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HomeMy WebLinkAbout06-17-11 (3)~,~•--~ 1505610148 REV-1500 EX (01-10) (~FICIAL USE ONLY PA Department of Revenue C%ounty Code Year File Number Bureau of Individual Taxes Po Box 2sosol INHERITANCE TAX RETURN 21 10 010 0 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 074-01-3401 09252010 03141914 Decedent's Last Name Suffix Decedent's First Name M I RIFE CHARLES J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 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) © 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 11. Election to tax under Sec. 9113(A) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number TIMOTHY C WAGGONER, CPA 7:L7-506-1222 First line of address WAGGONER FRUTIGER & DAU Second line of address 5006 E TRINDLE RD City or Post Office State ZIP Code MECHANICSBURG PA 17050 Correspondent's e-mail address: T W A G G O N E R a1i W F D C P A• 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 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. SI TURE OF P N R~jSPO E FOR LING RETURN DATE AD SS (~ ~ / -----1 l~~ 3~'i. a 1- SI NATURE OF P ARER OTHER TH PRESENTATIVE DATE WAGGONER, FRUTIGER DAUB, LLP ADDRESS 5006 E TRINDLE RD SUITE 200 MECHANICSBURG, PA 17050 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610148 9M46474.000 1505610148 REGISTER OF WILLS USE OI~I,,Y ~ !`~1 ~ ~ ~ `"'v3~ -~ ~~~ ~. ~J ©`rt`- ~ CJ7 r~ `;T:7 ~. ..,~.~ I~ :~~ ~- ~ ~ ~~ -~ Estate of Charles J. Rife Executors (Page 1) Name Fred H. Junkins Address 12 Houston Drive 074-01-3401 Mechanicsburg, PA 17050-1611 Tax ID 192-34-0428 • , 1505610248 REV-1500 EX Decedent's Social Security Number 074-01-3401 decedent's Name: RIFE C H A R ~_ E S _ J RECAPITULATION 1. Real Estate (Schedule A) 1 4 0 0, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) . 2. 2 , 2 5 0 , 9 7 7.0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) 4, 4 7 0 , 41, 3.0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, 1,12 9 , 5 3 6.0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 0 . 0 0 8. Total Gross Assets (total Lines 1 through 7) 8 4 , 2 5 0 , 9 2 6.0 0 9. Funeral Expenses and Administrative Costs (Schedule H), , 9. 2 51, 3 3 4.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 6 , 2 3 7.0 0 11. Total Deductions (total Lines 9 and 10) , 11. 2 5 ? , 5 71.0 0 12. Net Value of Estate (Line 8 minus Line 11) 12, 3 , 9 9 3 , 3 5 5.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13, 1, 3 9 4 , 3 3 3.0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 2 , 5 9 9 , 0 2 2.0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2) x .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 t xable 0 4 ~ t li l X t nea ra . a e 0.0 0 16. 0 • 0 0 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 rateX .15 2, 599, 022.00 18. 389, 853.00 19. TAX DUE . 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 389, 853.00 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ai. i.n ni.nn~, DECEDENTS NAME STREET ADDRESS CITY MECHAN CSBURG STATIE FlA ZIP 705 - Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 3 0 0, 0 0 0. 0 0 B. Discount 0 • 0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 389, 853.00 300, 000.00 (3) 0.0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8 9 , 8 5 3 • O O 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: i h Yes ^ No n t a. reta e 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 Dec. 12, 1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? . ,~ " " ^ 3. Did decedent own an in trust for or payable-upon-death bank account or security at his or her death? 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ^ contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 'G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(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. Total Credits (A + B) (2) 9M4671 2.000 REV-1502 EX + (01-10) pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Charles J. Rife _ 21 10 01006 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 that 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. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Residence - 1849 Fisher Road Mechanicsburg, PA 17055 Value based on gross sale price per settlement sheet attached swasss 2.000 TOTAL (Also enter on Line 1, Recapitulation.) S If more space is needed, use additional sheets of paper of the same size. 400,000 400,000 REV-1503 EX ; (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles J. Rife _ 21 10 01006 All property jointly-owned with right of survivorship must be disclosed on ;3chedule F. ITEM DESCRIPTION NUMBER 1.12.164361 Shares Ericsson L M Tel Co Adr B Sek 10 The Nasdaq Stock Market Llc CUSIP: 294821608 2 254.674812 Shares Hewlett Packard Co Com New York Stock Exchange CUSIP: 428236103 Dividend accrued on 9/25/2010 3 37,151.83 Shares Templeton Fds Inc World Fd C1 A Mutual Fund (As Quoted By Nasdaq) CUSIP: 880196100 4 11,376.13 Shares T Price Intl Fds Inc Intl Stk Fd Mutual Fund (As Quoted By Nasdaq) CUSIP: 77956H2O3 5 38,338 Shares Allied Irish Bks P L C Spon Adr Ord New York Stock Exchange CUSIP: 019228402 6 753 Shares Bank Of America Corporation Com New York Stock Exchange CUSIP: 060505104 7 1 Share . Berkshire Hathaway Inc Del C1 A New York Stock Exchange CUSIP: 084670108 8 4,026.5931 Shares Emerson Elec Co Com New York Stock Exchange CUSIP: 291011104 9 2,900.9946 Shares Exxon Mobil Corp Com New York Stock Exchange CUSIP: 302316102 VALUE AT DATE OF DEATH 132 10,521 20 520,126 152,440 57,986 10,120 125,415 213,450 179,315 Total from continuation schedules _ 981,452 TOTAL (Also enter on line 2, Recapitulation) $ 2 , 2 5 0 , 9 7 7 SCHEDULE B STOCKS & BONDS 3wasss 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Charles J. Rife 21 10 01006 Schedule B (Page 2) Item Value at Date No. Description of Death 10 190 Shares Frontier Communications Corp Com New York Stock Exchange CUSIP: 35906A108 1,529 Dividend accrued on 9/25/2010 36 11 5,210.1286 Shares General Electric Co Com New York Stock Exchange CUSIP: 369604103 85,980 Dividend accrued on 9/25/2010 625 12 528 Shares International Business Machs Com New York Stock Exchange CUSIP: 459200101 70,620 13 792 Shares Verizon Communications Inc Com New York Stock Exchange CUSIP: 92343V104 25,873 14 1,901.142 Shares Vanguard Horizon Fd Inc Captl Opp Adm Mutual Fund (As Quoted By Nasdaq) CUSIP: 922038500 130,114 15 1,978.213 Shares Vanguard Horizon Fd Inc Global Eqt Ptf Mutual Fund (As Quoted By Nasdaq) CUSIP: 922038203 32,997 16 5,346.091 Shares Vanguard Specialized Portfolio Healthcare Adm Mutual Fund (As Quoted By Nasdaq) CUSIP: 921908885 274,201 17 111.243 Shares Vanguard Index Fds 500 Portfolio Mutual Fund (As Quoted By Nasdaq) CUSIP: 922908108 11,760 18 2,720.513 Shares Vanguard/Primecap Fd Inc Admiral Shares Mutual Fund (As Quoted By Nasdaq) CUSIP: 921936209 171,147 19 878.299 Shares Vanguard Tax-Managed Intl Fd Cap Appreciate Mutual Fund (As Quoted By Nasdaq) CUSIP: 921943205 24,961 Total (Carry forward to main schedule) 829,843 Estate of: Charles J. Rife 21 10 01006 Schedule B (Page 3) Item Value at Date No. Description of Death 20 3,602.729 Shares Vanguard/Windsor Fd Inc Windsor II Inv Mutual Fund (As Quoted By Nasdaq) CUSIP: 922018205 85,385 21 1,600 Shares Hewlett Packard Co Com New York Exchange 66,096 Dividend accrued on 9/25/2010 128 Total (Carry forward to main schedule) 151,609 REV-1507 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE D MORTGAGES & NOTES RECENABLE ESTATE OF FILE NUMBER Charles J. Rife 21 10 01006 All property jointly-owned with right of survivorship must be disclosed on Schs~duls F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 John Maxwell/CJR, LLC 3~ Note receivable, dated 11/22/2008 397,000 Interest accrued to 9/25/2010 10,157 2 Steven Maxwell 3~ Note receivable, dated 01/23/2009 61,990 Interest accrued to 9/25/2010 1,266 3wasAC ~.ooo TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of same size) 470,413 REV-1508 EX + (s-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Charles J. Rife 21 10 01006 _ Include the proceeds of litigation and the date the proceeds were received by thie estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash in wallet 25 2 M&T Bank - Checking Acct No. 9849838140 valued at date of death 11,264 3 Traveler Checks 30 4 Vanguard Money Mkt Resvs Inc Prime Portflio CUS I P: V1~IIrtXX 21, 4 3 7 5 Household furnishings valued based on net public auction proceeds per attached statement 15,507 6 Personal property transferred pursuant to list maintained with will (see attached schedule) - Destiny Heilig 60 7 Personal property transferred pursuant to list maintained with will (see attached schedule) - Doris Junkins 3,100 8 Personal property transferred pursuant to list maintained with will (see attached schedule) - John Maxwell 2,300 9 Personal property transferred pursuant to list maintained with will (see attached schedule) - Steven Maxwell 1,110 10 Personal property transferred pursuant to list maintained with will (see attached schedule) - Susan Heilig 120 11 Personal property transferred pursuant to list maintained with will (see attached schedule) - Fred Junkies 200 12 3 - Gold Coins - Safe Deposit Box; 2-$10 Liberty, 1-$10 Indian, and 1-$5 Liberty valued based on appraisal from D&S Coins 2,650 13 Internal Revenue Service 2010 tax refund 4,673 Total from continuation schedules 1,067,060 TOTAL (Also enter on line 5, Recapitulation) $ ( 1, 12 9 , 53 6 3wasAO ~.ooo (If more space is needed, insert additional sheets of the same size) Estate of: Charles J. Rife 21 10 01006 Schedule E (Page 2) Item Value at Date No. Description of Death 14 PA Dept of Revenue 2010 tax refund 751 15 T Rowe Price Variable Annuity Valued per attached report 575,596 Interest accrued to 9/25/2010 355,009 16 Vanguard/Windsor Fd Inc Windsor II Admiral Mutual Fund (As Quoted By Nasdaq) IRA Rollover CUSIP: 922018304 135,704 No beneficiary designation, payable to the estate Total (Carry forward to main schedule) 1,067,060 REV-1511 Exr (10-09) SCHEDULE H pennsylvania DEPARTMENrOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles J. Rife _.21 10 01006 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION _ AMOUNT A. FUNERAL EXPENSES: ~. Gingrich Memorials Headstone 2,075 Total from continuation schedules I 4,063 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 101, 000 Name(s) of Personal Representative(s) Fred H . Junkies Street Address 12 Houston Drive City Mechanicsburg State PA ZIP 17050 Year(s) Commission Paid: 2 011 2. Attorney Fees: 9 6, 0 0 0 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: 5. Accountant Fees: 35,000 6. Tax Return Preparer Fees: 7. 1 PP&L Electric Electric utilites 581 2 Waste Management Trash utilities 1,194 Total from continuation schedules 11,421 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 2 51, 3 3 4 swas,ac 2.00o If more space is needed, use additional sheets of paper of the same size:. Estate of: Charles J. Rife Schedule H Part 1 (Page 2) Item No. Description 2 Malpezzi Funeral Home Funeral services 3 Post Funeral Family Meal 4 Aver Cremation Services Cremation services 21 10 01006 Amount 3,740 238 85 Total (Carry forward to main schedule) 4,063 Estate of: Charles J. Rife 21 10 01006 Schedule H Part 7 (Page 2) 3 ACCP, Inc - Real estate closing costs net of real estate tax reimbursements 4,004 4 Steve Barrett Real estate appraiser for personal residence 525 5 Postage 62 6 Peerless Insurance Property insurance 7g 7 Travelers Insurance 191 8 Bob Hering Public auction labor 800 9 Scott Junkins Public auction labor 60 10 Howard Himes Public auction labor 120 11 Robert Himes Public auction labor 120 12 Paul Junkins Public auction labor 120 13 Ritters Hardware Supplies 95 14 John Krause Public auction labor 240 15 Canopy Rental Auction services 360 16 Porta-John Rental Auction service 155 17 Dick Riley Public auction labor 330 18 Don Cook Public auction labor 780 19 Mike Spangler Public auction labor 80 Total (Carry forward to main schedule) 8,121 Estate of: Charles J. Rife 21 10 01006 Schedule H Part 7 (Page 3) 20 Destiny Heilig Public auction labor 80 21 Suburban Propane Gas utilities 878 22 Chuck Bricker Auctioneer and personal property evaluation services 450 23 Patriot News Legal notices 155 24 Susie Heilig Public auction labor 80 25 Cumberland County Law Journal Estate notice publication 75 26 Waggoner Frutiger & Daub, CPAs 2010 tax and accounting services 400 27 Susie Heilig Public auction labor 687 28 Susie Heilig Public auction labor 495 Total (Carry forward to main schedule) 3,300 REV-1512 EX + (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES at LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles J. Rife 21 10 01006 _ Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unneimbursed medical expenses. (TEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. _ PP&L Electric Electric utilites 126 2 Susie Heilig Medication 30 3 Postage 28 4 Capital Blue Cross Health insurance 172 5 ATT Credit Services - medications 381 6 Paytime Payroll Service Payroll services for caregivers 747 7 Peggy Densham Caregiver labor 257 8 Peggy Densham Caregiver labor 622 9 Susie Heilig Caregiver labor 1 044 10 Ratters Hardware Supplies 54 11 Verizon Telephone Telephone utilities 362 12 Waggoner Frutiger & Daub, CPAs 2010 tax return preparation 1,200 13 Internal Revenue Service 4th quarter estimate 1,214 TOTAL (Also enter on Line 10, Re<;a~itulation) ~ S 6 , 2 3 7 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: t.11ai 1Ci3 V . 1C11C 21 1 0 01006 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Liist Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1. Destiny N. Heilig Personal property transferred pursuant to list maintained with will (see attached schedule) - Destiny Heilig Inventory Value: 60 None 97,664 2 Donna Kunkel None 306,754 3 Doris J. Junkins Personal property transferred pursuant to list maintained with will (see attached schedule) - Doris Junkins Inventory Value: 3,100 None 100,704 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. 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: 1~ See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 1, 3 9 4 , 3 3 3 ~~ nivra spaces is neeaea, use aaoltlonal sneers or paper or me same sr,-_e. 9 W46AI 2.000 Estate of: Charles J. Rife Schedule J Part 1 (Page 2) 21 10 01006 Item No. Description Re]Lation Amount 4 Elaine Rosato None 97,603 5 Jennifer Elyard None 306,754 6 Leslie Atherton None 97,604 7 Linda Niziolak None 167,320 8 Peggy Densham None 125,490 9 Susan Heilig Personal property transferred pursuant to list maintained with will (see attached schedule) - Susan Heilig Inventory Value: 120 None 97,724 10 John W W. Maxwell Personal property transferred pursuant to list maintained with will (see attached schedule) - John Maxwell Inventory Value: 2,300 Nephew 301,086 11 Steven A. Maxwell Personal property transferred pursuant to list maintained with will (see attached schedule) Steven Maxwell Inventory Value: 1,110 Nephew 299,896 12 Douglas Maxwell Nephew 199,191 13 Barry Maxwell Nephew 199,191 14 Sherri Maxwell Niece 199,191 Estate of: Charles J. Rife Schedule J Part 1 (Page 3) Item No. Description 15 Fred Junkins 3 - Gold Coins - Safe Deposit Box; 2-$10 Liberty, 1-$10 Indian, and 1- $5 Liberty valued based on appraisal from D&S Coins Inventory Value: 2,650 Personal property transferred pursuant to list maintained with will (see attached schedule) - Fred Junkins Inventory Value: 200 None Relation 21 10 01006 Amount 2,850 Estate of: Charles J. Rife Schedule J Part 2B (Page 1) Item No. Description 1 Harrisburg Hospital 111 South Front Street Harrisburg, PA 17101-2099 2 Harvard Medical School 25 Shattuck Street Boston, MA 02115 3 Holy Spirit Hospital 503 North 21st Street Camp Hill, PA 17011 4 Lehigh University 27 Memorial Drive West Bethlehem, PA 18015 5 Massachusetts Eye & Ear Ex Resident Association 243 Charles Street Boston, MA 02114 6 Massachusetts Institute of Technolgy 77 Massachusetts Avenue Cambridge, MA 02139 7 Mechanicsburg Area Foundation The Foundation for Enhancing Communities 200 North Third Str, 8th Floor Harrisburg, PA 17108-0678 8 Messiah College One College Avenue Grantham, PA 17027 9 Pennsylvania Hospital 800 Spruce Street Philadelphia, PA 19107 10 Reformed Mennonite Church 54 North Middlesex Road Carlisle, PA 17013 11 Wills Eye Ex Resident Association 840 Walnut Street Philadelphia, PA 19107 21 10 01006 Amount 55,773 97,603 83,660 97,603 97,603 97,603 348,584 348,584 41,830 27,887 97,603 ESTATE OF CHARLES j. RIFE SSN: 074-01-3401 DOD: 09/25/2010 PENNSYLVANIA INHERITANCE TAX RETURN INDEX TO EXHIBITS Document Return Reference 1. Last Will and Testament Page 1, Line 6 2. HUD -Settlement Sheet Schedule A, Item 1 3. EstateVal Report Schedule B, Items 1-22 Schedule E, Item 16 4. Chuck Bricker, Auctioneer Settlement Report dated 04/02/2011 Schedule E, Item 5 5. Personal Property Transferred Pursuant To List Maintained With Will Schedule E, Items 6-12 7. Safe Deposit Box Inventory D&S Coins Valuation Report dated 05/19/2011 Schedule E, Item 12 8. T. Rowe Price Correspondence dated 06/01/2011 Schedule E, Item 15 9. Calculations Of The Estate Distributions Schedule J, Part I Items 1-15 Schedule J, Part II B Items 1-11 LAST WILL AND TESTAM NT BE IT REMEMBERED THAT I, CHARLES J. RIFE, a resident of Cumber and County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMEN ,hereby revoking any and all Wills and Codicils previously made by m.e, as favell as The Charles J. Rife Living Trust which I signed May 21, 2007 and ail modifications or changes which were made to that Trust. I I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after m~j decease. II I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the ,administration of my estate. III I give and bequeath items of personal property to specific individuals that I have set forth in a list which I have prepared, signed and maintain with this Will. IV I give, devise and bequeath all the rent, 'residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, as follows: A. THIRTY-FIVE PERCENT (35%) to charitable and non-profit organizations as hereinafter set forth: Reformed Mennonite Church, Middlesex Township 2% (This is the church attended by Glen Cxross. If there is any question about the exact identify of this church, then my Executor shall have full authority to determine what entity receives this b~eq~uest.) Holy Spirit Hospital 6% Pennsylvania Hospital (8th & Spruce, Phi adelphia) 3% Harrisburg Hospital ~ 4% I Massachusetts Institute of Technology i ~% i Harvard Medical School ~ 7% Wills Eye Ex Residents Association ~ ?% Massachusetts Eye 8v Ear Ex Residents Association 7% Lehigh University 7% Messiah College 25% Mechanicsburg Area Foundation 25% If any of the bequests in this Section A should lapse or not be able to be paid to the institution designated, then that t-equest shall be divid ed e uall q y among the other organizations in this Section. B. THIRTY-FIVE PERCENT (35%) to individuals, as follows: Elaine Rosato, per capita 7% Leslie Atherton, per capita 7% Doris J. Junkins, per capita 7% Linda Niziolak, per capita 12% Jennifer Elyard, per capita 22% Donna Kunkel, per capita 22% Susan Heilig, per capita 7% Peggy Densham, per capita 9% Destiny N. Heilig, per capita 7% If any of the individuals named in this Section B shall predecease me, then the share that would have gone to that individual shall be divided equally among the surviving identified individuals in this Section. 2 C. THIRTY PERCENT (30%) to heirs of C THERINE R. MAXWELL, as follows: John W. Maxwell, per stirpes 25% John has received money from me in the form of a loan. If that loan has not been repaid in full, then the unpaid balance of the loan shall be offset against what he receives from my estate. Any such offset funds shall be distributed equally among these five designated. heirs of Catherine Maxwell. If the loan balance exceeds this distributive share, any remaining debt shall be forgiven. Steven A. Maxwell, per stirpes 25% Steven has received money from men in the form of a loan. If that loan has not been repaid in full, then the unpaid balance of the loan shall be offset against what he receives from my estatc~. Any such offset funds shall be distributed equally among these five designated heirs of Catherine Maxwell. If the loan balance exceeds this distributive share, any remaining debt shall be forgiven. Douglas Maxwell, per stirpes 16 1 / 3 Barry Maxwell, per stirpes 16 1 / 3% Sherri Maxwell, per stirpes 16 1 /3% V The house in which I reside has been in rciy family for many years. I direct that when the residence along with the approximately ten acres on which it is erected is conveyed that a deed restriction be inserted which would prohibit any further subdivision of that real property. VI I nominate, constitute and appoint FRED H. JUNKINS as Executor of this LAST WILL, to serve without bond. If FRED H. ,JUNKINS is unable or unwilling to act in that capacity, then I nominate, constitute and appoint M&T BANK, as Executor of this LAST WILL, to serve without bond. 3 IN WITNESS WHEREOF, I, CHARLES ,J. RIFE, have set my hand to this LAST WILL this ,~r'~-'~ ~ day of ~~; ~~- 2009. CHARLES J. RI E Signed, sealed, published and declared by the above-named CHARLES J. RIFE, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. /. °~ ~~ ~. 4 i I ACKNOWLEDGE;MENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND css. I, CHARLES J. RIFE, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the irtstrum~nt as my LAST WILL; that I signed it as my free and voluntary act for the F~urposes therein expressed. i CHARLES J. FE Sworn or affirmed to and acknowledged bc~fo.re me by CHARLES J. RIFE, Testator, this ~ D ~~ day of ~C~~.~S-fi , 2009. ~ . // /~~'1 "~ i 7'~~ Notary lic ~. ..__ NOTARIAL SEAL--~ DIANE M SMITH Notary Publlc MECHANICSBURG BORO, CUMBERLAND CNTY My Commisslon Expires J un 22, 2012 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, (j /,/ /1-~~1- ~ ~ . S; ~ ~/~ and ~f rr.-~((f.`~. l~, ~~~i~G rrL ~~~-/ _~_ ~/ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do de os; and saw Testator sign and execute the instrument as hhs LAST WILL ethat CHARLES J. RIFE signed willingly and that :he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. L ~ jq a~ Sworn or affirmed to and acknowledged before me this ~G`~ day of ~~-~,,~~-Z tS1-- 2009. ~ ~ ~' Notary Public NOTARIAL SEAL DIANE M SMITH Notary Public cJ MECHANICSBURG BORO, CUMBERLANDCNIY My Commisslon Expires Jun 22, 2012 SUBSTiTL1TE FORM 1099 SELLER STATEMENT; The Mformatlon contained heroin h Important tsx Mformation and b being fumishad b the Intamal Re~tinua SsMCe. N you are roqulred to file a rotum, • na pence penally a other sanction will be imposed on you N this Ibm la roqulrsd to be reported and fhs IRS datsrminp Nat k has not been ropoRed. Ths Cantroel Sales Price described on line 1 above oonstltutes fha Grow Pmeseds of tlrle Innsee0on. SELLER INSTRUCTIONS: NMIe rosl estate was your pAnelpal nsldanea, Hla Form 2119, Sala or Exchange of PAndpal Raaldanea, for eny gain, wkh your Inwme tax rotum; for othertrsnsactions, eompkte Iha appllable parts of Forrn 4797, Fortn 8252 and/or Schedule D (Form 1040). You ere roqulrod bylaw to provide the astttemant agent (Fed. Tax ID No: with your comset taxpayer Idsngfleatlan number. Ifyou do not prodda your comeel taxpayer Wen00eation number, you may be subject m Gvll or alminel penalties imposed by law. n er pane se perjury, I certify Ihet the number shown on Ihls sLtsmsnt le my corral taxpsyer IdentMcstion number. TIN: / SELLER(S) SIGNATURE(S): / SELLER(S) NEW MAILING AOORESS: Provloua adlgona are obsolete form HUD-1 (3/BB) rel Handbook 4305.2 A. Settlement Statement u.s. D9D9rtmanf of Hniretnn e...l i 1.1...., n_.._i__-__. Previous editions are obsolete U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number. MT2011.32 C~TTI C~ACAIT CTATGAALAIT form HUD-1 (3/B6) ref Hsndliook 43062 PAGE 2 - - - - - - ------ - - ~ ~A i a .~tsm ment;~em L. SETTLEMENT CHARGES PAID FROM PAID FROM _ 700. TOTAL SALES/BROKER'S COMMISSION based on rice 400 000.00 0.000 = BORROWER'S SELLER'S _ Division of commission line 700 as follows: FUNDS AT FUNDS AT _ 701' to SETTLEMENT SETTLEMENT 702. to - _ 703. Commission aid at Settlement _ 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801, Lo n Orl inatlon Fee 802, Lo n Dlscoun 803. rafsai Fee _ 804. Credit Re rt 805. -' 806, -' 807, 808. 809. 810. 811. - 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE _ 901. Interest From to Ida _ 902. Mort a Insurance Premium for months to _ 903, Ha rd Insurance Premium for earo to 904. 905. _ 1000. RESERVES DEPOSITED WITH LENDER FOR _ 1001. Hazard Insurance 2 mo. /m0 _ 1002. Mort a e Insurance 2 mo. /mo _ 1003. Cit Pro Tax 2 mo. !mo _ 1004. Coun Pro Tax mo, /mo _ 1005. School Taxes mo. mo _ 1009, A r ate Anal sis Ad'uslment 1100. TITLE CHARGES 1101. Settlement or Closin Fee 1102. Abs ract or Title Search 1103. Title Examination 1104. Title Insurance Binder 1105. Document Pre aration 1106. Nota Fees 1107. Attome 's fees to Saldis Sullivan 8 Ro ers 824.00 Includes above ftems No: 1108. Title Insurance to Abstract Com an of Central P Inc. 2122.88 includes above items No: 1109. Lender's Polic 1110. Owner's Poli 400 000.00 •2122.88 _ 1111, Attome 's Fees to Murrel Walters POC 1112. 1113. - 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES ~ _ 1201. Recordin Fees Deed 54.00 ~ • Mort a e • Release 54.00 _ 1202. Cit / ount tax/stam s Deed 000,00 • Mort a e 4 000.00 _ 1203. State Tax/stam s Deed 000.00 ' Mort a e 4 000.00 1204. Par I Certification to Recorder of Deeds 10.00 _ 1205 Deed ~ o a e • Release _ 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve 1302, 2011 Cou /Tw Taxes to Dennis Zerbe 476.50 1303. 1304. 1305. 1306. 1307, 1308, _ 1400. TOTAL SETTLEME ARGES enter on lines 103 Section J and 502 Section _ 7 010.88 4 476.50 nuu t;en ~ ~r i~,.v~ ~uN Ur tlUrErt ANO SELLER t haw arafullyy reviewed HUD-1 ent t snt and to tlrs beat of my knovAedps and belief, II Is a true and aoarate stetemenl of slJ.recet ,end dlabursements made on my account or by me In tMe benseetlon. I fu eerllfy tha a copy or the HUD-1 Settlement Stetament. V r n nn - e ne i 1 s e WARNING; IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION The HUD-1 S enl S e which I hew prepered Is a bus end accurele exount of this transaeUan. I have csua or will ca e s nds to be disbursal In sixord a with thla t t t CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE T1TLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. s a emen . ,~ Estate Valuation Date of Death: 09/25/2010 Estate of: Charles J Rife Valuation Date: 09/25/2010 Report Type: Date of Death Processing Date: 06/06/2011 Number of Securities: 24 File ID: Rife Estate 9-25-2010 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 12.164361 ERICSSON L M TEL CO (294821608; ERIC) ADR B SEK 10 The NASDAQ Stock Market LLC 09/24/2010 10.94000 10.79750 H/L 09/27/2010 10.90000 10.70000 H/L 10.834375 131.79 2) 254.674812 HEWLETT PACKARD CO (428236103) COM New York Stock Exchange 09/24/2010 41.70000 40.87000 H/L 09/27/2010 41.76000 40.91000 H/L Div: 0.08 Ex: 09/13/2010 Rec: 09/15/2010 Pay: 10/ 06/2010 41.310000 10,520.62 20.37 3) 37151.83 TEMPLETON FDS INC (880196100; TEMWX) WORLD FD CL A Mutual Fund (as quoted by NASDAQ) 09/24/2010 14.00000 Mkt :14.000000 520,125.62 4) 11376.13 ROWE T PRICE INTL FDS INC (77956H203; PRITX) INTL STK FD Mutual Fund (as quoted by NASDAQ) 09/24/2010 13.40000 Mkt :13.400000 152,440.14 5) 38338 ALLIED IRISH BKS PLC (019228402; AIB) SPON ADR ORD New York Stock Exchange 09/24/2010 1.57000 1.50000 H/L 09/27/2010 1.52000 1.46000 H/L 1.512500 57,986.23 6) 753 BANK OF AMERICA CORPORATION (060505104; BAC) COM New York Stock Exchange 09/24/2010 13.60000 13.30000 H/L 09/27/2010 13.63000 13.23000 H/L 13.440000 10,120.32 7) 1 BERKSHIRE HATHAWAY INC DEL (084670108; BRKA) CL A New York Stock Exchange 09/24/2010 128730.00000 122994.00000 H/:L 09/27/2010 125758.00000 124177.00000 H/:L :1 25414.750000 125,414.75 8) 4026.5931 EMERSON ELEC CO (291011104; EMR) COM New York Stock Exchange 09/24/2010 53.82000 51.66000 H/L 09/27/2010 53.65000 52.91000 H/L 53.010000 213,449.70 9) 2900.9946 EXXON MOBIL CORP (302316102; XOM) COM New York Stock Exchange 09/24/2010 62.13000 61.36000 H/L 09/27/2010 62.07680 61.68000 H/L r 6:1.811700 179,315.41 10) 190 FRONTIER COMMUNICATIONS CORP (35906A108; FTR) COM New York Stock Exchange 09/24/2010 8.09000 7.81000 H/L 09/27/2010 8.29000 7.99000 H/L 8.045000 1,528.55 Div: 0.1875 Ex: 09/07/2010 Rec: 09/09/2010 Pay: 09 /30/2010 35.63 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) _ Date _ __.. _T _. _. _-. ___ _. __- _._- _ __. of Death: 09/25/2010 -_ Estate of: Charles J Rife Valuation Date: 09/25/2010 Report Type: Date of Death Processing Date: 06/06/2011 Number of Securities: 24 File ID: Rife Estate 9-25-2010 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 11) 5210.1286 GENERAL ELECTRIC CO (369604103; GE) COM New York Stock Exchange 09/24/2010 16.66000 16.30000 H/L 09/27/2010 16.65000 16.40000 H/L 16.502500 85,980.15 Div: 0.12 Ex: 09/16/2010 Rec: 09/20/2010 Pay: 10/25/2010 625.22 12) 1600 HEWLETT PACKARD CO (428236103; HPQ) COM New York Stock Exchange 09/24/2010 41.70000 40.87000 H/L 09/27/2010 41.76000 40.91000 H/L Div: 0.08 Ex: 09/13/2010 Rec: 09/15/2010 Pay: 10/ 06/2010 41.310000 128.00 66,096.00 13) 528 INTERNATIONAL BUSINESS MACHS (459200101; IBM) COM New York Stock Exchange 09/24/2010 134.15000 132.34000 H/L 09/27/2010 135.00000 133.51000 H/L 133.750000 70,620.00 14) 792 VERIZON COMMUNICATIONS INC (92343V104; VZ) COM New York Stock Exchange 09/24/2010 32.68000 32.40000 H/L 09/27/2010 33.07000 32.52100 H/L :!2.667750 25,872.86 15) 1901.142 VANGUARD HORIZON FD INC (922038500; VHCAX) CAPTL OPP ADM Mutual Fund (as quoted by NASDAQ) 09/24/2010 68.44000 Mkt E~8.440000 130,114.16 16) 1978.213 VANGUARD HORIZON FD INC (922038203; VHGEX) GLOBAL EQT PTF Mutual Fund (as quoted by NASDAQ) 09/24/2010 16.68000 Mkt 16.680000 32,996.59 17) 5346.091 VANGUARD SPECIALIZED PORTFOLIO (921908885; VGHAX) HEALTHCARE ADM Mutual Fund (as quoted by NASDAQ) 09/24/2010 51.29000 Mkt 51.290000 274,201.01 18) 111.243 VANGUARD INDEX FDS (922908108; VFINX) 500 PORTFOLIO Mutual Fund (as quoted by NASDAQ) 09/24/2010 105.71000 Mkt 105.710000 11,759.50 19) 2720.513 VANGUARD/PRIMECAP FD INC (921936209; VPMAX) ADMIRAL SHARES Mutual Fund (as quoted by NASDAQ) 09/24/2010 62.91000 Mkt 62.910000 171,147.47 20) 878.299 VANGUARD TAX-MANAGED INTL FD (921943205; VMCAX) CAP APPRECIATN Mutual Fund (as quoted by NASDAQ) 09/24/2010 28.42000 Mkt 28.420000 24,961.26 21) 3602.729 VANGUARD/WINDSOR FD INC (922018205; VWNFX) WINDSOR II INV Mutual Fund (as quoted by NASDAQ) 09/24/2010 23.70000 Mkt 23.700000 85,384.68 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 09/25/2010 Valuation Date: 09/25/2010 Processing Date: 06/06/2011 Shares Security High/Ask Low/Bid 22) 21436.63 VANGUARD MONEY MKT KE5V5 1NC (VMMxXI PRIME PORTFLIO 09/25/2010 23) 3225.663 VANGUARD/WINDSOR FD INC (922018304; VWNAX) WINDSOR II ADM Rollover IRA Mutual Fund (as quoted by NASDAQ) 09/24/2010 24) 500 (865345102) Total Value: Total Accrual: Total: $2,408,116.30 Estate of: Charles J Rife Report Type: Date of Death Number of Securities: 24 File ID: Rife Estate 9-25-2010 Mean and/or Div and Int Security Adjustments Accruals Value 1.00000 1.000000 42.07000 Mkt X12.070000 21,436.63 135,703.64 N/A $809.22 T-~-_ ~-_.--- Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Sye3tems, Inc. if you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) . ~_ _ ` F a- ~ _ ~' .. ~ ~ ~~• ~c ~ ~ ~ ~ ~ ' •- . ( E - L ' ' ~ ~ O - t ~ c < _ • - . ~. - .. . .~~ . ,~ . _ ~- ~ ~ ~ A ' ;. .~~ ~. e ~~ ~ ®,.00 1 si~rac® ..,o. ~..~. ~ ~- - - - ~' ~.~ ~~ ~~ J ~ I ~ ~ !• V ~ • ~ ~` 1 j• ~ E J . C ~~ ~ V ~ L! 1 y ~~' ~..f i ~ ~1 ~ % ~~~, Z~~~ ~~ ~~~ ~' ~~.~~ ~~ PERSONAL PROPERTY TRANSFERRED PURSUANT TO LIST MAINTAINED WITH WILL These Items Were Transferred Prior to Public .suction JOHN 1~L~:XWELL VALUE English Grandfather Clock 2,200.00 Double Glass Door Bookcase 100.00 STEVEN I~~~:XWELL Walnut Blanket Chest 800.00 Wood Wheelbarrow 120.00 Taiwan Drill Press 40.00 Vise 10.00 6 Augers (5 pc) 30.00 Handsaws 20.00 Blow Torch 10.00 Draw Knife 10.00 Bench Grinder 20.00 Asst. Pliers 10.00 Asst. Wrenches 40.00 DORIS JLTNKINS Highcase Chest-O-Drawers 3,000.00 Doughtray 80.00 Wood Bookshelf 20.00 FRED JUNKINS Atmospheric Clock ~ 200.00 Coins in Safe Deposit Box SUSIE HEILIG Gate Leg Table 100.00 Bookshelf 20.00 DESTINY HEILIG Small Gate Leg Table 60.00 REV-485 EX+ (9-00) .$jY. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX: IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE .FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER 21 10-1006 074-01-•3401 DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH Rife Charles J. Se tember 25, 2010 ADDRESS OF DECEDENT (STREET (CITY) (STATE) (ZIP CODE) 1849 Fisher Road Mechanicsbur PA 17055 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) Miirre7 R_ WI~1 t _r~, ITI,~ E~~~i rP (STREET NAME) (CITY) (STATE) (ZIP CODE 54 E. Main Street Mechanicsbur PA 17055 NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) Fred H. Junkins (STREET NAME) (CITY (STATE) (ZIP CODE) 12 Houston Driue, Mechanicsburg, PA 17050 b. (NAME) (RELATIONSH'IP) (STREET NAME) (CITY (STATE) (ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) • NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) / ' 'f (STREET, N~M~) ~ s~ ,K ~' ;;,,[[ ` I'~Sv ~~/ !-E:~~`' (2~ ~[L`~ L~~~INL ~(~~%>~G /f~ (ST lE~ c7 `7 ~ (ZIP CODE) 1 NAME OF PERSON MAKING LAST ENTRY J J ~ C ~ 4 DATE AND TIME OF LAST ENTRY J~ 1. ~ i C ~ r, 3 -::? - ~ c: DATE OF CONTRACT TO RENT BOX NUMBER OF BOX TITLE UNDER WHICH BOX IS REQUESTED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) ~ b. (NAME ~ (STREET DDRESS j ~~k ~< s~f~ ,~ rz ~ (STREET ADD SS) ~ ~ ~i~~rc,, s`~ c~ ~ ~r~ (CI~TjY) (ST/A~TE) (ZIP CODE) l [ ~~r~~r,~,~ ~ ~~~~n~ /~~ />T 6 }j (CIT ~'rC"L~I~I~/~!~[ ~~ S ~L/~ C / CIE) - l.7 ~ CODE) ..,~U NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY N 1 ~~ iN ~ ~-~ ; ~,c Y G% nn,~'~ ~~ ~3~ ~:'D ~- .lu.~ ~c~,~ , ~ u~-c ~ ~4 T ~~cc. ,c W ~~,.~ -~ WAS A WILL IN THE BOX? ^ YES NO If yes, a . Date of will: b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) ? (CITY) STATE) ~ ~~ /'~ u vS" a N ~~ ~ ~-~~'r~l~ ~' ~ L s~~!~ C ~i1 ~ '7 ~ (ZIP CODE) ~ ~ c. Name and address of attorney, if any (NAME), _/U ~~C... ~C.~ ~ ' ~/'4 ~ ~~~~` (STREET NA ) ~~ E ~~ /9 ~ JV ~~ _ CITY) (STATE/~j (ZIP CODE) L f 1/~! ~ S ~ C ~ ~ /'" i1 ! ~ - / l- G .~C L / 's ~ SAFE ~EPOS~T SOX INVENTORY Page of INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name irl which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of b~~ok, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possiible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION _ S_ '~ (~ ~`~ ~~ ~f <{ 2 L ~ /~ Z L( L- JJ' _ "~ l ti C ~ ~ A :d ( .L ~(~ (~~I ~ (TL'r c ~(/T r' ~ ~ ~ s( /,c DES ~N ~ ~,ti' t ,t.~ cg ck ~ ~~.. G' ^L~.~.'C'2' ~4 L ~~/~(~ c -,2 t ~ h ~~ ~,'[° _ '~ '~ rC ~ ~~_~'~' L ~ l -~ ~=. _ tJ ~~~~ ~LLfs{' ~vl'>~ ~l1.+~ 13 ~ (r' /t L•~CI ~.:i (. ~- _. ~ -vAc~~~ C. ~ ~'..~~{~~/lQ ~Ltc_'~ ._ ~(~ n/ LvTL-~c?Q/l ~- L~/1~G' ~6~~'~.d1~c.~ /~~ '~i~' I CERTIFY UNDER PENALTY PE J RY T ,:SHE ABOVE RECORD IS CORRECT AND COMP T O T EST IVIY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE j SIGNATURE PRINT NAME PRINT NAME AND CHECK P OPRIA E BOX BELOW: PRINT TITLE C ~ '~ ~~ ~ DATE / (~~d (((l `~'' CHECK APPROPRIATE BOX' ~Executor(frix) ~ Administrator(trix) Estate Representative ~ Joint owner of safe deposit box Y~"~ ~{5"f NOTE: Attach additional 8'/z" x 11" sheet(s) if necessary or use duplicates of this page of form. D & S COINS 224 FOURTH STREET NEW CUMBERLAND, PA. 17070 (717) 774-4182 Customer's Order No. _ BOUGHT/SOLD TO ADDRESS PAYMENT METHOD - CASH DATE 5 `-~~~-~I CHECK QUAN. DESCRIPTION PRICE AMOUNT 2 ~~ ~ v~ ~ 7J~ _ ~~~ --- r~ i ALL Claims and Returned Goods MUST be accompanied By This Bill SIGNATURE '~ tp ~ -~ ~ ~ ,a,.. ~ ~ Q C ~ ~ ~ ~ r~ 4 U ~ ~ ~ C ,r.+ ~ C ~ ~' 'V Q :~z cti Q U ~ ?~ ~ ~ O ~ ' (,~ ' ~ p U ~~, C ~ ~ C ~ ~ ,~ ,{~ ~ C ~ C ~ V ~ ~ U ~ ~ ~ tJ fX ~ ~ ~ ~ ~ ~ ~ ~.r ~ ~ Q ~~ .~ O ~ q ,«.. ~ ~ ~ N ~ ~ C1 ~ ~ ~^ ~ C ~ w _ ~ W ~ ~ { ~ ~ ~~ ` ~ , Yli +, v, ~ Q) ~ ,© ~ ~ ~ ~ ~, i• p w „~ ` O C C~ i .~j [? ~ ~ ~ (~ ~ C ~ ~ ~ e ~ ~~ o ~C~ ~ ~ ,~~c~U ,~ ~ ~ ~~Q -~ ' ~ ~ ~ e ~ ate" ~ +r ~ ~~ ~~ ~ C ~ ~ ~ ~~~ ~ ~ ~ ;~ 1 ~~ ~ H N _~ ~ 0 ~ ~ ~Ca~ o~ ~; ~~ _ ~ ~ ~ ~U ~ ~ Q ~ ~ V~ ~ ~ . ~ ~, ~ ~ U ~ ~ ~ . d c_ ~ ~ .v ~ R: ~ U U ~ E= Harrisburg Hospital 4% 1.40% 55,773 55,773 Harvard Medical School 7% 2.45% 97,603 97,603 Holy Spirit Hospital 6% 2.10% 83,660 83,660 Leigh University 7% 2.45°~ 97,603 97,603 Massachusetts Eye and Ear Ex Resident Association 7% 2.45% 97,603 97,603 Massachusetts Institute of Technolgy 7% 2.45°~ 97,603 97,603 Mechanicsburg Area Foundation 25% 8.75% 348,584 348,584 Messiah College 25% 8.75% 348,584 348,584 Pennsylvania Hospital 3% 1.05% 41,830 41,830 Reformed Mennonite Church 2% 0.70% 27,887 27,887 Wills Eye Ex Resident Association 7% 2.45% 97,603 97,603 Total 1,394,333 1,394,333 Destiny N Heilig 7% 2.45% 97,604 60 97,664 Donna Kunkel 22% 7.70% 306,754 306,754 Doris 1 Junkins 7% 2.45% 97,603 3,100 100,703 Fred Junkins 0% 0.00% - 2,850 2,850 Elaine Rosato 7% 2.45% 97,604 97,604 Jennifer Elyard 22% 7.70% 306,754 306,754 Leslie Atherton 7% 2.45% 97,604 97,604 Linda Niziolak 12% 4.20% 167,320 167,320 Peggy Densham 9% 3.15% 125,490 125,490 Susan Heilig 7% 2.45% 97,604 120 97,724 Total 1,394,337 6,130 1,400,467 John W Maxwell 25% 7.50% 298,786 $ 2,300 301,086 Steven A Maxwell 25% 7.50% 298,786 $ 1,110 299,896 Douglas Maxwell 16.667% 5.00% 199,191 $ - 199,191 Barry Maxwell 16.667% 5.00% 199,191 $ - 199,191 Sherri Maxwell 16.667% 5.00% 199,191 $ - 199,191 Total 100.00% 1,195,145 $ 3,410 1,198,555 Grand Total 3,983,815 15,670 3,993,355 Gross Estate $ 4,250,926 Bequests (9,540) Less Debts (6,236) Funeral (6,138) Admin Exp (114,197) Fees (131,000) Debts &Admin (257,571) Residue $ 3,983,815 $ 9,540 $ 3,993,355 Charitable @ 35% (1,394,335) Net 2,589,480 Add bacik Bequests 9,540 PA taxable $ 2,599,020