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HomeMy WebLinkAbout04-18-111505611180 ---~ REV-1500 EX (02-11) (FI) Pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21-10-026~i ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 80-6155809 03052010 01214924 Decedent's Last Name Suffix Decedent's First Name MI MARTIN MAE E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW Ox 1.Original Return 0 4. Limited Estate Ox 6. Decedent Died Testate (Attach Copy of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE VI/ITH THE REGISTER OF WILLS 0 2. Supplemental Return Q 4a. Future Interest Compromise (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) 0 3. Remainder Return (Date of Death Prior to 12-13-82) 0 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes 0 11. Election to Tax under Sec. 9113(A) (Attach Schedule 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Nlumber _; STEPHEN D . TILEY 717-243-5~ :~~' _ -a->: REGISTER OF S USE ;__r..r ~"~ ---~ _~ _ _, ._i._ ~. ~ --rj -, _ .-- .:-- ~ -; First Line of Address - ".%±> ;~ CX3 _. __ , _} \. 5 SOUTH HANOVER ST . ,,,__ -r Second Line of Address ~ -~'-~~ I'r,.~ -~ ~.~ ", ~. ~~ ~ DATI? FILED City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepares other than the personal representative is based on all information of which prepares has any knowledge SIG TURE OF PE SON,RESPONSIBLE FOR FILING RETURN D TE ADDRESS CAROL J. LUCIANI, 836 FISHBURN ROAD, HERSHEY., PA 17033 SIGNATU OF PREPARER OTH/E~R TH REPRESENTATIVE GATE / . s - ~ 1 ~ ~ -i /fig r- ~ ~ .~ ~'' /' /i ADDRESS ~ ~ STEPHEN D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 150561118 J ~~ ,~ ~' REV-1500 EX (FI) Decedent's Name: M A E E M A R T I N RECAPITULATION 1. Real Estate (Schedule A) ......................................... 1. N 0 N E 2. Stocks and Bonds (Schedule B) .................................... 2. 6 7 . 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 3 O 8 9 O 2 . 0 0 6. Jointly Owned Property (Schedule F) []Separate Billing Requested ...... . 6. N 0 N E 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ...... . 7. N 0 N E 8. Total Gross Assets (total Lines 1 through 7) ...... 8 3 0 8 9 6 9.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 2 7 3 2 9 . 0 O 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. 7 8 3 3 . D 0 11. Total Deductions (total Lines 9 and 10) ............................. 11. 3 5 ], 6 2 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... 12. 2 7 3 8 O 7 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 16 4 4 9 6 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 10 9 311.0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 O 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 9 7 4 6 3. 5 0 17. 116 9 5. 6 2 18. Amount of Line 14 taxable at collateral rate x .15 118 4 7. 5 0 1 s. 17 7 7.13 19. TAX DUE ....................................................... 19. 13472.75 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505611280 Decedent's Social Security Number 80-6155809 1505611280 0 1505611280 J REV-1500 EX (FI) Page 3 File Number 80-6155809 Decedent's Complete Address: 21-10-0263 DECEDENTS NAME MAE E MARTIN STREET ADDRESS 59 MAGAW AVE. CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 13472.75 Total Credits (A + B) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 0.00 (3) _ 158.95 (4) 0.00 (5) 13631.70 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 1~'es No a. retain the use or income of the property transferred ................................................................................ ....... [] b. retain the right to designate who shall use the property transferred or its income .................................... ...... [] c. retain a reversionary interest ................................................................................................................... ....... d. receive the promise for life of either payments, benefits or care? ............................................................ .. .... [] 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................... . ...... 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ...... ...... [] 4. Did decedent own an individual retirement account, annuity or other non-probate property which , contains a beneficiary designation? ............................................................................................................... ...... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving :spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. 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(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. Practitioner Portal Penalty and Interest Calculations CALCULATION DATES- 12/ 5/ 10 TO 4/ 19/ 2 011 TAX DEFICIENCY $ 13,472.75 CALCULATED INTEREST $ 158.95 BALANCE AS OF 4/19/2011 $ 13,631.70 .Start Ove r 4/18/11 9:24 AM https://www.doreservices.state.pa.us/pitservices/Default.aspx Page 1 of 1 REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Estate of Mae E. Martin 2-10-0263 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Two (2) Shares WGL Holdings, Inc. at $33.51 per share 67 (Washington Gas & Light, Co.) TOTAL (Also enter on line 2, Recapitulation' (If more space is needed, insert additional sheets of the same size) 7 REV-1508 EX+ (11-10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Estate of Mae E. Martin 21-10-0263 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F_ IT more space Is needed, use additional sheets of paper of the same size. ESTATE OF: MAE E. MARTIN SCHEDULE E-1 1 2 3 4 5 6 7 8 9 10 Specific Bequest to Alicia Jean Luciani Paragraph Third(a) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to Doris D. Walters Paragraph Third(b) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to Carol J. Luciani Paragraph Third(c) of Last Will and Testament Household Property and 1999 Toyota Camry Automobile See Exhibits "A"& "B" attached Specific Bequest to Joseph Luciani Paragraph Third(d) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to James Albert Luciani Paragraph Third(e) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to David Seitz Paragraph Third(f) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to Grace E. Terry -Deceased Paragraph Third(g) of Last Will and Testament Gift lapses due to death. Property to Residuary but of no value. See Exhibits "A"& "B" attached Specific Bequest to Don E. Elliott Paragraph Third(h) of Last Will and Testament See Exhibits "A"& "B" attached Specific Bequest to Ross D. Elliott Paragraph Third(i) of Last Will and Testament See Exhibits "A"& "B" attached Miscellaneous Tangible Household Personal Property not Specifically Bequeathed. See Exhibit "B" attached listing of items of monetary value. F:[LE NUMBER: 21-10-00263 265.00 150.00 2,700.50 15.50 17.00 400.00 0.00 10.00 5.00 Estate of Mae E. Martin lst & final Mae E. Martin 4.17.1 l.xls Page 1 ESTATE OF: FILE NUMBER: MAE E. MARTIN 21-10-00263 SCHEDULE E-1 Other items (clothes, etc., of no monetary value and gifted to charity, or disposed of.) 800.00 11 M&T Bank (See Exhibit "D"): Personal Checking Account No.: 3740921055 860.25 Non-Interest Bearing 12 Orrstown Bank (See Exhibit "E"): Personal Checking Account No.: 108-004553 8 658.51 Accrued interest to DOD 0.00 CD #4000033455 10,000.00 Accrued interest to DOD 5.00 CD #4000033456 50,000.00 Accrued interest to DOD 5.00 13 Members 1st Account No.: 360135 (See Exhibit "F"): Checking Account - 0011 0.00 Accrued interest to DOD 0.00 Savins Account - 0000 10.00 Accrued interest to DOD 0.00 Certificate of Deposit - 0040 50,507.53 Accrued interest to DOD 100.00 Certificate of Deposit -0041 50,523.07 Accrued interest to DOD 100.00 14 John Hancock Life Insurance Company Refund of unused long term care insurance premium 980.07 15 Refund -Travelers -Auto Insurance 294.76 16 Prudential Securities Administrative Proceeding (Class Action) 10.00 17 CitiBank -Credit Card Refund 55.73 Estate of Mae E. Martin 1st & final Mae E. Martin 4.17.11.x1s Page 2 ESTATE OF: MAE E. MARTIN SCHEDULE E-1 18 Social Security Benefits Returned 19 Cumberland Crossings Cottage Occupancy Agreement Refund due under agreement, upon resale of unit at 59 Magaw Avenue, South Middleton Township, PA (Transfer of Possession o July 31, 2010) (See Exhibit "G") 20 Shippensburg University Foundation -Gift Annuity Checks Check Dated 9/25/08 for $200.00 Check Dated 12/31/08 for $200.00 21 Refund -Internal Revenue Service -Year 2009 Form 1040 22 Refund -Internal Revenue Service -Year 2010 Form 1040 FILE NUMBER: 21-10-00263 162.00 127,213.20 400.00 3 ,316.00 1,338.00 Total: 308,902.12 Estate of Mae E. Martin 1st & final Mae E. Martin 4.17.1 l.xls Page 3 REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Estate of Mae E. Martin 21-10-0263 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Egger Funeral Home 361 2. St. John's Episcopal Church -Funeral Luncheon 126 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 12 299 Name(s) of Personal Representative(s) Carol J. Luciani Street Address 836 Fishburn Road city Hershey state PA zIP 17033 Year(s) Commission Paid: 2011 2. Attorney Fees: Fre 8~ Tiley 9,500 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: 366 5. Accountant Fees: Frey & Tiley 6. Tax Return Preparer Fees: Frey Si Tiley 7. See Schedule H-1 4,677 TOTAL (Also enter on Line 9, Recapitulation;) I $ 27 If more space is needed, use additional sheets of paper of the same size. ESTATE OF: FILE NUMBER: MAE E. MARTIN 21-10-00263 SCHEDULE H-1 15-Mar CenturyLink -Electronic Payment 72.54 Orrstown Bank Personal Checking 17-Mar UGI Utilities -Electronic Payment 188.93 Orrstown Bank Personal Checking 14-Apr UGI Utilities -Electronic Payment 37.01 Orrstown Bank Personal Checking 15-Apr CenturyLink -Electronic Payment 71.81 Orrstown Bank Personal Checking 20-Apr Check Printing Fee -Estate Checking Account 19.75 28-Apr Carol J. Luciani -Reimburse for Mailing Expenses for personal property 170.03 3-May First Energy (Electric) 20.24 Automatic payment from M&T Bank Personal Checking 14-May UGI Utilities -Electronic Payment 61.62 Orrstown Bank Personal Checking 17-May CenturyLink -Electronic Payment 72 72 Orrstown Bank Personal Checking 18-May Carol J. Luciani -Reimburse for Joe C. Hoke Auctioneer Appraisal of Personal Property 75.00 18-May Diakon Luthern Social Ministries Cumberland Crossings -May Maintenance Fees 1 092.00 1-Jun First Energy (Electric) 20.19 Automatice payment from M&T Bank Personal Checking 14-Jun Cumberland Crossings -Unit Maintenance 1 006.00 14-Jun CenturyLink -Electronic Payment 72 44 Orrstown Bank Personal Checking 14-Jun UGI Utilities -Electronic Payment 20.18 Orrstown Bank Personal Checking Estate of Mae E . Martin 1st & final Mae E. Martin 4.17.1 l.xls Page 1 ESTATE OF: MAE E. MARTIN SCHEDULE H-1 FILE NUMBER: 21-10-00263 30-Jun First Energy (Electric) 20.91 Automatice payment from M&T Bank Personal Checking 14-Jul UGI Utilities -Electronic Payment 12.35 Orrstown Bank Personal Checking 29-Jul Refund - CenturyLink $39.75 (39.75) 2-Aug First Energy (Electric) 24.34 Automatice payment from M&T Bank Personal Checking 17-Aug Frey & Tiley -Reimburse -Total $270.54 Two Short Certificates 8.00 Advertising -The Sentinel 187.54 Advertising -Cumberland Law Journal 75.00 13-Aug UGI Utilities -Electronic Payment 11.05 Orrstown Bank Personal Checking 18-Aug UGI Utilities, Inc. 16.00 18-Aug Met-Ed -First Energy (Electric) 51.65 18-Aug Cumberland Crosings -Unit Maintenance 1,066.60 Final Monthly Maintenace Fee and Trash Removal 18-Aug Frey & Tiley -Three Short Certificates 12.00 1 S-Oct Refund -UGI Utilities (11.05) 19-Oct Register of Wills -Short Certificate 4 ~ 2011 15-Apr Frey & Tiley -Reimburse for Short Certificates 8.00 ??? Reserve to File to Account 230.00 Total: 4,677.10 Estate of Mae E. Martin 1st & final Mae E. Martin 4.17. l l .xls Page 2 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES ~ LIENS t5 rATE OF FILE NUMBER Estate of Mae E. Martin 21-10~-0263 Report debts incurred by the decedent prior to death that remained unpaid at the date ~f r~parh 111f`II~flinn unrnimhu.re.l .... ...:.........______ ~- -- - ~~-----, ...............,.,..,,a~ ~~~ccw vi uie saint size. ESTATE OF: FILE NUMBER: MAE E. MARTIN 21-10-00263 SCHEDULE I-1 12-Apr Pledge gift to WBT, Inc. 20 00 Automatic Debit from Orrstown Personal Checking 12-Apr Pledge gift to Saint John's Episcopal Church 250 00 Automatic Debit from Orrstown Personal Checking . 12-Apr Commonwealth of Pennsylvania Payment on Account of 2009 Personal Income Tax 165.00 12-Apr Cumberland Crossings -Nursing Care 4 342.74 12-Apr Robert C. Cairns, Tax Collector -Per Capita Tax 4.90 12-Apr Carol J. Luciani -Reimburse for Miscellaneous Pre & Post Death Expenses (Clothes and food) 212.96 12-Apr West Shore EMS -Ambulance 283 82 10-May Pledge gift to WBT, Inc. 20.00 Automatic Debit from Orrstown Personal Checking 17-Dec Refund Homeowners Insurance -The Hartford Ins. Co. (77.00) 2011 3-Feb Refund - Dr. Leonard's (7.74) 15-Apr St. John's Episcopal Church (Fulfill Pledge) 2 370.00 15-Apr Pennsylvania Department of Revenue Final Personal Tax Return -Year 2010 68.00 15-Apr United States Treasury Year 2010 Fiduciary Income Taxes -Form 1041 142.00 15-Apr Pennsylvania Department of Revenue Year 2010 Fiduciary Income Taxes - PA-41 38.00 Total: 7,832.68 Estate of Mae E. Martin 1st & final Mae E. Martin 4.17.1 l.xls Page 1 REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: Estate of Mae E. Martin NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1 See Schedule J-1, Tax Calculations FILE NUMBER: 21-10-0263 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Various ~T~otal Taxable: $29,563.00 2 Carol J. Luciani 836 Fishburn Road, Hershey, PA 17033 Half-Sister C>ne-Third Residuary ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. The Biship Henry Hobson Memorial Fund, 300 West Fourth Street, Cincinnati, OH 45202 5,000 2. Shippensburg University Foundation, 1871 Old Main Drive, Shippensburg, Pennsylvania 17257 One-Third Residuary 3. WITF, 4801 Lindle Road, Harrisburg, Pennsylvania 17111 One-Third Residuary 4. See Schedule J-1 Tax Calulations -Charitable Residua Values 159 496 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 164,496 If more space is needed, use additional sheets of paper of the same size. ~ N .L~ y ~ O ~+ U ;~ ~ ° 0 c o a ~ 0 O 00 ° O U '-' ~n ~ o° °O 0 O N O .-, ~ O .C '~ O O C/~ O ~ .C ~ ~ C ~ O -..~ O ~~+ ~ ~ 'C7 C ~ i ~ ~ •~ ~ ~ x x ~ ~ z W M ~ O O p ~ C . 0 C~0 N C ~ O O ~; O O 0 C ~ ~ ~ g O O ~ Z ~ N ~ ~ W ^+ .~ -a N ~ W ~ a ~ c~ W c~ _ s ~ ~ ~ ~ ~ ,t C cG H w ~ ~ C G ~ ~ ~ Z a ~ ~ _" ~ bA w ~ O ,~ ~ ~ ~ ~ ~. a w U _ ... '" A F~ °' Q = ~ ~ W V ~ c ~ ~ ~ o, ~ ~o N o N ~ w ~ 0 Q ~ ~ ~ ~ . ~ ~ O ~ ~ ~ O D ~ ~ :,,,, C~ oN ~ E-' ~ ~ ~°o ~ ~ w~~~ ~ as C7 ¢ Q 3a ~ C ~ ¢ ~~ ~ c rtao~ Q~ ~ ~ ~`~~ ~ roc . -~ a ~ ~ cC ~ ~ ~ ~ ~ N M O ~ W ~ ~ ~ W C~ e ~ O z w '" ~ N G7, E-~ w AG O ~ w w E-~ W d W ~ a~ .a ~~ ~'~ O c~ U L ~ ~ CC .~-+ U ao ~ N O G. 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A F .., E° a~ c 0 U CJ V V 0 0 0 0 ~ ~o 0 0~ 0o d;, M ~ N ~ ~, a4 A. _~ C .~ cC w a~ c .~ 0 a~ w f { t LAST lrtriLL A[~fD TESTAMENT OF fV€AE E. fVIARTIt~d I, NEae E. fi~artin, of South Middleton Township (59 Magaw Avenue, Carlisle), Cumberland County, Pennsylvania 17015, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last WII and Testament, hereby revoking and making void any and all Wills and Codicils heretofore made. FIRST .) ~J v y r~ (a) I direct the payment of my just debts and funeral expenses as soon after my death as may be convenient. I advise my Executrix that I have previously made arrangements with Ewing Brothers Funeral Home, Inc., of Carlisle, Pennsylvania. (b) I direct that all federal and Pennsylvania estate taxes, Pennsylvania inheritance taxes, and generation-skipping transfer tax payable as a result of my death, not limited to taxes attributable to property passing under this Will, shall be paid by my Executor from my residuary estate, including any part of my residuary estate that otherwise qualifies for a deduction for federal estate tax purposes, however, no federal or Pennsylvania estate tax, Pennsylvania inheritance tax, or generation-skipping transfer tax shall be payable from or chargeable to any property that passes to my surviving spouse, whether under this Will or otherwise, and that qualifies for the federal estate tax marital deduction. 1 direct my Executor not to seek reimbursement for any tax so paid from any beneficiary under this WII, heir of mine, or other transferee of property included in my gross estate. (cl By the above direction I specifically intend to alter the statutory provisions regarding the payment of inheritance and any estate tax. All specific bequests shall be given inheritance and estate tax free, and the inheritance and any estate tax on any specific bequest shall be paid out of my residuary estate by my residuary beneficiaries. I direct that a proportionate share of inheritance and any estate tax due as a result of taxable gifts, be paid by the charitable, non-taxable, beneficiaries. Therefore, I direct that my net estate before inheritance and estate tax be calculated, that the residuary bequests then be calculated, and the inheritance and any estate tax be calculated and paid; but that thereafter, for distribution of my net estate, that total inheritance and estate tax, together with any penalties or interest thereon, be deducted from my net estate, and then my after-tax net estate be distributed to my residuary beneficiaries pursuant to paragraph Fifth of this Will. SECOND {a) I declare that I am the widow of George F. Martin, who died on June 19, 1988, and that we had no children. (b) !make the follo~~ring non-binding request of my Executrix: That any furnishings that are to be given away be given to the Samaritan Fellowship, of Carlisle, Pennsylvania, if they will receive the same. (c) For the purposes of this will, in determining whether a person has survived me or survived another person, the person shall not be deemed to have survived if he or she dies within ninety (90) days of my death or of the death of the other person. Last N'ill and Testament of Mae E. Alartin Page 1 of5 THIRD I make the following specific bequests: (a) To my niece, Alicia Jean Luciani, 836 Fishburn Road, I-lershey, Pennsylvania 17033, I give and bequeath six (G) place settings (five-piece) of my Reed ~Y Barton sterling silver flatware, Silver Wheat l~attern,.plus servings pieces as follows: One (1) meat fork, One (1) tablespoon, gravy ladle, butter knife; 1 Lazy-Boy leather rocker-recliner; all photographs and negatives not otherwise specifically bequeathed; all oil paintings by Aunt Florence and Uncle Bob Reddie; 1 Kaleidoscope; glass and crystal bottles, pitchers and Icnicl;lcnaclcs in bay window; and books of plays and sonnets by Slialcespeare. In the event that the said Alicia Jean Luciani should fail to survive me, then I give and bequeath this property to my half sister, Carol J. Luciani, or if she should fail to survive me, in equal shares to her issue, per stirpes. (b) To my niece, Doris D. Walters, of 2118 South Eastwood Drive, Joplin, Missouri, I give and bequeath six (G) place settings (five-piece) of my Peed & Barton sterling silver flatware, Silver Wheat pattern, plus servings pieces as follows: 2 tablespoons and sugar shell. In the event that the said Doris D. Walters should fail to survive me, then I give and bequeath this property to my nephew, Thomas Martin Walters, of 2118 South Eastwood Drive, Joplin, Missouri, or in equal shares to his issue, per stirpes. (c) To my half sister, Carol J. Luciani, of 836 Fishburn Road, Hershey, Pennsylvania 17033, I give and bequeath the following personal property: Tiffany lamp shade; Dining room furniture consisting of table with 2 leaves, 3 armchairs, 3 side chairs, china cabinet, and table pads; Grandmother Elliott's two-tone gold circle pin with sapphire; Grandmother Elliott's rocking chair; scrapbooks from Germany and Elliott family Eible; pink Wedgwood heart-shaped pendant; bed linens, blankets, and towels; all craft materials and collection of handbags; collection of music; diamond engagement ring; microwave oven and all kitchenware; '1999 Toyota Camry automobile; 1 small 2- rawer chest (walnut finish); 1 lingerie chest; 1 oil painting by George Newman; 1 small desk with 4 drawers (walnut finish); 1 lamp (double candelabra with hunting scene on shade); 5 Hummel figurines; 1 Yamaha Clavinova piano; my Cherry bedroom fumiture, a including bed (with electric unit), double dresser, chest of drawers, and night stand; metal filing cabinets with top used as a desk; small two drawer chest in my living room; ~~ large bookcase in living room; 3 framed photographs of old sheet music; any and all sheet music I may have at the time of my death; decorative plates of birds; wild ducks, and other animals; and framed picture of me and my dog Hazel. In the event that the said Carol J. Luciani should fail to survive me, then 1 give and bequeath this property in equal shares to her issue, per stirpes. °'~ (d) To my step brother-in-law, Joseph Luciani, of 83G Fishburn Road, Hershey, Pennsylvania 17033, I give and bequeath the following personal property: Alt books except as otherwise bequeathed, magazines and records; bookcases not ~ othertivise specifically bequeathed; and computer and printer. In the event that the said .~-~ Joseph Luciani should fail to survive rrre, then I give and bequeath this property in equal shares to his issue, per stirpes. (e) To my nephew, James Albert Luciani, of 836 Fishburn Road, Hershey, Pennsylvania 17033, I give aiid bequeath the following personal property: Twelve (12) blue water goulets !wedding gift from cousins Elizabeth and P.aymond Schwering); 5 rose color sherbet glasses (wedding gift from cousins Edna and Lewis Hendrixson); and 1 white alabaster bust of young boy. In the event that the said James Luciani should fail to survive rne, then I give and bequeath this property in equal shares to his issue, per stirpes. (f) To my friend, David Seitz, of P.O. Box 81G, Conden, Oregon, l give and bequeath the following personal property: One (1) 1874 Waterbury mantel clock. In the event that the said David Seitz should fail to survive rne, then this gift shall lapse. Last l~l'ill mid Tes'lmuen[ of Adae E. Martin Page 2 of ~ ;x i . i { ~ ~ Clifton Heights, Pennsylvania 19018, I give and bequeath the following personal property: One (1) sterling silver cigarette box; 2 small sterling silver candleholders; and 4 Norman Rockwell mugs. In the event that the said Grace E. Terry should fail to survive me, then this gift shall lapse. (h) To my half brother, Don E. Elliott, of 206409 Anndyke Way, Germantown, Maryland 20874, I give and bequeath the following personal property: One (1) crystal punch bowl and matching punch cups; and 1 blue Wedgewood bowl. In the event that the said Don E. Elliott should fail to survive me, then I give and bequeath this property in equal shares to his issue, per stirpes. (i) To my half brother, Ross D. Elliott, of 26 Sabastian Blvd., Gaithersburg, Maryland 20878, I give and bequeath the following personal property: One (1) Zenith 27" television and 1 Zenith VCR. In the event that the said Ross D. Elliott should fail to survive me, then I give and bequeath this property in equal shares to my step brother- in-law, Joseph Luciani, or his issue, per stirpes. (j) To my neighbor, Agnes C. Goudie, of 60 Magaw Avenue, Carlisle, Pennsylvania 17015, I give and bequeath the sum of $1,000.00. In the event that the said Agnes C. Goudie should fail to survive me, then this gift shall lapse. FOlJRTH 1 give and bequeath the sum of $5,000.00 to each of the following individuals and organizations, provided that they survive ma: (a) My sister-in-law, Lucy J. Tanner, of 33 Rockwood Road, Apt. 44, Norfolk, Massachusetts 02056. (b) My niece, Alicia Jean Luciani, 836 Fishburn Road, Hershey, Pennsylvania ~ 17033. ~~~ , (c) My nephew, James Albert Luciani, of 836 Fishburn Road, Hershey, Pennsylvania 17033. v (d) My half brother, Don E. Elliott, of 206409 Anndyke Way, Germantown, ~ Maryland 20874. (e) My half brother, Ross D. Elliott, of 26 Sabastian Blvd., Gaithersburg, Maryland 20878. (f) My friend, Grace E. Terry, of 2 South Glenwood Avenue, Apt. A-2, Clifton Heights, Pennsylvania 19018. (g) The Bishop Henry Hobson Memorial Fund, Forward Movement Publications, 300 West Fourth Street, Cincinnati, Ohio 45202. In the event that any of the individuals named in this paragraph Fourth fail to survive me, then the gift to them shall lapse. FIFTH All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: (a) One-Third (1/3) to my half sister, Carol J. Luciani, of 836 Fishburn Road, Hershey, Pennsylvania 17033. In the event that the said Carol J. Luciani should fail to survive me, then her share shall lapse, and be divided equally between the remaining two shares of the Shippensburg University Foundation, and WITF, Inc. Last bVill and Testmnent of A1ae E. Martin Page 3 aj5 a d {b) One-Third {1/3) to tl~e Shippensburg University Foundation, 1871 Old Main Drive, Shippensburg, Pennsylvania 17257. (c) One-Third (1/3) to WITf=, inc., of 4801 Lindle P.oad, Harrisburg, Pennsylvania 17111. SIY.TE~ I hereby nominate, constitute and appoint my said Ralf sister, Carol J. Luciani, as Executrix of this my Last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of the said Carol J. Luciani, I nominate, constitute and appoint my said half brother, Don E. Elliott, as Executor of this my Last Will and Testament. I expect that my said Executrix or Executor to be paid their full Executor's commission, as allowed by law. I further direct that no bond or other security shall be required of any Executor or Executrix appointed in this Will for the performance of his, her or its duties in any jurisdiction in which he, she or it may be called upon to act. The terms Executor or Executrix may be used interchangeably in this Will and shall refer to any Executor or Executrix appointed in this wi(I, or any other Administrator appointed by a court of competent jurisdiction. SEVENTi-I In addition to, and not in limitation of, the powers conferred by law or by other provisions of this Will, my Executrix shall have the following powers, each of which may be exercised from time. to time by my Executrix in [his/her] sole discretion: (a) To retain in the fon~ received, and to sell either at public or private sale, or to distribute in kind, any real or personal property. (b) To manage both real and personal property. (c) To invest and reinvest in all forms of property, notwithstanding the fact that any or all of the investments trade are of a character or size which but for this expressed authority would not be considered proper for an Executrix.. (d) To exetcise any option or rights arising from the ownership of investments. (e) To compromise claims without court approval and without the consent of any beneficiary. 1N W(T NESS Wl-IEi:EC~F, I have hereunto set my hand and seal to this my Last Will and Testament, written on five (5) pages (including notary page), this 24th day of July, 2009. Z~~a.e~ ~. ~G/ .:,~~t,~/ (SEAL) Mae E. Martin Signed, sealed, published, and declared by Mae E. Martin, the Testatrix above named, as slid for her Last Will and Testament; in our presence, who, in her presence, at her request, and in the presence of each other, leave hereunto subscribed our names as attesting witnesses. P Last 61'iU grid Testament of Alae E. A4arciu Page 4 of5 t COMMONWEALTH OF PENNSYLVA[~tIA ) SS: COUNTY OF CUMBERLAND ) We, Mae E. Martin, the Testatrix in, and Stephen D. Tiley and Sharon d. DeVos ,the witnesses, to the Last Will and Testament, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: a. that I, the Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and b. that we, the witnesses, were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the Last Will and Testament as a witness and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Mae E. Martin r~ -~ , ~~- -~ ~~~ ~~~ P ,~ Subscribed, sworn to and acknowledged before me by the Testatrix and the witnesses above-named, this 24th day of July, 2009. /.,~ 't -----~f Notary Public ~ a ems, e+~p ag c~r,~ c~rt~,e c~~ Ra ~Y Cessrnn~ss:cn F1ca'~ez neat' a0, aoto Last i~'il! acid Testwnent of Alae E. Martin Page 5 of 5 a Mae's Will Checklist Alicia: Appraised Value: $ 150.00 • six (6) place settings (five-piece) of my Reed & Barton Sterling silver flatware, Silver Wheat pattern, plus servings pieces as follows: one (1) meat fork one (1) tablespoon gravy ladle butter knife • 1 Lazy-Bo leather rocker-r I' y ec finer $ 100.00 • all photographs and negatives not otherwise specifically bequeathed N/A • all oil paintings by Aunt Florence and Uncle Bob Reddie $ 10.00 • 1 Kaleidoscope N/A • glass and crystal bottles, pitchers and knickknacks in bay window $ 5 00 • books of plays and sonnets by Shakespeare (unable to find) N/A . $ 265.00 Doris Walter: - • six (6) place settings (five-piece) of my Reed ~ Barton Sterling silver flatware, Silver Wheat pattern, plus servings pieces as follows: two (2) tablespoons and sugar shell $ 150.00 $ 150.00 Carol: • Tiffany lamp shade $ 15.00 • Dining room furniture consisting of table with 2 leaves, 3 arm chairs, 3 side chairs, china cabinet, and table pads $ 200.00 • Grandmother's Elliott's two-tone gold circle pin with sapphire (unable to find) N/A • Grandmother's Elliott's rocking chair $ 25.00 • scrapbooks from Germany and Elliott family Bible (gone) N/A • pink Wedgewood heart-shaped pendant (Avon) $ 3.00 • bed linens, blankets, and towels $ 5.00 • all craft materials and collection of handbags $ 0.50 • collection of music $ 3.00 • diamond engagement ring $ 100.00 • microwave oven and all kitchenware $ 10.00 • 1999 Toyota Camry automobile (not working-apprx miles:50,000-60,000) $ 1 ,500.00 • 1 small 2-drawer chest (walnut finish) $ 50.00 • 1 lingerie chest $ 30.00 • 1 oil painting by George Newman $ 5.00 • 1 small desk with 4 drawers (walnut finish) $ 100 00 • 1 lamp (double candelabra with hunting scene on shade) (broken) $ . 2 00 • 5 Hummel figurines (2 broken, 3 good)(price for all 5 pcs) $ . 10.00 • 1 Yamaha Clavinova piano (1998, model 880) $ 400.00 • my Cherry bedroom furniture, including bed (w/electric unit), double dresser, chest of drawers, and night stand $ 200 00 ~• metal filing cabinets with top used as a desk . • 3 framed photographs of old sheet music $ $ 5.00 15 00 • any and all sheet music I may have at the time of my death $ . 10.00 • decorative plates of birds, wild ducks, and other animals $ 12.00 • framed picture of me and my dog Hazel N/A $ 2,700 50 .x r page 1 of 2 ~~'~ Mae's Will Checklist (cond't) Joe: • All books except as otherwise bequeathed, magazines and reports (3) • Bookcases not otherwise specifically bequeathed • Computer and printer (no computer) $ 15.00 $ 0.50 N/A Jim. $ 15.50 • Twelve (12) blue water goblets (wedding gift from cousins Elizabeth & Raymond Schwering (only 11 found) and 5 rose color sherbet glasses (wedding gift from cousins Edna 8~ Lewis Hendrixson) $ 7.00 • 1 white alabaster bust of young boy ~ ~n nn $ 17.00 David Seitz: • one (1)1874 Waterbury mantel clock (Conn.) $ 400.00 $ 400.00 Grace Terrv: (deceased) - • one (1) sterling silver cigarette box (gone) N/A • 2 small sterling silver candleholders (gone) N/A • 4 Norman Rockwell mugs (no value) N/A Don: $ • one (1) crystal punch bowl and matching punch cups $ 10.00 • 1 blue wedgewood bowl (gone) N/A Ross: S 10.00 • one (1) Zenith 27" television (gone) N/A • one (1) Zenith VHS ~ ~ nn $ 5.00 Misc. Items: • one (1) green recliner $ 20.00 • two (2) marble inlaid end tables w/drawers (2 @ $100.00/each) $ 200.00 • cedar chest $ 150.00 • book shelf $ 5.00 • clothing $ 150.00 • one (1) 8' 1950's sofa $ 250.00 • misc. box lots (15 boxes @ $1.00/each) $ 15 • stern w/speakers .00 $ 10.00 ~$ 800.00 Grand Total: $ 4,363.00 . , -- page 2 of 2 . !~-~ ~ Joe C. Hoke, Auctioneer ~~ d ~ -1 ~~ c~, • tEBANON, PA. 1701? • PHONE: 717-?7?-?03D L~r~o-~.~- ~ C-tau-~"a~- 0 ~~~~-~ ~ti~~ ~ ~~ ~ L~ J ~ ~~ ~ ~~ ~_; ~~~ ~~. `~ ~,, ~; ~ . ~~ ,, R ~~ ~, ~, ~ f n ~ i,% r<\ ~~' ' ' ~=~~ ~ ~ ~~ i r + ,~ „/IJ~ ~ ~ ~,~~ ~ ))~~ L r 1, ~ r /~~J,. ~~ ~ ~- C--- ~ Val' ~ . ~~ ~ ~'_. ~ /' t,~~l D~L°_f~Y' ~~ ~ < ~; .: M ~-~ Joe C_ Neke_ oi,rtinr~oor M~+2~~~ • LEBANON, PA. 1701? • PHONE 717-Z72-203D ~~ 7 - ~~a-a a3 9 (~ aD/~. ~~~~~~~ ~ ~ ~. . ~~ 1~'' ~~ ~,~ @~~ ~ ~~'~ ~ ~ ~ ~' ~~ ~~~ 3' AE E MARTIN ESTATE CAROL J LUCIANI, EXECUTRIX 5 S HANOVER STREET CARLISLE, PA 17013 ~~~,~, z ~~ ~~ Vow' C~. ~IO f~ e.~ /'~kC~/ONL°P•Y~ ~~ ~GC. 000 ~~3-L `~>> ~~a a~~9 :~~lr~~~~~~ J ~J ~ ~~-J <.u.:, ,. , .: ~-~' 8 ~ `,„,_ 3 OxRSTOwivBArrx • A Tradition ofFxcellancs ! ~_ ~--, MEMO ' ~ M, ~~:03 L3 i 036: L08 00705511' 0 i 4 W d W ~ PAY TO THE ~ ORDER OF.~e ~y~~~ a ~ . f. ~313~8 10 4 DATE ~~ ~ oG~~© GL Holdings Inc (WGL) Date Price High 3/5/10 33.68 33.68 No Splits (NYSE) U.S. Dollar Low Volume 33.34 329,000 Get another quote any day after 1/2/1970 1 /2/1970 ~~-.~.. Symbol: Date: 3/5/2010 G~ Iti~tanth >;Daily i ~. r °~;~, F f ,~, .jlt J~ ,-~ ~"= ~sy,. Imo 2mo 3mo 6mo ~: ~~~ Quotes delayed at least 15 minutes. Market data provided by Interactive Data. Terms & Conditions. Powered and implemented by Interactive Data Managed Solutions. ~~`~ Q M&TBar-k 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Frey and Tiley Attorneys at Law 5 South Hanover Street Carlisle, PA 17013 Re: Estate of Mae E Martin Social Security: 198- l 2-6563 Date of Death: March 5, 2010 Phone 888-502-4349 F ax (302) 934-2955 November 30, 2010 Dear Sir or Madam: Per your inquiry on November 1, 2010, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o, f) Opening Date Balance on Date of Death Accrued Interest Total Checking Account 3740921055 Mae E Martin 06/02/00 $860.25 $ .00 __. ... $860.25 _. For further account information, closures and/or reimbursement of funds please call the Spring Garden Office at #717-2A0-4525. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not indude any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, ~ ~ ~-/1 ~~ t- Tammy Spencer ~ _ , ,~`` `~ r Adjustment. Services ~,-~ NOV-08-2010(MON) 1337 VKI~~`1'UWN BANK A Tradition of Excellence Stephen D. Tiley, Esq. Frey 8~ Tiley 5 South Hanover Street Carlisle, PA 17013 Fax 243-6441 November 8, 2010 Re: Estate of Mae E, Martin Social Security Number 198-12-6563 Date of Death March 5, 2010 IT IS HERERBY CERTIFIED THAT TT~,E ABOTT.E NAMED DECEDENT HAD THE FOLLOWING ACCOUNTS WITH O,RRSTOWN BANK.• CI-IECKING ACCOUNT Account No. -- 108004553 Account Type - 50+ Interest Check Date Opened - g / 10 / g g Joint Account (name/ date) - None Balance - $8,678.45 Accrued Interest - $.OS CERTIFICATES OF DEPOST7' Account No. - Account Type -- DatE Opened - Joint Account (name/ date) - 8alance - Accrued Interest - 4000033455 3-5 Month Growth 6/25/09 None $10,050.47 $1.32 ~.: P. 001 /002 77 East King Street P.O. Box 250 Shippensburg, PA 17257 1.888.ORRS70WN VY'W1JV'.O C~'St®WC~. Ca~'3 NOU-08-2010fMON) 13 37 Account No. - Account Type - Date Opened -- Joint Account (name/ date) -- Balance -- Accrued Interest - P, 002/002 4000033456 6- ~, ~, Month Growth 6/25/09 None $50,337.94 $8.27 Best Regards, Vices L. Gullixon Customer Service Specialist 2. `~ ~`~-} , ~ ~,~ ~:. . ~- MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 360135-00 Date Account Established 06/23/2009 Principal Balance at Date of Death $10.00 Accrued Interest to Date of Death $ 0.00 Total Principal and Accrued Interest $10.00 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 360135-11 Date Account Established 06/23/2009 Principal Balance at Date of Death $0.00 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $0.00 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 360135-40 Date Account Established 06/23/2009 Principal Balance at Date of Death $50,646.04 Accrued Interest to Date of Death $5.54 Total Principal and Accrued Interest $50,651.58 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 360135-41 Date Account Established 06/23/2009 Principal Balance at Date of Death $50,852.75 Accrued Interest to Date of Death $11.00 Total Principal and Accrued Interest $50,863.75 Name of Joint Owner None MEMBERS 1ST FEDERAL CRED T UNION C~~~ Leigh- ne Stallings Lending Insurance Support Specialist November 3, 2010 Estate of: Mae E. Martin Date of Death: 05/05/2010 Social Security Number: 198-12-6563 .. 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wv~~wmemberslst.org DIAKON L UTHERAI'V SOCIAL MINISTRIES 63890 ESTATE OF MAF', MARTTN ~"I On7C nn inn ~~, -INVOICE NUMBER - INVOICE DATE: INVOICE DESCRIPTION GROSS AMOUNT ~+ ~+ -+ DISCOUNT _ v z/ V V/ 1 1 NET AMOUNT 33011 03/30/11 REFUND 127213.20 0.00 127213.20 127213.20 0.00 127213.20 DL4KON L UTHERAN SOCIAL MINISTRIES 63890 ESTATE OF MAE MARTIN ~1 QnD~ nn inQ i~ ~ ~; INVOICE NUMBER ' : ;; INVOICEDATE INVfJlCE DESCRIPTION GROSS'AMOUNT DISCOUNT - NET AMOUNT 33011 03/30/11 REFUND 127213.20 0.00 127213.20 '°°~°°'~%`~ " a ` ` ~> ~~ "€ THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER ~ ~~ ~m~'~' emu, ~, „ '~ ~ ' , DIAgONLUTHERANSOCL4Z MINISTRIES ~ ~ wACNOVIA BANK 960 CENTURYDRIVE 111ECHAIVICSBIIRG PA 17QSS _ ' - s-5o • _ 310 ~~ `DATE °. - '~=' , ~ . =.~~ .CHEGK~NO: .. ~ ~-~ ~~~ _R .AMOUNT ~,... - 04/08/11. 318025 *127,213.20* " ONE HUNDRED TWENTY-SEVEN THOUSAND TWO HUNDRED THIRTEEN AND 20/100------ Void after 1(80 days PAY ESTATE OF MAE MARTIN 6389 `~. i '~~ 0 TO THE C/O CAROL LUCIANI, EXECUTOR ORDER FREY & TILEY LAW OFFICE • ~ 5 SOUTH HANOVER STREET ~~ ~ '~` CARLISLE PA 17013 2nd signature required over $20,000.00 "" "~•_"9~~°' ° "~°1'~"~f"°~~'~"'~~ ~""{ THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK-HOLD AT AN ANGLE TO VIEW ~u~{;w~k~~w~{i°•~; "?g;~ /~? <3 II^03 L802511' ~:0 3 1000 50 3i:200003007968511• v 3 ~ ~ O o c m ~"~~ ~ ~ ~ i v i N G Z Qo ~ d ~ ^ n a ~~ ~ ~+ V Z O ~ , ' ~ ~ -.~ 1 O m VO ~' V 1 CXECRB AND OTXER TfEM6 ARE RECE VED fOR OEFOBIT SUBJECT TO TXE PROVISIONS OF TXE UNIFORM COMMERCIAL CODE OR ANY APPUCABIE CDILECTIOM AOREEMEXT. -~I O ' ~ m° v ~ -Dj ~ O °m r ~ ~ !~ ~ f~~ ~ W ~ O m m \ O D m ~ O ~ ~ a , ~D to C. O ~ ~ O : ~ ~ ~ ~ m t o C ~ f'{~ ~ ~ _ ~ I m ~ m ~ r Z Ill 0 ~ ~ ~ n ~ ~ . O Fr V`1 Tn o 37 q D ~ ~ ~ ` "'~ ~Nf t~~t Q _ ~ m D ~ _ i ~ Z. t;;`~ W a ~ m ° m X ~~~ ~ O ~ "' w~'C)n a, -~ _" Llt O a X :" ~ a .... ~" + LPI i .. ..... .`. Ir... ..... mr j '~ ny C m ~p xa m ~ -.~ mn < ~ ~ O 9r ~ j = T' X70 m; OJ a m • ~ ~ ~ ~. ~ ... f r ~ `~ .. ~ \. ... ~ •` ~r ~ ~ ~. m 3 N ~ B ~ ~ ' v rr = r. ~ Q ~ t . ~.. Q R-~ r ~j ~ N N • r.,,~ ~-.. w - sR • s ° n ~ O e • (~~ r r _•• _ CJ ~ tp ~" Cfi - A ~f> ~ ~. c~ ~~, ~,J _, r - - - - - - CU1y~BERLAND CROSSINGS A DIAKON LUTHERAN SENIOR LIVING COMNIL'NITY August 4, 2010 Carol Luciani 836 Fishburn Road Hershey PA 17033 Re: Refund for Mae Martin -Cottage #59 Dear Carol: I am writing in response to your request for information about the amount of th.e refund which can be expected by the estate of Mae Martin. According to the terms of her contract with Cumberland Crossings, Mrs. Martin's estate will receive a refund of 90% of his entrance. The following are the particulars in this case: Refund Option 90% Entrance Fee $139,750.00 Improvements $ 1,598.00 Total eligible for refund $141,348.00 When a new occupant takes possession of cottage #59 and pays his or her entrance fee in full, Diakon will send you a check for 90% of this amount. Unofficial amount refund $127,213.20 (This is unofficial until the final monthly bill for the cottage is paid.) Please call me if you have any additional questions. I am at your service, Oliver hazano@diakon.org 1 Longsdorf Way Carlisle, PA 17015 Phone 717.245.9941 Fax 717.240.6017 Toll Free 800.722.0267 www.diakon.org :l~.k~P';jL i'r Oliver Hazan Marketing and Sales Director Cumberland Crossings Phone Line /Marketing Office 717.2 40.6013 Cell Phone 717.21.5.1730 Fax 717.243.2054 CUMBERLAND CROSSINGS A DIAKON LUTHERAN SENIOR LIVING COMMUNITY August 4, 2010 Carol Luciani 836 Fishburn Road Hershey PA 17033 Re: Refund for Mae Martin -Cottage #59 Dear Carol: I am writing in response to your request for information about the amount of the refund which can be expected by the estate of Mae Martin. According to the terms of her contract with Cumberland Crossings, Mrs. Martin's estate will receive a refund of 90% of his entrance. The following are the particulars in this case: Refund Option 90% Entrance Fee $139,750.00 Improvements $ 1,598.00 Total eligible for refund $141,348.00 When a new occupant takes possession of cottage #59 and pays his or her entrance fee in full, Diakon will send you a check for 90% of this amount. Unofficial amount refund $127,213.20 (This is unofficial until the final monthly bill for the cottage is paid.) Please call me if you have any additional questions. I am at your service, Oliver hazano@diakon.org ,f Oliver Hazan Marketing and Sales Director Cumberland Crossings Phone Line /Marketing Office 717.240,6013 Cell Phone 717.215.1730 Fax 717.243.2054 1 Longsdorf Way Carlisle, PA 17015 Phone 717.245.9941 Fax 717.240.6017 Toll Free 800.722.0267 ~~""~~' ` ' www.diakon.org