Loading...
HomeMy WebLinkAbout11-03-101505610101 EX (oi-io) ~ REV- ~ 5OO OFFICIAL USE ONLY _ PA Department of Revenue pennsytvania County Code Year File Number oEOAaTMENT~FpINHERITANCE TAX RETURN Bureau of Individual Taxes PO Box Z8o6o1 RESIDENT DECEDENT ~ ~ ~ a Q Q ~ s ~ Harrisburg, PA 1128-0601 - ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ,~ ~~ 07 ,~g-o 8 o i ~~ ao ~ o ~~ o~~ ~ ~ 8 Decedent's Last Name Suffix Decedent's First Name MI o~ /~ T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI /K~ Spouse's Sociai Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death p 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. !a113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Cx~-aec F~ F ~~r ~-~~s ~ ~ r ?~ ~ 7~ ~ ago 9 First line of address lQ CL o`uSE~ ,~D~-~ Second line of address /~ / ~' City or Post Office /~'1 ~CH~f/Il/CS 8 ~l~G State ~~ ZIP Code REGISTER OF WILLS'• USE~OiyLY ~ r ~. ~ ~-~ ~. .._. ' ~ 4J .~ r~ `.~..' 1. ~ ~~ ~ r._. w j ~ fE-IFILEU r~ { ~ ± . ~ ~-• ...,: , Correspondent's a-mail address: Cesf'll ~`G~s ~~ Co/YICQSfi n e ~ _~~ 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ~~ /yE',/Vj(~y . Mfg S. 6t%/lar~~ad FYI Clia~~CS~ur ~A /70 SS ~ _.,~__ _.. ~~ S,GNATU~~FA RE~iERR THA o~~i'~i~~ / p/29 /,Q ADDRESS ~~~ S/~~CZ,VS ILL CR o 1[ SCr__.. ~ ,/~P.L'.Ll ~ rCS~ u ~f~ /7 o SS ---__ o.. ~- PLEASE SE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: '~ ~ ~ P~ ~ M I ~-~ I $ ' - O / a G b S O RECAPITULATION - 1. Real Estate (Schedule A) ........................................ ..... 1. ~ S O 9 ~ O• D ~ 2. Stocks and Bonds (Schedule B) .................................. ..... 2. . D O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • Q Q 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4. • p D 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. ~ ~' ~ ~ 9 . 7 S 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. . ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 3 ~ ~ a ~o • O 8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8. ~-, ~ 3 1 ? ~ • 8 9. Funeral Expenses and Administrative Costs (S~hedule H) .............. ..... 9. ~ ~ 3 y 9 ' q 3 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... ..... 10. (o D s q ~ 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. L~ O ~ s $ * g 3 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. ~ '7 ,Z ~, ~ 9 ~ q 9 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. ~ ~ .Z 7•, ~ 9 „ ~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 1 ~~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .O f.~ . Q D 15. O O 16. Amount of Line 14 taxable at lineal rate X .0'~ 17 2. 2 / 99 9 16. ` 7 ? ~ 9 • q o 17. Amount of Line 14 taxable at sibling rate X .12 . Q Q 17. ~ O 18. Amount of Line 14 taxable at collateral rate X .15 Q Q 18 • O 19. TAX DUE ..................................................... .... 19. 7 ~ 4 9 ~ 1 ~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 1505610105 1,5056101,05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iN01VIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HENRY MARY JANE 48 S WHARF RD MECHANiCSBURG, PA 17055 REV-1162 EXt11-96? NO. CD 012644 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- Told ESTATE INFORMATION: ssrv: i8~-o~-2808 FILE NUMBER: 2110-0155 DECEDENT NAME: SMITH RUTH P DATE OF PAYMENT: 04/22/2010 POSTMARK DATE: 04/21 /2010 COUNTY: CUMBERLAND GATE OF DEATH: 01 / 26/ 2010 101 ~ $5, i 30.00 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY SEAL CHECK# 997 S 5,130.00 INITIALS: CJ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1500 EX Page 3 Decedent's Complete Address: Fife Number p~ ~ ~- ~ a ... ~ SS DECEDENT'S NAME ~ u~ P. ~rn~~-h STREET ADDRESS CITY ~-n ~ STATE ~~ ~ ZIP r 7 ~ ~~ '~ `~C.~1 Arl I C S~LI r q I Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments f5- ~~~ 00 A. Prior Payments _ _ ____.s. ____ ~ ___ B. Discount ~ 070.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) (1) 7, 7~f 9, g° ,~S boo , c~ tj ... B ~ a,3~g.9° Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................ © ^ ........................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spause 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. REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF s/N ~T/y ~~?~ FILE NUMBER ar-io --/ss 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. ~// ~a~ Ccnfa~n f~na~t o~' /a~,d si~Cca~e ~r.>r f f~ / vns~;p E.~ ~a~t/~4~eri, Gdt[h ~ oil [r~c`rr.i~,r/qnu~, ~n4., Ec,ir iht/J D/ec~ w~Th Q q~~/l ,',? ,die U SQ Q.~14~ ~4 ~iti lti1-t ac~~rrSs b~ O ,?G7 o~alur L'hu.r ~~+!, ,iyle~ian~c s6 ti ~ , P~ l ~o .rs: ~»r a ~' filer a'cs~ri~~ioh , See ~ruc ~ eo~r~ ~y ~ de~a~ o~' ~nr~yanc~v_ a~~ai ~ier,e7s, daret~ >3 ,/n~ o?olD. 0~4.'~ ~0/`Cirli~s liJL/~e so/q/ ~n ,~3Q ~~~. ,~ l,~Q y .~~.~ a-n~! ~a trnerr ,~ GI'//a9ncr-~ ,`j,S w.~~ , S~~~Gn~cnf fiik.~c Go/acs BH /8 ~Tkne r' A ~ o BYO ~ Ce»s~ dera ~i oll o ~' /~ o, 90Q. n . ~ /S-D, ~jDD. 0 0 fee ~e~f~~~~iit ~SlCe~` ar~uc~ea' TOTAL (Also enter on line 1, Recapitulation) I $ ~~"D i ~~D d~ (If more space is needed, insert additional sheets of the same size) Tax Parcel Number: 10-21-0285-010 THIS INDENTURE MADE THE J~~'-day of ~ , in the year of our Lord two thousand and ten (2010). BETWEEN MARY JANE HENRY, as Executrix of the Estate of RUTH P. SMITH, deceased, late of the Township of Hampden, Cumberland County, :Pennsylvania, Grantor, and BARRY K. WAGNER and CARMEN E. WAGNER, husband and wife, of 2055 Good Hope Road, Enola, Cumberland County, Pennsylvania, Grantee. (The singular usage herein shall include the plural.) WHEREAS, the said Ruth P. Smith, was vested in her lifetime with title to the premises hereinafter described, in the Township of Hampden, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said Ruth P. Smith, departed this earthly life, testate, on the 26th day of January, 2010, and Letters Testamentary were duly issued to the said Mary Jane Henry, 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 Mary Jane Henry, Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED FIFTY THOUSAND NINE HUNDRED and No/100ths ($150,900.00) DOLLARS, and other good and valuable considerations, to her in hand paid by the said Grantee, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bazgained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in her vested by the Fiduciazies Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Grantee, his heirs and assigns: ALL THAT CERTAIN tract of land situate in the Township of Hampden, County of Cumberland and Commonwealth of Pennsylvania, bounded and described as follows to wit: BEGINNING at a point in the centerline of the Salem Church Road, at the corner of lands now or formerly Michael E. McEwen, et. ux; thence along the centerline of said road, South 42 degrees 30 minutes East, a distance of 115.00 feet to a point in the; centerline of said road; thence along the northern line of a private right-of--way fifty (50) feet in width, generally called Forest Drive, South 43 degrees 15 feet West, a distance of 210.00 feet to a hub at the corner of lands now or formerly Paul L. Rudy, Jr., et ux; thence along said lands now or formerly of said Rudy, on a line roughly parallel to the centerline of the said Salem Church Road, North 41 degrees 31 minutes 50 seconds West, a distance of 129.84 feet to the corner of said lands now or formerly of said McEwen; thence along said lands now or formerly said :McEwen, North 47 degrees 18 minutes East, a distance of 207.22 feet to a point in the centerline of said Salem Church Road, the point and place of BEGINNING. CONTAINING a gross area of 25,494 square feet, a road right of v~~ay area of 3,525 squaze feet and a net azea of 21,969 squaze feet. The above description was prepared from a Survey and subdivision for Ruth P. Smith dated Apri16, 1973, and revised Apri127, 1973, made by John C. Brilhart Surveying and Mapping Services, of Mechanicsburg, Pennsylvania which is recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Plan Book 23, Page 159 (occasionally previously erroneously referred to as Plan Book 23, Page 59}. For further reference as to root title, see Plan Book 20, page 61 in said Recorder's Office. BEING part of the same premises which Robert Putney and Emily A. Putney, his wife, by their Deed dated September 28, 1957 and recorded in the Recorder's Office aforesaid, in Deed Book "B", Volume 18, Page 317, granted and conveyed unto Charles E. Smith and Ruth P. Smith, his wife. The said Charles E. Smith died August 31, 1971, whereupon title to said premises became vested solely in Ruth P. Smith, by virtue of the doctrine of survivorship incident to tenancies by the entireties. Her said estate is the Grantor herein. 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 Grantee, his heirs and assigns, to and for the only proper use and behoof of the said Grantee, his heirs and assigns, forever. AND THE SAID GRANTOR, Executrix, as aforesaid, her successors and assigns does covenant, promise and agree to and with the said Grantee, his 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 Executrix of the Estate of Ruth P. Smith, deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence o£ yf ~ ( (SEAL) c', ~/~ RY J E HENRY, Executr x of the v~ Estate of RUTH P. SMITH, Deceased COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: On this, the ~ ~ day of ~~~~ , A.D. 2010, before me a notary public, in and for the Commonwealth of Penr~aylvania, personally appeared MARY JANE HENRY, known to me (or satisfactorily proven) to be the person whose name is subscribed as Executrix of the Last Will and Testament of Ruth P. Smith, and acknowledged that she executed the same in such capacity. IN WITNESS WHEREOF, I hereunto set my hand an official seal. ' _ Notary Public My commission expires: (SEAL) COMMOrtNVF_ALT,y C~ Fg?~NS`fLVAtvis~ t~totariai ; peal '~ Charles E ~Rttic_•ItiS +%? !Votan~ ~=~~liC Monroe Two,, ~'af~7i~erl~nu GoLnty My t;flmmission Expi-es .e;.;ne '?0, l0 ; 2 Member, Phrinsyt6~nie t'~ss~~ietleri of Notar;e:s CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: Attorney for Grantee Q~QrA1vsN~q~.hocm OMB Approval No. 2502-0265 y k r ~ A. Settlement Statement (HUD-1) '=C ~4; `~QRV D4JE~~ t. Type of Loan . Q FHA 2. ~ RHS 3. Q Conv. Unins. . ®VA 5. Q Conv. Ins. 6. File Number. 201004645.PFD 7. Loan Number: 1000025106 8. Mortgage Insurance Case Number. 101060611227 ~. Note: This form is fumishtsd to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. !tams marked (p.o.a)"were paid outside the dosing,' they are shown here for inlwmational purposes and are not included in the totals. ~. Name and Address of Borrower: 3arry K. Wagner ?055 Good Hope Road =Hole, PA 17025 E. Name and Address of Seller. The Estate of Ruth P. Smith 267 Salem Church Road Mechanicsburg, PA 17050 F. Name and Address of Lender. Walker Jackson Mortgage Corporation 1000 Urban Center Drive, Suite 500 Birmingham, AL 35242 G. Property Location: ?67 Salem Church Road Ulechanicsburg, PA 17050 Cumberland County, Pennsylvania H. Settlement Agent 20-1747090 Lakeside Abstract 8 Settlements, LLC 15 Triplett Court Diltsburg, PA 17019 Ph_ (71732-9000 I. Settlement Date: June 18, 2010 10-21-0285-010 Place of Settlement: Cody Financial 3805 Market St. Cam Hill, PA 17011. I. Summary of Borrower's transaction K. Summary of Sellers transaction 00. Gross Amount Due from Borrower. 400. Gross Amount Due to Seller. 01. Contract sales rice 150,900.00 401. Contract sales rice 150,900.00 02. Personal ro 402. Personal ro 03. Settlement Cha es to Borrower Line 1400 9,698.71 403. 04. 404- 05. 405. .d ustments for items id Seller in advance Ad ustments for items id Seller in advance 06. Ci /Town Taxes to 406. C' !town Taxes to 07. Coun Taxes 06/19/10 to 01!01/11 187.37 407. Coun Taxes 06!19/10 to 01/01/11 187.37 08. Assessments 06/19/10 to 01/01/11 418.51 408. Assessments 06/19/10 to 01/01/11 418.51 09. Credit sewerrtrash 2nd tr 35.86 409. Credit sewer/trash pd 2nd qtr 35.86 10. 410. 11. 411. 12. 412. 20. Gross Amount Due from Borrower 161,240.45 420. Grose Amount Due to Seller 151,541.74 00. Amounts Paid or in Behalf of Borrower 500. Reductions in Amount Due Seller: Ot. De sit or earnest move 3,000.00 501. Excess d sit see instructions 02. Princi al amount of new loans 154,144.00 502. Settlement cha es to Seller Line 1400 11,595.92 03. Existi loans taken su 'ed to 503. Existi bans taken sub'ed to 04. Brlkrcredit $730 WJMC Admin Fee 504. Payoff First Mortgage 05. 505. Pa ff Second Mo a e 06. ~. 07. 507. De 'dish. as rooBeds O8. 508. 09. 509. .d ustments for kerns un id Seller Ad ustments for kerns un id Seller 10. C' !town Taxes to 510. Ci !town Taxes to 11. Coun Taxes to 511. Coun Taxes to 12. Assessments to 512. Assessments to 13. 513. 14. 514. 15. 515. 16. 516. t 7. 517. 18. 518. 19. 519. 20. Total Paid /for Borrower 157,144.00 520. Total Reduction Amount Due Seller 11,595.92 00. Cash at Settlement frorMo Borrower 600. Cash at settlement tolfrom Seller 01. Gross amount due from Borrower line 120 161,240.45 601. Gross amount due to Seller line 420 151 541.74 02. Less amount id b !for Borrower line 220 ( 157,144.00 602. Less reductions due Seller line 520 ( 11,595.9 03. Cash D From ~ To Borrower 4,096.45 603. Cash X~ To ~ From Seller 139,945.82 The undersigned hereb dcnowledge receipt of a completed copy of this statement ~ any attachments referred to herein Borrower Seller The Estate of Ruth P. Smith Barry K. agner mGr 7 nti ~~ry , ~GXeCu~ r. X Ite Pubic Reporting Burden for ihle COIIBCtiOn d k110fTnatial is ettinl8ted N 35 minutes per reepOnSB for cakecUnp, fevleW/Ig, 8nd reporting Ule data. This egerxy may not ODieCf ttYS kdorrrtetiort. 8rld ere not xnplete dris tam. unless k displays a wnently valid OMB contrd rxmDer. No coMiOentiality is escured; this disdosure K mandatory. TAia is designed to provide Cte parties to a RESPA Covered transaction wNh stforrnation urvg the settiemerrt Process. Page 1 of 3 HUD-1 (201004645.pfd/201004645.PFD/41) .. Settlement Charges 00. Total Real Estate Broker Fees $ 9,054.00 Paid From Paid From Division of commission (line 700) as follows: Borrowers Sellers 01. 4 552.00 to John Glise Inc. Realtor Funds ~ Funds at 02. 4 502.00 to Jacc Ga hen Realtor sattlemeM Settlement 03. Commission aid at settlement g p54.00 04. Broker Fee to John Glise, Inc, Realtor 150.00 05. 00. Items Pa able in Connection with Loan 01. Our o ' ination cha a Incudes O ' ination Point 0.25°~ or $ 385.36 $ 3,768.18 02. Your credit or charge (points) for the speafic interest rate chosen $ -2,652.82 from GFE #1 (from GFE #2) 03. Your adjusted origination charges from GFE #A 1,115.36 04. sisal fee to John Deza olds from GFE #3 375.00 05. Credit Re ort to Credit Plus from GFE #3 50.00 06. Tax service to (from GFE #3) 07. Flood certification to (from GFE #3) 08. Final Inspection Fee to John Dezagottis (from GFE #3) 200.00 09. (from GFE #3) 10. (from GFE #3) 11 • (from GFE #3 00. Items R wired Lender to Be Paid in Advance 01. Daily interest charges from 06/18/10 to 07/01/10 13 CAB $22.174000/day (from GFE #10) 288.26 02. Mort a insurance remium for months to Wacker Jackson Mo a e Co vatic from GFE #3 3,244.35 03. Homeowners insurance for 1.0 ars to Friends Cove Mutual Ins. from GFE #11 POC:329.00 ~• from GFE #11 05. (from GFE #11) 000. Reserves De ited with Lender 001. Initial deposit for your escrow account (from GFE #9) 1,326.49 omeowne s insurance mon s per mont 003. Mo a e insurance months $ r month $ 004. Property taxes $ 1, 357.21 County Taxes 3.000 months ~ $ 29.08 per month Assessments 13.000 months $ 97.69 r month 005. $ 006- months Q $ per month $ 007. months @ $ per month $ 008. $ 009. Aggregate Adjustment $ -140.40 100. Title Char s 101. Title services and lenders title insurance (from FE #4) 1,438.25 102. Settlement or closin fee $ 103. Owners title insurance to First American Title Insurance Company 104. Lenders title insurance to First American Title Insurance Company from GFE #5 $ 1,283.75 105. Lenders title oli limit $ 154,144.00 106. Owner's title oli limit $ 150 900.00 107. ant's rtion of the total title insurance remium to Lakeside Abstract 8 Settlements LLC $ 1,091.19 108. Underwriters ortion of the total title insurance remium to First American Title Insurance Com an $ 192.56 109. 110. 111. 112. 113. 200. Government Recording and Transfer Charges 201. Government recordin cha s to Cumberland Coun Recorder of Deeds from GFE #7 152.00 202. Deed $ 62.00 Mortgage $ 90.00 Releases $ Other $ 203. Transfer taxes to Cumberland County Recorder of Deeds (from GFE #8) 1,509.00 204. City/County tax/stamps Deed $ 1,509.00 Mortgage $ 205. Statetax/stam Deed $ 1509.00 Mo e $ 1,509.00 206. 207. 300. Additional Settlement Cha 301. R wired services that u pn sho for from GFE #6 302. Termite In coon to Lb 's In lion 75 00 303. Home Warren to Home Bu rs Resale Warren Co 459.00 304. 305. 2010 Coun Tax to Michael Lan an 348 92 400. Total Settlement Cha enter on lines 103, Section J and 502, Section K 9 698.71 11 595.92 BY sipnkig Pegs 1 of tfwe sfatemerrt, the 6ipnetories acknowledge receipt o1 a cortipleMtl coDY of papa 2 b 3 of this mree f Lakesid bstract 8 Sett manta, L C, ttlement Agent Page 2 of 3 HUD-t (201004645. pfd/201004645. P FD/42) omparison of Good Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HU0.1 har es That Cannot Increase HU0.1 Une Number ur origination charge # 801 4,018.18 3,768.18 cur credit or charge (points) for the specfic interest rate chosen #802 -2,652.82 -2,652.82 wr adjusted origination charges # 803 1,365.36 1,115.36 ~ansfer taxes #1203 1,509.00 1,509.00 ha That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1 ovemmeM recording charges #1201 150.00 152.00 ppraisal fee # 804 400.00 375.00 redit report # 805 50.00 50.00 nal Inspection Fee # 808 200.00 200.00 ortgage Insurance Premium #902 3,244.35 3,244.35 rtle services and lenders title insurance #1101 1,513.75 1,438.25 wners tide insurance to First American Title Insurance Compan #1103 20.00 Total 5,578.10 5,459.60 Increase beMreen GFE and HU0.1 Charges $ -118.50 or -2.12°/ barges That Can Change Good Faith Estimate HUD-1 ~itial deposit for your escrow aoc:ount #1001 1,829.48 1,326.49 aily interest charges #901 $ 22.174000/day -598.63 288.26 omeowners insurance #903 480.00 329.00 pan Terms our initial loan amount is $ 154,144.00 our loan tens is 30 years our initial interest rate is 5.2500 % our initial monthly amount owed for principal, interest and $ 851.19 includes ny mortgage insurance is ^X Principal Q Interest ^ Mortgage Insurance an your interest rate rise? ^X No ^ Yes, it can rise to a maximum of °h. The first change will be on and can change again every _ months after . Every change date, your interest rate can increase or decrease by °k. Over the life of the loan, your interest rate is guaranteed to never be lower than °~ or higher than %. ven ff you make payments on time, can your loan balance rise? ^X No ^ Yes, it can rise to a maximum of $ ven if you make payments on time, can your monthly ^X No ^ Yes, the first increase can tie on and the monthly mount owed for principal, interest, and mortgage insurance rise? amount owed qn rise to $ The maximum it can ever rise to is $ ~oes your loan have a prepayment penalty? ^X No ^ Yes, your maximum prepayment penalty is $ bes your loan have a balloon payment? ^X No ^ Yes, you have a balloon payment of $ due in _ years on otal monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowners insurance. You must pay these items diredly yourself. X^ You have an additional monthly escrow payment of $154.19 that results in a total initial monthly amount owed of $1,005.38. This incudes princpal, interest, any mortgage insurance and any items checked bekrnr: X^ Property taxes ^X Homeowners insurance ^ Flood insurance ^ D ^ ate: R you nave any quesvons auout the Settlement charges antl Loan Terms listed on this form, please contad your lender. Page 3 of 3 HU0.1 (201004645. pfd/201004645. PFDl43) HUD-1 Attachment Borrower(s): Barry K. Wagner ,married man Seller(s): The Estate of Ruth P. Smith 2055 Good Hope Road 267 Salem Church Road Enola, PA 17025 Mechanicsburg, PA 17050 Lender: Walker Jackson Mortgage Corporation Settlement Agent: Lakeside Abstract 8~ Settlements, LLC (717)432-9000 Place of Settlement: Cody Financial 3805 Market St. Camp Hill, PA 17011. Settlement Date: June 18, 2010 Property Location: 267 Salem Church Road Mechanicsburg, PA 17050 Cumberland County, Pennsylvania 10-21-0285-010 Adjusted Origination Charge Details Origination Charge Origination Charge 385.36 to Cody Financial Mortgage Services, Inc Commitment Fee 730.00 to Walker Jackson Mortgage Corporation Price Premium 2,652.82 to Cody Financial Mortgage Services, Inc Total S 3,768.18 Origination Credit/Charge (points) for the specific interest rate chosen CrediUCharge -2,652.82 to Cody Financial Mortgage Services, Inc Totat Z -2,652.82 Adjusted Origination Charges E 1,115.36 Reserves Deposited with Lender Homeowner's Insurance 109.68 4.000 at 27.42 per month County Taxes 87.24 3.000 at 29.08 per month Assessments 1,269.97 13.000 at 97.69 per month Aggregate Adjustment -140.40 month Total S 1,326.49 Title Services and Lender's Title Insurance Details BORROWER SELLER Title Bringdown Fee 79.50 to Lakeside Abstract 8~ Settlements, LLC Closing Protection Letter 75.00 to First American Title Insurance Company Lenders title insurance 1,283.75 to First American Title Insurance Company Total ~ 1,438.25 S 0.00 WARNING,: It is a crime to knowingly make false statements to the Unked 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. (201004645. pfd/201004645. PFD/44) HUD-1 Attachment - Continued Lender's Title Insurance BORROWER SELLER "fees also shown above in Title Services and Lenders Title Insurance Details Lender's Policy Premium to First American Title Insurance Company Lender's Endorsement Charges Endorsement Endorsement Charge ALTA Endorsement Form 8.1 (Environmental Protection Lien) 50.00 ALTA Endorsement 100 (Restrictions No Apparent Existing 50.00 Violation) ALTA Endorsement 300 (Mortgage Survey Exception) 50.00 Total 1,133.75 150.00 S 1,283.75 S 0.00 WARNING: h 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 imprisonmerrt. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (201004645. pfd/201004645. PFD/44) REV-1508 EX+,(1.97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENT DECEDENT RN PERSONAL PROPERTY ESTATE OF ~~/~~' ~;~ ~ FILE NUMBER ~/_ /D _ /~~ 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 DEATH 1 ' ~'k+~9S ~ ~J,/1v - I`Q ~ b /1 Q~tC~ I C i ~-~t /tl I'cSC' I'1'1 P.-~~ (,~S ~r S~I~Glj1~ ~-'T" ~~`~°T ~f~1 cSG~G ~ /~°Q ~ ~eSTQ /G ,¢. L, h~ 4~0 ~, CGtcn~y maces ,~' P~7.37 D. L.ize fol3, ~SSeSS,~1~nf ,¢ `/~s. s- C'. /;,ne ~fo9, G'rcA/,f ~eux,~-/T,-~sl, tel. Z~ 4 fi-': ~` ?~s.86 ~SeP_ S~C~IC~!-f' .S,~teGf 41/frxChcc~) ,~. Z~>oinS ~ ~~mIICL`~ , Q~S ~JP~' Y~ ~ua~ e~ b y ~'Ltcrr y ~ . ri ~lc clcca~ ,I~tc ct~'ons 5; DO ~~ ~ , . .3• ~dal~~r~e~ al i iris Dl' i~Wu'I ~vr y v~ ~ouson~ /~y .~ ~. l/Sca/ /~a~k ,~ ,~cckcr 3/8 " ~~ c/r; // , ~/~ ; h r oo ,.8, us~l L',~a~r gran <Shc~f cs~,ndc-.r /K ; h /p. r , ~ ~ . ~o . o0 9 D. /fj~,k,~ ,~5~^ oSfCi/f / ZS ¢/ 2 S' F O~a~ /?oYl- fl~~ OD~o/!C ~ lun,~C ,V4 ~K~ . /~?~sc. ,~o,~e~taa/e ~eran,:cs ~i~t c~ra~r acs ~.Ja s s ~/, 00 G, c5/y,4// /~soR/ ~~ o /~~e~- ~ / , ~,~ `]~ .Zfe,nis a~ ~~ fiZC/I~S ~a,~~k /~• C'~t ~ ~/~ D88' y~o/~. /3. ~~, ~i f ~a d. o. ~/ ~.~ ~rc,~r /-~ . /O ~ SSG . 7' 7 e . ~ hcG~; ,/~a.~t ~/o o~ ~ yoG ~ ~ G . ~ ~ ¢ o ~. ~. ,N •rf. /fir, sn .•c ~cnr C .s; z s ~, 70 ~'. i me ~tp, b l ~ p-!6 / 70 0 -o -- /^. .T /? f . ,rr~C/; ~p cif. D. af• Op L{'Crit E' ~ ~, DOQ• 00 X .~.8~ ~. ~;me ~ 6~~ ors 3~ ~~ ¢ N. ~~ f /~ccr, fn c~.o. a! on .1'-ttyt G .~ ooo. o0 (cSe2 I/ll ~u a ~i ons ~ffa G~lQ a/ 1 9'` // / ~¢d~ >S ova / -rn Vcn 1ra~y o~ d~/'So~t Q !~ 4 ~ G~ d Sa ~~sG . TOTAL (Also enter on line 5, Recapitulation) $ ~~~ ~5( 9. ~~ (If more space is needed, insert additional sheets of the same size) E/mew Murry Auctions, /nc. License No. AU-649-L 717-790-2240 www.richardmurrYauctioneer.com 14 North Walnut St. Second Floor Mechanicsburg, Pa. 17055 IN RE: Personal Property Appraisal OWNER Estate of Ruth Smith 267 Salem Church Road Mechanicsburg, Pa June 3. 2010 DOD -January 2t~, 2010 This appraisal is completed as per request to determine a fair market for the fallowing list of personal property. This is a common fair market for Estate purposes. Carnival Glass Table Set $90 Carnival Glass Pitcher & glasses 90 Carnival Glass Berry Set 40 Carnival Glass Goblet Set 40 Dining Room Suite 125 Pink Depression Glass 30 Green Depression Glass 25 Yellow Depression Glass 10 Clear Glass 15 Tumblers 5 Costume Jewelry 20 Gold Jewelry 110 Milk Glass 10 Man's ring 30 Fob and other Jewelry 5 Candles N/V Bird Figurines 10 Cookie Jar and Dishware 5 Decorative Rug 40 Sewing Boxes 5 Christmas Decorations N/V Santa & Rabbits Figurines 5 Hen on Nest 5 Mr. Peanut 5 E/mer Murry Auctions, /nc. License No, AU-649-L 717-790-2241 www.t•ichardmw-rvaucti on eer.com Tooth Pick Holder Mixing Bowls Rabbit Figurines Mugs Christmas Tree Glass Sean Glassware and Salt & Pepper Shakers Bowl and Pitcher Candlewick and Fostoria Glassware Electric Frying Pan Large Fan Nut Cracker Washboard Eight Track Tapes Cookie Jar and Warmer Cook Books Christmas Balls Tupperware Baking Pans 14 North Walnut St. Second Floor Mechanicsburg, Pa. 17055 5 15 5 N/V 5 5 10 60 N/V 10 5 5 N/V 5 10 15 N/V N/V Upon observation of the aforementioned items it is to the best of my knowledge and belief that $875 Eight Hundred Seventy Five Dollars would represent a fair market value. ~Q =L %'~//`~ ~~ Citizens Bank• May 1 1, 2010 CHARLES E SHIELDS III 6 CLOUSER ROAD MECHANICSBURG PA 17055 Estate of RUTH P SMITH Date of Death: Jan 26, 2010 SSN: 181-07-2808 Dear Sir/Madam: 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of hislher date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Barbara Richards Operations Services a~ Citizens Bank Account Number 6140884012 Account Title RUTH P SMITH Date O ened 1 /6/ 1990 Account T e Princi al Balance as of DOD $10546.77 Interest from Last Postin to DOD $6.07 Account Balance as of DOD $10552.84 YTD Interest to DOD $8.96 a~ Citizens Bank" Account Number 6100699064 Account Title RUTH P SMITH Date O ened 11/22/1971 Account T e Checkin Principal Balance as of DOD $5282.70 Interest from Last Postin to DOD Account Balance as of DOD $5282.70 YTD Interest to DOD $ .25 ~~ Citizens Bank' Account Number 6140761700 Account Title RUTH P SMITH Date O ened 4/4/2000 Account T e Time De osits Principal Balance as of DOD $5000.00 Interest from Last. Postin to DOD $3.83 Account Balance as of DOD $5003.83 YTD Interest to DOD $ .00 Citizens Bank- Account I`Jumber 6140883997 Account Title RUTH P SMITH Date O ened 8/31 / 1990 Account T e Time De osits Principal Balance as of DOD $5000.00 Interest from Last Postin to DOD $11.17 Account Balance as of DOD $5011.17 YTD Interest to DOD $ .00 Ruth P. Smith Estate Inventory White milk glass bowl & 2 candle holders Small ceramic basket for knickknacks Aladdin lamp shaped small teapot Small round casserole dish Set of 8 old-style steak knives in wooden holder Glass manual orange juice pressure squeeze Ceramic hotplate holder China closet -corner (modern reproduction) and Modernistic kitchen table with 6 chairs Small modernistic push tea cart with flap Miscellaneous kitchenware Homemade spice rack Miscellaneous pots & pans & mixer Miscellaneous hand kitchen utensils Home made eagle to mount on wall Refrigerator Kit-made grandfathers clock -small/medium sized Needs cleaned up & fixed Old set plug-in fake fireplace logs Cheap-made log carrier Fireplace front frame small & fireplace accessories Old Lazy-Boy chair Small coffee table & table lamp 2 small end tables & 2 small table lamps Stand-alone table lamp with flower designs Stand-alone coffee table Small ring with birthstone Assorted beer mugs & butter tray, candleholders & flower pot 2 ceramic roosters Round wicker basket with 12 small cups & trays for snacks 2 table lamps with flower designs Old black & white TV and old recorder Miscellaneous books & videos Tray with mirror embedded in it Bed & chest drawers & small vanity Small bed, chest drawer, small vanity & bureau (If Sonnie doesn't want) 3 old leather purses Vinegar jugs & canning jars 8 foot aluminum ladder Assorted hand tools Small aluminum ladder Bug collector Ceramic pot (small) Total $ 5.50 1.00 2.00 1.00 2.25 1.25 1.25 145.00 32.50 3.75 0.75 6.75 1.50 1.50 25.00 55.00 3.75 3.25 38.75 14.00 5.50 11.00 5.75 6.50 20.00 5.75 3.00 9.50 8.50 6.50 3.75 4.00 112.50 160.00 5.00 15.00 12.00 11.00 4.00 1.00 1.00 $756.50 Murry valuated one room of items REV-1510 EX + (3-97j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF S ~ I TN ~ U TI'S P, FILE NUMBER 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 i:~ yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1. r (.~; v~r- Sbu,rr.~ ~-i,~G ~hS tt..h , eo . , cF M i n n t4 pol i5 A-n nu,~ty Con~Fa-amt ,~vn. `140 -- Sy X14 33 ~ ~ Q.~ ~s~-/a~ua~'~ ~ri~ur~en~' ~ ) 3`f,/Zlo,oy /oo~v ~ --0 ~ 3~, /~6,ay TOTAL (Also enter on line 7, Recapitulation) I $ ~ ~, ~ ~ (~ , 0 (If more space is needed, insert additional sheets of the same size) .iver~aurce Lie ~n~ur~nce Conlpan~r $29 Art~ekiprise Financial Ce+~tar f~i #x~eapr~ l i s, MN 55474 September ~8; 2010 Estate Cf Ruth P Smith C:~Q Mary ~ Henry 48 S Wharf Road Mary J Henrr~ Executor Mechanic,burg, PA 17x55 Contract Owner : Ruth .P Smith Contract Nu:nl~er: 9920-5947933 Dear Estate of Ruth P Smith: Please accept our cr~ndolenres nn your toss. Enclosed is a check ~.n the amount cyf X34, 216.04. This check represents the death benefit due on the above annuity contract. The fo:tlawing is provided for yo~.r records: STP,2~AP.L~ BEATH BEI~EF~'T : $ 34 , 216 . 04 FEDE;RF-L TAk N71'I`HHELD t 0 . r 0 STATE TAX WT°~'IiHELL~ : ~ • © 0 CHECK AIMQUNT : 34 , 2 I6 , J 4 TAXABLE A1rIt3CTI~ T : ? , 216.0 4 Zi= you have any ~uer~tions, please contact our Cuatomer Servir_e Team at i-800-333-34:x'7. Sincerely, Ri~~erSoux•ce Fife Znsux•ance Company C46AJP4T.C01 - Msg l~~f~sbus~r P~1 1TO5.5 t -. y ~ ~ ;~ a,n w'w. ~ y h. y ~ ~ n ~ , ~ ~ r ~ i ~ N r . ~• ~ " *~ .. t.~.i, }.,. C:_Y: .:. ~.,ar. .: ... v.. .. ...._ ...e . _ ..~. ' lw~Y. `r+Yo ...~~. :;~ ~ .. .. ~. ~... ~. A .. }.x.j`i .d4"ti b~ a 3.A C6°b~39~~5~!' !.:O~~gOO~,45~: 5i3~?~«' REV-111 EX+ (12-99) ~t1 ;'i ~~ '~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ~/JT/ 7N, ~l~TiS/ ~ ,~/ -/o - /S'S' Debts of decedent must be reported on Schedule 1. ITEM -- NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,i'Y>. Y ors ~u Hera j f~(o m e d ~ `l. 9,S'/', o 0 See l~Ct~i jo t a ffa clsc~~ 07, ~ yP~ ~d ~-rS - (~Sk~- ~SoOr'a.y ~ a 6 S. vo 3 C m a >h k ~) ~ l-i 5~' C h u.roh e~ W e sf Shd ra° - ~~rn.~ l)'1e~,1 ~'` ~ a o . a v B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) rYlar u ~4ne ~cn r ~ _ Social Security Num//ber(s)/EIN Num"'ber of Pe/r~sonal Representative(s) _ Street Address T ~ .S• f~v~jQ/~f ~OLI ~ _ City M~Gtl11C bN State 1~ Zip /'70SS Year(s) Commission Paid: 2. Attorney Fees ~ qy~ ~, vh -~C~S l~ 1 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant /VD D/4'E' ~G/G /./,3LiC Street Address City State __ Zip Relationship of Claimant to Decedent 4. Probate Fees q~11r.~ p,~ jq / 17ct,~ / SS ~G ~ SI~o Ir ~' C Gr-'~'! ~'C' a,'f c S 5. Accountant's Fees ~ ~od~y ~ l~Q Soh, ~Mt /~-C~+,cuu~t>tmrtf ~ ~ ~~~0 OQ,k (~ 1 Ct', Inechan~ csbur~ P~, 1~~5~ (~h. (005- 4&ZS) ~~' 6. Tax Return Preparer's Fees ~ P~P• CIoY-oaf' loyd, At~•} µo, ~clkc. loot, ,(~!~ 4~s 7. /~o~YGt~f'iSih9 i/T Curn bGr~land >~ ~'ourna.l U ~!. ~dver~i S~'~~ irJ, ~'arl;sly ~+~fine~ 1. Fi I ~'h~ Fu ~~ ,-~ n .fir. %,,c Qc /~c rrr ~ ~c ec, . o >< !ti ; //s ~s~ c eon fah, shed) ~ ~ 50,3. 2S i ~ S~ JZ? 3, Z S J~ioNE ¢IS~..SD ~~.5•D ~ o 0 X75.OD ~I3~f. ~~ ~/~". 00 t~7D~Do TOTAL (Also enter on line 9, Recapitulation) I $ ~D/ ~ y ~ ~ 3 (If more space is needed, insert additional sheets of the same size) p, 2 I s ~y~ fr, ~nz~~/- C~ C ~ n e l?~7S -- /lea Iff ~~.~i. 7..,c l So q. o0 Li/le ~~a- ~/o ~ .~r' Term: /~ .CMS ~ ~~$", oa ___ _-- _ _ __ __.__ ______ _____~~s_T~s~ .__ __ __--_ _______ __ .__ . -_ _____.__~_. _ __ _ . _ _ _ __ _ _ - ,~ , ~ir1G ~~D 3 -- o $w rt /~GSa~. ~ILYn~cn ¢~S~q.oo .. .. .. _-... ..._... ..... . _ - _ _ _ _ _ - __ . _ _ _ _.----m _ _ _.~._ _L%~e_._ -l3c~S^ ---o?b/v ~u~T~ ~~ ~ /11~'~tac/ ~~~~ 1~. _ -_~~yme!~_~ __ ~.----~r~ _.. lv~~n~•-,__ ~~rt~l~a_s~x__ o~ ~ome___~ove_ ~ Y __~t- __ _ __ _____ - -- - ~ - / ~? ~ %a!l~Z~ _~S~grc --__~_._ /5 _B~__k12~~/100~1 7~r ~01~ o~t~ ,00 __ w. _.~n _ _ _ __ _ .-eSP~ L:/i[ci< __v7o~ ~7_Gt~C~Qd _,~1b----7t~- cS/~et~ LtG~ti~!oY.G'~-_._. - _ __ ~! _ _ n~~. _______.__ - __ - __ ___ _ _ -_l~ _ _ /S. - - _ .16. _ _ /Z~ _ ~ ~. _ / ~ _~~~~!"_~l~lrn~.~/__/r!~cn~nS~___-~nc._.._?ai'~ .l~ll~Q``~L_u -._c~~'_~~lr?t3~I1~L~~4 ___ __.__ __.__~0~~.00 ___.. .~~ ~ ~ . r _._~.~r~ ~- ~K~ .__/~'~s/~' ,_~~II!iCe,S____. _. _ ~! ~G___/^LI/,_P~~p~,~~~r .___.!~ ..~!S~ ~o/n _.-ert_- ~r_ __~/e.--~~Pc;nc b_uri~,,_ t' _ C'h~cs. ~._~~,'~~s ~- ,~_ _ _ _ . ____..__. ____ ._.__ ____~ 3som. _ ~~~~'aisa,/_--a~__ ~ta/ ~s~~ ~aC~~~ _A~ra.s~/_-~/K~`ons ____ ..... .... ...... ~3 00. c9o _/harln. 5~---~[1os-~~~,__/?,~o~ti~~cs,~___a-~'_..~:~~._-~ - _____ _.__ x`1'8. ~'~' }~t~~,bu~SQ-nnenl'S__~p... _~ia.r~___e~~.nc___ HGAI~_ ~_r_ Costs____4.~it1_._...~s,GS_._au~ ..___.. _. __.__. ...__.__- . G_~.c~ _ d~r____-'t'1+~i.hfi~~_ t~.~?... -._9~i'1~ _-_ 1~J~e __ .~~'1___._~:1--~p~ __ ~ r_ e ~_ -----____. fiP.tJ--~ es~a~e ___l¢ _ __a<me5. ~-4~h_~h, h~ixid~c.mr~.~_-_,~X-~ _,_r~~,r_!n~,_.~.~._ _ ~_._._. s _ ._.._. . . ~3. l~pL - sta. rs C' . Veri z~ n ~ 3s. !o II~~ ` r ~ _ ~- ~Gtrhy-_ . f!1(~,g11,U' -- __~C' _~?-u~~._. _ +r-_ ~Oo. k- ~.~1-_._ hD~'' Lt1A.~~" _.._ --_.._. _.. ~~ Sa~• ~d JJ "-~` _ _ I~e!M~b~`_ __ j'-1ur ~ane_ ~u~r~. ~ar easti __~r~ 1~~v _ _ .. ___ _ _ _ _ _~ t f ~ 3~ ~~f ~ h~~{~/~ NL~V~'~ 1IL ~W ~. w VV/f/~~ ©/~~/ ~ f t ~/.DOsw ~~ ~` /C ~ ~• ~ r _ _ PP ~_ ~~ _: ~T o~__ ~~/T~/,__ _ _ l~S/ ~ _ fi/~F moo. _ ~~--/0-/3',r __ e..as ~1 aco(N annt.~ -wt< ~~ . _ _ __ _ . _ _ _ -. 1~-~~~ t p~v ~rGl~i~a~f'_ _ /I. 33 _ ~w~s~ _ n~'de~u~h/c~ _ _ _ _ _ __ o - 0?0 ~ l~Gr'i ZsrJ __- -__ _-_ . __ _ __ _ _ -- _ ____ ~ _ .~3.7~ ____ ~ ~- ~_ _ /7QA'1B(!~ _ /ou~S`u~, _ _ ~urcr, ~. _ -- ~ISD~oa _ _ ~3. ~e~~~n_~P~^s V"~l~SS ---.~_ ~r d/'ok~i?~~~~K l,~J.~~scs1 ,{mr Sa[~e ___ 4~df.ov __ a . ~P.I`% Zdr1 _ _ _ _ _ _ s= s-~. ~~ - ~~. ~ P/'f~i/) ~D/'K d'ri~C/' <6 ~Ql~(C lt~J C~°G~~ t~ • _ _l~l~ 1'r~ /p/XD ~'c T~''o~t _ ~tott.~ So f zt l~ ~C S tC .Sr'. ~s p laU ~7 ~~L _ _ _ _ _ _ _ _ _ . _ ~/6Eoz_ _ __ ~, l~er. zo~j _ _ _ _ _ __ 7~• ~~ 2Q } I __ ; i _ _ -, _ i ~_ _ __ i __ i i _ j _ _ ~. ~ _ _ _ _ j _ i S/rn~ /~~GIIY'y ~~!'/7GG!' _~jf" Ya!!~(.LLAOi?s ~~Ft~'_~/J/~~f/.SQ~ _ __ _ . __ _ _ __ _ _ __ _. __ _. _ - _ . _ __ _ __ _ _ _ - - _ _ _ _ _ _ _ - _ _ /~~/: 00 _ . __ _ _ _ Four Generations.-. Celebrnling Life, Honoring Traditions BOYD L. MYERS, JR., Supervisor RS 37 E. MAIN STREET MECHANICSBURC~ PA 17055 ~i,!neral ~~me, ~nC (717) 7fi6-3421 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items tha[ you selected or that are required. If we are reyuired by law or by a cemetery or crematory to use any items, we will explain in writing below. if you selected a funeral tha ay require embalmin uch as a fu f with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if e`le~ct~a`~ ngement h as a die t crem~ibr to edi to burial. If we charged for embalming, we will explain why_be~ w. For the Service of ~v"" 11 -T Date of Deat~ ~~~~ Charge to: f~ ~- Address ~~ ~~ Ctt~ State a Name A. CHARGE FOR SERVICES SELECTED: 1. PROFF.SStONAL SERVICES ^-~ Services of Funeral DirectortStaff .. 8 ~"`-"' Embalming .. ........ .. ..... b -~'~ Other prepara[ion of body f ~ ~ ........... . SUB-TOTAL OF PROFESSIONAL SERVICES......... Al f 2. FACiLi"TIES AND SERVICES Use of facilities and services for f,.--}~ Lw viewing (Visitation/Wake)....... . Use of facilities and services S ~ for funeral ceremony ....... ~ Use of facilities and services for Memorial Service ........ f~ Usr of equipment and services f for graveside service .. Other use of facilities SUB-TOTAL OF FACILITIES/EQUIPME NT . .. .... A2 f w 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Ho` Local .......................... f Hearse (Casket Coach) f Loca{ ........ ...... .. ... Limousine ~~ ~ Local. .. ...... aJ~-°e~= Family car Local.... .. f Flower car or floral disposition Local ......... ....... g- Lead car! er y car `~ ~ ~~ ~~ ~ .. Local ... ~'' ~ f Car for pallbearers Local ................. .. ... . . f Out of town transportation .. .. .. . f a t Other clothing f f _ Cremation urn .. .. ... .......... f (Description) - OTHER f - $ _ TOTAL MERCHANDISE SELECTED .................. B f ~~ C. SPECIAL CHARGES: Forwarding of remains to f (Funeral Home) Receiving of remains from f (Funeral Home} Immediate Burial ....... ....:.... f Direc[ Cremation ................. f f _~- ~... SUB-TOTAL OE SPECIAL CHARGES ................ C f D. CASH ADVANCED ~V Opening Grave .......... f Cemetery Equipment ........ ... f Lot and Deed .................... f Newspaper Notices-Local .........E '7 u :~ Newspaper Notices-Out-of-town .... f -~ Telephone & Telegrams ........... f - Airfare f _ Clergy/Mass Offering ..... ........ f_1~.'~-~`~ Pallbearers .. .. ........... f - Certified Copies of the De t,,h ~ ~~ Certificate ~}.L ~f `' ...... f ~- Police Escort ...... ........... f _ Flowers .... ...... ............ f _ Vault Service Charge ..... ........ f _ f _ f_ _ f _ f _ f _ f - ;~6i. ~ SUB-TOTAL OF ADVANCES ....................... D f SUB-TOTAL OF AUTOMOTIVE EQUIPMENT........ A3 Y"`'~ We charge you for our services in obtaining TOTAL OF PROFESSIONAL SERVICES, (specify cash advances that are marked-up) FACILITIES AND AUTOMOTIVE ~, ~/Gf~"~ ~, '~r~ EQUIPMENT .... ....... A f (~{ 73 v. B. CHARGE FOR MERCHANDISE SELECTED: Casket ... ................ f C U (Description) Other Receptacle ........ .. ... f (Description) -~-~- Outer burial container .... .. f ~-1.' (Description) Acknowledgement cards ..... :... . Regisrer book(s) ...... .. .. .. .. S Memory folders ....... ..... . . Prayer cards ............ .. ..... f Temporary grave marker .. .... f Burial clothing . .. .. f I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of [his Statemen[ of Funeral Goods and Services Selected. 1 represent that 1 have sufficient funds available for payment of the cash price for the goods and services selected. i aiso agree to make payment of f within da}'s. I agree to he jointly and severally liable with am~one else who signs below. A late charge of ~ per month amounting to per year will be applied to the unpaid balance beginning days from the date of [his agreement. I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts 1 owe under this agreement. Those costs may include attorneys' fees, tour[ costs and other costs. Any additional services or merchandise ordered or requested after the ate of this agreement will be considered part of this agreement and the cost thereof will be reflected nn the final biH or statement. (Seal) __ (Purchasefl / ~ ~~ SUMMARY OF CHARGES A . Professional Services, Facilities and Equipmen[, and Automotive ,e„I Equipmen[ .. ................. f ~~S B . Merchandise ..................... f _~~ ~ C . Special Charges .................. f r" D. Cash Advances .................. f~~ `~ ~ c;s~. t,,~ TOTAL OF ALL SECTIONS ........................ S (t J ~ PAID AT TIME OF OR PRIOR TO ~ ARRANGEMENTS ..... .......................... 8 .- ~/ BALANCE DUE ................... .............. 5~~~ 1- R ON FOR EMBA I G r_ ~y~S'T-" ~ ~~ f' w~'~,-t ]f any law, cem ery, or crematory requirements have required the purcha of any of the items listed above the law or requirement is explained below. (Seal r '-' ~ (Purchaser) [tensed Funera D' ector RITE -Funeral Dueceor GLt.OW -Customtt ( r ~'~ ('~ ^ (.~.~ .mil ~-l<y/~o ~~~ E/mar Mur Auctions /arc. ~ ~ www.richarralmuriyauctionee~. cony License No. AU-649-L (717) 790-2240 (717) 626-2636 14 North Walnut St. 2"d Floor -- Mechanicsburg, Pa. 17055 June 10, 2010 Estate of Ruth Smith 267 Salem Church Road JTH P. SMITH ARY JANE HENRY EXEC i7 SALEM CHURCH RD. ECHANICSBURG, PA 17050-2874 ' 'acy to the -rder of ,;~ Citizens Bank 105 t ~-7615/360 ~ ~ 1 ~~ ~ ~~ r~o `1 ~, ~--- / S ~ ~ ~ ~ Sec urily ` /~~ ` l -I 7-~~l'_ Features ll eS i .~'f-~ i~'~"\A ~ rF~iY~btH'k r/ ~Z~ o..r-~~ ~1Yf)LLU~~"$ = Back is on II• II' 1' 1' 11~ "`~"'~"'~"'~ 000 L05 .036076L50. 622463286 ~ .~-~.a.,-~, ,~ - i r -i Total Cost: $159.00 ..cc.ell vl<Y/!~/r/ E/mer Murry Auctions, /nc. www.richardmurryauctioneer, com License No. AU-649-L (717) 790-2240 (717) 626-2636 14 North Walnut St. 2"d Floor -- Mechanicsburg, Pa. 17055 June 10, 2010 Estate of Ruth Smith 267 Salem Church Road Mechanicsburg, Pa. 17050 Reference: Personal Property Appraisal Compiling Subject matter: $125.00 Final copy and typing: $25.00 $150.00 Sales Tax 6% $9.00 Total Cost: $159.00 - Vlh~'~ t ~~ufP a '° ,~ ~ s< a - ~ ~,r~ . ~ a N ~ ~ m ~ \. ~'' r ~~ a ~~~v vc = + v ~ ,D ~ ~ m Z r ~ ~ -~.~ J ~^yn ~ ~~+~V ~~ v r ~' ~' ~' Cp ~, r ~, ""~ N r r~ ~` ~: ~^~„~ ~r W ~~' ~ : ,~' '. ~'i ~+~.~.~ r •,. g ~ N ~ ~ . ~~ ~ ~.r y {/yj ~~~ ' Y S '~~ a ~ w ~~ REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~~ T~ n 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 _ 1. ~1 >t G~'1 Ll ~ ~ ~ Lt/1~ 9~ ~ ~U-eq,S U, r tt~ P ,Lr. Cx.~ ~ fq -~ ~ 11 ~. O D ~. '~2;ir,r~burse~-rttr-ts ~ ,fn ar y 1"a.~ Htr-ry ~r ratio n ~ t s ~. spt~ iw~ C~ ~~r'0~7f"!tG/~G ~~ ~~D Lug .v,/^. !,lJtci^rIC r q-~~. ~ C_ /h,sc. G~oce~; ~s, vf~,,,; ns, ~. ~ a y ?. ~0 3 ~76 . ~ 3 ~Je~sf S~io/'e C'rr~s I 1 ~, so TOTAL (Also enter on line 10, Recapitulation) $ ~0 ~ Jr, 1 (!f more space is needed, insert additional sheets of the same size} WEST SHORE EMS -BLS ~ 205 GRANDVIEW AVE ~~ SUITE 211 ~~~~~ CAMP HILL, PA 17011 Phone #: (800} 367-0512 Federal Tax ID: 23-2463002 ~t~~~~ ~®~.~ EMERGENCI' R9EDICt1L, SERVICES PATIENT NAME: RUTH SMITH INSURANCE: 199597W RUTH SMITH 267 SALEM CHURCH RD MECHANICSBURG, PA 17055 PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: REASON(S) FOR TRANSPORT in- vo>,cE 19610 WCS 199597W NONE 01 /22!2010 05:36 PM HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL 267 SALEM CHURCH RD SHORTNESS OF BREATH DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT Stretcher One Way Transport A0999 1.0 96.06 96.06 Transport Van Mileage A0999 3006.0 3.74 11242.44 Total Charges 11338.50 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Total Credits PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT --a- .-..--.-..r,ur-et r.~ lr/'+v rcLr tl+o~ ntl $11338.50 _ SMITH, RUTH P PATIENT NAME: 19610 PATIENT NUMBER: DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT AMOUNT DUE CALL NUMBER 199597W AMOUNT $ BILLING DATE: 02/04/2010 ENCLOSED E IS N(~T Ct7VFRFn Rv nn~n~reQ~ nn nncn~rn~ `~~ " ~ VISA , ~ ASSISTANCE. y/$,q ~ Mcster~ard'~ - AND ~~I MASTER CARD ACCEPTED WEST SHORE EMS -BLS 205 GRANDVIEW AVE CAMP HILL, PA 17011 11338.50 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~K r~ FILE NUMBER ~!_/~ ^~~~. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ' ~- ~3 ~IE~Y,,e Y ,~,~-l~ y s,~-N~ ~a `~ . /7b5.S a• C~i2o~ Y~ e~s~ ~ E7f2 ~QU~ l>, tom- ~3 /`f0(o /~eCa~? >Ar. , ~a i11,br~`ct!~e, ~ 3q~/9 3. C,~l/.~-,~QL~S S,/~?/Ty Sorg 3 y /o?3oZ0 ~c/f~ Lane, ~rf~iagc, /V1Q (~f~3~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) Y, RUTH P. SMITH, currently of 267 Salem Church Road, Hampden Township, Cumberland County, Pennsylvania being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon as conveniently may be after my decease. 2. A11 the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my three (3) children in equal shares, to Wlt: (1) Mary Jane Henry, currently of Mechanicsburg, PA, (2) Carolyn Cressler, currently of Miami, Florida, {3) Charles Smith, currently of Moblesville, Indiana. 3. Should any of my above-named children die without any issue surviving them, then the share of such deceased above-named child shall not be divided between my other surviving above-named children, but rather their share shall go to any of my surviving grandchildren in equal shares per capita. Should any of my above-named children die with issue surviving, then their share shall go to their issue per stirpes. 4. I nominate, constitute and appoint my said daughter, Mary Jane Henry, to be the Executrix of this my Last Will and Testament. If she should predecease me, or for any other reason fail to qua3ify as such Executrix, I nominate, constitute and appoint the Commonwealth National Bank to be the Executor in her -1- place and stead. I further. direct that neither of them shall be required-;to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. 5. I authorize and empower my personal representative, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized, or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of, or grant options in regard to any or all property of any kind forming a part of my Estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my Estate; to mortgage or pledge any real or personal property forming a part of my Estate, or to join in or secure the partition of same; to compromise any claims or demands of my Bstate against others or of others against my Estate; to make distribution in kind and to cause any share to be composed of cash, property in undivided fractional shares in property different in kind from any other share; and to execute and deliver such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF,-.I have hereunto set my hand and seal this lC~~ day of May, A.D. 1988. (SEAL? Signed, sealed, published and declared by the above-named RUTH P:--. SMITH, 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±w~-f each other', have hereunto subscribed our names as witnesses. -2- • 1 ... ~ I fi - ~J , rl ._- .,~. - _ ~ - - C~~QNWEALTH'~F PENNS~LVANhg: . SS. ~cOUNTY of CUMBERLAND- I, RUTH P. SMITH, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and _ executed the-. instrument as my Last Will; that I signed it willingly and that I; agned it as my free and voluntary act for - - -• the' purposes therein expressed. Sworn or affirmed to and acknowledged before me by the above Testatrix this ~b ~ day of ~~/ A.D. 1988. ~ ~ ~~~ ~~ Notary Public ,~ ~,• - ~_ 1 ~~ My t;o~~ii°~I~so:~ ,~::r'r,a 3:~aa 2U, l9$8 COMMONWEALTH 4F PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND We , Jane B. Shields and Elizabeth A. Ctiirll , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw RUTH P. SMITH, Testatrix, sign and execute the instrument as her Last Will; that RUTH P. SMITH executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of RUTH P. SMITH, Testatrix, signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me this 10 day of /~Q., A.D. 1988. ~/~ ~ ~ ~~'~ ~" Notary Public rlaT,ar,•i r~•;~tic Mechanicsbur_, Pn ;;-.:~o~r'aud County My Commission Expue; lu~ta Z(1, 1988