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HomeMy WebLinkAbout03-08-11 (3)1505610143 REV-1500 EX (01-10) ~ L.iM3 OFFICIAL USE ONLY PA Department of Revenue pennsylvania county code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 0025 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 209 12 8154 12 13 2010 Decedent's Last Name Suffix FERTENBAUGH (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Date of Birth 06 28 1924 Decedent's First Name MI GLENN G 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 ~ qa_ Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate lax Return Required 6 Decedent Died Testate (Attach Copy of Will) ~ ~• AttacheCo aof Trust a Living Trust py ) ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ YY 10. betvreenl2 31 ~J~andt (dat~e5~f death T ~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D BOGAR 717 737 8761 First line of address ONE WEST MAIN STREET Second line of address City or Post Office State ZIP Code CAMP HILL PA 17011 c REGISTER OF V~jUSE ONLa( -v a ':,, _f C~~~ ~ ~ ...~ ~~~ ..~_ ~ ~- DATE FILED ~~ -~` ( ~ i~ C7 ~ '~ ~J ;? Correspondent's a-mail address: jbogar@bogarfaw.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 o preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGN-ATU~E~ PERSON gC~PONSIBj~ FOR G TURN DA E /,~l <,,((//// viYr- (mss ~/"'l/D William G. Fertenbaugh _~ L~/1 / ADDRESS ~ / 35 A umn Dri a Dillsbur PA 17019 SI U OF P A OTHER THAN REPRESENTATIVE DATE /,,,, ,~ ~ James D. Bogar ~, j W. ~ 1,1 One West Main Stet, Camp Hill, PA 17011 ],505610143 Side 1 1505610143 ~.,..~. J REV-1500 EX Decedents Name: Fel•tenbaugh, Glenn G. Decedent's Social Security Number 209 12 8154 RECAPITULATION 50,000.00 1. Real Estate (Schedule A) ....................................................................................... 1. 39,372.47 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 9,044.36 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 10 , 572.33 7. Inter-Vivos Transfers & Miscellaneous I~q Probate Property u Se arate Billin Re uested S h l d G 112 0 O 5 . 8 4 r p g ............ q ( c e e u ) 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 2 2 O , 9 95. O 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 15,373.99 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 812.90 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 16 , 18 6 . 8 9 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 204,808.11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 2 0 4 , 8 0 8.11 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 0 4 , 8 0 8.11 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ................................................ ............... ................................................ .. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 1505610243 0.00 9,216.36 0.00 0.00 9,216.36 J REV-1500 EX Page 3 rlar_arlpnt'c Cmm~lPtP Address' File Number 21-11-0025 DECEDENT'S NAME Fertenbaugh, Glenn G. STREET ADDRESS 2 Wayne Circle CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (1 } 9,216.36 (2) 460.82 (3) (4) 3. Interest 460.82 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5, 1f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,755.54 Mak y _ ISTER OF WILLS, AGENT. e Check Pa able to: REG 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^x c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... 0 ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 0 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 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 January 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)]. 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}}. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1502 EX+ (11-OS) SCHEDULE A i ~ ~ REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEpENT ESTATE OF F1LE NUMBER Fertenbau h, G{enn G. 21-11-0025 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate -All that certain piece or parcel of real estate having erected thereon a dwelling 50,000.00 house being known and numbered as 2 Wayne Circle, Camp Hill, Pennsylvania 17011. The property was acquired by Glenn George Fertenbaugh and Jane Fertenbaugh, his wife, by Deed date February 1, 1950 and recorded February 2, 1950 in the Cumberland County Recorder of Deeds Office in Deed Book "H", Vol. 14, Page 236, a copy of said Deed being attached hereto and incorporated herein. The said Jane Fertenbaugh died February 23, 1994, whereupon full and complete title to the within described property became vested so{ely in Glenn George Fertenbaugh, a/k/a Glenn G. Fertenbaugh, the decedent herein. The property was sold pursuant to an Agreement of Sale for Real Estate dated January 26, 2011, a copy of which is attached hereto and incorporated herein. Final Settlement took place on February 25, 2011. A copy of the Deed conveying said real estate, along with a copy of the Settlement Sheet, are attached hereto and incorporated herein. The sale price of the real estate was $50,000.00. TOTAL (Also enter on Line 1, Recapitulation) 50,000.00 (If more space is needed, additional pages of the same size} Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-OE} i ~~~ AND THE SAID ALLEN PARK DEVELOPMENT CORP. DOTH HEREBY CONSTITUTE ANU APPOINT ED4YARU A. REFSETJ TO BE-ITS ATTORNEY, FOR IT AND IN ITS NA~.4E, At`10 AS AND FOR ITS CORPORATE ACT AND DEED TO ACKNOYlLEDGE THI S DEED BEFORE ANY PERSON HAVi NG AUTHOP. ITY BY THE LAWS OF THE CO~MvIONWEALTH OF PENNSYLVANIA TO TAKE SUCH ACKNOWLEDCdv1EtJT, TO THE INTENT TFJAT THE SAA4E MAY BE DULY RECORD- ED. IN TESTIMONY WHEREOF THE SAID ALLEIJ PARK DEVELOPI+AENT CUR P. HAS CAUSED THIS INDENTURE TO BE SIGNED BY ITS PRESIDENT, ATTESTED BY ITS SECRETARY ANG AFFIXED HEREUNTO THE COMMON AND CORPORATE SEAL OF THE SAID CORPORATION, THAT THE SEAL AFFIXED HERETO IS THE SEAL OF SAID CORPORATION, THAT IT WAS SU AFFIXED BY ORDER OF THE BOARD OF DIRECTORS OF SAIL COPPORATION, AND THAT THEY SIGNED THEIR NAMES HERETO BY LIKE ORDEP."T~E:;UAY AND YEAR FIRST ABOVE WRITTEN. -. SIGNED, SEALED AND DELIVERED IN ,~,,,gL~ERT ALCATZ THE PRESENCE OF ~~ PRESIDENT. +r'' SH IRLEY J.~ SHYSTER ATTEST: EDVlARD A. REFSEN SECRETARY. STATE OF PENNSYLVANIA) ' COUNTY OF DAUPHIN )SS. I HEREBY CERTIFY THAT OtJ THIS 1ST DAY OF FEBRUARY IN THE YEAR OF OUR LORD, ONE THOU- SAND NINE HUNDRED ANA FIFTY (1950) BEFORE ME, THE SUBSCRIBER A NOTARY PUBLIC PERSONALLY APPEARED EDYlARO A. REFSEN, THE ATTOR~fEY NAMED iN THE FOREGOING DEED, ANU BY VIRTUE OF AND IN PURSUANCE OF THE AUTHORITY THEREIN CONFERRED UPON HIA4, ACKNOWLEDGED THE SAID DEED TO BE THE ACT ANU DEED OF THE SAID ALLENPARK DEVELOPMENT CORP. WITNESS MY HAND AND NOTARIAL SEAL THE DAY:.~.AND YEAR AFORESAID. - w S IRLEY J. SHYSTER s: [.1 T17LE OF OFF.I CER sr~ ;~"NOTARY PUBL I C -~•... GD. MY COMM. EXP. FEB. 1 , 1953_ No. 6bJ3 ~ )EED ~ AP THI S I NOENTIlR E, ALLEN PARK DEVELOPMENT CORP. ~ ~g•SO MADE THE 1ST DAY OF FEBRUARY A.D. ONE THOU- 2~1~50;,.t i TO ., •.. _ __,..( SANG NINE HUNDRED ANO FIFTY (1950) BETWEEN GLENN GEORGE FERTENBAUGH ET UX~ ~ -"---- ' C S, ~1 00 ~ ~ THE CORPORATION BY THE NAME, STYLE ANU TITLE L8~'o L. ALLEN TWP. CATED FEB. 1, 1950 ~ OF ALLEN PARK. DEVELOPMENT CORP., A CORPORATION DULY ORGAN- ENTERED FEB. 2,'1950 ~ IZED ANU LAWFULLY EXISTING UNDER-AND IN ACCOE©ANCE WITH THE LAWS OF THE COMMONH'EALTH~OF PENNSYLVANIA, HAVING ITS REGISTERED OFFICE ItJ THE BOROUGH OF CARLISLE, COUNTY OF CUC'ABERLAND, AND COhhVIONWEALTH OF PENNSYLVANIA, OF THE ONE PART AND GLENN GEORGE FEP,TENBAUBH ANO JANE FERTENBAUGH, HIS WIFE, OF LOYJER ALLEN TOWNSHIP COUNTY OF CUMBERLAND IN THE STATE OF PENNSYLV ANIA OF THE OTHER PART WITNESSETH: THAT THE SAID PARTY OF THE .FIRST PART FOR ANO IN CONSIDERATION OF THE SUM OF ONE 01.00) DOLLAR, AND OTHER GOOD AND VALUABLE CO NSIGERA71OpJS LAWFUL MONEY OF THE UNIT- ED STATES, TO IT iN HAND PAID BY THE SAID PARTIES OF THE SECOND PART AT THE TIME OF THE EXECUTION HEREOF, THE RECEIPT WHEREOF IS HEREBY ACKNOWLEDGED, HAS GRAfdTED,.BARGAINED, SOLD, . ALIENED ENFEOFFEO~ RELEASED AND CONFIRMED, AND BY THESE PRESENTS.UOES_G,RANT, ~ARGAI~N, SELL, ALIEN, ENFEOFF, RELEASE ANU CONFIRM UNTO THE SAID PARTIES OF THE SECUND PIA~T, THEIR HEIF~S ANO ASSIGNS, ALL THAT CERTAIN PIECE OR PARCEL OF LAND, WITH THE BUILDINGS ANG IMPROVEMENTS THEREON ERECTED,, BEING KNOF+IN AS LOT N0. 13.6, ON PLAN OF LOTS. LP,ID OUT FOR ALLEN PARK DEVEL- OPh1ENT CORPORATION, CALLED "CUMBERLAND PARK" AS RECURGED IN PLAN-BOOK 4, PAGE 80, CUPABER- LAND C ~,UNTY RECORDS, S I TUATE ON THE NORTHWESTERLY S i DE OF. 4YA`lNc C I ROLE (FORMERLY AVENUE "M"), CUMBERLAND PARK, TOWNSHIP OF L9WEP. ALLEN, COUiJTY OF C,UMBERLANU A1JD C06rub10NYYEA.LTH OF PENNSYLVANIA, BOUNDED AND DESCP,,IBED AS FOLLOWS, TO WIT: BEGINNING AT A P01 NT OIJ THE NORTHWESTERLY. S1 DE OF NIRYNE C 1 R CLE (FORMERLY P.VENUE "tvi") r ~n FI'ET W f DE) AT A .DISTANCE OF N I NETY (`9,0) ) FEET MEASURED NORTH S I XTY-THREE ( 63)' DEGREES _'~ 7~~~'ri.i:'r ~;,;:~~'J.. ~ lr< <3L~ LC=7 L~~"LG-r.t-c.'~-~•i + v 4~C~L~~~~~Ly ~'..~ `~.~~1 /) (.~' ~i - _ - . _.. .. ~ ~."~ n n t n C~1 fiF ~. K. c.-- ~ ~-~ , ~ _ S,~-l'r~=l `~;~~-~c~- ifi ~'~,1 (~"~... ~ `"~ , ~ ~C:2L~>i- ,ti ~~1= ~.~ '~'-~~~a.~'.L'.: ('7..i,~~, OF WAYNE CIRCLE (FORMERLY-AVENUE "M") WITH T.HE NORTHER ST ERLY SIDE OF WAYtJE ROAD (FORtviERLY AVENUE "L") (50 FEET. 191 DE) (BOTH LINES PRODUCED); THENCE ALONG LOT N0. 135 NORTH TWENTY-S!X (2G) DEGREES TWENTY-SIX (26) MINUTES THIRTY (30) SECONDS- WEST A DlSTANCE of EIGHTY-NINE (89) FEET TO A POINT;; THENCE ALONG LOT N0. 134 NORThi'OtJE (1) DEGREE THIRTY-SEVEN (37) MINUTES THIRTY (30) SECONDS EAST; A OISTAIJCE OF SIXTY-TWO AND THIRTY-THREE OIJE HUNDREDTHS (62.33) FEET TO A POINT; THENCE ALONG LOT N0. 137 SOUTH.FORTY-THREE (43) DEGREES NIFJETEEN (19) ti41NUTES THIRTY (30) SECONDS EAST A DISTANCE OF OPJE HUNDRED THIRTY-EfGHT AND FOP,TY=ONE ONE HUNDREDTHS (13F3.1+1) FEET TO A POINT ON THE NORTH- WESTERLY SIDE OF WAYNE CIRCLE •(FORM:ERLY AVENUE "A!i"); THENCE ALONG SAID SIDE OF WAYNE CIRCLE (FORM- ERLY AVEIJUE "M") ! N A SOUTHWESTERLY D IRECTt ON ON A L I NE CURVI NG TO THE R I GHT HAVING A RADIUS OF i NINETY-ONE ANU FIFTY-ONE OtJE HUtJDREDTHS (91.51) FEET THE ARC 015TANCE OF FORTY-EIGHT ANU FIFTY- EIGHT OIJE HUNDREDTHS (4g.5g,) FEET TO A POINT OF TANGENT; THENCE STILL ALONG SAID SIDE OF WAYNE i CIRCLE (FORMERLY AVENUE "M") SOUTH SIXTY-THREE (63) DEGREES THIRTY-THREE (33) MINUTES THIRTY (30) I SECONDS WEST A DlSTANCE OF .TWENTY-THREE AND FORTY-SIX ONE HUNDREDTHS (23.46) FEET TO THE FIRST i MENTIOPJEU POINT ANU PLACE OF BEGINNING. UNDER AND SUBJECT TO THE RESERVATIONS-AND RESTRICTIONS CONTAINED IN PRIOR DEEDS. - BEING PART OF THE SAME PREMISES'WHICH MARK -E. GARBER AND WIFE CONVEYED TO THE PARTY OF THE i FIRST PART- HERETO BY DEED .DATED OCTOBER 11, 1949, AND RECORDED OCTOBER 20, 194 g, CUMBERLAND -COUPJTY REL'OROS IN DEED BOOK."F", VOL. 14, PAGE 439. TOGETHER WITH ALL AND SINGULAR THE BUILDINGS, PRIVILEGES, HEREDITAMENTS ANU APPURTENANCES WHATSOEVER THEREUNTO BELONGING, OR 1N ANYWISE APPERTAINING, AND THE REVERSIONS AND REMAINDERS, ~ RENTS, ISSUES ANU PROFITS THEREOF; ANU ALL THE ESTATE, RIGHT, TITLE, INTEREST, PROPERTY, CLAIM AND DEMAND WHATSOEVER OF IT, THE SAID PARTY OF THE FIRST PART EITHER. IN LAW OR EQUITY, OF, IN ANU TO THE SAME. j - TO HAVE ANU TO HOLD THE SAID MESSUAGE OR TENEMENT AND LOT OR PIECE OF GROUND ABOVE DESCRIED, HEREDI7AAAENTS ANU PREMISES HEREBY GRANTED, BARGAINED AND 5UL0, OR MENTIONED, OR IPJTENDED SO TO BE, WITH THE APPURTENANCES, UNTO THE SAID PARTIES OF THE SECOND PART, THEIR HEIRS AND ASSIGNS, TO I AND FOR THE ONLY PROPER USE AND BEHOOF OF THE SA10 PARTIES OF THE SECOND PART, THEIR HEIRS AND ASSIGNS FOREVERo AFJD THE SAID PARTY OF THE FIRST PART FOR ITSELF AND ITS SUCCESSORS, DOES HEREBY COVENANT i AND AGREE TO AND WITH THE SAID PARTIES OF THE SECOND PART, THEIR HEIRS AND ASSIGNS, THAT IT I THE SAID PARTY OF THE FIRST PART ANU ITS SUCCESSORS, ALL..AND SINGULAR THE SAID HEREBY GRANTED, PREMISES, WITH THE APPURTENANCES, UNTO THE SAID PARTIES OF THE SECOND PART, THEIR HEIRS AND ASSIGNS, AGAINST IT THE SAID PARTY OF THE FIRST PART AND ITS SUCCESSORS, AND AGAINST ALL AND ~ I EVERY OTHER PERSON AND PERSONS WHOMSOEVER LAWFULLY CLAIMING OR TO CLAIM THE SAME OR ANY PART THER EOF ' SHALL AND WILL WARRANT AND FOREVER DEFEND BY THESE PRESENTS. ANU THE SAID ALLEN PARK DEVELOPMENT CORP. DOTH HEREBY CONSTITUTE AND APPOINT EDWARD A. REFSEN TO BE ITS ATTORNEY, FOR IT AND IN ITS NAME, AND AS AND FOR ITS CORPORATE ACT ANO DEED TO' ACKNOWLEDGE THAI ~ DEED BEFORE ANY PERSON f~AVI NG AUTHORITY BY THE LAWS OF THE COr,AMOtJ1YEALTH OF PENNSYLVANIA TO TAKE SUCH ACKNOVYLEDGMENT, TO THE INTENT THAT THE SADAE MAY BE DULY RECORDED. IN TESTIMONY WHEREOF THE SAID ALLEN PARK DEVELOPMENT CORP. HAS CAUSED THIS INDENTURE TO BE SIGNED BY ITS PRESIDENT, ATTESTED BY IT5 SECRETARY AFJU AFFIXED HEREUNTO THE COMMON AND CORPORATE SEAL OF THE SAID CORPORATION, THAT THE SEAL AFFIXED HERETO IS THE SEAL OF SAID CORPORATIOI, THAT IT WAS SO AFFIXED BY ORDER OF THE BOARD OF DIRECTORS OF SAID CORPORATION, AND THAT THEY SIGNED THEIR NAMES HERETO BY LIKE ORDER, THE DAY AND YEAR FIRST ABOVE WRITTEN. SIGNED, SEALED AND DELIVERED IN ALBERT ALCATZ THE PRESENCE OF y~V•¢~j~~• -''`J ~"z=~ PRESIDENT. SHIRLEY J. SAYSTER ~ ,. ~ ~~ ;ATTEST: > _ .~ a ` ~''~ EDWARD A. REFSEN ~ • %' i SECRETARY. ' i STATE OF PENNSYLVANIA) i COUNTY OF DAUPHIN )SS I I HEREBY CERTIFY THAT ON THIS 1ST DA. OF FEBRUARY IN THE YEAR OF OUR LORD, ONE THOUSAND PJ l I~IE HUNDRED AND F! FTY (1950) BEFORE hAE, THE SUBSCRIBER A NOTARY PUBLI C PERSONALLY APPEARED EDWARD A. REFSEN, THE ATTORNEY NAMED IN THE FOREGOING DEED, AND BY VIRTUE OF ANO IN PURSU OF THE AUTHORITY THEREIN CONFERRED UPUN HIM, ACKNOWLEDGEU THE SAID DEED TO BE THE ACT ANO of THE sAi D ALLEN PARK DEVELOPMENT CORP. ~ WITNESS MY HAND AND NOTARIAL SEAL THE DAY AND YEAR AFORESAID. SHIRLEY J. SAYSTER TITLE OF OFFICER • NOTARY PUBLIC GD MY COMM. EXP. FEB. 1, 1953 N0. 671 i! AP II DEED ) ~ ~:~,~;, ~. „;~s~~;UE ~' TH I S I NOENTURE, ALLEN PARK DEVELOPMENT CORP. ~ ~~ ,,,~~~~Q,, ~` MADE THE 1ST DAY OF FEBRUARY A,D. ONE THOUS AI ~~Lv~L.. ,... n TO ~ "__._---.~-1::-_-1 NINE HUNDRED AND FIFTY (1950) BETWEEN THE COf ORAT10tJ BY THE NAME, STYLE AND 7lTLE OF ALLEN PARK DEVELOPME HARRY L. CLOUSER ET UX ' ~ CORP., A CORPORATION DULY ORGANIZED AND LAWFULLY EXISTING CONS. $1.00 ( UNDER AND IN ACCORDANCE WITH THE LAWS OF THE CONNOMMi1rrEALTH OF LOC. L. ALLEN TYJP. ~ PENNSYLVANIA, HAVING ITS REGISTERED OFFICE IN THE 80ROUGH OF DATEfl FEB. 1, 19:50 CARLISLE, COUNTY OF CUMBERLAND AND°COMMONWEALTH OF PENNSYLVA ENTERED FEB.2, 1950 ~ OF THE ONE PART AND HARRY L. CLOUSER ANU +~RLENE 0. CLOUSER, W I FE, OF L04UER ALLEN TONINSH I P COUNTY OF CUMBERLAND, l N THE S' OF PENNSYLVANIA OF THE OTHER PART WITtJESSETH: THAT THE SAIp PARTY OF THE FIRST PART FOR AND IN CONSIDERATION OF THE SUM OF DNE ($1.00) DOLLAR, ANU OTHER GOOD AND VALUABLE CONSIDERATIONS, LAWFUL MONEY OF THE UNiTI STATES, TO IT IN HAND PAID BY THE .SAID PARTIES OF THE SECOND. PART AT THE TIh1E OF THE EXEGUT~ ION HEREOF, THE RECEIPT WHEREOF IS HEREBY ACKNOWLEDGED, HAS GRANTED, BARGAINED, SOLD, ALIEN ED, ENFEOFFED, RELEASED AND CONFIRMED, AND BY THESE. PRESpNTS DOES .GRANT, BAR GAIN, SELL, ALI ENFEOFF, RELEASE AND CONFIRM UNTO THE SAID PARTIES OF THE SECOND PART, THEIR HEIRS AND ASST ALL THAT CERTAIN PIECE OR PARCEL OF LAND, WITH THE BUILDINGS AND IMPROVEMENTS THEREON ERECT BEING KNOWN AS LOT N0. 56 ON PLAN OF LOTS LAIp OUT FOR ALLEN PARK DEVELOI~MENT CORPORATION, CALLED "CUMBERLAND PARK" AS RECORDED 1N PLAN BOOK 4, PAGE 66, CUMBERLAND COUNTY RECORDS, SI DATE ON THE NORTHWESTERLY SIDE OF ALLEN ROAD (FORMERLY .AVENUE "R"} , CUMBERLAND PARK, TOWN- SHIP OF LOWER ALLEN, COUNTY OF CUMBERLAND ANO COMMONWEALTH OF PENNSYLVANIA, BOUNDED AND DE; CRIBEU AS FOLLOWS, TO WIT: ' BEGINNING AT A POINT or! THE NORTHwi:~TERL.Y SIDE OF ALLEN ROAD (FORMERLY AVENUE "R") (!~ FEET WIDE) AT A DISTANCE OF ONE HUNDRED SIXTY-FIVE AND FOUR ONE HUNDREDTH (165.04) FEET ME URED NORTH FIFTY-EIGHT (5$) DEGREES'THIRTY (30) MINUTES EAST FROM THE INTERSECTION OF THE 5A 1D SIDE OF ALLEN ROAD (FORMERLY AVENUE "R") WITH THE NORTHEASTERLY SIDE OF WILLIAM PENN DRIVE (FORMERLY AVENUE "J") (80-FEET WIDE) ( BOTH LINES PRODUCED); THENCE ALONG LOT N0. 55 NORTH THIRTY-ONE (31) DEGREES THIRTY (30) MINUTES WEST A piSTANCE OF ONE HUNDRED TWENTY (1; FEET TO A POINT; THENCE ALONG PART OF LOT N0. 75 AND PART OF LOT N0. 76 NORTH FIFTY-EIGHT DEGR EES THIRTY (30) MINUTES EAST A OISTANCE.OF SIXTY (6O) FEET. TO A POINT; THENCE ALONG LO' D10. 57 SOUTH THIRTY-ONE (31) DEGREES THIRTY (30)'MINUTES EAST A UISTANCE OF'ONE HUNDRED TWENTY (120) FEET TO A POINT ON THE NORTHWESTERLY SIDE OF ALLEN ROAD (FORMERLY AVENUE "R") THENCE ALONG SAID SIDE OF ALLEN ROAD (FORMERLY AVENUE "R") SOUTHFIFTY-EIGHT (56) DEGREES THIR TY (30) MINUTES WEST A DISTANCE OF SIXTY (60) FEET TO THE FIRST MENTIONED POINT AND PLACE OF BEGINNING. UNDER. AND SUBJECT TO THE RESERVATIONS AND.RESTRiCTfONS CONTAINED IN PRIOR UEEDS. B)=ING PART OF THE SAME PREMISES WHICH MARK E. GARE3ER AND WIFE CONVEYED .TO THE PARTY 0 THE FIRST PART HERETO BY UEEp DATED OCTOBER 11, 1949 AND RECORDED OCTOBER 20, 1949, CUMBER j LAaUD COUNTY RECORDS IN DEED BOOK "F", VOL. 11~, PAGE 439. TOGETHEf~ 44r! TH ALL ANU SINGULAR THE BUILDINGS, PRIVILEGES; HER ED 1 TAMLN T S AND APPURTEtJAI CE5 WHATSOEVER THEREUNTO BELONGING, OR 1N AIdYWiSE APPERTAINING, A"JU THE REVERSIONS ANA RE• MAINDERS, RENTSy LSSUES.AND PROFITS THEREOF; AND ALL THE ESTATE, RIGHTS TITLE, INTEREST., PF PERTY, CLA f M .AND DEMAND WHATSOEVER OF I T. THE SA1 D PAR ~ Y OF Tur 1"I R.C7 PACT c ~ Turn ~ R~ ~ ~,,, ~~ Page ~-~f" .i~~`~iia:.av~; ( J. btz~'~t''s~~gCr~~t~ A~t:~ig:~s:, { ~~ell~z'c-:5~erxt fi~i:ES ~~GP:E-~1~7` i5 z~i df .~~'csry. ~c2 u.+..zc.xax~rsttii -.t:c~icua z~-u.;y..rrc;; ~.~~ SEe~1~e~~a;~re~s~~~ s~~l. ~~ cv~e~ ta,.&~.i-e~~ rek~ a ~o ~~.r~~.a~e ~`~FC1 ~.~ .kt~l"'~ct . ..... .... t ~, ~; -_ . __._. _ .. . _ .. _ ... - t ' Y ` t.. 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Page: 3 of T.~iLTD.E12 3~PL~:SSE~~I41Y:: :aj 'I~3_te .shad tie tAudezz.d ;gip v~ap o£ c~arran-!y died ~ ;possessc7 is to. ~e-d~lvered ~p kev-s tco. ~ vacas-..:t #~u.Iding ~ azi~r) tragr~: clean; Exec o~ deb~5 or~b~T c}eed:az~l, ass%~z~m°eii€ ~z e~:stizzg rea.se(s) ai::~e_of set;lea3~ri~ ~ preniises• :are terianf- os~upied-a~ f~~ie<~P~?i~ a~%s ~greeznent, z~~ess: ot~xex:~ise S~ec:.~fzed: ~ie~eri. ~) ~e1%~r ~Ai1.Z mot erzfel~ zu~a an~r n~u~ lc:ases~ n ~t-eii;~roii~ o~ ~~istinn leases; if an}~; ~~ :~i'e pt~iszs ~>;Yhatzt e~zess w~-i~#en ~~s~~of-the Stzpe~_ c~: ~-oi~ia~ ~e~~cier flf~ari execute~t ~~d. a~r~ puz'c~s~-ziej% Ys :h~reb~: tzra~._, . d~.B~yez~-res~fves ~:ie:_rzght.t~: ma~~.~~Sre=~e(.~euierit:.~.n.~sp~~u of the s~~c~ prelxuses . ~37~4T'F1Q~3iYG~ ~ ASS t7F ~~' S~~~r ~ i~~'1?.Ii:~"dii1. i-h.e ~'.rca :.. _ "-• LP ~'e'~'{in~lx~.c~~ a~i;~iezu~. rrieaaoned in ~3ir~~:a~az ~~2 J:~ere~): aid amp pcs~so~i~l. Property . specr~xc:~.l~jr sc;~xeciu.~ed. ,l?_~s'~in in' .ids ~zeses:i cU~iizaxi~ ncrr3na.k iarear az7d: t,.ar e~'ep'E;~~ bj; Veit Rx' s~ia1l' bear ris:I4 ~i~`iriss-~~z?~ ffr-~~: or...:g~x~'~~a~~z~lte~ u~~~I rt~c cif s~1~1e,~e~i:~, 3xt the ~e~t~n~ ~~:d~*~age~: ~ .~~i~Z,." ;~xop~rly ~ i~.~~~ded xz~, .tbis ~a~~ by. ~i'e ~a~ Eiyo~ii~~ ~.s%-s.,,- not repai-~ a,~;~~~i~z~.,d 3asicc~s~tCt:~cttlerr*e:~.t, ~ir-v:er-~.~}3 r~~` ~2~;ve rFie o~f3oxx.Q~~es~nd~~: ~s.~~r~en~nt:-~rzd ~~ececrni~g:~tsn3;onze~ p~ael.-ate acc;~t~t ~~o~~cc~pta,•.~t~e ~.arap~a~~z.ta2 its ~t ;erg co~~ froii zi~.~h~z` u~~tYI3 tae` ~~-oce~:c~s ~ c3= 3zsan ~e x.~cover;~ o~i~i~c ~ ~SeIler:, =er is Iiei=eby :zanf#zod:.:~ix~:~ ~;~ ~a~ uis~xz~ fits ~ec~~able~ ~'~~st ~.• pip as z~~ the ~t~ ~~' ~c .~~t.ce ~fhis d~ .~i~nt ~~ .~~iper- ~.~~~sv, i£~x~saz~ ;. ~-~;a~j~7~~ri •~~~ ~~ss f1`~.a2a ~e ar~ar'~ c~ xoi~~5:aria~s irk ~axc~er ~ secu~. ~as~c :Eia~ea~z~z~~s ~~.su~~:cov~ea~e, .... °~~RI~~xK ~~is ~g~~rnen~ -s'k~a~ z~~~ ~~-;reeQ~d. ~ ~:?.~c~ ~txr t~~e ~t~c~.r~g af=l.~.:s zir -~.-z~ n~~r ~e~ sir ~r~ace ~~ ~uh~c re~c~„ r ~~~~~~~~~k~ ~~s~~:~;~-s~~ti ~~ ~~~ ~~spo~ .~ra~~~; ti~e.e e See, s'v?x~;r:~~~;: ..._ ~ _. ~~~~s'~ ~c~ ~ic€es~l7.cs, ~ t~ie~~rzt a ~n . ~rssi ~~~[~I.~ 7~a:~ ;s~.a~'F~e ~~ ~fiiG ~~~ x~i.~ i~~, -~s; ~~.r,~~3z,~s~:i~~ :~t~'~~~ ~~~~ ~ a?~~~ u~c~r t' ~g~~e~z:~. ~v1Ya~t~ -th'e~~'~~mxxx~~`t~e ~ #~~ ~ da`f~~ -rris ~J. ?~f ~.~~~1 sow- ~.c~~~'' _ ~ ~ ~irX~ ~. .~:a bus ~nr-e~nt, ~;i~n~cI: ~~~B~~er~. ~~ #'~~r ~r~~r~ ~~ ~.dc~xrai °caa~~~.~ as. s13~c~ ~t:~?~'~ #~ ar"~'~, ~ ~; use .. :... c ~` - - - ~; gin. ~ a~ ~,; cr~ ~~ cc5o~?~ in '€~e ~'t5cg~ ~ za~a~~a~e ~ ~ ~ , ~ou~ es~ .. ?~ ,~ apprq fi:f~.~~~: ~:tar~ ;rr~.~ fix: o~ it:~,~5:r ~ ~.~ ~: z~drm a~~ r~E: y.s Ur R. ~ ~L3~ 3~.L:C~ :~2t~<.a:~t'lY~ ©~-5a~f~. ;7~,~.:t'Z't'SC~ 'V:.9Zt~~ ~E b~ = }arac~t~ ~~a~s~ ~~,y. =~r?~ ~~# ri~e~s; ~z ~ ~4 -.?~ta~zx.~ie~-m~~~ ~~Fa:~d . ~3~G~;~s ~~~~ tea" ~s:w~c~ c~~t ~:ti~ ~ar~.es ~~r~~; ~ ~-z~~a~~susi~ s _ •~ _ .:. ro~€r~ci SeT1e~- v.~a~ x~r~~ ~~ ~~ ~i~ ~a .#aa a~ici..r.~ar~i~s#~ic~ris~',t_s~` t~=;~,gr-e~.~~ ~e~ ~a3Ye~erf; ~ r;p'~r~t~~ ~x~r~ ~emeti~ ~~ir• s;~ '_"~ca#"_ ~c r~a~~ ~ t'S.~e.~ a~ - •~ - ~ pry ~~s~' ,e`13e~ ~nr :fit's ~1 ~d~. 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Rags 4: a cu-e iIti_-G.LUD~~ ~n fl-~e ssle ~c~ purclln.se Pr-ire_ 'i`he fo3t~sv~~g i~er~s ~~: E~C~ti~`D~D ~rt~. tfie - ---- ~~ Noxi~. of~i-he a~i©~~ .~i~b;~onec} i~cii:idec ~iieTrzs .sI?a'll. be:~:~ovec~ b~= ~?~er•-f~.ara~z.e~iiises art. -~~e.c~f pis AgEee=ueni_ ~eliez-•~~.~e3~y ~varranis ~~~t ~ell~r.~evili:drli~e~- mood ~~e tai ~all,t~.e a~EiW7es d~sc7~~eclYn,t1~%s flai-a~_ ~~~r, ar~~.an,~- curer i~ ~ ~ ~ res.~r rte~z~af ~ersc~~~-ity spQc~fcail~r~ sc::I~e~z~e~ to ?,~e n~icli3:Fte~ an ~t~ss ~~e: . ~ .._.. ~Cuv~-S ~' - - _ I~Ci:OS>U~-S°. TIS~1~=3~ '~~ I~ ~- - sec~z o~'~e iitt~;da~cil r .~~~ S-e~er 33~~ los~zre Jr ~ uu t. S~2?.,£I1;Le71'~ ~~3'f7:3~~ ... ~ = -E3=t~~n'~TC ~E~~1k'3~X .• 1T1C~2t~te~ W~F~eIi :cl~~~s~'s ~d~c~~ aride~dd ~ rr:ac~~ ~ p~:r.G. als~.s znen~. J .• i _ : - -~ ;. I~:s Tostrz~.e mad ~raspe~t~.Qz~ ~enc~ix'~i'~ } ~:- ~ya~~d..X-'~-i~a.~ `Ce~~r~,.~; ;C~nt~r~e~c_y {: ~ Vit3~~~L:g; ~xr_~ri~datr.~r3r ~- {~ ) `L~z-FaT .icy A~rl~rd~ ( ~; ~Ious~g:~a1~ lea.~~?-a~~~c3:Pa~.I;;:L}isc3,c~si:x~~~ ~ `:Qi"s~~s~'e ~~ a-t~a~cd: S:~s~az~.ss~ ~ .} :T~e~a~=~3~~t7 Pa~i~:~xc}~re ( J~ +•t t~,:F3'orcte ~is~irn: ~ ~ ~3~"d, :fir o~ert5 ~'4i ~:.~:Q~~rz~eef~a'Z:a ~'~-h~i~; ~eiv~r ~`~I~c.`tr~~u~ 5;~;'ze. ~o~er:~: k~:~fr~esi~n~x:_. ;(~- Es~~~~r~,ves~r.=~?isc ~XTGiI~<t3T~E.,~'`h1~ gg~cez~e ~trz~~an~' ~~ut~~s ~i~e~r xr-fa;~'' ~e ~e~: ~~av thy-p~~t~~s-~s~ca~ ~i~ #c~zsr~~s~zi• .. - ~ i~'a-~~ - .. ~ra~-x~.' - . ; ~-.~ ~~~~ ~a~~c~a.~~-~~ ~.n., ~-~sr 's~.~Z:•~ .J?' 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'. ,. - .. _ / ~ „ . _. _: . _. d a '~ _:_ - .., , ,.. _ . . _; ..,_ .. „__ . + . ~3~F3 . .. .:. - _.. . ~,; TI~i ~-.I~.isclos;zr~. ~d A _~io~I~i~~~n~ is g3ve~.~ t~s ~~ ~3ay of . ~~ ~^~t 2-0 ~ , tc: ~.~~~ t Y'~ . t~ ;.~C ~`'~:_.~"t-~~ner~s~j ~i~-.~~; ~~ GV. i~=a~ii. ~~az~T~: as a: pz-in€~i~~~-ref .. ~; ~.~..~'~~ ~~~,. ~. a=~eai:estate uibes~.iez~~eam~ai~(`-`~~oznpa~~r'~~, ;~ Cc~~p~.n~ is ~i~it~I'~st~ 3X3 ~i`:C,~i~,5~I27.a Owxio~'~ ~a1 ~es~ie loo~t~et~. a~~. ~~ ~~'~_- ~ t~--~:~i~, - '~ 3 ~~~~.----- - . ~, a~ a ~~tpl~ .~ Vic: ~om~az;~.t, zs ~.~ttri~ ~e~el.~ ors tfi~ C.~z~p~~...be~h~lf, ~c?i Xnf.~~~~n° eF~act~u ::~~ ~~ z~ esf~t~~t a ~~:c~c:xt~ .r-1e~' #~ix~s ~ .. . vc~ic~iLct:~.l e~ia~~:..-the=~~p'=t-Q,~eal~ze ~ ~rflfzi:i-zA: s:~:s'r~r . ~iax capa~afiF, 1~Ta.~', T~~i~ as: ~-~i~e~rs~re~~~ ~, tlhe' Corn-i~un~~~fh. ~sf, :~'e~s~-~;rr~xu~, _ ~~'~. ~:a~.~~'s ~n~e ~'es~o`z~xi~ anrL ~a~ ~s. ~ i;~ ~ ~~ap~.np~ ~n.c~ ~~ ~~ r~.fl~' t~~!'n ~a~v ` ~'~.ss,~xz~ ~e~ -e~~; ~d~ce:-ter .~ec~ ~~ . fir, x~vs= .~~ a~: Y ~e~'~~r c~ie~z~ r~l~~ir~,~~7•y 3~ea~~:: ` ,~ ~ ~ b ~~e~~~. ~i~g~i ~T~7':~1~~ ~:e~~~arii~•s ~` ~~:~or ~~~~ purc~~ase ~o~~i~:z~ea;rs _a~. ~s:~a=~~:: ,,~ ~er~.~~o'c~~~s' mart 1'"~ Naas at~ur's~ ~'!'.~~~- ~~-t -`-~s -~ ~-~~~1;' .~ eo _ ~ .~s~r.~-e ~o~~a: I~~d'r~~ e~t~e p~~es"~~ ~ r-~t. i.~~ s~ safe ~~ ~_.ex-~s:~~c1 esta~~'Ea ....: _ ~r,ac.wleci:,~ss: ~~ ~ x~ia. ~ ~~~~~~ ~~`#~.' ~. r~r~ree~x,ntaras' ~*~' e~~ ~~ ~:onfs ~ ~z€-~xg~ ~~t~u: -hex aad; :~~'f~i. ~e~~ ~~ex's ~. ~s'~a~e •~z-rz~s~s a~en.~Y ~'~~~.~c~ .~h~ •~ ~ ~s ~~e~;a `. _ -.. ~-~~35 r-~:~ :; ~~krxirl~dg~?~r~.t ~~ .~~ :r•~a• ~~xs~, a~ ?~te,~~t ,, r- ~'~J= ~ ~ ;, ~ ~ r Tax Parcel No. 13-24-0797-136 THIS INDENTURE, MADE THE ~~ day of `~%~' two thousand eleven (2011 ~EZ'WEEN WILLIAM G . FERTENBAUGH, Executor of the Last Will and Testament of GLENN G. FERTENBAUGH, late of Lower Allen Township, Cumberland County, Pennsylvania, party of the first part , ar2d OTTER CREEK ASSOCIATES, LP, a Pennsylvania Limited Partnership, of party of the second part: WHEREAS, the said Glenn G. Fertenbaugh by his Last Will and Testament, duly proved and recorded in the Cumberland County Register of Wills Office, Pennsylvania, in Docket Book 21-11- 0025, Letters Testamentary being issued on January 6, 2011, provided, in pertinent part, as follows: SEVENTH: I hereby nominate and appoint my beloved wife to be the Executrix of this, my Last Will and Testament, and I direct that no bond or other security shall be required of her in any jurisdiction. If my said wife is unable to serve as Executrix, then I nominate and appoint William G. Fertenbaugh, Executrix/Executor of this my Last Will and Testament, and I further direct that he/she not be required to post any bond or other security. EIGHTH: I give to my Executor/Executrix, authority o exer- cise all the powers, duties, rights and immunities conferred upon fiduciaries by law with full power to sell to mortgage and to lease, and to invest and reinvest all or any part of my Estate on such. terms as he/she deems best. NOW THIS INDENTURE WITNESSETH, that the said party of the first part, by virtue of the power and authority aforesaid, in said Will contained, and in consideration of the surn of Fifty T:r~ousand Dollars ($50,000.00) to him paid by the said party of the second part, at and before the ensealing and delivery of these presents, the receipt whereof is hereby acknowledged, h.as granted, bar- gained, sold and conveyed, and does hereby grant, bargain, sell and convey to the said party of the second part, their successors and assigns forever: ALL THAT CERTAIN piece or parcel of land, with the buildings and improvements thereon erected, being known as I,ot No . 136, on Plan of Lots laid out f or Allen Park Development Corporation, called "Cumberland Park" as recorded in Plan Book 4, Page 86, Cumberland County Records, situate on the Northwesterly side of Wayne Circle (formerly Avenue "M") Cumberland Park, Lower A11en Township, Cumberland County, Pennsylvania, bounded and described as fol- lows, to wit: BEGINNING at a point on the Northwesterly side of Wayne Circle (formerly Avenue "M") (50 feet wide) at a distance of ninety (90) feet measured North s ixty-three ( 63 } degrees t1-~i rty-three ( 3 3 ) minutes thirty (30) seconds East from the intersection of said side of Wayne Circle (formerly Avenue "M") with the Northeasterly side of Wayne Road {formerly Avenue "L") (50 feet wide) (both lines produced); thence along Lot No. 135 North twenty-six (26) degrees twenty-six (26) minutes thirty (30) seconds West a distance of eighty-nine (89) feet to a point; thence alone. Lot No. 134 North one (1) degree thirty-seven (37) minutes thirty (30) seconds East a distance of sixty-two and thirty-three one hundredths (62.33) feet to a point; thence along Lot No . 137 Soutlz forty-three (43 ) degrees nineteen (19) minutes thirty (30) seconds East a distance of one hundred thirty-eight and forty-one one l~.undredths (138.41) feet to a point on the Northwesterly side of C~]ayne Circle (for- merly Avenue "M") in a Southwesterly direction on a line curving to the right having a radius of ninety-one and fifty-one one hundredths (91.51) feet the arc distance of forty-eight and fifty-eight one hundredths (48.58) feet to a point of tangent; thence still along sand side of Wayne Circle <f:-ormerly Avenue "M" ) South sixty-three ( 63 ) degrees thirty-three (33) minutes thirty (30) seconds West a distance of twenty-three and forty-six one hundredths (23.46) feet to the first mentioned point and place of BEGINNING. UNDER AND SUBJECT to the reservations and rest=rictions contained in prior deeds. HAVING erected thereon a dwelling house being }mown and numbered as 2 Wayne Circle, Camp Hill, Pennsylvania 17011. BEING the same premises which Allen Park Development Corporation, a Pennsylvania Corporation, by deed dated February 1, 1950 and recorded February 2, 1950 in the Cumberland County Recorder_ of Deeds Office in Deed Book "H", Vol. 14, Page 236, granted and conveyed unto Glenn George Fertenbaugh and Jane Fertenbaugh, his wife. The said Jane Fertenbaugh died February 23, 1994, where- upon full and complete title to the within described. real prop- erty became vested solely in Glenn George Fertenbaugh, also known as Glenn G. Fertenbaugh, the Decedent herein. The said Glenn George Fertenbaugh died December 13, 2010. TOGETHER with all and singular the rights, liberties, privileges, hereditaments 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 Glenn G. Fertebaugh at and immediately before the time of his decease, in law or equity or otherwise howsoever, of, in, to or out of the same: TO HA.~TE AND TO HOLD the said granted premises to the said party of the second part, their successors and assigns forever. AND the said party of the first part, does covenant , promise, grant and agree, to and with the said party of the second part, their successors and assigns, by -these presents, that the said party of the first part, has not done, committed, or knowingly or willingly suffered to be done, any act, matter or thing what- soever, whereby the premises aforesaid, or any part thereof , is , are, shall or may be charged or encumbered, in title, charge or estate, or otherwise howsoever. IN WITNESS WHEREOF, the said party of the first part has here- unto set his hand and seal the day and year above written. Signed, Sealed and De7,ivered n Presence of ~~, c_ ~~-- L~- SEAL ,~ ~ ) William G. Fertenbaugh, ecutor of the Estate of Glenn G. Fertenbaugh COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF ~ , On this, the day of 2011, before me, the undersigned officer, personally appeared William G. Fertenbaugh, Executor of the Estate of Glenn G. Fertenbaugh, known to me (or satisfactorily proven} to be the person described in the forego- ing instrument, and acknowledged that he executed the same in the capacity therein stated and for the purposes therein contained. seal . IN WITNESS WHEREOF, I hereunto set my hand and official i f __, .. ~ (SEAL ) Notary P My Commission Expires: COMMONWERLTFI OF PEN~ls;YLV~~,tp NOTARIAL SEAL DARREN L. MILLER, Notary public Manchester Twp., York County My Commission Expires September 11, ~a12 CERTIFICATE OF RESIDENCE T do ~ hereby certify that the precise residence acid complete post office address of the within named grantee is : ~~5~ ~'~~' > ~, ~~ ~~ ` _~r ~~ 2 O 11 Agent for ~~_~• Anchor ,~Lstracting Co.; Inc. hia Street t Philadel 29 E A. Settlement Statement U.S. Department of Housing and Urban Development OMB No. 2502-0265 - p as ---~r. York Pennsylvania 17401 B. TYPE OF LOAN ; Telephone; 717-69a-4800 Fax: 717-843-2250 1. i]FHA 2. (]FmHA 3. ^Conv. Unins. 4. ^VA 5. ^Conv.lns. ~- ,v, w;~; 6. FILE NUMBER 11-8027 7. LOAN NUMBER ~, - '~'~ `' 8. MORTGAGE INSURANCE CASE NUMBER is orm is urnts e o give you a s a emen o ac ua se emen cos s. moun s pat o an y e se emen ages are s own. C. Note: Items marked "(p.o.c.)" were patd outside the closing; they are shown here for information purposes and are not included in the totals. WARNING: It is a crime [o knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and im risonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010. TltIeEXPrOSS Settlement System D. NAME OF BORROWER: Otter Creek Associates, LP ADDRESS: 1650 Greenbriar Road York PA 17404 _ E. NAME OF SELLER: Estate of Glenn George Fertenbaugh ADDRESS: F. NAME OF LENDER: CASH ADDRESS: _ G. PROPERTY ADDRESS: 2 Wayne Cir., Camp Hill, PA 17011 Lower Allen Townshi H. SETTLEMENT AGENT: Anchor Abstracting Company, Inc., Telephone: 71T-699.4800 Fax: 717.699.0687 PLACE OF SETTLEMENT: 27 East Philadel hia Street York PA 17401 I. SETTLEMENT DATE: 0212512011 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 50 000.00 401. Contract sales rice 50 000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement char es to borrower line 1400 1 155.75 403, 104. 404. 105. 405, Ad~ustments for items aid b seller in advance Ad'ustments for items paid b seller in advance 106. Cit !town taxes 02125111 to 12131111 181.35 406. Cit !town saxes 02125111 to 12/31/11 181.35 107. Count taxes 02125111 to 12/31111 149.19 407. Count taxes 02125111 to 12!31111 149.19 108. School taxes 02!25111 to 06/30111 314.60 408. School taxes 02125111 to 06130111 314.60 109. 1st Qtr. Sewer & Refus~2125111 to 03131111 40.42 409. 1st Otr. Sewer & Refus~2125111 to 03131111 40.42 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 51,841.31 420. GROSS AMOUNT DUE TO SELLER 50,685.56 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest movie 2 000.00 501, Excess De osit see instructions 2 000.00 202. Princi at amount of new loans 502. Settlement char es to seller line 1400 913.19 203. Existin loan s taken subject to 503. Exisiin loan s taken sub"ect io 204. 504. Pa off of First Mort a e Loan 205. 505. 206. 506. 207. _ 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 210, Cit !town taxes 510, Cit /town taxes 211. Count taxes 511. Count taxes 212. School taxes 512. School taxes 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 2 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2 913.19 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 51 841.31 601. Gross amount due to seller line 420 _ 50.685.56 302. Less amounts aid b !for borrower line 220 2 000.00 602. Less reduction amount due seller (line 520 __ 2,913.19 303. CASH FROM BORROWER 49,841.31 603. CASH TO SELLER d7 77~ ~7 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a retur a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent (Fed. Tax ID No: 23-2980846) with your correct taxpayer identification number. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. TIN: - I SELLER(S) SIGNATURE(S): ~ SELLER(S) NEW MAILING ADDRESS: SELLER(S) PHONE NUMBERS: (H) (W) U.S. UtF'AKI MtN I Ur tlvuJnv~ HIVU uK~Hlu utvtLUrIVItIV I rre IV'_ITCer: 1 l-ryvLr CCTTI ~M~IUT ~TAT~MFNT TitIPFYnrF~cc Cattl~mont Svctvm f'f~,Lt L. SETTLEMENT CHARGES f__ ___ PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSfON based on rice $50 000.00 = ~ _ BORROWER'S SELLER'S Division of commission line 700 as follows: - ~__ FUNDS AT FUNDS AT 701 $ to SETTLEMENT SETTLEMENT 702. $ to __ 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount 803. A raisal Fee 804. Credit Re ort 805. Lender's Ins ection Fee 806. Mort a e A lication Fee 807. Assum tion Fee 808. 809. _^ 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to $ !da _ 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000.~RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. $ Imo 1002. Mort a e Insurance mo. $ Imo 1003. Cit Pro ert Tax mo. $ Imo 1004, Count Pro ert Tax mo. $ (mo 1005. School taxes mo. $ !mo 1009, A re ate Anal sis Ad'ustment 0.00 0.00 1100. TITLE CHARGES 1101, Settlement orclosin fee to AnchorAbstractin Com an Inc. 1102, Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Pre aration 1106. Notar Fees to Darren Miller 35.00 14.00 1107. Attorne 's fees to James D. Bo ar Es . POC includes above items No: 1108. Title Insurance to Chica o Title Insurance Com an 558.75 includes above items No: 1109. Lender's Polic NONE 1110. Owner`s Polic 50 000.00 - 558.75 1111. 1112. 1113. Tax Cert fee to Lower Allen Townshi clo Bonnie K. Miller 10.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed $ 62.00 • Mort a e $ • Release $ 62.00 1202. Cit /Count tax/stam s Deed $500.00 • Mort a e $ 500.00 1203. State Taxlstam s Deed $500.00 • Mort a e $ 500.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve 1302. Pest Ins ection 1304. 2011 Local & Count Taxes to Lower Allen Townshi clo Bonnie K. Miller 389.19 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1 155.75 913.19 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD•1 Settlement Statement and to the best of my knowledge and be{ief, !t is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction.) further certify that I have received a copy of the HUD-1 Settlement Statement. Otter Creek Associates, LP v y: ar ai a er Estate of Glenn George Fe nbaugh ~./• ~---~T - ~ ~a n aug , e ecu or WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settle nt Statement wliltfi-i-}taye prepared is a true and accurate account of this UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have used or will cause the 1'uhd to be disbursed in accordance with thi statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 ANp SECTION 1010. SET'rLEMENTAGENT: DATE ~ 1 Rev-1503 EX+ (6-98j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 All property jointly-owned with right of survivorship must be disc{osed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 693517106 PPL Corp -Common Stock 25.55 14,870.10 2 693517106 PPL Corp -Common Stock -These shares were jointly 25.55 24,502.37 owned with Jane Fertenbaugh, spouse of the Decedent, by account established on January 12, 1990. The said Jane Fertenbaugh died February 23, 1994, whereupon full and complete title to this stock became vested solely in Glenn G. Fertenbaugh, the Decedent herein. TOTAL (Also enter on Line 2, Recapitulation) 39,372.47 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) PPL Historical Prices ~ P1'&L Corporation Common Stock Stock -Yahoo! Finance Page 1 0~ 1 t~ew User? R°gister Sign in He!p Preview iylaii WI TooEt~ar ``al~uo! Iv,aii ,~~~~~~ [ ~ ~~~~ ~ _. . ~ ~ ~, _ ~ ,n Web Search Dow $ 1.39% Nasdaq ~ 1.85%a HOME iNVESTlNG NE41rS & OPINION PERSONAL FINANCE MY POrrTFOLiOS TECH ICE`tER GET QUOTES Finance S earch Tue, i~4~ `..?::~? ;, =: ;'prn ~.;.7~ US A4ari;eti_S c;c?se in 4H tnitt5 PPL Corporation (PPL) At 2:56PM EST: 24"H3 :~ 0.60 (2.37%) _. 1 .Pt ~~ti ~~ ~~L ~S 9 ~ y' ~ ~ ~ ~ ~ ~. ~ ,; t, ~ ~ s r r 'Ti 1' FREE ~~`,~/TRA[aES , ;~. w,~ ;~ Historical Prices Get Historical Prices for:. GQ, Set Date Range ~_____ _ o Daily Start Date: Dec 13 ~' 2010 , Eg• Jan 1, 2010 ;Weekly End Date: Dec `13~! 2010 .. Monthly ~;; Dividends Only j ; ,Get. Prices First ~ Previous (Next I Last I Prices ' Adj Date Open High Low Close Volume Close" Dec 13, 2010 25.26 25.64 25.25 25.55 3,808,600 25.55 ` Close price adjusted for dividends and splits. l=ust I Previous I Next j Last r~' Download to Spreadsheet Curcency in USD. Copyright <~ 2Q4 7 Yahoo! lnc. AN rights reserved. Privacy Policy -About Our Ads -Terms of Service - Copyright/IP Policy -Send Feedback - Yah00 t. N ew5 NertWQrk Quotes delayed, except where indicated otherwise. Delay times are 7 5 rains for NASDAG. NYSc and Amex. See ai5o dLiay times fdr other exchanges. uuotes and other inform a0on supplied by independent providers identified on the Yahoo! Finance partner page.Quotes are updated automatically, but wi!! fie turned cff after 25 minutes of inactivity. Quotes are delayed at least 75 minutes. All information provided "as is" for informational pumoses only, not intended for trading purmoses or advice. Neither Yahoo! nor any of independent providers is liable for any infanriational errors, inaxnpleten~ss. or delays, or for any actions taken in reliance on information contained herein. By accessing the Yahoo! site, you agree not to redistribute the infcrnaticn fnurd therein. Fundamental company data provided tray Capital IQ. Historical chart data and daisy updates provided by Commodity Systems, Inc. {CSI). Intema(io nal historical chart data, daily updates, fund surnrnary, Turd performance, dividend data and Morningstar Index data provided by Morningstar, tnc. 1~r1-,~•~~firtanc-~P vahnn_c~m/o/hn?s=PPL&a=11&b=13&c=2010&d=11&e=13&f=2010&g=d 3/1/2011 To authorize the direct deposit of future dividend payments complete form on reverse side and mail this portion to: PPL Corporation Investor Services, GENTw13 Two North Ninth Street Allentown, PA 189 01-1170 GLIJNN G FERTEN~AUGI-i Payee and 2 WAYNE CIR Payment CAMP HILL PA 17C1w-6660 Address: PPL Account Number: 3099021295 Account Registration and Primary Address: GLENN G FERTENBAUGH 2 WAYNE CIR CAMP NlLL PA 17011-6660 As of record date: December 10, 2010 Receive your future PPL dividend payments quickly and safety. Simply complete the Authorization Form far Direct Deposit of PPL Dividend Payments on reverse side, detach and mail to PPL Corporation at address above A postage-paid reply envelope is enclosed for your convenience. PPL Corporation Two North Ninth Street Allentown, PA 181 ~ 1-1179 www.pplweb.com PPL Shareowner Account Number: 3099021295 Account Registration and Primary Address: GLENN G FERTENBAUGH 2 WAYNE CIR CAMP H I LI_ PA 17011-6660 Share Information: Certificate Shares' 258.000 DRS (Book} Snares: 324.000 -..:Plan Sl;ares:-._ __._. __ . O.OC4 Total Record Date Shares: 582:000 Year To Date Qividends: Grass Dividends Paid in Cash: 203.7a ~ Gross Dividends Reinvested: .40 Total Grass Dividends: 203.74 Total Taxes Withheld: .40 Change of address required? 1. Call 1-8Qt)-345-3085 toll-free. 2. Or change your address by accessing your account at www.sha reowneron line. cam 3. Or mail your change of address to: Shareowner Services P.o. Box s4s~4 St. Paul, I'111N 55164-0874 Please be sure to include your account number. Changes must be authorized by ati registered owners} or their legal representatives}. Qividend Check Summary Check Number: 03013569 Dividend Record Date: Qecernber 10, 2010 Dividend Payment Date: JANUARY 3,2011 Net Amount; $203.70 Record Date Dividend Shares Paid by Rate per Dividend Class of Stock Check Share Amount PPL CORP COMMON 582.000 .3500 203.70 Information on the Internet: Account access and transactions: wvvwshareowneronline.com General inquiries: www.wellsfargo.comishareownerservices ~~ PPL News and Information: www.pplweb.COm Information by phone: 1-$00-345-3085 toll-free within U.S. or 651-453-2129 from outside U.S. Select Option 1 at first menu for PPL's News and Information Service. ~ Select Option 2 at first menu for account access and inquiries. %~~1 j Security Qverview hops:/(w~v~v.shareow rieibnline.cam/TransactionManagemenit/S ecuc i... Download Account Number. 30971}92715 Security Type: COMMON Sale, '~?.i,~C;r3+9~ & Registered Owner -Primary Secondary Address ~.;ty :t•. : a ~a 4?~?"t"'D'V4?~i~a ~'2SL~ZE' i'i~a' ?O:'i~O:iG' ?Sc ~..,....~ ~Pi^-55~ _°S ..~^.2.:!:':?::.~ 3; Jf` SnCS JL .."t"ir i'~; ^..$~.v ...... iii _, ~,n7r~;aS. { WdRt~O... St3curity Overview .,~t3ie .=(ec+=o^~ tnL~.•s<:,~r;:-ts !.~~ r , ~{ee-~ ale; ts~ ?~:;ar =iars~ PPL CORPORATfUN .,ell a~,a s ~E~a.~..,: ~,..,~,~rJ ~~:t~r,~s GLENN FERTENBAUGH 8 `''='''`~'` Same as Primary Address JANE R FERTENBAUGH JT TEN v r~, 2 WAYNE CIRCLE r_~z~ CUMBERLAND PARK CAMP V-i{LL PA 170i i ~, ~anaa Email WFERTE35A@VERIZON. NET ;'.:i St Today is Tuesday -Dec 14, 2010 Sign On Failures : 0 Last Sign C?n info: Dec 14, 2010 i r i. ~ '. ' ~:, ' . y' a?c~ G«'j; NYSE: PPL 25.50 Change: -6.455 1 -L'.2~i% 1?liAJio d:olpm .,< 1 ~d (tm ~ 3:;? ~ cam ~ tY Open: 25.62 High: 25.73 30d High: 25.73 15 Low; 25.47 -~----------->--------___ 3u Voiume: 3.52M ~`~'"~ ~-- 25 Yfeid: 5.49 PIE Ratio: 13.35 2G xt;• Mkt Cap: 12.328 «~tcr afs cs't2 ~0 AG' Et i2~t3rta Latest News Similarcampanies: SO { G { L;'::Y. 7:04am 12114110 ,.,avrn -lotdvr.gs Ir.,.:saT;cs Ja°r?e. . 8;42am 12!13110 ieaurn ~i~=angs, tnc. ulcers J... Number of Sfiares and Asset Value =Current Asset Value ($) Share AisYritfutian (Value calculated at 25.5 per share price) Certrficate: v.«£i0 0-00 QRS. D.O~JO 0.00 Plan'. cs5~ 997 24,454.42 Total: 958.997 24,454.42 Quotes delayed at least 15 minutes. Market dais provided try interactive Data. `~r~~s c~ u:,r.:~itio.^s. Powered and imp[emeMed by Irrteractive Data Managed Solutions :asne i ~ r xv}~. a^....I.iij $ r„+~3: ~ =fcL.~ ?re.~:r~;~-~ a^d r<rC . .: i S~>/r~.~ee~ 2• nas~rs ~ ~_~.,z! Us ~ G ;c aaie i>suPr, Shareovmer Services is a division of WeAs Fargo Bank, NA ~ 1999 - 2010 Wells Fargo. ai rights. reserved- 1 of 1 l_2/ l4l10 5.41 P1~1 Rev-1508 EX+ (6-98) SCHEDULE E y CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbau h, Glenn G. 21-11-0025 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1993 Chevrolet Caprice -VIN#1 G1 BL83E4PW102259 -Sold at private sale 500.00 2 Personal Property -sold at auction 3,473.00 3 Personal Property -sold at auction 105.25 4 Personal Property -sold at auction 441.11 5 Forest Park Health Center -Refund of overpayment 4,425.00 6 Pennsylvania Department of Treasury -Unclaimed Property ID No. 8346056 -This is a 100.00 refund/rebate from LL Bean, Inc., with a value of less than $100.00. TOTAL (Also enter on Line 5, Recapitulation) I 9,044.36 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98} P ~~ VM1 uW 1- /W W ~' CERTIFICATE OF TITLE FOR A VEHICLE ~, . ..__ _ . __._ ......_, ..... M .~.._..~:.__. _~,.:~:.,:~..,,_ __ _ _. ~`1 ~~ ~; ~, U .f. ~:;f s~.~' ~'~" ~~"1, l..Yt~al7~ I .1 7~~~ I {.~~~;~ ~i~~.._.~~ , I ~~~~'`i'C'~~'i~~?`~~}r~ ~~ VEHICLE~IDENTIFICATION NUMBER I PEAR h.4AKE OF VEHICLE , ,1 I TITLE NUMBER ~ ( ~ ' DODY TYPE-" ~~ DUP SEAT CAP ODOM PROCD. DATE I PRIOR TITLE STATE ODOM. MILES GDOM. STATUS ~~ ~~ I+ "mil P ~ ~~ `a . 4 a . ;1 , ~ ~ ~~ ~ y ~ I „ '" .. ', ~ .',L 1 ,;i I PA TITLED DATE I . ,. . .,.: DATE OF fSSUE u f NLADEN WEIGHT GVINR ~ GCWR I , TITLE BRANDS ~OCOMETER STATUS ' I 0 -ACTUAL MILEAGE ~ I I : 1 ='MII_EAGE EkCEEDS THE MECHANICAL . ` LIMITS 2 =NOT THE ACTUAL MILEAGE 3 =NOT THE ACTUAL MVLEAGE OGOMETEA TAMPERING;iUERIF1Ed'llil~'III ICI; !..,, i,ll 4 =EXEMPT FROM. ODOMETER DISCLOSURE EGISTERED ~~li'i I In ',~~Ilp~~~ l~lllj~ 'I'';IIi l l1l d ll TITLE BRANDS ~ A = ANTIQUE VEHICLE`"' C -CLASSIC VEHICLE ,~ ? ~ ' l'::t~..:l~~`~~ D COLLECTIBLE VEHICLE 1 gl~~llllllll ~III ~ - ~ , 0 ~ OR GIONALLY MFGO FOR NON=U S ( lt ~~ t ' DISTRIBUTION s ~u ~ t'w[ ~ ~ H = AGRICULTURAL VEHICLE t t ~ L = LOGOfNG VEHICLE ' } ~ U I ~'Ih P = IS(VJAS A POLICE VERICLE R =RECONSTRUCTED ' II ly, ~ ' ~~~f f ' I fl~tl'1111i~ I '~ ~}III~IIWI'I I 1 h ~ I 11 - S =STREET ROD T = RECOVERED THEFT VEHICLE- V =V HICLE CONT S ,(~~ , I ~ ~ ~ ~ III I d ~I i )~ r~ ~ ~ ~ Ilt ~71 'I ~ ~ E AIN REISSUED VIN W =FLOOD VEHICLE I'; ' FIRST LIEN FAVOR OF; l ~ j' ~ I~ ,!l l ~ ;~ 1~~1 l ~ I III ° il~t;ll'I~ j I }.IEN uECb ~ pF: ' ~ x = ISNJAS A TAXI ~';, ~'`'l11~iN l~''f I th II~Iw~Ni~~ ` IIII~ 11~~i1I ~1~ ~ 111111 I I ~,1 I I F~'I I~ "hill lal Illu}H~Ii~h . 1~f~~i~~l~ jl ~ P~ I 'I l i l I l ll l ~ it ~l~ 1 I h {I I ~ I ~I I I I l ll ~ 1 1 I ' ; I I I l p tI ~ 11 1 I I o s I ls tl ~ # h t e t o f Ilenholder mu t forward thls ot` T'I e117 ~'~theaBur eai) M Vehf to1 es wth thei.I I ~,IFI Ii;I! approprlafe form and fee. ~~PI4,N ~ ,li ,li I ~I, ,, l hl'I I p,, „„ ~ ~ ~ FIRST LIEN RELEASED DATE ~ I l h~I l , I'1 ilii 1 1 1 ~, I I'~'I I .III 11 I •;II'I I II~I~I ." i ' II ~ IIGIIIIuII~LI~II ~~ ~ d'~~~ I Illl'(~~ l I I'I,I I`Illllu I BY SECOND LIEfJ RELEASED AUTHORIZED REPRESENTATIVE . DATE I, MAILING ADDRESS BY , ~..`~~~~,.+~ AUTHORIZED REPRESENTATIVE ~LE~Ih~ G ~'ERTEh~L~~IU~W 2 _ I~tRYt~EE ~I_R ~..KS~ ~ (1Ai~F 't-tl~L ' f~A i7C?1 1 4 ~~ - Pennsylvania f DEPARTMENT OFTRANSPORTATION. I-.certify as- of the date of issue, the offlclal records of the Pennsylvania Department f~t~.t•- E1 ~I lJ L~ .S. ~ ~`t L._ t:. I''. of Transportation reflect that the person(s) or company named herein is the lawful owner s of the said vehicle. Secretary of Transportation ~ ~ ;. ~ , SUBSCRIBED AND SWORN If a co•purchaser other than your spouse is listed and you want'the,title to ~, O',BEFOR ,ME 11i,l~gif I be Isted as Jornt TenantSlWlth Right of Survivorship (Qn death of one ~, ~,: ,4141i!~1'1 i+l+l~l n~ II il~d;~;1~ II'~ r~ I ° I '~~ Mo. I~ oar vEAa owner, ilia goes to surviving pwnef),CHECK HERE O. OtHerwise, the title PI~'~i?i~i r' I ~,:, ." Ill i' 1 wi{I be issued as "Tenants in Gommori" (On deathot one.ovvner, interest of ~°:.1;1'1 ' I1 I' ~ ~ deceased owner oes to hislher heirs or estate)... ..'.I. I I I I 9 I~° SIGNATURE~OF PERSON ADMINISTERING DATH ~ : I I IF NO LIEN, CHECK ^ ` IS THIS AN ELT? (iF YES, FIN REQUIRED) YES ^ NO^ J 1,,, I ~ ~ 1ST LIENHOLDER FINANCIAL INSTITUTION NUMBER: " , 1STLIENHOLDERNA _ ME STAEE7 CITY ', I STATE ZIP - IF NO 2ND LIEN, CHECK ~ IS THfS AN ELT? (IF YES; FIN REQUIRED} YES I] NO ^ The undersigned hereby .makes application for CeAlllcateof Title to.~the vehicle described - above, subject to the encumbrances andolher legal clalms,sel forth here. - 2ND LIENHOLDER FINANCIAL INSTITUTION NUMBER: 1 `, 2ND LIENHOLDER NAME - 516NATLIRE OF.APPLICANT OR AUTHORIZED SIGNER ,,. STREET 1 - SIGNATURE OF CO•APPLICANT/rRLE OF AUTHORIZED SIGNER CITY - - STATE - ~ ZIP i:l(fiVll~if ._ Iy,:ii-LL. II MI II .. :.il.r Il., r,l..l' I Ir ~,.r~..~ .~' ..., i:l'~ ,. x.',,.. I.I. ... , r I., ,t. ...1'11.. ~. - .,.. .. Rev-1509 EX+ (6-98) ~. ` SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSH{P TO DECEDENT A. William G. Fertenbaugh 35 Autumn Drive Son Dillsburg, PA 17019 B. Michael R. Fertenbaugh 6 Countryside Court Son Camp Hill, PA 17011 C. JOfNTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A, B 05/29/2007 Members 1st Federal Credit Union - 10,005.72 33.333% 3,335.24 Certificate of Deposit No. 164142-41; principal balance at date of death $10,000.00; accrued interest $5.72. This certificate of deposit is a rollover from certificate no. 164142-44, originally established May 29, 2007. 2 A, B 05/29/2007 Members 1st Federal Credit Union - 5,001.56 33.333% 1,667.19 Certificate of Deposit No. 164142-45; principal balance at date of death $5,000.00; accrued interest $1.56. This certificate of deposit is a rollover from certificate no. 164142-43, originally established April 17, 2007. 3 A PPL -Common Stock, CUStP #693517106 11,139.80 50.000% 5,569.90 TOTAL (Also enter on Line 6, Recapitulation) I 10,572.33 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) MEMBERS 1St FEDERAL CREDIT UNION 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 Date Joint Ownership Established 164142-00 12!30/1996 $4,152.10 $.41 $4,152.51 Michael Fertenbaugh William Fertenbaugh 09/03/2010 CHECKING ACCOUNT: Account Number/Suffix 164142-11 Date Account Established 03/10/1997 Principal Balance at Date of Death $5,717.45 Accrued Interest to Date of Death $.51 Total Principal and Accrued Interest $5,717.96 Name of Joint Owner Michael Fertenbaugh William Fertenbaugh Date Joint Ownership Established 09/03/2010 INVESTMENT SAVINGS ACCOUNT: Recount 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 Date Joint Ownership Established 164142-05 09/09/2010 $108,109.53 $25.84 $108,135.37 Michael Fertenbaugh William Fertenbaugh 09/09/2010 CERTIFICATES OF DEPOSIT: Account Number/Suffix 164142-41 Date Account Established 04127/2010* Principal Balance at Date of Death $10,000.00 Accrued interest to Date of Death $5.72 Total Principal and Accrued Interest $10,005.72 Name of Joint Owner Michael Fertenbaugh Date Joint Ownership Established 04/27/2010 *Rollover from certificate 164142-44, originally established 05129/2007. *Rollover from certificate 164142-43, originally established 04/17!2007. VISA ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Joint Cardholder *Contractual Pledge of Shares. 467209000364604 03!08/2010 $.00 None 164142-45 03/16/2009' $5,000.00 $1.56 $5,001.56 Michael Fertenbaugh 03116!2009 E BERS 1sT FEDERAL CREDIT ION Danielle A. Kline Lending insurance Support Specialist January 7, 2011 Estate of: GLENN G. FERTENBAUGH Date of Death: 12/13/2010 Social Security Number: 209-12-8154 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org PPL Historical Faces ~ PP&L Corporation Common Stock Stoclc -Yahoo! Finance 1~age i or i t~ew User? R~gister Sirn In Help Prevsew f~ai( a+~~/ Tooibar Yah~~c! ('vial __ _ ,~a~ . ..'. ,. ~~.<.~~ K,_x.~,...~..~~., ,~...,>~~_.. Web Searc Dow $ 1.39% Nasdaq ~ 1.85% HOME INOyFSTINv hiEt~trS ~ OPINION PERSONAL FINANCE R4Y POt~TFOLIOS T_CH TIGER ---~ GET QUOTES Finance Sarrtn Tua, i~A~r '. ''i i 1, ?.: i ?FJ:`1'; .~> I - L:f t~~ie.rf~ets c.}css~~ in ~& rtti€€s PPL Corporation (PPL) At 2:56PM EST: 24.H3 ~ 0.60 (2.37%) PPL ~~ , ~ ~ "~~ FREE ' 'i"RALlES ~,' '•; "' ~ Historical Prices Set Date Range Start Date: Dec 13 2010 Eg. Jan 1, 2010 End Date: Dec 13 2010 ~~ Get Prices Get Historical Prices for: ~° Daily '~~ Weekly ~' Monthly =`~ Dividends Only First ~ Previous ~ Next ~ Last Prices Date Open High Low Close Volume Adj Close" Dec 13, 2010 25.26 25.64 25.25 25.55 3,808,600 25.55 Close price adjusted for dividends and splits. First ~ Previous ~ Next ~ Last ~tDOwnioad to Spreadsheet Currency in USD. G0, Copyright riJ 2011 Yahoo! Inc. All rights reserved. Privacy Policy -About Our Ads -Terms of Service - CopyriyhUlP Policy -Send Feedback - Yai100! N eW$ Network Quotes delayed, except where indicated otherwise. Delay times are 15 miss for NASDAQ, NYSE and Amex. See also datay times far other exchanges. 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' hrr,-,•~~f;,,an~P ~ahno_c~m/a/hn?s=PPL&a=11&b=13&c=2010&d=11&e=13&f=2010&g=d 3/1/2011 To authorize the direct deposit of future dividend payments complete form on reverse side and mail this portion to; PPL Corporation investor Services, GENTW13 Two North Ninth Street Allentown, PA 18101-1170 GLENN G FERTENBAUGH & Payee and 6aILLIAM G FER TENBAUGH JT TEN' Payment 3 5 AUTUMN DR Address: DILLSBURG PA 17 019 PPL Account Number: 3097'151549 Account Registration and Primary Address: GLENN G FERTENBAUGH i~ WILLIAM G FERTENBAUGH JT TEN 35 AUTUMN DR DILLSBURG PA 17Q19 As of record date: December 10, 2010 Receive your future PPL dividend payments quickly and safely. Simply complete the Authorization Forrn far Direct Deposit of PPL Dividend Payments on reverse side, detach and mail to PPL Corporation at address above A postage-paid reply envelope is enclosed for your convenience. PPL Corporation Twa Nor#h Ninth Street Allentown, PA 18101-11.79 www.pplweb.com -PPL Shareowner Account Number: 3057151549 Account .Registration and Primary Address: GLENN G FERTENBAUGH WILLIAM G'FERTENBAUGH JT TEN 35 AUTUMN DR DILLSBURG PA 17Q19 Share Information: Certificate Shares: 218.040 DRS .(Book) Shares: 218.000 Plan Shares:___.. __ _.__ _ _ O.G00 Total. Record :Date Shares: 436:OOt3 Year To Date Dividends: Gross Dividends Paid in -Cash: 152.60 Gross Dividends Reinvested: .00 'Total Gross Dividends: 152.60 Total Taxes Withheld: .00 Change of address required? 1. Call 1-800-345-30$5 tot!-free. 2. Or change your address by accessing your account at www.shareowneronline.com 3. Or mail your change of address to: Shareowner Services P.Q. Box 64874 St. Paul, MN 55164-0$74 Please be sure to include your account number. Changes must be authorized by a1f registered owner(s) or their legal representative(s). Dividend .Check Summary Check Number: 0301386 Dividend Record Dater December 10, 2010 Dividend Payment Date: JANUARY 3,20'! 1 Net Amount: $152.60 Record Date Dividend Shares. Paid by Rate per Dividend Class of Stock Check- Share -.Amount PPL CORP COMMON 436.QCi0 .35fl0 152.60 ~._ . ._.4._.__. ... Information on the Internet: Account access and transactions: www.shareowneronlirte.COm Genera! inquiries: www.wellsfargo.comishareownerservices PPL News and Information: vvww.pplweb.com Information by phone: 1-800-345-3085 toll-free within U.S. or 651-453-2129 from outside U.S. Select Option 1 at first menu for PPL's News and Information Service. Select Option 2 at first menu for account access and inquiries. y 1 f Rev-1510 EX+ (6-98) SCHEDULE G i.. INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRD4NSFERSATTACN A COPY OF THE DEED OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION SIF APPLICABLE) TAXABLE VALUE 1 Members 1st Federal Credit Union -Savings Account 4,152.51 1,300.00 2,852.51 No. 164142-00; principal balance at date of death $4,152.10; accrued interest $0.41. This account was made joint with the Decedent's sons, Michael Fertenbaugh and William Fertenbaugh, on September 30, 2010, a period of less than one year prior to his death. (AN EXEMPTION IN THE AMOUNT OF $1,300.00 IS CLAIMED AS TO MICHAEL FERTENBAUGH !N ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE TAX ACT, BEING 72 P.S. SECTION 9108(c) AND 72 P. S. SECTION 9107(c)(3)). 2 Members 1st Federal Credit Union -Checking Accoun 5,717.96 1,700,00 4,017.96 No. 164142-11; principal balance at date of death $5,717.45; accrued interest $0.51. This account was made joint with the Decedent's sons, Michael Fertenbaugh and William Fertenbaugh, on September 30, 2010, a period of less than one year prior to his death. (AN EXEMPTION IN THE AMOUNT OF $1,700.00 IS CLAIMED AS TO MICHAEL FERTENBAUGH !N ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE TAX ACT, BEING 72 P.S. SECTION 9108(c) AND 72 P. S. SECTION 9107(c)(3)). Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 7, Recapitulation) I 112,005.84 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G w INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continue d RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF RANSFER.SATTACI{ ACOPY OF T~E DEED OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 3 Members 1st Federal Credit Union -Investment 108,135.37 3,000.00 105,135.37 Savings Account No. 164142-05; principal balance at date of death $108,109.53; accrued interest $25.84. This account was made joint with the Decedent's sons, Michael Fertenbaugh and William Fertenbaugh, on September 9, 2010, a period of less than one year prior to his death. (AN EXEMPTION IN THE AMOUNT OF $3,000.00 IS CLAIMED AS TO WILLIAM FERTENBAUGH IN ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE TAX ACT, BEING 72 P.S. SECTION 9108(c} AND 72 P. S. SECTION 9107(c)(3)). TOTAL (Also enter on Line 7, Recapitulation) I 112,005.84 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) MEMBERS 1St FEDERAL CREDIT iTNION 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 Date Joint Ownership Established 164142-00 12/30/1996 $4,152.10 $.41 $4,152.51 Michael Fertenbaugh William Fertenbaugh 09!03/2010 CHECKING ACCOUNT: Account Number/Suffix 164142-11 Date Account Established 03/10!1997 Principal Balance at Date of Death $5,717.45 Accrued Interest to Date of Death $.51 Total Principal and Accrued Interest $5,717.96 Name of Joint Owner Michael Fertenbaugh William Fertenbaugh Date Joint Ownership Established 09/03/2010 INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 164142-05 Date Account Established 09!09/2010 Principal Balance at Date of Death $108,109.53 Accrued Interest to Date of Death $25.84 Total Principal and Accrued Interest $108,135.37 Name of Joint Owner Michael Fertenbaugh William Fertenbaugh Date Joint Ownership Established 09/09/2010 CERTIFICATES OF DEPOSIT: Account Number/Suffix 164142-41 164142-45 Date Account Established 04/27/2010* 03/16/2009* Principal Balance at Date of Death $10,000.00 $5,000.00 Accrued Interest to Date of Death $5.72 $1.56 Total Principal and Accrued Interest $10,005.72 $5,001.56 Name of Joint Owner Michael Fertenbaugh Michael Fertenbaugh Date Joint Ownership Established 04/27/2010 03/16/2009 *Rollover from certificate 164142-44, originally established 05129/2007 . *Rollover from certificate 164142-43, originally established 04/17/2007 . VISA ACCOUNT: Account Number/Suffix 467209000364604 Date Account Established 03/08/2010 Principal Balance at Date of Death $.00 Joint Cardholder None *Contractual Pledge of Shares. E BERS 1ST FEDERAL CREDIT ION 0c-~,~.f~ ~. `~ Danielle A. Kline Lending Insurance Support Specialist January 7, 2011 Estate of: GLENN G. FERTENBAUGH Date of Death: 12/13/2010 Social Security Number: 209-12-8154 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org REV-1151 EX+ (10-06) . ~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCETAxRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 702.70 Street Address City State Zip Year(sl Commission paid 2. Attorney's Fees Bogar & Hipp Law Offices 9,450.00 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 323.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 4,897.79 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,373.99 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Dockside Willies -funeral luncheon 311.00 2 Malpezzi Funeral Home 391.70 H-A 702.70 3 Other Administrative Costs Cumberland Law Journal -Executor's Notice 75.00 4 Diller's Transfer -tire disposal 91.00 5 Haar's Auction -Auctioneer's commission 31.58 6 Haar's Auction -Auctioneer's commission 132.20 7 Ian Spitzer -home appraisal fee 300.00 8 Journal Publications -Executor's Notice 140.00 9 Lower Allen Township -trash removal 103.95 10 Members 1st Federal Credit Union -check printing fee 21.25 11 Mike Coteau -Auctioneer's commission 1,215.55 12 PA American Water -water bill 15.08 13 PA American Water -water bill 15.08 14 PA Department of Transportation -duplicate title 22.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 ITEM NUMBER DESCRIPTION AMOUNT 15 PPL -electric bill 42.50 16 PPL -electric bill 36.64 17 PPL -electric bill 28,32 18 RESERVES: -Costs to conclude administration of Estate, including filing PA Inheritance Tax 850.00 Return and Inventory, preparation of Accounting, preparation and filing of Federal and State Personal income Tax Returns and payment of taxes and preparation and filing of Federal and State Fiduciary Income Tax Returns 19 UGI -gas bill 36.90 20 UGI -gas payment 92.24 21 US Treasury Department -payment for 2010 personal income tax due 1,648.00 H-B7 4,897.79 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-°~ ) Rev-1512 EX+ (12-08) .., COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Fertenbaugh, Glenn G. 21-11-0025 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Comcast -final cable bill 34.40 2 Cumberland Goodwill Fire Rescue -medical transport 54.13 3 Graham Medical -medical bill 4.60 4 Graham Medical Clinic -medical bill 14.73 5 Guardian Long Term Care Pharmacy -medicine 259.34 6 Holy Spirit Hospital -medical bill 89.60 7 Howard Roy Cohen -physician's bill 54.99 8 Philhaven -medical bill 15.59 9 Spirit Physician Services, Inc. -medical bill 20.22 10 Spirit Physicians -medical bill 185.99 11 UCPA Urology -medical bill 72 52 12 Verizon -phone bill 6.79 TOTAL (Also enter on Line 10, Recapitulation) I 812.90 (If more space is needed, additional pages of the same size) Copyright (c} 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08} REV-1513 EX+(11-08) SCHEDULE J COM INOHERITANCEOTAx RETS~yRNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Fertenbauah. Glenn G. 21-11-0025 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) No i Tru ee I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 Michael R. Fertenbaugh Son One-half of rest, 6 Countryside Court residue and Camp Hill, PA 17011 remainder William G. Fertenbaugh Son One-half of rest, 35 Autumn Drive residue and Dillsburg, PA 17019 remainder Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) #4 WILL (Married Man Without Minor Children) ~1.ast 'k~i11 ana ~~s~tamQnt of CGl-~(YlY G 1' ~R7'E/1'.6~'1 UG ff C~ ~~ ~' ~~ ~ ~ ~ ~ resentl residin at • /~ / J P y g being of full age and sound and disposing mind and memory, hereby make, publish and declare this to be my Last Will and Testament. FIRST: I hereby revoke any and all Wills and Codicils by me anytime heretofore made. SECOND: I direct that all of my just debts and funeral expenses be paid out of my Estate as soon as practicable after my death. THIRD: I am presently married to ~ ~ ~ ~ L3 ~ ~ FOURTH: I hereby give, devise and bequeath all of my Estate, real, personal and mixed, of every kind and nature whatsoever and wheresoever situated, to my beloved wife absolutely and forever.. FIFTH: In the event that my wife shall predecease me, then and in that event, I give, devise and bequeath my Estate hereinabove mentioned in paragraph "FOURTH" herein, to my beloved child or children or grandchildren surviving me, per stirpes. - SIXTH: In the event I am not survived by my wife or any children, or grand- children, then, and in such event, I give, devise and bequeath my said Estate to the following named beneficiary/beneficiaries or their survivor/survivors in equal shares. a. ~ z r ~ `` ~ ~ ~~ ~ ~ ~~ l 7 2 ~t~ Name and addre s of beneficiar Y i , I~ ame and address of beneficiary c. Name and address of beneficiary d. Name and address of beneficiary e. Name and address of beneficiary (Over) SEVENTH: I hereby nominate and appoint my beloved wife to be the Executrix of this, my Last Will and Testament, and I direct that no bond or other security shall be required of her in any jurisdiction. If m said wife is unable to serve as Executrix, then I nominate and appoint ~ ~ /~~'~ ~ ~~ . ~ t= ~ ~ ~ ~ ~ ~ y ~ ~~ Executor/Executrix of this my Last Will and Testament, and I further direct that he /she not be required to post any bond or other security. EIGHTH: I give to my Executor/Executrix, authority to exercise all the powers, duties, rights and immunities conferred upon fiduciaries by law with full power to sell to mortgage and to lease, and to invest and re=invest all or any part of my Estate on such terms as he/she deems best. ., IN WITNESS WHEREOF, I hereunto set my hand this '~ ~~ 'day ~ if ~~ ,~, `~~~`~~-~~ (SIGN HERE) ~- Signed, sealed, published and declared by the above named testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence, and in the presence of one another have hereunto subscribed our names as attesting witnesses, the day and year last written above. L ~' ~ residin at ~ ,. ~ ,~~ _ J ~~~ --~~ '~"` - ~ residin at ~ ~ ~. ` ~~-~~ g residing at