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HomeMy WebLinkAbout03-03-11 1505610148 . EX (01-10) REV-1500 OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 21 10 10 2 0 PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 165-20-3713 09 092010 12081924 ' Decedent's Last Name Suffix Decedent's First Name M I BARAN JOSEPHINE D (If 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 - - REGfSTER OF WELLS 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) 0 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 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 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JENNIFER D• WETZEL, ESQ• 717-620-2440 First line of address PERSUN & HEIM, P•C- Second line of address PO BOX 659 City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's a-mail address: J D W E T Z E L a1i P E R S U N H E I M• C O M Yt7 -~ ;-_,~t F_.~ <:'~ _;. :' -. :. , '._. .. =' t". .~ 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 personal representative is based on all information of which preparer has any knowledge. 462 ROSLAI`f~E DRIVE HUMMELSTOWN, PA 17036-9100 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~~rc.~l~~GZtiz~~ /~ /~~~~ ~< L~l l JENNIFER DENCHAK WETZEL, ESQUIRE ` / ADDRESS (f ~--~ ~ PO BOX 659 MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY '„~ 1505610148 REGISTER OF~lLLS USE ONL"`G d..~ ~. F ' .:i`~ C 7 ~ `::z y l., ~ C~? J - ._.m~ ~ _.._I .. DAFf'~ FILED --- c- Side 1 9M4647 4.000 1505610148 Estate of Josephine D. Baran Executors (Page 1) Name Shari Zimmerman Address 462 Roslaire Drive 165-20-3713 Hummelstown, PA 17036-9100 Tax ID 210-49-5799 EXHIBIT TO PAGE ONE PENNSYLVANIA INHERITANCE TAX RETURN Estate of Josephine D. Baran Date of Death -September 9, 2010 Social Security No. 165-20-3713 File No. 21-10-1020 A safe deposit box inventory form was requested for the decedent and was received from the Department of Revenue. Upon examination of the safe deposit box, which was "shared" with decedent's daughter and executor, Shari Zimmerman, it was discovered that the decedent was not listed as an owner on the box at PNC Bank. Furthermore, an examination of the contents revealed no additional assets owned by decedent. Therefore, the number of safe deposit boxes rented by decedent is listed as zero on the inheritance tax return. J 1505610248 REV-1500 EX Decedent's Social Security Number 165-20-371,3 Decedent's Name B A R A N J O S E P H I N E D RECAPITULATION 1. Real Estate (Schedule A) 1 3 0 9, 5 6 0. 0 0 2. Stocks and Bonds (Schedule B) . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 4. Mortgages and Notes Receivable (Schedule D) 4, 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) g 0.00 0.00 0.00 238,092.00 10,829.00 348,906.00 907,387.00 9. Funeral Expenses and Administrative Costs (Schedule H), , 9, 2 5 , 714 •0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 9 , 4 6 2 • D 0 11. Total Deductions (total Lines 9 and 10) , 11. 3 5 , 17 6 • D D 12. Net Value of Estate (Line 8 minus Line 11) 12, 8 7 2 , 21,1 • D 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13, D • D D 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 8 7 2 , 21,1 • D 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 (a)(1.2) X .0 . D • D D 15. 16. Amount of Line 14 t xable ~ at lineal rate x .0 4 8 7 2 , 211.0 D 16. 17, Amount of Line 14 taxable at sibling rate X .12 D • D D 17. 18. Amount of Line 14 taxable at collateral rate X .15 D • D D 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 0.00 39,249.00 0.00 0.00 39,249.00 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~i, i,n i,n~n DECEDENTS NAM E ARAN JOS PHINE D STREET ADDRESS M A 0 TY CITY MECHANICSBURG STATE PA ZI P 1,7055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 3 0, 0 0 0. 0 0 B. Discount L, 5 0 0• 0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in box on Page 2, Line 20 to request a refund. (q) (1) 39, 249.00 31,500.00 (3) 0.0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7 , 7 4 9 • 0 0 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 i ^ a. reta n 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 i i i h d i ^ w out rece v ng a t equate cons deration? . . 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 spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)J. 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. Total Credits (A + B) (2) 3M4671 2.000 REV-1502 EX + (Ot-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Josephine D. Baran 21 10 1020 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 that is jointly-owned with right of survivorship must be diisclosed on Schedule F. swasss 2.00o If more space is needed, use additional sheets of paper of the same size. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Josephine D. Baran 21 10 1020 Include the proceeds of litigation and the date the proceeds were received by the estate. 3WasAD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF: FILE NUMBER: Josephine D. Baran 21 10 1020 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVNINGJOINTTENANT(S) NAMEtS) A Zimmerman, Shari JOINTLY OWNED PROPERTY: ADDRESS RELATIONSHIP TO DECEDB+lr 462 Roslaire Drive, Hummelstown, PA 17036-9100 Daughter ITS NUMBER LETTER FOR JOINT TENANT DATE MADE JOItJT DESCRIPTION OF PROPERTY MICLUDE NAME aF FINANCIAL INSTRUr1aN AND BANK ACCOUNT NUMBER oR SIMLAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. ~~ OF DEATH VALUE OF ASSET % OF DECEDENT'S INTFREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 6/19/2008 PNC Bank Savings Account #5005233711 21,658 50.0000 10,829 Interest accrued to 9/9/2010 0 50.0000 0 TOTAL (Also enter on Line 6, Recapitulation) 3 10 , 8 2 9 swasAE z.ooo If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Josephine D. Baran _ 21 10 1020 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. ITEM NUMBE DESCRIPTION OF PROPERTY INCLLOE T}f N4MEOFTHETRANSFEREE, THEIR RELATIONSFUP TO DECEDENT AND TFEDAT'EOFTRAISFER. ATTACHAC.OPYOf THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1• Edward Jones Traditional Individual Retirement Account #336-91186-1-1 (Shari M. Zimmerman, Beneficiary) 26,822 100.0000 0 26,822 Interest accrued to 9/9/2010 99 100.0000 99 2 Edward Jones Transfer on Death Account #336-14263-1-9 (Shari M. Zimmerman, Beneficiary 318,610 100.0000 0 318,610 Interest accrued to 9/9/2010 3,375 100.0000 3,375 TOTAL (Also enter on line 7, Recapitulation) $ 9W46AF 2.000 If more space is needed, use additional sheets of paper of the same size. 348,906 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 Josephine D. Baran 21 10 1020 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Hoover Funeral Home 7,006 2 John R. Zimmerman 612 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees: 15 , 0 0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4 5 6. 7. 1 2 9W46AG 2.000 State ZIP TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. 352 1,000 1,744 25,714 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Misc. costs to close estate John R. Zimmerman REV-1512 EX + (12-08) pennsylvania SCHEDULE I DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDEIJT DECEDENT ESTATE OF FILE NUMBER Josephine D. Baran 21 10 1020 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. awasnH z.ooo If 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: Jose hive D. Baran 21 10 1020 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).] 1, Shari Zimmerman 462 Roslaire Drive Hummelstown, PA 17036-9100 100 of Residue: 872,211 Daughter 872,211 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. ~[ NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. gee <for this certificate, $6:00 P 16800624 Certification Number 1105-143 REV 112006 TYPE / PRINT W ' PERMANENT <~u~~ u4ic -. 0 U w 0 0 W 1 This is to certify that the information here given correctly copied from an original Certificate of'Dea~ duly filed with me as Local Registrar. The origin certificate will be forwarded to the State Vit Records Office for permanent filing. 1 l ( ~~ct Local R bistrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH '' - (See instructions and examples on reverse) srnrE FILF NuMReR '' 1. Name of Decetlroll (First,-middle, last, su0ix) 2. Sex 3. Sodal Seaaity Number 4. Dale of Death (Monty, day, year) JOSEPHINE D. BARAN female 165 - 20 - 3713 Se tember.'9 2010: 5. Age (Lest 8irllday) Under 1 ar ther t da 6:-Dale of BiM Montyt, da , ar 7. a Cit end smote w can 8e. Place d DeaN Check one 14araM Days Hours kMxaes Hospital: ONer: _ - 8'S Yrs.. December 8 , 19 2 4 Gl en L on , PA ^ Irtparienl . ^ ER / Ordpetient ^ DOA ~Nasing Home ^ Residence ^ other - Spetity: 8b. Canty tit Death &. City, Bore, Twp. d Death Bd. Fars7dy Name (II not ns8htdon, give street and number) 9. Was Drxedenl of Hispanic Origkt? ~(~ ^ Yes 10. Race: American Indian, Black, Wtrle, etc. . ;. - (II yes, speciN. fwWn. (SPA r Cumberland Lower Allen Twp . Bethany village Meld~rt, Ptxrra ~~ •~) _ white 11. Decedent's Usual ken Kktd of wok done • moll d wa ' ile. Do na stele relic 12. Was Decadent ever H Ste 1 3. Decedert's Education (Spocdy only trighest grade rxxrrp leled) - 14. Marital Status: Herded, Never Married, 15. Surviving Spo use; (If wile, give rnaMeo name) ,, Nhtd of Work KirtdW Business/kdustry U.S. Amted Faces? FJerttenlery / St>cortdary (0-12) College (1-4 w 5+) Widowed, Divorced (SpeaityJ ' Switchboard 0 er. :Bell Tele. of PA ^ Ye6~ -+~ 12 widowed 16. Decedent's Maflbtg Address (Street, aly /town, slale,;ip Dods) Decedent's Did Decedent }~ Lower ::Allen. P enna . Lwe in a 17 Act al Reside e 17 St l ` Y D L d 462 Roslaire Drive PA 1 Hummelstown 7036 u nc a. a e c. [~ t es, ecedent ive in - Tw Tom? a 17b.l:ourdy Cumberland 17d.^Na,DecedeMlJvedwi8dn' , . Actual Lkttits of City/ Bono 18. father's Name (First, rrtidde, last, suitor) 19. Moutafs Nana (First, middle, rmiden sumeme) , , '`~ Bolish Swiencki Mar Barad ie `' 20a. Informant's Name (Type /Print) 20b. Inlormertt's hlaikrrg Address (Sireei, txty J ~, stela, zfp sods) ' .:.Shari Zimmerman 462 Roslaire Drive,.Huminelstown, PA~~T7036':'r ~~~,. 21a. Method of Oisposilion r ~ Cremation ^ Donation 21b. Dale of Disposition (Mardh, day, year) 21c. Place of Daposil'an (Name of aynelery, crematory w other place) 21d. Location (City/town; state; zip code).. , .,, : , _ ; , , ~ r ^ 13taiBl ^ Removal Irani SIa1e r Was Crrmtalkxt or Donetbn Aulhorh p Og,ar. r W Medleel ExaminarlCrooner7 e`~Yes^ No Se tember .11, 2010 Hoover F H & Cremator Inc - Harrisbur `, PA :17112 • . 22a. Sigrrelure Ftxtarel Service Licensee (or per acting as such) 22b. lJcertse Number 220. Name and Address of Fedtlly : , - -°~ FD010092-L Hoover F H & Cremator ,...Inc,.-P O Box 475, Hershey; 'PA 17033 b gems 23a-c any when rxMiykg evagable at lime of death ro 23a. To the best o f my kmwledge,lda]alh ed el the tlme, d~le/an'd/fplace~slated. (Signature arM lilk) / ~ 1 23b~. les NCton Lk~er be-r 7 /" '} ~ 23c, Dale Sign ed (Month,. daY. Y e ar) /1 rxH81y taus a ll,`! , I~) J~ . , l J ~ 1 ~/ dJ 1 ` ~ , n ~ I l'~+ ~ ~(J / 1~~~ ~ ~ 1 / f O~ C.' C," ~ Cam,' C:/ , ) - . Ikms 24-26 must be oorrgtleled by person h d th 24. Time d Death 7 1 25. Dale Promrwreed Deed (M_on1h, day, year) - /~ / ' C y ~' a ~ 20. Wes Case Referred to Medlcai Exandner / Cwaxrr Imo a Reason Other Than Cremation or Donation? ~ ^ w o pranotxtces ea . ~i_ M. G ~L~ l~ G ..~~ t/ C./ Yes No s„ v i . CAUSE OF DEATH (Sao Instructions and examples) r Approximate interval: PeA II: Emer other 28. Did Tobacco Use Conlnlwle to Death9 Item 27: Pert l: Enter Ute chain of eveNS - diseases, k~rxfa6, a cornp6celions - Ihel direcliy caused the death. DO NOT enter terminal events such os cerdrac onesl, ~ Onset to Doam bui not resulting to the underlying cause given h PeA 1 ' ^ "Yes ^ Probe ~}' ^ ` " respiralay arrest, w vonlrictdor fibriBatiori eMttatl showing the edokx3Y. List only one ce160 at each kne. i ~ ~ ` ' ^ No ~ Unknown IMMEDIATE CAUSE ttfine disease w /q ^ ~.. i aatdiltm reBultin in doa8lf f y 12~A sr'"1- f (G C l~ R C I ry ern /~ ~ t= '~I~ L ~ ~ L/~Sr,- ar7, f1~ ~h ~ 29. FamMe: B . : g ~ a. ' ..- . - . _. . - tt ~~ N l g t NN p . Due to (a as o cartserryence on: r ~ o pre nan w n ast year Mfe~ly bsl 0ondt0ons, it arty, i Sequ e b ." Pregnant et lime of death ^ n g he Duo to (w as a consequence d): --- i Her tlleaUNDERLYING CAUSE a~ Not pregnant, but pregnant within 42 days M deatlt i (lkscaBO w MWrY Thal inllteled Ole r c. ~ events resuMi n death) LAST ; , ^ N b re • eg , Due b (a as a calsegtiertce oq: i _ ot gegrtant. ut p gnant 43 days l01 year. : betas death ..:,:% .:. - ., • d. ~ - ~ ^ ~ Unknown it pregnant-witltin tiro past year 30a. Was an Autopsy 30b. Ware Autopsy Fmdrtgs 31. Manner of Death 32e. Data of Injury (Month, day, year) 32b. Descnbe Fbw Irthxy Occurred a 32c. Place of Irejtrry: Hann, Farm, Sueet, factory, - PedormedT AveBade Prior to CanpleUon of Cause of Death? ~ Nelaal ^ tlankddo ., 011ice Building etc (Specify) , .4 - ~N ^ Y ^ Y ^ ^ AccMant ^ Pendatg Irwesligalion 32d. Tine of Inryry 32e. Mjury at Wark7 321.11 Trnnsponatron Injury (Specify) 32g. Location of trtAiry (Street oily / bwri; state) es o es No ^ Suicide ^ Coutrl Not bo Determined ^ Yes ^ No ^ Driverl0perelor ^ Passerger ^ Podostrian ' M. ^ Other - Spadly. r .. `; 33a. Cenifier (check ady one) 33b. Sklnalure and Titie of CerGNer , - ~ ~ ~ ~ ....,- . , CenllyMg physklen (Physir9art cenkying cause of death when anaher plrysiden has pronoatced death and completed Cem 23) 7o the best of my knowledge, death oceared.due to the cause(s) and manner as sleled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ _ ~ - `/1~,.-OV~~j ' Ih/ ' ~ .:. :.. ~ - '- ` `- ~~ ~~~:~ • , Pronouneing and certitying physklan (Physidan bolt pronwncktg death and cenilying to cause of death) 33c. License Number ~ 33d. Dale Signed (MOnlh, doy, year) To the bell of my knowledge, death occurred al the time, date, and place, and due to the ceuse(s) antl manner as staled _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ M ~ it Z ~ G~ ~ ~ y ~ 20 I D • Medical Examiner/Crooner T , . 1 On Iha basis of examinatbn and / or investlgelion, In my opinion, death occurred M the time, date, and place, xnd due to the cause(s) and manner as sleled_ ^ 3q. Name sal Address of Person WlwyC~om~pbt Cause of Death (Item 27) Type! Print (~ ~ ~ ~ (~ ~ ~ '. 35. Regislrefs Sig re nd Dishict urMtey~ 1 36. Dale FgoA (Month, day, year ) ~ GV ~ ~ ~ }1L P, ' ( P~ r ~ o / J Cdl ` ~ `~ - CQ ~ ~ . '. . , L \ m 3 ~ S 6 T1L(N ~ L~tL1~ C_.C. . c ~c. ti ~ ~ 0 Disposition Permit No. v ~ ~ t~ 1.~ ~' S T WI I,L AND TE S TAMEN I, Josephine Baran, of Dauphin County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all other Wills and Codicils at any time heretofore made by me. ITEM I. I direct that all of my just debts and funeral expenses be paid for as soon as practicable after my decease, as part of the administration of my estate, from the funds in my residuary estate. ITEM II. I direct that all inheritance, estate, transfer, succession and death taxes of.any kind whatsoever which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the funds in my residuary estate. ITEM III. All the rest, residue and remainder of my estate, of whatever kind and wheresoever situate, I give to my husband Carl J. Baran. If we die under circumstances where it is impossible to determine which of us predeceased the other, my husband shall be determined to have survived me. ITEM IV. If my husband predeceases me, I give all of the rest and residue of my estate to my daughter Shari Zimmerman of ~;i•~p~ ,;.r, ~..~c ~..~ ~ ~~Q/L.o~i^-~ { SEAL ) Josephine Baran 1 Dauphin County Pennsylvania. ITEM V. I direct that my Executor or his successors or assigns, shall not be required to enter bond or security in any jurisdiction in which he may act, but if a bond is required notwithstanding this direction, I direct that a surety bond shall not be required. ITEM VI. I hereby nominate, constitute and appoint my husband Carl J. Baran as my Executor. If he is unable or unwilling to serve, I nominate, constitute and appoint my daughter Shari Zimmerman as alternate Executor. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Testament, which consists of two (2)pages, to each of which I have affixed my signature this •~ day of ~~ ~~ 2004. ~~ ,~~ „ - ~'~~~~--~ ( SEAL ) G' Josephine Baran SIGNED, SEALED, PIIBLISHED AND DECLARED by the above named testator, as and for her will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses in attestation there ~~ residing at '~rl ~ ~' ~ ~'l ~. /(,~ h o7 ~' Witnes s - ~~ residing at Aga (n~~ ~Q ~ ~ y wit ess S DYtQ S~~ ~~ (~(~ ~ ~ 2 COMMONWEALTH OF PENNSYLVANIA ) COTTNTY OF DAIIPHIN: ) SS I, Josephine Baran, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Last Will and Testament, and that I signed it as my free and voluntary act for the purposes therein expressed. ,~,Uos phine Baran ~: t,~ We, having been duly qualified according to law, depose and say that we were present and saw Josephine Baran sign the foregoing instrument as her Last Will and Testament; that she signed it as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing and at her request signed the Last Will and Testament as witnesses; and that to the best of our knowledge she was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Subscribed, sworn to or affirmed and acknowledged before me by the above named testator and by the witnesses whose names appear opposite on the ~_ day of ~,, ~~ ', 2 0 04 /~~ ,, No ary Public ~. Witness Witness Notarial Sea) Nikki M. Ormsbee, Notary, Public Lower Paxton T ~ My Commission ~''r~auphin Cou Pr Mar. 7, 2006 Member. Pennsylvania Association Of Notaries k ` ' ^' COMMONWEALTH OF PEt~lNSYLYANIA = °~' :~ o DEPARTMENT OF REVENUE =_ C~ _~ ~~ r--. REALTY l _.. r- TRANSFER DEC - r'$1 9 ~ Q. O ~-- TAx .~ DEEH-- o R B. t l l40 ~ G THIS I NDEJ\JTURE made the 4t,h day of COMMONWEALTH OF PENNSYLVANIA = DEPARTMENT OF RF VEtJUE REALTY TRANSFEP, DEC - 7'R7 p ~~J' . ®~ ~- TAX C3 P. B. 1 1140 ---- DECEMBER , 19 87 , between SHAFFER & SON, INC., a Pennsylvania corporation as Grantor and CARL J. BARAN & JOSEPHINE D. BARA]V (HUSBAND & WIFE) as Grantee. ~ C~ ~ ~ .,, ~.. F ~y~~., ~F .~ ~` ~p~ ~'7;. . =s ~ , . , W I TNESSETH : ~ "' ~ D ;, ~-.~ ; ~ _~. }+~Y y~~;r~.~ ' `~.5, + iI~ a~ Ti+r~ y~+. ~r+~ ~ ~ ~ That the said Grantor for and in consideration of t~ m z~ o f ONE HUNDRED SEVENTY TWO THOUSAND FIVE HUNDRED DOLLARS. AND NONE 00 / 1007C7i- 7c ~ -~ %~ ~~'_ %~ ~ 3~ ($172,500.) Dollars lawful money of the United States of America, unto it well and truly paid by the said Grantee at and before the sealing and delivery o-f these presents, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, enfeoffed, released and confirmed, and by these presents does grant, bargain, sell, alien, enfeoff, release and confirm unto the said Grantee , their Heirs and Assigns, ALL THAT CERTAIN condominium unit in the property known, named and identified in the Declaration referred to below as "Oakmont V, a Condominium," located in Derry Township, Dauphin County, Pennsylvania, which as heretofore been submitted to the provisions of the Pennsylvania lJniform Condominium Act, b8 P.S.A. Section 3101, et. seq., by the recording in the Dauphin County Recorder of Deeds Office a Declaration dated June 2, 1986 and recorded September 3, 1986, in Record Hook 811, Page 414 and a Declaration Plan recorded in P3 an Book F-4, pages 46-51, Township of Derry Dauphin County Pa. " Real Es#ate Trams TaX Date 1~-`~~$~1 ~_, 1 ~ r~ - ~~ ~1~~ BOi1~~U'~~ PAGE ~~~ ng~ ~t ~.~., s and an Amended Declaration Plan revised January 8, 1987 and recorded January 20, 1987 in Plan Book H-4, pages 75-81, as amended by Amendment I dated February 16, 1987 and recorded in Record Book 891, page 72 and Declaration Plan recorded in Plan Book H-4, page 97, and as amended by Amendment II dated April 29, 1987 and recorded in Record Book 928, page 81 and Dec`lara :ion Plan recorded in Plan Book J-4, pages 1-7, and as amended ` by~~'Am.endment II7 da~t.ed May 14., 1987 :.and r~ec:orded in Record Book 936, p:ag:e ~~ r }~ Th ~ ~ ., .~ ~ t= _ ~; ..., .. ~ ~:: r , .~., .., _~ , ~. • - d e d~ n P 1~'a o, a fe' 2, n d a, ~.Qi~ _~ _ #-~~~~.k ~.~..y._...:~..,.,. .. _. ~,;:...~;~~~.~_..w ,_~-.s€~f<.?~ :~`~~'S:91~ ra--u3~_r~_+r~zi~° _ ~. ~a; ~=~ ..~g.q9- {Pa ,e•.-172 and Dec7.ar atTi~on ~P.l at`i: °r;e.c°b:rd~e'd°'` i n NP,l~a~n ?B~o.o:k ~L ~4~, ~ es ~b9-264, ._. ~ . -' t. and as amended by Amendment V dated 10/29 , 1987 and recorded in Record $ook 1027 , Page 200 and Declaration Plan recorded in Plan Book M-4 , Pages 98_103 , together with an undivided interest in the Common Elements of 3.57'/. (subject to amendment) being and designated in such Declaration as Unit No . 201 , and a 1 so known as 462 ROSLAIRE DRIVE Hummelstown, PA 17036, as more fully described in such Declaration, together with a proportionate undivided interest in the Common Elements r-.e:'d ~' ~ ~vs~~tii= '>ec~l;a~r a:~,,.a~o~nx) ~o~~" 3 5?'/. Ft sub 3~.ec t \ to,~ amendments) ~ ,. - y ~ ~i 'I ° t ' i ] ii~?I~~e~l~r~ 1~k,~. 01~~ ~ 1;~1 • ~~i4 .1a:1^~. ~~} ,z ~'~ n„ r{t dt- ; ~~> ~ ~s ~ t-:~ I ~~t -~ ~~ yam{ lfJ~ Y~'-' ~ ~ J. : ~ '~. ~t,;i .~ ~ ~ ! ~BE I'NG -PART ~ of. the same premises which O1 i n .L . Mi 1 1 er and Joyce A . '~ Miller`, his wife, by their deed dated and recorded March 12, 1982 in the Office of the Recorder of Deeds in and for Dauphin County, Pennsylvania, Bo~f1044 PAGE 242 in Record Book 277, page 342, granted and conveyed unto Shaffer & Son, Inc.; and BEING PART of the same premises which Hershey Trust Company, Trustee for Milton Hershey School, by its deed dated March 24, 1982 and recorded March 25, 1982 in the Office of the Recorder of Deeds in and for Dauphin County, Pennsylvania, in Record Book .279, page 229, granted and ~~.F_~~; ~ ~c ~~~e~Y~d unto Sh:a~.f:fer & Son 3:. I nc,. ~ ~` ~ ` ~ , ;n~y~ ~;a d,~ a~1~~1~ ~ctio ve * an~s~, ~ ~cVo#n:d3i*t: o rts~, ~~ ~t ~~~sTe°m . ~~~.s ~ ;_ ` ~d ~ e<e m e;Ei 5;~0 ~~-~e d~o~r~ _ r ~ 's'td ~-. ~ . s ' i rs~ '"C `#~t~~" "T~~t rk.~l~. ~: r y~ pp ..,, ;sue - -,,~~ _ _7~ ~"~ -r-±,.~. --_ mac,,;.''- ~, _rc ~.~, ~'7."F~?. a~,ss~'~'~ y TOGETHER ~wa~t;t~-- ,a.lA-1 <and": s~i~ngu'l~ar =t~h•e "S't~r-ee_t=s~, A'1~1'e=ys,;-,:.Pa=ss°a°g;e~s=, Ways, Waters, Watercourses, Rights, Libert"ies, Privileges,`Hereditaments ,a and Appurtenances whatsoever thereunto belonging or in anywise appertaining, and the Reversions and Remainders, Rents, Issues and Profits thereof; and all the Estate right, title, interest, property, claim and demand whatsoever of the said Grantor, in law, equity, or otherwise howsoever , o'f , :i n and to the ,same and every part thereof . .~ ': ~ "TO :HAVE AI~iD TO HOLD the sa.i d Unia above-des_cr i:b:ed and the 't , ",thEh`i" ~ he`rs and •ass'igns~, that it," the said Grantor and its successors, all and singular he~Her:editaments and Premises hereinbefore described and granted, or mentioned and intended so to be, ,with the appurtenances, unto 00~~1044Pa~E 243 ~. f) .~',_ y the said Grantee , their heirs and assigns, against the said Grantor and its successors, and against all and every other Person and Persons whomsoever lawfully claiming or to claim the same or any part thereof, by, from or under them, or any of them, shall and will, subject as aforesaid, WARRANT and forever DEFEND. LN W.ITNESS WHEREOF, ~~, y be ?~e.~xeou~tsed . and ~ is corpor at{ ~e sai,~! cv. ~ .._ > ~ 1 ~P ~ ~ . ~~i actor has caused these presents to v hereto . n~: R%~~ ~~ ~': O w+ ' ~"~`'' '" ~ Fred A. Shaffer, President f `~,'~~ ~~, hors, Secre ary ~ ~v_ ~ .. ~ ~ ~ ~ ~ ~~ COMMONWEALTH OF PENNSYLVA~ ~ S~ s m~ COUNTY OF DAUPE~ ~ c ~ ~ Dn this, the 4th day of December , 14 87 , before me:, the undersigned officer, personally appeared Fred A. Shaffer, who _.~ - 'k ~- =n.o~w ~ed: te~d h.:mse;l>f to be the Pr~es.ident of Shaffer &. Son:, Inc .~, and that !` ezring :~_aut;hor~i z~d~ to_ d~o'~ sod, exe.cute.d °~t'he -f~o~rego ing ~a~. ~ l~~r.~en~c~®~~~t~a~n~.ec~~~ . ~b~.s i gn~~r.Yq' ~"t~g.~ne a~f._ t:he. Attorney for Grantee g~~~1044 P,~GE 244 www.DauphinCounty.org ~ Property & Taxes ~ Information for Property 24-084-054-000-... Page l of 1 ~~~~ ~` I );r~ 1. (' } .~I ! '~ i F~ ~ t_i ~,,! _1...~, ~~ :~~ Prapr e~ "axes In ormation for Property 24-084-054-000-0000, Tax Year 2oio I'D LIKE TO... Property i of i (See All) View CAMA Information Property Information View Assessment Info. Tax Year Property ID Images (See All) View Bling & Collection 2010 24-084-054-000-0000 _ _ _ View Delinquent Taxes Township Property Use ,~ Print this Farcel DERRY TWP r Ro'7 -CONDOMINIUM a~ ~ - Neighborhood -{.- Site Address Start a New Search 24087 - OAKMONT 462 ROSLAIRE DR Go to Property & Taxes ,•+r. • Go to Dauphin County Owner Name and Address Mailing Name and Address ~ '° Website BARAN CARL J BARAN CARL J 462 ROSLAIRE DR 462 ROSLAIRE DR ~'~'`'`=• ^~~~° Go to Dauphin County GIS HUMMELSTOWN, PA t7o36-9too HUMMELSTOWN, PA t7o36-9too .~ `,,,-~„ _ Interactive Maps Assessments Annual Billing ~~ ~ ~ / ~~ Land Building Total Pref. Land Pref. Building Pref. Total Non-Exempt 3t,3oo i86,7o0 2>t8,ooo 0 0 0 ~~ d ~y ~~ V Exempt o 0 o O o 0 0 0 Total 3i,3oo i86,7o0 ~i8,ooo ~ 0 0 0 ,/ /. ~~ Exemptions 3a / ~ ~J V Type Status Land Amount Building Amount Exemption Amount Farmstead? Farmstead Value , Homestead Appl Approved (Full) 3i,3oo t86,7o0 2t8,ooo No 0 Copyright ©zoo9-2oto, DEVNET, Inc. All Rights Reserved. ............... Cotmty of Dauphin, Department of Information Technology 2 South Second Street, Fifth Floor Harrisburg, PA t7to8-t295 webmasterCtdauphinc.org httn://www.da.l>Inhinnrnnertvinfn nru/nrnnPrtvinrn,;,-v t,t~,-„~,=,,;P,x,R,,,.,,-,,A~-o~1nQ~nc~lnnnn ~ nil ~ i~ni n ~~h r Jan. 3. 201' ".45AM PNC BANK 412-10~-2747 No. f'~97 ?. 1/2 QPNC ~~~~ L January 3, 2011 Person c~ Heim. P.C. Attn: Jennifer Denchak Wetzel P O Box 659 Mechanicsburg, PA 17055-0659 RE: Josephine D Baran SSN: 165-20-3713 DOD: 09-09-2010 Dear Ms. Wetzel: In response to your re4uest for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5140002705 JOSEPHINE D BARAN DOD balance: $ 94,941.02 + 0.78 accrued interest Savings Account Account # 5005233711 JOSEPHINE D BARAN SI~ARI M Z~1V1ER1ViAN VACATION FUND DOD balance: $ 21,657.71 + 0.26 accrued interest Please note that this office provides date of death balances for deposit accounts (IRAs, CDs,~Checlcing and Savings). We do not process any financial transactions or provdde statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (t-888-762-2265) or stop by youc local PNC Bank branch office. . Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Established:. 07-01-1965 Established: 06-19-2008 Page 1 of 2 ESTATE OF "JOSEPHINE D BARAN" HOME INVENTORY Prepared by: Shari Michelle Zimmerman an 11/li/1~ T.T 2 VIN ROOM Love Seats @ $2889 $ 5778 6 Throw Pillows $ 882 2 End Tables @ $1309 $ 2618 2 Table Lamps @ $1779 $ 3558 1 Coffee Table $ 599 • Tray w/glassware $ 200 • Hurricane Lamp w/Candle $ 150 1 Console Table $ 1209 • 3 Porcelain Vases $ 500 • 2 Torchieres @ $999 $ 1998 2 22"Ginger Jars @ $289 $ 578 2 Cypress Planters ~a $539 $ 1078 10 Votive Candies (holders) @ $5.50 $ 55.10 1 8` Floor Torchiere $ 2469 1 Oil Painting = 4' X 6` $ 900 1 Planter $ 189 3 8" CandlesJHoiders @ 10.25 / 25.99 $ 77.97 1 Breakfront $ 1416 • 5 Lfadro Statutes $ 1675 • 3 Sandhurst Dog Statues $ 540 • 3 Doves in flight on stand $ 130 1 Oriental Oil Painting $ 40.00 Inside bookcases (2) alongside Fireplace • 50 Hard-cover books $ 200 • 2 Artificial plants $ 125 • 6 Vases $ 350 • 2 Crystal bowls $ 350 • 2 Brass statutes (shark & dolphin) $ 175 • 4 Brass Bowls w & w/o Lids $ 500 • 1 Brass/wood Clock w/chimes $ 500 • 2 Asian Vase & dish sets ~2.~4Q Sub-Totai: $29,050.07 F.NT~:AN~E HALLWAY 1 Pendant (Dark Bronze Hanging Light} $ 3422.74 1 Asian Lady ail Painting (12' x 24~ $ 560 2 Gold-colored Benches $ 635 1 Console Table $ 229 1 Elongated Black Oriental Mirror $ 259 2 Gold multi-colored Pictures $ 150 1 Fern Planter in oriental vase on stand $ 500 2 Large square pictures (oriental} $ 1200 2 Lewis Vineyard Oil Paintings (1 pair} $ 2999 1 Curio $ 735 • 12 pieces of Cut Crystal $ 500 • 1 Lladra Statue Sub-Total: $11,564.74 T)TNTN(T ROOM 1 Breakfront $ 2119 • 8 Lladro Statues $ 1720 • 5 Cut Crystal pieces $ 1100 • 32 pc Chine Set $ 1500 • 12 pc Silverware $ 1100 1 Server $ 785 • 6 Tablecloths $ 60 • 12 Dessert Dishes $ 70 • Candles of ALL kinds $ 100 • Extras (i.e. felt pads, corkscrew) $ 50 1 Gold-trimmed round Mirror $ 259 2 Small Lamps $ 312 1 Walf Planter $ 300 1 Picture (3' x 5~ $ 375 1 Elongated table $ 679 4 Chairs Cc~ $239 $ 956 2 Captain Chairs @ $288 $ 576 1 Pedestal Bouquet Centerpiece ~ 514 Sub-Totai: $12,580,00 FAMILY ROOM 1 Leather Sofa $ 4295 1 Love Seat $ 3895 1 Leather Ottoman $ 1195 2 Leather Recliners w/Ottomans $ 2395 2 Brass Lamps $ 962 4 End Tables $ 800 2 Lamps $ 375 1 Love Seat $ 747 1 White Swivel Rocker $ 421 • 3 Throw Pillows $ 60 1 Striped Chair $ 347 • 1 Throw Pillow $ 30 1 Potted Palm Tree $ 50 1 Plague over Fireplace $ 100 1 Coffee Table $ 439 9 Pictures $ 640 1 Table $ 219 • 4 Matching Chairs $ 328 1 Wooden Desk $ 1500 • 1 Brass Lamp $ 145 • 1 Old World Map Picture $ 125 1 Stereo Cabinet $ .200 • 1 Lamp & Glass Candy Dish $ 125 Inside Bookcases (2) along Fireplace • 20 Hard-back Books $ 100 • 8 Bowls/candlestick holders/vases $ 125 • 2 Glass Platter & Bowl $ 75 • 2 Statues $ 65 Inside Bookcases (2) in Corner by Steps • 270 Books (all kinds) $ 4000 • 5 M ugs $ 50 • 2 Sets of Encyclopedias $ 1 500 Sub-Total: $25,308 MASTER BEDROOM 1 Queen-size Bed $ 172 • 1 Bedspread w/matching Drapes $ 2000 2 Night Stands $ 428 •2 Lamps $ 414 2 Pictures $ 365 3 Benches $ 195 1 Armoire $ 459 • 2 Oriental Brass Jars w/lids $ 225 • 1 Bowl w/lid $ 110 1 Entertainment Center $ 1200 • 3 Oriental Vases $ 105 • 2 Green Planters $ 95 • 1 Lladro Statues $ 110 28 Recipe Book $ 245 3 Pictures $ 378 1 Chair $ 135 1 Triple Dresser $ 679 2 Mirrors $ 230 1 Lamp $ 150 1 Floral Arrangement & tray $ 125 Sub-Total: $ 7,820 MOTHER'S CLOTHING 35 Outfits $ 4690 12 Dresses $ 1440 10 prs of Shoes $ 224.90 6 Handbags $ 180 3 Evening Purses $ 105 4 Bathing Suits & Cover-ups $ 230 5 Coats $ 995 3 Blankets $ 225 1 set of Pillows $ 100 Sub-Total: $8,189.90 KITCHEN 1 Hanging Glass Light $ 715 1 Glass/Metal Table $ 425 4 Matching Metal Chairs w/cushions $ 374 24 pc Dinnerware $ 435 32 pc Flatware $ 365 6 pc Carving Knives $ 138 6 Paring Knives $ 76 1 Stainless Steel Refrigerator $ 699 ~ `~ %~`~ 1 Stainless Steel Dishwasher $ 799 P''"'` ~' 1 SS Glass-top Stove w/Oven $ 999 S -dam C~~ 1 Stainless Steel Microwave $ 49 4 Recipe Books $ 85 1 Picture $ 150 3 Baskets $ 60 10 Dish Towels $ 12 8 Potholders $ 6 1 Table Mixer & accessories $ 60 3 M ixi ng Bowls $ 70 1 Hand Mixer $ 35 8 Shrimp Cocktail Dishes $ 40 8 Bowls w/lids $, 45 48 pc Crystal Glassware $ 125 Glassware $ 65 Sub-Total: $ 6,277 GUEST BEDROOM 1 Full-size Bed $ 240 • 5 Throw Pillows $ 300 1 Bedspread & matching Drapes $ 385 2 Night Stands @ $174 $ 348 • 2 Lamps $ 200 1 Triple Dresser $ 680 • 2 Gold trim Mirror @ $144 $ 288 • 1 Lamp $ 100 1 Lingerie Chest $ 455 1 Old Rocking Chair $ 80 1 TV and Stand $ 270 6 Pictures $ 125 Sub-Tota 1: $ 3,471 LIVING ROOM $ 29,050.07 ENTRANCE HALLWAY $ 11,564.74 DINING ROOM $ 12,580.00 FAMILY ROOM MASTER BEDROOM $ 23,308.00 $ 7,820.00 MOTHER'S CLOTHING $ 8,189.90 KITCHEN $ 6,277.00 GUEST BEDROOM G RAN D TOTAL: $ 3{471.00 '~~ h~ J' Ya r- r ov~..~ ~'- o ~eu~ i ~Prn,~ G~ r ~~ GtJ'e.G~. ~ y c%~i~ S ~~a,-,~ MetLi f e Metropolitan Life Insurance Company Notice of Claim Payment BrlDist. .Agency Date oP Notice 500 SCHOOLHOUSE ROAD 56L-000 821 12/11/2010 JOHNSTOWN, PA. 15915 ~,~ ~ T~C>~ NAME OF DECEASED DATE OF DEATH DIST PHONE NUMBER CARL J BARAN l0/2 /2006 (717) 724-9700 PERSUN AND HEIM PC 1700 BENT CREEK BLVD SUITE 16 0 PO BOX 6 5 9 Please See Important Notice on Reverse Side MECHANICSBURG PA 17055-06.59 Policy Number Codes Refer to Messages Below. 636 1 1 9400 A A Items Payable Policy Amount 10000.00 One-Year Term Insurance Additional Insurance 31 127.26 Dividends With Interest Dividend to Policyholder 438.08 Terminal Dividend 400.00 Premium in Advance Interest on Claim TCA AMOUNT 41965.34 Deductions Premium in Arrears Loan Loan Interest TOTAL 41965.34 A. Your claim has been approved and a Total Control Account has been established in the amount shown above as TCA. You will be receiving a package from MetLife including a checkbook and a large booklet explaining your account within the next several days. If you have any questions about your account please call our toll free number (1-800-638-7283) to speak to a customer rep. This claim has been approved: for the total of the amountsappearing in the boxes below. Items determining these amounts are listed to the left. Amount Held for Deferred Payment x+1965.34 Check,.luued 6y Customer Service Center I JY4343SCRE(10/04) Jan, 3. 2011 11:45AM PNC BANK 412-705-2747 ~ ~-~~ P. 112 (~ PNC January 3, 2011 Person & Henn P.C. Attn: Jermifer Denchak Wetzel P O Box 659 Mechanicsburg, PA 17055-0659 RE: Josephine D Baran SSN: 165-20-3713 DOD: 09-09-2010 Dear Ms. Wetzel: ca, F I~ia response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: ' Cbeclwtg Account Account # 5140002705 ~ Established: 07-01-1965 JOSEPHINE D BARAN DOD balance: $94,941.02 + 0.78 accrued interest Savings Account Account # 5005233711 ~ Established: 06-19-2008 JOSEPHINE D BARAN S~IA~ M ZJlV1MERMAN VACATION FUND ~ i + 6 accrued interest ~~~'-'° DOD balance. $ 21,657.71 0.2 Please note thact this office provides date of death balances for deposit accounts (IRAs, CDs,~Checking and Savings). ~We do oot process a~- financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BAN,R (1-888-762-2265) or stop by your local PNC Hank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page a of 2 i Paul M Smith 547 Old West Chocolate Avenue Financial Advisor Hershey, PA 17033-1640 Bus. 717-534--8563 www.edwardjones.com November 18, 2010 Persun & Heim, P.C. Ms. Jennifer Denchak Wetzel 1700 Bent Creek Blvd. PO Box 659 Mechanicsburg, PA 17055-0659 Dear Ms. Wetzel: Re: Acct. 336-91186, Josephine D. Baran ~~~~'~ j Traditional IRA Shari M. Zimmerman f~ G EdwardJones MAKING SENSE OF INVESTING ~y Description CUSIP/Symbol Total Value Accr Div (* muni) 2827.36 Invesco VK Equity & income Fund A ACEIX 22050.88 99.08 157.881 Invesco VK Global Franchise Fd A VGFAX 3176.57 0 121.884 Invesco VK US Mortgage Fd A VKMGX 1594.24 0 The values were obtained from an outside historical pricing service, and while we believe that they are reliable, we do not guarantee their accuracy. Sincerely, Paul M Smith Financial Advisor Edward Jones, its employees and financial advisors do not provide tax or legal advice. You should consult with a qualified tax specialist or legal advisor for professional advice on your specific situation. The information provided is believed to be reliable, but its accuracy and completeness are not guaranteed. Cost basis information maybe from an outside source that has not been verified. Cost basis is provided for information only and should not be used for tax purposes without the assistance of your tax preparer. Pwl M Smith 547 Old West Chocolate Avenue Financial Advisor Hershey, PA 17033-1640 SC~ ~, Bus. 717-534-8563 www.edwardjones.com November 18, 2010 Persun & Heim, P.C. Ms. Jennifer Denchak Wetzel 1700 Bent Creek Blvd. PO Box 659 Mechanicsburg, PA 17055-0659 Edward Jones MAKING SENSE OF INVESTING Dear Ms. Wetzel: ~' ~e»~t ~ Re: Acct. 336-14263, Josephine D. Baran TOD Shari M. Zimmerman, Beneficiary Per your request, I am writing to provide valuation for the following securities belonging to Josephine D. Baran. Qty Description Cusip or Maturity Rate Total Value Accrued Symbol Date ~ Interest(*muni) 25000 Berks Co PA 084538FD4 03/01 /28 5.00% 25022.50 $27.78 Reading/Highland 70000 Hollidaysburg PA 435475PJ1 03/15/30 4.625% 72968.00 $1564.79 SD 25000 Lehigh Valley PA 524805U97 07/01/31 5.00% 25420.00 $236..11 Gen Purp 25000 Montgomery Co 613604UQ8 06/01/27 5.125% 25355.00 $348.78 PA Ed & Hlth 20000 Montgomery PA 613604UR6 06/01/32 5.125% 20186.00 $279.03 Abington Mem 20000 Mt Lebanon PA 621842PK3 02/15/29 4.30% 20396.00 $57.33 SD 25000 Reading PA SD 755638SK0 01/15/32 4.625% 25682.50 $173.44 25000 South Fork Mun 83786DCZ8 07/1/28 5.00% 23482.50 $236.11 Auth 20000 West Shore PA 955817CN9 01 /01 /22 5.70% 20058.00 $215.33 Hosp 25000 Philly Auth Ind 71781 EAW5 07/01/23 5.00% 25010.00 $236.11 Dev Airport 57 UIT Van Kampen 920915600 ----- ----% 35029.35 $0.34 INV #26-M ~~~~ 6 d9.8~' ~, 3 ~5", l~" The values were obtained from an outside historical pricing service , and while we believe that they are reliable, we do not guarantee their accuracy. Sincerely, ~.o Paul M Smith Financial Advisor Edward Jones, its employees and financial advisors do not provide tax or legal advice. You should consult with a qualified tax specialist or legal advisor for professional advice on your specific situation. The information provided is believed to be reliable, but its accuracy and completeness are not guaranteed. Cost basis information may be from an outside source that has not been verified. Cost basis is provided for information only and should not be used for taz purposes without the assistance of your tax preparer. EXHIBIT TO SCHEDULE H PENNSYLVANIA INHERITANCE TAX RETURN Estate of Josephine D. Baran Date of Death -September 9, 2010 Social Security No. 165-20-3713 File No. 21-10-1020 A.2. Funeral Expenses paid by John R. Zimmerman include the funeral luncheon ($107.50) and cemetery bill ($505.00). B.7.2. Additional expenses paid by John R. Zimmerman include all household utilities for several months (sewer, gas, garbage, water, and electric) ($1002.00), homeowner association dues ($320.00), and homeowner insurance ($422.00). EXHIBIT TO SCHEDULE I PENNSYLVANIA INHERITANCE TAX RETURN Estate of Josephine D. Baran Date of Death -September 9, 2010 Social Security No. 165-20-3713 File No. 21-10-1020 2. Debt paid by John R. Zimmerman is the final nursing home bill owed to Bethany Village in the amount of $212.23. 21140v1