Loading...
HomeMy WebLinkAbout11-02-10J 1505610101 REV-1500 Ex ~°~-~°, ' PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °EPARTME"T °FRE~F"°E County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN Harrisburg, PA 1128-0601 RESIDENT DECEDENT -o? I I ~ O O / (, ~ ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY S7 8 ~$ ~~{sz ~2 13 d.o~ o ~ Z,pyc f 9~S Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Nf~ Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW i 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust D 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 ~'~~'~L ~S F ~H l~'~ DS i i / 71 ~ 7 ~6 0~0 9 First line of address C L D u$ ~ Oe ate O /~ .D Second line of address / V ! ~' City or Post Office State ZIP Code REGISTER~ W ILLS USE ANLY ,r ~ v ~ C, f ! ~~ ~ ~ . - ~~ ~~ ,_ _ . ~ r- - ti7~_,~ : ' Y r . ~ 1 i ~~ . t L_.~ `'f Jr ~7 -,--._ .SATE: FILED P ~~osS973S' ~' Correspondent's a-mail address: _ ~l° S O / e%~5.3 4 ~Cca•S ~~ ~e f ' Under penalties of perjury, I declare that I have examined this return, including accompanying schedules tements, and to the best of my knowledge and 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. SIGNATU E OF PERSO SPONSIBLE FOR FILING RETURN X ~ _ _ _ ~!7~t~/~/.ii ~ /J ~ DATE SIGNATURE 53f ~REPA$ER OTHER ADDRESS y~..~GEs ~ sy/~ C!o ~Scr / L 1505610101 `//e,~roaf' Royce /, ~!/~ ~ r7~o 3Q ~ Q/'1 /C$ K r p/~ /70S'S"' PLEASE USE OR GINAL FORM ONLY Side 1 DATE ,.,~~ 1505610101 J ~) \Y'~ A ~~. ) :,.~ __, ;~~ 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: 1. e ~ /'~ Q /~ • J~ ~ S RECAPITULATION (~O OOO•pO 1. Real Estate (Schedule A) ..:.......................................... L 2. Stocks and Bonds (Schedule B) ....................................... 2. 3 ~ Jr ~P ? ' 1 3 .DO 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. I ? a ~ ~ ` 3 ~' Jointl Owned Property (Schedule F) O Separate Billing Requested ....... 6. . 0 ~ 6. y 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ D Q O Separate Billing Requested........ 7. (Schedule G) s. 1 7 9 ~ ~ (o'~~ 8. g ................ Total Gross Assets (total Lines 1 throu h 7 • • • • • • • • ~ • ~ - 9. ............. 9. Funeral Expenses and Administrative Costs (S~hedule H) ..... . 3 1 ~ J o~ • O c) 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .. 10. . . .3 g, ~ / 7 •3 ~, - 11. . Total Deductions (total Lines 9 and 10) ........................... . .... 11. 7 7 ~ ~ 3 0' . a, o ......... 11 ....12. / d ~~ ~ 9 ~ , 3 0 12. ................. ) Net Value of Estate (Line 8 minus Line 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 3 C ~ ~ 3 t ~ ' , t an election to tax has not been made (Schedule J) ............ • 14. Q ~ ~O *~ .3 .~ . S 14. .................... Net Value Subject to Tax (Line 12 minus Line 13) .... ~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 O O ` 15 ~ O (a)(1.2) X .00 16. Amount of Line 14 taxable ~ O ~ at lineal rate X .0~ 16 O` O 17. Amount of Line 14 taxable t°" ~ 9 c1 8 ~ ~ S . 12 .7 7 ~ , 17. 6 ~ ~ 3 • 7 - J , at sibling rate X . . - 18 . Amount of Line 14 taxable 1 s• 2 ~ U ~ (f C.~ 5 18 v~~ Z 9 ,~ . 6 ~ " ~ ~~ - / _ at collateral rate X .1 _ ~' `f 0 (o~ ~~ 19 . TAX DUE ................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1,505610105 J REV-1500 EX ~~'a~e~ . ~ File Number a f --~Q --.~65' Decedent's Complete Address: DECEDENT'S NAME C~(ka K. Pr~scotfi STREET ADDRESS ~v"7 ~ . Coo vG,r ~~: __ _ - n1 echanicsb a ----A- .. - ----- _ - - -- -- - -- ~I STAT~A ZIP ~7oSS' Tax Payments and Credits: z 1. Tax Due (Page 2, Line 19) (1) (~~ 6 D g. ~ q 2. Credits/Payments JE A. Prior Payments ______/~~_ ~° $ ~'.~_________ _- B. Discount _ __ __,~~_(~ ~Q o - - Total Credits { A+ B } (2) '~~/, .T.S`D' ° 3. Interest (3) O 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. (4} ~~ (o y~ ~ ~ ~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5} 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 ~;urviving 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH CF PENNS~I_.VANIA DEPARTM"NT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RE`/-1162 EX(11-n6) NO. CD 012675 ABSTRACT ABSOLUTE 125 WEST HARRISBURG STREET DILLSBURG, PA 17019 ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: SSN: 578-38-2452 FILE NUMBER: 2110-0165 DECEDENT NAME: PRESCOTT CELKA K DATE OF PAYMENT: 04/ 30/ 2010 POSTMARK DATE: 04/29/2010 COUNTY: CUMBERLAND DATE OF DEATH: 02/ 13/2010 REMARKS: RECEIPT TO ATTY SEAL CHECK# 2489 AMOUNT 101 ( $10,687.50 f TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: $~ 10,687.50 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE: TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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. ITEM NUMBER DESCRIPTION _ ,. i41/ flat Certain {raGf o{ land %m~rored b~ ~ o[ we))i n S ~ fie ar.~" X07 ~'. (°_oo vPa"' st ~ ~ 3orn-1 i~ lYlec~ran i esbUr~ ~ C~c.mberlc~d Co ~, t~~nns''YY(VtlUri.ta ~~iL-., was Sold ~ -mason E. (1t1~ ~~~'"" ~~~~ U . wt't~t m A,>~ ~. D >f !` h ~ S W 1 >~ e, o h l ~'pr ~ f q~ c2p I C? , fee S~ hem ent cvnd f.~n ~ ~-m~d ~~~ o f d~ eel u.tF'aa.~.d here~~ VALUE AT DATE OF DEATH ¢ 3 0 00 • °~ 1 , o TOTAL (Also enter on line 1, Recapitulation) $ ~ ~~ (If more space is needed, insert additional sheets of the same size) ~ i +~ ~ VIVI[3 NppfOVi9I IV V. LJUL-ULq: ~~~°~? ~ ~ A. Settlement Statement HUD-1 ~~~ , . - ... 1. X^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 2010019A6 219713588 PA44Ei0051387703 4. ^ 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 8 Address of Borrower: E. Name & Address of Setter. F. Name & Address of Lender: Jason E. Ott, Mary P. Ott Estate of Celka K. Prescott Bank of America N.A. 1200 Church Road, Mechanicsburg, PA 17055 cJo James Price, Executor, 1343 Forest Hill Drive, Front Attn: Enterprise Closing Prot, 7105 Corporate Royal, VA Dme/MS: TX2-, Plano, TX 75067 G. Property Location: H. Settlement Agent: I. Settlement Date: !)4/09!2010 307 E Coover Street Absolute Abstract, LLC Disbursement Date: 04/09/2010 Mechanicsburg, PA 17055 Telephone: 717-432-7102 Fax: 717-432-1535 Mechanicsburg t3orough Place of Settlement: TitleExpress 125 West Harrisburg Street, Dillstwrg, PA 17019 Printed 04/09/2010 at 9:20 am by CEC 100.. . GroseAmount Due from Borrowe[ 101. Contract sales price 130,000.00 102. Personal 103. Settlement charges to borrower (line 1400) 8,365.04 104. 105. Ad ustments for items d b seller In advance 106. City/town taxes to 107. County taxes 04/09/2010 to 12/31/2010 431.09 108. Assessments 04/09/2010 to 06130/2010 296.53 109. SewedTrash - 2nd Qt 04/09/2010 to 06/30/2010 103.36 110. 111. 112. 120. Gross Amount Dus from Borrower 139,198.02 Z00: Amour>ts Paid b ,or irr Behalf of Bomow~er: 201. Deposit or earnest money 2,500.00 202. Principal amount of new loanjs) 127,645.00 203. Existin 1 s taken sub'ect to 204. 205. 206. 207. Seller Assist 1,100.00 208. 209. Ad ustrnents for items un d b sailer 210. Cityltown taxes to 211. County taxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. 220. Total Paid b Borrower 131,245.00 300.- ' Cash at Settleme~ fromlta Borrower ". ._ 301, Gross amount due from txxrower (line 120) 139,196.02 302. less amounts paid byffor borrower (line 220) 131,245.00 303. Cash ^X From ^ To Borrower 7.951.02 .400. Gross~~Antount Due to Seller 402. Personal ro art r~_ 403. 404. 405. Ad ustments for items seller in advance 406. Cityltown taxes to 407. County taxes 04!09/2010 to 12/31/2010 431,Q< 408. Assessments 04/0912010 to 06/30!2010 296.5: 409. SewedTrash - 2nd Qt 04H)9l2010 to 06/30/2010 103.3E 410. 411. 412. 420• Gross Amount Due to Seller 130,830.9! 500. Reductions hl Amourrt Due t0 Seiler 502. Settlement charges to seller (line 1400) 9,928.3: 503. Existin loa s taken sub'ect to 504. Payoff of first mortgage loan 505. Payoff of second mortgage loan 506. __ 507. Seller Assist 1,100.0( 508. 509. Ad ustments for items un ld b seller 510. Cityltown taxes to 511. County taxes to 512. Assessments to 513. 514. 515. 516. Estate Escrow/Return 17,971.9( 517. 518. 519. 520. Total Reductlon Amount Due Seller 29,000.2: 600. .Cash at Settlement tolfrom Seller 601, Gross amount due to seller (fine 420) 130,830.9! 602. Less reductions in amount due seller (fine 520) 29,000.2: 603. r np Cash ^X To ^ From Seller sap may m urma n, you are regta 101,830.71 o corn a this 1tMrR uMaae N diaplaya a currently valid OMB wntrol number, No conlldsrala6ly k Sewrsd; INs diaciowre is mandatory. THIS k OaaipnW to Provide d,e pertiw to • RESPA covered Waneactlon rMtlr inromu4on dwinp the SellbrneM propea Previous editions are obsolete Page 1 of 4 HUp 700. Total Real.Estate Broker Fees $ 8,050.00 Paid From Paid From` Division of commission fpe 700 as follows: iBorrower's Selier's 701• $4,175.00 to RE/MAX Realty Associates, Inc. Funds at Funds at 702• $3,875.00 to RE/MAX A-1 Realty, Inc. Settlement Settlement 703. Commission paid at settlement 8,050.0( 704. TransactioniProcessing Fee to REIMAX A-1 Realty, Inc. 195.00 SOD. '.Items P ble In' Connection with Loan 801. Our origination charge (Includes Origination Point % or $0.00) $654.00 (from GFE #1) 802. Your credit or charge {points} for the specific interest rate chosen $159.56 (from GFE #2) 803. Your adjusted origination charges (from GFE A) 813.56 804. Appraisal fee to LandSafe A sisal $460.00 P.O.C. B' (from GFE #3) 805. Credit report to landSafe Credi-,1nc. $35.00 P.O.C. B' (from GFE #3} 806. Tax service to BAC Tax Service $89.00 P.O.C. L' {from GFE #3) 807. Flood certification to LandSafe Flood (from GFE #3) 26.00 808. to 900. ,:.items R ` wired i Lender to ti'e=P~rid In A~dxance 901. Daily interest charges from from 04/09/2010 to 05/0112010 @ $17.4900/day (from GFE #10) 384.78 902. Mortgage Ins. Premium for months to Federal Housin Admin. (from GFE #3) 2,195.38 903. Homeowners insurance fa months to .(from GFE: #11) 904, months to from GFE'. #11 1000: i Reserves De ' '" ited`wid~' L'ender'.' 1001. Initial deposit for your escrow account (from GFE #9) 1,123.07 1002. Homeowners insurance 4 months $ 25.00/month $100.00 1003. Mortgage insurance months $ 0.00/month $0.00 1004. City Property Tax months $ 0.00/month $0•~ 1005. County Property Tax 3 months $ 49.11lmonth $147.33 1006. Assessments 11 months $ 108.84/month $1,197.24 1007. Aggregate Adjustment $-321.50 1100.: Title Cha' 'es 1101. Title services and tenders Gtle insurance (from GFE #4) 320.50 1102. Settlement or dosing fee to $ 1103. Owners title insurance - Frst American Title Insurance Company (from GFE #5) 1,008.75 1104. Lenders title insurance -First American Title Insurance Company $ 1105. Lenders title policy limit $127,645.00 1106. Owners title policy limit $130,000.00 1107. Agent's portice of the total title insurance premium $837.26 1108. Underwriters portion of the total title insurance premium $171.49 1109. Notary Fee to Came E. an $25.00 20.0 1110. 100 No Vio11100 to Absolute Abstract, LLC $~•~ 1111. 300 Survey1300 to Absolute Abstrad, LLC $~~~ 1112. 900 EPL-Res18.1 to Absolute Abstract, LLC $~•~ 1113. CtosingSvcLtrlCL to Absolute Abstract, LLC $75.00 1200. GovemmentRecordiri `andTrasisfer'Cha es 1201. Government recording charges (from GFE #7) 138.00 1202• Deed $62.00 Mort $76.00 Release $0.00 1203. Transfer taxes (from GFE #8) 1,300.00 1204. CityfCounty tax/stamps Deed $1,300.00 Mort a $0.00 1205. State Tax/stamps Deed $1,300.00 Mort a $0.00 1,300.0 12~• Deed $0.00 Mort a $0.00 1207. 1300. ;Additional Setdemerit Ch es' 1301. Required services that you can shop for (from GFE #6) 1302. Survey to $ 1303. Radon Mitigation System to Til Ins ions 8~•~ 1304. Home Warranty to American Home Shield 435.[ 1305. Tax Cert. Fee to Absolute Abstract, LLC 10.f 1306. Sewedfrash - 2nd Qtr. to Mechanicsburg Borough 113•: . r r .. .. - r r 8,365.04 9,928.31 'Paid outside of dosing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. Previous editions are obsolete Page 2 of 4 HUC .,• HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUO-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of aN 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 S~ettlem~snt Statement. Jon 'Ott Mary P. Ott c ~1C~QCu ~ ~ E e of Celka .Prescott .,. The HUD-1 Settlement Statement which t 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 UPO 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 Tax Parcel Number: THIS INDENTURE MADE THE ~ ~{ day of ~/~~ ~ , in the year of our Lord two thousand and ten (2010). BETWEEN JAMES PRICE, as Executor of the Estate of CELKA K. PRESCOTT, deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantor, and JASON E. OTT and MARY P. OTT, husband and wife, currently of the Borough of IVlechanicsburg, Cumberland County, Pennsylvania, Grantees. WHEREAS, the said Celka K. Prescott, was vested in her lifetime with title to the premises hereinafter described, in the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said Celka K. Prescott, departed this earthly life, testate, on the 13th day of February, 2010, and Letters Testamentary were duly issued to the said James Price, by the Register of Wills of said Cumberland County, docketed to No. 21-10-0155; and WHEREAS, the lands herein-mentioned were not specifically devised: NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said 3ames Price, Executor, as aforesaid, for and in consideration of the sum of ONE HUNDRED THIRTY THOUSAND and Noll00ths ($130,000.00) DOLLARS, and other good and valuable considerations, to him in hand paid by the said Grantees, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained., sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in him vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does ;grant, bargain, sell, alien, release, and confirm unto the said Grantees, their heirs and assigns: ALL THAT CERTAIN piece or parcel of land situate in the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of Pennsylvania, being bounded and described as follows, to wit: BEGINNING at a point on the North side of East Coover Street (fifty (50) feet wide) at the dividing line between Lots Nos. 4 and 5, Section "A" on the hereinafter mentioned Plan of Lots; thence along said dividing line North 17 degrees 12 minutes West, a distance of one hundred forty-five and ninety-four hundredths (145.94) feet to a point; thence South 72 degrees 48 minutes West, a distance of sixty-five (65) feet to Lot No. 3, Section "A"'; thence South 17 degrees 12 minutes East along said Lot No. 3, Section "A", a distance of one hundred forty-five and ninety-four hundredths (145.94) feet to the North side of East Coaver Street; thence along he North side of East Coover Street North 72 degrees 48 minutes East, a distance of sixty-five (65) feet to Lot No. 5, Section "A"; the place of BEGINNING. BEING Lot No. 4, Section "A" in the Plan of Blackburn Village, as recorded in the Cumberland County Recorder's Office in Plan Book 6, Page 13. HAVING THEREON constructed a single brick dwelling house, known and numbered as 307 East Coover Street, Mechanicsburg, Pennsylvania. BEING the same premises which George C. Sponsler, Executor of the Estate of Josephine M. Sponsler, deceased and the same said George C. Sponsler, surviving Trustee of the Trust under the Will of Edwin E. Sponsler, deceased, by his deed dated March 30, 1990 and recorded in the Recorder's Office aforesaid in and for Cumberland County in Deed Book "M", Volume 34, Page 525, granted and conveyed to Celka K. Prescott, single person. Her Estate is the Grantor herein. Said Deed was corrected as to a typographical error by a CORRECTIVE DEED dated May 24, 1990, recorded in the Recorder's Office aforesaid, in Deed Book "O", Volume 34, Page 1032. TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees, their heirs and assigns, forever. AND THE SAID GRANTOR, Executor, as aforesaid, his successors and assigns does covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Executor of the Estate of Celka K. Prescott, deceased, Grantor herein, has hereunto set his hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence of: s/ Gkas ~'. ~~~~la~s i ~~ ~,~. (SEAL;) JAMES PRICE, Executor of the Estate of CELKA K. PRESCOTT, Deceased COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: On this, the ~~ day of ~ r ~~ , A.D. 2010, before me a notary public, in and for the Commonwealth of ennsylvania, personally appeared JAMES PRICE, known to me (or satisfactorily proven) to be the person whose name is subscribed as Executor of the Last Will and Testament of Celka K. Prescott, and acknowledged that he executed the same in such capacity. IN WITNESS WHEREOF, I hereunto set my hand an official seal. Notary Public My commission expires: (SEAL) CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: Attorney for Grantee REV-a 503 EX+ (6-98) COMMONWEALTH ~~F PENNSYLVANIA INHERITANCE TAX RETURN ' RESIDENT C:)ECEDENT scNE~u~E B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship_must be disclosed on Schedule F. ucc-ta-tutu tu:tcam rrom-Maas l 747 Pcn nsylvan is ~ Avr., N W ~uitr i00 W~shin~crni, t7C: ~AAAfi toll rr« Roo-7~)?-~~, t September 16, 2010 Charles E Shields, 111 Attorney-At-Law 6 Clouser Road Mechanicsburg PA 1705;- Re: Celka K. Prescott, deceased, Account # 22J-11316-1-7 DOD 2!13/2010 Dear Mr. Shields: MorganSt~nley Srni~hBarney Per correspondence received dated March 18, 2010 and subsequently September 13, 2010, I am enclosing the Date of Death values for tl~e above referenced accoun#. I am giving dates for Friday 2/12/10 ~ Tuesday 2!76/10. as our mutual client died an the weekend_ Stock Stock Symbol Type Rl~lP Equity RNP ~ ~ Ski. Mutual BFACX Fund BFACX Date High Low Close 2/ 12/2010 $10.25 $10.02 $10.21 2/ 16/2010 $10.40 $10.25 $10.38 $20.65 $20.27 $20.59 Average: $10.325 $?0.135 $10.295 2/12/2010 $11.91 $11.91 $11.91 $11.92 $11.92 $11.92 $23.83 $23_$3 $23.83 Average: $11.915 $11.915 $11.915 Should you have any questions, please advise. Sincerely, civ~. pricc - 'io.~3 t A.VG. Pri ct = l~, 9~ Adrranne D. Medford, VP Complex Service Manage- Morgan Stanley Smith Barney, LLC 202-778-1328 202-747-918'! (Fax) The information set forth was obtained from sources believed to be reliable, but we do not guarantee its accuracy or completeness. Past perform:~nce is no guarantee of future results. LGIL ffif ICIW 1-^O~D r.uuciuuo r-o~c btc~r~.tt~ \Ca~~L:r ~,unl. N:m~.y LI (:, Rhn,l~cr.ilPt~ Oct-14-2010 10:12am From-MSSB v e ~- ~° ~, t. ~ ti d ..?. O O N ~i-r CD ~ N „~ -Q .i.+ ~ •_ ~ C~ ti ~ (~ N ~ ~ ~ ~~ 0 ~_ m r N ~a ~ ~ ~ C . V m C a ' o '„„ VJ ~ V a ~ m x W E m~ V J J A ~ E m w ~ E d = ~ d S r T N C > ~ O N 2 ~ ~ C (7 ~ G1 W Z m a.~2un~~ ~ a W N N a 3 ~ ~a R~ O a y a ~ 1~C] O ~ w~ o~r"0a' c~0at9 ~wo~ ~Q~~ g~~v ~VM~ ~o 0 .~ m Q N ~I m Y C A .O .a m ~ o a e V o O m Q N ~, o w V a ~ a cl C ,` 0 a 0 a c~ v ; 3 ~ Q < . ~ O c m ~a m a C .Iw 8 202 118 1210 T-d98 P.003I006 F-552 m N m A ~p o c A E a m O b q 8 p ~ '[ N ~ c ~ 'C 060,.E ~ ~ Q O u M b ~ a= 0 0 E E ~ a ~a O G `~ o N y~ a °i -- fi m o w c ~ io ~ ~ °~ C e ~ 'o ~ a Q E '° u o C o i m ~ ~ ~ c ~ C C V ~ ~ b ~ m O U Q~ O N ~ ~ ~, ~o ~~ ` ~ M ~ Z ~ .~ ,• y N ~ ~ ~ ~ ~ ~s w ca S ^~ ~ ~' '~ o ~~". ~ ~ w ~; 2 m .~ ~~ ~ ~ 6 E ~. 8, m v c ~o W .c c c i ~ m ~ ~ ~o m N w .~,do N N q ~~ ~ ~ ; a ip W m Ti $ m_ ~: ~~ ~ ~- ~ ;~~ w~ ~ o _q ? q .~ s W~ o ~ o ~, ~ 1 m -` ~ ~ u a c ~ G `j V i ~m~ffi . mzz S ~ y w y H m W, s w u t N O w m N • i v ~ ~ r b a y t c R L T-488 r.~ 242 77$ i270 ~rom-~SSB x_2010 14:12am O e N ~ er .~. ~ ~ d ~ O O N ~ N 3 .Y~ m ~r ~' 7~ ": N V ~- ~ '~ S~ ~ ~ ~ ', •_ m.. r Q a "~" an a ~ ~- cv Q '~ a '~ ~ G h Oft 'LS+•..- ~ ~. q SS '~S ~'~ ,,,p o 'mss ~ =,~ V ~ ao eu ~, ,~ 7~ 0. a o~ofia ~ °~' fib :°.ts~„', S1 y .a.. v CS ..ra h .... ~ y .SC ~ Of ~ -.. oa 0~ ~ , ~ ~ y p 0~7 00 ~ qLi `a 'CS Q p ~ v ~ C' ~ a ~ ~~ w `CS a ~ II ~ " • ti ~ N ~ r„ ~ y ~ ~ q ~ ?+ U or ~ t'S ~ r' ~a.~r 4 pp !6 ~ ... vi Ot Ow/ x ~ g = ,,. ~ ~s ~ y ~ u o :! e's ~ m ~ ' 'co abo ~ ' ... W '~. R y 'Q v ~ . A. h ~ C 'ty ~ ~ ~ ~ m ~ O ~ ... ~ ~ C .4 ~ ~ ~O r? C ~ Oa w •» ~ ~ O •~ L~ ~ ~ w - = ~ Obi ±~~~" C ~ ~ ~ Q. ~ tea, m a ~' ~ ~ ~ ~ ~~- ° ~ a a. - ~- ~ h ~..- C y v s G~ ~' "' » ~~ ~ n Q 'ts ... o'- 9 ~ ~+. p t„S ~.` 4 y R. ~~ Z y`UO j O N ~~ ~ e`er ~~ c =~~+~ c i ~' sa. ~ ~ ~_ ~ cs m ~ `~ • s ~ ~ ~ a. ~ C a qv; a O Ca ~ ~4 CS .. m~ ~"' c u ~ ~ R~ 'C a'U m~ O ~ ~~ a ~ Qr yv ~... 00 ~ ~ 0~ p v w ~ a a v z N ~ ~ q Q F o a cs w •°.; R yam. ~ as _ `~ _ _ _ .~ ~ y, »U ~ 4Y C{. o- fi ~ yam' ~ w r + ~?~. ~ F r ,.~ ~ 0~ C ^~ ,O ~ pC ~ ~ Fy » ~0 O d ' ._ "C1 .... V O ~ O ~' Qy .~ri G (3 O 4 oa ~ "'~ c,1 oe; n ~ ~ '°'tY O Q '!7 !~ Q. a' ,"~ 4 ~ V aptJ ai'~ i y o~ a~ ~"cs ~ ~' d ~.~ ~ 1p C ~ tq ~ ~ V ~+ ~ ~ C^ ~ G~ '~ v 3°~ d `~ °' _ gt q ... ~~, to y ~ y ~ w ~ q,~ ~ „iJ C'f L ~ } ~ O ¢ C A otl :. m O to °O W Z O }. ~ ~ °~ W d C ~~ WIZ .~ a n~ "Q~O U z "' o o ~ 0 0 .,, ae v Y Oct-14-2010 10:12am From-t~SSB 202 TT8 1270 T-498 P.005I006 F-552 a O M m a m 0. O O CV ~~ ~ N ~ ~ ~ ~ y ~ •r ~ ~ ~ V~ ~~ ~jr~. ~J 7~.- i a ~_ U: ti ~c t• 1 h ~ q~ •~ ~ ~ C o ~ ~.~~ a ~ ca QC~ Q~ ~ yb c~.4~~C c 9'x,'4 + z`V o.~oy ~k ~. 4 h ~ O ' _ •y .Ll^ ~ 'b ~ t ~ h V db ~ ~OZj ti 4U b w ~ Q '~ ,h C! .~ ~ ~~ ~w o }~~a ~ O~ -_ ~m~~~ ~ ~ V 1 ~ ~ ~ ~ ~ Q ~ `~Q C ~ L ~ ~ `:3 4 ~ ~ 4 ~i •~ ~ +~ h ~ ~ e. ~ ~ V " , ~ A~ y~.~ b '~ ~~ - 0 0 O ~ ~ a g ~ ~ ~ ~ ~ O ~ V b ~ ~ yb ~ ~ o~ a y Q o,h o ~ ~ a •~ ~ Y r ~ ~~ ~ ~ '~ ~ ' ~~, y :~ Ci v ~ ~~ b i ~ C Q ~ y ~ 'A _ QI ~ _ -` ~ ~ '+ 2 .~ d . 01 Oi ,-_ Tj o~ ~ v ~ ~~ ~ _ v'' ° h ' ~' ~~ '~b 5~ o ` Q - '`~~' ~ ~` ~ ,~ ~ Q c `' o y ~ - fi ~ c ~c ~~' 3 ~+ 1+r Q ~ ,q ~ ti ~ Q h 0 ~+ _ ~ CQ.~ ~~ ~zo ~~._ y~a~ab ~ ~, ~ ~ ~ 4~ Q ~ ~ v ~~ ~ 0 ,~ ., V ^ y ~~ • •~ r r ~~ ~. ~ ~~ ~ O `~ C~ a~ b Q 0 •~ b y p R ~, ~ 4- c Q • C .~ tr-o~.o -fi ,c ~ = ~m~~ fi ~ ~ ;o sn ni 4 ~e ~ ~ c ~ ~ ,~ `'~ ~ O'' sib O a h :~ ~ :~ C C O ~ , y q~ O- C7 -0 ~ ~ d .ti y ~ O1 L ~ L fi r ~. 0Q- V ~ 4 ib y~~1 ~ ~~ e o; ~ a~ ~ ~` ~i° ~~~~ o ~L ~~ ~O s.~ ~ ° a , ~ b o ~• q ~ ~ ~ C 0 ~ `~ tr ,~ 0'~ '- O7 • ~ N ~_ '~ ~ ~ '~ r ~ .d ~ ~ R e ZS ~'4 °~ h~ 0 ~b -~ ~ •. h ^b ~ ~ w O C O Q V fi p ~ ti. C 3 p~j Q ~ d~ 3 y + ~ ~ ~~ b O d b~ V O~ O ~ ~ O -'-yc i.~ `1 ~ m r ~ n w ~ ~ _ 'L3 v ~ :. p O aiq .p ~ p; = QV .~ D pp ~ + -~ w ~ •~ ~ y y a' ~' •~ O+ O ' o ~0 a. C~ 'O '~ C O ~ t ~~ G ti ~ c, c y q ~ ~ Ob ~ O ~~c,.0 ~ 01 ~ ';' p b ~ ~ ' `ZS b ~ ~ fi fi ~ O 'rs ~ _ ~ ~ v ~ O o~ N~N ~ P ~` ~ ''~ b ^ n- ~-.csm `-moo ~ ~~~=~o, ~ ~~a= ~ + = ~ o~ a~ - ~v b fi ~ h 0 --~~ ° ~ -~ o s b w ~ Q ~i~'~ u y v ~- d p° O i ~ ~ _ ~_ '4 fi C~~ i•-, r: ~ O y ~ ~~~-v ~ ~ ~ y~~ y ~ O O ~t :b ~ '..qd ~ ~ ~ ~ 41 ~ Q ~ ~ ~ y ~ ` -•• us;:w~ v A ~ ~ ~ ~ ~ ~ o~ ~ ~ V V ~ a ~~~ V ~ v! Q V ~ ~ ~ R ~"O~S ~ ~ w ~ ~ ~ '~ '~ ~Od ~ ~ C.~~~ ti °' q~ ~ ? „ ~ ~ ~~ 1= c b ~ ~~ a w C~ R A £~~ ~~ b ~~_'~K ~ ~ Iti ~~--~h. q 0~i O O C3V-~O + Or :~ O u `s V ~.Q~~V.C -~ . '~ N m ,a m a~ n -a 8 ~~ P ^- • ~ ~ O ~ m z~c 'O m N .~ c ~~ Ufa C Ua m W py (n 8 O U ~ m ~ d N N F- N N~ cep~ N N i Pf M ~ ~ N M O N@ G Q ti m U o 5 ~ n m _a • U ~+ U a v • ~ ~ V z y ~~~ eb ~o ~ o~ z v ~ ~ ~ ~ ~ d Z a '~ m U f- W N N ~ E~ ~ ~ O C EO Q m N C Cm C O U m n Ym D O 2 N w V N Q J QU U OC W t Q W O 0 Z 2 0 M m ~_ _~ 0 ~ ~ d ~~ - 10 10 :12a~ F r om--~SSB ~ 2a T-498 P uvvl,,,, ~~~ ~„ y as ~o ~ -~ ~ o+ - ~ `" ~ ~ ~ ~ ~ ~ ~. ie~ ~ w~ ~:, $ w, ~ Vl ~y y ~ ~ ~ ~ ~ , ~ 0 4 ~ (^ W O VV y m - c m es a ~. ~ r ~ ~ . a ca ~ .,: - ~ bOy~s+q, ~ t~OQ u~O ~~ ~, ap q t1t .~ S".. O/ i./ "'- O ill N ~ rte.. ~ uN U i'` i jj, y ~ '~Li ~. ~ ~ o~ a~T ~ ~~Oi .. U C ~- , ti. -- q, '~ ro w ~ CY ~ =: •'v ~ ~ p V C a''- ~ o c r~ ~ ~ ~ o ~ A. ° w ~,,,~ 4 v w of `s,° ~ ~`I :0~'+6"oe ~fi,~ c~a~, cT. ~ y °° a ~ ° a ~ ,° a ~ ,off` y a° 'e ~ ~ ~~" ... '~ T: `.. .. .y.. ti. W} N ~ ~ ~ W ~' ice! L1•~ ~ ~ ~^.w-. 4. ~ ~ ~ ~` O '~ -~ ~ syi/ fA Os y' Q~ ,~ 0 C ~ °' ~ y d~ r C~ ~v LL v ~ C ~ ci1 'es i1 0. y U ~i ,~ ~ } c. `'~ z y w x ~ es o '' .. .~,~ y W ~ .Q tip a ~ g ~ 'Cs oC ~ Z' Y 'O '''~ w { x"w„a''Cs~. Y ~ ~G 0 ~ Cs ~' a ~ n~i 4 R"'! ~ of e U ,...,a ~, O ~ "~ t„y ~ rr ~ . ~.. ~•~ ~~ 4 ~ ~~ ~~ g ~ o+ c~u +t~'., ~ e ~w ~ ~.. C • q ~ ~ ~ p '"CY ~ Q ~ ~ C~00 C +~ w V +.,. Ol _ .. C w C or ~¢ ~ ~Q fl~ a Nr t'0 i ~ 't1 p ~' ~ .y~ ~ ,~ O '~+,G DO ' op b !~ a .,. `C3 O h d 0. ~bQ~ ~ CS. O Q ,~ ~t,S ~, ~ ~-. ~ y ~ ~ ate. U y~.. ,,., CA w .C ~-' is. ~ `cs a ~ a d ~ o °a' ,"`„ o ° 0.A` ~+ ~ c~ t. ~. ~ ° ~ ~ ~ 1s1 a ~ c ~ ~ ~. C =3_ ~ a ~.y to ~ ; % + ~ K ~ ~ ~ u h Q v.. ~ 0 ~ t!i t+ ~ (s~ W ~ ~ ~ ~ i'r 1f! ~ ~ `"~j LY+ s t kt ~- %~ ~+ q ~ +~ ~ ~ Ce ~ t~ a ~ ~ ~ Q QI A Hwy CO "~ "~y ~r .O tl ~ ,gip ~1 ,~ ~"y M ?+ la ~~~, Ct4 ~ oa n+ .j ~ O 9l ~y 4: ~j C r. w ~ •st o0 ~ Q .., O ~ ~ ~ ~ i ~~ ~ ~ to c~ O ^• ~ ~ :: c? U ~ V -. d 2p2 718 1274 COMMONWEALTH OF' PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER #'I~ZE s Co T T, C FL Kp- J~, ~ 1-- /o -!~S tndude 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 discbsed on Schedule I ITEM NUMBER D ESCR4PTION VALUE AT DATE OF DEATH ~ . 1 ~ ~e ~ M b u r5 em en7s Amc~ ~hD! f'Gtn~ On S on Sad.{e. OF ~ e.sf[x.~ S ch~# • ~ Sa~lcm ent shcc~- l~. L; ne 5f o7. County Taxes ~~ 31.09 3. Line 4o B_ ~}ss~sst-~en~'s Xo?44. S3 t^. L-ne 404_ ~et,~e,~-1Tras~ o~hdfj'fi': >~ f a 3. 3b °~ - ~~~ d 6~V1 ~Y, ~'tG ~Ztt' 1'1'1 ~. ~o~ . G ~ ~ gq. Gg ~ - o~ooa ~mc aonot~la. ~rl~~k, m~) a ~l,~~~, ~1d ~ ~laarl ¢S oao ,o~ 'f, 1 ~ See ~o PY ~ C~.k a#'~.c~c.~Q . ~ T ~' u,nk /~. C h t ek i ~ l~~'. I U o . ~ 6 7 rt o ~ of ~ ~F ,~ .:.,, d ,,,_, ~t3_ S a,v ~ n~s l~e~-. No. 1~so o ~~ o o x 1~- 6 n x J o, g q o, S3 ~ .. ~~ . A-rrr, fi~ d , o. d . 011 z~-ern 3 0. ~3 ~SGC Yaluccl~'o» ~~1'f'~.r' u,}~c.he-~, CQ5 Corree.~e~ Coco»~1 •' ~ ~a•~G eT QsSArf'G+d ~onc~l~`~r ~' f{aarS won ~ /~Iq..?S- (5~c i i'~m ~ zed Shc~~' a~-a~ti Q d~ 6 . ( t'Yt ~ S ct ~lantou s itGmS no~' So~~ a~' cx.~cc~'on : wa~lku- ~ ~'DQS ~'' J-8.57~ TOTAL (Also enter on line 5, Recapitulation) ~ $ j ~? ~,$~ ,~7 (If more space is needed, insert additional sheets of the same size) NI~TSank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-l2 Phone (888) 502-4349 Fax (:302} 934-2955 March 8, 2010 Charles E Shields, III 6 Clouser Road Corner of Trindle and Clouser Roads Mechanicsburt, PA 17055 Re: Estate of: Celka K Prescott Social Security: 578-38-2458 Date of Death: February 13, 2010 Dear Sir or Madam: !l~~C,st ~/1C)/ Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o, f} Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Checking Account 2672022643 Celka K Prescott 01/25/95 $ 0.00 $ 0.00 $ 0.00 Savings Account 15004200218160 Ownership (Names oj~ Celka K Prescott Opening Date 02/07135 closed 0226/10 Balance on Date of Death $10890.53 Accrued Interest $ 0.43 Total ,Fr~889~t S~.C! ~ /C3, ~~t~.9(v ~~F.._....-----_....._.. Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or Warne of any possible joint account holder. For any additional information on the above acxounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Carlisle Pike branch, 6560 Carlisle Pi7ce Suite 500, Mechanicsburg, PA 17050. Call# 717-795-1710 Sincerely, ~~~~ No 'ssa Sears Adjustment Services OVn„/YyN~7 ~/ W~~W Qa.Aar,~.- doxQ,t~.at ~a-,-z~a~a~ ld~l ~~- z/ZZ/~~) /~~.tc Wes. - ~ ~ ,~ E.r ~~ ~~ d ~-~f ,`r) U a r 9- rre~ r -cr-~-~vav vo.vo rrr .+~r-reo rrea~.e r r~~ ,....... ......... ~....., r. _ Date : ~71,~"'~~~'~»+~-1.~ www. haars. cam HAA R s ~ AUCT X C1N 717-~4~;~~-~a~4~ Oett le~aent Se 11 per ~ ~~-7 JAM ARxCE 13~+~ F4FtEST H x LL_ AR FRANY ROYAL. VA ~~6a~ Wage : j Item pescriptictr~ _..._...........~.......__~....~......,.__.........Y..~.~_...,..__w~._......_....~,~......w......~.~....,,~......,...~ Price qty ._....._....._..._~. ~._,......~.._._.._..,...~ Total ~.__.~.,,_. .,..~_ ,. ~ "' ~..0 t ~ ( ~ ~ . '~.•~ -- Rake 1 i. S+D -- Moe--broura 1 :~.5~ -~ Snaw shovel i 1.ID~ "' Shi Q V ~ ~. :~. ~F r~.-~ -~ Rake 1 t5. ~~ ~' Stone havk 1 ~. 2~~ Wedye clippers 1 ~.~~ -~ S aw i ~. ~50~i TT/r TT ~r '"~ Jry~i 1 ~ ~~WL ~ ~r ~Ki ~- Tarp i - `.°`.rQ~ LOT 1 s ,. ~~ "" Wel'1~ eater ~ ~ ry I~r /~.1~~ -- Fd o s e 1 ~-. ~td+~ -- E4.EC CANDLE i a, fi~ ~- Picket 1 ~. ~-~7! ~- Chain saw 1 ik. +~0 ~ D W ~ T` p A t ^- ~ 1 ..~ . IZ ~1~ pp , a .-- Pux lut -- pots -- pans 1 a.75~~ -- Prax lot ~ pressure eovkeT~ :L . Dq ~- Luggage i ~. ~~ -- Double bRsrner range 1 9. Qt(~ ~.», F1C`S'~ Cla9s 1 ~. ~~ Wooden rack ! ::. Q-~ ~- k~ag ~- irons ~- mxT•rnr I 1» ik ~- 3tep caver•s ~. 1. ~~ M ~: basket planters 1 ~. @~t -- ~ o x ~, o t -- milk .jar ~~- ~. i . rz+~ c~-s;~erole disr~e~ . _ .-. ... _ . _.. . - E+ox 1~ o~~, -- ]. ant errs ~.. pan ~ _ .... .. ._. .. .! ~. ~~ glassware a nd ._ Fan 1 ~. tZ-Q~ -- Mower i ~. a~ -- f= 1 nor 1 i ght ?. ~fi ~ 14. 0~ Reel ineT` 1 "~5. td~ ~. ~' v i 0. ~-0 1'v stand ! 0. ~5~s~2 ~- G~u#r It rack 1 5. ~~ -- Fan 1 1 ~. ~~ _. Cart 1 , ~~ .- ~t and ~-. ~~+ ~: a. ~-+~ Bnakcase i S. ~Q- Pook~ase i ~. ~~ -~- k~oakease 1 12, Q~ -- Drop IeTf table 1 3. 0+D tr~ www» ha~ars. cam Sett 1 e~nent ~el3.er: s~7 NAAR~ S AUC7 I CiN ~ ~ 7"'43~.'""$~'~-fa JZM F'~cICE Page: 1343 F'gREST N T L~. DF~ FRQNT RgYAL VA ~~6 s~ item De~cri.ption Price Glty Tot~-I Card t ab I e 1 $. 00 -- fed tray 1 ~.:~~~~- ~' at i 4 Ch a i r y 1 ~. 0~ ,~ Smal I Chest i ~. ~~0a St a»d 1 C,. ~-~ -• ~Qmp~,~tpr desk 1 17.0@ -- F~atia tab3.e 1 ~.7.0~ -- Fiat i n chair 5 1 i 1. t~~! ~- Chair 1 c:» Q~Q- --~ F'pldinq table i ~. ~0 -- 2 chairs ~. ~~ ~ lq» ~-~ -- Green Chest x 1::» 0~ -• Snack tablee 1 5. Q~~ -• Step ladder 1 ~;~.0k~ -- I ron i rtg board 1 ~.:~~0f~ •~ Table-end 1 1 ~. 0~ Items; 6+~ Amaur~it : 41~. ~~ Gammisei.on at tiib. ~~~~ lE~;~. 7~ Less ad,justmentss 167.70 w .y..r ~..• rw ..a rr w .r- -.- .+ Net d~~e to sellers i'~1. ~~ www. haars. co rn F•~aaR~ S RUGT I ©hi 717~..43;~--$~45 REV-1511 EX+ (,12-991 t SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~,12.ESCO`rT, CEGk~ K• ~1- /o --~~~'. Debts of decedent must be reported on Schedule I. {TEM NUMBER DESCRIPTION AMOUNT A. f=UNERAL EXPENSES: 11 1 rn 0.~ ~eZ2! ~u h Gra~ T~LOfYI G o ~ rn ~t ~~ G$b ~ . J ~ (Sc~ ~~~rn i z~ btea,~dorvr~ a ~aclsca~~ ! ©, SSb. S7 •?. ~lar~/jlemo~'i~Is, Fn~rav:n~ ~~' ~fGca~sJ~/,~ x 603.75' B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions J Name of Personal Representative(s) J~ MES PR I ~ ____ 7j ?DQ. Do Social Security Number(s)/EIN Number of Personal Representative(s) ""r Street Address ~ 3 43~Ufi:S7 f"~ s I ~ ~Y~ VC City ~0 n t ~ 4 4.~ State ~~ Zip o? a 6 3 [~ Year(s) Commission Paid: 2. Attorney Fees CJ'1/~/2 ~~•s F. SHI LRl~S .(~.~ X63. -~~".]DD.oD 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant JVD O/YF FL./G !(3LE _ l1! D ~~ Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees ~ O-^r4tl7r,~ 155uC 6~f' Short CP.rr'~'i dj tCf.~t~,s ~~ o ~ e ~O O ~~. o>F ctox opt a ooq fkx~s,r;,~. ~~oo• aD 5. Accountants Fees II ~! o y R~tc h n G 5 f 'U(i K, A-CC'.o te,riii~ ~SocZ 6. Tax Return Pre arer's Fees p ~ rl`p Ca ~5eo~ aol n j P~ 41, !a4(, ~ . ~25~ ih.~I 9° 3 75.00 . 7~ I~drer ~isln in cu.mb. 1-~.w Jr1. . 7s• no g. ~<rert,`si•, ; ~ ~arl ~ SIlE oScn~ne~ ~ l 3 ~. ~~ ~_ 1~ ~, F ~ ~ i n ,fin ~ . 7vy~ Re ftt rni ~qq . o~ ~ ~ ~ I S ~~'. 00 U ID, ~i ~ i ~i~5f aM.d ~i ~a~ /~-~ Go can {~'n ~ 1$0,40 I { . /}- d d• >~'vn~l pry ba ~ ~8e , ~> 7 0, o0 loo f TOTAL (Also enter on line 9, Recapitulatic-n) $ 3~ ~~a• g~ (If more space is needed, insert additional sheets of the same size) ~. ~ S Cl-l~ D . fi(., ee n ~'d - _-._ _____~._._~__~___ LAS T . o ~ ~~~~"C'o ~'T C~=7-x,~f ~• ~i L~ /1'O. _ . ~I -~o-~~.~ __ _ .._____.,~._.~_..~..____.______. _,.__ _.~_____..__..___. _._.~_____._._M_~.___.___.____ - ___~._.__..__._____ ____._...__~________.________ _.. -~_~--. ___.__CosTS, E~C~E/YSE-3 .A~~ SLUT=OICF~~ P~~~'TZ.F~. -~nlT'.__ ~!~?'____ _.~.___..___ ON c~LF ~C~9'~. ~3 T. /~~? ~~/E~. r~ ~ L, ne So7 ose/lCr ~Ss~Sf ~~tea~ ~~~G^c~ f ~t~k~'d L~os~' ~{ _.__w~..~___.__ ___.~_.._ _~n~°-__._____~_._. _____.___.__.__._.______ ..~_.__.---_.__.__.__._.__.--_. ______.~________.-._...-._._ . _ rc m e~ ~ ~fi o`t ~ s~bs~'an ~i~) h4d on oYer- rea d ~ ~ ._ -- -. ~! lop . °° LinC 703 ~ca.l-}Drs Siar.les C'y /~ mm~ss~bns r_.________.~_______~_____ _____~_____..~.__ .___-. ,.______..__~___._._____._.__~._.----___.__._._.--._ ~ _ o0 $ O$D -___ • ~..._._.___-----._-._. C' . ~~'hG /!O 9 /~mf?Zr~r /~e.E ~~p.oo _ ~ _. u} 4x~ra A~m c r i cep ~drr~ h; ~ 1 d E . l.i ne 130 4 Home . ~___._....._ ~ ~,._________.~__.______.--- ._--___~~__-___-_~..__.___w_-~__w~-____ _.___.... ~ ~S. oD ~__--_-_____.__._ . _____ _.~:___<i ne _.__~~ 3~5._~_~.._ l~ C'erf ~cG ~ A-~soi ~.te. ~~ f ~.~!- LAC M~. .._._._ ___.~.__._.._______ _____.w_.___.~___________~.A.._.______~._____.___ _ ~~o . vo __....._~.__.____.__-_...._....._ _. G- nine ~ ~.~6 'S~ea.~e.r~''Trash - Znd Mfr: _- iYlechanicsb~. --_~' ~''.___ _ _...~___~_L~._'S_. ~t_-_ 13. __~._..._..__.__ ~..a.._.m.~___ __ ._. ± m bu~se~~.~s ~ n ____.._____~~h.~r.l~.~_...~._. ~sh ~~s _, L ~o_ ea~~'~,'ed _ _____. .__ __.r.____ _____-----__..__...._ ____._ .~__~._____.___-~_ --.._ ___ _ _..__.___...~__.______- ., 1~,.~1~.5~.._......~...._.._.__w..._.._._____~_ _- -~J ..~ ~.t ' ~~~'i ~ La,~ s _ ---- - ~S~"Cr~ss may 1- n ~.._ ~~'~ cr~.q~ i ~~~~_. ____._ _ ~ _ .~.~_~ __.._..______..~_ _. _ _ ---- _. _ __ .__~ ~ t ~h; 7~' 1 d_~. __... _ . ~e~ ~,.rs~!~~en_~S _ ~?__ ~ m~,~ ~r..- c e r same s / ~.-- ~p-~,c ..__~._. ~. __,__.. __.._ .__..~.__...__ .___ _.._____--------__~ ___._ _-_- - - - ~ --. _ __ _ _.... --__--__ _ . _ _. _. _.._.__.___..._~I S's_. _._~~~m.e~x~ .~~____~[c~.~_c~Ys__!~,c~'o..~._._._5~~.c_.~_.~~...~&~o_N~l.._.a~ __~n~l.~~btt -.. __._._ __..-. ---__ _.__._.... -_ - __. .__~_M_ ~~'GrY1S~._..wt~"._ :_~ ~.,5_~.~ ~~. ~P_ot.~'~_..~..ce~_ ~at._. ~'.,~r .~s~e~ ,~~~'~.c~ G ~~D b, ao _ ~ ~ 1Vlal~ezzi Funeral Home i ~ ~ 8 Markel Plaza way Mechanicsburg, PA 17055 - _ -- www.mal Jeremy J. Sbartzer, FD Micbr~d .i. Mslptzsi, Owner, FD April 15, 2410 Anusia Allen 790 Santa Rosa Boulevard Fort Walton Beacft, FL 32548 The Funeral Service for Cclka K. Prescott " (717) 697-4b96 rlafuneralhornc.com Krk G Kniae. FD We sincerely a reciate the confidence you have placed in us and wilt continue to assist you in every way we can. Please feet free to contact us if you have any questions in regard to this statement. T7 if FOLLOWING IS AN ITEMIZED STATEMENT O~ THE SERVICES, FACILITIES, AUTOMOTIVE EQUiPMI;NT. AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL. ARRANGEMENTS„ 1. PROFESSIONAL SERVICES: CASH ADVANCES: Opening Crave S 750.00 ' ~ Cstnctcry Equipment S?~ 00 Certified Death Certif-catas X48.00 Newspaper Noaccs • Patriot S 1$3.?2 NevvspaperNotices -Washington Post $2b1.85 Flowexs ` S2.I2.00 Clecg,I-/Mass Ot~'ering S [00.00 Organist ''S IZS:tlO SoloistlCantor - _ '~57~~00~; clergy tvA) ~ sr~ooo~t . Organist (VA) ~ S~'~-0:00 TOTAL CASH ADVANCES AND SPECIAL CHARGES S2I755fi~ CONTRACT PRICE ~ SIOSSO".57~ TOTAL AMOUi~IT DUE SIO,SaO.S'T .. ,... (71.7} 697-4 96 8 Market Plaza Way . _ _ Mechanicsburg, PA 17055 www.malpezzifuneralhome.com Jeremy J. Shartzer, FD Michael J. Malpezzi, Owner, FD Kyle C. Knipe, FD April 15, 2010 Anusia Allen 790 Santa Rosa Boulevard Fort Walton Beach, FL 32548 The Funeral Service for Celka K. Prescott We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOT.[VE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL AR]r2ANGEMEN"TS. 1. PROFESSIONAL SERVICES: Funeral Mass in PA $540.00 Funeral Mass in Virginia $540.00 Graveside Service $475.00 Vehicle to transfer remains to Funeral Home $325.00 Hearse (Casket Coach) $425:00 Services of Funeral Director/Staff $1,895.00 Embalming $785.00 FUNERAL HOME SERVICE CHARGES $4,985.00 SELECTED MERCHANDISE: Poplar Casket ;52,220.00 Guardian Concrete Vault :51,125.00 Prayer cards $45.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $8,375.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES: Opening Grave $750.00 Cemetery Equipment $220.00 Certified Death Certificates $48.00 Newspaper Notices -Patriot $183.72 Newspaper Notices -Washington Post $261.85 Flowers $212.00 Clergy/Mass Offering $100.00 Organist $125.00 Soloist/Cantor $75.00 Clergy (VA) $100:00 Organist (VA) $100.00 TOTAL CASH ADVANCES,AND SPECIAL CHARGES $:L,17S.S7 CONTRACT PRICE $10,550.57 TOTAL AMOUNT DUE $10,550.57 r ;41.14 f V. IMfA 11~~ ~•• J..r YJ O s v~ ~ ~ J^~~r~ ~ d r ~ ... J ~ S • Q ""'~ ~ ~.,,,,,r, j' ,,,, ,,.~ et v ,~-.~ '. Ll ~"~ '~ .--- ~~ 7t, ~ ~ ..- 1, ~~ ~( "'^) wt ~L1 ;'{X ~ C~ ~' ~' S .~ w {L v ~! - •' REV-1512 EX+ (12-L13j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF p~-FSC D TT C FLX~ k. FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. Su,ral~ Todd n'lenzori,~l f-~ornc, Curl:sly, Per-nc~. ~a9,S39. '~7 C~Ce b•1~-'~ ~fatcrnen~ a1(tachcd~ ~,o F S ~ + ~. Cticok. n~.3337, died ~cb. ~, ~o ~ C~n.,rlLs ~ ~.lds ~, For 25~: p~ann;r~~, It.~a.~ cidv~ce, ~i ps ~ ~u.ra~, Told H6,,.,Q, ~orep. of ~c~as, f ~6 ~~ . d ~ ~ n o~' clear Gu1~'i I fib. f (~ ~ b t o drron~ M s T ~ee.a u~ a,r+cl `l `f /• -~P~c~rc wa.s ~' I>~~d wt, d.o. d . vaI n,e, hence -f~,;s -- ~~S f yy~~- „ 3. C~ /sv_ ~.a i~0 d ax¢d kb. [ 2, 7 0 - o ~ rTarn,es ~r ce ~a r rr.~n,.b ~,~rsen~¢`+~`' ~` c 0.sSor~ec[ ~(~.l')525, e~G - ce~u.~.~n a.1~' ~iY7l~l~avt aT' ~(ka ~ir'SCm~ BOO. Op ~-~fer c[ earl oh ~,. 11, 2-0 l o . ~. CIu.~ n._ 33~f/ daTe~ ~eb. ~2, 2~f0 ~}n ~'h+us-a d~[~erf Qs G~ ~ S~S7, ~ pq~, 00 ~~ ~ra„el, ea.r~-, ~T~. rncl~e a~' c~'~ ~P~1~Dh pf C~GI ~ Prc S ~o~t-, ~i-?-7~-'- C~eare~ ©~ F'eb. I7, zoto, s. (;~icck moo. 33yz dc2~~ ~. ~3, 20~ o ~' ~n~ ~ wa-~r r-r- c.lca~n~c(. ~4. la CPlease no~e scyte.c~ ~ . shn ws no balms. ~.+~- che,~k,'n ~.~'. ~ .. ova d •o. d _ ~ v~i~nc~s I~-~e-~' was ~ eb, i~1 S u-~ ~ ; e,-~t 1'1~ ~ Coves Ch~.tes a.l r>• a.d,~ t~a~aw n . See /V1 ~ 7- ~•r~-t,E', n~,c.l , ~-tm(sJ a,~~.c~ d~ ~ . l ~c~.~vmctt~ ~ w ~ t~d-~t gal ~roM Saud A-~o~': ~ o~i~,t+v ~n-~, ~r, s u r_ ~(~ o . 7, werdra ~ P,-of ec.+~i'on ~e o~ ~-~~~~t ~ ~,~'.vo ~~ .~-rty,~'ry ~ ~ afl'l~lD ~~ o0 ~. 1-rl~llennikrn ~.rtnau~ .SyS~r»s , ~,r ph~trmacewti~als, oli>~s,sih P.#c; See '8 it-i,~9 l~~checl. ~h~ s w as ct rna n,~~ l~ p~-p~,rec~ , b ~ t I, n~ and -~sc ~'y ~ s a.>~e bo.IQn~e s a.Fkr ca .~ p,~,Ys /Aaarc 6~ a, ~6I. /! mec,Ic~ ~isu.r. TOTAL (Also enter on line 10, Recapitulation) $ ~ ~ ~~ S/ 7, 3 r2 (If more space is needed, insert additional sheets of the same size} Sarah A Todd Memorial Home 1000 West South Street Car}is}e, PA 17013 Telephone: (717) 245-2187 Attorney Charles Shields III 6 Clouser Road Mechanicsburg, PA 17055 5 f i~ I ~ Ivl ~ IV I Statement Date: 04/09/2010 Due Date: 04/25/2010 Amount Enclosed $ Account #: 102051. RE: Celka K: Prescott Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Amount Due .00 .00 3,741.90 1,027.79 24,769.78 •9 .3 NOTE: ***** PAYMENT I5 DUt UPON Ktl.t1P ~ '~~'^~^~ tsu ~ NU t~ i trc THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 04/08/10 do not reflect on statement. NOTE: ** LATE PAYMENTS. ARE SUBJECT TO A 1.25% LATE CHARGE PER A $10.00 FEE, WILL BE CHARGED for RETURNED CHECKS ** Celka K PrescotC -Account #: 102051 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Telephone: (717) 245-2187 Statement Date: 04/09/20.10 Due- Date: 04/25/2010 ~ • ~ ' Ae '! • !.. eta fi;..f*t i ~ 1 ~ }~~ brr~x r . ' ~.~~~r~ ~ Ml.~i.. j'K.: . 00 0 04342M NM I17 7094 CEl.KA K PRESCOTT 307 E COOVER ST MECMANICSBURG PA 17055-4224 .. .. STATEM!'NT PEtt~ ..... ~ .. PAaE . .. Ff'b.17-MAR.16,2010~ 1 Of 4 .... .. ... '•' •• ...SE~L~E~CT;ED ..AC~CDUNT:•..SUMMARY ACCDUNT ACCOINiT INTERESt EARNED MATURITY prp2NC TYPE NUMBER 1/EAR-TO-DATE DATE oALANCE CLASSIC CHECKING 000002672022643 0.00 MsT P~RSONAI SAVIN6s 015004Zoo21ei6o l.eo TOTAL DlPOSIT3 450. T7 0.00 450.77 CLASSIC CHECK G ~~~I T~7lE.- s - - I. ' __~.. ACCOUNT N0. 2672022643 CARLISLE PIKE ACCOUNT SUMMARY IN6 ... ... ..:.... iTS..i... ... • ........... ....... ....... ........ ... . • •~ANCE ~ • ::..... •.. ' OT ~~k 'ADO , ..:...:'.: • ~...CN~:.......b..':.:.:: 'tRACT~ONB' :....... N0. AMOUNT NO. AMOUNT N0. AMOUNT O.ao b,Z9a.___ __ 9.32 z 35a. .DATE• '~ ~ ..... .~ ...~ • ~ TRANSA~TYON~ • DE RIi 02-17-1 0lOINN2N6 BALANCE a2-17-10 PHONE TRANSMER DEPOgiT 02-17-10 CHECK Nt~lR 33i-1 02-17-1 CHECK NUlR;ER 5340 02-1s-10 CHECK NutibER 3342 02-22-10 STATE FARM RO 27 sFPP OS-01-10 tiAA-CRkP aiSTR. ANNUITY 03-05-10 TIAA-CREF DZSTR. RECLAIM ACCOUNT ACTIVI .. .... .. .... r ...•.. :.:...'.'. ~•~ aYNER• ............ ST' P .::... ~ •SAI~E....:.. 0.00 430.77 1C?2do4•'~ ' ':~:~....:.:':gA~E::....:::. X0.00 6,000.00 s,ooa.oo soo.oo seo.oo 9.12 490.E 60 . ;~1 450.77 2~ .16 7Y8.93 290 .;tb 430.77 .... ... ...... - ...... ..... ....... ......... ':,CN6CK5•'~fAiO ~3tMM1ARY.. -- _-- `„~_,__, s3ao oz-l7-io soo.oo 3541 oz-l7-lo S,ooo.oo SS42 e2-'[s-1o v.1z i~ kr~~1~~t,~~T'~s~-b~~~rlt~~s~~ ~T'~}t}f~N ~t ... 11 f'~~iJ.~.. .. .1 •:~ w iiv .~ ~~ Is. ~~~ I I ..-~•~ • • •, ..STATEMENT. PERIOD ' • iA6~ , . :.::~ FEa.17-MAR.16,2010 2 OF 4 """"' CELKA K PRESCOTT SPRING Is THE SEASON To sAVE WiTN YOUR Nat CHECK CARD. MARCk FORMARD MITN SPRING SAVINGS AT NATIONAL RETAILERS MMEN YOU USE YOUR CARD IN STORES, ON THE NE8 AND OVER THE PHONE. Just 8E SURE TO SELECT (OR ASK TO USE YOUR CI-Rb AS1 "CREDIT^. PICK UP A GOU!"GN EOOK AT YDUR LOCAL MRT BRANCN OR VISIT WWW.MTB.COM/SFIOPPING FOR FRESk DEALS ON SrRiN6 SAVINGS. • . CEU(A K MBeT PERSONAL 3AVIN03 •_~~~T~~~tE~~ _ .,, ACCOUNT N0. 150042002id160 CARLISLE PZI(E iNTE«!sT EARNED FOR STATEMENT PERIOD e.0a ACCOUNT SUMMARY ... B .... ......... ......BAI/WC ... . ............ . .~ .....O~ftiElt~' iRDOZTZONS'.'.~...::. ..: •IIDRJIMALS~' 3' • ; ~ .... SUDTRAGT ':. ~. ': ' . • . : •:..:: ~ TNTEREST• • ... . . .......... ~ A .. . N0. A ND. AMOUNT la •91.02 0.00 10 0.05 0.00 errhllAl7 At`TTVTTY .... T ...•. ..... ..~.~. .. "TItANSAGTi0N1• RZMTYON...:: •.. ........:..... ••OT11El~~~;AtlElYT~ONS ......~ TiG~YY~...:~ ~.,~' ... CAiitL~...~~. 02-17-10 dECIN1~lING OALANCE i10.a91.02 02-17-1o PkONE TRANSFER MITNDRAkAI 6,000.00 02-17-1e OD PROTECTION TO 2612022643 '141.16 02-17-10 OVERDRAFT PROTECTION TRAl~SFER FEE 5.00 42-1f-10 ATM MINI STATEMENT INqu2RY FEE ON 02/lb 1.00 NCCIiANZGS6URC MECHANICSBURG PA US 5,943.56 02-2i-10 INTEREST PAVMlNT O.OS b2-2i-10 CLOSEOUT 3,943.11 0.00 ENDING BALANCE 10.00 ANNUAL PERCENTAGE YIELD EARNED ~ 0.04 X ~~ .>r..tr~ti.~f,ylF~t7~lf~~}~eft Yr~r~.#af~~tft1~'~t9t i"Ih 1 ~C7Y~LrJ1CJ t~O.GJ -'1'1 JMI'iG.7 rR 11.C JYCJ OLG G 1 `T [, 1" . [:t0 ..~vv~~yxs+, Cox .~•~alit'y,ko ~,ii~'~'~*?~i~+~~~~~i~v~'~~~~rt#ifj~t~iri~I""i~~r'~}'** jy'f _ aw+4 r ~~ . ....STATEMENT. MRcRX01D ,• :.. :PAGE....:..... FE6.17•MAR.16,2071p 3 Of 4 ~"" CELKA K PRESCOTT wNAT ARE YOU LOOKING FORMARD To; 6ET THE guIDANCE YOU NELD TO PLAN FOR TONORROi~r. LET'S TAUC A60UT THE bES1 MAY TO 6ET YOU YMERE. .NISI VISIT ANY M=T aRANCH, OR GALL i-eoo-7~-3222 TODAY. wE•RE NERE TO HEL1P. MEMIdER FDi[ . ~~ ENO Of STATEMENT +r+e . , ~ c.~, gat ~ ~tR >< ,~r r~f~- -~: ~+~ :., a~•• ~ 1 i~l~ 1 r~;~;iiiofi iai#r3 F1~~4~,csi-fi~ ~In~rse~x ~F Q(1QVf.11 r~Mwj ~.-u-Mos~uRo. -~ ~row+~ ~ !A wilt ~ p ~A1QeTI3cVlk 7 ~ . ~ ., -:Q3~3o29~5~-. ~~?Oz~6ti~r33~0 CbeCk 03300 Ft16 i01/17/2D10 =500.00 etEUt~ >L PEiE5G07't ~"'" ~ 3 d 1 ao. a. cawcR sr,0o:- w.~r _. ~~ o ~ iMai ~~ t 'LCL~r•E~yiL~'~/G~•a~j { ~ ciG:tif7~~b e ~t~~yt _<.4~ tE_~'cS~c4i.~ ~~~..1~~1 __, _.__._. ut11.LA6~ ® ~"r' ~MSrxad~ ~/~w~ I ,~,,-~~~ ~1 ~,iL~I~~ ~~4tct'Rrx ~,~?=~~c~.t•-_~ ~.~_"[fit s -~-.- -:03i]D2~5~~: 26?ZOZ~6~.3~'33~.L i`1t9DO0SD000t3,' -...M/Y~J~Rl~~r.ww. ~.rvtrr.~.w~~r..__ __ •~. ~-irt.hlsir7~rry-.- Check 03301 Paid :01/17/2010 GEUCA K.'!t[9C0'R aw i COOMM arnss~ ACCO!IMiT PAC!• • 00000267202x3 ~- o- 4 r » ~~ ~ r f ~ L ~ 4 c y • I N~ ~~ ~ Y ,~. i1 ~ ~~ • i iY i 1• R .- ~ ~~ ' ~ ~: .~ y ~ e ~ ~,~~Zyi ~f ~~ ~= t~ - ~ ~ ' ~ ~ . `~ , R Cheek R33l0 Paid X04/17/4010 1600.00 - ~ • w O o ~ t`~ •~ r~ ~• , ,:. _ ^. r .; '. • ~ . ~, ~ w ~ j- ti ' ~ H j • ». r /9000. D0 Chsck 033!1 Aaid :4Z/1?/4010 S50DO.OD ~~ 3a 4 2 i 1'Al' ID AR 7 w ~ , ! ~ ~ / 'D _.- ~ 1 ~.~L r a ~ . -- - w__ ~ _ ~1OCKLARS/E~ ~~ ~ 1~M&TI3~nk i Ej2181 A 9~~ I' 2 5 8~3'?`7I ~3 a..~..~ ~aMV_._ ~` /w ~:03L3DZR55~= 26?zD'2264~~~]42 Q~ '~•• .~ ;~ r ~ :~ ., ~. t, = _ ~% • ~ M • ~ i' • "~ • _ ~' ~i11~wp ~ i ~, X10 ~J J' 1 Ji'f"r t'f~`~~ I~RI~ '~? ~~~--- - .: ~- Check 03314 Pa.ffl :09/1!/4010 ~f.iZ CAa~ M3314 Paifl X04/i!/!010 f1.3! - Millen,~~um Phcy. Systems PJfechanicsk 5020 Ritter Road, Suite 110 Mechanicsburg PA, 17055 {NVOICE 09/28/2010 Account Number: STMH1669 102051 PVT 12/02/2009 6002220 1.00 DoxYcvcline Hyctate Oral Tablet 100 MG $ 1.87 $ 0.,00 $ 1.87 RX 53489-0120-02 12/02/2009 6002221 1.00 Wartarin Sodium Oral Tablet 5 MG $ 2.13 $ 0.00 $ 2.13 RX 51672-4032-01 12/02/2009 6001425 255.00 PoNethylene Glycol 3350 Oral Powder $ 16.06 $ 0.00 $ 16.06 RX 51991-0457-58 12/02/2009 6001424 24.00 HYOSCyamine Sulfate Sublingual Tablet Sublingual 0.125 MG $ 17.56 $ 0.00 $ 17.56 RX 68013-0018-01 12!02!2009 6001429 10.00 NovoLog Mix 70/30 Subcutaneous Suspension 70-30 % $ 97.76 $ 0.00 $ 97.76 RX 00169-3685-12 12/02/2009 6001431 12.00 Advair HFA Inhalation Aerosol 115-21 MCG/ACT $ 199.00 $ 0.00 $ 199.00 RX 00173-0716-20 12/02/2009 2000078 30.00 OxyContin Oral Tablet Extended Release 12 Hour 20 MG $ 102.68 $ 0.00 $ 102.68 RX 59011-0103-10 12/03/2009 6003537 1.00 DoxvcYCline Hvclate Oral Tablet 100 MG $ 1.87 $ 0.00 $ 1.87 RX 53489-0120-02 12/04/2009 4000060 17.00 Lvrica Oral Capsule 150 MG $ 39.48 $ 0.00 $ 39.48 RX 00071-1016-68 12/04/2009 6001407 8.00 Levothyroxine Sodium Oral Tablet 125 MCG $ 3.46 $ O.~DO $ 3.46 RX 00378-1813-01 12/04/2009 6001416 9.00 Citalopram Hydrobromide Orat Tablet 10 MG $ 3.65 $ 0.00 $ 3.65 RX 55111-0342-01 12/04/2009 6001418 9.00 Mirtazapine Oral Tablet 15 MG $ 5.53 $ 0.00 $ 5.53 RX 00093-7206-56 12/04/2009 6001419 8.00 Lisinopril Oral Tablet 40 MG $ 3.91 $ 0.00 $ 3.91 RX 00172-3761-60 12/04/2009 6001420 6.00 Dexamethasone Oral Tablet 4 MG $ 4.66 $ 0.00 $ 4.66 RX 00054-4184-25 12/04/2009 6001437 26.00 DoxycYCline Monohvdrate Ora! Capsule 100 MG $ 18.82 $ 0.00 $ 18.82 RX 00591-0411=50 12/04/2009 6001438 8.00 Furosemide Oral Tablet 40 MG $ 2.64 $ 0.00 $ 2.64 RX 63304-0625-10 12/04/2009 6001440 3.00 Metolazone Oral Tablet 5 MG $ 4.77 $ 0.00 $ 4.77 RX 00185-0055-01 12/04/2009 6002106 9.00 Wartarin Sodium Oral Tablet 5 MG $ 5.18 $ O.CIO $ 5.18 RX 51672-4032-01 12/08/2009 6005631 450.00 CMP Menem 50omg/5oml NSS $ 462.28 $ 0.00 $ 462.28 RX 00310-0321-30 12/09/2009 6007088 1.00 Citalopram Hydrobromide Oral Tablet 10 MG $ 1.96 $ 0.00 $ 1.96 RX 55111-0342-01 12/09/2009 6007089 1.00 Wartarin Sodium Oral Tablet 3 MG $ 2.12 $ 0.00 $ 2.12 RX 51672-4030-01 Millertrtium Phcy. Systems Mechanicst 5020 Ritter Road, Suite 110 Mechanicsburg PA, 17055 INVOfCE 09/28/2010 Account Numbelr: STMH1669 12/09/2009 6007090 1.00 Wartarin Sodium Oral Tablet 1 MG $ 2.10 $ 0..00 $ 2.10 RX 51672-4027-01 12/09/2009 6007091 1.00 Mirtazapine Oral Tablet 15 MG $ 2.17 $ 0.00 $ 2.17 RX 00093-7206-56 12/09/2009 6005601 1,500.00 CMP Vancomvcin 1 qm/250m1 NSS $ 94.69 $ 0.00 $ 94.69 RX 00409-6533-01 12/10/2009 6008205 1.00 Wartarin Sodium Oral Tablet 3 MG $ 2.12 $ 0.00 $ 2.12 RX 51672-4030-01 12/10/2009 6008206 1.00 Wartarin Sodium Oral Tablet 1 MG $ 2.10 $ 0.00 $ 2.10 RX 51672-4027-01 12/10/2009 6006886 600.00 CMP Merrem 500mq/50m1 NSS $ 564.97 $ 0.00 $ 564.97 RX 00310-0321-30 12/10/2009 6006887 250.00 CMP Vancomvcin 1qm/25om1 NSS $ 19.11 $ 0.00 $ 19.11 RX 00409-6533-01 12/11/2009 6009115 1.00 Dexamethasone Oral Tablet 4 MG $ 2.23 $ 0.00 $ 2.23 RX 00054-4184-25 12!11!2009 6009116 2.00 Furosemide Orai Tablet 20 MG $ 1.97 $ 0.00 $ 1.97 RX 63304-0624-10 12/11/2009 4000435 3.00 Lyrica Oral Capsule 50 MG $ 8.41 $ O.t)0 $ 8.41 RX 00071-1013-68 12/11 /2009 6009117 2.00 Metolazone Oral Tablet 2.5 MG $ 3.54 $ 0.00 $ 3.54 RX 00185-5050-01 12/11/2009 6006887 250.00 CMP Vancomvcin 1gm/25om1 NSS $ 19.11 $ 0.00 $ 19.11 RX 00409-6533-01 12/11/2009 6006922 250.00 CMP Vancomvcin 1gm/250m1 NSS $ 19.11 $ 0.00 $ 19.11 RX 00409-6533-01 12/11/2009 6007171 500.00 CMP Vancomvcin 1qm/25om1 NSS $ 34.23 $ O.C10 $ 34.23 RX 00409-6533-01 12/12/2009 6009118 1.00 Dexamethasone Oral Tablet 4 MG $ 2.23 $ 0.00 $ 2.23 RX 00054-4184-25 12/14/2009 6005581 255.00 Polyethylene Glycol 3350 Oral Powder $ 16.06 $ 0.00 $ 16.06 RX 51991-0457-58 12!14/2009 6006237 15.00 Santyl External Ointment 250 UNIT/GM $ 55.25 $ 0.00 $ 55.25 RX 00064-5010.15 12/15/2009 6005585 10.00 Humaloq Subcutaneous Solution 100 UNIT/ML $ 105.00 $ 0.00 $ 105.00 RX 00002-7510-01 12/17/2009 6006235 12.00 Warfarin Sodium Oral Tablet 4 MG $ 6.24 $ O.O~D $ 6.24 RX 51672-4031-01 12/18/2009 6005626 11.00 Metolazone Oral Tablet 5 MG $ 12.82 $ 0.00 $ 12.82 RX 00185-0055-01 12!21 /2009 6006237 15.00 Santo External Ointment 250 UNIT/GM $ 55.25 $ 0.00 $ 55.25 RX 00064-5010-15 A~liller~^.i~.im Phcy. Systems PJlechanicsk 5020 Ritter Raad, Suit= 110 Mechanicsburg PA, 17055 tNVOtCE 09/28/2010 12/25/2009 6005589 10.00 NovoLoq Mix 70/30 Subcutaneous Suspension 70-30 00169-3685-12 12/26/2009 6006237 15.00 Santyl Extemaf Ointment 250 UNITIGM 00064-5010-15 12/27/2009 2000886 30.00 OxvContin Oral Tablet Extended Release 12 Hour 20 MG 59011-0103-10 12/28/2009 6005575 17.00 Levothvroxine Sodium Oral Tablet 125 MCG 00378-1813-01 12/28/2009 6005579 17.00 Lisinopril Oral Tablet 40 MG 00172-3761-60 12/28/2009 6005584 14.00 Dexamethasone Oral Tablet 4 MG 00054418425 12/28/2009 6005586 17.00 Furosemide Orat Tablet 40 MG 63304-0625-10 12/28/2009 4000291 35.00 Lvrica Oral Capsule 150 MG 00071-1016-68 12!28!2009 6005576 18.00 Cita-opram Hvdrobromide Oral Tablet 10 MG 55111-0342-01 12/28/2009 6005577 18.00 Mirtazapine Oral Tablet 15 MG 00093-7206-56 12/28/2009 6011045 11.00 Wartarin Sodium Oral Tablet 5 MG 51672-4032-01 12/31 /2009 6027021 15.00 Santyl External Ointment 250 UNITIGM 000645010-15 Account Number: sTMHlsss $ 97.76 $ 0.00 $ 97.76 $ 55.25 $ 0.00 $ 55.25 $ 102.68 $ 0.00 $ 102.68 $ 5.39 $ 0.00 $ 5.39 $ 6.33 $ 0.00 $ 6.33 $ 8.54 $ 0.00 $ 8.54 $ 3.64 $ 0.00 $ 3.64 $ 79.42 $ 0.1)0 $ 79.42 $ 5.55 $ 0.00 $ 5.55 $ 9.31 $ 0.00 $ 9.31 $ 5.94 $ O.t)0 $ 5.94 $ 55.25 $ 0.00 $ 55.25 102051 PVT RX RX RX RX RX RX RX RX RX RX RX RX $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 2,461.16 $ 0.00 $ 0.00 $ 0.00 2,461.1 E REV-1513 EX+ (,9-~JO~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENE~{CZAR{ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF P 12ESCo~,T. L' ~L~~ /~' FILE NUMBER ~~ `, D ~,b~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SNARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~ ~ DTE .' Th t a~: S ~ri ~ l~i aI? hNlSf oe I''CQ ~ a ~ ~ ,/ ,,~. /~'n4Si~ ,¢ /u, >P - ~ ~awor. ~j /~-Ilcr~ v, r. s inter ~ bro~r ~'d ~o ~ ~. ~u.san (~tsden niece- Sa 1 q o~ ~o~~ Q u~~ w a- ~d g o "pcnv~r, Co i a rad fl FS`o 3 { 3 ~3 ~ resf- H, l~ -Dry r~ ~ ~ blood - ~i^ont R-~y~-~, vA• 2a~3o iF ~%~f' o~ q~eq /~Qv~eca/ ->~ r /ack o~ ~~ . ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n 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. fit. ~~ters Cu.t~to { -~ Chur~l~ ~S~b ~(o Rex. `mot aw~.l ~ u~d 2~ nsk p~ ~3ox a1 Ida sh; ~~~on , Y~ ~ z~ 4 ? d. Ckurch e~ ~~ Go o~ ~he~hrt'~I ~ ® ~ Flo Rw- t~~~ del w ~~ 34 35 ~rivtc~{~ ~d . Camp Hilt, P~} I~o-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) _- ' ~ `GG G~ ~ ~ ~~ ~~~ ~~ ~ ,~ ~~~ ~. 3., ~ ~~ s. ~. ~. may;., ~iv?a~ ~'~ ~,~i~ f~'~"0 ~ fba~, ~ ~vr ~ . ~~ ~ ~` ~~~ w ~ ~ '~u~~ '~~ <so~o1,~ ~~~`~` - ,V,~ ~ ~ ,~ `cam `tM ~ dip->yf G~ ~ r~ ~~~ N~ wN~f: ~'~` ~~ ~~09 ~~ W~ ~ ~7~ ~ ~ ~~ ~~rr C~~rr i~ ~' ~ , ~'~ ~f - ~ LAST WILL AND TESTAMENT OF CELKA K. P'RESCOTT I, CELKA K. PRESCOTT, currently of the Borough of Mechanicst~urg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at anv 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 conveniently be done. 2. In the event that I possess a dog at the time of my death, I give and bequeath the said dog to my beloved sister, ANUSIA M. ALLEN, and her husband, EMORY RAW~ORTH ALLEN, ciu-rently of 34469 DuBuisson Road, Slidell, Louisiana 70460. 3. I give and bequeath to my Executor, hereinafter named, all the contents of my house (exclusive of cash, stocks, bonds, certificates of deposit, banking books, and similar instruments) to be distributed as he sees fit in his sole and absolute discretion which shall be considered fir.~al. Any death taxes due thereon shall be paid from the residue of my Estate. 4. All the rest, residue, and remainder of my Estate, real, personal, and mixed, whatsoever and wheresoever situate, shall be sold at public or private sale, by auction, by realtor, or otherwise, as my Executor in his sole and absolute discretion may deem best. After the payme:nt of all costs, fees, commissions, death taxes, charges, expenses, and the like associated with the: settlement of my Estate, I direct that the then remaining net balance be divided and distributed as follows: A. Fifty (50%) percent thereof to CATHOLIC RELIEF SERVICES - U.S.C.C., currently of 209 West Fayette Street; Baltimore, Maryland 21201. B. Twenty-five (25%) percent thereof to ST. PETER'S CATHOLIC CHURCH, P.C). Box 27, Washington, Virginia 22747. C. Ten (10%) percent thereof to CHURCH OF THE GOOD SHEPHERD, Trindle Road, Camp Hill, Pennsylvania 17011. 1 D. Ten (10%) percent thereof to my friend, JAMES PRICE, cturently of 244 Duck Run Lane, Star Tannery, Virginia 22654. This gift shall be in addition to and not in place of his commission for serving as Executor. Five (5%) percent thereof to my niece, SUSAN BASDEN, currently of 1909 South Quebec Way, Building 2, # 308, Denver, Colorado 80231. In the event that any of the above-named entities or individuals ceases to exist or predeceases ,, me, then its, his or her share, as the case may be, shall be proportionally divided amongst the other named beneficiaries above which are .still in existence or have survived me. S. I nominate, constitute and appoint the said, JAMES PRICE, to be the Executor of this my Last Will and Testament. In the event that he is unable or unwilling to act as Executor, I appoint my sister, ANUSIA ALLEN,. and her husband EMORY RAWORTH ALLEN, to be Co-Executors in his place and stead. I further direct that they shall not be required to file bor.~d or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~I~ day of (li~~Q..., , A.D. 2006. `,7~~~.a ccs~" (SEAL) CELKA K. PRESCOTT Signed, sealed, published and declared by the above-named CELKA K. PRESCOTT, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~..~~-