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HomeMy WebLinkAbout06-01-11T J 1505610143 REV-1500 EX (01-10) "- PA Department of Revenue OFFICIAL USE ONLY Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 11 0372 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195 32 1031 03 O1 2011 02 27 1922 Decedent's Last Name Suffix Decedent's First Name MI THOMSON DORIS E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maint fined a Living Trust (Attach Copy of~rust) 9. Litigation Proceeds Received ^ 90. Spousal Poverty Credit date of death between 12-31 ~J1 and -1-95) c:UKKESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIONI SHOULD BE DIRECTED TO: Name Daytime Telephonle Number JAMES D BOGAR 717 7 3 7 IB 7 61 First line of address ONE WEST MAIN STREET Second line of address City or Post Office SHIREMANSTOWN Correspondent's a-mail address: jbogar@bogarlaw.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best o 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. SIGNATUR F PERSON RESPONSIBLE FOR FILING RETURN .DATE ^^^^ ^ ~ ~-f-1~ ~ c.~'~-G~.>~ Kathleen E. Liddick ~/~ ~ /// 27 Wild Rose Lane Mechanicsbur PA 17050 SIGNA OF PREPA R OTHER THAN REPRESENTATIVE DATE % ~ James D. Bogar Jt" a (~' ~ ~ nnnorc. __ One West Main S~`tr~et, Shiremanstown, PA THIS RETURN MUST BE FILED IN DUPLICATE 1WITH THE REGISTER OF WILLS State ZIP Code PA 3, Remainder Return (date of death prior to 12-13-82!) ^ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTER OF ~S USE O~Y ~ {,. '".. +i~ ~p ~ ~ r i { . A ., C7 ~~ ~ _~~ ,.- ~. .»,... DAT ILED ~~ r L, 1505610143 Side 1 Lsos61o14~ J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Thomson, Doris E. 195 32 ..1031 RECAPITULATION 1. Real Estate (Schedule A) ............................................................................ ........... 1. 5 0, 7 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 6 , 3 95.16 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. ', 25 , 572.43 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. ', 5 6 , 92 3. 7 6 7. Inter-Vivos Transfers & Miscellaneous ~.q Probate Property (Schedule G) u Separate Billing Requested............ 7, 1~ 3 9 , 8 83.7 9 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 7 9 , 4 7 5.14 9. Funeral Expenses & Administrative Costs (Schedule H) .............. ......................... 9. 12 4 , 4 7 4 . 5 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9& 10) .................................................. ................. 11. 2 4, 4 7 4. 5 9 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 3 5 5 , 0 0 0 . 5 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 3~5 5 , 0 0 0 . 5 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. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .045 355 , 000 .55 16. 15 , 975.02 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0, 0 0 19. Tax Due .................................................................................................................. 19. 15 , 9 7 5. 0 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 `,~,~, 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Thomson, Doris E. STREET ADDRESS 7 South Rupp Avenue CITY Shiremanstown Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 798.75 File Number 21-11-0372 STATE ZIP PA (1) Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 17011 15,975.02 798.75 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 15,175.27 Make Check Pa able to: REGISTER OF WILLS, AGENT ~.._ ~s . , e `tt y~y, ~~ fi ~.. 4 ~~, ~ 1 ~ rT'C i ~ ,C ~ ' }f 'rt. ~., 1.t ..:J N.N .~ ... e. .... w-,. Kai ~~~~~(~~.'\' 'x+i~s 4 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 :............................................................................... ^ b. retain the right to designate who shall use the property transferred or its income :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? .............................. ^ .. .......................... . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................ ~ ^ ...................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. . ~~W.'~." .c.~w.' *.,;tc ...~6i ~...u .sir. 7, , . ~_~. .'!r ,.r tom'' 4: f& .»~~ $;*r t"t .~ ~ - xr,~ ~ } -T ' ~ ~ r;::, i _ .. r--... ~~ .. „f, .,.<: o.cr_„, .~..w ~ ,..i...,x;~4 s.. ~~'1 ~.v..w ..~ 1ur ...~ .?r ..~... s......i_~t~ ;~~ s a -::., ..,. m.~u c._.;~,. ..., ._.. ~.~na. ~::;t ...x, '_.. s For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or.for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by' blood or adoption. Rev-1502 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMIBER Thomson, Doris E. 21-11-O~i72 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate -All that certain piece or parcel of real estate having thereon erected a dwelling house known and numbered as 7 South Rupp Avenue, Shiremanstown, Cumberland County, Pennsylvania 17011. The property was acquired by Doris E. Thomson by Deed dated January 9, 2009 and recorded January 14, 2009 in the Cumberland County Recorder of Deeds Office at Instrument Number 200901053, a copy of the Deed is attached hereto and incorporated herein. The above-described real estate is being transferred to Kathleen E. Liddick, pursuant a specific bequest in the Last Will and Testament of Doris E. Thomson. A copy of the Deed is attached hereto and incorporated herein. The County Assessed Value of this property is $150,700.00. 150,700.00 TOTAL (Also enter on Line 1, Recapitulation) I 150,700.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-OB) 1~~ Illdlll~'IIIINIII~I Tax Parcel No. 37-23-0557-201 THIS DEED, MADE THE /~ "" day of ~ ~ nuQ ~ in the year two thousand nine (2009 BETGYEEN DORIS E . THOMSON, individually and as Trustee of . THE DORIS E. THOMSON REVOCABLE L2VING TRUST, Grantor, and DORIS E . THOMSON, individually., of Shiremanstown, Cumberland County, Pennsylvania, Grantee: WITNESSETH, that in consideration of One and No/100 Dollar ($1.00) ,~ in hand paid., the receipt whereof is hereby ackno~vrl- edged, the said Grantor does hereby grant and convey to the said Grantee, her heirs and assigns: ALL THAT CERTAIN lot or tract of land with the buildings a~.d improvements thereon erected situate in the Borough of Shiremanstown, Cumberland County, Pennsylvania, more particularly bounded and described according to the Plan of Shirernan Manor dated September 9, 1959 and recorded in the Recorder of Deeds Office in and for Cumberland County, Pennsylvania, in Plan Book 11, Page 41, to wit: BEGINNING at the point of intersection of the line of the eastern edge of Rupp Avenue and the line of adjoiner between lots num- . tiered 14 and 15, Block E; thence North 78 degrees 56 minutes East by said line of adjoiner for a distance of one hundred twelve and five one-hundredths (112.05 ) feet to a point; thence South 11 degrees 4 minutes East for a distance of seventy-five (75) feet to a point at the northwest corner of Lot No. 13, Block E; thence South 78 degrees 56 minutes West by the northern line of Lot No. 13, Block E for a distance of one hundred twelve and five one- hundredths (112.05) f eet to a point on the eastern line of Rupp Avenue; thence North 11 degrees 4 minutes West by the eastern line of Rupp Avenue for a distance of seventy-five (75) feet to the point and place of BEGINNING. BEING Lot No. 14, Block E. HAVING ERECTED THEREON a single family dwelling known and num- bered as 7 South Rupp Avenue, Shiremanstown, Pennsylvania. BEING the same premises which Parnell M. Warick, a singly man, by deed dated January 15, 1987 and recorded January 16, 198 in the Cumberland County Recorder of Deeds Office in Deed Book ]t,, Volume 32, Page 424, granted and conveyed unto Landis D. Thomson, Jr. and Doris E. Thomson. The said .Landis D. Thomson, Jr. died January 12, 2000 whereupon full and complete title to the within described real estate became vested solely in Doris E. Tltiomson, surviving spouse. ALSO BEING the same premises which Doris E. Thomson by Quit Claim Deed dated February 22, 2001 and recorded April 9, 2001 inn the Cumberland County Recorder of Deeds Office in Deed Book X42, Page 452, granted and conveyed unto The Doris E. Thomson Revockable Living Trust dated March 10, 2000. Doris E. Thomson is c~.esig- nated as the Trustee .thereunder. AND the said Grantor hereby covenants and agrees that she, will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence of ~ 7 ~; i .-~.1~.-~ Cam. ; ~~--rim-- r -~' ( SEAL ) DORIS E. THOMSON, individually and as Trustee of The Doris E. Thomson Revocable Living Trust T- - -- --- c COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND , On this the ~~~ da '~ ~~/~~-x(~~ y of 2009 before m e, the undersigned officer, personally appeared DORIS E. THdJMSON, individually and as Trustee of The Doris E. Thomson Revocable Living Trust, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. seal. IN WITNESS WHEREOF, I hereunto set my hand and official l °. (SEAL) Notary Public ~Fe~3,,s:ae My Commission Expires : ~~"~•~`^~~`" ..w ?..v"e5~ COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL BETH B. LENGEt, NOTARY PUBLIC SHIREMANSTOWN BORO., CUMBERLAND COUNTY MY COMMISSION EXPIRES DEC. 12, 2011 ,p "' a „:: 9~ x tST+ ~:~ ~~ t~' :~,' ' .~ c, ~~;.• I do hereby certify that the precise residence and complete post office address of the within named grantee is 7 South Rupp Avenue, Shiremanstown, Pennsylvania 17011. ~~,•~,u,~ ~' 2 0 0 9 Ja es D. Bo r Attorney fo Grantee (N.T.S.) ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 200901053 Recorded On 1/14/2009 At 8:29:1 3 AM * Instrument Type -DEED Invoice Number - 35298 .User ID - RAK * Grantor - THOMSON, DORIS E * Grantee - THOMSON, DORIS E * Customer - BOGAR * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $10.00 JUSTICE RECORDING FEES - $12.50 RECORDER OF DEEDS PARCEL CERTIFICATION $10.00 FEES AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 MECHANICSBURG SCHOOL $0.00 DISTRICT SHIREMANSTOWN BOROUGH $0.00 TOTAL PAID $49.50 * Total Pages - 5 Certification Pale DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA ~+~ ~ e ~ ~ ~~ ° RECORDER C~ D EDS ~~ ~: `~~ T750 * -Information denoted by an asterisk may change during the verification process and may not be reflected On this page. 0017M1 TaxDB Result Det~.?ls 1 - Page 1 of 1 Detailed Results for Parcel 37-23-0557-201. in the 2010 Tax Assessment Database DistrictNo 37 Parcel ID 37-23-0557-201. MapSuffix HouseNo 7 Direction S Street RUPP AVENUE Ownerl THOMSON, DORIS E C/O PropType R PropDesc LivArea 1120 CurLandVal 37200 CurImpVal 113500 CurTotVal 150700 CurPrefVal Acreage .19 C1GrnStat TaxEx 1 SaleAmt 1 SaleMo O l SaleDa 14 SaleCe 20 SaleYr 09 DeedBkPage 200901053 YearBlt 1960 HF_File Date 10/28/2004 HF Approval_Status A http://taxdb.ccpa.net/details.asp?id=37-23-0557-201.&dbselect=l 5/19/2011 Tax Parcel No. 37-23-0557-201 THIS INDENTURE, MADE THE .~c~~ day of two thousand eleven (2 011) BETWEEN KATHLEEN E . LIDDICK, Executrix of the Last Will and Testament of Doris E. Thomson, late of Shiremanstown, Cumberland County, Pennsyl- vania, party of the first part, and KATHLEEN E. LIDDICK, married person, of 27 Wild Rose Lane, Mechanicsburg, Cumberland County, Pennsylvania, party of the second part WHEREAS, the said Doris E. Thomson by her Last will and Testa- ment, duly proved and recorded in the Cumberland County Register of Wills Off ice, Pennsylvania, in Docket Book 21-11-0372, Letters Testamentary being issued on March 23, 2011, provided., in perti- nent part, as follows: FIRST: I give and devise all that certain real estate owned by me, along with the furniture and contents located therein, but excluding therefrom any and all intangible personal property, same including but not necessarily being limited to, bank ac- counts, certificates of deposits, stocks, bonds, mutual funds, retirement accounts, cash and bank accounts, to my daughter, KATHLEEN E. LIDDICK ... FOURTH: In addition to all powers granted to them by law and by other provisions of this Will, I give tree fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it... EIGHTH: I nominate and appoint KATHLEEN E. LIDDICK, Execu- trix of this, my Last Will and Testament... NOW THIS INDENTURE WITNESSETH, that the said party of the first part, by virtue of the power and authority aforesaid, in said Will contained, and in consideration of the surn of One Dollar ($1.00) to her paid by the said party of the second part, at and before the ensealing and delivery of these presents, the receipt whereof is hereby acknowledged, has granted, bargained, sold and conveyed, and does hereby grant, bargain, sell and convey to the said party of the second part, her heirs and assigns forever: ALL THAT CERTAIN lot or tract of land with the buildings and improvements thereon erected situate in the Borough of Shiremanstown, Cumberland County, Pennsylvania, more particularly bounded and described according to the Plan of Shireman Manor dated September 9, 1959 and recorded in the Recorder of Deeds Office in and for Cumberland County, Pennsylvania, in Plan Book 11, Page 41, to wit BEGINNING at the point of intersection of the line of the eastern edge of Rupp Avenue and the line of adjoiner between lots num- bered 14 and 15, Block E; thence North 78 degrees 56 minutes East by said line of adjoiner for a distance of one hundred twelve and five one-hundredths (112.05) feet to a point; thence South 11 degrees 4 minutes East for a distance of seventy-five (75) feet to a point at the northwest corner of Lot No. 13, Block E; thence South 78 degrees 56 minutes West by the northern line of Lot No. 13 , Block E f or a distance of one hundred twelve and f ive one - hundredths (112.05) feet to a point on the eastern line of Rupp Avenue; thence North 11 degrees 4 minutes West by the eastern line of Rupp Avenue for a distance of seventy-five (75) feet to the point and place of BEGINNING. BEING Lot No. 14, Block E. HAVING ERECTED THEREON a single family dwelling known and num- bered as 7 South Rupp Avenue, Shiremanstown, Pennsylvania. T _ __ BEING the same premises which Doris E. Thomson, individually and as Trustee of The Doris E. Thomson Revocable Living Trust by deed dated January 9, 2009 and recorded January 14, 2009 in the Cumberland County Recorder of Deeds Office at Instrument Number 200901053, granted and conveyed unto Doris E. Thomson, individu- ally. The said Doris E. Thomson died March 1, 2011. TOGETHER with all and singular the rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of the said Doris E. Thomson at and immediately before the time of her decease, in law or equity or otherwise howsoever, of, in, to or out of the same: TO HAVE AND TO HOLD the said granted premises to the said party of the second part, her heirs and assigns forever. AND the said party of the first part, does covenant, promise, grant and agree, to and with the said party of the second part, her heirs and assigns, by these presents, that the said party of the first part, has not done, committed, or knowingly or willingly suffered to be done, any act, matter or thing what- soever, whereby the premises aforesaid, or any part thereof, is, are, shall or may be charged or encumbered, in title, charge or estate, or otherwise howsoever. IN WITNESS WHEREOF, the said party of the first part has here- unto set her hand and seal the day and year above written. Signed, Sealed and Delivered in the Presence of ,. ~~ KAT EEN E. LIDDICK, Executrix of the Estate of Doris E. Thomson COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this, the G day of ~~~~ 2011 , before me, the undersigned officer, personally appeared KATHLEEN E. LIDDICK, Executrix of the Estate of Doris E . Thomson, known to me (or satisfactorily proven) to be the person described in the forego- ing instrument, and acknowledged that she executed the same in the capacity therein stated and for the purposes therein con- tained. seal. IN WITNESS WHEREOF, I hereunto set my hand and official . ( SEAL ) Notary Public My Commission Expires: COMMONWEALTH Of PENNSYLVANIA NOTARIAL SEAL BETH B. LENGEL, NOTARY PUBLiC SHIREMANSTOWN BORO., CUMBERLAND COUNTY MY COMMISSION EXPIRES DEC. 12, 2011 CERTIFICATE OF RESIDENCE I do hereby certify that the precise residence and complete post office address of the within named grantee is 27 Wild Rose Lane, Mechanicsburg, Pennsylvania 17050. ~~ ll ~ ~ 2011 J ES D. BO R (N.T.S.) Attorney for r ntee REV-i83 EX (o4-io) =~ r ~ pennsylvania L DEPARTMENT OF REVENUE Bureau of Individual Taxes PO BOX 280603 Harrisburg, PA 1'7128-0603 REALTY TRANSFER TAX STATEMENT OF VALUE See reverse for instructions. RECORDER'S USE ONLY I State Tax Paid I Book Number Page Number Date Recorded Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) the deed is without consideration or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from tax based on family relationship or public utility easement. If more space is needed, attach additional sheets. A CORRESPONDENT -All inquiries may be directed to the following person: Name Telephone Number: James D. Bogar, Esquire (717) 737-8761 Mailing Address City State ZIP Code One West Main Street Sh;r~nan~town PA 17011 B. TRANSFER DATA C. Date of Acceptance of Document Grantor(s)/Lessor(s) ~-Teen E. Lddl.Ck, Executrix Grantee(s)/Lessee(s) of the Estate of Doris E. Tharinson Kathleen E. Liddick Mailing Address C/O Jc3ReS D. BOgar, ESqulre Mailing Address One West Main Street 27 Wild Rose T.ane City State ZIP Code City State ZIP Code Shiremanstown PA 17011 Mechanicsburg PA 17050 D. REAL ESTATE LOCATION Street Address City, Township, Borough 7 .5. Rupp Avenue Sh i r~manstown, Borough of ShiremanstoWil County School District Tax Parcel Number Ctanberland Mechanicsburg 37-23-0557-201 E. VALUATION DATA -WAS TRANSACTION PART OF AN ASSIGNMENT OR RELOCATION? ^ Y ~ N 1. Actual Cash Consideration 2. Other Consideration 3. Total Consideration $1.00 + 0.00 - 4. County Assessed Value 5. Common Level Ratio Factor 6. Fair Market Value $150,700.00 X 1.0 = 150 7 F. EXEMPTION DATA 1a. Amount of Exemption Claimed ib. Percentage of Grantor's Interest in Real Estate ic. Percentage of Grantor's Interest Conveyed 100 100 s Check Appropriate Box Below for Exemption Claimed. ® Will or intestate succession. Doris E. Thomson 21-1.1-0372 (Name of Decedent) (Estate File Number) ^ Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.) ^ Transfer from a trust. Date of transfer into the trust If trust was amended attach a copy of original and amen e trust. ^ Transfer between principal and agent/straw party. (Attach complete copy of agency/straw party agreement.) ^ Transfers to the commonwealth, the U.S. and instrumentalities by gift, dedication, condemnation or in lieu of con- demnation. (If condemnation or in lieu of condemnation, attach copy of resolution.) ^ Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and note/assignment.) ^ Corrective or confirmatory deed. (Attach complete copy of the deed to be corrected or confirmed.) ^ Statutory corporate consolidation, merger or division. (Attach copy of articles.) ^ Other (Please explain exemption claimed.) Under penalties of law, I declare that I have examined this statement, including accompanying information, and to the best of my knowledge and belief, it is true, correct and complete. Signature of Corr-mss ondent or~esponsible Party Date ~L%r ~j ~s j FAILURE TO COMPLETE H '>f`HE RECORDER'S REFU t FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION MAY RESULT IN 3 RECORD THE DEED. Rev-1503 EX+ (6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 ..~~ N,v~eny wumy-ownea wain ngnt or survrvorsnip must pe dlsclosetl on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 137 shares of MetLife Stock 46.68 6,395.16 TOTAL (Also enter on Line 2, Recapitulation) I 6,395.16 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) 1V1CiLLllli ., 111VG.7LV1 1\1.r1Q.L1V11.7 .. 111aLV11~CL1 1 ll~li LVVI\U.~J ~- (~~ V 1 V t /-~ PrfClt Investor Relations Company Overview Executive Officers Board of Directors Stock Information Stock Quote Stock Chart Historical Price Lookup Investment Calculator Financial Information News & Events Conferences & Presentations Analyst Coverage Shareholder Services Information E-mail Alerts Information Requests Contact Information Historical Price Lookup Symbol MET (Common Stock) Select Date March ~ ~ 01 2011 =,, u~ ~~ Loo:kwUp Price Results Date Requested 03/01/11 Closing Price $46.04 Volume 8,222,100 Split Adjustment Factor 1:1 http://investor.metlife.com/phoenix.zhtml?c=121171 &p=irol-stocklookup~f&t=HistQuote 5/19/2011 1V1G1L.11G ., 111VGJ1_V.1. JtG1CI.W.U.LI.J .. 111JLV11l~C1,1 1 1,L~G :I.~VV.[~U~J C3pen ~47.5a Qay's High $47.61 day's Low $45.76 Copyright ©2008 MarketWatch, inc. All rights reserved. Please see our Terms of Use. Designed and powered by Dow Jones Client Solutions Intraday data provided by Interactive Data Real Time Services and subject to the Terms of Use. intraday data is at least 20-minutes delayed. All times are ET. Historical and current end-of-day data provided by Interactive Data Pricing and Reference Data. Privacy Policy Date of .Death Value Calculatioans : . $46.68 (Mean Price. on Date of Death) X 137.00 (Number of Shares) $6,395.16 (Total Date of Death Value) 1 CL~GG V1G http://investor.metlife.com/phoenix.zhtml?c=121171 &p=irol-stocklookup~f&t=HistQuote 5/19/2011 +t: r DORIS E THOMSON Account Market Value Stock Price as of Total Market f 1 /09/2010 Value $40.530 $5,552.61 The aggregate amount paid to all Trust Beneficiaries in this distribution is $165,579,185.12. ~_In~l~tor ID ~~., 8062 8468 3643 2010 Dividend Summary Record Date Total Trust Di•vedend pE3~ Current Interests Trust Interest Distribution 11 /09/2010 37-000' $0.74 - $101.38 Payable Date Tax W~:hheld Net Distribution Prior Year Distribution 12/14/2010 $0.(10 $101.38 $101.38 For inquiries about your account, you may visit www.bnymellon.com/sharE~cvvner/equityacces:>, or call 1-600-649-3593. Trust Beneficiary Information You may purchase or sell shares of MetLife, Inc. common stock through the MetLife Policyholder Trust (the `Trust"), free of any commissions or other fees, under the MetLife Purchase and Sale Program, as amended. A copy of the brochure describing the program is available on the Internet at www.metlife.com by selecting Investor Relations and then the Shareholder Services Information page, or by calling the number listed above. You are permitted to transfer your Trust Interests only in the circumstances described in the brochure. You may also instruct that all (but not less than all) of your shares of MetLffe, Inc. common stock held by the Trust be withdrawn from the Trust. Information regarding your withdrawal rights may be found in the Purchase and Sale Brochure or by calling the number listed above. An annual sharef':clders' meeting to elect members of the Board of Directors of Mett.ife, Inc. and for the transaction of other business is expected to be held on April. 26, 2011. The deadline for submitting shareho{der propos,~ls for consideration at: this meeting is November 23, 2010. A coF}y of MetLife, Inc.'s annual report and proxy statement will be available fn3e of charge on or before March 31, 2011, along with other MetLife, Inc:. and Trust filings under federal securities laws, (i) on the Internet at wwar.i~Aetlife.com by selecting About MetLife, Corporate Governance, under Related Links, (ii) by writing to MetLffe, Inc., c/o BNY Mellon Shareowner services, PO Box 358447, Pittsburgh, PA 15252-8447 or (iii) by calling the number listed above. These and other SEC filings by MetLife and the Trust are also available on the Internet at wwwsec.gov. - - -- ~lease Note: Imp~lrtant 201 d Tax Information _ MetLife FORM 1099-DIV. ~ U.S. TAX INFORMATION FOR 2410 OMB NO. 1545-Of10 DIVIDENDS/DISTRIBUTIONS COPY B FOR RECIPIENT RECIPIENT'S TOTAL ORDINARY IDENTIFICATION NUMBER DIVIDENDS QUALIF-lED DIVIDENDS FEDERAL INGOME TAX WITHHELD BOX t A BOX 16 BOX 4 -~ 195-32-1031 $101.38 ~ $101.3E3 $p.lq PAYER'S NAME BNY MELLON SHAREOWNER SERVICES AS CUSTODIAN OF THE METUFE POLICYHOLDER TRUST SECURITY DESCRIPTION TO WHOM PAID TRUST INTERESTS DORIS E THOMSON 7 S RUPP AVE SHIREMANSTOWN PA 17011-6530 iMQORTANT 2010 TAX IMFORMATIO~I This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. Box 1A -Shows total ordinary dividends that are taxable. Include this amount on line 9a of Form 1040 or 1040,4. Also, report it on Schedule B (Form 1040) or Schedule 1 (Form 1040A), if required. The amount shown may be dividends a corporation paid directly to you as a parti- cipant (or beneficiary of a par;,cipant) in an employee stock ownership plan (ESOP). Report it as a dividend on your Form 1G40/1040A, but treat it as a plan distribution, not as investment income for any other purpose. FEDERAL IDENTIFICATION NUMBER 51-6516987 FOR IiVFORMAT'ION REGARDING THE REPORTED BY THE BANK OF NEW YORK MELLON 480 WASHINGTON BOULEVARD JERSEY CITY, NJ 07310 ABOVE, cA>~.1-r~o-6gs~5s3 Box 4 -Shows 15ackup withholding. For example, a payer must backup withhold on certain pay- ments at a 28°/> rate if you did not give your taxpayer identification number to the payer. See form W-9, Request for Taxpayer Identification Number and Certification, for information on ; backup withholding. fricl~de this amount on your income tax return as tax withheld. Nominees. If this fornn includes amounts belonging to another person, you are considered a nominee recipient. You must file Form 1099-DIV with the IRS for each of the other owners to show their sharps of the income, and you must furnish a Form 1099-DIV to each. A husband or wife is not required to 1`ile a nominee return to show amounts owned by the other. See the 2010 General Instructions for =orms 1099, 1098, 3921, 3922, 5498, and W-2G. Box iB -Shows the portion of the amount in box 1A that may be eligible for the 15% or zero capital gains rates. See the Form 1040/1040A instructions for how to determine this amount. Report the eligible amount on line 9b, Form 1040 or 1040A. Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA ESTATE OF Thomson, Doris E. FILE NUMBER 21-11-0372 rui property ~omt~y-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 M&T Bank -Checking Account No. 9847128791. Date of death balance $22,647.85. Accrued interest $0.11. 2 Mass Mutual -Three (3) pension checks in possession of Decedent, but not cashed as of her date of death. 3 MetLife - 2010 Dividend check in possession of Decedent, but not cashed as of her date of death. 4 Postmark Credit Union -Savings Account No. 43-00. Date of death balance $70.18. 5 Furniture and Contents -Per appraisal. 6 U.S. Treasury - 2009 Personal Income Tax Refund. ~ VALUE AT DATE OF DEATH 22,647.96 174.12 101.38 70.18 1,890.00 688.79 TOTAL (Also enter on Line 5. Recapitulation) I 25,572.43 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Q MsH'Bar,k 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services James D Bogar One West Main Street Shiremanstown, PA 17Q11 Re: Estate of Doris Thomson Social Security: 195-32-1031 Date of Death: March 1, 2011 Phone 888-502-4349 F ax (302) 934-2955 March 30, 2011 Dear Sir or Madam: Per your inquiry on March 18, 2011, 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, fi Opening Date Balance on Date of Death Accrued Interest Total Checking Account 9847128791 Doris E Thomson Kathleen E Liddick(POA) 01/13/09 $22,647.85 $ .11 $22, 647.96 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the Mechanicsburg Office at #IS14-234-5793. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any acxounts in which the deceased may have been listed as power of Attorney, Custodian of Uniform Transfers, Representative payee, or Trustee under a Written Agreement Sincerely, ~, O,m~ ~ Tammy Spencer Adjustment Services O S TMARK C R E D I T U N I O N March 24, 2011 James D. Bogar Attorney at Law Attn: James D. Bogar One West Main St. Shiremanstown. Pa 17011 Re: Estate of Doris E. Thomson SS 195-32-1031 Dear Mr. Bogar: for first class financial services Doris E. Thomson has an account with Postmark Credit Union that was opened 04/12/1945. The account number was 43. The account was an individual account. Doris also has a Visa credit card with no balance. The card has been closed due to the notification of her death. Postmark Credit Union does not have safe deposit boxes. The account balance including accrued interest as of the date of death is as follows: Account 43 Account 43-00 Account Type Balance Open Date Savings $70.18 04/12/1945 If you have any questions, please don't hesitate to call me at 717-671-5119, ext 615. Sincerely, `~-~~ Michele L Treece Member Service Administrator 2630 Linglestown RoacJ • Harrisburg, (~A 1 71 1 0-3666 717.671.5119 LINDEN HALL ANTIQUES 211 N. OLD STONE HOUSE ROAD CARLISLE, PA 17015 717-249-1978 To: James D. Bogar, Esquire 1 West Main Street Shiremanstown, PA 17011 From: William G. Rowe, Appraiser 211 N. Old Stone House Road Carlisle, PA 17015 Re: Personal Property Appraisal Doris E. Thomson Estate 7 South Rupp Street Shiremanstown, PA 17011 Date: May 26, 2011 DINING ROOM Dining room set Antique dry sink Oak stand Rack Knick knacks Miscellaneous household T.V. LIVING ROOM 3-pc. Coffee table set Wall hangings Coffee table Lamps T.V. /tapes Jug Rocker Night stand 3 pcs. Upholstery - no value Desk - no value KITCHEN Small appliances Refrigerator Dishes Pots /pans BEDROOM #1 Bedroom set Costume jewelry Pink lamp Jewelry cabinet Miscellaneous household $100.00 $150.00 $25.00 $10.00 $50.00 $50.00 $10.00 $20.00 $10.00 $50.00 $10.00 $10.00 $25.00 $15.00 $10.00 $0.00 $0.00 $15.00 $25.00 $15.00 $10.00 $175.00 $25.00 $40.00 $60.00 $20.00 Thomson Appraisal 1 05/26/2011 BEDROOM #2 Bedroom set $100.00 Knick knacks $10.00 Stand $5.00 Blanket chest $100.00 Linens $20.00 PORCH Patio furniture $10.00 Grill - no value $0.00 BASEMENT Freezer - no value $0.00 Trunks $25.00 Cedar chest $40.00 Linens $20.00 Racks $40.00 Book shelf $10.00 Tools $50.00 Oak chest $75.00 Knick knacks $10.00 Tool box /tools $50.00 Stands (3) $15.00 Small cedar chest $20.00 Tool box /tools $75.00 Ladders (2) $20.00 Christmas items $10.00 Oak stand $30.00 Dresser $75.00 Tool chest $100.00 SmaN tool box $50.00 Exercise bike - no value $0.00 TOTAL $1,890.00 i' i~---~ 1 d-___~__ _~ William G. Rowe Thomson Appraisal 2 05/26/2011 Rev-1509 EX+ (6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kathleen E. Liddick 27 Wild Rose Lane Daughter Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 3/4/2009 Metro Bank -Savings Account No. 109,465.09 50.000% 54,732.55 627159643. Date of death balance $109,465.09. 2 A 1/14/2009 Metro Bank -Checking Account No. 4,382.42 50.000% 2,191.21 538218413. Date of death balance $4,382.42. TOTAL (Also enter on Line 6, Recapitulation) I 56,923.76 (If more space is needed, additional pages of the same size) Copyright (c} 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) BAN K 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 March 24, 2011 James D Bogar Attorney at Law One West Main St Shiremanstown, PA 17011 RE: Estate of: Doris E Thomson Tax Identification Number: 195-32-1031 Date of Death: March 01, 2011 To Whorn 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: Savings Account Number: 627159643 Date Opened: 03/04/2009 Primary Owner: Doris E Thomson Secondary Owner: Kathleen E Liddick Date of Death Balance: $109,465.09 Account Type: Checking Account Number: 538218413 Date Opened: 01 /14/2009 Primary Owner: Doris E Thomson Secondary Owner: Kathleen E Liddick Date of Death Balance: $4,382.42 Please feel free to contact me at (717) 412-6126 if I may be of further assistance Sincerely, t4 _( !' ~, Pamela Lighty Savings/CIF Assoc to Metro Bank Rev-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °i° OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF RANSFER.SATTACNTA COPY OF TIHE DEED OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Old Mutual Financial Network -Annuity Policy No. 139,883.79 139,883.79 L9093394. The Decedent's four (4) children and her grandson are the named beneficiaries of this account. TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 139,883.79 Form PA-1500 Schedule G (Rev. 6-98) .=1n~r~~.i~i ie~~~~rcr~ t3id Nfutua! FinanGiati Network 777 Research Drive Lincoln, NE 68521 PH 1.666.702.2194 FX 402.479.0198 OM FINANCIAL LIFE INSURANCE COt49PANY OM FINANCIAL UFE WSURANCE COMPANY OF NEW YORK Apri14, 2011 James D Bogar Attorney at Law One West Main Street Shiremanstown, PA 17011 Policy: L9093394 Owner: Doris E T~p~son Annuitant: Doris E Thomson Dear Mr. Bogar: We have been notified of the death of the policy owner. We wish to convey our sincere sympathy to the family in their recent loss. Our records indicate that Kathleen E Liddick 1/4, Ronald C Thomson 1/a, Robert C Thomson 1/5, Shawn A Liddick 12/50 and Carolyn L Daniels 3/50 are the beneficiaries. The approximate benefit amount is $140,129.26. The approximate taxable gain is $34,288.36. If your portion of the processed does not exceed $10,000.00 your processed will not be set up in a Retained Asset Account. The value as of 3/1/11 is $139,883.79. This policy was issued 8/29/05 and was opened with $102,700.21. The cost basis for this policy is $105,840.90. This is the only policy we were able to locate with our company. A beneficiary, who is a natural person (i.e. not a corporation, estate, trust, etc.), may choose only one of the following settlement options. A beneficiary that is not a natural person (e.g. corporation, trust, estate, etc.) may only choose option 1 or 3. 1. Lump Sum Payment -The beneficiary will receive a single lump sum payment of the policy proceeds through an OM Financial Life Asset Account. The personal Asset Account is an interest bearing checking account established in the beneficiary's name. The account currently earns interest at a rate of 1 %. We will mail the beneficiary a personalized checkbook. To access the funds, the beneficiary would simply write a check. We would also send the beneficiary monthly statements for the account, just like a bank. 2. Substitute Owner Election - ***THIS OPTION IS AVAILABLE TO THE SURVIVING SPOUSE ONLY*** -The surviving spouse beneficiary will become the w w w. o m f n, c o m Old Mutual Financial Network is the marketing name for OM Financial Life Insurance Company (Home Office, Baltimore, MD); and OM Financial Life Insurance Company of New York (Home Office, Purchase, NY). L~ ~~~~ ~ {]Evi FINANCIAL L{FE INSURANCE CQh7PANY `" OM FINANCIAL. LIFE fNSURANCE C~MPAh1Y OF NEW YORK ~=fl ~at~~ir[ ~~l~ti~rc~rk new owner of the policy. All terms and conditions of the policy remain unchanged, including any remaining surrender charge period. 3. 5-Year Deferral -The beneficiary may defer settlement of this claim for a period not to exceed 5 years from the policy owner's death. The beneficiary may withdraw all or part of the proceeds at any time during the 5-year period. Withdrawals may be subject to surrender charges, if the policy includes surrender charges on the death benefit. 4. Stretch Annuity Payout - ***THIS OPTION IS AVAILABLE TO NON-SPOUSES ONLY*** -The death benefit is paid out over a period of time based. on the life expectancy of the beneficiary. A Stretch Annuity payout cannot be 1035 exchanged to another insurer once elected. 5. Income for a Fixed Period -This option guarantees to pay the beneficiary regular income over the period of years chosen by the beneficiary. If the beneficiary should pass away before the all the payments are made, the beneficiary may designate a beneficiary who may receive a lump sum benefit or elect to continue receiving the income payments for the remainder of the fixed period. Payments must be for a minimum period of 5 years and for no more than 50 years. 6. Life Income with a Guaranteed Period -The beneficiary is guaranteed to receive payments for as long as he/she lives. If the beneficiary passes away during the guaranteed period, the beneficiary may designate a beneficiary to receive the remaining guaranteed payments. 7. Life Income -The beneficiary receives income for as long as he/she lives, but with no payment after his/her death. 8.. -Life Income with Lump Sum vRefund -The beneficiary will receive payments as long as he/she lives. If the beneficiary dies. before the total amount of payments made equals the total death benefit applied to purchase the payments, the beneficiary may name a beneficiary to receive a single payment equal to the original death benefit less any payments made. The beneficiary will also need to complete and/or provide the following: 1. Claimant's Statement, having the beneficiary's signature WITNESSED. 2. Certified Death Certificate displaying the manner of death (a photocopy is NOT acceptable) 3. Original Policy (if the original policy is lost or has been misplaced, please make a note of this on your claim form). If the surviving spouse is electing to continue the policy, the original policy should not be returned. 4. Proof of authority, if the beneficiary is not a natural person: a. Estate Beneficiary -Certified Letters Testamentary b. Trust Beneficiary - A copy of the portion of the trust agreement naming the trustee. A self-addressed return envelope is enclosed for your convenience. If you should have any questions, feel free to contact our office at 1-866-702-2194, extension 3365. Old Mutual Financial Network is the marketing name for OM Financial Life Insurance Company (Home Office, Baltimore, MD); and OM Financial Life Insurance Company of New York (Home Office, Purchase, NY). ~~ ~ ~ ~~ ~ OM FINANCIAL LIFE INSURANCE CCJh9PANY Oi'JE FINANCIAL LIFE INSURANCE Gt)h'IPANY OF NEW YORK Sincerely, Kristina Hradecky Life Claims Examiner OM Financial Life Insurance Company Old Mutual Financial Network is the marketing name for OM Financial Life Insurance Company (Home Office, Baltimore, MD); and OM Financial Life Insurance Company of New York (Home Office, Purchase, NY). REV-1151 EX+ (10-06) t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 --------- --r----_. _.. ~~............ .. ITEM DESCRIPTION N MBER AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 5,451.21 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zia Yearlsl Commission paid 2. Attorney's Fees Bogar & Hipp Law Offices 14,700.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 335.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,987.88 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 24,474.59 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 ITEM NUMBER DESCRIPTION AMOUNT Funeral ExnenGes 1 American Legion Post 109 -funeral luncheon 110.00 2 Jesse H. Geigle Funeral Home -Balance of funeral bill 296.32 3 Jesse H. Geigle Funeral Home -Funeral bill 4,920.00 4 Walmart, Gross-ery & BJs -Funeral luncheon 124.89 H-A 5,451.21 5 Other Administrative Costs ABC Fuel Oil Company, Inc. 237.48 6 Camp Hill Emergency Physicians -Medical bill 34.89 7 Comcast -Final Cable charges ($70.70 and $62.75). 133.45 8 Community Life Team EMS -Medical bill 45.78 9 Cumberland Law Journal -Executrix's Notice 75.00 10 East Pennsboro Ambulance 73.75 11 Golden Living Center -West Shore 45.50 12 Golden Living Center -West Shore 247.89 13 Interstate Waste Services -Trash bill 37.02 14 Interstate Waste Services -Trash bill 37.02 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 ITEM NUMBER DESCRIPTION AMOUNT 15 Journal Publications -Executrix's Notice 150.00 16 Judy C. Prowell, Tax Collector - 2011 County/Borough Taxes 582.62 17 Judy C. Prowell, Tax Collector - 2011 Per Capita Tax 9.80 18 Lower Allen Township -Sewer bill 55.00 19 PA American Water -Water bill 25.44 20 PA American Water -Water bill 25.50 21 Pharmerica -Prescription medical bill 10.01 22 PPL -Outstanding check written 2/27/11. 28 83 23 PPL -Electric bill 26.31 24 PPL -Electric bill 22 42 25 Quantum Imaging -Medical bill 3.44 26 Recorder of Deeds -Fee to record Deed 63.00 27 RESERVES: -Costs to conclude administration of Estate, including filing of PA Inheritance 1,750.00 Tax Return and Inventory, preparation and filing of 2011 Personal Income Tax Returns and Fiduciary Income Tax Returns 28 Sears -Monthly accidental death premium 12.75 29 Verizon -Outstanding check written 2/27/11. 159.98 30 William G. Rowe -Fee to appraise personal property. 95.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-9U) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 ITEM NUMBER DESCRIPTION AMOUNT H-B7 3,987.88 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-9~; REV-1573 EX+ (17-08) COM INHEgITAN~E~ A1C RET~IRN ANIA RE IDEN DE EDEN I SCHEDULE .! BENEFICIARIES ESTATE OF FILE NUMBER Thomson, Doris E. 21-11-0372 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)1 See attached schedule ~ ~ Total ~ Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Doris E. Thomson 03/01/2011 195-32-1031 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Kathleen E. Liddick Daughter 27 Wild Rose Lane Mechanicsburg, PA 17050 2 Shawn A. Liddick Grandson 27 Wild Rose Lane Mechanicsburg, PA 17050 3 Robert C. Thomson Son 11 Redbud Drive Mechanicsburg, PA 17050 4 Ronald C. Thomson Son 1403 West Iron Springs Road #23 Prescott, AZ 86305 Specific bequest of real estate, furniture and contents and thirty percent of rest, residue and remainder Ten percent of rest, residue and remainder Twenty percent of rest, residue and remainder Forty percent of rest, residue and remainder 1 LAST WILL AND TESTAMENT OF DORIS E. THOMSON n Jj _~ ,- I, DORIS E. THOMSON, of Shiremanstown, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I give and devise all that certain real estate owned by me, along with the furniture and contents located therein, but excluding therefrom any and all intangible personal property, same including but not necessarily being limited to, bank accounts, certificates of deposits, stocl~s , bonds, mutual funds, retirement accounts, cash and bank accounts, to my daugh- ter, KATHLEEN E. LIDDICK, provided that should she predecease me, then to my grandson, SHAWN A. LIDDICK, son of KATHLEEN E. LIDDICK. SECOND: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, as follows: (A) Forty ( 4 0 0 ) percent thereof to my son, RONALD C . THOMSON, provided that should he predecease me, I give and bequeath his share, in equal shares, to my surviving residuary beneficiaries as set forth in this Clause SECOND. (B ) Twenty ( 2 0 0 ) percent thereof to my son , ROBERT C . THOMSON, provided that should he predecease me, I give and bequeath his share to his issue per stirpes by representation. (C ) Thirty ( 3 0 0 ) percent thereof to my daughter , KATHLEEN E. LIDDICK, provided that should she predecease me, then to my grandson, SHAWN A. LIDDICK, son of KATHLEEN E. LIDDICK. (D) Ten (10 0) percent thereof to my grandson, SHAWN A. ti~ W LIDDICK, provided that should he predecease me, I give and bequeath his share, in equal shares, to my surviving residuary beneficiaries as set forth in this Clause SECOND. THIRD: Should my grandson, SHAWN A. LIDDICK, not have attained the age of twenty-three (23) years at the time for dis- tribution to him, I give, devise and bequeath riffs share to my hereinafter named Trustee or Trustees, IN TRUST, to hold, manage, invest and reinvest his share so received, and to use and apply from time to time such portion of income and principal for his education (including college, trade school or other similar training or education), as my Trustee or Trustees, in their sole discretion, deem advisable. The Trustee or Trustees, in exercising their discretionary authority with respect to the payment of income or principal of the within 'Trust to SHAWN A. LIDDICK, shall take into consideration any income or other resources available to him from sources outside this Trust. Any income or principal not so applied shall be dis- tributed to SHAWN A. LIDDICK when he attains the age of twenty- three (23) years. In the event that my grandson, SHAWN A. LIDDICK, dies prior to the termination of this Trust established herein for his benefit, the interest of SHAWN A. LIDDICK in said Trust shall cease with any income and principal being divided equally among my surviving residuary beneficiaries as set forth in Clause SECOND hereinabove. FOURTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give 2 options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, ~~ to protect or improve any property held under my will, and for w ,~ investment purposes. _~ ;~~ (I) To select a mode of payment under any qualified ~ retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise 3 any other rights which they may have under the plan, in whatever n i manner they consider advisable. FIFTH: I nominate and appoint my daughter, KATHLEEN E. LIDDICK, as Trustee of the hereinabove described trust. In the event of the death, resignation or inability to serve for any reason whatsoever of the said KATHLEEN E. LIDDICK, I nominate and appoint my son, RONALD C. THOMSON, as Trustee of the hereinabove described trust. I direct that my Trustee shall serve without bond and shall receive fair and reasonable compensation. SIXTH: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SEVENTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. EIGHTH: I nominate and appoint KATHLEEN E. LIDDICK, Executrix of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said KATHLEEN E. LIDDICK, I nominate and appoint JAMES D. BOGAR, Executor of this, my Last Will and Testament. I direct that my Executrix or Executor, Trustee or Trustees, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. 4 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ,~i~i day of ~ ~' 2009. ~~ ;~rt,~ ~ i _~ ~-"'f ( SEAL ) DORIS E. THOMSON Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address 5