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01-26-11 (2)
150561D148 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individua{ Taxes Po Box Zsosol INHERITANCE TAX RETURN 2 ], 1, 0 0 5 0 D Harrisburg, PA 1~12s-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 463-10-2090 0502201,0 092119],6 Decedent's Last Name Suffix Decedent's First Name M I CONROY RUTH B (tf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82} 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTI~I MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LINDA J- LUNDBERG 717-730-2265 First line of address PNC BANK, N•A. Second line of address P-O- BOX 308 City or Post Office CAMP HILL State ZIP Code PA 1,7001,0308 ~~ _ ~'~ ~; __~ =-= ;~ Correspondent's e-mail address: LINDA - L U N D B E R G tt7 P N C• C O M REGISTER OF WILLS USE ONLY t~ .:. . '_ ~ ,;--~ -._, _`` i -?-~ ~ - .f~: _: a-- i r, ~,` I~~ i - ;, ..., 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 pens nal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSI F R F NG DATE PNC BANK, N • A • BY : ~ ~ ADDRESS \, \ P-0. BOX 308 CAMP HILL, PA 1701,1-D3D8 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 ],5D561,01,48 1,SD561,01,48 9M4647 4.000 J 15D561D248 REV-1500 EX Decedent's Social Security Number 463-],D-2D9D Decedent's Name C O N R O Y RUTH B RECAPITULATION 1. Real Estate (Schedule A) 1. 1, 3 5 , D D D - D D 2. Stocks and Bonds (Schedule B} . 2. 5 51, 6 5 D • 3 7 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. D . D D 4. Mortgages and Notes Receivable (Schedule D) _ 4. D • D D 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 2 6 4 , 4 7 D • 17 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested , g_ D - D D 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 4 3 ,1, 5 8 •5 9 8. Total Gross Assets (total Lines 1 through 7) g, 9 9 4 , 2 7 9 • ], 3 9. Funeral Expenses and Administrative Costs (Schedule H}, _ ,g. 8 7 , 4 37.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I} _ 10. ], -, 4 D 2 • 9 3 11. Total Deductions {total Lines 9 and 10) . _ _ 11. 8 8 , 8 4 D - 4 3 12. Net Value of Estate (Line 8 minus Line 11) , 12. 9 D 5 , 4 3 8 -7 D 13. Charitable and Governmental Bequests/Sec 9113 Trusts foc which an election to tax has not been made (Schedule J) , _ . 13. ], 4 , 3 8 6. 2 D 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 8 91, 0 5 2.5 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 1 4t~xable at lineal rate X .0 - D- D Q 1 g• D- D D 17. Amount of Line 14 taxable at sibling rate X .12 D , ~ ~ 17 [] . D [] 18. Amount of Line 14 taxable at collateral rateX.15 89L, D52 • 48 18. ],33, 657.87 19. TAX DUE 19. ],33, 657.87 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1,5D561,D248 1,5D561,D248 9M4648 4 D00 REV-1500 EX Page 3 File Number »_ -I_n n inn DECEDENTS NAME ONROY RUTH B STREET ADDRESS UM ER AND CITY STATE ZIP CAMP HILL PA 7,7[]1],- Tax Payments and Credits: 1, Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ], 1, 8 ,1 ~ 0.0 6 13. Discount 6 , 215.8 ~ 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 1,33, 657.87 124,31,5.86 (3) (]-~~ ~-~~ (5) 9,342-D1 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 C~ 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; ~ r~ `~ 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? . - ^ C~ L 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 ® C~ L 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. X9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. X9116 (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 Jufy 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. X9116{a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2} [72 P.S. ~9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. ~9116(a}(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + 8) (2) sn~as~ ~ 2.000 REV-1502 EX+ (01-1D) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Ruth B . Conrov 21 10 0500 All real property awned 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 that is jointly-owned with right of survivorship must be disclosed on Schedule F. ywaESS z.ooo If more space is needed, use additional sheets of paper of the same size. REV-15D3 EX + (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Ruth B . Conrov 21 10 0500 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (TEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 30, 000 Par U.S.A. Savings Bonds Series EE 76,176.00 Due 11/01/12 @253.9200 2 60,000 Par U.S.A. Savings Bonds Series EE 80,472.00 Due 1/01/21 @134.1200 3 2,000 Par U.S.A. Savings Bonds Series HH 2,000.00 Due 02/01/2019 @100.00 4 4,000 Par U.S.A. Savings Bonds Series HH 4,000.00 Due 09/01/2021 @100.00 5 409.365 Shares Capital Income Builders Fd Cl C Mutual Funds, Money Market Fds CUSIP: 140193301 19,608.58 6 1,278 Shares Exxon Mobil Corp CUSIP: 302316102 87,044.58 7 8,120.508 Shares Franklin Custodian Fds Inc Util Ser Cl A Mutual Funds, Money Market Fds CUSIP: 353496409 89,731.61 8 8,693.925 Shares Nuveen Mun Tr Insd Mun Bd B CUSIP: 67065Q806 90,242.94 9 2,010.474 Shares Tax Exempt Bd Fd Amer Inc C1 C Mutual Funds, Money Market Fds CUSIP: 876902305 24,447.36 Total from continuation schedules 77,927.30 TOTAL (Also enter on line 2, Recapitulation) $ __ 551 , 65.0 . 37 31N4696 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Ruth B. Conroy Schedule B (Page 2) Item No. Description 10 2,645.157 Shares Virtus Equity Tr Virtue Balan A CUSIP: 927913855 11 3,188.022 Shares Virtus Equity Tr Virtus Strg OW A 12 713.618 Shares Washington Mutual Invs Fd Inc C1 C 21 l0 0500 Value at Date of Death 32,879.30 26,779.38 18,268.62 Total (Carry forward to main schedule) 77,927.30 REV-1508 EX + (696) COMMONWEALTH OF PENNSYLVANIA INHERITANCE 7AX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Ruth B. Conroy 21 10 0500 Include the proceeds of litigation and the date the proceeds were recei~d by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Allstate Annuity #GA16865925 107,$17.00 2 PNC Bank checking account #xxxxxx2807 30,661.56 Interest accrued to 5/2/2010 1.10 3 Cash - JJB Hillard, Lyons Brokerage Account 90.40 4 Sovereign Bank - Certificates of Deposits 89,743.39 5 Cash found in decedent's home 449.11 6 Harmans Coins - Proceeds on sale of coins 80.00 7 Refund - 39.12 Lifeline subscription, Cancellation 8 Refund - 6.87 Woman's Day Magazine, Refund of subscription 9 Refund - 106.15 Cancellation of Lawn Doctor of Camp Hill service acct. #7373758 10 Refund - 161.75 The Patriot-News, Cancellation of newspaper subscription 11 Cordier Antiques - gross proceeds from auction of personal property 12,080.00 12 Refund - 9.54 Home Depot, Proceeds on store credit 13 Refund - 20.00 Karns Market - proceeds on surrendered gift card 14 Refund - 374.68 State Farm Fire ~ Casualty Co Policy #381227913 re refund homeowners insurance 15 Hilliard (JJB) Lyons (WL) Inc. - refund on termination fee for brokerage a/c #17099485 175.00 16 Refund - 98.46 Total from continuation schedules _ 22,556.04 3VV46AD 1 000 TOTAL (Also enter on line 5 Recap. (If more space is needed, insert additional sheets of the same size) 264,470.17 Estate of: Ruth B. Conroy 21 10 0500 Schedule E (Page 2} Item Value at Date No. Description of Death State Farm auto insurance refund 17 Kemper Investors Life Insurance Company Annuity 22,556.04 Total (Carry forward to main schedule} 22,556.Q4 REV-1509 IX+ (01-10) pennsyfvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Ruth B. Conroy 21 10 0500 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNING JOINTTENANT(S) NAAAE(S) ADDRESS RELATIONSHI?TO DECEDB~fT JOINTLY OWNED PROPERTY: ~,~ NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCR~TION OF PROP9~lY INCLUDE NAME aF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER oR SIMLAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °~ ~ DECEDENT'S INTB~EST DATE OF DEATH VALUE OF DECEDEt~lT'S A~frEf2EST None TOTAL (Also enter on Line 6, Recapitulation) $ 0.00 9VJ46AE 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE G pen nsylvan is DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ruth B. Conro 21 10 0500 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. {TEM NUMBE DESCRIPTION OF PROPERTY 1NCLIAE Tre NOME OF TFE'iRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND T1-E DATE OF TRAns~. ATTADFiAC.OPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION F APPLICABLE TAXABLE VALUE 1. Western National Life Annuity Contract XP221783 43,158.59 100.0000 0.00 43,158.59 ~, TOTAL (Also enter on line 7, Recapitulation} $ 43,158.59 If more space is needed, use additional sheets of paper of the same size. 9\~~~46AF 2.000 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ruth B. Conroy 21 10 0500 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Daniel McGraw - reimburse funeral luncheon 347,53 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) pNC Bank , N . A . Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant N/A Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 PPL Electric Utilities re service Acct #75110-7200 2 Myers-Harner Funeral Home, Inc. - fee for additional death certificates Total from continuation schedules . ____ ___ _ TOTAL (Also enter on Line 9 Recapitulation) ~ $ 9L1r4s;;V 2 Q00 If more space is needed, use additional sheets of paper of the same size. 3,455.00 39,176.00 31,059.00 663.50 196.99 72.00 12,467.48 87,437.50 Estate of: Ruth B. Conroy 21 10 0500 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Myers-Hamer Funeral Home, Inc. - fee for additional death certificates 1,330.00 3 Gate of Heaven Cemetery - engraving fee 125.00 4 Good Shepherd Parish - funeral mass honorarium 2,000.00 Total (Carry forward to main schedule} 3,455.00 Estate of: Ruth B. Conroy 21 10 0500 Schedule H Part 7 (Page 2) 3 Johanna Brown reimburse for payment to Kurt Krusen, DVM re euthanasia of cat 173.00 4 UGI Utilities Inc 445.76 5 Cordier Antiques - commission labor and advertising re sale of personal property 5,341.31 6 Pennsylvania American Water Services 72.38 7 SES Insurance Brokerage Services, Inc. 244.00 8 Placey & Wright Attorney for Estate 239.96 reimburse Legal advertising paid on behalf of Estate 9 Hilliard (JJB) Llyons (WL) Inc - fee charged by prior trustee/custodian a/c #17099485 84.57 10 Register of Wills 34.00 - fees for short certificate, inventory and PA Inheritance tax return filing 11 PNC Bank, N.A. - fee for real estate appraisal 355.00 12 Settlement apportionment charges per 10/14/10 HUD-1 Statement Commission paid $4,050.00 Tax certification, recording deed, etc. 1,427.50 5,477.50 Total (Carry forward to main schedule} 12,467.48 ' REV-1512 EX+ (12-OB) Pennsylvania DEPARTNIENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8~ LIENS ESTATE OF FILE NUMBER Ruth B. Conroy 21 10 0500 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46F.H 2.000 1f more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Ruth B. Conro 21 10 0500 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 [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Johanna E. Brown 476 Woodcrest Drive Mechanicsburg, PA 17050 General Bequests: 2,000.00 Cousin 2,000.00 2 Frances M. Stover 1723 New Bloomfield Road New Bloomfield, PA 17068 General Bequests: 2,000.00 Friend 2,000.00 3 Mary C. McGraw (DECEASED 4/29/98) Sister-in-law 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. If more space is needed, use additional sheets of paper of the same size. 91~~46A1 2.000 Estate of: Ruth B. Conroy Schedule J Part 1 (Page 2) 21 10 0500 Item No. Description Relation Amount 4 John M. McGraw 121 Nicks Way Syracuse, NY 13209 Beneficiary named on Western National Life Insurance Annuity Contract #xxxP221783: 14,386.19 One Fifth of Residue per Item Sixth (B) of last Will and Testament: 171,656.02 Nephew 186,042.21 5 Daniel P . McGraw 6 Feathery Circle Penfield, NY 14526 Beneficiary named on Western National Life Insurance Annuity Contract #xxxP221783: 14,386.19 One Fifth of Residue per Item Sixth (B) of last Will and Testament: 171,656.02 Nephew 186,042.21 6 Philip R. Fogle 4850 E. Trailwood Way Springfield, MO 65809-4320 One Fifth of Residue per Item Sixth (B) of last Will and Testament: 171,656.02 Nephew 171,656.02 7 Patricia J. Leong 2555 Karamy Court Colorado Springs, CO 80919 One Fifth of Residue per Item Sixth (B) of last Will and Testament: 171,656.02 Niece 171,656.02 Estate of: Ruth B. Conroy Schedule J Part 1 (Page 3) Item No. Description 8 William A. ~ Linda Hilbert 4921 S 310th Place Auburn, WA 98001-2650 One Fifth of Residue per Item Sixth (B) of last Will and Testament: 171,656.02 Nephew Relation 21 10 0500 Amount 171,656.02 Estate of: Ruth B. Conroy 21 10 0500 Schedule J Part 2B (Page 1) Item No. Description Amount 1 Good Shepherd Catholic Church-Camp Hill 3435 Trindle Road Camp Hill, PA 17011 Beneficiary named on Western National Life Insurance Annuity Contract xxxP221783: 14,386.20 14,386.20 LAST WILL AND TESTAMENT OF RDTH B . COI~FROY I, RUTH B. CONROY, now of the Borough of Camp Hill, Cumber- land County, Pennsylvania, declare this to be my Last Will and Testament and rereby revoke all prior Wills and Codicils made by me. ITEM I. I direct that all of my just debts and funeral expenses, including the cost of my gravemarker, if any, shall be paid for as soon as practical after my decease as a part of the administrative expenses of my estate. ITEM II. I direct my personal representative arrange for and expend the sum of Two Thousand ($2,000.00) Dollars for masses for the repose of the soul of my late husband, JOHN M. CONROY, and myself . ITEM III. I intend to attach hereto a list of personal property that I give to the persons designated in such list and direct that distribution of those items be made accordingly. ITEM IV. I give the sum of Two Thousand ($2,000.00) Dollars to my late husband's second cousin, JOHANNA BROWN. ITEM V. I give the sum of Two Thousand ($2,000.00) Dollars to my friend, FRAN STOVER. ITEM VI. I give and devise all of the rest, residue and remainder of my estate of every nature and wherever situate in equal shares, share and share alike, as follows: A. My sister-in-law, MARY C. McGRAW. B. My late husband's nephew, JOHN M. McGRAW, or his issue, per stirpes. ._ C. My late husband's nephew, DANIEL P. McCRAW, or his issue, per stirpes. D. My nephew, DR. PHILIP R. FOGLE, or his issue, per stirpes. E. My niece, PATRICIA J. (FOGLE) LEONG, or her issue, per stirpes. ~~ ~ ~~ Ruth B. Conroy F. My nephew, WILLIAM A. HILBERT, JR and his wife, LINDA HILBERT, or the survivor of them. ITEM VII. If any income or principal shall be payable to any person who shall be minor or who shall be incapacitated for any reason, my personal representative as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity, without the appointment of any guardian or committee or any authority of court. and shall be entitled to make direct application hereunder or to make application by payment thereof to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Gifts to Minors Act. Any remaining income and principal to which such person shall be entitled shall be paid and distributed to such person upon the termination of minority or incapacity. ITEM VIII. I apgoint PNC BANK, NATIONAL ASSOCIATION, Ca~~np Hill, Pennsylvania, Executor of this my Last Will and Testament. No bond shall be required by my personal representative in any jurisdiction. ITEM IX. In addition to the powers given to my Personal Representative(s) by operation of law, the following powers are herein given to him to be exercised by him at his sole discretion. A. To retain any property received and to invest any funds held by him during the term of my Personal Representative's service in any stocks, bonds, notes or other securities or property, real or personal, within the limitations of the law. B, To continue the operation of any business in which I am engaged or in which I have an interest at the time of my death for the term of his service as he deems advisable, with the power to borrow money and to pledge the assets of the business and to do all other acts which I, in my lifetime, could have done, or to delegate such powers to a partner, manager or employee without liability for any loss occurring therein. ` Ruth B. Conroy - 2 - C. To hold investments in the name of a nominee, exercise and dispose of warrants. D. To sell or otherwise dispose of any property, real or personal, at any time forming a part of my estate, during the term of his service, for cash, property or credit, in such manner and on such terms as my Personal Representative deems advisable within the limitations of the law. E. To manage, operate, repair, improve, mortgage or lease for any term any real estate at any time held or owned by my Personal Representative. F. In general, to exercise all powers in the management and settlement of my estate which any individual could exercise in the management of similar property owned in his own right upon such terms and conditions as my Personal Representative deems best, and to execute and deliver all instruments and to do all acts which he may deem necessary or proper to carry out the functions of a Personal Representative. G. To engage in litigation and compromise, arbitrate or abandon claims and property. H. No interest of any beneficiary of my estate shall be subject to anticipation or to pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his or her interest, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of the Personal Representative hereunder for the liability of such beneficiary, whether such liability arises from his or her debts, contracts, torts or other agreements of any type. IN WITNESS WHEREOF, I have hereunto set my hand and seal thi~ ~ .i1 ~ day of ~~-!~ ~.J~~ 1993 . ~Z/~/' uth B. Conroy The preceding instrument, consisting of this and two other typewritten pages, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by Ruth B. - 3 - Conroy, the testatrix therein named, as and for her last Will, in the presence of us, who, at her request, in her presence and in the pres.- ce o ach other, subscribed our names as witnesses hereto. ir''' ~~~(~ y ~~- ~. ~ z,~ z~ ,~,~. X16 p ~ ~~ - 4 - RIITH B. CONROY List of Gifts of Personal Property I give the following items of personal property to the persons listed. ITEM Dated: Ruth B. Conroy ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN I, Ruth B. Conroy , 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 signed it as my free and voluntary act for the purposes therein expressed. Ruth B. Conroy Sworn or affirmed to and acknowledged before me, by Rut/n~h B. Conroy , testatrix, this _ - ,3 rc± day of X ).tI)~1 i~l ~l ~ - 199 3 n~~snavTm COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF DAUPHIN W e , i C~'l a,r ~. T ~ C~ C.P~ ~/ n ~ !ti/ ~ C~GZ ~ ~(,cJ {~ r~ 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 testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge the testatrix was at that time 18 or more years of age. ~f ound.-- 'n and under no constraint or undue influence. %" ~~ ~ \ i~ U~c.l~'-C~ ~ , . Sworn to and subscribed before me this Z.3~~ day SD f u.l No ary Public OMB Igo. 2iU2-(:1265 ~y'' U e~f ';~ .~ k;~ ,„..,d`B. TYYl; Ufa LUAN A. SETTLEII~NT STATEMENT (HUD-1) 1. ^ FHA 2. CI kl~s 3. ~ coNV. uNrNS. ~'''`~`""; 4. ~, VA 5. ^ CONV. INS. 3 ~ 6. FILE 1~lUMBER: 7. LOAN NUMBL-.R ~. *~ 1U-00216-ALT OODUU3380 •':th : ~~' 8. MOkTGAGE INS. CASE NO.: T C. NOTE: This form is furnished to give you a statement of actual scttlcritent costs. Amounts paid to and by the settlement agent are shown. Items %~ -narked "(p.o.e.)" were paid outside the closing they are shown here for informational purposes and arc not included in the totals. D. NAME & ADDRESS William F. Busch and Mary Ann ICleinfelter OP BORROWER: E. NAME ~ ADDRESS PNC Bank, NA, Executor of The Estate of Ruth B. Conroy OF SELLER: ___ F. NAME & ADDRESS Orrstown Bank OF LENDER 2695 Philadelphia Avt:nue Chambersbu~ PA 17201 G PROPERLY LOCATION: 1921 Dickinson Avenue Camp Hill, PA 17011 H. SETTLEMENTT AGENT: Assured Land Transfers, Inc. 30I Market Street, Lemoyne, PA 17043 (717) 761-4720 PLACE OF SETTLEMENT' Michael L Bans, Esquire 429 South 18th Street, Camp Hi11 PA 170111717) 761-4720 L SETTLEMENT DATE: 10!14/2010 100. Gross Amount Due From Borrower: 400. Gross Amount Due To Seller: 101. Contract salts 'ce 135 000.00 401. Contract sales rice 135 000.00 102. Personal erty 402. Personal ro y 103. Settlement charges to borrower: (line 1400 S 024.82 403. 104. 404. l OS. 405. Adjustments For Items Paid B Seller In Advan ce: Adjustments For Items Paid B Seller In Adv ancer 106. City/town taxers to 406. City/town taxes to 107. County taxes ~ 10/14/10 to 12/31/10 ]76.13 407. Coun taxes /0/14/10 w 1?/31/10 176,13 ]O8. Assessments to 408. Assessments to 109. Sewer 10/11/12 10/14/2010 to 12/31/2010 62.77 409. Sewer 10!11/121011412010 to 12!3112010 b2.77 110. School Taxes 10/] 4/ZOI O to 6/30!2011 1 374.75 410. School Taxes 10/14/2010 to 6/30/2011 1374.75 111. 411. 112. 412. 113. 413. 114. 414. 115. 415. 116. 416. 130. Gross Amount Due From Borrower: 141,638.4 420. Gross Amount Due To Seller: 136,613.65 200. 7 is Pa'd In Be rrower: ~ 00. c 'ons In A o t Due T e 201. alit or earnest money 15 000.00 501. Excess de osit see instructions) 202. Princi 1 amount of new loans 100 000.00 502. Settlement char es to seller (line 1400 5 477.50 203. Existin ]oan(s taken subject to 503. Existing loans taken subject to 204. 504. Payoff 1st M . Ln. 205.. 505. Payoff 2nd Mtg. Ln. 206. 506. D osit To Seller 15 000.00 207. 507. 208. 508. 209. 509. - Adjustments For Items Unpaid By Seller: .210. City/town taxes to Adjustments For Items Unpaid By Setter: 510. City/town taxes to 211. Coun taxes to 51 1. County taxes to 212. Assessments to 5 ! 2. A ;s-ssments to _ 213. 513. 214. 514. 215. 515. 216. 516. 217. SI7. 218. 518. 219. 519. 220. Total Paid BylFor Borrower: 115,000.00 520. Total Reductions In Amount Due Seller: 20,477.50 300. ash At ettle a Fro rrovver: Cash At ettlement Fro ller: 301. Gross amount due from borrower {line 120) 141 638.47 601. Gross amount due to seller line 420) 136 613.65 302. Less arnaunt aid by/for borrower (line 220 115,000.00 6Q2. Less reductions in amount due seller (lint 520 20 477.50 303. Casa (~FRONf) +L._11O) Borrower: 2b,b38.47 603. Cash Q~}TO) (FROM) Seller: 116,136.15 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, revtewmg, and reporting the data. 7 tits agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. X X X - - _ -- X - -- _ - - Previous editions are obsolete Page 1 of 4 HUD-1 L• SF,TTLEMENT ChIARGES Escrow ]0-00216-ALT 700. Total Real Estate J3roker Fees Paid From Borro~~-er's Yaid From Seller's Divi ion of _ mmission li e 7 0 As Follows: Funds Funds - At At to Settlement Settlement 703. Commis i aid at settlemen 4.05. 0 704. 801. ur ri anon c e o Bank 1 3 0: from . Yo c or c for the i " t e t rate chos a 8 our ad' c do c es Orrs4own ank I 0 I 8 e 1 • als Inc. ~ # 50 . I 80 r c ort t v' 2. S I 806. T e 'ce t ~ L $07. Flood certification (from GFE #3) I I a~ et •ce ] ee To: ank 75.0 o ~ c tion a Irmo •s 0 810. I 811. I 82 1. 84 I 81 I I 817. 818. 819. r 1. 1. Dail~~ int c es 10 to 11/ 1/2 0 1 1 da ,4 2. ort ce rem• or m . from F { 03. H me w er's ins ranee for ] i11vilIe Mutual Ins. O B 1 . • o E #1 904 F] d ' ranee r r 906. 1 c s• 'f ow account #g 002. H er's in ce 0 months 0.00 er I 1003. Mortg.~pe insurance 0 months Ca $ 0 00 per month { 11004. City nronerty taxes o months n $ 0 00 per month I I { ] 005. County property taxes 0 months (7a $ 0.00 per month $0.00 I I { 1006. Annual assessments 0 month n $ 0 00 Rer month I { I _1007. Flood insurance 0 months (al $ 0 00 Qer month I { I 11008 Schoo] Tax Reserves 0 months Cad $ 0 00 per month $0 00' I I { . A e e dustmen 0 1010. 1101. i t ices a title • su c fro I 1102. ement or c ee 03. Owner's title ins red an Inc. B •c .ate 1 • 11 4. a der's ti 1 ~ ce d Tr f c. asic Rate B58.75 0.0 I 110. • der's is 't .00 I 11 ~ er's titl 1107. Amt's portion of the total title insurance premium $276.25 Assured Land Transfers, Inc. 1108. Underwriter's portion of the total title insurance premium $48.75 First American Title Insurance Company • I1 vAmi t an i s e Inc. 8.50 . Wile Fee to Assured d Transf 20.00 1 I 1 lectroni u ent Feet red ers Inc. .00 ~ 2. darsem is 0 300 0 t sured L fers Inc. 150.00 __ I 1113. Closin¢ ervice Letter * • st enc~ 'r+ ara. ce 7S. 1 i 114. Notary Fee to Cash $10.00 I O1. G v t re rd • c fr 1 0 1202. Deed 62.00 o e 96.00 Release 0.00 1 r fer es fr # 1 i / 0.00 a e 0. 20 fate t stain s eed ~ Mo a 0.00 0 1 1207. Ol. R uired servic tha on can sho o FE I 1302. Survey to { { 11303 Pest inspection to I I -~ 1304. ax erhficatron Reirnbursement to Johnson Duffle Stewart 8c Weidner I i 1305. Sewer 10/1 1/12 to Camp Hill Borough I I 1306. I _ 5.00 7~.SOI { 113 0 7 . i ---~ ~ ' " " ~ I 1400" Tntal SettiPmen t Charge (Enter on line 103. SectzoR J-and -line 502. Section K) I 5 024 8~I 5.477.SOI Previous editions are obsolete Page 2 of4 HtJD-i Coma: rison of Good Faith Estimate (GFE) and Hi1D-l Char es Good faith Estimate HUD-1 , IiUD-1 Line Number Chas That~annot Incr~.~e __ _ ~ _ -- - Our on nation charge 7 `Ol ~ L_1,3~0_QQ_ ~_ 1 350.00 Your credit or charge (Q.oints} for the ~ecific interest rate chosen ff 802 ___~ L I # 8(}3 _~ I Your adjusted origination charges 1.350.00 . t_____l .00 _ Transfer taxes #I203 _ ~ ~ 1 350.00 I 1,350.00 I CharQ a To 1 Cannot Increase More Than 10° Gopd F8i imate H[JD-1 ove m nt rec in chaz es #120 ~ ] 95.00 - 158.00 raj 4 4 -00. e~ ort 805 2 . 12.1 Tax Serv'~,e Fc # 80 ood ' ' ~ Fee 0.00 # ' I I Total ~ 708.66 755.15 I I Increase b~t~reen_GF~ and Ii -1 Charges I $ 46.49 or 6.5603 %I ar n Chan a Gaod ai sH ate - lnitial de our cr unt #1001 ' intere char a 13.1400 !da 2 2 ? .4~ Ho s ' urance I 720.00 ~ 1 . Title 'ces d 's "tle " u ce 1 0.00. 5 er i e insurance ~,~ .0 7 . l # 1 I - ~- L # f # I T.nnn Tnrr*oc Your initial loan amount is $ 100,000.00 Your loan tens is 30 years Your initial interest rate is 4.750000 Your initial monthly amount owed for prncipal, interest, and $ 521.65 includes and any mortgage insurance is ^X Principal Q Interest ^~ Mortgage Insurance Can your interest rate rise? ~] No. ^ Yes, it can rise to a maximum of %. The first change will be on gad can change again every after ..Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? ^X No. ^ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly ~ No. ^ Yes, the first increase can be on and the monthly amount amount owed for principal, interest, and mortgage insurance rise? owed can rise to $ Tht maximum it can ever rise to is $ . Does your loan have a prepayment penalty? (X No. ^ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment'. ^X No. ^ Yes, you have a balloon payment of $ due in years on Total monthly amount owed including escrow account payments [~ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ^ You have an additional monthly escrow payment of $ that results in a tots[ initial monthly amount owed of S . 'This includes principal, interest, any mortgage insurance and any items checked below: ^ Property taxes [~ Homeowner's insurance 'r: ^ Flood Insurance ^ ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. X X Previous editions are obsolete Page 3 of4 t1UD- ] SELLER'S AND/OR BORROWETt'S STATEMENT Escrow: 1 U-UU2l 5-ALT I have carefully reviewed the HUD- l Settlement Statement and to tl',e hest of my knowledge and belief, it is a true and accurate statement of al] receipts and disbursements made on my account o: by me L~ iius transactiun. I further certify that I have received a copy of the MUD-1 Settlement S~ateinr_nt. Borrowers/Purchasers William F. Busch ;~ '~ ` f ~ Mary Ann Kleinf ter, ~ ;. ~. ~ ~ ~..; Sellers PNC Bank; NA, Executor of The Estate of Ruth B. Conroy B c The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement i Settlement Agent: __ ~ ~ 1 Date: /~ ~ ____ Title Officer, Assured Land T rs, Inc. WARNIlVG: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine or imprisonment For details see: Title 18 U.S. Code Section 1001 and Section 1010. Page 4 of 4 Issues sorted by security. ESTATR 'PAX SECURITIES VALUATION PAGE NO. 1 AGCOUNT: 6264825 Nsme of Estate: RUTH B CONROY , DATE OF DEATH; 3uadaY, MsY 2 .2010 • IT&M G'USIP NO. SHARES/ DESCRIPTION PRICE HZGH/ASK I.OW/BID MEltibi SECURITY AC(~tUED CCMdEC7TS PAR VALUE DAIS PRICE PRICE PRIC$ VALUR DIV/I2iT 1} 140198301 _._ _ 409.3650 CAPITAL IHCOMB SLDR SD 04/30 47.9000 47.90000 19,608.58 MDT FDlID CL C 2) 302316102 1,278 E.X700~T MOBIL CORD 04!30 69.3100 67.7300 68,52000 NY3L • COM 05!03 68.2200 67.1800 67.70000 68.11000• 67,044,58 3} 353496409 8,120.5080 FRAN~.IN CUSTODIAN FDS IIJC 04/30 11.0500 11.05000 89,731.61 MDT FDND UTIL SEbt CL A 4) 67065Q806 8,693.9250 NUVEEIQ ffi7N TR Ol/30 10.3800 10.38000 90,242.94 i41JT FUND II13D !R3l7 BD & 5) 876902305 2,010.4740 TAX EXBMP SD E'D AMER ~3C 04/30 12.1600 12.15000 24,447,.36 MDT FUND ' CS. C 6) 92828N403 2,645.1570 V7RTDS EQUITY TR 04/30 12.4300 12.43000 32,879.30 MDT FUAID VIRTUS BALAN A 7) 92828N510 3,188.0220 VIRTUS EQRTITY Z"R 04/30 8.4000 8.40000 26,779.38 MDT FUbID VIRTUE STitG i39P A 8) 939330304 713.fi180 94ASHINGTOIQ MDT INVS P'!) I2iC 04/30 25.6000 25.60000 18,268.62 MDT FUND CL C 9) 993077106 90.4000 CASH 90.40 0.00 MANUAL Grand Totals 369,092.77 0.00 Total Priacspal plus Aacrced iutereat and dividends 389,092,77 24tis report was praparod nsittg APBR1-I38 Ver. 7.4.1 software, as EVALUATION S&RVICES, INC. product. Phase 201 784 8500. Visit our xeb sites at itNW.API~'RAZSP,.167.CCM and Ti4P90.COSTBASIS.INFO. ~+-- O c- N C33 C(S Q- ~ O C o ,.~,~ N s _ 1 N~ o c~,.v 4 ~ (6 ~ 0 ~ t G 'i 4 .^^y 1.~ t3• o i.T~- ~ ~ 7 ~ U 4 it .... ~~ -a 0 tf1 O r c~~ cv o ~m -t3 -cy ~ O ~ ~ a~ 4) T C~ ~ N ~ ~ ooc~a~ 2 sx 'a ~ ~ ~' ~ O -.- -~ cn ~ O ~ N ~ S? r U- U '~ _(6Y N O ~ ~ O Y • ~ ~] 0 ~ N of ~ ~~ .~.. T • , T36? ~' ~ ~{ 'L5 ~ ,~ ~ ~ +C4 ~ ~ ~ ~ ~ ~~~'~ ~ U S.1 ~ `~ ?~ ' i~ ~ SJ V ~W d c~6 ~, ~i ~ 'L'3 O Z 'O ~ .;3 9 N ~ ~ ~ ~~ ~~ G ~y1 ~ ~ ~ z = -o y~_ ~ ~ ~ U N o Q o ~ ~' ~ ~~ ca ~ .~y -a a~ ~~ ~ ~~ L7~ N N ~ O ~ ~ N V ,S1 ~ ~ ~~, U ~WW ~ v ~ a a ~ ca_--.~ „a ,~ to N tU ~ ~ ~ ~ •~,. ~ C~ aN~ ~ ~~~3 to N ~ "~ ~ s1 .fl Q~ * + ~a . s~~~s EE 710 18 8876 JOHN M. CONROY 1921 DICKINSON AVENUE CAMP HILL, PA 17011 OR RUTH B, CONROY LIBERTY EOND ACT. Af AMENDED, ETQD~011 THE RACKNEREOF~ ~~,~ AT THE MATURITY HEREOF WILL PAY 710 18 8876 JOHN M. CONROY 1921 DICKINSON AVENUE CAMP HILL, PA 17011 OR RUTH B. CONROY s~~~s EE TNIS BOND If IEEVED UNDER AUTNO 1 D LIBERTY BOND ACT. AS AMFNDEO, AND W fUUER TO THE TER ATED DN THE BACK NEREOF, `W Y CERARTMFNT OF THE 7REASVRY • `N ,,,~ wASNIMGTON SK^y r3'MOM rrnaFry _____________~_._~_.w.~.~,~.,.....sw~..aese.eee.¢.aeeaereencanca0afeeeOGG~'Je4eEeE4 ISSUE DATE WHICH IS THE FIRST DAY OF NOV 19.82 (MONTHI __ {Y'EARI__ F~~D RESERVE, gK ISSUING ~~i~E'T'~" '~, I ao99 I I 1 DATING STAMP ~ N0~,23, 198'2 X38 593 EE ISSUE DATE WHICH IS THE FIRST DAY OF NOV_1_9__8_2______ (MONTHI __ (YEARI_- {F~~~D RESER'VE', L.VK ~IN6 AC) 't, I , ' 0099 I ~ UATING STAMP 1 r 1` I NOV , 2 3, 19$'2 ~35~94 EE T ~ t ~.~\ AT THE MATURITY HEREOF WILL PAY ~ 710 18 8876 JOHN M, CONROY 1921 DICKINSON AVENUE CANiP HILL, PA 17 011 OR RUTH B, CONROY s~~iES ~E TNIf BOND K IffUEO UNDER AUTNORI D LIBERTY BOND ACT, Af AMENDED, AND K SUBJECT TO THE Tf R ATED ON THE RA[K NERfOF. ..:~ _ DEIARTMENT OF TNF TREASURY ~~ wASNINGTON Srra ryeJ'Jer T..,vury eCi9~Y.'eY09v1ECfi9eEeDOCD~M9iEEe9oeeosYHJeOSDeI tMUG'JMrRSOmeeeweeweea,~ameenoa.+emvewom.cl 15SUE DATE WHICH IS THE FIR57 DAY OF NOV 1982 (MONTHI __ IYEARI-~ ,f.F(/~D//~~P.ESERV~~, LJK RS~UIN~A.C~~ 'll 0099 ~ DATING STAMP 1 ,, N01F.23, 18"2 XIS u95 ~'~ O O ~^- T O O N N ~~ N O O N t0 ~a C C ~L ~a a LL ~ o ^O 7]\~~ d ~ + . ~ ~ ~ ~ ~ ~ ~ Z . ` +~+ ~ T N T N T N T N T N T N ~,v 0 0 0 0 0 0 t4 N N N N N N ~ T 0 T 0 T 0 T 0 T 0 T 0 1 Y.. 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L (~ 0 ~ ~ ~ ~ N N ~ .~ a~ ca ~`-LU N Q ~ to ~ o ca ~ c c c c o .Q~~~ ~ , Q~* • ~a~ 0 ~-- a~ cu a~ i o O~' i~ n~ ~; ~;...,: .J ~w ~~.._..~ w I W` N~ i o.. ~ ?~~ ~ ' m. o M O ~: T I C .~ ,i ~'~ -. m . ~~ ~ uL ~ f c0 ~„~,.`~ ,tun: 10. 2010 1:30~~ F~-C BA~~K 412-705-2147 .~ ~c~.4032 P. 2/2 - ~ar~~~~v .Tune 10, 20I0 Carat A. Leip~art 1'NC Bank - ~ .. Wealth Management RE; ltutl~ ~ Conroy . SSN: X63-10-2494 ~a~: os-o2-2010- - D~a~ M~. L~i~hart: In response to your request for I]ate of Death (DaD~ balances for the customer no#ed above, our records show the following: - Checking Account Account # 5140412807 ~ ~ Established:.12-25-1973 IZ.~JT13 B CONI~OY Dam balance: ~ 30,661.55 + 1.~0 accxued interest . InVesh~iettt ,A.ccaunt - . the decedent maintained .investment Account 17099455. For f~.u~her inforamatioz~, you znay call the Brokerage T~epartment at 1-500-762-b 111. ~ . Please note that this a€fice provides date of death bala~oces for deposit accounts (IRAs, CDs, Checking and Saviuzgs3. We do n©t process eny finanei~ trar~artions or pr©vide state~ae~xts,. If`yoc~ .geed assistance with any of these items, please call 2-888-PNC-BAN."K ~t-S$5-762-2265) or stop by Your local FN'C Dank branch office. - Sincerely, National Financial Services Center - - PI~IC Banl~ ~I_A_. . Member ~D1C ~ . Page 1 of 1 Jan, 12. 2011 9.05AM ~AGE~, June 28, 2010 PNC BANK NA AT'I1~t: LINDA r LI.rNDBb/1~Cr Po Boy cos CAMP ~TYLL 1'A 17001-03 0 $ Re: Annuity Contract X1'221783 Contract Owner Ruth S Conroy, deceased Dear Ms. Lundberg: No, 1076 P, 12 WESTERN J NATCONAL L i 1 8 Insurance C o m p a n y P.O. Box 871 Amarillo,7exas 7910S-0871 t .800.424.4990 Pf~~ R,q~VK RECEIVEp Sul o ~ zolo I~P ~ A Thank you for your recent inquizy regarding this annuity contract. 'VV'e would~like to take this opport~ll.nity to respond to your request. The accumulated value of this contract as of May 2, ZO10 was $43,158.59. The cost basis is X20,000.00. According to our records, the current beneficiaxies are Daniel P McGraw', John McGraw, and the Good Shepherd Catholic Church of Camp dill, Ms. Lundberg, we appreciate the opportunity to assist you. Should you have any questions, please contact. our Client Care Center at 1-8 00-424-4990. Sincerely, it e 'Vanderford Annuity Claims Department . Received Time Jan, 12, 2011 9:24AM No, 1154 Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 64094-4212 Telephone: (877} 499-641 S Facsimile: (866) 635-4523 June 22, 2010 Ruth B. Conroy Estate PNC Bank, N.A., Executor P.O. Box 308 Camp Hill, PA 17001-0308 Re: Ruth B. Conroy Contract No: GA16865925 Dear Executor: c ~(o~s're in good hands: ~N~ ~1 ita ~EG~E~lCD ~Il~i~ 2 g Z01~ ~~~T ~~,~ We received a request to complete IltS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the~value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of traasfer of the contract}. Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: May 2, 2010 Annuity Value as of Date of Death: $ 107,817.00* Cost Basis: $ 90,000.00 Named Beneficiary: Estate of Ruth B. Conroy Contract Issue Date: July 21, 2004 *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877--499-6418 Ext. 24597. Sincerely, ~~~ Jennifer Evans / G Sr. Claim Examiner C 0• ~ 10~3~ 1"t5.74 + i07~8i`7•~- 29~ -`~4 ~ .. ~t ~. .. RAG . . ~ULfl72414 ~~~-~ PNC Bank NA GF~ Attn: Linda J Lundberg P4 Box 308 Camp Hill, PA 17 001 Ruth B Conroy, Deceased _. June 26, 2010 Contract Nv. S005499003 Claim No. CL 060340 Dear Ms. Lundberg: Tt has been our privilege to serve you by handling the clai m for the contract listed above. We have complet ed our processing an d have enclosed a check for the full and .final settlement on this contract. After. careful review, we have determined the total va lue of the claim as follows: Cont-ract Value at ~Due::Proof ~ ~+ $. 22,-556.04 4or date of death on some contracts} Less Total Indebtedness Repaid - $ 0.00 less Surrender Charge (if applicable} - $ 0.00 Total Death Benefit _ $ 22,556:04 As a beneficiary, you' are entitled to 100 percent of the total death benefit. The breakout of your share of the claim is shown below. Your Share of the •Death-Benefit + $ 22, 555.04 plus Interest Payable from the Termination Date to Payment + $ 15.99 less Federal Taxes Withheld - $ 0.00 Total Check Amount = $ 22,573.03 The total taxable amount on this account is $11,573.03. We will create the relevant tax form at the end of the calendar year. ' - • r If you have any questions, please feel free to contact the Claims Department at 1-888-397-8485, option 1. We will be glad to assist you in any way possible. Si rely, C 'stopher McMahan Claim Examiner . Kemper Investors Life Insurance Company KiLLt-i Administrative Office: 1707 N. Randall Rd., Suite 330, Elgin, Illinois 60123-9409 SOOM (05/07) ~4CQ98 Pi~~ B~V~t #~~C~I1/Ef~ ~UL Q ? Z0~0 ~ ~ ~~ ESTATE OF RUTH B CONROY PNC -BANK NA EXECZJTOB FO B08 308 CANPHILL, PA 17001 Protective Life Insurance Company Administrator for Kemper Investors Life Insurance Company 0~8 -S005499003- ~~~~~~~ --s.~. ~~as/a9/i0 Joso~s72 2,573.03 The attached check is in payment for the item described above. ~\'// Easy, Convenient Banking. Sovereign Bank Checking I Savings I Loans 1 ~~ 1.877.SOV.BANK I sovereignbank.com CUSTOMER RECEIP7 Easy, Convenient Banking. Checking I Savings I Loans 1.877.SOV.BANK I sovereignbank.com ili ~Ji•1~~ Ita~tr ~~~ti4; li} ~~_~` T1i~ ~~~~~ 7 4 ki• C'L E'i t~° r ~r.r r r4' T ~r~1'--: ~il~~w~! aL-IL~ i " Sovereign Bank 1~~~~ CUSTOMER RECEIPT ?Ei ~tY~ Il~te ~,~,;'~~t'~~i~i 1~?= ~_~ T1i~ is=~Jf ~i Easy, Convenient Banking. ~, /\\~ Sovereign F Checkm Savm s Loans / ~ gl g I 1.877.SOV.BANK I sovereignbank.com CUSTOMER Tii ~it!-i ~i _,t~, ~ ~;'~'_!~:' 1 G 1 ~ _ ~ f fi I iY wi~i 1 Hid ~~~~JJ~I i~~.% i -7 ~~a~ i'j~~Gb ~r~? ~ titlt ~1n~~~~::1.~i.? Easy, Convenient Banking. \1 /~ Sovereign Bank Checking I Savings I Loans i~l'~~ 1.877.SOV.BANK I sovereignbank.com CUSTOMER RECEIPT ~~it. '1.;'a4:li. oh;~ Q BR0008 9107 Member FDIC N () • iE • 7c 34557.86 + 1~~151•y5 + 11621.93 + 191411 •E5 + 8y ~ 'l43 • S9 ~' ~'' Sovereign Bank ~/11~~ # ~~ _ _ r~Z2lb4 o~~ ~~/'~(~,t 2313 ~~;y~F3 ~A a. .. J~ ~ x Y~ ~ '~ ~,~_ j~-^{(. `~~r .~ yy (`Zj J~~ i y~ -'.d'`~i'„7E M'i `,;Ai'.,~~~~Mn ~+'J3"-y'~~"~'a' 4'~ l ~•' :t c si "f, ~ ~~ ~ 5 4 ~~~ l.~-'-... ~g ~ '+rM ~4: ~~{R.`+.T3:~ ~ _ ~,~ ti., ~ 7 ~ ai.'F 1~ 1~ a~ ~q.+ w . PAY TO THE ORDER OF ,_ ? ~.~v ~j.' '~''~' f " k ~ "~~ ~ ~'~ ~'`'` ~ ~ ~ _ ~ ~'`~„~'`~ D~aWer Sovereign .Bank ~~:: ~~~'i'IABLE 7 ~ ,, f~ S DRAWEE: SOVEREIGN BANK ISSUED BY: SOVEREIGN BANK ~ ~ A 1ZED SIGNATURE ;~~~ Sovereign Bank ~~~~ ~~cc~u~r ~Q 1 deg a ~~T~ c+~~~'~ DETACH AND RETAIN FOR YOUR RECORDS ~~~~~~ Printer Friendly Page 1 of 2 Today is: 06/04/2010 User: mnixon1 Name: Michael F Nixon F..rd Custerr,er Session Customer Profile Mid Atlantic [6017] « Back to Search ~~~~9.:~ Name: RUTH B CONROY Address: 1921 DICKINSON AVE Customer Service History: SSN/TIN: 463-10-2090 CAMP HILL PA 17011- 5424 At-a-Glance (Last 180 Days} Email: Birth Date: 09/21/1916 ReForted Problems 0 Home Phone: (717) 737-3758 ' s Maiden: Mother Pendi.~r. Reouests 0 Work Phone: Portfolio Code: Custcmer Nctes 0 Celi Phone: Portfolio Manager: ----~ Fax Phone: ID Protector: All Existing History Certified W9: YES Certified on: 1i1i512002 61 Notice: 62 Notice: Received C Notice: NO ~i~an;;iaf_Si~r?~rr2~ DDA;Savir,os Certifictates of Deposit Bank Cards Loans Other Accounts I=INANCIA#.. SUMMARY iEsa+cnCE ftcm p rior d8yj Ending Ledger t3alance F~vaitable Fiala,=c5 Total Accounts $0.00 $0.00 Total Certificates of Deposit $89,704.00 $89,738.00 Total Deposits $89,704.00 $89,738.00 Total Outstanding Loans $0.00 $0.00 Total Available Credit $0.00 $0.00 I~DAtSAVINGS ACCflUNT5 AccoEmt i~ccount Status Tax ~'trcecnt N,:,;T~er Tape open D2te Reporter P,eiationship No current accounts on record. ErJing t_e-..deer Available Balance Balance Statement CERTIFICATES QF aEPOSIT kcGau€,t Staaus Erding L~.dger Available Interest r"t;;Ex;;1~tt PJu~zihf>r t..Tpr•.n (.;atr> ':~x 1•~e?:,rter itc•;?ataonshitl Baianre 8af..~nce Rate h?aturily DatE; 105~5143Sfi Open YES Primary $34,531.00 $34,555.00 0.7400% 02/27/2013 08/27/2004 1(355421'{0 Open YES Primary $16,141.00 $16,151.00 0.1500°~ 06/29/2010 06/29/2007 23355473'i.7 Open YES Primary $19,621.00 $19,621.00 0.1000% 11/25/2010 11/25/2009 2335547325 Open YES Primary $19,411.00 $19,411.00 0.0010% 11/3012012 11 /25/2009 BANK CARDS ~,c.:auri Stat:ls t:a,~1 :',.+.,:~^;snr •v,;~en Gate Card T~~pe No current accounts on record. L C3ANS ii(:GC1U,it )tiilll'i r-'villl:3Ilits i~~; ~;C;i''ll iJt[;'T;'t)E' J1~:!iIC%:11iiH1 JJ)E?r, t-?31~- raE?I ~rlrlfirl7! `vrOS5 PI1t1Ci~1~11 1?'13t~1i1C,F? ~il:~rE35t RatE? No current accounts on record. http://middleware.sovereignbank.comlprintFriendly._jsp?needSig=no 6/4!2010 ~C+HriI~ M. McGRAW. . Foy xr:~c f ~a~..r~ ~+~~~~ :~~~22L3801,,.2?z:~b?~.0000~12~b uu r ~ .~1~°:0~ 0: ~7 5 f 60= i 2:73/3;7 Y ~ciatio'n`: '1... w~_ ~Tl~ ., ` . ~; a ++°~~9~00?++' f:03~3~2?38~. 5i~49990?~~++° DANIEL P MCGRAW •-~JQ'~ ; 6 FEATHERY CIR • ' - . PENRtELD NY 14526 ----. 53-2831 1 1 3' ~' : ~: ~. Paq to the ~~~ ~ ~2-- ~ \lV t `~-~. ~.~.~~ ~' `~ •~~ ozdez of T- . -~--._~~ ... -.~, ... ~~•~~ s.senlr ~OL~La1 ~ ON.IIt M bCk• . S~.'ERN NATIONAI, LIF INS CE COMP ~ • t'AYABLE THRU STATE STREET BANK & TRUST - BQSTOfV, MA 02101 STATE STREET, QUfNCY ` A F`crz ~ I.~~i~ CSc ~ ~ ~: ~i30~836~.050~ O~i~i4;?524~~t'283 ~, ~ J~ . v, ~;