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HomeMy WebLinkAbout03-04-1115056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year 1=ile Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 2aoso~ 21 10 01017 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 065-30-6911 10/04/2010 06/02/1928 Decedent's Last Name Suffix Decedent's First Name MI Schmidt Adele E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tai: Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 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 Luther E. Milspaw, Jr. (717) 236-3141 ; .., Firm Name (If Applicable) {~`iilSi`ci2 i,r~~ T? ~ I ,I ~ i ' - t~ fT.,.) r --- ,.-.-. i ...~ ._., i ..,~ First line of address ~..1 ' + ~_ _ _~- _. 130 State Street _ ' ~ 4 -,, - - - Second line of address ~~ ~ ~ °--. -. ....__ ~ `-~ _ d-; _ P.O. Box 946 , i _._. ~ ~ -.:. I ' ' ___ r...r~:~ ` . _. ~~ C~.j City or Post Office State ZIP Code r _.> Harrisburg PA 17101 Correspondent's a-mail address: IuthermllSpaw@milSpawlawfirm.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT ~ ~~~ SP - $hBLE ~~IL T ~ _ _ __ ~'j~~'1~'~/ ~~'~ _ _ _ ~i `~'~~/ ADDRES ~~,~- /7 . ,~ {~~ ` '.) d 1 SIGNATURE P R REPRE ATIVE ~ DATE ~ ~ / ADDRES (~ ~_ f ~t ~r~ E J ~f'% ~ ~ i -~'rf _~-a ~ ~" i I ~ ~Jl..~i'Gr - 1 h1 /r/~tll~ f . PLEASE`l1SE ORIGIN`AjL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Adele E Schmidt 065-30-6911 Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 169,185.78 2. Stocks and Bonds (Schedule B) ....................................... 2. 270,946.21 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. 9 9 ( ) ............................ Mort a es & Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 326,505.69 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 00 (Schedule G) Separate Billing Requested........ 7. . 8. Total Gross Assets (total Lines 1-7) .................................... 8. 766,637.68 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 93,307.09 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 1,276.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 94,583.09 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 672,054.59 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 672,054.59 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 0.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 10 01017 DECEDENT'S NAME Adele E Schmidt STREET ADDRESS 200 Glenn Road _ _ __ - CITY Camp Hill DECEDENT'S SOCIAL SECURITY NUMBER 065-30-6911 ____ __ _ _ STATE 'ZIP ~ PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. CreditslPayments A. Spousal Poverty Credit --_. ____ _ _____ 6. Prior Payments -- - C. Discount ----__- - _ - -. _ Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty - Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 0 c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ ^x 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero (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 four and one-half (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 twelve (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. s-..:, ~; j ._.:~ LAST WILL AND TESTAMENT _ _~~~, ~ ~ ~- ~ ~~ ~~ _=~ _- ~ i ~ f ADELE EVA SCHMIDT ~~~--~=:~~~-~~~a ==~~ = _:: :1 - -i i:.' -~ i I, ADELE EVA SCHMIDT, of 200 Glenn Road, Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all prior wills and codicils made by me. ITEM I: I have separately made funeral arrangements through the W. Orville Kimmel Funeral Home, 2001 Market Street, Harrisburg, Pennsylvania. Such arrangement documents have been placed in my safety deposit box number 510 held at Citizen's Bank, located on the Carlisle Pike, Pennsylvania. ITEM II: I hereby nominate, constitute and appoint KERRI L. McCARTHY, now or formerly of 27 Bragg Drive, East Berlin, PA 17316, as Executorix of this, my Last Will and Testament. If the said Executrix does not survive me, or is unable or unwilling to serve for any reason, I nominate, constitute and appoint BARBARA A. McCARTHY, now or formerly of 166 Lake Meade Drive, East Berlin, PA 17316, as Alternate Executrix hereof. My Alternate Executor shall be entitled to deduct a fee equal to five percent (5%) of the gross value of my estate as compensation for her services. My Executrix, Alternate Executrix and other fiduciaries under this instrument are directed to utilize the services of my attorney, LUTHER E. 1 Initials . . MILSPAW, JR., ESQUIRE with offices currently located at 130 State Street, Harrisburg, ' Pennsylvania 17101, for all purposes hereunder. ITEM III: I give, devise and bequeath the following specific bequests without restriction to the following charity: A. My Dunham, New York ca 1850 piano to the Historic Harrisburg Association of Harrisburg, Pennsylvania; ITEM IV: I give, devise and bequeath all of the rest, residue and remainder of my property and estate at the time of my death or to which I may be entitled, whether real, personal or mixed, and wheresoever situated, including any and all property as to which I may have the power of appointment, following its liquidation, to the following individual and entities for charitable purposes, all said gifts to be made in the name of Mr. Donald W. Schmidt and Mrs. Adele E. Schmidt: A. One-fifth (1/5) to Hillsdale College located at 33 East College Street, Hillsdale, MI 49242-9989, to be used for educational purposes; B. One-fifth (1/5) to Young America's Foundation, 110 Elder Street, Herndon, VA 20170, to be used for educational purposes; C. One-fifth (1/5) to Leadership Institute, Steven Wood Bled, 1101 North Highland Street, Arlington, VA; to be used for educational purpases; D. One-fifth (1/5) to Masonic Charities, One Masonic Drive, Elizabethtown, . PA 17022 to be used for the Children's Home; and E. One-fifth (1/5) to Migdal Ohr, now or formerly of 6 Belilius Street, Jerusalem, 94704 ISRAEL, to be used for the orphanage. 2 Initials _. .... ITEM V. All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax, and any penalties thereon, shall be paid by the executrix out of the principal of my residuary estate, and all interest with respect to any such taxes shall be paid by the executor out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of the executrix, without reimbursement from or apportionment among the beneficiaries, recipients or owners of such property for any such taxes, penalties or interest; provided, however, that the executrix shall not pay any such taxes, penalties or interest attributable to any property included in my estate solely because of a power of appointment there over which I possess but have not exercised or any transfer subject to generation-skipping transfer tax. ITEM VI: My Fiduciaries under this Last Will and Testament shall have the following powers in addition to those granted by law: (a) To retain and to conservatively invest in all forms of real or personal property, including stock, common trust funds, mortgages, investment funds oz• other securities, consistent with limitations imposed by law or investments by fiduciaries, as they deem proper, with regard, however, to the principal of diversification of risk of productivity, and consistent with an investment strategy that will result in reasonable income and protection of principal against inflationary effects. 3 Initials o compromise c `alms ari ~o a an on any property which in the ~ ~ " °`' ~"" " °`~~~ Fiduciaries's opinion is of little or no value. (c) To allocate any property received or charge incurred to principal or income or to each without regard to any law defining principal or income. (d) To enter into agreements from time to time as they may deem necessary or expedient with reference to the reorganization of any corporation, the stocks, bonds, or other obligations of which shall form a part of the estate. (e) To manage, care for, improve, protect, control, deal with, mortgage, pledge, sell or otherwise dispose of the estate or any part thereof, in their discretion, in any way and in every way in which any owner could manage, care for, improve, protect, control, deal with, mortgage, pledge, sell or otherwise dispose of the same. (f) To sell at public or private sale, to exchange or to lease for any reasonable time any real or personal property and to give options for sale or leases. (g} To add to the principal of the estate any additional asset by deed, life insurance contract or otherwise. ITEM VII: No fiduciary shall be required to post bond in any jurisdiction. 4 Initials .~f ray ,.:;:p .. - , _. _ ..,~ __. ~._ m..~..,.m-,.,.~,A„.~..~~..,,,,,,,,,~,~ . , , .. .. ~..n~~ ..,.~..~,,.,~...~.. ._ ..._ _ .. ___ _ .,. ...wa,. ~..1.. rc,„e, IN WITNESS WHEREOF, I, ADELE EV.A SCHMIDT; herewith set my hand and seal to this, my Last Will and Testament, typewritten on six (6) sheets of paper including the self- proving attestation clause and signature of witnesses, this 13`'' day of January, 2010. ADELE EVA SCHMIDT Signed, sealed, published and declared by the above named Testatrix, ADELE EVA SCHMIDT, as her Last Will and Testament 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. ,~ ~/ ~% ~ ~ ~--- f WITNESS i~ - ~ /~ ~ .. /' r r •.,s "~ 5~ j / ~ WITNESS ~ J'+~ ~- 5 Initials TH ~F PE-~SyY,,~TAl`zIA '• sS. C~MM~Ny~EAL T,Y OF DAUPHIN the Testatrix Cp~N essersmith, w $eshore and Teresa Md foregoing instrument, ~V A SCHMiDT, Matthe that the E are signed t° the attach der igned authority d ~'e, ADEL whose names declare to the k . ~X~» as her Last Wlll an esses, respectively, do hereby and with ed according to law, rnent «by m;ar voluntary act ul qualifi e attached ins executed it as her free a Ce and hearing of bung d y ned and executed th and that she in the preSen • Testatrix sig ned it willingly, witnesses, owledge the Testatrix tament and that she sig therein, and that each of the Tes ressed d under no constraint or sex ses, and that to the best ° d an for the pu~'ose p ill as witnes ©f sound min si ned the ~ 8 years o f age or older, the Testatrl~ n1egighteen ( ~ was at the undue influence. AD~J"E EV A SCHMIDT ,, f ~ . ,~r`Y`~~ Witness ~~ ~ ~ ~ `;. Witness V A SCHNIID`P ADDLE ~ wledged before me by e b Matthew $eShore and cribed, sworn to and ackno to before m y Subs _ «X~~~ and subscribed and sworn 2OlO. Cb Ynark this 13~ day °f 3anuarY~ Testatrix, y witnesses, essersmi~s ~ f Teresa M t - . ,,,.•.~.• N~~ S~At- TARA L EB'~lGtiT NotacY public GOOt~~'l CiTY~ OAOpH1N ices Oct 2pt2 HARRISBURG i 1. Noy Commission ExP ,: Notary Public Initials _____.------ 6 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND estate of ADELE E SCHMIDT SHORT CERTIFLCATE I , GLENDA EARNER STRA SBA UGH Register for the Probate of Wills and Granting Letters of Administration in and foz- CUMBERLAND County, do hereby certify that on the 7th day of October, Two Thousand and Ten, Letters TESTAMENTARY in common form were granted by the Register of said County, on the late of EAST PENNSBORO TOWNSH/P (First, Midd/e, Lastl a/k/a EVA SCHMIDT in said county, deceased, to KERRI L MCCARTHY (First, Middle, Lastl and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 7th day of October Two Thousand and Ten . File No . 2010- 01017 PA File No. 21- 10- 1017 Date of Death ~ 0/04/2010 S . S . # 065-30-6911 eg/ster 11 s eputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL . ~SL~: '~_. i i-~Sl ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Adele E. Schmidt 21-10-1017 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 disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• Single family dwelling located at 200 Glenn Road, Camp Hill, Pennsylvania 17011; transferred 169,185.78 to decedent by deed recorded June 13,1977 in the Office of the Recorder of Deeds of Cumberland County in Deed Book "F", Vol. 27, Page 459. *** Contract sales price including adjustment for taxes as listed on HUD-1 attached hereto. TOTAL (Also enter on Line 1, Recapitulation.) I $ 169,185.78 If more space is needed, insert additional sheets of the same size. Atn.e"'°~y OMB Approval No. 2502-0285 ~T o ~ ~ ~4r "j III ~~w~ A. Settlement Statement (HUD-1) ~ ,~ ~ ~eh oe4E B. Type of Loan 8. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 1. ©FHA 2. [] RHS 3. Q Conv. Unins. 10-528 0213028941 44804679812038 4. [] VA 5. ~ Conv. Ins. C. Note: Thls form Js fumished to glue you a statement of actual settlement costs. Amounts paid to and by the sadlement agent are shown. Items marked "(p.o.a)' were geld autslde the closing; they aro shown here for/nformatlona! purposes and are not included !n the totals. D. Nam© and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: Ronald C. Beers, Jr. Estate of Adele E. Schmidt SUNTRUST MORTGAGE INC. 200 Glenn Road 901 SEMMES AVENUE Camp Hill, PA 17011 RICHMOND, VA 23224 G. Property Location: H. Settlement Agent: 88-0510988 I. Settlement Date: 200 Glenn Road Community Land Transfer, LLC Camp Hill, PA 17011 2331 Market Slreel November 1, 2010 Cumberland County, Pennsylvania Camp Hill, PA 17011 Ph. (717)909-6949 Place of Settlement: 2331 Market SUeet Cam Hill, PA 17011 J. Summary of Borrower's transaction K. Summa of Seller's transaction 100. Gross Amount Due from Borrower. 400. Gross Amount Due to Seller: 101. Contract sales rice 188,000.00 401. Contract sales rice 168,000.00 102. Personal ro art 402. Personal ro art 103. Settlement Char es to Borrower Line 1400 10,009.18 403. 104. 404. 105. 405. Ad ustments for items aid b Seller in advance Ad ustments for Items a1d b Seller in advance 108. Cit !town Taxes to 408. Clt /Town Taxes to 107. Coun Taxes 11!01/10 to 01/01/11 81.88 407. Coun Taxes 11/01/10 to 01/01/11 81.86 108. School Taxes 11/01/10 to 07/01/11 1,027.87 408. School Taxes 11/01/10 to 07/01/11 1,027.67 109. Sewer 4th QU. 11/01/10 to 01/01!11 78.25 409. Sewer 4th Qtr. 11/01/10 l0 01/01/11 76.25 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 179,194.94 420. Gross Amount Due to Setter 168,185.78 200. Amounts Paid b or in Behalf of Borrower 500. Reductions to Amount Due Seller: 201. De osit or earnest mono 5 000.00 501. Excess de oast sea Instructions 202. Princi al amount of new loans 185,767.00 502. Settlement char es to Seller Line 1400 11,495.00 203. Existin loans taken sub'ect l0 503. Exlstin loans taken sub'ect to 204. 504. Pa off First Mortgage 205. 505. Pa off Second Mort a e 206. 508. 207. 507. De osit disb. as roceeds 208. 508. 209. Seller Assist 7 547.94 509. Seller Assist 7,547.94 Ad ustments for items un aid b Seller Ad ustments for items un aid b Seller 210. Cil !town Taxes to 510. CI !Town Taxes to 211. Count Taxes l0 511. Coun Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. Escrow fnherilance Taxes to Communit Land Escrow 37,800.00 218. 518. 219. 519. 220. Total Paid b /for Borrower 178,314.94 520. Total Reduction Amount Due Seiler 56,842.94 300. Cash at Settlement fromfto Borrower ~ 800. Cash at settlement tolfrom Seller 301. Gross amount duo from Borrower line 120 179 194.94 801. Gross amount due to Seller Ilne 420 169,185.78 302. Less amount aid by/for Borrower Nne 220 ( 178,314.94) 802. Less reductions due Seller (Ilne 520) ( 58,842.94 303. Cash Q From ~ To Borrower 880.00 803. Cash a To ~ From Setter 112,342.84 The undersigned hereby acknowle gate eipt of a ~ mpleted copy of th(s statement & any attachments referred to herein Borrower r'1/ L. ~v R Wald C. Beers, Jr. Seller Estate f dale EzSc ~ 7~ /~~ ~., ~j j//I`/ Tlra PuhGc Reporting Ourden ror Ihb rnnecUon of Nlormatfon to asYmaled at 3S minutes pu roaponse /or eoaecWrp, redaNrnp, and repaAinp the date. This agency may not coAecl Nb informs W n, and you are not required to complete this form, uMssc q displays a currently veW OaA9 conlyd number. No conlidantle6ly K assured; Uds dkdosws W mandatory. /his 4 desgned b provide the partles to a RESPA covered bansa Won with (nrormaUon during Ne sattlemmt process. Page 1 of 3 HUD-1 (BEERS.RONALD.PFD/10-526/9) L. Settlement Char es 700. Total Real Estate Broker Fees $ 9,800.00 Peld from Paitl from Divisron of commission (1 ne 700) as follows: eorrowere sclera 701. 9 800.00 to THE O ESTEAD ROUP I Puna: el funs: et 702. t0 Settlement SrNemenl 703. Commission id at settlem n 9 800.00 704. 705. Buyer Commission to The Homestead Group, Inc. 300.00 800. Items Pa able in Connection with loan 801. Our on ina[ion char a Includes Ori ination Point % or $ 4,536.97 from GFE #1 ,-~s' a ',. , ' ; ~'Fc~ .,.; 802. Your credit or charge (points) for the specific Inlarest rate chosen $ -3,836.97 (from GFE #2) : ,,,~ ~: • .~ W ~: ',:,~ , 803. Your adjusted on ination charges from GFE #A 600.00 „ , . f; 604. A raisal fee to Central Penn A raisal from GFE #3 425.00 ~~ - ^~-fir 805. Credit Re ort to CREDCO from GFE #3 18.00 ~ - _ 806. Tax service to (from GFE #3) - 807. Flood certification to CORELOGIC (from GFE #3) 6.00 ,. 808. from GFE #3) ~-. ~. ;J 809. (from GFE #3) ~,;: 810. (from GFE #3) ~ ,~ 811. (from GFE #3) ~ ~ 900. Items Re uired b Lender to Be Paid in Advance 901. Daily interest charges from 11/01/10 to 12/01/10 30 @ $14.190000/da (from GFE #10 425.70 ~,";`, •° ^~%{ 902. Mort a e insurance remium for months to De t. of HUD. from GFE #3 3,647.70 ' ~ + =: 903. Homeowners insurance ar 1.0 ears to late Farm Ina. from FE 1 448.00 ~ ~ • -~• 904. from GFE #11 r:~~, Y"-•;.i, 905. (from GFE #11) `t ~;; 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 796.01 ?~,t ~"~`~ ~- •~~~ ;` omeowne s nsurance moo s er moot 1.9 ,, _. _ _ 1003. Mort a e insurance months $ er month ' { _ - 1004. Property taxes $ ~ .~'., ;.. ~x,; .:tit=~:ar'.~:'a ' County Taxes months @ $ er month - „ ~ .._,- : ~ ;~ Assessments months $ er month ~,,3; • _ 1005. $ ~=.:i:x.°;~~,~ao~ ,+S ~'~'` ~xr~ i 006. months @ $ per month $ 1007. Counlyffownship Taxes 10.000 months ® $ 40.81 per month $ 408.10 1008. School7axes 6"000 months @ $ 129.16 per month $ 774.96 ~~,~{~~~i~;t `: •-'`~- = ,.'', 1009. Aggregate Adjustment $ -499.04 sr:`e~t+'k~.£gi=a:!ic`~~ ~~~15~~cti.'t."~.= 1100. Title Char es 1101. Title services and lenders title insurance rom ) 1,498.75 15.00 1102. Settlement or closin fee $ °. 1?s ~,".. ~ ,~ 1103. Owners title insurance to COMMUNITY LAND TRANSFER INSURANCE ACC from GFE #5 10.00 1104. Lenders title insurance to MMUNITY LAND TRAN FER IN N A T. $ 1,188.75 ~.~F ~" ;:: ~ ~.; _~; 1105. Lenders title alit limit $ 165 767.00 ~ •.,;,,~ • r~.. ~ _ _ , r, +,; 1106. Owners title olic limit 188,000.00 +; ~ .'~_ t 107. A ant's ortion of the total title insurance remium to Communil Land Transfer LLC $ 1 054.90 ~; -• - ,,,;;;T a, ,~- 1108. Underwriters ortion of the total tllle Insurance remium to COMMUNITY LAND TRANSFER INSUR $ 143.85 ~ . ~ ~`ri•,: ;: ;,s „ ~ .;,F~;, , ;.~ 1109. 1110. 1111. 1112. 1113. 1200. Government Recording and Transfer Charges 1201- Governmen! recordin char es to Recorder of Deeds Office from GFE #7 154.00 ~:, `;;rL`'`:} ~5.:3~ 1202. Deed $ 62.00 Mortgage $ 92.00 Releases $ Other $ :,i*~::.F.~ :~ . 1203. Transfer taxes to Recorder of Deeds Office (from GFE #8) 1,680.00 ` ~E~S~.~~ gig; , 1204. City/County tax/stamps $ 1,680.00 $ ~ ~; ~'-. ~,~"' = ~' 1205. Stale tax/stam s $ ~ _,.r; - ' 1 680.00 1206. 1207. 1300. Additional Settlement Char es 1301. Re uired services that ou can sho for from GFE #6 ~,,;:.~.,,.,•.,~-^ 1302. 1303. 1304. 1305. 1400. Total Settlement Char as enter on lines 103, Section J and 602, Section K 10 009.16 11 495.00 , .,, ..y ,..y. , ... ,.........,.,. ,..,y., ,...... w..,..mwy. .. arya v.. npwwu ,.Vl v. pay. S a u.s mo p.y. s~.wm.~u. V Community Land Transf ,LLC, Settlement Agent Certified to be a true copy. Page 2 of 3 HUD-1 (BEERS.RO NALD. PF D/10-526/9) REV-1503 EX+ (6-98) t~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Adele E. Schmidt 21-10-1017 All property jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) lnvesCo PERIODIC STATEMENT July 01, 2410 - September 30, 2414 oi~iiii~i~si~ii~iiiia~~iiisiii~i~ >D756D 6588D23 OD1 DD8116 ADELE E SCHMIDT 27 BRAGG DR EAST BERLIN PA 17316-9342 ~~~ ' ....._ ............... ... _: .......:r _.........,..... ,: , .........:...,..........., .,:.... ... ,z.: , ......_......_ _i G.....li F } f I .fl ... ... .........._.. .................... ....... ..._...... :.._..;._.~.:::r:i:.:' ::'.:y;~..:.a_._: _.__.._.........rrl. .... .........:._. ...,E : r.:,..:.r_,. ` .. _ , a._..._ :i :. r~::::r~::::::s:;::;::s:'.`.,3. , .~ ~. ...._. r ~ ... _...r.__. _ i,.--a .. ...f .... ..... ... P .: ~i1 .vJ,.....:.a_.. C F.L......_: 1 i. 1 r.J.:.,_.. 3:..._... .... ,.. I Ci:.._.,..... x.......+ .................a.~i...._....:. __ ...~ 6 ,,. a ....3.rt__ .,.u_..u~l viii ~i. ~I. ~: . ...........:}- :............}~f ~ .._.,.............................. .._ .._.. .._..r:,: ....;, . .. ......:. ................ ....:.:.:.a•. .•;.;;::...:r.:ri::i:i?:-:ii' -::si:i=.i !i:91 i9tYi .iki:ii :i,ru:i: ~ ~--.~.,~...._..... __, ._:.....,._:._ .......:...... . _:.:,t,.~..__...::::::::,::::•tr:;::,::4:;._• ,:~ ,i,=~:e.:ifeE='i='c:5eisdif~:ci.i:!;i}~r13_ ;::•;s:r:::ii'iF.r.:.~:~. .. .. ,~;.:..i~_iii'ii~::.e=_7 :.. .,...:. ~... ...,u ..k. ...;k;.. ,. it __....._.,.;,~.._..:r:::: ~::•:~Qii:~ol(tiil~ t., i{i!e .. ~ ~ , ... ~ .r ~ ' .. ~~: ~ ....: _.... ... .. ~ i'! :.E 'i: 'i ci~ l:r i, ; ! .. 4 :3' .......... ..............:::~::~ I , __-__-- _ - - ~;:z~~->`~~~'~: €'a r ' _ ~ ~• '~ ~ ~ __ 'i_F';9: •. _ :..w~ .,. i .9'' :.,kj,ia;;yl::m'.-iy;;tt;-•~:, th.,a ~ ~' ~i~ %n"ii'iri's~:f!nir'i ~'n,. I ~fl•? i f . iiP:4:i?iiG~1II i.. !(,~ 4}~ ~},j i i~ ~~. ;fi:;n;_.:~~' :. jj~. i k; ; ,;~;1;,~i:~;r " ; ~ I i ~~i M r tnf rmation on Your Invesco~"' Account: Fo o e o ._... ,,;....... ... .... 1• ~: b..... .k'r.'_.8e,_i ,:::Ti'5~-:;:::::~::::.!i=ei-::7.i3°_aP.lie=e;:..ra:-::•':'.i~::n},.. ........._. ...._:. Value on Ol3/30J10 ~ : .ul:Scri :tea F .:: i}.i.. C:t@Gi?,i;r. ,i: it l' , ~ ~~~g57,17 • Contact Your Financial Adviser Additions ~~ ~.~ • Visit us online at www.invesco.com ' ' Withdrawals ~'~ talk to a Client Services Representative at • $4 ~ 840-959-4246 from 7:40 a.m. to 6:00 p.m. CT __ Exchange In • == Exchange Out $4•~ '~" Transfer of Shares $0.40 .._ Change in Market Value $5,540.82 ~ Value on 09~I30/10 X60,497.99 Tired of finding rcxam to file these statements? Then go paperless with ease using e-delivery and get your Invesco statements, daily transaclion confirmations, tax forms, prospectuses and annual and semianrwal reports online via email. You'll still receive aA the same service and shareholder information you've come to expect, just with an electronic servioe that's alt about EEEEs: environmentally friendly, economical, efficient and easy. Once you sign up, we'll email you a link t4 access your documents, and you'U no longer receive paper copies by mail. To enroll, please visit invesco.com/edeliveryaod login to your account. You can cancel the service and resume receiving paper copies at any 6me by going to the same web page. Information is now available on invesco.corNus regarding the factors considered by the Boards, including all of the Independent Trustees, of the Invesco funds (formerly known as the AIM funds) in renewing the funds' investment advisory agreements and sub-advisory agreements (if applicable), and the independent written evaluation of the reasonableness of the funds' management fees prepared by the funds' Senior Officer, who is independent of Invesco and Invesco's affiliates. Your Financial Adviser: MICHAEL C BANWELL FINANCIAL NETWORK INVEST CORP 5 KACEY CT STE 101 MECHANICSBURG PA 17055-9220 PHONE: 717-766-4551 , You are 100% invested in INVESCO VAN KAMPEN GROWTH AND INCOME FUND-CLASS A £3116-Roll You are 100% invested in DOMESTIC EQUITY FUNDS These Invesco funds are also available. / TARGET MATURITY FUNDS / TAXABLE FIXED-INCOME FUNDS / ALLOCATION SOLUTIONS / INTERNATIONAUGLOBAL EQUITY FUNDS / TAX-FREE FIXED-INCOME FUNDS / SECTOR EQUITY FUNDS Important This account statement re#lects financial transactions for tha period indicated. CarefuNy review all of the infom~ation to verify the accuracy of the transactions. Please notify us immediately if theca is an error. If you fail to notify us of an error within 34 days of this statement, you will be deerc~cf to have ratified each transaction. 07560 65SSOZ3 015920 025706 00001100002 (~ U ~L a Y O >. 0 a .~ U N U C (~ O M O M ~ r O r lf7 O cfl o0 QO N ~ O CO a0 1` N M M N I` 00 N d' M M M M N CO CO f` CO M O ti ~ O ~' ll~ M CD N ~ ~ Oo~~ Qo~~- z a O U Z Q cn ~ Z J Z V Q wZU ~ ~ ~ - w W LLi Z Z U Z Q Q zp~~ J ~ W W O ~ ~ ~ Q~F-E- CO In lf) M O ~ O M d: ti N lC) CO ~ O O N ~ ~ O O O O ~ r- M N ~_ U X 'd' 1~ ~ eh M ~- N QO ~ M M r- M I` f~ O CO 00 00 O N o0 QO N _~ f~ > U a` Y ~ GO O CO 00 M N CO ~ M CO O d0 00 N M ~ N O~ ~ M 0 0 0 r- ~ 00 ~ l1') ~ N 00 d: M ~ 1~ ~ r ~-- CO 00 M ~ CO CO N O ~ CO N O d: M I` d' In 00 GO 00 M M M I~ cD 1` c0 ~ M O M o0 cM O ~t cD N O tom- O N CO ~ N N 00 N~ ~ M M N M Q O M 00 CO I~ O O N N ~- ~ ~- QO N tt N C O N CO 00 O~ ~ ~ ~" O E M 00 00 ~t M O M M O M M CO ~ M M M ~ CO ~ M M M ~ ~- r- ~t ~ ~- N O O N N O ~-- CO ~ ~ CO N N O E M O ti ct ~ d' CO ~- O I` M o0 ~- ~ I` CO O O M e- ~ O CO X 0 0 QO 00 I~ N 00 00 N N E lf~ d0 O CO d' N to ~ O~ Qj d' M r- lf~ CO Op ~ ~ ~ ~ ~ CO ~ ~ In CO O ~- M ~ M M CO O N N ~ ~ ~ O M~ ~ •- N ~ N r- N ~ ~- ~ r- ~ x a >X (~ JOmI-~pQ c! QO ~ Q Q U 0 ~ c a .~ p 7 U N C N U X ~ X X X C7~tip p~~Q2C~w pti.w2~~~ X~ X x X x~ X ~~mw~~~m~~>~ ~z0=a~Qt-F-~-w~ ~ - J ~ ~J o U p ~ -~- J ~ fn U H U Z ~ JJ Wp J ~'J J ~VU ~lL U Zw F-~ ~ - Jp~ Z~ ~ p~ Z p U~~ p p m= ~~ Q w w~ ppp ~>-~~' I-ZQ ~~ U~ JW p ~pW >'ZZ Jm pjH O~ ~m >W F-u-QZ ap~~H I-~Z ~~ ~~ ~C~ ~ ~ a ~ VO ~ ~ p O p ~ Q p ~ Y w >- O OU ~ ~ ~ j U~ Z U~~?~= O O? Q Q cn J~ Z Z Q (~ O - C~pJ= ~Zw~wOw~F-~U~~oa> ~ o r* Q cn * Q r* r r r Z Q p~~ ~ * r cn~ J= ~ w~~o~~wo C~ ~ wF-cn r z~Qz~pp~p~--w~ r ~- r Q ~~ r -~pOO-~~O~-mW~ r m~F->*n~W WZ~ Z ~ W Q~ Q ~ J Ll1 * r I- Z J Q YV W~~(~2(n W F-* Z r Um>(n HIS-Z~cj~WV~=~=Z Z~? r U ~ZUQ~ UU~~xOap~azpu'xQ_i-w Q c~wwo0 a . ~ a. p(nUQW ~pw~~ J>~ ~~(l~~ZZ~~ QQZatS~tS~I-~Q~QW~~Z2 ~~~0=000I¢it¢i v v v Q z w~ Z Q~ O~ C~ W O w z~ ~ z ?~~ cn w C~ ~- a~ p m Z Q~~ w w p~ z w~~~ J J JW W~2pW ~J~-Z(nH>~~ W W JJ O~~~OO~pOOQQQ~wpa.~~v~ J~~~ww QQQQUppp~c~=~~~~zo>a~Q~~~~~ 07 l!7 00 ~ M~ M M M M M N d7 O O ti `~' ~ CD ~ M r r O d' '~t f` OD i~ CO ~ Lf~ CO CO N i` ~ ~ .'- CO 00 CO ~ O U7 M I` f~ f~- ~' I` 00 ~-- f~ O ~ I` CO M M ~ ~ ~ M d' ~- N O CO ~ O N O ~- 07 M ~ tf') I` •- ~ lf~ N ~- CO M O to O O O ~ O CO CO O CO lf~ r- N ~ M 00 CO r- M~ ~ N M N lf) N l!') I~ O d0 In O N N CO ~ N r lf') ~ N N M ~- .-- N N REV-1508 EX+ (6-98) ~, SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Adele E. Schmidt 21-10-1017 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Citizen's Bank; Checking Account No. xxxxxx2014 5,786.23 2. Citizen's Bank; Checking Account No. xxxxxx9513 58,352.92 3. Citizen's Bank; Money Market Account No. xxxxxx8266 147,854.17 4. Member's 1st; Savings Account No. xx523-00* 6,566.76 5. Member's 1st; Certificate of Deposit No. xx523-41 * 52,171.89 6. Member's 1st; Certificate of Deposit No. xx523-56* 15,377.03 7. Member's 1st; Certificate of Deposit No. xx523-57* 39,721.69 8. Jewelry 370.00 9. Rosenthal China (pompadour pattern - 54 piece set) 175.00 10. Crystal stemware 115.00 11. Miscellaneous plates, shot glasses, and steins 10.00 12. China tea cups and saucers; miscellaneous plates 5.00 TOTAL (Also enter on line 5, Recapitulation) $ I 326,505.69 (If more space is needed, insert additional sheets of the same size) y~ ; SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner VISA ACCOUNT: Account Number Date Account Established Balance on Date of Death Joint Cardholder St MEMBERS 1St FEDERAL CREDIT LR~iION 36523-00 02/02/1984 $6,566.60 $.16 $6,566.76 None 36523-41 04/01 /2009 $52,159.80 $12.09 $52,171.89 None 36523-56 07/25/2009 $15,374.40 $2.63 $15,377.03 None 36523-57 10/05/2009 $39,715.68 $6.01 $39,721.69 None 4672090000265124 07/24/1997 $0.00 None ME BERS 1ST/FEIDERAL CREDIT UNION Leigh-Anne Stallings Lending Insurance Support Assistant November 19, 2010 Estate of: Adele E. Shmidt Date of Death: 10/04/2010 Social Security Number: 065-30-6911 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800} 283-2328 wwwmemberslst.org November 17, 2010 Dear LutherE Milspaw, Jr, Attorney at Law This letter is in response to your letter dated 11 %10/2010 regarding Estate of Adele E ' Schmidt.. Below please find an account listing and account balance as of the time of death of the depositor. Account # Account Balance 6100702014 checking $5786.23 6230559513 checking $58352.92 6230558266 money market $147854.17 Should you require further documentation pertaining to this matter, please feel free to contact my office at (717) 432-9639. Sin erely, Tracey L. Moul Assistant Branch Manager Dillsburg Branch I..~ t: S }: C': a. FSF~ ~ • 91t L.? ~ - 4-K.` ~y. .L '•!.~ i~~~ R ~e`.a R~~ ~• d' ~a . - `~ U i~+ ~ ~ ".: {~! It C ~: ~. f~ Yl ~-i f"? r' ~ ]. t:! ~?~ ;~d Ja# i' 7 s !•~` 1.; ;/`~ ~'? `:1 ~~'i ~ t {.ti ~ :~. l i f'} C? ~* ir. s. % ~,. ~:: ':-" :.' {'} !l= a'• 'i9'' , r ztt ~ _ ~ f • i "~f-.c~~~~ 7 LltlL~ll~ t~f`~~Y"~~'1~ ~tt!'f~ i'::~C'~:...`~t~c'.Ji•' ~ ~..... ~~~~•?r'r'`~1 1-~t:?tCs{~ ,_ _, - .~ .Y ,.., _ f: ~ i~ =s ~~' ~ ~ r •` ~ ~~. ~'! ~' i•~ ~ ! ~: ifs f,, '. •L Ct t"1! ~~ Ca ~i l.: !' ~. ~::1'~::i. C3 ~1 ., •!••'t j''' :f C': ~ t}~'s:. }1 .i C~ ~: +~t .~ ~2 ~ ~I •t... .,s• .`. t f w~~•~ .4 ~I C~ i,7 J. ~ M / ~ L £~E ~,e }f ~I .E ,? , (j /_ .... -7e F~ ~''[{f j y~ y '~ ~ C t~ { .. a *r{'.~i {! t } •~ i i ~d M L 7 / Y ~~ rwE ~ i~ l.f ~ ~ ~. • J( J ] ` ` i I 43 R ~: •t L:/ ` .._ ~ ~ it :t '~' '~ P r" ~: ~ c ` t:.~ ~' s~ ~i 1~1 ~ f3 r" is .'~:. 1 ~f ~ ~%f ~?t• eey~!! ~ !!1 ~.,•'I it •~~ ~ ~~ t} t..t t t •tt A t..i ~, ~•J L ~I..E~~f ~:: ~ Ott m ~. s ~ :i ra ~ ~~~ ,:3 ~ ~ ~~E~ ~/ ~ ~•:, ~. .~~- u ti.-. ~~F ~F +~ i... a..~ ~..,. f~ 5 .ra r'1 ~~ .,~ ~ t ~i ~ Ifs t* 71 ~~ :a Y ~`..~,'~r ~r ~ i.::: ' ~ ~"i <~ '11{ ~' t'} t.t '~' t? r~ '~ C3' j..t r" ~ t_t ~ ~: 11 f? ~ ~ i ~ Q 1~n1 t=~ : ~ ~.t i :`'~~' :L t ? ~'1 ! ~S List of Items to be Auctioned Adele E. Schmidt Estate Jewe ~T _ ~ ~ • Man's 14 K gold 3 diamond ring ~ ~ • Woman's 14 K white gold Bennis watch • "Jade" and Pearl flower pin with gold stems . - Green scarab brace et - .__ . _--_ _ . _ Rosenthal China, Pompadour Pattern ~ • ~ 15 dinner plates ~ y. 8 salad plates • 8 bread and butter plates ____ • 8 dessert dishes • 8 cups and saucers _ • 1 vegetable bowl with lid • 2 vegetable dishes • 1 meat platter - • 1 cream pitcher • 1 sugar bowl • 1 gravy boat Nachtmann + Cristallene • 2 crystal (colored) decanters ~ ~ 7 . 5 • 6 crystal (colored) wine glasses _ . _ ~a~ ~ • 7 crystal (colored} wine hocks • 6 crystal (colored) snifters--- °r`~-T`~chumann Arzberg Tradition Plates with lace edges • 6 plates (6") numbered IV, V, VII, VIII, IX, and X L~ ~ ~3 • 1 plate (8") Kaiser China • 3 flower plates 2 List of Items to be Auctioned Adele E. Schmidt Estate (Continued) -----~ ~, Zinn-Galerie • 5 Pewter shot glasses ~ ~ • 2 Pewter mini steins • 1 glass mini stein (perhaps NOT Zinn-Galerie) China Tea Cups and Saucers • S tea cups and saucer sets ~~ ~ .y Schirridin~ China, Bavaria ~' • 1 decorative plate European Souvenirs t,;,~ • :Painted, wooden plate --Amsterdam ~ R. • Perfume Pin -Paris ~ ~ • Key Chain -Frankfurt ~ ~~ '~ ~ ~~ ~ Mini "jewelry" saber -Germany ~-----. 3 .~ i' ~~F.' RUW~ S AUGTIaN SERVICE (RH 79L) .:,:. 2505 Ritner Highway Carlisle, PA 17015 ~~ we (AU 2295L~ Bill Rowe (AU 15381J) ~ 249-1978 697-4794 .~~48-26?7 Dave`- . ~ ... -,~ ,` Ar~ction Is Action Call "Rowe" For Satisfaction .. SELLERS NAME .~ ~ ~~ ~ ^° DATE ~ ~ ~ "~ ~ ~'" ADDRESS __ ~• "'~' ~ ~..,~'~.. c .~~- PHONE ;:,~~.. ~~' ,~. °"~' '~ '"" ~,.. -OTHER ~'..~'~~; `~°'" ~~~~. ~ ~ ..~ ~ "~' -` t ~ AUGTIONEER~ % P AUCTIQN-DATE/LOCATION ~ CLERK ~ % ~~ D~SCRIFTION OF MERCHANDISE `4. ~~ F; .~ ,.. _.. F...-..~ 1~; .. _ ..:,~ _ ~ ~ ~, ~ " r I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped,as necessary to obtain bids, i certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in thin agreement:... .. _ ._ ..._._: _ _u..,. _ .._ ,~.. ,. ;~? AUCTI N SIGNATURE ~'' . " ~'` SELLERS SIGNATURE lam' ~ ~ ~.- ~, dotal Sales (Clerking Tickets Attached) $ - ~ ~~ Less Sale Expense: . ~~ -- ''~~' .~ % Commission Auctioneer $ -- ~"""`°~ % Commission Clerks $ OTHER: TOTAL SALE EXPENSE.:DEDUGTED $ ,'. .~1... ._.. r ..~1wwrw SELLERS ~ NET t, ~ ` ~, '~ ~.~ . r _~ ..~,i-1511 Et ~ ;1J-0~3) ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Adele E. Schmidt 21-10-1017 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Woodlawn Memorial Gardens (granite base for headstone) 1,276.00 2. W. Orville Kimmel Funeral Home (remaining balance due) 771.12 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 38,331.88 Name(s) of Personal Representative(s) Kerri L. McCarthy Street Address 27 Bragg Drive city __East Berlin ____ ___ state _ PA__ ZIP 17316_ Year(s) Commission Paid: 2010-2011 2. Attorney Fees: 30,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State _-_ _ ZIP __ Relationship of Claimant to Decedent 4. Probate Fees: 703.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 500.00 ~• The Patriot-News (legal publication) 318.12 B. Cumberland Law Journal (legal publication) 75.00 9. Dauphin County Register of Wills (Oath of witness fee) 40.00 i o. Cumberland County Register of Wills (filing of Settlement Agreement) 20.00 ~ ~. Total expenses/costs listed on additional page 21,271.47 TOTAL (Also enter on Line 9, Recapitulation) I $ 93,307.09 If more space is needed, use additional sheets of paper of the same size. ESTATE OF ADELE E. SCHMIDT SCHEDULE "H" FUNERAL EXPENSES AND ADMINISTRATIVE COSTS 11. Postage (U.S. and Germany) 21.65 12. German death certificate 26.45 13. Rowe's Auction Service (Commission) 236.25 14. Rt. 15 Storage (November rent) 53.0() 15. PA American Water (Final water bill) 51.82 16. PPL (final electric bill) 133.18 17. Verizon (final phone bill) 8.94 18. Masonic Village (final phone, tv, room/board bill) 1,100.08 19. American Home Shield Corp Warranty 453.0() 20. Ruppert's Lawn Care & Landscape 144.16 21. Settlement charges to Seller** 11,495.0() 22. Seller Assist** 7,547.94 Total Expenses and Costs: $ 21,271.47 * * See copy of HUD-1 at Schedule "A". t ~ j N r n ~ ~ f~D (~D N d tC~1 d ~' ~"~ ~ (9 ~ ~. ~fp 0 H S x Ix x i I°z, x x Ix I ! ° ~a ro ~ ~~~ ~~~ H '~7 ~ C'1 bd y~ -..~ ~ ~; °'^''~ W ~'g cZy o ~ . „ . , ~. ~ ~ ~ ~ o ~ ~ ~ w ~, ~ ~ ~; ~ a ~"~ ~ a . ^ ~ ~~ r y .~ v : ^: z a A ~ . ~~~~ ~~~ 1 r ~ 1 ~ , • ,_ ~~ ~ ~ z ~ ~ n n H~ ~° co `,~ ~. ~~ ~? v~r~G~ X07 ~ A ~ ~ a o ~ o ~ c~ C' ~ G~ ~ o ~ ~ o coo ° ° ~"o~~? 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Bill To: ` .E!~~•h-~. ~~/( ,[=' ~..l.~t~i~~-i-~, ,. ., ,, Professional Services, Facilities and Equipment, Automotive Equipment $ . '` -~ ~.- `~ Merchandise Selected Special Charges Cash Advances Grrave Open/Close .................................. Cemetery Eq 'pment .. .......................... . Newspaper ~ ~°-~~~~"Iv- - ........................ Newspaper ....................... . Clergy ............................................... . Organist ............................................. . Soloist ........................ ................... Death Certificates~;~(tx? ~ ~`} .................... Hairdresser .......................................... . Flowers .............................................. . Engraving .......................................... . Misc .................................................. Misc ................................................... Total $ i '7 ~~` ~ ~"' t.~ ,; ~- ~~: , $ ;. TOTAL, OF ALL SELECTIONS PAID (::7~~tE t~r~>; ~ ~~ c:~ BALANCE Date Paid in Full A ~ % U Check # ~ ~' ~~ r.~.'; ~- G Q ,. . $ /~- ~, ~~ $ Y `~. i ;~ f $ jL ~~7.;`~~ v~f RT 15 SELF STORAGE 845 NORTH US HIGHWAY 15 DILLSBURG, PA 17019 Phone :(717132-3231 Date of Invoice: 10/17/2010 ADELE E SCHMIDT %KERRI MCCARTHY 27 BRAGG DRIVE EAST BERLIN, PA 17316 Dear ADELE E SCHMIDT, The rent for your storage room(s) is as follows: INVOICE Room # Payment Due Date Current Balance D46 11 /1 /2010 $0.00 Next Due Total Due $53.00 $53.00 Balance Due: $53.00 Please mail your check promptly to avoid any late charges. Payments received 1 days after the due date are considered late and subject to a late fee of $10.00. Thank you for your business. DEREK MARTIN RT 15 SELF STORAGE Account Summary Rccm(s) # Date Of Last Payment Amount Of Last Payment Monthly Rent ~~ ~. ,~ ~G j G, Of ~~ ~ , *~ . Item Amount D46 Rent $50.00 9/23/2010 Other $0.00 $53.00 Late Fees $0.00 $50.00 Fees $0.00 Services $0.00 Insurance $0.00 Taxes $3.00 Balance Due $53.00 CG~~G~ ~o~q~ Customer Account Information Billing Summary For Service To: i\Ars A E Schmtdt ----------Prior Balance-----------•------------ _ (~ -~--- 8 200 Glenn Rd Prior Water Balance $13.9 ! Account Number: 24-0653742-9 Prior Balance Other ~ $5.50 Premise Number: 24-0385881 Payments prior to Oct 22, 2010. Thanks! . 00 Total prior balance, Oct 22, 2010 19.48 Billing Period & Meter Information ---------Current Water Charges---------- Billing Date: Oct 22, 2010 Service Charge i 13.00 Billing Period: Sep 18 to Oct 19 (31 days) Water Volume ($.007890 x 200) ~ 1.58 Next reading on/about: Nov 16, 2010 STAB PAWC Water 0.45% . 07 ~ Rate Type: Residential DS1-PAWC Charge 1.85% ! . 27 Total water charges, Oct 22, 2010 ~ 14.92 Meter readings in current billing period: ----------Other Current Charges---------- Meter Number N000184740 is a 5/8-inch meter. Customer Protection Water Line 5 . SO i Present-actual 358700 Late Payment Charge ~ . 21 Last-actual 358500 Total other charges, Oct 22, 2010 j 5.71 Gallons used 200 .~-----------------• ----------AMOUNT DUE I $40.11 Water Usage Comparison d d it ~~ ~i f ~~ 1 ~ `' ~ j A~ Monthly usage m hun re ga ons. :t 0 9 1'~ ~"'" ~~ 6 G rr~~`I~t U ~ r Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 1 i/1s/i0 wilt be subject to a 1.50% penalty. * The due date pertains to current charges only. Any past due balance should be paid immediately. * Approximately 3.90 percent or $.58, of State taxes are included in your current bill. * Effective January 1, 2010, the State Tax Adjustment Surcharge (STAB) increased from 0% to 0.45%. * Residential customers: Save time and manage your account when it is most-convenient for you. On My H2O Online, you can check your balance, pay your b~11 or even sign up for automatic bill payments. Sign up today at amwater.comlmyh20. * Effective October 1, 20}0, the Distribution System Improvement Charge (DSIC) increased from 0.96% to 1.85%. The DSIC funds the replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours} Visit us on the INTERNET: www.pennsylvaniaamwater.com RAW tt)OAM411 IAM4 121 Qt~0678/000Ei78 PCMOKZ TM609 t23 AtM 31385 O N O J F M A M J J A S O 2 v c n b a t a ~ ~ u e ~ 0 y 9 p 0 For Service To: Mrs A E Schmidt 200 Glenn Rd Account Number: 24-0653742-9 Premise Number: 24-0385881 Blflfng Period & Meter Informat/on Billing Date: Nov 04, 2010 Billing Period: Oct 19 to Nov 02 (14 days) Next reading on/about: Nov 16, 2010 Rate Type: Residential Meter readings in current billing period: Meter Number NOOOi 84740 is a 5J8-inch meter. Present-actual 358700 Last-actual 358700 Gallons used 0 Water Usage Comparison _ ~,A(111H'1L/_LLSOaA t~l~llt~'1I~rCr1 n~llnnc Monthiv usage in hundred gallons. ^: ~N°~,~~ I U t I ~ << < ~~ 0 Messages to you from Pennsylvania American Waiter This is your Final Bill for service. ~t has been a pleasure serving you and we hope we may ag-aln have the opportunity in the future. Approximately 3.90 percent or $.24, of State taxes are included in your current bill. * Effective January 1, 2010, the State Tax Adjustment Surcharge (STAS) increased from 09o to 0.45%. * Residen~al customers: Save time and manage your account when it is most-convenient for you. On My H2O Online, you can check your balance, pay your bill or even sign up for automatic biI! payments. Srgn up today ai amwater:com/myh20. * EttecGive October 1, 2010, the Distribution System improvement Charge (DS1C) increased from 0.96 to 1.85%, The DSIC funds the replacement of water dstrbution tacil~ties. 002386!002386 N(;NrtFiM IRtiUtl lf3 Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours} Visit us on the INTERNET: www.pennsylvaniaamwater.com iaAVd100AAA429U1AA4301 A1M 14765 ~'If~ // --~-------Prior Balance---------------------_ Prior Water Balance $ 29.11 Prior Balance Other $11.00 Payments prior to Nov 04, 201D. Thanks! -40.11 Total prior balance, Nov 04, 2010 .00 ----------Current Water Charges---MNM_ Ser+rioe Charge 6.0 7 STAS PAWC Water 0.45% . 03 DS! -PAWC Charge t .85% .11 Total water charges, Nov 04, 2010 6.21 --------Lather Current Charges---------- Customer Protection Water Line 5.50 Total other charges, Nov 04, 2010 5.50 ----------AMOUNT DUE --------------------- $11.71 o s a F a A a v ~ u e~ o v c n~ r ~ y n~ g p t v .~~--"'"`~ Page 1 :~,:. .~:..r: PPL Electric ~~ 39770-75007 Utilities `" ..~~:. Electric Summary Page Service Balance as of Oct 22, ZOlU $'78.69 For: Chargges: ADELE SCHMID7' T.'Otar.E'PL Electric Utilities Charges $31.93 200 GLENN 12D CAME' FE1LI, PA 17011 Total Charges $110.62 Y.. .~a. :• .5~.:. :'T:. ~~`.' ,JR •'~ ~' ~•~ ~~ :~.• •'~~ . .~... .. .. ... .: • ... .... ..........a ......~ .... .... ••' ~ Account: Balance $110.62 Questions about this bill? Please Lj ~~! contact us b Nov 9 ~ at 1-800-342-5775 (1-S00-DTAL-P L) r+ ~ ~t n } ~ or write to: Customer Service 827 Hausman Rd. 1 ~;~ ~"~~ t ~ r y " ~ ~' `4~ Allentown PA 18104-9392 www.pplelectric.com Electric Use This graph,shows your electric use over the last 13 months. Types of 1VCeter Readings: Actual - Adjusted Estimated Customer 48 40 32 24 16 8 0 KWH -Average Per Day Meter Reading Tnformatiun Meter #79599441 Oct 22 Actual 249 Sep 28 Adjusted 50 24 Da s KWH Billed 199 Average -Oct 2009 2U1U T nperdture 55F 57F KVVH Per Day 23 8 Yearly [Jae: T otul Average Use Monthly Nov 2008 -Oct 2009 10481 873 Nov 2009 -Oct 2011) 7593 633 Other important information on back ~ c t~ 099 ONDJFMAMJJASO 2t)U9 Months 2010 ,~ Page 1 PPL Eiectrie pp - :~f~~i_;;~~_=::_::: ut1~It1~S ~° 39T7O-75007 Electric Summary Page Service Balance asp of Nov 1, 201{1 X78.69 For: f'har es: aut.Lr~ scx~tltn~ 'i'ota~~PL Electric IJiilities Charges $-SG.13 2(>D GI,F,NN RD CAMP HILL PA i~~~t ~ Total Charges ,~ $22.Sfi .:..: i::.:.:~:.:: Tinal Bill ....... .__ : -.: -: ' ...::....:. .:.. - _- - ~: ~~: .. ... . ......... Account Balance $22.5ff Questions about this bill`s Pl~se contact us b}}~ Nov 22 ~ vil at 1-800-34Z-5775 l (1-800-DlAI~-PI'L) Customer Service ~7/~ 827 I~ausman Rd. Allentown, PA 18104-9392 www.pplelecitic.com V Electric Use his graph shows your electnc use over the last l 3 months. Types of lYieier Readings: Actual - Adjusted I?stimated Customer 48 40 32 24 16 8 0 KWH -Average Per Day Meter .Reading Information Meter #79599441 Nov 1 Actual 32fi Oct 22 Actual 249 1 U Da s KWH Billed 77 Average -Nov 2009 2010 't'empperature SOF 55F KWH Per Day 23 8 Yearly Use: Total Averaggi~ YJse Monihl Dec; 2008 -Nov 20(19 10481 87~ Ue.~; 2009 -Nov 2010 (ii)26 577 (.)ther important information oa back ~ __..--_____.._..__---._--....~~------------- i{1 (J lit {111t~A1~l. . n~~i•~'.-~:'s: :....-. ..: .-..- --~~_-..._~----.._-..~.._-- ~w_---_~.. c~~ -~ i-o ND3FMAMT7ASQN 2009 Months 2010 .r , .. ~~` Account Number Due Date Amount Due ,,_ s ~'- 717 732-2750 .609 05Y Upon Receipt,, $8.94 ~_ ~~ ~ - ~ --- , ,~- - - Amount Information r~' _ .~ V C: Statement Date: 70/16!10 ' ~~ ~ !~~' 1 ~ ~~~-'" MRS E S(:HMiDT ___-- .'~ ~ : ~ ~//~1 JV v (! Phone: 717-732-2750 l„/~'` :, , ~ jX ~, r ~~a t ~tnrtzon Nevws Get More, Save More Call 1-866-373-7758 to make sure you're getting the best Verizon services at the best value -from pftone and Internet, to N and money-- saving bundles. Together we'tl evaluate your current services, and find ways io save you even more. Moving? Catt 1-866--UZMOVES Call 1-866-VZMOVES to bring the power of the Network to your new home. We can connect your TV, Internet & phone quickly-maybe before you're finished unpacking. Plus, we have Bundles to fit your needs arx! you- budget. Service availability varies. Vernon Foundation Looking for homework help? Help with school projects? Thousands of FREE educational resources are available for students, parerns, and teachers at Thinkfinity.org Account Summary Previous Balance No Paymern Received Balance Forward New Charges Current Activity Taxes, Fees and Other Charges Total Naw Charges Amount Due -Please Pay Now Revised Final Bill Thank you tsor !offing us serve you. Questions about your bill or service? $33.21 $.00 $33.21 cl(~rl~ ~ o~q7 /j'j~/ -$17.64 -$6.63 -524.2'! ai8.94 ~ ~-- f- ~-,, `~, ` L, J ~~ r t ` ~ t .. ` ,~.~~. ` ` 1 -` -` +:,~ ~ 1 ~~ti. t! View your bills in detail at vodzon.com or call 1-800-VERIZON (1-800-837-4966). Enter your ten digit number 717-732-2750. Use 609 if asked tar the three digits following your account number. Use Quick Codes! - Enter 4PAY (4729) to pay bill, Enter 46AL (4225) for balance. .~aGE ELIZABETHTOWN .iC DRIVE ~tTHTOWN, PA 17022 StND TO: KERRI MCCARTHY 27 BRAGG DR EAST BERLIN, PA 1?316 9/30/10 STATEMENT PAGE 1 OF 2 REMIT TO: MASONIC VILLAGE ELIZABETHTOWN 581 FREEMASON DRIVE FINANCE OFFICE ELIZABETHTOWN, PA 17022 ~ 7243~SCHMIDT, ADELE E ~ 10/31/10 ~ I,091.40 ~ _ Please return above portion with payment to Masonic Villa es • - ~ ~ ~ 7243 0/31/ 0 4 Dafe D~scri ton ; Quantit Rate : Char es .: ,.a.:mentslAd' Balance PAYMENTS - - --' '~ 09/16/10 Payment - Thank you! 511 7,803.30 7,803.30C ACCOUNT: SCHMIDT, ADELE E 22017 CURRENT CHARGES 09/01/10 COINSURANCE - BUMETANIDE - UD 5.44 09/10/IO COINSURANCE - CITALOPRAM HYDROBR 4.73 09/13/10 COINSURANCE - HYDRALAZINE HCL 7.00 09/lb/10 COINSURANCE - CITALOPRAM HYDROBR 6.26 09/17/10 COINSURANCE - OMEPRAZOLE - UD 7.00 09/17/10 COINSURANCE - DILTIAZEM HCL - UD 7.00 09/17/10 COINSURANCE - METOPROLOL TARTRAT 4.58 09/17/10 COINSURANCE - LEVETIRACETAM CSAM 7.00 09/20/10 COINSURANCE - PROCHLORPERAZINE M 7.00 09/20/10 COINSURANCE - MIRTAZAPINE SOLTAB 7.00 09/20!10 LORAZEPAM INTENSOL 30 47.20 09/20/10 COINSURANCE - TRAZODONE HCL - UD 4.03 09/23/10 COINSURANCE - HYDRALAZINE HCL - 7.00 09/24/10 COINSURANCE - NORMAL SALINE 7.00 09/28/IO COINSURANCE - AMOX TR/POTASSIUM 7.00 09/28/10 COINSURANCE - LEVETIRACETAM - UD 4.81 09/29/10 COINSURANCE - LEVETIRACETAM - UD 7.00 09/29/10 COINSURANCE - OMEPRAZOLE - UD 7.00 154.05 ACCOUNT: SCHMIDT, ADELE E 22015 CURRENT CHARGES 09/30/IO TELEPHONE-FIXED CHARGE 30 24.50 09/30/10 CABLE TELEVISION 30 43.00 09/06/10 OXYGEN CONCENTRATOR RENTAL 6 20.58 09/02/10 CALCIUM CARBONATE - UD 16 8.00 09/02/10 THEREMS-M 16 5.44 09/13/10 MIRALAX 238 12.93 ACCOUNT REPRESENTATIVES CAN BE REACHED AT C717) 367-1121. JOYCE DEITZ-- EXT 33321 RETIREMENT LIVING--PENNY WITMER--EXT 33325 p~~I~ ~`9 ~~ ~~~ 5~~ ~~'E OF i'ENN~ PLEASE PAY THIS AMOUNT NOTE: Charges and payments not appearin on this statement wilt appear on next month's statement Thank you! O 72 3/31/10 1 091.40 - ~ DF.L ,. .:;bescri :trop ~ :. Quant[t . ~ :.Rate char es > : a mentslAd < Balance: CONTINUATION J9/13/10 UROLOGICAL 1 2.95 2.95 09117/10 CALCIUM CARBONATE - UD 13 7.28 09/17/10 FERROUS SULFATE - UD 13 5.98 09/17/10 THEREMS-M 13 5.20 09/22/10 ROUND TRIP 11-25 MILES 1 38.00 38.00 09/25/10 UROLOGICAL 1 .68 .68 09/30/10 TELEPHONE- LONG DISTANCE 1 9.81 9.81 184.35 ADVANCE CHARGES 10/03/10 Room and Board - OCTOBER 3 251.00 753.00 753.00 f~7> ~ ~~' '1 _ ;~ t _ ~ t r , , ~ ~, , ~ ~ ~ i{ _ ~,~ ~~ ,( «~~/~ ~ i ! ACCOUNT REPRESENTATIVES CAN BE REACHED AT C717) 367-1121. JOYCE DEITZ-- EXT 33321 PLEASE PAY THIS AMOUNT~~ RETIREMENT LIVING--PENNY WITMER--EXT 33325 NOTE: Charges and payments not appearing on this statement wi11 appear on next month's statement Thank youl MASONIC VILLAGE ELIZABETHTOWN ONE MASONIC DRIVE ELIZABETHTOWN, PA 17022 SEND TQ: KERRI MCCARTHY 27 BRAGG DR EAST BERLIN, PA 17316 ~~i~ ~i ~~ c~ c+ ~ ~~. ~y~~lO~'c•~. or r>~~~~r 10/31/10 STATEMENT PAGE 1 OF 1 REMIT TO: MASONIC VILLAGE ELIZABETHTOWN 581 FREEMASON DRIVE FINANCE OFFICE ELIZABETHTOWN, PA 17022 ~ 22015~SCHMIDT, ADELE E ~ 11/30/10 ~ 8.68 Please return above portion with payment to Masonic Villa es • ~ ~ ~ 0 .6 Date.: .,. ::-:: Descri tion ~-' ' , Quantit : ` ~ ~ Rate :: ~ ' Char es : ; a::m.~ti~alAd :Balatti~e '- PREVIOUS BALANCE 1,091.40 PAYMENTS 10/30/10 Payment - Thank you! 0998 1,091.40 1,091.400 CURRENT CHARGES 10/04/10 TELEPHONE-FIXED CHARGE 4 3.16 10/04/10 CABLE TELEVISION 4 5.52 8.68 ACCOUNT REPRESENTATIVES CAN ~E REACHED AT 0717) 367-1121 . .JOYCE DEITZ-, EXT 33321 PLEASE PAY THIS AMOU RETIREMENT LIVING--PENNY WITI!~ER--EXT 33325 NOTE: Charges and payments not appearing on this statement 'N a nth' statement liou 81 2818 18:88:35 18666558924 --> ?1? 763 8298 Aaerican Hone Shield Page 88Z AMERICAN I^IOME SH}ELD` ' e ~ in Rome war~antie~ November I, 20x0 PROPERTY ADDRESS 200 Glenn Rd Camp Hill, PA 174111133 CONTRACT #: CONTRACT PRICE: A1tyQ[J1VT MAID: EXISTING BALANCE: CLOSING DATE: DtJE DATE: Tc~ Whom It May Concern: B CLL iNG NOTICE Ivlichael Fax: 717-7b3-4290 i ~~~"r~1~~'`v 3~ ~A~ ~~~~C:~tl,1~ ~ ~ ~v 1 {~T cT 90897921 ~ /~. X561.70 ~ 1,~,,.~" `- ( ~ ; ~ ~ f ~ ~ ~'~ ~ r ~s ~~ ~` ~ ~ n ~ ~ ~ ~~, ~~. $56,1::70 b "~ (,`,1 ~ ~ L~~~~ ~~: ~,~-~ t ~~_~ f(It. (/ /~~ ~~p / a 11/QI/10 t ~~ ~ ~ 1 ~ ~ ~~ 1 ~ 1 /22/ 10 ~~ ~~~ r ~ } , ~. ~ ~ ., ~~ ~ . U ~C- Please return this sheet with your paymentt as indicated above. If you would like it to be bill®d to ,your V'ZSA,IV~AS T~1~ CA.RD, Alv1~?R~CAN' EXPRESS or C1SC4'~'E1t, pleasE fill in the appropriate inI*or~nat~on an the bottom aFtbis paste. l~'yo~t have al~~eady sent in payment, please contact our Accounting Department at (840) 827-4G:i6, ext. 274b. Thank you. AN1IvRxCAN HtaME SHII3LD CORPC)RATION `I:'~l'~ O~ C~pt~7' CARC: AJ.v~OCrN'1' "1`O C~A~tGE: CARP ~il.Tlv~~R: SIGNATURE (as it appears on the card): C~~ ~ Please send remittance to; Atnarican Homc $hiold Corpo~~ation 1'Q Bpx 2803 Mempltis, TN 3810 ! -9010 Fax: 877433-3853 ~XP1~tATItaN DATl3: Rupperts Lawn Care & Landscaping, Inc. 1183 West Trindle Rd. Mechanicsburg, PA 17055-4508 Bill To A. Eva Schmidt /Fred Lawrence 27 Bragg Dr. East Berlin, PA 17316 Date Invoice # 11 i ] /2010 4280 Balance Due $144.16 ALL INVO[CES ARE DUE; EJPON IZECIFP"1• ANY INVOICI PAYMENTS NOT RECEIVh:D WI'T'I-IIN 30 DAYS I•'ROM Ii~1VCIICE DATE?. WI[,l_. I3E CHARGI~D A $2.00 RE-I3ILLING FEE !! Please return tap portion with pa}mletn or ~~~rite invoice # on check to ensure proper credit. Quantity Description Rate Amount 4 Cut Lawn on October 5, 12, 19 & 26 34.00 136.OOT Final bill if any further services are required please call 795-1956. ,: . ' `! .? ~ ~, ~~~ ~1 ~ ~. v i ~ ~~ ,~ V PA Contractor # PA059673 Retain bottom portion for your records. Invoice # 4280 Phone # 717-795-1956 Fax # 717-795-1716 ruppertslawncare@msn.com ~,,.~-- .!' y L Subtotal $136.00 Sa#es Tax (6.0%} $g.16 Tota i $144.16 Payments/Credits $0.00 Balance Due $144.16 G~~/~ _ / 1512 rn , ;1'-Uti) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Adele E. Schmidt 21-10-1017 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 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Schmidt 21-10-1017 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. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II 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. American Friends of Migdal Ohr, 1560 Broadway, Suite 510, New York, NY 10036 1 /5 2. The Leadership Institute, Steven Wood Bldg, 1101 North Highland Street, Arlington, VA 22201 1 /5 3. Hillsdale College, 33 East College Street, Hillsdale, MI 49242-9989 1 /5 4. Masonic Charities Fund, One Masonic Drive, Elizabethtown, PA 17022 1 /5 5. Young America's Foundation, 110 Elder Street, Herndon, VA 20170 1 /5 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 100% If more space is needed, insert additional sheets of the same size. Internal Revenue Service Date: June 16, 2000 Leadership Institute 1101 North Highland Street Arlington, VA. 22201-2854 Dear Sir or Madam: Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ronnie Clemons #31-04020 Customer Service Specialist Toll Free Telephone Number: 8:q0 a.tn. to 9:30 p.m. EST 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 51-0235174 This letter is in response to your request today for a copy of your organization's determination letter. This fetter will take the place of the copy you requested. Our records indicate that a determination fetter issued in June 1987, granted your organization exemption from federal income tax under section 501(c)(3} of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a}(1) and 170(b}(1}(A)(vi}. This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to fife Form 990, Retum of Organization Exempt from fncorne Tax, only if its gross~receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. Ail exempt organizations (unless specifically excluded} are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise~taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt~from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. 09/05/2006 TUB 16:36 FAX 7173675813 X016/021 i INTERNAL RFSVSNUE SERVTCS DISTRICT bIRECTOR P. O. BOX 2508 CINCINNATI, OH 45201 Date: dPR 17 t9~~ MASONIC CHARITIg9 FUND ONI~ MASONIC DR $LIZABETHTOWN, PA 3.7022-2199 Dear Applicants DBPARTM~iNT OF THE TRBASURF Employer Identification Number: 23-2720910 DLN: 17053073744018 Contact Person: D . A . D04~N'I~JC3 Contact Telephone Number: (513) 241-5199 ' Qur Letter Dated: November 1993 . Addendum Applies: Na This mvdifisa our letter of the above date in which we stated that you would be treated ag an organization that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501{a} o£ the Internal Revenue Code as an organization described in section 501(a)(3) is still in efgect. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section-509(aj o£ the Cods because you are an organization of the type described in section 509(a}(1) and 170(b)(1){A}tvi). Grantors and contributors may rely an this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lone your section S09ta)(X) status, a grantor or contributrr may not rely an this determination if he or she was in part xespansible for, or was aware of, the act or failure to cat, or the substantial or material change on the part of the organization that resulted in your lose o£. such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a)(1) organization. If we have indicat®d in the heading flf this letter that an addendum applies, the addendum enclosed is an integral part of this latter. BQCause this letter Could help resolve any questions about your private foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone .number are shown above. Sincerely yours, .. .~.. ~e ' ~ D~.atr ct' Director - Letter 1050 (DO/Ga) Internal Revenue Service District Director The American Friends of Migdal Ohr 250 West 57th Street New York, NY 10107-0001 D Dear Sir or Madam: a Department of the Treasury 10 MetroTech Center 625 Fulton Street Brooklyn, NY 1 ~ 201 Date: JUL 18 1994 Person to Contact: Patricia Holub Contact Telephone dumber: (718 ) 488-2333 EIN : 13--3389558 Reference is made to your request for verification of the tax exempt status of The American Friends of Migdal Ohr. A determination or ruling letter issued to an organization granting exemption under the Internal Revenue Code remains in effect until the tax exempt status has been terminated, revoked or modified. Our records indicate that exemption was granted as shown below. Sincerely yours, ~c~ntrr~ia ~oju~ Patricia Holub Manager, Customer Service Unit Name of Organization: The American Friends of Midgal Ohr Date of Exemption Letter: April 198? Exemption granted pursuant to section 501(c)(3) of the Internal Revenue Code. Foundation Classification (if applicable): Not a private foundation as you are an organization described in sections 509{a)(1} and 170{b)(1)(A)(vi} of the internal. Revenue Code. C .1.'iit~rilal Revenue Service llistri~.t Director Date:. May 15, 1991 Hillsdale College 33 E. College Hillsdale, MI 49242-1298 Dear Sir or Madam: Department of the Treasury P.O. Box 2508 Ci~~cinnati, OH 45201 Person to Contact: Sarah Varnum Telephone Number: 513-684-3957 Refer Reply to: EP/EO, Room 4010 Employer Identification Number: 38-1374230 This is in response to your request for a copy of your determination letter. Our records indicate that by a determination letter issued in August 1943, you were recognized as exempt from Federal income tax under section 101(6) of the Internal Revenue Code of 1939 which now conforms to section 501 (c) (3) of the Code of 1986. That letter is still in effect . You are classified as an organization that is not a private foundation within the meaning of section 509 (a) of the Code because you are an organization described in sections 509 (a) (1) and 170 (b) (1) (A) (ii) . The classification was based on the assumption that your operations would continue as stated in the application. If your sources of support, or your purposes, character, or method of operations have changed, please let us know so we can consider the effect of the change on your exempt status and foundation status. Revenue Procedure 75-50, published in Cumulative Bulletin 1975-Z on page 587, sets forth guidelines and recordkeeping requirements for determining whether private schools have racially nondiscriminatory policies as to students. You must comply with this revenue procedure to maintain your tax-exempt status. As of January 1, 1984, you are liable for taxes under Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other Federal excise taxes. If you have any questions about excise, employment, or other Federal taxes, please Zet us know. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. l2~ :1i11sdale College You are required to file Form 990, Return of Organization Exempt from Income Tax, only if your gross receipts each year are normally more than ,525,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. The law imposes a penalty of $10 a day, up to a maximum of $5,000, when a return is filed .late, unless there is reasonable cause for the delay. You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Forrn 990-T, Exempt Organization Business Income Tax Return. In this Zetter, we are not determining whether any of your present or proposed activities are unrelated trade or business as defined in section 513 of the Code . Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanen t records. If you have any questions, you may contact us at the address or telephone number shown in the heading of this letter. Sincerely yours, Xarold M. Browning District Director ~~ ~~~ l~epar~m~nt ~~C tha "I'r~,~xuty rnlernal rte~'enuc Scrrrce CINCINNATI OH 45999-0038 YOUNG AMERICAS FOUNDATION 110 ELDEN S"t STE A HERNDON VA 20170-4891940 r~~ .• 1 ~~ ,~ ~„~.U1~ In reply refer to: 0248306044 Nov. 28, 2007 LTR 4168C EO 23-7042029 000000 00 000 00015597 BODC: TE Employer Identification Number: 23-7D42029 Person to Contact: Ms. Smith Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your request of Nov. 16, 2007, regarding your tax-exempt status. Our records indicate that a determination letter was issued in December 1969, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501(c)(3) of the Internal Revenue Cade. Our records also indicate you are not a private foundation within the meaning of section 509(x) of the Code because you are described in section 509ta)(2). Dor~or~s may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible far Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, 7~~- `~ ~~ Michele M. Sullivan, Oper. Mgr. Accounts Management Operations I ~' t ~. ,~ 1..i, ~,...1 ~~- ~..., cr- ~., ~ ,l ,! ~; L2.. ~= ~::~: U L ? - : , cl'~ -- ~'w: ~ p ~, s i~ i wpb, ~'T., ~y ~:.~:.. Q ~..__ ._~ '~ "~ 3 ~ ~' U Q '` -~ M a ~ o ~ ~~ G~ N ~ M ~ ~ ~ ~ .--~ C N 0. u' ~ ° o '~ O . ~ ~ a m ~U pU ~ ~ ~ ~ o0U ~U ~ o i ~ O• o ~ V