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HomeMy WebLinkAbout05-09-11 (2) 1505610140 REV-1500 EX (°'_'°' PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 8 8 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date Of Blrth MMDDYYYY 5 2 8 6 4 7 5 9 2 0 8 1 4 2 0 1 0 0 2 2 8 1 9 5 3 Decedent's Last Name Suffix Decedent's First Name MI D Y K S T R A A N N M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI C R I B B I N S P A U L S Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number B E N J A M I N J B U T L E R 7 1 7 2 3 6 1 4 8 5 First line of address 5 0 0 N T H I R D Second line of address P O B O X 1 0 0 4 City or Post Office H A R R I S B U R G State ZIP Code REGISTER OF WILLS USE ONLY ~~ _- "_ ~ - ~~ , ~. I. -. , - - ~~ PATE F`fL- D -°_-, ~' -z:~, :~ -r r ... -_; \.~J t _\..l Correspondent's a-mail address: LAWYERS(a,BUTLERLAWFIRM COM ~ ~ ~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIR(~4d Tl tRF nG ococnni ADDRESS 4110 CARRINGTON COURT WE ER THAN REPRESENTATIVE MECHANICSBURG PA 17050 DATE ~,~~ 500 N THIRD STREET, PO BOX 1004 HARRISBURG PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 RESPONSIBLE FOR FILING RETURN .~.. ~ ~ DA S T R E E T PA 1,7108 1505610140 J `~' REV-1500 EX 1505610240 Decedent's Social Security Number Decedent's Name: ANN M• D Y K S T R A 5 2 8 6 4 7 5 9 2 RECAPITULATION 1. Real Estate (Schedule A) ........................................ ... 1. 2. Stocks and Bonds (Schedule B) ................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ....................... ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 2 9 1 5 0 , 3 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .... ... 7. 2 7 5 4 5 0, 0 0 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 3 0 4 6 0 0 ~ 3 7 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 6 0 1 7 . 9 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 6 0 ], 7 9 0 12. Net Value of Estate (Line 8 minus Line 11) .................. ....... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ ........ .. 13. 14. Net Value Subject to Taz (Line 12 minus Line 13) ............ ........ .. 14. 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.o - 2 9 8 5 8 2 4 7 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 2 9 8 5 8 2.4 7 2 9 8 5 8 2.4 7 0. 0 0 0. 0 0 0. 0 0 0. 0 0 o. 0 0 1505610240 J REV.-1500 EX Page 3 Decedent's Com lete Add File Number p ress: 21 to ossg DECEDENT'S NAME ANN M. DYKSTRA STREET ADDRESS 4110 Carrington Court West CITY Mechanicsburg STATE _ Zlp PA 17050 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments (1) 0.00 A. Prior Payments B. Discount 3. Interest Total Credits (A + g) (2) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund . (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE . (5) 0.00 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: a. retain the use or income of the property transferred; ...................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income; ............................... o a c. retain a reversionary interest or .......................................................................................... ^ ...... 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? ................ ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q 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(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ANN M. DYKSTRA 21 10 0888 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Citizens Bank -Checking Account No. 6103562787 with accrued interest of $0.00 *net of checks written before death but clearing after death* 2. Dickinson College -Accrued Vacation Pay 3 ~ I Long Term Care Insurance -Refund 4.2006 Acura RSX 5~ ~ 1999 Mazda Miata TOTAL (Also enter on line 5 Recapitulation) I $ (If more space Is needed, Insert additional sheets of the same size) VALUE AT DATE OF DEATH 4,974.15 1,324.81 2,851.41 15, 000.00 5,000.00 29,150.37 REV-1510 EX+ (OS-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF ANN M DYKSTRA FILE NUMBER 21 10 0888 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1. Property at 4110 Carrington Ct W, Hampden Twp, Cumberland VALUE OF ASSET INTEREST (IF APPLICABLE) County, PA transferred to Paul S. Cribbins (spouse) and Ann M. 278,450.00 100.00 3,000.00 Dykstra on August 13, 2010; $222,760.00 x 1.25 = $278,450.00 2. Dickinson College (TIAA-CREF - 403(b)) Non-Taxable: Decedent was working for Dickinson College and was under 59 1/2 at the time of her death i TOTAL (Also enter on Line 7 Recapitulation) I $ If more space Is needed, use addltlonal sheets of paper of the same size. TAXABLE VALUE 275,450.00 275,450.00 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ANN M. DYKSTRA Decedent's debts must be reported on Schedule I. FILE NUMBER 21 10 0888 ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. B. ADMINISTRATIVE COSTS: ~ ~ Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ~_ ZIP Year(s) Commission Paid: 2. Attorney Fees: Butler Law Firm 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 2,040.00 Claimant Paul S. Cribbins 3,500.00 Street Address 4110 Carrin ton Court West City Mechanicsburg State PA ZIP 17050 Relationship of Claimant to Decedent Souse 4. Probate Fees: 153.50 5. Accountant Fees: 6• Tax Return Preparer Fees: ~• Cumberland Law Journal -Estate Advertising 8• The Sentinel -Estate Advertising 75.00 9~ Cumberland County Register of Wills -Filing Fee 219.40 30.00 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS TOTAL (Also enter on Line 9, Recapitulation) I $ It more space is needed use additional sheets of paper of the same size. 6 017 REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FSTATC l1C. SCHEDULE J BENEFICIARIES ANN M. DYKSTRA NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Paul S. Cribbins 4110 Carrington Court West Mechanicsburg, PA 17050 FILE NUMBER: 21 10 0888 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spousal AMOUNT OR SHARE OF ESTATE 298,582.47 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET If more space Is needed, use additional sheets of paper of the same size. $ LAST WILL AND TESTAMENT OF ANN M. DYKSTRA I, ANN iVI. DYKSTR.A, of Hampden Township, Cumberland County, Peru7sylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM 1. I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by my Executor out of my residuary estate, as an expense and cost of administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. In the absolute discretion of my Executor, he may pay such taxes immediately or may postpone the payment of taxes on future or remainder interests until the time possession thereof accrues to the beneficiaries. I also direct my Executor to pay the expenses of my last illness and fimeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM 2. I am in the process of gifting the sum of Thirty Thousand ($30,000.00) Dollars to DICKINSON COLLEGE of Carlisle, Pennsylvania. If the funding of this charitable gift has not been completed as of the date of my death, I instruct my Executor to complete the funding with assets from my estate. f' ITEM 3. I give, devise and bequeath all the rest, residue and remainder of my estate of any kind whatsoever, real, personal or mixed, and wheresoever situate unto my husband, PAUL S. CRIBBINS, if he survives me. In the event that my husband, PAUL S. CRIBBINS, predeceases me, I give, devise and bequeath said rest, residue and remainder to my brother, DANIEL J. DYKSTR.A, JR. ITEM 4. In addition to the powers conferred bylaw, my Executor shall have the following powers: (a) To retain in his absolute discretion and for such period as to him shall seem advisable, any and all assets constituting my estate, without liability for any loss inciuYed by reason of the retention of such assets. (b) To change investments and properties, and to invest and reinvest all or any part of the corpus of my estate, in such securities, investments, or other property as to him seem advisable and proper, irrespective of whether the same are authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. (c) To sell all or part of the property which at any time may constitute a part of my estate, at such time, upon such terms, for cash or on credit, with or without security, in such manner and at such prices, either at public or private sale, as to him shall seem advisable and proper, and to execute good and sufficient deeds and bills of sale therefor. (d) To lease any property held by him and for the duration of the term, irrespective of the provisions of any statute or of the termination of my estate; and to mortgage, - ~- pledge, collect, convert, redeem, exchange, or otherwise dispose of any securities or other property at any time held by him. (e) To borrow money, whether to pay taxes, exercise subscriptions, rights, and options, pay assessments or to accomplish any other purpose of any nature incidental to the administration of my estate, and to pledge any securities or other property held by him as security therefor. (f) To enforce any bonds, mortgage, or other obligations or liens held hereunder; to enter upon such contracts and agreements and to make such compromises or settlements of debts, claims, or controversies as he may deem necessary or advisable; to submit to arbitration any matter or difference; to vote personally or by proxy any shares of stock which may at any time be held by him hereunder. (g) To consent to the reorganization, consolidation, merger, liquidation, readjustment of or other change in any corporation, company or association, or to the sale or lease of the property thereof or any part thereof, any of the securities or other property of which may at the time be held by him thereunder, and to do any act or exercise any power with reference thereto that maybe legally exercised by any person owning similar property in his own right, including the exercise of conversion, subscription, purchase or other options, the deposit or exchange of securities, the entrance into voting trusts, and the making of agreements or subscriptions which he may deem necessary or advisable in connection therewith, all without applying to any court for permission to do so, and to hold, redeem, sell or otherwise dispose of -3- - - any securities or other property which he may so acquire, irrespective of whether the same be authorized for the investment of estate funds by the laws of the Commonwealth of Pennsylvania. (h) To cause to be registered in his name as Executor hereunder, or in the name of his nominee without qualification or description, any securities at any time held in my estate. (i) To determine the manner in which the expenses incidental to or comlected with the administration of my estate hereby established shall be apportioned as between income and principal. (j) To carry out agreements made by me during my lifetime, including the consummatiori of any agreements relating to the capital stock of corporations owned by me at the time of my death, and including the continuation of any partnership of which I may be a member at the time of my death whenever the terms of the partnership agreement obligate my estate or personal representative to continue my interest therein, and to enter into agreements for the rearrangement or alteration of my interests or rights or obligations under any such agreements in effect at the time of my death. (k) To apportion extraordinary and stock dividends received by him between income and principal in such manner as he may see fit; provided, however, that all rights to subscribe to new or additional stock or securities, and all liquidating dividends shall be deemed to be principal. -4- My Executor may freely act under all or any of the powers of this Agreement given to him in all matters concerning my estate hereby established, after forming his judgment based upon all the circumstances of any particular situation as to the wisest and best course to pursue, without the necessity of obtaining the consent or approval of any court, and notwithstanding that he may also be acting as an individual, or as an agent for other persons as an individual, or as an agent for other persons or corporations interested in the same matters, or maybe interested in connection with the same matters as stockholders, directors or otherwise. The powers herein granted to my Executor maybe exercised in whole or in part, from time to time, and shall be deemed to be supplementary to and not exclusive of the general powers of executors pursuant to law, and shall include all powers necessary to carry the same into effect. The enumeration of specific powers herein shall not be constnied in any way to limit or affect the general powers herein granted. ITEM 5. I hereby nominate, constitute and appoint my husband, PAUL S. CRIBBINS, as Executor of my estate. In the event that he is unable or unwilling to serve in this capacity, I then nominate, constitute and appoint my brother, DANIEL J. DYKSTRA, JR., as Executor of my estate. My Executors are specifically relieved from the duty or obligation of filing any bond or bonds. My Executors are hereby authorized to disclaim any interest in property in accordance with Chapter 62 of the Probate, Estates and Fiduciaries Code or Section 6103 thereof and may do so without court authorization. ~~ -5- ITEM 6. For the convenience of my Executors, I note that this Will has been prepared by Ronald D. Butler, Esquire and the Butler Law Firm. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, this ~ ~ ~,y day of ~ ,y s ~ T , 2010. (SEAL) Ann ykstra WITNESS: ~cz.~c~' ( °' residing at ~ 8~ it ~- l7/la residing at ~`~~ ~~_ ~~_~ -6- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPHIN 1 SS. We, ANN M. DYKSTRA , ~ E_sL~ ~ B _ V o ~ ~ a ~~ A ~ _ v-rc_~1~ ,and - ,the Testatnx and the witnesses respectively, whose naives are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her) and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age and older, of sound mind and under no constraint or undue influence. Ann M. D stra Witness /~~~~ _.. Witness Subscribed, sworn to and acknowledged before me b ANN M. DYKSTRA, the Testatrix, and subscribed and sworn to before me by (s e< « ~ C,~~ L a d o N ~ ~. g"-~,£~ ,the witnesses, this [ ~ da of ~~G-~ , 2010. - y tart' Public My Commission Expires: COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CHERYL L. FERGUSON, Notary Public City of Harrisburg, Dauphin County My Commission Expires April 6, 2012 -7- ~~'0000 256995n^ ~~'0000 256 14 lu^ ~:0 2 1 309 3 79~; ~:0 2 1 309 3 791: 8 i 108 900 2u' B 1 l OB 900 2n' ._ . £tzens Bank° Account Number Account Title Date Opened Account Tvne Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6103562787 Ann Marie D k: - 10/31/1994 $4994.15 00 $49_ $ .00 ~~ ~-.J l~ Parcel I.D. No. 10-16-1058-250 THIS DEED MADE the (3'~ 001X4 B day of _ ~ G y ST in the year two thousand ten (2010). BETWEEN ANN M. DYKSTRA and PAUL S. CRIBBINS, her husband, of Hampden Township, Cumberland County, Pennsylvania, GRANTORS, parties of the first part, AND ANN M. DYKSTRA and PAUL S. CRIBBINS, her husband, of Hampden Township, Cumberland County, Pennsylvania, GRANTEES, parties of the second part. WITNESSETH, That in consideration of ONE ($1.00) DOLLAR in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey to the said Grantees, their heirs and assigns, ALL that certain lot or tract of ground situate in Hampden Township, Cumberland County, Pemisylvania, more particularly bounded and described as follows, to wit: BEGINNING at a point on the northern right of way line of Carrington Court West at the southwest corner of Lot #13; thence along said right of way line by a curve to the right, said curve having a radius of 25.00 feet and an arc distance of 29.91 feet to a point; thence along the same by a curve to the left, said curve having a radius of 60.00 feet and an arc distance of 86.09 feet to a point being the southeast corner of Lot #15; thence along Lot #15 N16-54-52E 111.06 feet to a point on the western line of Lot #10; thence along Lot #10 and Lot #11 550-20-27E 131.14 feet to a point being the northern comer of Lot #13; thence along Lot #13 S36-44-38W 150.00 feet to a point, being the place of beginning. CONTAINING 12,864 square feet. BEING Lot #14 on a Final Subdivision Plan of Governor's Glen, prepared by H. Edward Black and Associates, dated May 20, 1993, last revised June 14, 1993, and recorded on September 17, 1993, in the Office of the Recorder of Deeds in and for Cumberland County in Plan Book 66 at Page 127. . BEING the same premises which Troy L. Boone and Dawn M. Boone, his wife, by their deed dated Apri126, 2002 and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Record Book 251, Page 2343, granted and conveyed unto Ann M. Dykstra, single person. The said Arun M. Dykstra has since intermarried with Paul S. Cribbins, who joins with her in this deed as Grantors herein. This is a deed from wife to husband and wife and is therefore exempt from Pennsylvania realty transfer tax. .AND the said Grantors will specially WARRANT conveyed. Sealed and delivered in the presence of ~~- ~~~ AND FOREVER DEFEND the property hereby (SEAL) . Dykstra (SEAL) Paul S. Cribbins I hereby certify that the correct mailing address of the Grantee herein is as follows: 4110 Carrington Court West Mechanicsburg, PA 17050 l`~~~` Attonzey or Agent for Grantees COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF DAUPHIN: _ ~ On thisI 3~'` day of ~ .y ~ u ST , 2010, before me, a Notary Public, the undersigned officer, personally appeared ANN M. DYKSTRA and PAUL S. CRIBBINS, her husband, known to ine (or satisfactorily proven) to be the persons whose names are subscribed to the witlun instrument, and acknowledged that they executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have heretmto set my hand and notarial seal. otary Public My Commission Expires: COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CHERYL L. FERGUSON, Notary Public City of Harrisburg, Dauphin County My Commission Expires April 6, 2012 ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 71.7-240-6370 Instrument Number - 201022713 Recorded On 8/18/2010 At 9:16:23 AM * Instrument Type -DEED In N voice umber - 71051 User ID - KW * Grantor - DYKSTRA ANN M , * Grantee - DYKSTRA, A1~iN ivi . * Customer -BUTLER LAW FIRM * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $23.50 JUSTICE RECORDING FEES - $11.50 RECORDER OF DEEDS PARCEL CERTIFICATION $10.00 FEES AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 CUMBERLAND VALLEY SCHOOL $0.00 DISTRICT HAMPDEN TOWNSHIP $0.00 TOTAL PAID $62.00 * Total Pages - 4 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA s~~ °~ cuse~ ° ~ ~~~/o RECORDER O S +rso * -Information denoted by an asterisk may change during the verification process and may not be reflected on this page. iuiuiniiii~ii~iuiu TaxDB Result Details Page 1 of 1 Detailed Results for Parcel 10-16-1058-250. in the 2004 Tax Assessm t D DistrictNo en atabase 10 Parcel_ID 10-16-1058-250. MapSuffix HouseNo 4110 Direction Street CARRINGTON COURT WEST Ownerl DYKSTRA, ANN M C/O PropType R PropDesc LivArea 1978 CurLandVal 40000 CurImpVal 182760 CurTotVal 222760 CurPref Val Acreage .30 CIGrnStat TaxEx 1 SaleAmt 209500 SaleMo 04 SaleDa 30 SaleCe 20 SaleYr 02 DeedBlcPage 00251-02343 YearBlt 1996 HF File_Date 11/12/2004 HF Approval_Status ~ A http://taxdb.ccpa.net/details.asp?id=10-16-1058-250.&dbselect=l n in inn,,. Pa. Common Leval Ratios for Real Property Assessments Page 2 of 4 Bradford 2.20 2.31 2.43 2.63 2.68 2.79 2.77 2.94 Bucks 28.57 32.26/8.07 8.93 10.10 10.99 10.64 10.31 9.17 ~~ Butler 8.93 9.62 9.90 10.20 10.42 10.7[ j8.06 6.2561 7.30 Cambria 6.29 6.14/3.07 3.57 3.60 3.22 3.01 3.03 2.82 Cameron 2.83 2.68 2.81 3.08 2.96 2.85 2.99 3.08 Carbon 2.22 2.32 2.52 2.74 3.12 3.20 3.01 2.72 Centre 2.53 2.68 3.04 3.24 3.41 3.62 3.47 3.46 Chester 1.35 ( 1.47 1.65 ( ~1.82 1 ~~~ I_~C~C] .93 1.93 1.89 1.81 ~~ Clarion 4.98 5.26 5.10 5.38 5.65 5.16/j .87 3,7061 3.80 Clearfield 4.88 5.24 5.13 5.47 5.75 5.68 4.74 5.29 Clinton 3.55 3.53 3.73 4.24 4.46 4'S [ ] •00 1.0061 1.03 Columbia 2.92 3.05 3.26 3.47 3.55 3.76 3.69 3.69 Crawford 2.83 2.95 2.87 3.02 3.04 2.98 2.85 2.78 Cumberland 1.05 1.11/1.00 1.00 1.14 1.22 1.26 1.26 1.25 Dauphin 1.07 1.14 ~~~ ~~ 1.24 1.33 1.40 1.46 1.42 1.42 Delaware 1.15 1.26 1.38 1.55 1.64 ~~~~ 1.72 1.63 1.56 Elk 5.00 5.05 5.26/2.18 2.18 2.65 2.49 2.61 2.52 Ene 1.00* 1.09 1.13 1.18 ~~~~ Fa * ~~ ~ ~~ 1.20 1.21 1.26 1.22 yette 1.00 1.03 1.10 1.14 1.17 ~~ ~~~ 1.17 1.22 1.23 Forest 4.72 4.74 4.37 4.83 5.21 4.20 5.10 4.26 Franklin 6.45 6.90 7.69 9.35 10.20 9.62 8.62 8.13 Fulton 1.97 1.98 2.20 2.61 2 ~~~~ ~~~~~~ .99 2.99 3.00 3.44 Greene 1.00* 1.13 1.21 1.21 1.16 1 C~ ~ .24 1.40 1.18 Huntingdon 5.99 6.29 6.80 7.46 7.87 8.62 8.27 7.58 Indiana 7.09 7.30 7.69/4.35 4.35 6.17 5.95 5.99 5.68 Jefferson 5.08 5.32/1.74 1.74 1.85 1.87 2.05 1.97 1.86 Juniata 5.69 5.65 6.41 6.21 6.25 6.33 6.90 5.88 Lackawanna 4.70 5.21 5.38 5.95 7 ~~~~ ~~C~C~ .09 6.67 6.17 5.88 Lancaster 1.16 1.22/1.00 1.00 1.22 1.31 1.36 1.35 1.33 Lawrence 1.00 1.08 1.10 1.14 1.14 ~~~~ 1.12 1.19~~1 1.18 Lebanon 11.91 12.20/6.25 6.25 ~~~ ~C~C~ 6.80 7.35 7.41 7.46 7.04 ~~ r--, r----~ r------~ r_____--, ~~ http://evans-legal. com/dan/comlevel.html ~o W /~/~ r- O I ; AW, O e- I ° , ` N ~ 'w M o w 0 ~i6~g~ a ~ ~ N ~ ~~i ~~ ~ ~o ° ~LL N aO'w O J N O Q 'u~ O O 1 CCU w a F d ~ w W O i--~ [-+ d 0 n a W z a ~~ ~ o a O O ,>. ~ 4 ~ ~~ =z ~ ~ a tt w O 3 ~j z a o ] o Fq N y P4 a a x y O ,1." +~ O U O1 M ~ p v' ~ •rl ',7 U] ~ U ~ ~ O b ~ ~ 0 ~+ cC .~ N N ~~+~o~ .N s.+ s-+ ,-a m w a~ ~ •a •~ A o ~ ~ N ~ U O ~d PG U ~ W U 0 500 North Third Street Tel: 717.236.1485 ~ ~ ~ ~ Twelfth Floor Fax: 717.236.7777 Hanishurg, PA 17101 lawyersQbutlerlawfirm.com Ronald D. Butler May 6, 201 1 Jana Butler Toole Benjamin J. Butler Suzanne M. Butler Register of Wills Cumberland County Courthouse 1 Courthouse Square Room 102 Carlisle, PA 17013 Re: Estate of Ann M. Dykstra a/k/a Ann Marie Dykstra 2010-00888 Dear Sir or Madam: Mailing Address: Post Office Box 1004 Harrisburg, PA 17108.1004 I have enclosed two originals and one copy of a Pennsylvania Inheritance Tax return and one original and one copy of an Inventory for the above referenced estate. Please time stamp the enclosed copies and return them to me in the enclosed self-addressed stamped envelope. I have also enclosed a check for $30.00 made payable to Register of Wills for filing fees and a check for $30.00 made payable to Register of Wills for additional probate. Your cooperation in this matter is appreciated. Very truly yours, Benjamin J. Butler BJB/mot n ~:. _, . ;- Enclosure _ _~~~ i-Lj ~~ ~- -c~ _ , ~_ .._ -_ ;-~, i , - ~ - ,~ ~~ _ :~ ~~ ,_ ;-- _ ; _; 7> U ,.' J ?~