from from 08!31/2010 to 09101/2010 @ $19.0141/day (from GFE #10) 19.01
902. Mortgage Ins. Premium for months to (from GFE #3)
903. Homeowners insurance for months to Nationwide (from GFE #11) 601.00
904, months to from GFE #11
1000. Reserves De osited with Lender
1001. Initial deposit for your escrow account (from GFE #9j 654.88
1002. Homeowner's insurance 3 months $ 50.08/month $150.24
1003. Mortgage Insurance months $ 0.00/month $0.00
1004. months $ 0.00/month $0.00
1005. County Property Tax 7 months $ 27.63/month $193.41
1006, Assessments months $ 0.00/month $0.00
1007. School tax 3 months $ 140.58/month $421.74
1008. Aggregate Adjustment $-110.51
1100. Title Char es
1101. Title services and lender's title insurance (from GFE #4) 1,358.75
1102. Settlement or closing fee to $
1103. Owner's title insurance (from GFE #5)
1104. Lender's title insurance $1,358.75
1105. Lender's title policy limit $154,226.00 Lender's Policy
1106. Owner's title policy limit $149,300.00 Owners Policy
1107. Agent's portion of the total title insurance premium $1,091.19
1108. Underwriter's portion of the total title insurance premium $267.56
1109. Tax Cert Reimbursement to Cornerstone Land Transfer, Inc. 5.00
1200. Government Recordin and Transfer Char es
1201. Government recording charges (from GFE #7) 158.00
1202• Deed $62.00 Mort a e $96.00 Release $0.00
1203. Transfer taxes (from GFE #8) 1,493.00
1204. City/County tax/stamps Deed $1,493.00 Mort a e $0.00
1205. State Tax/stamps Deed $1,493.00 Mort a e $0.00 1,493.00
1206. Deed $0.00 Mort a e $0.00
1207.
1300. Additional Settlement Char es
1301. Required services that you can shop for (from GFE #6)
1302. Survey to $
1303. to
1304. Septic Pumping to Advanced Se tic 235.00
1305. to
' i r • • - r ~ 10,483.52 4,708.00
`Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er.
Previous editions are obsolete Page 2 of 4 HUD-1
Com arison of Good Faith Estimate GFE and HUD•1 Char es
Char es That Cannot Increase HUD-1 Line Number
Our origination charge # 801
Your creditor charge (points) for the specific interest rate chosen # 802
Your adjusted originationcharges # 803
Transfer taxes # 1203
Char es That in Total Cannot Increase More Than 10%
Government recording charges. # 1201.
Appraisal fee to # 804
Credit report to # 805
VA Funding fee # 808
Mortgage Ins: Premium # 902
Title services. and. lender's title insurance- # 1101
Owner's title insurance # 1103
~~ ~ ~ ~-
Char es That Can Chan e
Initial deposit for your escrow account # 1.001
Daily. interest charge # 901 $19.0141lday
Homeowner's insurance # 903
Loan Terms
Good Faith Estimate HUD-1
4,711.88 4,711.38
-3,864.90 -3,864.90
846.98 846.98
1,493.00 1,493.00
Good Faith Estimate HUD-1
150.00 158.00
390.00 375.00
50.00 50.00
4,926.90 4,926.90
0.00 0.00
1,483.75 1,358.75
10.00 0.00
7,010.65 6,868.65
$ -142.00 or -2.0255%
Good Faith Estimate HUD-1
2,190.00 654.88
19.01 19.01
540.00 601.00
Your initial loan amount is $154,226.00
Your loan term is 30. years
Your initial interest. rate is 4.5000%
Your initial monthly amount owed for principal, interest, and any mortgage $781.45 includes
insurance is QX Principal
QX Interest
Mortgage Insurance
Can your interest rate rise? XQ No. ^ Yes, it can rise to a maximum of %. The first change
will be on / / and can change again every years after I ! .Every change
date, your interest rate can increase or decrease by %. Over the life of the loan, your
interest rate is guaranteed to never be lower than % or higher than %.
Even if you make payments on time, can your loan balance rise? QX No. ^ Yes, it can rise to a maximum of $
Even if you make payments on time, can-your monthly amount owed for QX No. ^ Yes, the first increase can be on / / and the monthly
principal, interest, and mortgage insurance rise? . amount owed can rise to $
The maximum it can ever rise to is $
Does your loan have a prepayment. penalty? QX No. ^ Yes, your maximum prepayment penalty is $ ,
Does your loan. have a balloonpayment? ^X No. ^ Yes, you have a balloon payment of $ due in
years on / /
Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes
and homeowner's insurance. You must pay these items directly yourself.
QX You have an additional monthly escrow payment of $218.29
that results in a total initial monthly amount owed of $999.74. This includes principal, interest, any
mortgage insurance and any items checked below:
^X Property taxes Q Homeowner's insurance
Flood insurance
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
.~~
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
~~ ~
Cba s . Mattias
!%"/r( '%l17y%~:~ (/°.,, i',~.i~C~+J~-~:c~ % i7!-L7.('l~~L~'~!~?~il
Ttie.Estates of Helen McDermond by her Executrix Lynette C. Lewis "
,,.
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance with this statement.
SETTLEMENT AGENT DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Accrued Interest From 1 /1 /10 to Date of Death
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Accrued Interest From 1/1/10 to Date of Death
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Accrued Interest From 1 /1 /10 to Date of Death
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Accrued Interest From 111/10 to Date of Death
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/S::ffix
Date Certificate Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Accrued Interest From 1/1/10 to Date of Death
Narne of Joint Owner
'Roll over from Certificate 46 (B), originally established 01/22/2008
'"Roll over from Certificate 46 (A), originally established 06/7/2001
"Rollover from Certificate 43, originally established 07/11/2007
43403-00
11 /03/1984
$8,471.46
$.49
$8,471.95
$2.93
None
43403-11
11 /10/1984
$9,393.09
$.18
$9,393.27
$.74
None
43403-42
04/27/2009*
$8,660.69
$4.19
$8,664.88
$22.65
None
43403-48
12/08/2005*'`
$6,770.21
$3.84
$6,774.05
$20.78
None
4:1403-52
08/15/2008*'`
$10,632.07
$8.12
$10,640.19
$43.83
None
MEMBERS 1ST FEDERAL C~~R~~EDIT UNION
C-~~~~ ~ ~~~d~'ll'rL
Leigh- nne Stallings
Lending Insurance Support
April 15, 2010
Estate of: Helen F. McDermond
Date of Death: March 9, 2010
Social Security Number: 177-16-0909
J U I I. L. L_ 1 , J~ I„ I/ I Y~ 11 -- V T r 1 I L 1 `'1 V ~JI ` r-::,'i ~l ~ I~'i 1, ~~ L. ;~ l,! 1. J
~ ~ . ~~ ~•J
Allstaic Life Insurance Company
P.C~. ~a~ 94212
Palatine, IL 60094-4212
1"elephc~ne; (S77) 499-6418
Facsimile: (866) b35-452
7unt~ 2, 2410
Ta_mera Siegrist
Falznlan and Haggis, P.C.
~~`' ~r
You're.'iri goad h~r~ds~.
Rz: Helen F. McDermancl
Contract No: GA0751887
Dear Ms. Siegrist:
~Ve received a request to complete IRS Farm 712 for the above referenced cc~ntrt~c;t. The parpose of Form
712 is to pro~ride an estate or donar with the ~val~ of a life insruance ~:o~~trac`t or its prr,~eeds as of ~ certtiin
date (ustYall~ the o~~rier's daze of death ar date cif transfer of the canrs~:t).
Pecause this contract is an anntlit~y, it is not reportable on 1RS Form 712. Y can, ho~Ye~~er, pro~Yide the
following inforn~atian for estate purposes;
1>ate of Dea,ch; March 9, 2f~ 10
Annuity value as of Datz of Death: ~ 16,12Z.26*
Cost Basis: ~ IZ,000.00
Named Peneficiary: Lynnette Ler~`~~is, Lauri Sheriff, ~ amie Deily
*The actual amount paid may differ due to IVIar~.et ~"alue Adjustments andlor any applicable Surrender
Charges_
T~" you have any questions, please contact me at 1-$77-499-6~1$ ~xt 2~F694
Sincerely,
Crystal 7. Parish
Sr. Claim Examiner
gun, ~, 2~~'' ~ ~. . ='~ti' ~~~5.=,~c ~J~~~~,!J~
Allstate fife lnstuance Company
l'_C~. $o:c 94212
Palatine, 7f ti0094-4212
Teleph~ne~ (877) 499-f~41$
Facsimile- (S66) X35-4523
7tule 2, 2010
Tam,era Siegrist
Falzman and ~uaes, p.C_
r
I~ ~ , ~. _. U , L
You're in good hands:
12e: FTelzn F. McDermond
Contract iV~a~ CrA07524~6
Dear lVis_ Sie~ist~
~Ve received a request to complzte IRS Farm 712 far the shave referenced contract. The pu~pase of ~or~x~
712 is to provide an estate or donor v~rith the value of a life insurance contract ur iu proceeds as of a certain
date (usually the owner's date pf death or date of transfer of the cc-nrract).
Because this co~nrract xs an annuity, xt is riot repo~~tahle an IRS Form 712. I, caza, he}~v~vez, pr~~~~ide tide
follo~wx~ng x~afar~cnatxon fax estate purposes:
T~atz of Deat11: - [arch 9, 2010
AzinuiLy Val~~re as of Date of Dea~~: ~ 15,809.30*
_ Cast Basis: ~ 14,OOta.00
Named Benefi~~iary: Sh~~wna Kelly, Brady Pa~rick Kelly, Sidney Erin 1%elly,
KyliE Shannon Kelly, Carle Eli~abGth Hahn, Cory '44'illi~~.rn Cahn
*'l~e act-ual ~unaunt paid may differ due to Market Value AcljusLrnert5 and/or any applicable Surrender
Charges.
Tf you have any questions, please contact m~ at 1-877-499-6418 L;~t. 2~~94.
Sincerely,
Crystal 7_ parish
Sr. Claim Exazi>rner
WSFG 5/ 1~3i~~10 3 . ~~ : ~v ;:>M 1~AC~L 2/~U<' Fax Se:~~~~~r
Annuity Operations
,~ Western. & Southern :Life PO Box 2918
Cincinnati, OH 45201-2918
A member of UJesten~ & Southern Financial Group toll free 800.926.1702
fax 513.629.1799
SALZMANN HUGHES, P.C.
ATTN: TAMERA
May 18, 2010
Subject: Annuity Contract Number W0020598895 -Helen Mcdermor~d
Western-Southern Life Assurance Company
Dear Tamera:
Lynnette Lewis requested that the following information be sent to you regarding
the above referenced annuity contract: .
Value as of 3/9/2010 - $14,017.25
Type -Non Qualified
Beneficiaries -Lynnette Lewis, Child
Lauri Sheriff, Grandchild
Jamie Kelly, Grandchild
If you have any questions, please call our Annuity Operations Department at
1-800-926-1702. A representative will be happy to help you.
Sincerely,
Scott Koch
Annuity Operations Department
DC0254-0807
Western-Southern Life Assurance Company