HomeMy WebLinkAbout02-17-111505610143
-~ REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue p@nnsylvania county code Year File Number
Bureau of Individual Taxes oEV~MrMEMrovaEVEauE
PO BOx.2s06o1 INHERITANCE TAX RETURN 21 10 0666
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
579 20 7698 06 11 2010 11 24 1924
Decedent's Last Name
MYERS
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
Suffix Decedent's First Name MI
ELISABETH D
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Return ^ 2. Supplemental Return
^ 4. Limited Estate ^ qa. Future Interest Compromise
(date of death after 12-12-82)
6 Decedent Died Testate
(Attach Copy of Will) ^ ~• (Attar ark opyionft~irued~a Living Trust
G
^
9. Litigation Proceeds Received
^ C
1D. b8tween 12 31 ~Jt a dit (datges~f death
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ b. Federal Estate Tax Return Required
B. Total Number of Safe Deposit Boxes
^ 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
GEORGE F DOUGLAS III ESQ 717 249 6333
REGISTER OF WILLS USE ONLY
First line of address
354 ALEXANDER SPRING RO
Second line of address
City or Post Office
CARLISLE
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Corresponden' 'adore gaougiasLsalzmannnugnes.com
Under penalti of pery'u t t I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, cor and pl ec ation of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATUR OF PE ON SPON FOR FILING RETURN J
James D Hughes 2 ~6/ ~~
pring Road, Carlisle,
OTHER THAN REPRESENTATIVE
~' George F. Douglas, III Esq.
DATE
~~//~
354 Alexander Spring Road, Suite 1, Carlisle, PA
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Name: Myer, Elisabeth D.
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
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.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous fin; Probate Property
(Schedule G) u Separate Billing Requested............ 7.
g, Total Gross Assets (total Lines 1-7) ..................................................................... 8.
Decedent's Social Security Number
579 20 7698
73, 287.14 ~~_
47,303.28
120,590.42 --
21,111.57
9. Funeral Expenses & Administrative Costs (Schedule H) ............................... ........ 9.
1,605.56
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..................... ......... 10.
22,717.13
11. Total Deductions (total Lines 9 & 10) .......................................................... ......... 11.
. 97,873.29
12. Net Value of Estate (Line 8 minus Line 11) ................................................. ......... 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................................... ......... 13.
. 97,873.29
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................................... ......... 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15.
(a)(1.2) X .00
16. Amount of Line 14 taxable g'7 , 4 7 3.2 9 16.
at lineal rate X .045
17. Amount of Line 14 taxable
00
400
17.
at sibling rate X .12 .
18. Amount of Line 14 taxable
0 . 0 0
18.
at collateral rate X .15
19. Tax Due .................................................. .............................................................. .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
0.00
4,386.30
48.00
0.00
4,434.30
Rev-1503 EX+ (8-98)
SCHEDULE B
STOCKS ~ BONDS
COMMONWEALTH OF PENNSYLVANIA I I
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
M ers, Elisabeth D. 21-10-0666
All property jointly-owned with Aght of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
Merrill Lynch Account No. 872-55489 -Corporate Bond
1 X10,000 John Deere Capital Corp -Series Note 2; 3.75%; 100.8472 10,084.72
issued 412212009; due 10/15/2010
Accrued interest on Item 1 through date of death 69.79
Merrill Lynch Account No. 872-55489 -Mutual Fund
2 3,199.7788 shares of BlackRock Corp. HY Fund 6.675 21,358.52
3 640.488 shares of MSF Total Return Fund Class B 13.03 8,345.30
4 999.756 shares of PIMCO Total Return Fund Class A 11.2 11,197.27
Merrill Lynch Account No. 872-55289 -Stock
5 331 shares of AT&T Inc. 25.445 8,422.30
8 473 shares of Verizon Communications 29.195 13,809.24
TOTAL (Also enter on Line 2, Recapitulation) 73,287.14
(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)
Rev-1508 EX+ (8-98)
SCHEDULE E
CASH, BANK DEPOSITS, 8r MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers, Elisabeth D. 21-10-0666
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Cash on hand 194.81
2 BlackRock Corp. HY Fund -dividend declared to shareholders of record prior to death and 183.19
paid after death
3 Merrill Lynch Deposit Account 872-55489 26,258.48
4 Orrstown Bank, Checking Account No. 108000580 14,634.34
Accrued interest on Item 4 through date of death 0•'~
5 1995 Cutlass Ciera -VIN 1 G3AJ55MXS6367143 2,650.00
6 Household Goods -Bequeathed as per Item THREE of the Will, Dining Room Table with 300.00
Buffet - X250.00, 2 Leather Chairs - X50.00
7 Household Goods at net proceeds of sale 1,348.25
8 Household Goods taken in kind 668.00
9 Jewelry -Bequeathed as per Item FOUR of the Will 400.00
10 AAA Central Penn -Membership refund 18.75
11 AARP -Membership refund 31.00
12 Diakon Lutheran Social Ministries -refund 20.24
13 Erie Insurance Group -refund of unused homeowners insurance premium 178.00
14 Erie Insurance Group -refund of unused Personal Catastrophe insurance premium 80.00
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 5, Recapitulation) 47,303.28
(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)
Rev-1508 EXt (8-98)
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAx RETURN continue
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers, Elisabeth D. 21-10-0fififi
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
15 Erie Insurance Group -refund of unused automobile insurance premium due to cancellation 51.00
16 First Energy -refund 27'54
17 Kaiser Permanente -refund 96.40
18 The Patriot-News -cancellation refund 145.00
19 Time Inc. Shared Services -cancellation of People magazine 10.95
20 TV Guide -refund 29.09
TOTAL (Also enter on Line 5, Recapitulation) I 47,303.28
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+(10-05)
COMMO~Nyy DALT~EDECED~N~RNANIA
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Myers, Elisabeth D. 21-10-0666
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
3,586.06•.:.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
James D Hughes
Street Address 354 Alexander Spring Road
city Carlisle state PA zip 17015 _
Year(sl Commission paid 2011 5,825.00
2, Attorney's Fees Salzmann Hughes, P.C. 6,575.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 319.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 395.00
7. Other Administrative Costs 4,411.01
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 21,111.57
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
M ers, Elisabeth D. 21-10-0666
NUM ER DESCRIPTION AMOUNT
Funeral Expenses
1 Ewing Brothers Funeral Home Inc. -reimbursement for funeral expenses funeral services 2,177.21
2 Jennifer Cortner -reimbursement for funeral expenses 592.60
3 Jennifer Cortner -reimbursement for funeral expenses 400.00
4 Laura Cortner -reimbursement for funeral expenses 250.00
5 Nancy Cortner -reimbursement for funeral luncheon 166.25
H-A 3,586.06
6 Other Administrative Costs
Cumberland Crossings -balance due on residential account
335.57
7 Jones S Martin Auctions, LLC -appraisal of personal property 200.00
8 Jones 8 Martin Auctions, LLC -Auctioneer's percentage and expenses paid to sell 1,799.21
household goods and automobile in order to administer the estate
9 Merrill Lynch -sale of security expenses paid in order to administer the estate 1,026.07
10 Met-Ed -electric service 62.44
11 Met-Ed -final electric service 63.71
12 Register of Wills - 2 short certificates 8.00
13 Register of Wills -filing fees 30.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
M ers, Elisabeth D. 21-10-0666
ITEM DESCRIPTION AMOUNT
NUMBER
14 Salzmann Hughes, P.C. -reimbursement for Legal advertising in the Cumberland Law 75.00
Journal
15 Salzmann Hughes, P.C. -reservation held for contingencies to administer the estate 500.00
16 The Sentinel -Legal advertising 187.54
17 UGI Utilities Inc. -gas service 62.00
18 UGI Utilities Inc. -final gas service 61.47
H_g~ 4,411.01
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (t 2-0a)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 81: LIENS
ESTATE OF (FILE NUMBER
Myers. Elisabeth D. _ 21-10-0666
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbureed medical expanses.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1 Alexander Springs Emer Phys -balance due on account 33.76
2 CenturyLink -final phone service 46.71
3 Cumberland Crossings -balance due for private pay 62.38
4 Home Instead Senior Care - in home care from 611110 to 6111110 887.40
5 Met-Ed -electric service 32'28
6 Met-Ed -electric service 87.52
7 Patricia D. Rosendale, CPA -preparation of final individual income tax returns for 2010 350.00
8 Pinnacle Health Emerg -balance due on account 33.76
9 Quantum Imaging and Therapeutic Associates -balance due on account 1.77
10 Smith Radiology, Inc. -balance due on account 7.20
11 UGI Utilities Inc. -gas service 62'78
TOTAL (Also enter on Line 10, Recapitulation) I 1,605.56
(It 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-OS)
eCV_1 c1 Z CYa /1111R1
.`~--._.--^ ` . --, SCHEDULE J
COM IN~~~EDENT DECEDEN~YLNANIA BENEFICIARIES
ESTATE OF FILE NUMBER
M ers, Elisabeth D. 21-10-0666
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUN T OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
1 Nancy D. Cortner Sister Specific Bequest 400.00
1308 Georgetown Circle per Paragragh
Carlisle, PA 17013-4701 Four
2 Mark Myers Stepchild Specific Beq per 32,691.09
1960412th Ave. NW Item THREE -
Seattle, WA 98177 Will 1/3rd -
Residue
3 Stephen H. Robillard Son 1/3rd Residue 32,391.10
245 N. Main Street, Apt. 302
Northampton, MA 01060
4 Brooke K. Wickham Stepchild 113rd Residue 32,391.10
520 O'Farrell Ave., SE
Olympia, WA 98501
Total 97,873.29
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a ro 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)
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c_~_, ,., Jl ~~ ~ ENT
ST WILL ANDc..,~~_ ~ ~~'.
LA
I. ELISABETH D. 1vI~C'ERS, of South Middleton Township, Cumberland County,
ennsvlvania, being of sound mind, disposing memory and full legal age, do hereby make,
P
lish and declare this to be my Last Will and Testament, hereby revoking all `Fills and
pub
Codicils heretofore made by me.
I direct my Executor or Executrix, as the case may be, to pay all of my
ONE.
debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of m death and interest and penalties thereon with respect to all property composing of my gross
Y
to for death tax purposes, whether or not such property passes under this Will, shall be paid
esta
b the Executor or Executrix of my estate. Further, to the extent that sufficient assets exist in my
Y
estate an and all inheritance or other estate taxes, whether to non-charitable or charitab e
Y
beneficiaries, shall be paid by my Executor or Executrix from the residuary of my estate.
TWO. My Executor or Executrix may, at his or her discretion, compromise
claims, borrow m~eney, retain property for such length of time as he or she may deem proper;
lease and sell property for such prices, on such terms, at public or private sales, as he or she may
deem proper; and invest estate property and income without restriction to legal investments
mess otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell
u
an • realt and/or personalty owned by me at my death and not specifically devised or bequeathe
y y
herein at public or private sale or sales and to give good and sufficient deeds and%or bills of sale
h, as I could do if living. My Executor or E~cecutrix is authorized and
therefor, in fee situp ',
m owered to engage in any business in which I may be engaged at my death, for such period of
e p
time after my death as seems expedient to said Executor or Executrix.
THREE. I hereby give, devise and bequeath my two (?) leather chairs in the den and
my dining room set to MARK i~1Y ERS.
FOUR. I hereby give, devise and bequeath of all my jewelry, of whatever nature
and wherever situate, to NANCY CORTNER.
FIVE. I hereby give. devise and bequeath all the rest, residue and remainder of
my estate, in equal shares, to STEPHEN H. ROBILLARD, BROOKE M. WICKHAM and
er sti es, which provides that the child or children of any deceased child shall
MARK MYERS, p rP
take the share their parent would have taken if living.
SIX. I hereby nominate and appoint JAh1ES D. HUGHES as the Executor of
this my Last Will and Testament. If he has predeceased me, failed to qualify or is not able or
does not serve for whatever reason, I appoint the then current senror partner of Salzmann
Hughes, P.C. or its successor, to be the Executor of my Last Will and Testament, whereby the
substitute personal representative shall have the same powers as the origrnal Executor hereof.
SEVEN. If, under any of the provisions of this Will, any principal becomes vested
in a minor, my Executor or Executrix, as the case may be, including any administrator c.t.a., shall
have the discretion either to pay over such principal or any part thereof to any parent of such
minor, any guardian of the person or estate of such minor, or any person with whom such minor
resides, or to retain the same as trustee of a power in trust for the benefit of such minor during his
or her minority. Any of the principal thus retained, and any of the income therefrom, including
the whole thereof, may be paid to or applied for the benefit of such minor from time to time in
the discretion of the trustee of such power. When such minor reaches rnajority, the funds so held
shall be paid over to such person, or, if he or she shall sooner die, to his or her legal
representatives. In so holding any principal or income for any minor, the trustee of such power
shall have all the rights, powers, duties and discretions conferred or rmposed upon my fiduciarres
acting under this Will. I further direct that no bond shall be required from any person receiving a
avment hereunder and receipt from such person shall be a full discharge to the trustee of such
P.
over who shall not be bound to see to the application or use of such payment. The trustee of
P
such power shall be entitled to commissions at the rates and in the manner payable to a
testamentary' trustee.
EIGHT. No person(s) or entities shall benefit hereunder unless such beneficiary
shall survive me by sixty (60) days.
yE. No Executor acting hereunder shall be required to post bond or enter `1 V ~
1VI~
security in this or any other jurisdiction.
TEN. No beneficiary may assignor anticipate his or her interest in any income or
rincipal held or distributable hereunder; and no beneficiary's creditors may attach or otherwise
P
reach any such interest.
ELEVEN. If any person or institution entitled to share in any distribution under the
terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest
the probate of this Last W'ili and Testament, such person or institution shall forfeit his, her or its
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The share of such person or institution so forfeited shall be
distributed as part of the residue pursuant to Paragraph Five hereof except that if such person or
institution is entitled to share in the said residue, that interest shall be distributed proportionately
to the other residuary distributees.
day of
IN WIT~iESS w'HEREOF, I have hereunto set my hand and seal this
January, 2007.
~~ 7
ELISABETH D.IVIYERS
Signed, sealed, published and declared by the above-named person as and for a Last V4'ill
and Testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
~~~
ACKNOWLEDGMENT AND AFFIDAVIT
Z' ELISABETH D. MYERS, SL'ZANNE ~I• SHEFFER and JENNIFER 1~I•
~ E,
EGLEY, the testatrix and witnesses respectively, whose names are signed to the foregoing
N
t bein first duly sworn, do hereby declare to the undersigned authority that the
mstrumen , g
i ned and executed the instrument as her Last V~'ill, and that she had signed willingly,
testatrix s g
she executed it as her free and voluntary act for the purpose herein expressed, and that
and that
f the witnesses, in the presence and hearing of the testatrix, signed the `Vill as a witness
each o ears of aae or
and that to the best of their knowledge the testatrix was, at that time, eighteen y b
older, of sound mind and under no constraint or undue influence.
COMMONWEALTH OF PENNSYLVANIA
COUNT' OF CUMBERLAND
~~~~
~2Xit~~
ISABETH D. NI ER
1 A N NI. S;EIEF ER
~~
JE NIFE NI. NEGLEY
. SS:
Subscribed, sworn to and acknowledged before me by EL15.=
testatrix herein and subscribed and sworn to befdare mJabua SU 007
JENNIFER Nt. NEGLEY, witnesses, this ~ ~ '~ , \
ETH D. MYERS, the
E IvI. SHEFFER and
--'-- ~;;:.~;ial Seai
~ e.r~;~ ,.:;-i.vnau9h, NotaryPubi'~c
Jaa,ru ,: .-: > ,'uR'!~rtand County
_. ,~ ~.~ .Aug. 14, 2007
-------. __,.,,~~n,~,n Gfi Notaries
ESTATE OF ELISABETH D. MYERS
APPRAISAL FOR SPECIFIC ITEMS BEQUEATHED IN
THE WILL
Items bequeathed to Mark Myers as per Item THREE of
the Will:
Dining Room Table w/ Buffet $ 250.00
2- Leather Chairs 50.00
300.0
Jewelry bequeathed to Nancy Cortner as per Item FOUR
of the Will:
Costume Jewelry & Rings 400.00
ESTATE OF ELISABETH D. MYERS
APPRAISAL FOR ITEMS TAKEN IN KIND
Mark Myers -household goods chosen as part of his
residual distribution:
Misc.Pottery Pieces. $ 50.00
White House Christmas Ornaments 10.00
Diploma & Morris Myers certificates 25.00
Silverware set 50.00
2- Carvel Hall s/s knife sets 15.00
Royal Copenhagen pitcher 10.00
3- Wall Paintings 45.00
4-Silver Dollars 18.00
40 Half Dollars 20.00
120- Quarters 30.00
10- Silver Half Dollars 10.00
10- Kennedy Halves 20.00
111- Pre 64 Quarters 111.00
13- Kennedy Half Dollars 26.00
45- Franklin Half Dollars 90.00
1974 &1977 Silver Dollars 10.00
14- 2 Dollar Bills 28.00
2- 1953 Red Letter 2 Dollar Bills 20.00
Marble Top Stand 75.00
Wall Mirror 5.00
$ 668.00
OxRSTOwivBaNx
A Tradition of Excellence
w~ ~"z,..'~..
77 East King Street
Shippensburg, PA 17257
July 8, 2010
Salzmann Hughes, P.C.
354 Alexander Spring Road, Suite 1
Carlisle, PA 17015
Attention: James D Hughes, Esquire
Shirley Wescott
Orrstown Bank
PO Box 250
Shippensburg, Pa 17257
Phone 717.530.2515
Re: Estate of: Elisabeth D Myers
Date of Death: June 11 2010
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON 'lHE ABOVE DATE, HAD THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account # Title of Account
l 06000580 Elisabeth D Myers
Best regards,
~~~~°~ 1 ~
hirley Wescott
Receptionist
Date opened Principal Accrued Interest DOD Bal
11/23/98 14,634.34 .44 $14,634.78
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