The URL can be used to link to this page

Home My WebLink About04-27-111505610143 ~ REV-1500 EX (01-10) , OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year - File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 2 1 10 0 0 5 31 Harrisburg, PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 162 22 5792 05 12 2010 O1 22 1927 Decedent's Last Name Suffix Decedent's First Name MI SUMMERS LOIS J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ® 6 Decedent Died Testate ^ ~ Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 1 ~, Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Return (date of death prior to 12-13-8c) ^ 5. Federal Estate ~i"ax Return Required ~ 8. 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 SHELLY J KUNKEL 717 236 9301 First line of address 109 LOCUST STREET Second line of address City or Post Office HARRISBURG State ZIP Code PA 17101 Correspondent's a-mail address: S J k U n k e I. W Z S@ m i n d s p r i n g. c o m 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 beliet. it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ArUF2E OF PERSON RESP SIQLE FOR ILING RETURN rDATE ~, ~-~ ~.. ~~~ ~..~, ~ n ,, ~ 1, N Joan L. Stoufer / i' ,~ _~. ~~i ~ i °~ ,, , I ADjlJt~ESS ' /../ ~~ensington Street , H rrisburg, PA 17104 F PREPARER OTHER THAN REPRESENTAl-IVE DATE ~_ Shelly J Kunkel ~~'h.vC_ a-7" ~-U// AD~ss U ~ - 109 Locust Street, Harrisburg, Pa 17101 Side 1 1505610143 ;r- -_ _ REGISTER OF~I~S USE QI~LY -- -` - ~~ ~ -- ~ r...._ t. ~-t I.. -:, . - - ~~ ._ . -~ _.. ~~_.~ ~. ~ _. _.l . . E..~ DATEx~II_ED - :-~ ;~~~ ~~._~ =--, - '_ ; ~. ., 4 ~~ ~ ~~ .., 7 1505610143 ~J~~ J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: .SUMMERS , L O I S J 1 6 2 2 2 5 7 9 2 RECAPITULATION '73 , 850.00 1. Real Estate (Schedule A) ................................................................................. ......... 1. 2 1.2,497.51 2. Stocks and Bonds (Schedule B) ....................................................................... . ........ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)..... ..... 3. 4. Mortgages & Notes Receivable (Schedule D) .................................................. ........ 4. 3 0 0 0 0 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .......... ...... 5. 5 iD s , 3 9 6 5 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........ ..... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ........ ..... 7. g. Total Gross Assets (total Lines 1-7) ............................................................... ........ g. 6 9 9, 0 4 4 0 6 9. Funeral Expenses & Administrative Costs (Schedule H) .................................. ....... 9. 1 '7 :3 , 0 2 4 6 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......................... ....... 10. .L , 2 5 7 1 4 11. Total Deductions (total Lines 9& 10) ............................................................. .........11. 1 7 4, 2 8 1 8 1 12. Net Value of Estate (Line 8 minus Line 11) .................................................... .........12. 5 2 4, 7 6 2 2 5 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) ......................................... ........ 13. h , 4 6 5 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ......................................... ........ 14. 5 18 , 2 9 7 2 5 __ __ 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 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate x .15 518 , 2 9 7. 2 5 18. 7 '7 , 7 4 4. 5 9 19. Tax Due .......................................................................................................... .........19. 7 '7 , 7 4 4 5 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610213 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 10 - 00531 Summers, Lois J STREET ADDRESS 522 Terrace Drive CITY it New Cumberland STATE zIP ~, PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 65,000.00 -- __- --_ 3,421.05 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. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 77,744.59 Total Credits (A + B) (2) 68,421.05 (3) 0.00 (4) (5> 9,323.54 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 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 I 1 d. receive the promise for life of either payments, benefits or care? ................................................................_ _ ', x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .....................................................................................................................~L. ' I, x _. ~_ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 'r__ JI !; x 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 FIILE IT AS PART OF THE RETUR 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. §!x116 (a) (1.3)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whE:ther by blood or adoption. ~~ ,'~ ,, SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Summers, LOIS J 21 - 10 - 00531 __ __ __ __ - All real property owned solely or as a tenant in common must be reported at fair market valueEair market value is defined as the price at which property would be exc anged between a willing buyer and a willing seller, neither bein~ compelled to busy or sell, both having reasonable knowledge of the relevant facts.Real property which is jointly-owned with right o 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH __ __ 1 Single Family Frame Dwelling known and numbered as 522 Terrace Drive, New Cumberland, 73,850.00 PA; Being Lot No. 28, Block "C" on the Plan of Simpson Terrace, Addition No. 2 to Forrest Hills; Transferred to Lois J. Summers, a single woman, by Russel Eichelberger, Executor of the Estate of Charles E. Eichelberger, on April 10, 1068, by deed recorded in the Cumberland County Recorder of Deeds office on April 16, 1968 at Deed Book "S", Volme 22, Page 812, Valuation is sale price as shown on HUD-1 settlement statement attached hereto as Exhibit A. TOTAL (Also enter on Line 1, Recapitulation;- I 73,850.00 ',~ ~.~';, SCHEDULE B ~~ STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT __ ,FILE NUMBER ESTATE OF Summers, LOIS ~ 21 - 10 - 00531 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE OF NUMBER ~ DESCRIPTION UNIT VALUE: DEATH 1 Invest Financial Corporation c/o Rowley Financial 600 J Eden Road, Suite 4 Lancaster, PA 17601 See individual investment account values on Rowley Financial correspondence attached hereto as Exhibit B for additional details: 25,000.000 units FNMA 6% Bond; CUSIP # 3135A06X2 25,000.000 units FNMA 6.25% Bond; CUSIP # 3135AOZF9 12,000.000 units GE Capital Corporate Internote 5.375% Bond; CUSIP # 36966RZ41 300 Shares Wells Fargo CAP XII Enh Tr Preferred stock; Ticker Symbol BWF 25.000 shares ADT 384 -Advanced Corporate Tr Strat Series 3 Tax Exempt unit investment trust; CUSIP # 00767X67 850.000 shares ADT 389 -Covered Call & Inc Strat Closed End Serios 8 unit investment trust; CUSIP # 00768A141 9.000 shares ADT 426 - Navellier/Dial High Inc Opp Series 5 unit investment trust; CUSIP# 007686602 702.000 shares ADT 429 -Preferred Income Port Series 6 unit investment trust; CUSIP # 007686776 30.647 shares ADT 429 -Preferred Income Port Series 6 ;CUSIP # 007686776; Dividend Reinvestment 25,042.75 24,993.75 12,120.00 7,785.00 26, 325.00 9,596.50 9, 242.10 7,083.18 309.23 - _ _ _. i TOTAL (Also enter on line 2, Recapitulation) '~ 122,497.51 .~ ~'`. SCHEDULE D "~~` MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Summers, LOIS ,1 21 - 10 - 00531 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Personal Loan -Balance owed to decedent by Marie Fetrow for personal loan made withouit 300.00 promissory note. Note also, offset of specific cash legacy distribution to Marie Fetrow set forth in Schedule J in full satisfaction of this debt. TOTAL (Also enter on Line 4, Recapitulation) ( 300.00 SCHEDULE E '~ CASH, BANK DEPOSITS,p&~MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERT i INHERITANCE TAX RETURN RESIDENT DECEDENT ;FILE NUMBER ESTATE OF Summers, LOTS ~ ! 21 - 10 - 00531 Include the proceeds of litigation and the date the proceeds were received by the estateAll property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF DEATH NUMBER 1 M&T Bank 4,963.11 499 Mitchell Road Millsboro, DE 19966 Checking Account # 80269958 Valuation per M&T Bank correspondence attached hereto as Exhibit E. M&T Bank 0.03 499 Mitchell Road Millsboro, DE 19966 Checking Account # 80269958 Accrued interest through date of death 2 M&T Bank 45,924.33 499 Mitchell Road Millsboro, DE 19966 Savings Account # 15004213062075 Valuation per M&T Bank correspondence attached hereto as Exhibit E. M&T Bank 0.51 499 Mitchell Road Millsboro, DE 19966 Savings Account # 15004213062075 Accrued interest through date of death. 3 Metro Bank 31,951.53 3801 Paxton Street Harrisburg, PA 17111 Individual Checking Account # 513207282 Valuation per Metro Bank correspondence attached hereto as Exhibit E. No accrued interest at date of death because account was closed prior to May 31, 2010. TOTAL (Also enter on Line 5, Recapitulation) 502,396.55 SCHEDULE E MISC. & '~ ; ' CASH, BANK DEPOSITS, ~ p COMMONWEALTH OF PENNSYLVANIA PE,RSON/..L PROPERT i INHERITANCE TAX RETURN RESIDENT DECEDENT Continued FILE NUMBER ESTATE OF Summers, LOTS ~ ' 21 - 10 - OO~i3'I Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of survivorship must be disclosed on schedule F. __ ITEM DESCRIPTION ', VALUE AT DATE OF DEATH NUMBER 4 Invest Financial Corporation 14,614.87 c/o Rowley Financial 600 J Eden Road, Suite 4 ', Lancaster, PA 17601 Individual Account # 5HT082542 Federated Capital Reserve -Cash portion of investment account See Rowley Financial correspondence attached hereto as Exhibit E. 5 Sovereign Bank 14,174.30 Mail Code: P.O. Box 841001 Boston, MA 02284 IRA Certificate of Deposit # 0358000933 Beneficiary: Lois A. Pilsitz (niece, pre-deceased) Beneficiary: Rae Jean Pilsitz (sister, pre-deceased) IRA funds paid to Estate of Lois J. Summers as a result of all named beneficiaries having pre-deceased the decedent Sovereign Bank 3.73 Mail Code: P.O. Box 841001 Boston, MA 02284 i IRA Certificate of Deposit # 0358000933 Accrued interest through date of death. 6 2009 Chevrolet Cobalt -Sale price per Bill of Sale attached hereto as Exhibit E. 10,150.00 7 Miscellaneous tools and equipment in outdoor storage shed. 850.00 8 Friendly Village Dishes and stainless flatware 250.00 9 Miscellaneous clothing and furnishings donated to Salvation Army -valuation per Salvation Army 465.00 guidelines Pa e 2 of Schedule E 9 SCHEDULE E t ~ '~ CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT Continued FILE NUMBER ESTATE OF Summers, LOis J i 21 - 10 - OOFi311 __- _ _ __ Include the p roceeds of litigation and the date the proceeds were received by the estateAll property jointly-owned wi th the right of survivorship must be disclosed on schedule F. ITEM 'VALUE AT DATE OF NUMBER DESCRIPTION DEATH 10 ~~, __ Kayne Auctions -Gross Auction proceeds from sale of miscellaneous personal property 1,265.50 11 Highmark - Prescription refund 32.49 12 The Patriot News -Subscription refund 26.25 I 13 _ Venzon Telephone refund I' 19.88 14 Comcast -Cable television refund 57.03 15 UGI -Gas utility refund 25.85 16 Cash found on premises at decedent's house 130.00 17 Miscellaneous rolled coins found at decedent's house 229.39 18 Erie Insurance Exchange 300,000.00 100 Erie Ins. Place Erie, PA 16530 ' Payment of Bodily Injury Liability ' Full and final settlement of all claims for motor vehicle accident - Claim # 010171073747 100% survivorship allocation See General Release of Erie Insurance and Cumberland County Court Order attached herel:o ', as Exhibit E. Net proceeds received by estate on February 16, 2011. Page 3 of Schedule E ~ SCHEDULE E CASH, BANK DEPOpSITS, &~MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PIIOPEI~Ti INHERITANCE TAX RETURN ' RESIDENT DECEDENT Continued FILE NUMBERR ESTATE OF Summers, LOTS .1 I! 21 - 10 - 00531 Include the proceeds of litigation and the date the proceeds were received by the estate411 property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION ' VALUE AT DATE OF NUMBER DEATH ___ 19 Nationwide Mutual Insurance Company !~ 75,000.00 One Nationwide Gateway Dept. 5867 Des Moines, IA 50391-5867 Payment of Underinsured Motorist settlement Full and final settlement of all claims for motor vehicle accident - Claim # 58 37 B 428557 01182010 01 100% survivorship allocation See General Release of Nationwide Mutual Insurance Company and Cumberland County Court Order attached hereto as Exhibit E. Net proceeds received by estate on April 27, 2011. 20 Pro-rated reimbursement for 2010 County Township RE Taxes per HUD-1 settlement sheet: attached hereteo as Exhibit A. 21 Pro-rated reimbursement for 2010-2011 School RE Taxes per HUD-1 settlement sheet attached hereto as Exhibit A. 22 Pro-rated 3rd Quarter Trash bill per HUD-1 settlement sheet attached hereto as Exhibit A. 23 Erie Insurance -Pro-rated refund on homeowner's insurance premium 24 U.S. Treasury - 2010 IRS refund on decedent's final 1040 137.46 606.35 2.94 160.00 1,356.00 F'age 4 of Schedule E SCHEDULE H t S ' FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ~'p ~ /~ ^^~+~+ INHERITANCE TAX RETURN ~~'NIS 1 RATI V G ~/VJ 1 J RESIDENT DECEDENT ;FILE NUMBEFt ESTATE OF Summers, Lois J 21 - 10 - 00531 Debts of decedent must be reported on Schedule I. __ _ _ _-_ _- __ ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Wiedeman Funeral Home -Funeral costs not covered by pre-paid funeral 821.00 arrangements, including second interment fee to inter ashes and additional death B. ADMINISTRATIVE COSTS: ~ , Personal Representative's Commissions Name of Personal Representative(s) Joan L. Stoufer Street Address 2020 Kensington Street city Harrisburg state PA zip 17104 Year(s) Commission paid 2. Attorney's Fees Wion, Zulli & Seibert -- Shelly J. Kunkel 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 Cumberland County Register of Wills Cumberland County Register of Wills -Additional probate fee Cumberland County Register of Wills -Additional short certificates 5. Accountant's Fees 6. Tax Return Preparer's Fees Steven W. Fahnestock & Associates - 2010 tax preparation 7. Other Administrative Costs 1 Cumberland Law Journal -Estate advertisement -_ TOTAL (Also enter on line 9, Recapitulation) 33,000.00 34, 952.00 427.50 200.00 16.00 190.00 75.00 173,024.67 ,.. Schedule H Funeral COMMONWEALTH OF PENNSYLVANIA w INHERITANCE TAX RETURN ~In X17 oonbnued RESIDENT DECEDENT -- _. __FILE NUMBER ESTATE OF Summers, Lois J 21 - 10 - 00531 2 _. The Carlisle Sentinel -Estate advertisement 208.78 3 Cumberland County Register of Wills -Filing fee for PA 1500 and Inventory 30.00 4 Cumberland County Register of Wills -Filing fee for Family Settlement Agreement 20.00 5 UGI -Gas utility bills for 522 Terrace Drive through date of settlement 182.21 6 PA American Water -Water bills for 522 Terrace Drive through date of settlement 162.87 7 PPL -Electric utility bills for 522 Terrace Drive through date of settlement 117.64 8 Verizon -Telephone utility bills for 522 Terrace Drive through termination of service 64.55 9 David R. Bradley - Lawnmowing services for 522 Terrace Drive through date of 390.00 settlement 10 Robin Gasperetti - 2010 School Real Estate taxes for 522 Terrace Drive 774.61 11 Clauser Real Estate Appraisals -Residential RE appraisal for 522 Terrace Drive 350.00 12 Kurt Eby Appraisals -Residential RE appraisal for 522 Terrace Drive 375.00 13 New Cumberland Borough -Sewer/Trash quarterly bill 97.55 14 Cindy Shultz -Hourly labor rate for boxing and sorting of personal property items for 360.00 Salvation Army and auction house 15 Joseph J. Dixon, Attorney at Law -Attorney commission on insurance settlement with 75,000.00 Erie Insurance Company per contingent fee agreement undertaken by decedent prior to her death and re-executed by Executrix on May 21, 2010. See Settlement Sheet of Joseph J. Dixon attached hereto as Exhibit H. 16 Joseph J. Dixon, Attorney at Law -Attorney commission on insurance settlement with 18,750.00 Nationwide Mutual Insurance Company per contingent fee agreement undertaken by decedent prior to her death and re-executed by Executrix on May 21, 2010. See Underinsured Benefits Settlement Sheet of Joseph J. Dixon attached hereto as Exhibit H. Page 2 of Schedule H Schedule H t, Funewal E~ & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /~^ 1 Iinis~lr~tiv~e Costs oonbnued RESIDENT DECEDENT - _. __ ESTATE OF Summers, Lois J FILE NUMBER 21 - 10 - 00531 p y penses 17 Jose h J. Dixon, Attorne at Law -Reimbursement of costs advanced and ex for medical records related to Erie Insurance Exchange claim and settlement and Nationwide Mutual Insurance Company claim and settlement See Settlement Sheet of Joseph J. Dixon attached hereto as Exhibit H. 18 Heistand Motors - PA state inspection and emissions inspections for 2009 Chevrolet Cobalt 19 PA Department of Transportation -Registration Renewal for 2009 Chevrolet Cobalt 20 Triangle Car Wash -Detailing charges for 2009 Chevrolet Cobalt in preparation for advertisement and sale of car 21 Nationwide Insurance - 3 months renewal of auto insurance policy pending sale of vehicle 22 The Paxton Herald -Advertisement fees for automobile sale listing 23 'The Patriot News and The Guide -Advertisement fees for automobile sale listings 24 Eric P. Bucher -Commission for sale of vehicle, reimbursement for gasoline and car wash prior to vehicle sale 25 Modern Jewelers -Jewelry evaluation and appraisal for miscellaneous items subsequently liquidated at public auction 26 Charles Faust -Coin evaluation and appraisal for miscellaneous items subsequently liquidated at public auction 27 Real Estate Transfer Tax -per HUD-1 settlement sheet 28 Purity Abstract Company -Tax certification fee per HUD-1 settlement sheet 29 New Cumberland Borough - 34rd Quarter Sewer bill per HUD-1 settlement sheet 30 Francis X. Brescia, Jr. D.O. -Professional fees for case review and narrative obtained for insurance settlement negotiations 31 Kayne Auctions -Auctioneer's commission for sale of personal property 2,035.84 74.62 36.00 111.25 403.55 6.00 57.92 177.00 174.90 45.00 738.50 10.00 54.46 2,000.00 442.92 Page 3 of Schedule H Schedule H 4 ~~ Funeral E & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN I~1C~'1111~ISb"al]Vle ~ ~~]~~ RESIDENT DECEDENT - _ - - ESTATE OF Summers, Lois J ~~ FILE NUMBEI~ !21 -10-00531 32 Cumberland County Prothonotary -Filing fee for Petition to Approve Settlement 92.00 Page 4 of Schedule H ~ SCHEDULE I ~" DEBTS OF DECEDENppT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES IX LIENS INHERITANCE TAX RETURN ~ RESIDENT DECEDENT __ ESTATE OF Summers, LOis J FILE NUMBEI~ 21 - 10 - 00531 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimk>ursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Shelly J. Kunkel -Final bill for Power of Attorney services and reimbursement for 1,150.00 expenses(parking) 2 ~ Comcast -Final cable bill for 522 Terrace Drive ~ 107.14 TOTAL (Also enter on Line 10, Recapitulation) I 1,257.14 REV-1513 EX+ (11-OS) '~ ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Summers, Lois J RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS[include outright spousal ' distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Marie Fetrow Friend 208 Senate Avenue, Apt. 804 Camp Hill, PA 17011 FILE NUMBER 21 - 10 - 00531 SHARE OF EST,4TE AMOUNT OF ESTATE (Words) ($$$) Friendly Village 950.00 China, stainless silverware, $700 cash bequest 2 Jeanette C. Ditzler Friend 1,000.00 104 North Second Street Wormleysburg, PA 17043 3 Mark Grabusnik Friend Tool shed contents 850.00 509 Terrace Drive New Cumberland, PA 17070 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 The Salvation Army Family Services 1,465.00 1122 Green Street, Harrisburg, PA 17102 2 The Carter Center, Inc. 1,000.00 One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307 3 The Humane Society of Harrisburg 1,000.00 7790 Grayson Road, Harrisburg, PA 17111 4 Helen O. Krause Animal Foundation, Inc. 1,000.00 P.O. Box 311, Mechanicsburg, PA 17055-0311 5 Total Additional Charitable Bequest -see attached continuation page 2,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER Sf-IEE:T 6,465.00 REV-1513 EX+ (9-00) ~~ SCHEDULE J Y'L~ COMM ONWEALTt1 OF PENNSYLVANIA BENEFICI ARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBEI~ Summers, Lois J 21 - 10 - 00531 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I ', TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 John Kitz Friend 1/3 Residuary E=skate 17 Wagon Wheel Road Glen Arm, MD 21057-9431 5 Frances Kitz Friend j1 /3 Re~~.duun.y ~~~a~e 17 Wagon Wheel Road Glen Arm, MD 21057-9431 6 Karen Kitz .Friend '1 /3 ~~s~.duun.y ~3~ta~e 6515 Sherwood Road Baltimore, MD 21239 Page 2 of Schedule J SCHEDULE J CONTINUATION PAGE II. B Charitable and Governmental Distributions continued: Disabled American Veterans P.O. Box 14301 Cincinnati, OH 45250-0301 $].,000.00 Children's Cancer Research Fund Donor Service Center P.O. BOX 7006 Albert Lea, MN 56007-8006 $1 000.00 Total carryover charitable bequests (see Line 5) $2,000.00 ** Note that per Paragraph FOURTH (c), the bequest of One Thousand ($1,000.()()) to REDEEMER LUTHERAN CHURCH, 413 South 19th Street, Harrisburg, PA 17104 has lapsed due to the closure of this church and dissolution and dispersal of its congregation prior to the death of Lois J. Summers. ** .;. ~~~t ill ~n~ ~QSt~rnQnt OF LOIS J. SUMMERS I, LOIS J. SUMMERS, of the Borough of New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay, to the extent possible out of my residuary estate, all of my just debts, funeral expenses and expenses involved or cc-nnected with the administration of my estate, including all estate, inheritance or other death taxes i`oi:her than generation-skipping taxes) and all interest and penalties thereon imposed, as soon after my death as reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in her opinion, it might be proper and more advantageous ~to retain or renew and pay as they become due and payable. It is my further desire that upon my death, :my body will be cremated and any costs will be expended from my estate for this purpose. Page 1 of 9 n L~~ -? '~ c~`~ . _= r ~rt ' Z j: f :\ _ ~ -'1 ~...~ ~ - i, :_C7 __`^ _.-~ 'Z-~ ~.., ~~ C".J C:~' :~='-,° ~~ ,i' " ~' 1 :/ ~'i~l i J - ~~ I .; LAST WILL AND TESTAMENT OF LOIS J. SUMMERS SECOND It is my request that any pets that I may own at the time of my death shall be humanely euthanized as soon after my death as is practicable and the same paid for by my personal representative from the assets of my estate. I further direct my personal representative to sell my residence and all appliances contained therein, either publicly or privately, and to add the proceeds of such sale or sales to my residuary estate to be disposed of as hereinafter provided. THIRD I specifically give and bequeath the following property together with all insurance proceeds thereon as follows: (a) my 2001 Saturn vehicle, my household furnishings, my clothing and shoes to THE SALVATION ARMY FAMILY SERVICES, 1122 Green Street, ]~arrisburg, PA 17102. In the event that I no longer own the 2001 Saturn at the time of my death, this bequest shall lapse and any replacement vehicle I may have acquired shall instead be added to my residuary estate; (b) my service of "Friendly Village" dishes and silverware to my :friend, MARIE FETROW; (c) my personal computer, television, DVD and VCR machines to my friend, JOAN L. STOUFER; and (d) my tools and equipment stored in my outdoor shed to my friend, MARK GRABUSNIK. ^~ Page 2 of 9 r'~; ~ t t~ '`~~ _~ • , ~ :,; `~ i1 S r ~ r~ L ~ t '`4 `mod ~ ( f. f .i ~1 ~4'~' ~ ,r'"~ . _ 4 '"~ ~i ~ ~ir~~~ "` y a~ c 'Tyry ~ ~ y~i ~~~'i ~,- „~' ~_, ~'k+,P ~"t .'~„1k~' y'~w~,~3,2'~ti2 i ^_~+-}1 ~„ ti q-~d ^' "~.,-~+t ~a ttf ~, '~ 4,~ `~`~nM1k ,~'~y : i y'7~ x i ~ - r: i~°I' *i,~~~ ~' . ~-~ '~`+~ ~~ ~' ~ ~ ..~ ~` p~~ e ~ ~- '.~ Z .},~~ ~~ ?.tie Ear e '~'~~e~t ' .~.. ~a . .. ,_ ... ni •iA~~' ,Y VC. i .~.3 .4;x~.. .. u.t l,/ ~_ J~.Y[7~"...J ~' \{i nk1~>I ~:1 d~ J.~.> >. ._. a.. ~..~4 D.c .~ ..i, t,.... T'.frsxv.CnLii,kuifYR4l. ~.~. LAST WILL AND TESTAMENT OF LOIS J. SUMMERS In the event I do not possess the above referenced property at the time of my death, my estate shall not be obligated to obtain these items, and all of said bequests shall lapse. FOURTH I further bequeath the following amounts as general pecuniary bequests: a One Thousand ($1,000.00) Dollars to THE SALVATION ARMY FAMILY () SERVICES, 1122 Green Street, Harrisburg, PA 17102; b One Thousand ($1,000.00) Dollars to THE CARTER CENTER, Il~TC., Atlanta, () Georgia; c One Thousand ($1,000.00) Dollars to REDEEMER LUTHERAN CHURCH, 413 () South 19th Street, Harrisburg, PA 17104; d One Thousand ($1,000.00) Dollars to the HUMANE SOCIETY OF :HARRISBURG () AREA, East Shore Shelter, 7790 Grayson Road, Harrisburg, PA 1'7111; e One Thousand ($1,000.00) Dollars to HELEN O. KRAI:JSE ANIMAL () FOUNDATION, INC. (HOKAFI), of Dillsburg, Pennsylvania; (f) One Thousand ($1,000.00) Dollars to DISABLED AMERICAN V E~,ERANS, P.O. Box 14301, Cincinnati, OH 45250-0301; (g) One Thousand ($1,000.00) Dollars to the CHILDREN'S CANCER RESEARCH FUND, Donor Service Center, P.O. Box 7006, Albert Lea, MN 55007-8006; (h) One Thousand ($1,000.00) Dollars to my friend, MARIE FETROV~T, currently of 208 Senate Avenue, Apartment 804, Camp Hill, PA 17011; and ,; ~,, Page 3 of 9 ~`~; `; ti ~M1~ ~ ~ \~ ~. ~ . ,~;~,'rQ y it n - r - t c ~ ~~ ~ _i ° ~kk h~`4 ~~ _ _ __ .T ,~.,i.. LAST WILL AND TESTAMENT OF LOIS J. SUMMERS i One Thousand ($1,000.00) Dollars to my friend, JEANNETTE C;. DITZLER, () currently of 104 North Second Street, Wormleysburg, PA 17043. In the event that any individual or entity above named should predecease me nor fail to be in ce at the time of my death, I direct that such gift(s) shall lapse and be added to the residue of existen my estate. FIFTH I ive devise and bequeath the rest, residue and remainder of my estate, together with all g ance roceeds thereon of whatsoever nature and wheresoever situate to my fri.erids, KAREN insur p Z currentl of 6515 Sherwood Road, Baltimore, MD 21239, FRANCES KITZ, currently of 17 KIT y on Wheel Road, Glen Arm, MD 21057, and JOHN KITZ, currently of 17 Wagon Wheel Road, Wag Glen Arm, MD 21057, providing that each survives me by thirty (30) days, in equal shares, per ita. In the event that none of my aforesaid residuary beneficiaries so survive :me, then I give, cap evise and be ueath all the rest, residue and remainder of my estate to the HUMANE SOCIETY OF d q HARRISBURG AREA to be divided as follows: a Fifty (50.0%) Percent to the East Shore Branch, 7790 Grayson Road., Harrisburg, PA () 17111; and b Fifty (50.0%) Percent to the West Shore Branch, 710 Eppley Road;, Mechanicsburg, () PA 17055. ~~~ '` ~`i` i.~l ~,, t,~ ,~ y}~ } ~1 .A Page 4 of 9 ~~ ~ ~ :~ ~ r,, 4 .. t ~.~':: LAST WILL AND TESTAMENT OF LOIS J. SUMMERS SIXTH I grant my personal representative the following powers in addition to and nc-t i.n limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reor€;anization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. '1 ana e o erate, re air, improve, mortgage or lease on any terms any real estate (c) Tom g , p P held or owned by my estate. (d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or othher securities or property, real or personal, without regard to the principle of diver:;ification or any other statute or general rule of law in her absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt. sE;ttlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and ors such terms and conditions as my personal representative shall see fit in her absolute discretion. .1~. ,~,. ~ .,.~ , `.~ ~ ~~ -. Page 5 of 9 ~5~ z,' ~ ~ ,, , ^~ ;! .J~t ~":- r $.. ~. i" f ~~. ^~ r'n `~" ~ r~l ~•- >~F i i I ~ ~ x,'~ ~ 7 -; 7 ~, r•'~ ~c< ~~ ~i -,s~ ,~a fx" 1, ~ ~ k.: ~ ~. 'fit ~'F,~ r 4 .~': 4- ~ . ~ ~ ''~ dFd .r ~ r ~`r, ~ ~Y a t y, `G ~-~R~} r .a r~. I~. ::.~ ~~y ~ t'~'ra *~ i ~~"i~k ~ k ~~ `~: 4f._ .n ~N`; t'~~` ~ ~, ~'~~' . t _ ~ ~ '+'` i w f J' . ', yM-a y '{5*a ~,.4; n ,~"' •LNt~~l +'L {y~ ~~ 5 ~ ~ -.A ~' u~ ti _' y ~ z. r ~ 3 ~' ~.:. ~ ..~' .' ." .a...~~~,~j~.t;~s.w~.`~~r.'.'i~s~'~+.1~~~~eg~L~n~L.."~ '?°"~«'-" ~t '~ '~.'~ ~". 4 ~` ~ihw ~c LAST WILL AND TESTAMENT OF LOIS J. SUMMERS To borrow money for the payment of taxes or for any other proper purposes in the fig) administration of my estate, and to mortgage or pledge estate assets as security. To com romise claims without court approval including, but not lirriited to, any (h) p troversies with the United States of America or the Commonwealth of con Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. i To distribute in cash or in kind upon any division or distribution of my estate. (} undertake any and all acts deemed necessary and proper by my personal (~) To e resentative for the proper, advantageous and prompt management of the rp settlement of my estate. In eneral, to exercise all powers in the management of my estate which any (k) g individual could exercise in the management of similar property owaled in his own ' ht u on such terms and conditions as to her may seem best and. ~to execute and rig ~ p deliver all instruments and to do all acts which she deems necessary or proper to carry out the purposes of this, my Last Will and Testament. SEVENTH ~~.., ,,`i',~~=~a '' ; ~ ~: interest of an beneficiary of my estate, either in income or in principal, shall be subject No Y ' ation or led e, assignment, sale or transfer in any manner, nor shall any beneficiary have to anticip p g er in an manner to charge or encumber his or her interest either in income or principal, nor the pow y e interest of an beneficiary be liable or subject in any manner while in th.e possession of my shall th Y personal representative for the liability of such beneficiary. Page 6 of 9 ~ ~ ~a ~ `- ~ r N ~~3 ~, a.~..~~ ...... _ .. ..._... _ .... ~ .. .. .._ ....-a.... ~~.....,.. _ ., __ ~~~ x,..... ~ ,c ...3...5=~.YdFwv.rv2t ~~a.tTi.~nae.a~`~~c....a,.,+i . -Fn~'`~,'yv,~~iuA~.'..r~~: LAST WILL AND TESTAMENT OF LOIS J. SUMMERS EIGHTH ' ate constitute and appoint my friend, JOAN L. STOUFER, as personal :representative I nomin , ill and Testament. In the event my friend, JOAN L. STOUFER:, is deceased, of this my Last W willin to serve or shall cease to serve for any reason whatsoever, thf;n I nominate, unable or un g int m friend, MARIE FETROW, as personal representative of this Iny Last Will constitute and appo y irect that m personal representative shall not be required to give or post bond and Testament. I d y for the faithful performance of her duties in this or any other jurisdiction. SS WHEREOF, I hereunto set my hand, to this my Last Will and. Testament this IN WITNE `~ ~ ` 2006. y,~ ~ ~~: "~.~- ..-&- day of ~ ~~s~~~ ~-,~~ , WITNESS: i~,.,o.~ v.. ~~::. I.~'~/' # ~, , ~~..~:. ., 'y: °,.•.~.~•• '~„~~'` ~` ~,~.,y~.-~'.---ms's •~'~••~•:~""~ ! ~, - ~. - LbIS'T; SUMMERS t`~ ~ ~ ~ {~ .~ r '..' '~ ~ ~, t' ~~`~ i ~~~' ~, ,~~ .~1 Page 7 of 9 ~€~~'~`~ t ~ i F~ ,~ ~ ~ ~~,{ aSF~? ~ ja Q` : r 3Y 44}tw~1 f - - - - ,_ _ _ ,. _.. . .. :~r.. . _. LAST WILL AND TESTAMENT OF LOIS J. SUMMERS ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, LOIS J. SUMMERS, the Testatrix whose name is signed to the attached c-r foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ', jam,,. -. ~ 'f ~/~ 1 ~,, LOIS J_..~UMIVIERS Sworn or affirmed and acknowledged before me by LOIS J. SUMMERS, the Testatrix, this ,- , .,,~~~~, day of ~"'~~,}~~:~~~ , 2006. ~OMMJt\1V'J~R,LT~-I 0~= F~~IEISYLV,~Nif-; ti ,,F Noiarial Spa! ~~~~ ~~ _ Lacy ~. ,.lay, Notary 6'u~iic N~TAIZ~ PYUB~IC ~am~a Hifi i3o,c~, C~~mt~~rlard (;C,unty My Corr~r~ission ~xpir~s Feb.1~, 2010 Member, PennS~/ivania !~sscciatior o~ ~lotaries ` ~~d i ~~~ ~i '~ Page 8 of 9 iN~ ~+ }~~ j yy`~ ~CC~,hy ~} ~ Y -,, A ~~? {~ J' ~~ ~~ 1 r LAST WILL AND TESTAMENT OF LOIS J. SUMMERS AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ~~ d~ ~...-~ ~ ~,.~- ~ c.~a ~ - and ~~~ ~~~~ i~ ~~~~~ ~~a ~~`~ ~ _ ~ r~ , the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it a:~ her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnessed and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~,,,,_ {jjJ ~ ~ ~t ~''- ~~ i .J `; , , ~ .~ ~'4 i Sworn or affirmed and subscribed before me b ~~--~ ~ ~ ~ ~' ~ ~`' _ r - and _ '~ -~..-~''~~. ~~~ ~~J ~'~~i ~`r_"fir' this e ~ ~'` day of ~~3~~ ~,.~~~'~'~~~~~ - ~ 2006. t )~ ; " N~JVEALTH OF PENNSYLVA ~~ Notarial Seal ~` ~ ~-- ~- Lacy Jay, N ubllc ~ °°~~.~' Cam~H;1i ,:;~,h~;rln,-l~CUrlty s ~ - I,~y rr~~~:. t . , ~~ - _ . ,._ -. ~}~~~~; NOTA~R~' PI~BLIC-~'' ~~.,~' ii~iar, Pernsy;E~~~nia ~issocia.~ ~'t~oi i~ictaries `O~ COiVIMONWEALTH OF PENNSYLVANIA `'~` Page 9 of 9 Notarial Seal Lacy A. Jay, Notary Public Camp Hill Boro, Cumberland County I~iy Commis3ion Exlaires Peb.17, 2t~~0 Nfemb2r, Pennsylvania Association of f~Jotaric-s t~ { 'ter - ~ .._:. _ ...... .~ _,. _ --:~,_ r~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: STOUFER JOAN L 2020 KENSINGTON STREET HARRISBURG, PA 17104 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 13EV-1162 EX(11-96) NO. CD 013179 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: 162-22-5792 FILE NUMBER: 2110-0531 DECEDENT NAME: SUMMERS LOTS J DATE OF PAYMENT: 08/ 10/2010 POSTMARK DATE: 08/ 1 0/2010 COUNTY: CUMBERLAND DATE OF DEATH: 05/ 1 2/2010 REMARKS: 10 ~ $6!5,000.00 TOTAL AMOUNT PAID: 565,000.00 CHECK# 1023 INITIALS: SAP SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER Q,.A`µ~~'Ojryo OMB Approval No. 2502-0265 ~~~~ *= A. Settlement Statement (HUD-1) ~ Q G AB C1 RN OEJ C~. . Type of Loan 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: ^ FHA 2. ~ RHS 3. ~X Conv. Unins. CHAPLIN 0307475293 VA 5. Q Conv. Ins. ,. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)"were paid outside the closing; they are shown here for informational purposes and are not included in the totals. ). Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: EFFREY J. CHAPLIN and JOAN L. STOUFER, Executrix of WELLS FARGO BANK, N.A. ENNIFER R. CHAPLIN ESTATE OF LOTS J. SUMMERS 6155 ROCKSIDE ROAD, SUITE 115 812 PINE STREET INDEPENDENCE, OH 44131 ;AMP HILL, PA 17011 ;. Property Location: H. Settlement Agent: 23-2402316 I. Settlement Date: Q2 TERRACE DRIVE PURITY ABSTRACT COMPANY JEW CUMBERLAND, PA 17070 3329 MARKET STREET September 24, 2010 ;UMBERLAND County, Pennsylvania CAMP HILL PA 17011 Ph. (717)737-8359 Place of Settlement: 3329 MARKET STREET CAMP HILL PA 17011 Summary of Borrower's transaction K. Summary of Seller's transaction )0. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller: )1. Contract sales rice 73,850.00 401. Contract sales rice 73,850.00 )2. Personal roe 402. Personal ro e )3. Settlement Char es to Borrower Line 1400 5,329.60 403. )4. 404. )5. 405. d'ustments for items aid b Seller in advance Ad'ustments for items aid b Seller in advance )6. COUNTY/TOWNSHIP 09/24/10 to 01/01/11 137.46 406. COUNTYrT'OWNSHIP 09/24/10 to 01/01!11 137.46 )7. CITY TAX to 407. CITY TAX to )8. SCHOOL TAX 09/24/10 to 07/01 /11 606.35 408. SCHOOL TAX 09/24/10 to 07/01 /11 606.35 )9. 3RD QTR TRASH 09/24/10 to 10/01/10 2.94 409. 3RD QTR TRASH 09/24/10 to 10/01/10 2.94 10. 410. 11. 411. 12. 412. 20. Gross Amount Due from Borrower 79,926.35 420. Gross Amount Due to Seller 74,596.75 )0. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller: )1. De osit or earnest m e 5,000.00 501. Excess de osit see instructions )2. Princi al amount of new loans 55,387.50 502. Settlement char es to Seller Line 1400 927.96 )3. Existing loan(s) taken subject to 503. Existin loans taken sub~ect to )4. LENDER CREDIT 135.00 504. Payoff First Mortgage )5. 505. Pa off Second Mort a e )6. 506. )7. 507. De osit disb. as roceeds )g. 508. _ )g. 509. d'ustments for items un aid b Seller Ad'ustments for items un aid b Seller 10. COUNTYlTOWNSHIP to 510. COUNTY/TOWNSHIP to 11. CITY TAX to 511. CITY TAX to 12. SCHOOL TAX to 512. SCHOOL TAX to 13. 513. 14. 514. 15. 515. 16. 516. 17. 517. 18. 518. 19. 519. 20. Total Paid b /for Borrower 60,522.50 520. Total Reduction Amount Due Seller 927.96 00. Cash at Settlement fromlto Borrower 600. Cash at settlement to/from Seller 31. Gross amount due from Borrower line 120 79,926.35 601. Gross amount due to Seller line 420 74,596,75 D2. Less amount paid by/for Borrower (line 220) ( 60,522.50) 602. Less reductions due Seller (line 520) ( 927.96) 03. Cash ~ From ~ To Borrower 19,403.85 603. Cash XO To ~ From Seller 73,668.79 The undersigned hereby acknpw~~dge receipt of a completed copy of this statement & any attachments referred to herein Borrower %~ ,~~! ,;, ~ ~ Seller L. TOUFER, Executrix of ESTATE OF LOIS J. JEFF J CH LIN / S JE FER R. APLIN ~e Public Reporting Burden for this collection of information is estimated at 35 minutes per response for wlleding, reviewing, and reporting the data. This agency may not tolled this information, and you are not required to ~mplete this form, unless it displays a anently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information gyring the settlement process. Page 1 of 3 HUD-1 (CHAPLIN.PFD/CHAPLIN/26) . Settlement Charges 10. Total Real Estate Broker Fees $ 2,215.50 Paid From Paid From Division of commission (line 700) as follows: Bonowers Seller's )1 . $ t0 Funds at Funds at )2. 2 215.50 to CENTURY 21 PISCIONERI REALTY INC Semement settlement )3. Commission aid at settlement 2 215.50 )4. )5. DEED PREP to WION ZULLI & SEIBERT 125.00 )1. Our on ination char e $ 495.00 (from GFE #1) )2. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2) )3. Your adjusted origination charges from GFE #A 495.00 )4. A sisal fee to RELS from GFE #3 POC $445.00 135.00 )5. Credit Re ort to RELS from GFE #3 14.84 )6. Tax service to (from GFE #3) )7. Flood certification to (from GFE #3) )g (from GFE #3) )g (from GFE #3) 10. (from GFE #3) 11 (from GFE #3) ~v. lacllla r~cyu~~cu u a.c~iuc, ~ )1. Daily interest charges from 09/24/10 to 10/01/10 7 @ $7.780000/day (from GFE #10) 54.46 _ )2. Mort a e insurance remium for months to from GFE #3 )3. Homeowner's insurance for 1.0 ears to ACCORD INS. COMPANY from GFE #11 POC $209.00 )4 from GFE #11 )5 (from GFE #11) ~uv. r~cacl vca vcNw~aou .. )01. Initial deposit for your escrow account (from GFE #9) 374.06 )02. omeowners tnsurance .000 mont s 7.42 per month 52.26 ..,,. )03. Mort a e insurance months $ er month $ X04. Property taxes $ COUNTY TAX months @ $ per month CITY TAX months @ $ per month SCHOOL TAX months @ $ per month 005. $ CitylTown Taxes months @ $ per month Assessments months @ $ per month 006. months @ $ per month $ 007. COUNTYlfWP TAX 8.000 months @ $ 41.39 per month $ 331.12 008. SCHOOL TAX 4.000 months @ $ 65.87 per month $ 263.48 009. AGGREGATE ADJUSTMENT $ -272.80 Ivv. ~~uc v~~a~ ca 101. Title services and lender's title insurance (from GFE #4) P.10-183 911.75 102. Settlement or closin fee $ BASIC - 103. Owner's title insurance to FIRST AMERICAN TITLE INS. CO. from GFE #6 108.00 104. Lender's title insurance to FIRST AMERICAN TITLE INS. CO. $ 744.75 105. Lender's title olic limit $ 55,387.50 107093513PAL . 106. Owner's title olic limit $ 73,850.00 106926995PA0 107. A ent's ortion of the total title insurance remium to PURITY ABSTRACT COMPANY $ 724.84 108. Underwriter's portion of the total title insurance remium to FIRST AMERICAN TITLE INS. CO. $ 127.91 109. Notary Fee Notary Clerk 110. Overnight Fee/payoff 111. TAX CERT FEE to PURITY ABSTRACT COMPANY 10.00 112. 113. _ 201. Government recordin char es to RECORDER OF DEEDS from GFE #7 159.00 .,. ,... . 202. Deed $ 63.00 Mortgage $ 96.00 Releases $ Other $ 203. Transfer taxes to RECORDER OF DEEDS (from GFE #8) 738.50 1204. City/County tax/stamps $ 738.50 $ 738.50 1205. State tax/stam s $ 738.50 $ 1206. RECORDER OF DEEDS rim IJUU. FiUUlallJlldl JClalclllcila a+~~a~ ca 1301. Re wired services that ou can sho for from GFE #6 119.00 .. .... 1302. TAX SERVICE FEE to WELLS FARGO RETS $ 100.00 1303. FLOOD CERT LOL to WELLS FARGO FLOOD SERVICES $ 19.00 1304. 3rd QTR SEWER to NEW CUMBERLAND BOROUGH 4.49 54.46 1305. ~dnn Tatar Caftrpmonf Chases (enter on lines 103. Section J and 502, Section K) _ 5,329.60 927.96 By signing page 1 of this statement, the signatories acknowledge receipt of a completed wpy of page 2 8 3 of this three page tale nt ,. PURITY A ACT COMPANY, Settlement Agent Certified to be a true copy. Page 2 of 3 HUD-1 (CHAPLIN. PFD/CHAPLIN/26) omparison of Good Faith Estimate (GFE) and HUD-1 Charges Good Faith Estimate HUD-1 harges That Cannot Increase HUD-1 Line Number ur origination charge # 801 495.00 495.00 wr credit or charge (points) for the specific interest rate chosen # 802 cur adjusted origination charges # 803 495.00 495.00 ~ansfer taxes #1203 738.50 738.50 harges That in Total Cannot Increase More than 10°/, Good Faith Estimate HUD-1 overnment recording charges #1201 160.00 159.00 ~praisal fee # 804 580.00 135.00 redit report # 805 14.84 14.84 wner's title insurance to FIRST AMERICAN TITLE INS. CO. #1103 108.00 Total 754.84 I 416.84 Increase between GFE and HUD-1 Charges $ -338.00 or -44.78°/ harges That Can Change Good Faith Estimate HUD-1 itial deposit for your escrow account #1001 1,695.00 374.06 aily interest charges # 901 $ 7.780000/day 15.56 54.46 omeowner's insurance # 903 600.00 tle services and lender's title insurance #1101 853.87 911.75 4X SERVICE FEE #1302 100.00 100.00 LOOD CERT LOL #1303 _ 19.00 19.00 pan Terms our initial loan amount is $ 55,387.50 our loan term is 30 years our initial interest rate is 5.1250 our initial monthly amount owed for principal, interest and $ 301.58 includes ny mortgage insurance is Q Principal Interest ^ Mortgage Insurance an your interest rate rise? ^X No ^ Yes, it can rise to a maximum of %. The first change will be on and can change again every _ months after . Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. ven if you make payments on time, can your loan balance riser ^X No ^ Yes, it can rise to a maximum of $ :ven if you make payments on time, can your monthly ^X No ^ Yes, the first increase can be on _ and the monthly mount owed for principal, interest, and mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ )oes your loan have a prepayment penalty? ^X No ^ Yes, your maximum prepayment penalty is $ )oes your loan have a balloon payment? ^X No ^ Yes, you have a balloon payment of $ due in _ years on 'otal monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ^X You have an additional monthly escrow payment of $124.68 that results in a total initial monthly amount owed of $426.26. This includes principal, interest, any mortgage insurance and any items checked below: ^X Property taxes ^X Homeowner's insurance ^ Flood insurance ^ ^ ^ tote: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Page 3 of 3 HUD-1 (CHAPLIN.PFD/CHAPLIN/26) HUD-1 Attachment Borrower(s): JEFFREY J. CHAPLIN and JENNIFER R. Seller(s): JOAN L. STOUFER, Executrix of CHAPLIN ESTATE OF LOIS J. SUMMERS 1812 PINE STREET CAMP HILL, PA 17011 [.ender: WELLS FARGO BANK, N.A. Settlement Agent: PURITY ABSTRACT COMPANY (717)737-8359 Place of Settlement: 3329 MARKET STREET CAMP HILL PA 17011 Settlement Date: September 24, 2010 Property Location: 522 TERRACE DRIVE NEW CUMBERLAND, PA 17070 CUMBERLAND County, Pennsylvania Additional Adjustments For Items Paid By Seller In Advance (Borrower Debit) Description Amount FromlThrough Prorated Amount 3RD QTR TRASH 38.60 07/01/10 through 09/30/10 2.94 Total Line 109/409 2.94 Adjusted Origination Charge Details Origination Charge ORIGINATION FEE 495.00 to WELLS FARGO BANK, N.A. Total $ 495.00 Origination CrediUCharge (points) for the specific interest rate chosen Total $ Adjusted Origination Charges $ 495.00 Reserves Deposited with Lender Homeowner's Insurance 52.26 3.000 at 17.42 per month 331 12 COUNTY/TWP TAX . 8.000 at 41.39 per month 48 263 SCHOOL TAX . 4.000 at 65.87 per month AGGREGATE ADJUSTMENT -272.80 at per month Total $ 374.06 Title Services and Lender's Title Insurance Details BORROWER SELLER CPL to First American Title In 75.00 to First American Title Insurance Company Email Document Retrieval 50.00 to PURITY ABSTRACT COMPANY Notary Fee 30.00 to Notary Clerk Overnight Fee/Package 12.00 to PURITY ABSTRACT COMPANY Lender's title insurance 744.75 to FIRST AMERICAN TITLE INS. CO. WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (CHAPLIN.PFD/CHAPLIN/26) HUD-1 Attachment - Continued Total $ 911.75 $ 0.00 Owner's Title Insurance BORROWER SELLER Owner's Policy Premium 108.00 to FIRST AMERICAN TITLE INS. CO. Total $ 108.00 $ 0.00 Lender's Title Insurance BORROWER SELLER 'fees also shown above in Title Services and Lender's Title Insurance Details Lender's Policy Premium 594.75 to FIRST AMERICAN TITLE INS. CO. Lender's Endorsement Charges 150.00 Endorsement Endorsement Charge END 100 50.00 END 300 50.00 END 900 50.00 Total $ 744.75 $ 0.00 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (CHAPLIN.PFDlCHAPLIN/26) ~ ~, ~~. Towle ~ .~ .. ~ _ ,. . Y -~ PLANNING i INVESTMENTS ~ COUNSEL 600 J Eden Road, Suite 4, Lancaster, PA 17601 Phone 717-509-6060 ~ Fax 717-509-6464 ! www.rowleyfiinancial.net ~- June 17, 2010 Shelly J. Kunkel Wion Zulli & Seibert 109 Locust St. Harrisburg, PA 17101 RE: Estate of Lois J. Summers Date of Death: 05/12/2010 Dear Shelly, Attached is the information requested for the Estate of Lois J. Summers. We established and completed the transfer of assets from her individual account #SHT082542 to the Estate account #SHT156338. There were no automatic deposits or loans to the individual account. I would like to schedule a meeting with Joan and you to discuss the holdings in the estate account. The individual account, directed by Lois, was managed for income with growth as the secondary objective. It may be necessary to reallocate of some of the holdings for the estate account. I will ask Gail to schedule a convenient time to meet with you and Joan. Thank you and I look forward to our next meeting. Sincerely, Wendy H. owley, CFP® Financial Advisor CC Joan Stoufer Enclosure INVEST Financial Corporation (INVEST), member FINRA, SIF'C, a Registered Broker Dealer and Registered Investment Adviser, is not affiliated with Rowley Financial. Securities, advisory services and certain insurance products are offered through INVEST and affiliated insurance agencies. ..~ N ~ N N r O ~' *_„ ~ ~ ' O ~ o ~ ~ Q t... .~ ~ f~ ~ ~ O O O O O 00 C'7 00 ~ M~~ O O O ~ r *- N C'7 ~ d' N C7 O ~ In CO N C~ ~ N d' O N CO N O ~}' CO O r ~ CO O O r ~ C7 ~ N O C'~ ~-- Q ~ N N N~ N~ O~ M O r Q ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ,n c~ ~ ~ ~n ~ ~ ~n oo ao 00 I~ ~ ~ C7 f~ O 00 C'~ N N a ~N~~~~~~~~~ ,- N C'7 I.n ,- r 01 N O O O C CO N ~t O 00 00 O O O N N Z d- ~ t.c) N C~ d' O O ti ~ ~ r N N r- N C'7 Y/ T ~7 v7 vMT /~~7 M~ vTT7 ~7 /~~ vTTT D7 W W W VJ W VJ ~ VJ V/ 0 0 0 0 0 0 0 0 0 ~ 0 0 0 0 0 0 0 0 0 0 ,F,, N N N N N N N N N O ~ O I~ O C'7 O O O r C7 ' i= Q C'7 N N r N r r r N (~ ~ Cp CO d' r- CO O O O T T O O O O O O O O O i.~} CO O O O O O O O O V 00 0 0 0 0 0 0 O O CD =/~ O O O O O~ O O N O C CO O O O O N~ O C7 ~ ~ O t0 N C~ 00 f` ~ N N N r N C ~ ~ O ~ U ~ ~ U ~ Q ~ N cn c c c o I- I- i- F- I- Q c~ o 0 0 ~----- Ummma.~~>>~ N O T (` .- N CO CO = X LL.. d' ~ ~t O i~ I~ O Q, c~ N N W co .- cn -~ r~ ~ •- oC o o pC X Q o0 m o0 E ~ ~ ~ ~ ~ m ~ ~ ~ ~ ~ cn~ MMm ~~~~~ r r- (p O O O O O M O (~ O O O O O 0 o ~_~ o r o ~~ O c.~ O :.; .. ~ ~. `T ,,.... v7 .i ~ O O O O O CAD ~ ~ 0 0 C 0 O ~~ M T C'0 r T .~. O ~ N ~ I,(') ap C ~ ~ N ^ +~ .O ~ O O N Q O ~ _N (~ ~ ~ E (~ '~ 1 C) ~ . ~ X ~ ~ ~ 7 ~~~ UW W cn p C O ~ ~O X N 0 ~° c~ N ~ C~ CD ~ ~' ' c 7 0 0 r` ~ ~ ~ ~ O ~ N N ~ ~j C~ N ti 0 0 C'7 (~ Q 'a= 'a= N a~ 0 0~ ti U ,.r Q O O (~0~~ C\T ~ Q a~ O O 'O .~ U 'C ~ +r r~~ N (n C O O ~ ~ ~ Cn .i ~ In C U ~ N '- ~ *r C N N 00 0~~~ EE 00 ~= (q ~ O O ~ ~ ~ ~ - ~ - _ ~ O O~ W ~ RS ~ C C o cn cn o = QU ~ ~ ~ ~ ~ ~ U ~ X i _~ ~ ~ o a Q Q o_ ~ ~ c~ ~- U m a~ a~ a~ ~ ~ ~- U Q > > > ~ ~ cts ~~ U a o c~ ~ ~ o cn . ~~ ~ U~~ o oQUZWa.. ~ ~ o~~ -~ w ~ ~ ~ ~ ~ ~ ZZ ~ ~_ ~ `~ o c~~rncornrn RS c~ c~ ~ LL a0 00 N N N ~ p j O N O O (n C'7 C'7 d' ~t d' U U C a~ N N o oppppp ~L N WIl.WC'3~000QQ UUZ ~. ~ e erns lvania p Y DEPARTMENT OF REVENUE April 12, 2011 Joseph J. Dixon, Esquire 126 State Street ~ ~ ' Harrisburg, PA 17101 Re: Estate of Lois Summers File Number 2110-0531 Dear Mr, Dixon: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. ~It has . ~ ~ ~: ,.. . _ ,. .been forwarded to this Bureau for the Commonwealtl}'s approval` of the allocation ~:f the proceeds: paid to ~ .. < < ~ .~ ,~, .. .settle the actions, ' . , ~ ~ , ~ ~. ` ~ .. , ,~ ~ ~ , ~ ~ ~. ~... .r! •~ • ~ .. Pursuant to the Petition, the 82 year old decedent died as a result of a motor'vehicle accident, - ~.~... ~ ; ~.,• , Decedent is not survived by any individuals eligible .to make a claim under the Wrongful death action.•..~ ~ ~ . ~ ~• , ., ., ~ '..;i '' ~~ : Please be advisedthat, based •updn these facts and for inheritance tax purposes only, •this ~ ~ ... ' •~ , . .:.: ~~; ~,•. . Department has no objection to the proposed allocation of the gross proceeds,of this action; t?he~full~sutri ~ ~ ,~: ~~, ~.. •. to the survival claim:., Proceeds of a survival action~are an asset included in the decedent's estate and 'are ~ ' ` , .. .. ' ` ' subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C:S.A. §8302; 72 P:S. §910ti, !107. ~ ~ ~ • • Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Me an, 669 A.2d 1059 (Pa. Cmwlth. 1995). ,. I trust that this letter is a sufficient representation of the Department's position on this matter.. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please- contact me if you or the Court has` any questions or requires anything additional from this Bureau. ~' cerely, ~ .. '~ . annon E. Baker Trust Valuation Specialist . Inheritance Tax Division _ , .` , . .. ` ~ ,~ , .f ,.. ... ,...,.. ......,,. .......,i.., ., ....a. ,,...+..; ~... .. ...... .. ...... .. .w,,. .........,. , .. ........... Bureau of Individual Taxes ~ PO Box 280601 ~ Harrisburg, PA 17128 ~ 717.783.5824 ~. shabaker@;state.pa.us -- ~~~~1/213~^ fJ1:'~'~ ?176521045 LORIRENfi~LDIWF~C~r~R P~aGE Et2f ~t4 ~ENER~AL ~El.EASE Far the consideration of CLAIM ~• 01Q17107374.7 LRW Three Hundred Tho+~sand Dollars 00/1 Ob --- -------- dorlar$ ($ 300.oOO.00 _ ~, receipt of which is hereby acknowledged, Ilwe release and dischargge, and for myself/ourselves and for my/our heirs, representatives, executors, administrators, successors and assigns, do hereby remise, release and forever discharge Janet M. Lehr hereinafter referred to as the releaseefs}, his/her(theirlitS heirs, executors, administrators, insurers, $ucc:essars and assigns, and any and ail other persons, frrmS, corporations, associations, of and from arty and all causes of action, suits, rights, judgments, claims and demands of whatsoever kind, in law or in equity, known d unknown, which Ilwe nr~w have ar may hereafter have, especially th claimed legal liability of refeasee(s~ arising from or by reason of any and all ofore haslhave been rorrrwhicha Id~oeafferoFinay beasusgtainedoby me/usrarisiroi9 outoc~f thin and unforeseen which here[ accident on off" about .]anua 1$th 2Q1 Q - ' -TEAR at or near Hanover -~-- in the county trf Yortc which liability releasee(s) expressly deny{ies). in the State pf Penns Ivania l1We a ree that the consideration set forth above is specifically appli able to and paid to menus vvith respect to any end all damage to any property, either real or personal, of mine~aurs and with respect to any and all personal or bodily injury of mine/ours, whether presently known ar unknown, fore$een or unforeseen or which may subsequently develop and the consequences thereof, all as arising out of the aforementioned accident. IIWe further agree that the consid ration set forth above is specific:al y app icable tq and paid to rite/us with respect to any right of contribution that l~we may have against the releasee~s), hrs~her/theirlit$ heirs, eXe~utars, administrators, insurers, successors and assigns relative to claims of others that may be brought against me us by reason of said accident. I11Ne further agree that the consideration se oral; a'oeve i^ s ccifcally applicable. to mylaur agreement thet (/we will not join nor attempt to join the releas4e~s~, his/herltheir~ts heirs, a~cecutors, admrnistrators, insurers, successors and assigns in any capacity, in any action that may be brought against melr~s arising oUt of said accident. 11We yyvvarrant for myself~ourselves and mylour heir, representatives, executors, administrators, successors and assigns that Ilwe have reserved no money ar other valuable consideration from any other person or persons by realQn of any causes of action, suits, covenants, agreement ,judgments, claims and demands Qf whatsoever krnd, -which Ilwe now have or may hereafter have,. for injuries to rrty~our person er property or for the other matters fpr which this release is given. I1W~ further understand and agree that this Release is inclusive of any and al( present and future liens or cla"ms far subrogation against the payments to be made in accordance with this Release. I we understand and agree that I>1we are responsible for the payment Qf any liens or charges against the pa mgrtt$ to be mode hereunder shourd any such liens, subrogation, claims or claims fvr exp n es and charges be asserte~. I tiffs includes, but is not limited to, nned~icel expense liens, workers com ensetion liens, ~I~I Aliens, liens asserted by any federal, stele or local govemttiental entity or agency or a med~cal expense claim. ~hould any person or entity make claim for ayment of eny liens car c4~arges against The IE or their counsel, Ilwe agree to indemnify and hold harmless The ERI~ and their counsel from any and aiT suGi7 liens, Charges, fees, claims, attornYy fees, casts, interests and any other sum. 1111Ue understand that this settlement is the compromise of a disputed claim, and that the payment is not to be Construed as an admission of liability on the part of the persons, firms and corporations hereby released by wham liability is expressly denied. `'I intending to be legally bound thereby, WITNESS my/our hands} and seal(s) this `- - day of Gjl WITNESS ///'/, ' /,,/J~/j .... 1 ~- ... w ~ x C-41A (R)121Q4 Kerry J. Ritchey, CPCU, AIC S' Assistant ice President & Claims Manager Erie ~~.. ! nsu rance ~• Branch Office• • 4901 Louise Drive Rossmoyne Business Center P.O. Box 2013 Mechanicsburg, PA 17055-0710 717.795.8200 Toll Free 1.800.382.1304 Fax 717.795.2315 www.erieinsurance.com February 11, 2011 Joseph J. Dixon,~E'squire ~~126 State Street Harrisburg PA 17101 -1026 Re: ERIE Claim # 017-010171()73747 ERIE Insured: Janet M. Lohr Loss Date: 01/18/10 Your Client: Lois Summer Dear Mr Dixon Enclosed, please find our check in the amount of $300,000.00 made payable to Estate Of Lois J Summer & Joseph J.Dixon, Esq. in. settlement of the above loss . A copy of this letter is being sent to your client pursuant: to 31 Pennsylvania Code Section 146.10. The letter is being sent: to your client at the address you provided us. We trust you will answer any questions your client has concerning the contents of this letter. _ Sincerely, Lori Renaldi-Wagar Liability Adjuster 877-835-1043 /LRW LITI9PA Enclosures: Check cc: Joan L. Stoufer File The ERIE is Above All in gERUICE° I _ JOSEPH J. DIXON ESQ 126 STATE ST ,,. HARRISBURG PA 17101-1026 Insurer: ERIE INSURANCE EXCHANGE Policy No.: Q01 1202589 Claim No.: 01 701 01 71 073747 Date of Loss: 01-18-2010 Check No.: 110430709 CMS No.: KD30709 Check Amt.: $300,000.00 For: PAYMENT OF BODILY INJURY LIABILITY FULL AND FINAL SETTLEMENT OF ALL CLAIMS Erie Insurance offers home, auto, business and life insurance. Cafl your local ERIE Agent to learn what is available in your area. Bank of America CustomerConneciion E~ 1 ~yg • 6! f N AUanta C)ekalb County, Georgia ERIE INSURANCE EXCHANGE ~~ ~ ci~ainn No.: 01 701 01 71 073747 CHECK NO.: 110430709 H E~ ome Office • 100 Erie {ns. PI. • Erie, PA 16530 ~:.<~: DATE OF LOSS: 01-18-201 O DATE ISSUED: 02-11-2011 ® ,. • Inns No.: KD30709 PAY THREE HUNDRED THOUSAND AND 00/)00 THE ESTATE OF LOTS J. SUMMER AND TO JOSEPH J. DIXON, HER ATTORNEY• oPEwaTO~a 732RITCHEY THE **** -- -- - - ------- -- ORDER JOSEPH J. DIXON, ESQ TAX ID NO. ****w***** OF 126 STATE ST ,~ ,~ ,~ ,~ ,~ , ` , ~' ~ , - FiARRISBURG, PA 17101-1026 _ - -- - - -- - PAYMENT OF i ~ ~~ ~~,,, ' ~ , ~t ~---~ , ~ ~ FOR BODILY INJURY LIABILITY FULLAND FINAL SET E ~ ~ (+ ENC Y ~ ~UTNORIZ_ED SIGNATURESecurity matarcs included. ~ TL MENT OF ALL CLAIMS \ J Derails on back. {{' L 1D~.30709n' ~:06 ~.1 ~ 2788: 3 Z99999~,9 211' ATTORNEY AT LAW 126 STATE STREET • HARRISBURG, PA 17101 PHONE: (717) 233-8757 • FAX: (717) 233-5860 EMAIL: dixonlaw~paonline.com www.jdixonlaw.com ,V SETTLEMENT SHEET OF ESTATE OF LOIS SUMMERS vs. JANET M. LOHR Date of Accident: January 18, 2010 Gross Check from Erie Insurance Company .................. ............ $ 300,000.00 Less Attorney Fee of Twenty-Five Per Cent ................................ $ '15,000.00 to Joseph J. Dixon, Esquire Less Expenses for Medical Records 03/18/10 Hanover Hospital $ 36.69 07/28/10 Record Reproduction Services 34.50 07/30/10 Record Reproduction Services 34.20 07/30/10 Star-Med 139.79 08/02/10 Star-Med 420.11 08/20/10 Nephrology Assoc. of Central PA 23.66 08/20/10 Star-Med 57.65 08/30/10 Healthport 68.02 09/09/10 Record Reproduction Services 92.87 09/14/10 Record Reproduction Services 92.87 09/21/10 State Street Copy - ~ ~ 421.38 09/22/10 State Street Copy _ 63.54 10/07/10 Star-Med ~ 184.49 10/07/10 Capital Delivery Systems 21.00 10/15/10 Healthport 91.41 10/15/10 Healthport 32.31 10/15/10 Family Practice Center 97.01 10/18/10 Healthport 103.34 10/21/10 ~ Capital Delivery Systems 21.00 TOTAL EXPENSES $ 2,035.84 ~~ -. <.. Total Amount Due to the Estate of Lois Summers ...... ..................... $ 222,964.16 I, Joan L. Stoufer, agree with the above settlement of the late Lois Summers insurance claim against Erie Insurance Company. I will receive tomorrow a check in the amount of Two Hundred and Twenty-Two Thousand, Nine Hundred and Sixty-Four Dollars and Sixteen Cents ($ 222,964.16), in settlement of the claim against Erie Insurance Company. Date: ~ .~,c.. ` ,~ Joan L. Stoufer II~IQRI~IIIRI~IIIII~~~~ Nationwide Insurance NATIONWIDE INSURANCE P O BOX 30000 RALEIGH NC 27656-1003 1-800-421-3535 0 r CV aD O CO ~ Policy Holder: L SUMMER5 Policy Number: T Contract Number: 0 0 Claim Key: 58 37 B 428557 0 i -18-10 01 Check Number: 58177563 Check Issued: 04-21-1 1 PAC Li"{ 1010 Below Check Covers Items Indicated ESTATELOF LO S J ND IS ~E NG PAID UNDERITHERUNDERINISURE MO ORESTSBODILY INJURY COVERAGE. IFYOU HAVE ANY QUESTIONS REGARDING YOUR CLAIM, PLEASE CONTACT YOUR CLAIMS REPRESENTATIVE. P o Box 30000 Check No: 5817563 74-1292 RALEIGH NC 27656-1003 Nationwided Date: 04-21-1 1 724 1 -800-421 -3535 Insurance Vold If Not Cashed Within 1s0 C)ay;s Ref: 58 37 B 42E'557 1]1 -18-10 01 58177563 Detach Stub Before Cashing And Keep For Your Record ,. , NATIONWIDE INSURANCE PAY **SEVENTY FIVE THOUSAND AND 00/100 DOLLARS*************************************~'~~************************** EXACTLY; Pay To The Order Of _; i,'':;`~. JPMORGAN CHASE BANK, N.A. -, c `r;, ., COLUMBUS, OH JOAN L STOUFER, ADMINISTRATIX OF THE STATE OF LOTS J. SUMMERS, AND HER ATTORNEY, JOSEPH J DIXON ESQUIRE HARRISBURG PA 17101 E $%;75, 000.00%: This is. full payment unless otherwise indicated on stub, s~ ,~ Authorized Signature ~I'S8L77563ii' ~:0724L2927~: OOL05846~~' ATTORNEY AT LAW 126 STATE STREET ®HARRISBURG, PA 17101 PHONE: (717) 233-8757 ~ FAX: (717) 233-5860 EMAIL: dixonlawa~paonline.com www.jdixonlaw.corn SETTLEMENT SHEET OF ESTATE OF LOIS SUMMERS vs. JANET M. LOHR U1o1DERINSURED BENEFITS Date of Accident: January 18, 2010 Gross Check from Nationwide Insurance Company ............... ............ $ '75,,000.00 Less Attorney Fee of Twenty-Five Per Cent ................................... ~ 18,750.00 to Joseph J. Dixon, Esquire Total Amount Due to the Estate of Lois Summers ...... ..................... $ .56,250.00 I, Joan L. Stoufer, agree with the above settlement of the late Lois Summers underinsured insurance claim against Nationwide Insurance Company. I will receive a check in the amount of Fifty- Six Thousand, Two Hundred and Fifty Dollars ($ 56,250.00), in settlement of the underinsured claim against Nationwide Insurance Company. ' I L Date: ' ..~ ~, r' r-~ , _~ \ . ~ ., ~ ~ ~ Joan L. Stoufer u~+i ~u7 LV_i i -~ u : iy r xx r ~ «;~~~sbo od C~ 003%004 '~'bte Estate of Lois J. Summers, IN THT COURT Off' COMMON 1.'IJEAS CU1V~E~,AND CpTJI~1TX, ~ENNS"S~L~ANIA NO. 1 ~ ~~~ C' ~' ,~, . - ~ t ern ,~ CIVII., ACTION - O ANA NOV'V, this _ day of 2011, upon consideration of the ]Petition to Settle Wrongful Death and Survival Claims Under 42 Pa. C.S.A. § 2206, it is hereby ordered and decxeed as follows: A gross settlement of wrongful death and survival claims in the amount of Threo ~Iundred aizd Seventy-Five Thousand Dollars ($375,000.00) is approved. 2. Attorney's fees for representation to Joseph r. Dixon, Esquire, in the amount of Ninety-T11ree Thousand,~Seven Hundred and Fifty Dollars ($93,750.00) is approved. 3, Reimbursement of costs to Joseph J. Dixon, Esquire, in the amount of Two Thousand and Thirty-Five Do11azs and Eighty-Four Cents ($2,035.84) is approved. 4. The estate of Lois J. Summers sha11 net from tl~e fiwo motor vehicle death claims, Two hundred and 5 eventy-Nine Thousand, Two ~Tundred and fourteen Dollars and Sixteen Cents ($279,214.16). ~. All proceeds ft'om the settlement should be considered survival daznage:s. v~7 zv~ cv i i ~.-c~ rn~ t I f L~3~35i3bV _ i ~a I~j 004/004 6. Any potential interest of Medicare in this claim is protected by the excess medical . bills policy in effect from Nationwide Ynsurance Company. B'S~ THE CaLrRT: TRlJE COp1r RRCIM RECQRD In ~timony whe~eo~, ~ hmr~ ~ncc-..e my h~ «~a ti,..sa~ ar ~~ coon m c.N~aa. ~ Q M&TSark 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Wion, Zulli & Seibert Shelly J Kunkel 109 Locust Street Harrisburg, PA 17101 Phone (888)502-4349 Fax (302)934-2955 May 21, 2010 Re: Estate of: Lois J Summers Social Security: 162-22-5792 Date of Death: May 12, 2010 Dear Sir or Madam: Per.your inquiry, 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, fl Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names oj~ Opening Date Checking Account 80269958 Lois J Summers 07/28/82 closed 0520/10 $ 4963.11 $ 0.03 ................................................................................................................................................... $ 4963.14 Savings Account 15004213062075 Lois J Summers 10/04/06 closed 0520/10 Balance on Date of Death $ 45924.33 Accrued Interest $ O.SI _ .... Total --._ .............. _........ __ ....._... __ __ _............ _ . $ 45924.84 __ ........ . Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Highland branch. Call# 717-737-3322 Sincerely, ~,{~/'~ l~T, ~.~ f t~. ~ _. - ~' Norissa Sears ' Adjustment Services 'METRO BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 May 30, 2010 Wion, Zulli & Seibert Attn: Shelly Kunkel PO Box 1121 Harrisburg PA 17108 RE: Estate of: Lois J. Summers Tax Identification Number: 162-22-5792 Date of Death: May 12, 2010 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 513207282 Date Opened: 09/12/2000 Date Closed: 05/21/2010 Primary Owner: Lois J. Summers Date of Death Balance: $31951.53 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, "`ry m~ >r Diana Reynolds '~~ °'',~~~ Metro Bank Research Associate/Deposit Services JUN 0 3 ~~) !~ R I e.~ 3 ~~ , IoW e .~ - ~ , k r _~ . _~_ PLANNING ;INVESTMENTS .COUNSEL June 17, 2010 Shelly J. Kunkel Wion Zulli & Seibert 109 Locust St. Harrisburg, PA 17101 RE: Estate of Lois J. Summers Date of Death: 05/12/2010 Dear Shelly, x.~ Attached is the information requested for the Estate of Lois J. Summers. We established and completed the transfer of assets from her individual account #SHT082542 to the Estate account #SHT156338. There were no automatic deposits or loans to the individual account. I would like to schedule a meeting with Joan and you to discuss the holdings in the estate account. The individual account, directed by Lois, was managed for income with ;growth as the secondary objective. It may be necessary to reallocate of some of the holdings for the estate account. I will ask Gail to schedule a convenient time to meet with you and Joan. Thank you and I look forward to our next meeting. Sincerely, Wendy H. owley, CFP® Financial Advisor CC Joan Stoufer Enclosure 600 J Eden Road, Suite 4, Lancaster, PA 17601 Phone 717-509-6060 i Fax 717-509-6464 i www.rowleyfiriancial.net INVEST Financial Corporation (INVEST), member FINRA, SIPC, a Registered Broker Dealer and Registered Investment Adviser, is not affiliated with Rowley Financial. Securities, advisory services and certain insurance products are offered through INVEST and affiliated insurance agencies. .; ..~ N ~ N N T H ' _~.. ~ ~ ' O o 4 .~ J ~ f~ ~ t.f) O O O O O 00 M 00 ~ CO f~ f~ O O O Ln T T N M ~ N M O~ t.C) CO N M O N ~ Cfl O O T f~ M~ N O~ T Q ~h Ln ~ N t~ CO O O ~ ~ 0 T N N T N M Q f!-~fF?f!?ff?f!}ff}(~}H3H?HTEfl ~'' (~ ~ CD ~ d' t.C) f~ d' In 00 CO op I~ ~~ M f~ O o0 M N N Q ~ N ~ d' 00 00 O CO 00 O m ~. *- N M~ T T O N O d7 O ~ Cfl N ~i' O CO CO O O O N N Z ~' ~ t~ N CO et O O ~ ~ y T N N T N M N T ~p `A ~p ~p vMJ ~./~~ M~ T~ ry~~ T~ /~~ /~~ /~~7 v7 v7 W W W VJ W V! /'!\ VJ iT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ,4; N N N N N N N N N ~ ~ O I O M O O O T C\7 '~ D M N N •- N T T T N \ \ \ ~ CO 00 d' T (p O O O ~ T T O O O O O O O O O I~ CO O O O O O O 0 0 "~ ~, ~ O O O O O O O O O O O O O O~ O O N O C CO O O O O N~ O M ~ O O O O M 00 f~ ~ N N N N Q N C Y ~ O ~ U ~ ~ U ~ Q ~ ~ ~ ~.~ ~ a~ Q cn c c c a~l_F_-1_-f_-I_- ~ O O O L U m m ro ~ ~» ~ ~ N O T f~ .-- N CO CO X LL ~ ~ d' O I~ f~ ~•~'~ooONC~XQmmm ~ ~ U Q Q c~ ~ ~ co ao 0o co ti ~n ~n c~ ~p co cfl cD co c~ ~ V M M O ~~~ (~ ti T T (p O O O O O M M M O O O O O O _ O ": O O w~~ O :.. p ._ , ~ r T ....._ Lp i~, _i O O O O O CEO yJ O O O O ~^ ~/? M .-. T ~"I O ~ N Ln pp _C ~ ~ N ~ O O Q'~ ~ a ~~ ~ ~~ ~ ~ ~ ~ X ~ t C) ~> C . ~ cli~~ UW W O p O N .~ ~ ~ , X • j f~ d' ~ ~ , O N ~ ~ N ~ 'C • Q ~ N ~ - CO M (~ ~ ~ ~ ° ° ~ ` cn +r I O r ~ ~ ~ O ~ ~ ~ U i i T"' ~ ~~ N (n C O O •~ a N ~ '- ~ ~ ~ O O ~ ~ N CO Cfl +-~ ~ ~ ~ ~ ~ L (n °i~ = O O ~ ~ U U C X 0 0 Q' W~ N~ C _ X o o .~ ~ a~ Q Q ~- ~~ U ~~c Q }' '`'' U Q > > > ~ ~ m a~i ~ N O ~ U U.~+.. o oQUza ~ _~~~ ~ Z Z W ~ ~ ~ ~ ~ ~ c~d-rncornrn ~ ~ ~ ~p a~i c m a~i a_°i ~ 0~~~~O ~~ m ~~~C'3~OO0QQ UUZ Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 - Bostor.~, MA 02284 August 16, 2010 Wion, Zulli & Seibert P.O. Box 1121 Harrisburg, PA 17108-1121 RE: Estate of Lois J. Summers Date of Death: 05/12/10 Dear Ms. Kunkel: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, ~C~,C~~.. ~~~~~ Helen Alboth Lead Specialist 617-533-1789 Sovereign Bank ESTATE OF Lois J. Summers SOCIAL SECURITY #: 162-22-5792 DATE OF DEATH: May 12, 2010 Account #: 0358000933 Type: IRA CD Open date: 1/;6/1982 In the name of: Lois J Summers Date of Death Balance: $14,174.30 Int.(YTD) from 1/1/2010 to 4/30/2010 $40.63 Accrued interest to date of death: $3.73 Other Info: Beneficiary: none named -reverts to the Estate of Lois J Summers Page 1 of 1 Bill of Sale On this ZSth day of October, 2010, in consideration of the sum of Ten Thousand One Hundred and Fifty Dollars ($10,150.00) duly received from Dave Rozman, hereinafter "Purchaser," I, Joan L. Stoufer, Executrix of the Estate of Lois J. Summers, hereby sell, assign, and transfer to Purchaser the following described property: 2009 Chevrolet Cobalt LS Sedan bearing VIN # 1G1ASS8H997216853 Buyer: Seller; Estate of Lois J. Summers Dave Ro an an L. Stoufer, Exe utnx 702 North 3rd Street Steelton, PA 17113 c/o Wion Zulli & Seibert 109 Locust Street Harrisburg, PA 17101 n ~r~ KAYNE Ali~~~~D11 ~OIY1~9~.Il~ Estate of Lois Su~~e~°s Auction total gross $126~~.50 Auction Expenses Layne ALiCtlon Company 35% sale of personal property $442.:92 AL~.Ctl®n ~'otal net 'hank you for using Mayne Auction Company dept 19, 2010 ~~22.:5~ Also we found these papers in a lock box we sold, so we're forvvardirig them to you