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Home My WebLink About07-06-112505620205 RC\ /~ +~ ~00 EX (oz-iij (FLL} ~ OFFICIAL USE ONLY PA Departmera cf Revenue Pennsylvania r - >_ .= County Code Year File Number Bureau o~ Individual Taxes INHERITANCE TAX RETURN _._ PO BOX z806o1 ,'1 ' ~ ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ,~ j ~ (. ~ ~ ~`' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYY'~` 202-20-9047 11 /24/2010 .07/08/1926 Decedents Last Name Suffiix Decedent's First Name I~t11 Ledebohm Rhea L {If Applicable) Enter Surviving Spouse's Information Belaw Spouse's Last Name Suffix Spause s First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainde Return {Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise tdate of ~,? 5. Federal E:;tate Tax Return Rerluired death after 12-12-82} Q n. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Nurn'.er of Safe Deposit Boxers (Attach Copy of WilO {Attach Copy of Trust.) O Q. Litigation Proceeds Received O 1Q. Spousal Povarty Credit {Date of Death O 11. Election tc Tax under Sec. 311 3fA; Between 12-31-91 and 1-1-95) {Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Day#ime Telephone Number L. Renee Lieux, Esquire (717) 731-1700 First line of Address Bybel Rutledge LLP Second Line of Address 1017 Mumma Rd Ste 302 City cr Post Office Lemoyne Stale ZIP Code PA 17043 WILLS US6-ONLY.-a._,l-fin ~.) ;' , ~ ~'~-- C-, ~ti r ; -L' ~ 7 t'-- " " CT-1 I _ i , C-}~-,~ _--. ~ ~ . ~J --a .. ~ ' b '"DATE FILED '. ~~ , ~ Q ; --rl Correspandent°~ a-mail aadress: lieux@bybelrutledge.com under oenaities of perjury, 3 declare that I have examined this return, including accompanying schedules and statements, and to the. best of my knowledge ar,d belief, it is true, correct and complete. Declaration of prepares other than the personal representative is based on all information of which prepares has any knc~~ledge. Si TF P O ~SPO LE FOG RETURN ~Dj~TE~ 1~~/' ~ R'=SS !/ ames I~-. Bailey, III, 3820 Centerf~d Road, Harrisburg, PA 17109 51 U E RERARER OT~ER PiRESENTATIVF! /DATE , ADDRESS Bybel Rutledge LLP, 1017 Mumma Road, Suite 302, Lemoyne, PA 17043 PLEASE l1SE ORIGINAL FORM ONLY 2505620205 Side 1 2505610105 l~ ~~ J REV-15ao ~x (FI} Decedents Name: Rhea L. LedebOhm 7,5~567,Q2~5 Decedents Social Security Number 202-20-9047 RECAPITULATION 1 Real Estate ?;schedule A} ............................................. 1. 175,694.54 2 Stacks and Bands (Schedule B} ........... . ........................... 2. 3. Closely Held Corporation, Partnership or Saie-Proprietorship {Schedule C) .. , .. 3. 4 Mortgages and Notes Receivable {Schedule C1} ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E}....... 5. 525,343.21 6. Jointly Owned Property (Schedule F) O Separate Billing Regtvested ....... 6. 7. Inter-Vivos Transfers & h~iiscellaneous Non-Probate Property {Schedule G) O Separate Billing Requested........ 7. 8 Total Gross Assets (total Lines 1 through 7} . ........................ . . . . 8. 701,037.75 9 Funeral Expenses and Administrative Costs {Schedule H) ................. .. 9. 29,631.35 10 Debts of Decedent, (~lartgage Liabilities and Liens (Schedule I1 ... . ......... .. 10. 4,753.83 11 Total Deductions {total Lines 9 and 10} ............................... .. 11. 34,385.18 12 Net Value of Estate {Line 8 minus Line 11) ............................ .. 12. 666,652.57 13 Charitable and Governmental Bequests/Sec 9113 Trusts far which an election to tax has not been made (Schedule J} .......... . . . . ........ .. 13. 621.00 14 Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 666,031.57 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, ar transfers under Sec. 9116 (a?(1,21 X ,0 15. 1~ Amount of Line 14 taxable at lineal rate X .(? 45 16. 1 T Amount of Line 14 taxable at sibling rate X .12 23,977.14 17. 23,977.14 18 Amount of Line 14 taxable at collateral rate x .15 69,933.32 18 69,933.32 19 TAX ouE ....................................................... ..19. 93,910.46 20 FILL IN THE OVAL IF YOU ARE REGIUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 7,50561®205 7,5~561,Q~D5 RE~1-1500 EX ('~"I) Pane; dire Number Decedent's Complete Address: Rhea L. Ledebohm STREET ADDRESS 355 S. Sporting Hill Road CITY Mechanicsburg STATE Z!P PA 1700 Tax Payments and Credits: 1. Tax Due iPage 2, Lane 19} 2. Cred;tsiPayments A Prior Payments 98,700.00 B Dsco~nt 4,695.53 3. Interest 4. If Line 2 !s greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. fill in oval on Page 2; Line 20 to request a refund. 5. If Line 1 -- Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 93,910.46 103,395.53 9.485.07 i~l Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN '°X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .................................................................................. ... ^ b. retain the right to designate who shall use the property transferred or its income .........................._............ .. ^ c. retain a reversionary interest ........................................................................................................................... d. receive the promise for life of either payments, benefits or care? ................................................................... 2. if death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................................................................._ ..._.. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death?........ _ _.. ^ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ............................................................................. contains a beneficiary designation? ....................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995; the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [?2 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 far the use of the sun,•iving spouse is 0 percent [72 P.S. §9110 (a' 1.1) (iij]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements far 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 fer 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 iineal beneficiaries is 4.5 percent, except as noted in [72 PS. §9116{a)(1 j]. 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}(1.3j]. 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. Total Credits (A + B) (2} (31 i4j F~ ;~ i`~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Rhea L. Ledebohm 21-10-1179 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. If more space is needed, insert additional sheets of the same size. A. Settlement Statement (HUD-1) OMB Approval No. 2502-0265 FINAL 1. ®FHA 2. Q RHS 3. ^Conv. Unins. 6. File Number. 7. Loan Number. 8. Mortgage insurance Case Number: SL11156 234042244 4. ~] VA 5. Q Conv. Ins. C. Note: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown ttems marked "(p.o.c)" were paid outside the closing; they are shown here for infomtational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: Steven L Rodkey Estate of Rhea Ledebohm Bank of Amer(ca 1405 Lambs Gap Road, Mechanicsburg, PA 17050 9000 Southside Blvd., Bldg. 70, P.O. Box 45140, Jacksonville, FL 32256 G. Property Location H. Settlement Agent: I. Settlement Date: 02/24/2011 87 Fetrow Lane Select Land Transfers, LLC Disbursement Date: 02!2412011 New Cumberland, PA 17070 Phone: 71712-9366 Fax: 717-730-9665 Fairview Townshi p Place of Settlement: TitleF~rpress 4705 E. Tdndle Road, Mechanicsburg, PA 17050 Printed 0 2/2 312 0 1 1 at 9:16 am ' by VS 100. Gross Amount Due from Borrower 101. Contrail sates price 175,000.00 102. Personal ro 103. Settlement charges to borrower (line 1400) 7,456.38 104. 105. Ad'ustments for ttems aid b seller In advance 106. City/town taxes to 107. County taxes to 108. Assessments to 109. School Taxes 02/24/2011 to O6C302011 615.34 110. SeweriRefuse 02124/2011 to 03/31/2011 79.20 111. 112. ' 120. Gross Amount Due from Borower 183,150.92 200. Amounts Paid b or In Behalf of Borrower 201. Deposit or earnest rtwney 3,000,00 202. Principal amount d new loan(s) 170,563.00 203. Existin loo s taken su 'eil to 204. 205. 206. 207. Seller Assistance 5,250,00 208. 209. Ad ustments for items un old h seller 210. Cifyftown taxes to 211. County taxes 01/01/2011 to 02/2412011 130.66 212. Assessments to 213. SchooiTax to 214. 215. 216. 217. 218. ~ 219. 220• Total Paid bylfor Borrower 178,943.88 300. Cash at SeWement fromlto eorcower 301, Gross amount due from borrower{Iinei20) 183,150.92' 302. Less amounts paid bylfor borrower (line 220) 178,943.68 303. Cash QX From ^ 70 8orrotinrer 4,207.24 ih4loml unleu M C4W.Ya • cutnnily v.W OMB wMml numWr. No ConflEenllctllY q Wun14 Mla dhaowre satlbmeM poeess. 400. Gross Amount Duo to Seller 401. Conhad sales pnce 175,000.00 1402. Personal orooErty 405. Ad ustments for Items aid b seller in advance 406. Cityltovm taxes to 407. County taxes to 408. Assessments to 409. School Taxes 0224/201 1 to 06/302011 615.34 410. SewedRefuse 02/24/2011 to 03/3112011 78,20 411. 412. 420. Gross Amount Due to Seller 175,694.54 500. Reductions In Amount Due to Seller 501. Excess deposit (see instructions) 502. Settlement charges to seller (line 1400) 24,642.50 503. Existin loo s taken sub'ed to 504. Pa off of first mort a e loan 505. Payoff of second mortgage loan 506.. 507. Seller Assistance 5,250.00 Ad ustments for items un aid b seller 510. CityAowntaxes to 511. County taxes 011012011 to 022412011 512. Assessments to 513. Scholl Tax to 520. Total Reduction Amount Due Seller 30,023.18 600. Cash at Settlement to/from Setter 601; Gross amount due to seller (line 420) 175,694.54 602. Less reductions in amount due seller (tine 520) 30,023.18 603. Cash QX To ~ From Setter 145,671.36 w..~r •r. co . . oR rou o<. r~~ve " " 1Ja 4 G-IpnoO b govNe IOe pNbf to ~ RESPA mvaroE Innstdbn wIM Inlomulion Curl,p tM m Previous editions are obsolete Page 1 of 4 HUD-1 700. Total Rexi Estate Broker Fees $10,625.00 Paid From Paid From Division of commissbn Tine 700 as follows: Borrower's Seller's 701. 55,375.00 to RelMaxlstAd'rantage Funds at Funds at 702 55250,00 ~ ReIM~cReattySeted Settlement Settlement 703. Commission paid at settlement 10,625.00 704. Broker fee to RelMax Realty Select 175.00 800. hems Pa able fn Connection with Loan 801. Our origination charge (Indudes Odgination Point % or $0.00) $ {from GFE #1) 802. Your credit or charge (points) for the spedfic interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) 804. Appraisal fee to LandSafe tsai Servk;e $465.00 P.O.C. B (hom GFE #3) 115.00 805. Credit report to LandSafe Credit, Inc. $35.00 P.O.C. 8 (from GFE #3) 806. Tax service to from GFE #3 807. Flood certificaticn to LandSafe Flood Determination, inc. (from GFE #3) 26.00 808. to 900. Items R wired b Lenderto be Paid in Advance 901. Daily interest charges irom from 02/24/2011 to 0310112011 Q $21.0300/day (from GFE #10) 105.15 902. Mortgage Ins. Premium for months to Federal Housi Administratlon (from GFE #3) 1,688.75 903. Homeowners insurance for 12 months to Allstate Pro & Casual $551.08 P.O.C. B' {from GFE #11) 904. months to from GFE #11 1000. Reserves De osited Lender 1001. Initlal deposit for your escrow arxount (from GFE fl9} 967.73 1002. Homeowner's insurance 3 months $ 45.93/month $137.79 1003. Mortgage Insurance months $ 0.00/month $0.00 1004. City Property Tax months $ 0.OOfmonth $0.00 1005. County Property Tax 2 months $ 73.61/month $147.22 1006. School Pfoperty Tax 9 months $ 147.381month $1,32(1.42 1007. Aggregate Adjustment $43.70 1190. Title Cha es 1101. Title services and lenders title insurance (from GFE #4) 1,503.75 1102. Settlement or dosing fee to $ 1103. Owner's title Insurance (from GFE #5) 20.00 1104. Lender's title insurance $1,438.75 1105. Lender's title policy limit $170,563.00 Lender's Policy 1106. Owner's title policy limit $175,1H10.00 Owners Policy 1107. Agents portion of the total title insurance premium $1,176,19 1108. Underwriters portion of the total title Insurance premium $282.56 1109. E-Doc Delivery Fee to Cornerstone Land Transfer A ent f $25.00 1110. CouriedWire Fee to Select Land Transfers a ent for Fh $15.00 1111. Ndtary Fee to Kandi Lenker $25.00 20.00 1112. Reimburse for Tax Certification to Select Land Transfers ent for Ft` $ 10,00 1113. Geed prep Fee to Select Land Transfers ent for Ft, 125.00 1114. Escrow for inhedtance taxes to Select land Transfers, LLC 11,812.50 1115. 2011 Cty/Twp taxes (escrowed) to Select Land Transfers, LLC 950.00 1200. Govemment Recordin and Transfer Cha es 1201. Govemment recording charges (from GFE #7) 155.00 1202• Deed $63.50 Mort $91.50 Release $0.00 1203. Transfer taxes (from GFE #8) 1,750.00 1204. City/County tax/stamps Deed $1,750.00 Mort a e $0.00 1205. State Taxlstamps Deed $1,750.00 Mort a e $0.00 1,750.00 1206. Deed $0.00 Mort a e $0.00 1207. 1300. Additional Settlement Char es 1301. Required services That you can shop For (from GFE #6) 1302. Secure Revised Legal Description to Hartman i£ Associates, inc. 300.00 1303. to 1304. to I 1305. to r t r ~ r 7,456.38 24,642.50 `Paid outside of dosing by (B)orrower, (S)eller, (l)ender, (i)nvestor, Bro(i~er. _ Previous editions are obsolete Page 2 of 4 HUD-1 Com adsonofGood'Faitfifatimate G •and>HtlU1~Cfia es' Cha es That Cannottncrease HUD~1 LineNumber Our odginatiai~charge #801 Your credit or charge (points) fa the.spedfic interest fete chosen # 8Q2 Your adjusted odginatiort charges #803- ` Transfer taxes # 1203 Cha es That Ih Total Cannot increase MoceThan tOW° Govemmenttecording charges # 1201 Appraisal fee ip # 804 Credit7eport to # 805 Flood CerUficatlon #.807 Mortgage insurance premium # 902 Title services and Ienderts Utle insurance # 1101 Owner's title insurance # 1103 ~. Char es That:Cah Chad Jnitlal deposit for yoar escow.account #.1001 Daily interest.charge # -901' $21 10300/da Homeowner's insurance #,.903 #' Loan Terms Godd'Falth'Estimate HU0.1 0.00 0.00 0.00 0.00 0.00 0.00 1,750.00 1,750.00 Good Faitfi`EsOmate HU0.1 155.00 155.00 465.00 580.00 35.00 35.00 26.00 26.00 1,688.75 1,688.75 1,503.75 1,503.75 20.00 20.00 3,893.50 4,008.50 $ 115.00 or 2.9536W° Good Faith Estimate HU0.1 1,611.00 967.73 105.15 105.15 551.08 551.08 Your Initial loan amount is $170,563.00 Your Iqan tennis 30. years .Your initlalinterest-rate is , 4.5000% Your (nitiatmonthly amount owed for prindpai, interest, and. anymortgage $989.95 includes irisurance is ^X Prindpal ^X interest X^ Mortgage Insurance Can your interest rate rise? X^ No. ^ Yes, it can rise to a maximum of %. The first change will be on / / and can change again every years after I I .Every change date, your Interest rate can increase or decease by %. Over the life of the loan, your interest rate is guaranteed to never be Power than °k or higher than %. Even if you make payments on•Gme, canyourdoanbalancerlpe? ^X No. ^ Yes, it can rise to a maximum of $ Even if you make payments on.Ume, can your monthly amount owed for. ^X No. ^ Yes, the first increase can be on / ( and the monthly prindpal, interest, and mortgage insurance risel amount owed can rise to $ Themaximum it carrever rise to is $ Does your loan have a prepayment penalty?: ^X No. ^ Yes, yourmaximum prepayment penalty is $ Goes your toan have abaltoon payment? ^X No. ^ Yes, you have a balloon payment of $ due in years on I ! Total monthly amount owed including,escrow acx;ount payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. ^X You have an additional monthly escrow payment of $268.92 that results in a total Initial monthly amount owed of $1,256.87. This indudes prindpat interest, ar mortgage insurance and any items checked below: ^X Property taxes Q Homeowner's insurance ^ Flood insurance ^ ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 HUD CERTIFICATION OF BUYER AND SELLER 1 have carefully :reviewed the HU0.1 Settlement Statement and to the best of my knowledge and belief, tt is a true and accurate statement of afl receipts and disbursements made on my account or by me in this transaction I further certify that 1 have received a copy of the HUD-1 Settlement Statement Steven L. Rodkey exec i:/1~ z z ao/~ E e of Rhea Ledebollm The HU0.1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. ~°~.~~,uu ~ ~ SETTLEMENT AGENT a/a y~r~ DATE WARNING: IT lS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON GONV!CT!ON CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 REV-15oR EX+ (11-10) i , pennsylvania SCHEDULE E ~E°ARTMENT or RE~EN~E CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Rhea L. Ledebohm 21-10-1179 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Cash in possession of Decedent 14,450.00 2 PNC Bank, 600 Grant St, USX Tower, Pittsburgh, PA 15219, Checking Account #50-0459-8217 11,872.71 g PNC Bank, 600 Grant St, USX Tower, Pittsburgh, PA 15219, Certificate of Deposit Acct #31900331392 31, 348.96 4. PNC Bank, 600 Grant St, USX Tower, Pittsburgh, PA 15219, Certificate of Deposit Acct #31400324934 19,225.76 5. PNC Bank, 600 Grant St, USX Tower, Pittsburgh, PA 15219, Certificate of Deposit Acct #31800239647 30,847.08 g. PNC Investments LLC, 1408 N Atherton St, State College, PA 16803, Money Market Acct #87841644 5,295.38 7 PNC Investments, LLC,1408 N Atherton St, State College, PA 16803, Annuity Acct#V000059398 129,842.81 g. IRS Refund 4,200.00 g Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Savings Account#113-00 10. Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Life Savings Account#113-004 11. Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Certificate of Deposit Acct #113-49 12. ~ Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Certificate of Deposit Acct #113-55 13 Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Certificate of Deposit Acct #113-56 14 Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, IRA Certificate of Deposit Acct #113-20 15 Members 1st, 5000 Louise Dr, Mechanicsburg, PA 17055, Money Market Acct #113-005 16. PNC Investments Merrill Edge, PO Box 1528, Pennington, NJ 08534, IRA Acct #7HP12W73 17, John Hancock, 1 John Hancock Way, Boston, MA 02217, Annuity Acct # S13021919 1 g. John Hancock, 1 John Hancock Way, Boston, MA 02217, Annuity Acct # S13022049 1 g John Hancock, 1 John Hancock Way, Boston, MA 02217, Annuity Acct # FX06009158 20 Personal property 21 Overpayment from Parthmore Funeral Home 3.251.89 4, 000.76 16,316.37 20, 518.69 26,246.98 3, 349.78 47,778.06 69,476.63 1,452.50 301.61 84,474.41 621.00 471.83 TOTAL (Also enter on Line 5, Recapitulation) $ 525,343.21 If more space is needed, use additional sheets of paper of the same size. AG r.IE. 2011 1:32PM PNC BANK 412-705-2147 ~~ 1~~1~iG 7H~ i~/A~ April 18, 2011 Bybel, Rutledge LLP L Renee Lieux 1017 Mumma Rd Ste 302 Lemoyne, PA 17043 RE: Name: Rhea L Ledebohm SSN: 202-20,9047 DOD: 11-24-2010 Dear Ms. Lieux: No. 4114 P. 1/2 1 Iz~ response to your .request I'or Date of Death (DOD) balances for the customer noted. above, our records show the following: Certificate of Deposit Account # 31800239647 Established: OS-25-2004 RHEA L LEDEBOHM DOD balance: $30,847.08 + 0.00 accrued interest Interest paid OI-O1-2010 thru 11-24-2010 $107.b0 YTD Account # 31400324934 Established: 02,06-2008 RHEA L LEDEBOHM DOD balance: $19,171.34 + 54.42 accrued interest . lc~,a~,1 l,~ Interest paid O 1-pl -2010 thru 11-24-2010 $208.77 YTD Account # 31900331392 ~ Establisk~ed: 07-25-2008 RHEA L LEDEBOHM DOD balance: $31,348.96 + 0.00 accrued interest lnterest paid O 1-01-2010 thru 11-24-2010 $150.92 YTD ,/Checking Account Account # 5004598217 Established: 10-24-2005 RHEA L LEDEBOHM DOD balance: $11,872.41 + 0.30 accrued interest Interest paid 01-01-2010 thru 11-24-2010 $23.6.2 YTD page 1 of 2 Apr,18. 2011 1:32PM PNC BANK 412-705-2147 N~,4114 P, 2/2 Please Hate that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your lace) PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Thir message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notes me immediately by reply or by telephone at 500-762-1775 and immediately destroy this faxed document. Page 2 of 2 Air, 2~, 2i~11 i0:49~N1 B PNC 1NVESTIVIENTS M~mher FINR~ ,nd uIDC April 26, 2011 Renee Lieux, Attorney 101 ~ Mumma Rd Suite 302 Lemoyne, pA 17043 ___.- Re: Estate of Rhea L. Ledebohm_-____-_.. N~„ 2471 F, 1 . .._ _.. . '__ Dear Attorney Lieux, _. Ms. Rhea L. Ledebohm held an iztdividual account at PNC Investments, LLC, which was opened on November 21, 2005. There were no changes to the account registration in the past year. At the time of her death the account was invested in a money market hind with ..... .. a value of $5295.38, 7f you have any questions, please feel free to contact me at (814) 231-1646. Sincerely, __ . _. . Tracie Mehalick Financial Consultant Associate The information herein has been obtained from sources we believe to be reliable but is not guaranteed and does not purport tv be a complete statement of all material factors. this is for informational purposes and is not a solicitation of orders.to„purchase of sell securities. Reproducfion is forbidden unless authorized. ,411=rights reserved, PNC investments LLG Member of The PNC Financial Services Group 1408 North Atherton Street State College Pennsylvania 7GB03 www.pnc.corn __ _ r -\taq[.rxeL5lur. ~Nu6:urkWar~tee tmportanumrestorlntormatlon:Securities and brokerage services are prcvided by PNC Invcamcatc: ~LC_ member rJASC , nd SIPC, Annuities and other insurance products are offered by PNC Insuranrr. Srrvicr;s LL(`, s ocensed i~iursncc syency. t0 O `~i ~ ~ a W "~V v "~v j'~ O `~ 1 O ~i, ~ N O M m O ~ V j O r \ Z V r •~ ~ j' \ O v z N M ~ N ~' z °~ W a N'`Ci+ aM V~-qX~ a ?~ ~ s0 ~ p-z~a ~~, ~ C t() ~ ~ lf) ~ p o ~ U U 0~0 Q ~ 7 W ~ '_ ~ Z~~ ~ C W ~ ~ ~ CD ~ ~> ~ZU Q ? 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Name P For th a year Jan. 1-Dec. 31, 2010, or other tax year beginning , 2010, ending , 20 OMB No.1545- 0074 , Address, a RHEA L LEDEBOHM -DECEASED 11 / 2 4 / 2 010 Your social security number and SSN r % JAMES H BAILEY III 202-20-9047 e 3 L 820 CENTERFIELD ROAD Spouse's socialsecuritynumber See separate instructions. A HARRISBURG, PA 17109 R ~ Make sure theSSN(s)above L Y Checking abox below will not change yourtax or nd. Presidential Election Cam ai n - Checkhereif ou,or ours ouse'rffilin ointl want $3 to otothisfund Y Y P 91 Y, 9 - You S Ouse Filing Status 1 X Single 4 Head of household (with qualifying person). (See instructions.) 2 Married filing jointly(even ifonlyonehad income) tf the qualifying person is achild but not your dependent, enter this Check Only 3 Married filing separately. Enter spouse's SSN above & f ull name here. child's name here.- one box. - 5 Quali in widow er with de endentchild 6a X Yourself. If someone can claim you as a dependent, do not check box 6a Boxes checked 1 on 6a and 6b 1 Exemptions b s OUSe j No. of children C Dependents: (2) Dependent's (3) Dependent's ti t l i b t hi ~4h)~ d<t7ufor •lived with you h I If more ~ secur ty num er re a ons p oyou ~ dPa75~. ~didnotlivewithyou (1)Frstname Last name socia due to divor than four ce or separation (see inst) dependents, t Dependents See InS on 6c nat and Check entered above here - ~ Add numbers d Totalnumberofexem tionsclaimed . . . . . . . . . . . . . . . on lines - above . . . . 7 Wages, salaries, tips, etc. Attach Form(s) W- 2 Income 7 8a Taxable interest. Attach Schedule B'rf required 8a 1 , 8 3 2 . Attach Form(s) b Tax- exempt interest. Do not include on line 8a 8b W- 2 here. Also ga Ordinary dividends. Attach Schedule B if required 9a attach Forms W-2G and b Qualifieddividends 9b 1099-Rif tax 10 Taxable refunds, credits, or offsets of state and local income taxes . 10 was withheld. 11 Alimony received 11 12 Business income or (loss). Attach Schedule C or C- EZ , 12 13 Ca ita4 ain or IOSS ,Attach Schedule D if required. - ~ check here P 9 ( ) If not required 13 , 14 Other gains or (losses). Attach Form 4797 , 14 If you did not 15a IRA distributions 15a bTaxableamt. 15b 8, 410 . getaW-2, see page 20. 16a Pensions and annuities . 16a 2 3 , 7 2 2 . b Taxable amt . 16b 17 3 61 . 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 but do Fsclose 18 Farm income or (loss). Attach Schedule F , 18 , not attach, any 19 Unemploymentcompensation, 19 payment. Also, 20a Social security benefits . . LOa ~ 12 , 9 6 4 . ~ b Taxable amount 20b 4 , 5 7 2 . please use Form 1040- V. 21 Other income. List type and amount 2i 22 Combine the amounts in the far ri ht column for lines 7 throu h 21. This is o urtotal income . - 22 3 2 17 5 . 23 Educator expenses 23 _ Adjusted 24 Certain business expenses of reservists, performing artists, and Gt'OSS fee- basis government officials. Attach Form 2106 or 2106- Q . 24 Income 25 Health savings accountdeduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903. 26 27 One- half of self- employmenttax. Attach Schedule SE . 27 28 Self- employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurancededuction 29 30 Penaltyonearlywithdrawalofsavings. 30 31a Alimony paid b Recipient'sSSN - 31a 32 IRAdeduction 32 33 Studentloan interestdeducfion 33 34 Tuition and fees. Attach Form 8917, 34 35 Domestic production activitiesdeduction. Attach Form 8903 35 36 Add lines 23 through 31 a and 32 through 35 36 37 Subtract line 36 from line 22. This is our ad'usted toss income - 37 3 2 17 5 . KBA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2010) 1040 (2010} FD1040-1 V 1.25 s Form oftwareCopyright 1996- 2011 HRB Tax Group, Inc. Form 1040 Tax and Credits RHEA L LEDEBOHM 38 Amountfrom line 37 (adjusted gross income) . 39a Check J ^X You were born before January 2,1946, ^X Blind. 1 Total boxes if: 1L Spouse was born beforeJanuary 2,1946, Blind. 1 checked - 39a b If your spouse itemizes on a separate return or you were adual- status alien, check here - 39b 40 Itemized deductions (from Schedule A) oryourstandard deduction (see instructions) -20- 59. 41 Subtract line 40 from line 38 _ 41 2 , 216 . 42 Exemptions. Multiply$3,650 bythe number on line 6d 42 3 6 5 0 . 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter - 0- . 43 0 , 44 Tax (see instructions). Check if anytax isfrom: a ^ Form(s) 8814 b ^ Form 4972. 44 0 , 45 Alternative minimum tax (see instructions). Attach Form 6251 45 46 Add lines 44and 45 - 46 0 47 Foreign tax credit. Attach Form 1116 if required 47 48 Credit for child and dependent care expenses. Attach Form 2441 48 49 Education creditsfrom Form 8863, line 23 . 49 50 Retirement savings contributions credit. Attach Form 8880. 50 51 Child tax credit (see instructions) 51 52 Residential ener credits. Attach Form 5695. 52 53 Other credits a 3800 b^8801 C ^ from Form: 53 54 Add In 47 through 53. These are yourtotal credits 54 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter - 0- - 55 0 , Other 56 Self- employmenttax. Attach Schedule SE 56 Taxes 57 Unreported social securityand Medicaretax from Form: a ^ 4137 b ^ 8919 57 58 Additional tax on IRAs, otherqualified retirement plans, etc. Attach Form 5329 if required 58 59 a ^ Form(s) W- 2, box9 b ^ Schedule H c ^ Form 5405, line 16 59 60 Add lines 55throu h59.Thisis ourtotaltax. - 60 0. Payments 61 Federal income tax withheld from Forms W- 2 and 1099. 61 62 2010 estimated tax payments and amount applied from 2009 return 62 5 , 6 0 0 . 63 If u h ve a Making work paycredit. Attach Schedule M 63 Ual n q fy g 4a Earned income credit (EIC) 64a child, attach b Nontaxablecombatpayelection 64b Schedule EIC. 65 Additional child tax credit. Attach Form 8812 65 66 American opportunitycreditfrom Form 8863, line 14 . 66 67 First- time homebuyer credit from Form 5405, line 10 . 67 68 Amount paid with request for extension to file . 68 69 Excess social security and tier 1 RRTA tax withheld 69 70 Creditforfederaltaxonfuels.AttachForm4136 70 71 Credits from Form: a ^ 2439 b ^ 8839 c ^ 8801 d ^ 8885 71 72 Add lines 61, 62, 63, 64a, and 65 throu h 71. These are our total a ments - 72 Refund 73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid . 73 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here - ^ 742 - b Routing number XXXXXXXX - c Type: ~~~ ^ Directdeposit? - d Accountnumber XXXXXXXXXXXXXXXXX See instructions. 75 Amount of line 73 ou want a lied to our 2011 estimated tax - 75 Amount 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions , - 76 You Owe 77 Estimated tax penalty (see instructions) - ~ 77 32,175. 5,600. 5,600. 5.600. Third Party ~ you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. No Designee Designee's name Phone no. Personal ID number - xR BLOCx -(717) 657-0316 -3776' - Sign Here Joint return? See page 12. Keep a copy for your records. Under penalties of perjury, I declare that I have examined this return and accorr belief, they are true, correct, and complete. Declaration of preparer (other than Your signature ~ Date Spouse's signature. If a joint return, both must sign. ~ Date Paid PrinUTypepreparer'sname Preparer JUD2TH W2LLOW USe Only Rrm'sname -HRB TAX Firm's address - HARRISB (PIN) chedules and statements, and to the best of my knowledge and )is based on all information of which preparer has any knowledge. Youroccupation Daytime phone number RETIRED Spouse's occupation /, gn re Date Check U if PTIN 3/03/2011 self-employed p00014895 INC Rrm'sEIN- 43-1871840 1710 9 ____ Phone no. (717) 6 5 7 - 0 316 Form 1040 (2010) 1040x{2010) FD1040- 2V 1.25 Form oftwareCopyright 1996- 2011 HRB Tax Group, Inc. VIVICSIVO. ID4D-UV/4 SCHEDULE A Itemized Deductions jai (Form 1040) DepartmentoltheTreasury Internal Revenue Service (99) - AttachtoForm1040. - SeelnstruCtionsforScheduleA(Form1040). Attachment S UenCe No. 07 Name(s) shown on Form 1040 Your social security number RHEA L LEDEBOHM 202-20-9047 Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see instructionsL 1 2 8 , 6 3 7 . _______-_______________ Dental SEE _ ATTACHMENT ________-______-___-______-________- Expenses ------------------------------------- -- ----------------- 2 Enteramountfrom Form 1040, line 38 . 2 32 , 17 5 . 3 Multiply line 2 by 7.5% (.075) . 3 2 413 . 4 Subtract line 3 from line 1. If line 3 is more than line 1 enter - 0- . 4 2 6 2 2 4 . Taxes You 5 State and local (checkonly one box): id a Income taxes, or 5 4 8 0. Pa } b X General sales taxes 6 Real estate taxes (see instructions) 6 2, 6 3 4. REAL ESTATE TAXES 2,634. -------------------------------------------------------------- - 7 New motor vehicle taxes from line 11 of the worksheet on page 2 (for certain vehicles purchased in 2009). Skip this line if you checked box 5b 7 8 Other taxes.Listtypeandamount- --------------------------------- 8 ------------------------------------------------------------- . . . . . . . . . . . . . . . 9 Add lines 5 throu h 8 . . . . . . . . 9 3 114 . 10 Home mortgage interest and points reported to you on Form 1098 10 Interest You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that Note. person's name, identifying no., and address - Your mortgage 11 interest 12 points not reported to you on Form 1098. See instructions for special rules 12 d ed uction may be limited (see 13 Mortgage insurance premiums (see instructions) 13 instructions). 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 . . . . . . . . . . . . . . . 15 Add lines 10 throw h 14 . . . . . . . . 15 16 Gifts by cash or check. If you made any gift of $250 or more, see inst . 16 6 21 . Gifts t0 Charity COMMUNITY AID 621. If you made a 17 Other than by cash or check. If any gift of $250 or more, see ift and got a instructions. You must attach Form 8283'rf over $500. 17 g benefittorit, 18 Carryoverfromprioryear. 18 see instructions. . . . . . . . . . . . . . . . 19 Add lines 16through 18 . . . . . . . . 19 6 21 . Casualty and Theft Losses 20 Casual or theft loss(es). Attach Form 4684. (See instructions.) 20 Job Expenses 21 Unreimbursed employee expenses- job travel, union dues, job education, and Certain etc. Attach Form 2106 or 2106- FZ if required. Miscellaneous (See inst.) - Deductions 21 22 Tax preparation fees 22 311. 23 Other expenses -investment, safe deposit box, etc. List type and amount - 23 24 Add lines 21 through 23 24 311 . 25 Fester amount from Form 1040, line 38 25 3 2 , 17 5 . 02) 26 Multiply line 25 by 2% ( 26 6 4 4 . . 27 Subtract line 26 from line 24. If line 26 is more than line 24 enter - 0- 27 0 - Other 28 Other- from list in instructions. List type and amount - Miscellaneous Deductions 28 TOtal 29 Add the amounts in the far rightcolumn for lines 4 through 28. Also, enter this amount line 40 ed on Form 1040 i It 29 2 9 . 9 5 9 - , z em DedUCtIOnS 30 If you elect to itemize deductions even though they are less than your standard riariurtinn rharkhere _.. - KBA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule A (Form 1040) 2010 1040- Sch A ~2010~ FDA-1 V 1.9 Form Software opyr ght 1996- 2011 HRB Tax Group, Inc. Supporting Schedules 2010 Name: RHEA L LEDEBOHM ----------------------------------------------- SSN: 202-20-9047 ----------------------- ------- Schedule A Line 1 - Medical Expenses Description ----------------------------------- Amount ---------------------- ------------------- COUNTRY MEADOWS SKILLED CARE 11,004 PHYSICIANS 901 LAB AND XRAYS 27 VISION CARE 116 AMBULANCE 169 HOSPITAL 334 PRESCRIPTIONS 2,275 MEDICAL EQUIPMENT 90 PRIVATE DUTY NURSING 12,659 SOCIAL SECURITY/RAILROAD RETIREMENT - MEDICARE INSURANCE PAYMENTS 1,062 Total 28,637 SCHEDULE B Interest and Ordinary Dividends (Form 1040A or 1040) Department of the Treasury - AttachtoForm1040Aori040. - Seeseparateinstructions. Internal Revenue Service (99) Name(s) shown on return RHEA L LEDEBOHM 1 List name of payer. If any interest isfrom aseller- financed mortgage and the buyer used Part I the property as a personal residence, see separate instructions and list this Interest interestfirst.Also, showthatbuyer'ssocialsecuritynumberandaddress - (See separate MEMBERS FIRST instructions and pNC BANK NA theinstructions for Form 1040A,or SOVEREIGN SANK Form 1040, line 8a.) PNC BANK NA AB No. 1545-1 ~o~a Your social security number 202-20-9047 1.182 . 78. 94. I_ 478. 1 Note. If you received a Form 1099- INT Form , 1099-OID,or substitute statement from a brokerage firm , list the firm's name as the payer and enter thetotalinterest shown on that 2 Add the amounts on line 1 2 1 8 3 2 . form. 3 Excludable intereston series EEand I U.S. savings bonds issued after 1989. Attach Form 8815. g 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a - . . . . . . . . . . . . . . . . . . . . . 4 1, 8 3 2 . Note. If line 4 is over $1,500 ou must com lete Part III. Amount 5 List name of payer ---------------_--- --------------------------- Part II ------------------------------------------------------------------------------------ Ordinary ^- ------------------------ --------------------------------------------------- Dividends --------------------------------- ---------------------------------------- ------ (Seeseparate ____ __ ------------------------------------------------------- - ---"----------' instructionsand the instructions --------------------------------- -- -- forForm 1040A,or ----------------------------------------------------------------- Form 1040, line 9a.) - ----- _---_--__---- ---------------------------------------------------------- - - -------------------------------------------------- Note. Ifyou ------------------------------------------- ------------------------------- 5 received aForm 1099- DIV or -------------------------------------------------- substitute --------------------------------------------- ---------------------- statementfrom _ ___________ ____ ------------ ------------------------------------- - - ----- abrokeragefirm, -------------------------------------------------------- li fir tth ' s m s e nameasthe --------------------------------------- ------------------------------- ---- payerand enter __ _ __ _____ --------------------------------------------------------- ~ - - '- theordinary ----------------------------------------------- id d h di own v en ss onthatform. ------------------------------------------------------______-__------- ---------- 6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a - g Note. If line 6 is over $1,500, ou must complete Part III. You must completethispartlfyou(a)hadover$1,500oftaxableinterestorordinarydividends; (b)hada Part III foreign account; or (c) received a d istribution from, or were a grantor of, or a transferor to, a foreign trust. YeS NO Foreign 7a At any time during 2010, d id you have an interest in or a signature or other authority over a financial ACCOUntS account in a foreign country, such as a bank account, securities account, orother financial account? and Trusts See separate instructions for exceptions and tiling req uirements for Form TD F 90- 22.1 X (See b It "Yes," enter the name of the foreign country - separate g During 2010, did you receive a distribution from, or were you the grantor of, ortransferor to, a instructions.) forei n trust? If "Yes " ou ma have to file Form 3520. See se orate instructions . X KBA For Paperwork Reduction Act Notice, see your tax return instructions. Schedule B (Form 1040A or 1040) 2010 1040- SCh B (c20 f 0~ FDS-1 V 1.6 Form Software opy fight 1996- 2011 HRB Tax Group, Inc. Form 1310 Statement of Person Claiming (Rev. November 2005) Refund Due a Deceased Taxpayer Department of th a Treasury - See instructions below and on a e 2. ~..,o...,~ rZe.,e„„o moo., ~~o p 9 OMB No.1545- 0074 Attachment Sea uence No. 87 Tax year deced ent was due a refund: Calendar ear 2 010 orothertax earbe innin 20 ,and endin 20 Name of decedent Date of death Decedent's social security number RHEA L LEDEBOHM 11/24/2010 202-20-9047 Please Name of person claiming refund Your social security number type JAMES H BAILEY III 197-40-6667 or Home address (number and street). If you have a P.O. box, see instructions. Apt. no. print 3820 CENTERFIELD ROAD City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. HARRISBURG PA 17109 .Part 1 Check the box that applies to you. Check only one box. Be sure to complete Part III below. A Surviving spouse requesting reissuance of a refund check (see instructions). B X Court- appointed or certified personal representative (defined below). Attach a court certificate showing your appointment, unless previously filed (see instructions). C ~ Person, other than A or B, claiming refund for the decedent's estate (see instructions). Also, complete Part It. Part II Complete this part only if you checked the box on line C above. Yes No 1 Did the decedent leave a will? 2a Has a court appointed a personal representative forthe estate of the decedent? b If you answered "No" to 2a, will one be appointed? If you answered "Yes" to 2a or 2b, the personal representative must file for the refund. 3 As the person claiming the refund for the decedent s estate, will you pay out the refund according to the laws of the state where the decedent was a legal resident? If you answered "No" to 3, a refund cannot be made until you submit a court certificate showing your appointment as personal representative or other evidence that you are entitled under state law to receive the refund. Part 111 Signature and verification. All filers must complete this part. I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of person claiming refund - Date - General Instructions Purpose of Form Use Form 1310 to claim a refund on behalf of a deceased taxpayer. Who Must File If you are claiming a refund on behalf of a deceased taxpayer, you must file Fonn 1310 unless either of the following applies: • You are a surviving spouse filing an original or amended joint return with the decedent, or • You are a personal representative (defined on this page) filing an original Form 1040, Form 1040A, Form 1040F1, or Form 1040NR for the d ecedent and a court certificate showing your appointment is attached to the return. Example. Assume Mr. Green died on January 4 before filing his tax return. On April 3 of the same year, you were appointed by the court as the personal representative for Mr. Green's estate and you file Form 1040 for Mr. Green. You do not need to file Form 1310 to claim the refund on Mr. Green's KBA For Privacy Act and Paperwork Reduction Act Notice, see page 2. tax return. However, you must attach to his return a copy of the court certificate showing your appointment. Where To File If you checked the box on line A, you can return the joint- name check with Form 1310 to your local I RS office or the Internal Revenue Service Center where you filed your return. If you checked the box on line B or line C then: • Follow the instructions for the form to which you are attaching Form 1310, or • Send it to the same Internal Revenue Service Center where the original return was filed 'rf you are filing Form 1310 separately. If the original return was filed electronically, mail Form 1310 to the Internal Revenue Service Center designated for the add ress shown on form 1310 above. See the instructions for the original return for the address. Personal Representative For purposes of this form, a personal rep resentative is the executor or adm inistrator of the d ecedent's estate, as certified or appointed bythe court. A copy of the decedent's will cannot be accepted as evidence that you are the personal representative. Form 1310 (Rev. 11-2005) 1310s{2010) FD1310-1 V 1.3 Form oftware Copyright 1996- 2011 HRB Tax Group, Inc. RRR-D7-2011 12:05 From:M1ST LEND~INS SUPRT 7177955178 lU: L• ~/7~e. ~ieGt~ DATE: 7 ~ '~ 'l~ FROM: i~eigh-Anne Stallings Letidiii~ Insurance Support Specialist Phone number (717j 795-5139 Pax number (717) 795-5178 Stalling1~~mcmbcrsl sl.or~; To:7177240670 P.1~2 PAGES: ~ . L Q d ~6o h.~ '1'}~i1s mc.st~ge COnT..~inS information Lr~nt P9embecs 1St. F~_deral CrediC Uui~u whictl [tray be r.onji~jertl,i~l and privilege~~. If you are nol ~n int.~ncic:ci rc:Cipicnt, please refrain from any disclosure, copying, diaL-ribuLiott or use of this i_nfo,r.m~ti.on and note that .auch ar_lioiis ~rr•~ prohibited. 1L- you have c-eceiver~ lltis Lr~~n;~n,i:;:;~~>n ~.~-~ i:YTOI=, please notify F.~y c.~r~~iil: -,~> ; t:m~~_tc:r. (~rncmbc~rs 1st , off. SODU Louise llrive, Mechanicsburg, Pcnnsylvs~nia 17055, www.Memberslst.urg APR-D7-2011 12:05 From:M1ST LEND~INS SUPRT 7177955178 MEMBERS 1't YHllk?KAI, CIr Y.UI'I' I,INIVN REGULAR SAVINGS ACCOU Account Number/Suffix 113-00 Dete Account Establishod 06/15/1950 PrlnGpal Balance at Date of Death $3,251.28 Accrued Interest t0 Date of Death $.61 Total Principal and Accrued Interest $3,251.89 Name of Jolnl Owner None t_IFE SAVINGS ACGOUN7: Account Number/Suffix 113.1)4 Date Account Established 02/01/2001' Principal Bslanca at Data of D9afh $4,000,00 _ Accrued Interest to Date of Death $-76 Total Principal and Accrued Interest $4,000,7 Name of Joint Owner None 'Oponed by a Transfer of Funds From the Regular Savings Account 113-00. ,MONEY MANAGEMENTACCQUNT: Account Number/Suffix 113-05 t3ate Account Established 08/31/2005 Principal Balance at Datc of Death $A7,763.01 Accrued Interest to Date of Death $15.05 Total Principal and Accrued Interest $47,778.06 Name of Joint Owr)pr None IRA CER71FIGATES OF DEPOSIT: Account Number/Suffix 113-20 "Date Account Established 02/09!2008" Principal Balance at Data of Death $3,347.46 Accrued Interest to Date of Death $2.32 Total Principal and Accrued Interest $3,39.78 Name of Beneficiary Estato 100% 'Rollover from IRA Certificate 113-17, Originally Established on 07!12/2007 To:717724O67© P.2~2 CERTIFICATES OF DEPOSIT: Account Number/Suffix 113.49 113-55 113-56 Date Account Established O~i/1912010' 06/03/2010" 10/12/2010""" Principal Balance at Dale of Deflth $16,301.06 $20,499.44 $26,225,36 Accrued Interest to Dat0 of Death $15.31 $19.25 $2'1.12 Total Principal and Accrued Interest $1ti,31G.37 $20,518.69 $26,246.98 Name of Joint Owner None None None 'Opened by a Transfer of Funds From the Regular Savings Account 113-U0. ""Rollover from Certificate 113-48, Originally Established on 05/05/2009. "'Rollover from Certificate 113.42, Originally Established on 03/12/2010, Certificato 113-42 Opened by Transfer of Funds from the Regular Savings Account 113-00. MEMDCRS 1sT f CDCRAL CREDIT UNION Leigh- ne Stallirtgs fending Insurance Support Specialist April 7, 2011 Estat® of: Rhea L. Ledebohm Date of Death: 11/Z4/2010 3oclal 3acurlty Number: 202-20-9047 5t1U(1 Louise llrive 1?(). 13t>x q() Mcchanicsbur~, Pennsyhratua 17()55 (!~()()) 2fi:3-2328 w-~v~;mclrbersl st.os~~ Q ~t O Q- Y 0 ca V Y ~ Q~ ~~ J. G ~~j~ i W o T ~ ; ~ O N ~ "' ~ -O 7 Q ~ ~ ~ . ~ ~ ~ W m .~ ~ d -o = Z N ~ ~. a a~ d ~ W 0 J 4 ~iI • /w~'' ~.1I a .,~, 0 0 P-~ co U O V ~ ~ O V ~_ O (6 ~ 7i ~ ~ ~~ .~ 0 07 SU ft5 O N ~ o ~-~ ~ .~, a'=° ~~ ~ o ~ o O T~ ~ N..; O -06~ c00 C ~? ~ .o ~ ~~~ ~ ~ N~ ~ O-~ S O~ 4O Ncfl ~ ~, T N F' ~ m N U ~ W O N ~ TZ C OY a 7 p to ~~ T d CO O t0 ~ J 01 G G C O ~ N ~~ U ~ ~ O O N L... 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Z` a n m no r O LoccE N m' N oo~ L E L aL U~ > C° O d ~° _N m U1 E N> 3 y N N OJ N O p O N ~ L N y e ~ O c0 N d C U c 'c °iy' ' °-~n O~~ L °' ~ c c 4' ro ~ 3 ° v ° 3 > N E ~ co v y ~a 0 3 LL c 7 0 3=-°- L a x° a g ~_° c o o uf' V~ o ~~' ~ dLLLL UNC ESQ i6 dW N 4 'O ~ .~ ~ N~ p~ C a d d O. O m Z ~~ T O d O, ~ a- w~ ~ O C v o~_c ~ m E~ d _ p m t (/) d~ V > N N~ 4 ~ C ~ 4 d N m LL V 'j ' C~ a ~~ C N ro d L TJ D> Q O vi Q m N a0 ~ 00 , C O d ~ o `oom'm~ LL E L cO~ vEo, ~ndr4 LLE~~~N d7y TUm O N L ~ d > C d N C y Y 7 O) p O . U 07 V~~ O J O ° do° O O ~mV° O - o°~~Q~Q d ~mo. ~`~> .~c° O~~.n ~"3y° c .~ ?C ~~m Zcm cm c w a ,rim omro`o. ,riymn Ntp y~ U ~v ~d N d ~ d y O d~ Q .N d; O N N T cp m d x 0 0~ Q O > ~O O u` Q 01 D° y L C C ~ U E ~ u.~ E m d~.~ a~ ro dQ m"c i m:c U 4 O m w 0 w x f 0 O m D aEi U 0 Q ch 7 r a S r- y = r ~ d 7 7 U U °i c O `~ c C ~ U U a` ~¢ N ro U N m N U c m m O O O O C d aEi c 7 0 Q T O N O a' O E 0 O LL APR, ,2411 3:57PM JOHN HANCOCK 617-663-2189 John Hancock Life Insurance Company ~U.S.A.)~ Jahn Hancock Annuities Servrce Center , 164 Corporate DM1Ve, Portsmouth, NH 03801-68 7 5 Mailing AOdress; PO Box 9505, Portsmouth, Nti D3802-9505 (B~~ 543-2363 ' www.jhannuities.COm April S, 20l 1 ; L Renee Lieux Bybel Rutledge LLP Facsimile: 717-731-8205 N4. 548 F. 1/1 LTi,~t,GC~~ the future is yours Dear Mr. Lieux: Re: Annuitized Contract No. SI302 ] 919 and SI3022049 Owner/Annuitant: Rhea L Ledebohm ' This is in respons@ to your letter dated April ~, 20I i regarding the annuity contracts referenced above. These contracts have no provision for partial or full~surrenders an@ do not contain a cash valix@. Therefore there is no date of death value present. Ff you have any questions or concerns about this letter, please call us at 877-543-2363. Our Claims Service Representatives are available on weekdays from 9:00 a_m_ to 5:00 p.m. EST. Sincerely, john HanCOCk Annuities ; Llle Inaurarxe anrwitios, indud~ng group annuiGea, are product; iss4+md by John Hancock Life tnaursnoa Compgrry (U,S,A)', Bfoomfieltl Hill6, Mi Tat ueeneea In New Ywk Fax Server 4/8/2011 4:48:46 PM PAGE 2/002 Fax Server John Hancock Life Insurance Company (U.S.A.) Jahn Hancock Annuities Service Gaoler 184 Corporate Drive, Portsmouth, NH 03801815 Mailing Address: PO Box 9505, Portsmouth, NH 03802505 (877)543-2383 v~.jhannuities.com Apri18, 2011 L. Renee Lieux Fax #: 717.731.8205 Dear 1VIr. Lieux: Re: CONTRACT/CERTIFICATE # FX06009158 1Z02~tLllGIC~ the future is yours This letter is in response to the inquiry recently submitted for the annuity contract referenced above. The date of death value as of 11/24/2010 was $84,474.41. Uyou have any questions or concerns about this letter, please call us at 877-543-2363. Our Claims Service Representatives are available on weekdays from 9:00 a.m. to 5:00 p.m. EST. Sincerely, Jolm Hancock Annuities Life insurance annuities, including group annuities, an- products issued by John Fiancack Life Insurance Company (U. S.A)", 6loomhekt F511s, MI 'not licensed in New York ~:% SCHEDULE H `i~~ pennsylvania oePaarMENr or aeveNUe FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Rhea L. Ledebohm 21-10-1179 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Grave preparation -Woodrow Morgan 200.00 2. Cremation burial -Evans Crematory 100.00 3. Meal after funeral -Kevin's Place, Lykens, PA 71 29 a. Headstone engraving -Evans Memorial 500.00 B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: 500.00 Name(s) of Personal Representative(s) James H. Ballet'; 111 Street Address 3820 Centerfield Road city _Harrisburg State. FA zIP 17109 Year(s) Commission Paid: 201 {~ 6.000.00 2. ~ Attorney Fees: Bybel Rutledge LLP 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation,) Claimant Street Address City _ __ __ State _ _ ZIP _ __ Relationship of Claimant to Decedent 4. Probate Fees: Cumberland County Register of Wills 413.50 5, Accountant Fees: 6. Tax Return Preparer Fees: H&R Block - 2010 tax preparation 774.00 ~ PA American Water -December 2010, January, February, and March 2011 102.27 s. Mileage(Postage expenses -December 2010 -April 2011 655.58 a PPL Electric -January -March 2011 431.28 ~o. ! Fairview Township Trash & Sewer -October 1, 2010 -March 31, 2011 198.00 ~ ~. Homeowner's Insurance -Foremost Insurance Company -October 1, 2010 -February 24, 2011 577.75 tz. I Settlement Costs on 87 Fetrow Lane, New Cumberland, PA I I 18,210.68 TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. ~~~ 4~ pennsylvania y DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS E5TATE OF FILE NUMBER Rhea L. Ledebohm 21-10-1179 Decedent's debts must be reported on schedule I. Tf more space is needed, use add~tionaf sneeu or paper or one same size. i~ Pennsylvania SCHEDULE I ~' DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Rhea L. Ledebohm 21-10-1179 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 ~ PPL Electric -November and December 2010 133.42 2. Country Meadows @ Home -Personal care service -December 2010 2..110.00 3. PNC Checking Account checks written pre-death and cleared post-death 2,189.41 4. Country Meadows pharmacy medication 321.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 4,753.83 If more space is needed, insert additional sheets of the same size. PPL Electric Utilities Electric Service For_ RHEA L LEDEBOHM-ESTATE 87 FETROW LN NEW CUMBERLAND PA 17070 Questions about this bill? Please contact us by Dec 28 at1-800-342-5775 (1-800-DIAL-1'PL) or write to: Customer Sers~ice 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electnc use over the last l 3 months. Types of Meter Readings Actual - Adjusted Estimated Customer 0 Page 1 ,~ 97260 80001 Summary Page UlG- IOU lzllc~ll~ 50 40 30 20 l0 0 KWH -Average Per Day Meter Reading Information Meter #56758955 Dec 7 Actual 28275 Nov 5 Actual 27601 32 Da s KWH Billed 674 Average -Dec 2009 2010 Temperature 46F 42F KWH Per Day 22 21 Yearly Use: Total Average Use Monthly Jan 2009 -Dec 2009 15822 1319 Jan 2010 -Dec 2010 8913 743 DJFMAMJJA50ND 2009 Months 2010 Other important information on back ~ Return this r PPL Electric Utilities Electric Service For: RI~EA L LEDEBOIiM-ESTATE 87 FETROW LN NE~~V Ci_JMBERLAND PA 17070 ' Page 3 97260-80001 I.Is~ cv1~~IkzgQr wr~kr Total from Last BiU $36.21 Payment Received Nov 29 -Thank You! $36.21 Billing Details Balance as of Dec 7, 2010 $0.00 Current Charges Charges for -PPL Electric Utilities PPL Electric utilities Residential Rate: RS for Nov 5 -Dec 7 Customer Service Distribution Charge: 827 Hausman Rd. Customer Char e 8.44 Allentown, PA 200 KWH at 2.0600000¢ per KWH 5.81 18104-9392 474 KWH at 2.64000000¢ per KWH 12.51 1-800-342-5775 ° PA Tax Adj Surchazge at 0.10300000 /° 0.03 (1-800-DIAL-PPL) "Transmission Charge: www. lelectric.com PP 674 KWH at 0.31600000¢ per KWH 2.13 Generation Char e: d ~ Capacity an nergy 200 KWH at 10.13300000¢ per KWH 20.27 474 KWH at 10.13300000¢ er KWH 4 0 ~ % 48.03 01 0 PA Tax Adj Surcharge at -0. 1 000 0 . - Total PPL Electric Utilities Charges $97.21 t#is ~Fnva~~ ~h Dater Thad lee ~~, ~~#I~. >. 7, Account Balance $97.21 General Generation prices and char es are set by the electric generation supplier you have chosen. The Pubic Utility Commission regulates distribution Information nces and services. The Federal Energy Regulatory Commission regulates ~ransrnission prices and services. Next meter ppL Electric Utilities uses about $0.45 of this bill to pay state taxes. In reading addition, about $5.73 of this bill pays the PA Gross Receipts Tax. on or about Jan 7 For your convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card. Call Bi1lMatrix at 1-800-672-2413. Bi1lMatrix will charge your credit and ATM card a service fee for making this payment. Before digging~ around your home or property, you should always call the state's One CaI1 notification system to locate any underground utility lines. You can do this by simpl dialing 811, which will connect you to the Ogle Call system. Be safe andyca1181 I before you dig. With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit www.ppleiectric.com. Save postage and late charges -sign up for Automated Bill Payment. Brighten your holidays safely. Check limi~t strin s before using to make sure cords and plugs are intact. Tum of~'inside Igoliday lights before you go to bed. Information about appliance energy use and tips on saving energy are available through the-Energy Library on our Web site, www.pplelectnc.com. Country Meadows At Home PO Box 6030 Hershey. PA 17033 Phone: (888)754-2220 Fax: (717)520-4760 www.countrymeadowsathome.com Rhea Ledebohm A~ C(7tINTRY STATEMENT M~-~"s ome® Personal Cure Services Date: 1210812010 Client Name: Ledebohm, Rhea Account #: 00618 Page #: 1 Date Transaction Amount Balance 1 1 124120 1 0 Balance forward 4,295.00 11/2912010 PMT #1010. J.Bailey 2,505.00- 1,790.00 12/0812010 iNV #5997. 320.00 2,110.00 ~~ ~c~3 12~t ~C~ ~ 1-30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS CURRENT PAST DUE PAST DUE PAST DUE PAST DUE AMOUNT DUE 2,110.00 0.00 0.00 0.00 0.00 $2,110.00 ~: Terms: Due Within 14 Uays Ut Keceipt. You may pay ay vtiarr, w~asiaicaiu; r,~«~~~4~~ ~-nNico~ ~~ "~~~`~~~-~ `-'~~ ~-~~~'- `^` hops //countrymeadows.billingdoc.net or by phone toll free 1-866-965-8610 PLEASE DETACH AND RETURN BOTTOM STUB WITH YOUR PAYMENT ~~ COUNTRY MEADOWS j~ ~ INVOICE DATE: 12/08/2010 ® INVOICE #: 5997 Personal, Care Services PAYER: Bailey III, James PO Box 3060 Phone: (888)754-2220 Hershey. PA 17033 Fax: (717) 520-4760 CLIENT: Ledebohm, Rhea www.countrymeadowsathome.com ACCOUNT #: 00618 James Bailey III Date Start -End Time Description Care Giver Unit QTY Rate Amount 11/22/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) Flinn, Amy HOURS 3.00 20.00 60.00 11/22/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) Miller, Jennifer HOURS 3.50 20.00 70.00 11/23/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) Miller, Jennifer HOURS 3.00 20.00 60.00 11/23/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) Miller, Jennifer HOURS 3.50 20.00 70.00 11/24/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) Flinn, Amy HOURS 3.00 20.00 60.00 Terms: Due Within 14 Days Of Receipt. You may pay by VISA. Mastercard. American Express or TOTAL: 16.00 (Hours) $320.00 Discover On Line at https //cour~trymeado'ws.billingdoc.net or by phone toll free 1-866-965-8610 Page 2 of 2 Account #: 00618 Country Meadows At Home oooo,se Invoice Country Meadows At Home PO Box 3060 Hershey, PA 17033 Invoice To James Bailey III 3820 Centerfield Road Harrisburg, PA 17109 Phone: (888) 754-2220 Fax: (717) 520-4760 AG COUNTRY ^/ / ~/~ M/ /~ ~ E/ / A/~~ / D~^ /O W S i/ ~ / r e3~ DATE INVOICE NO. PAGE Nov 24 2010 5862 Page 1 of 3 Terms: Due within 14 days of receipt Client Date Start -End Time Description/ Care Giver Unit QTY Rate /Per Amount Ledebohm. Rhea 1 1/08/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy 1 1/08/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOt1RS 3.50 20.00 /Hour 70.00 Flinn, Amy 1 1/09/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer 11/09/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Miller, Jennifer 11/10/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy t 1/10/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Flinn, Amy 1 I/11/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer i 1/1 1/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Miller, Jennifer 11/12/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy 11/12/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Flinn, Amy 1 1/13/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer l i/ i 3/2010 5:3CFwi 9:OOPM HCA-Hourly (3 hrs. service) HOURS ?.50 20.00 !Hour 70.00 , Flinn, Amy l 1/14/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy 11/14/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Flinn, Amy i 1/15/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy I Ii15/2010 6:OOPM 9:OOPM HCA-Hourly (3 hrs. service) HOURS I 3.001 20.00 i Hour 60.00 - Flinn, Amy I 11/16/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer l 1/16/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Miller, Jennifer 11/17/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy 11/i7/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Invoice Country Meadows At Home PO Box 3060 Hershey, PA 17033 Invoice To James Bailey III 3820 Centerfield Road Harrisburg, PA 17109 Phone: (888) 754-2220 Fax: (7 i 7) 520-4760 At COUNTRY MEADOWS ome~ DATE INVOICE NO. PAGE Nov 24 2010 5862 Page 2 of 3 Terms: Due within 14 days of receipt Client Date Start -End Time Description/ Care Giver Unit QTY Rate /Per Amount Flinn, Amy 1 1 /] 8/20 ] 0 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer 11/18/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Miller, Jennifer 11/19/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Flinn, Amy 11/19/2010 6:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 2.50 20.00 /Hour 50.00 Miller, Jennifer l 1/20/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service} HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer i i/20/2010 5:30PM 9:OOPM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Miller, Jennifer (1/21/2010 6:OOAM 9:OOAM HCA-Hourly (3 hrs. service) HOURS 3.00 20.00 /Hour 60.00 Miller, Jennifer 1 1/21/2010 6:15PM 9:45PM HCA-Hourly (3 hrs. service) HOURS 3.50 20.00 /Hour 70.00 Rank, Pamela Client Total, Hours & Dollars 89.50 1,790.00 Invoice Country Meadows At Home PO Box 3060 Hershey, PA 17033 Invoice To James Bailey III 3820 Centerfield Road Harrisburg, PA 17109 Phone: (888)754-2220 Fax: (717)520-4760 At COUNTRY MEADOWS ome~ DATE INVOICE NO. PAGE Nov 24 2010 5862 Page 3 of 3 Terms: Due within 14 days of receipt Client Date Start -End Time Description/ Care Giver Unit QTY Rate /Per Amount TOTAL: 89.50 (Hours) $1,790.00 Due within 14 days of receipt. You may pay by VISA, Mastercard, American Express or Discover by calling 1-888-754-2220. Please cut or tear off and send with your payment. Return Portion Invoice Date: Nov 24 2010 Invoice Number: 5862 Payer: Bailey [l[, James Client: Ledebohm, Rhea - Country Meadows At Home PO Box 3060 Hershey, PA 17033 Amount Due: $ 1,790.00 Amount Enclosed: Check Number Country Meadows West Shore 3 4905 East Trindle Road Mechanicsburg, PA 17050 Telephone: (717) 975-3434 Resident Statement Date: 03/01/2011 Re: Rhea Ledebohm Account#: 88178 Balance Due: -13.80 James Bailey III 3820 Centerfield Road Harrisburg, PA 17109 DATE BALANCE FORWARD 02/02/?_Ol~ PAYMENT CREDIT BALANCE - DO NOT PAY Thank you for choosing Country Meadows of west Shore 3! 321.00 (334.80) (13.80) Please include the top portion of this bill with your payment by the 15th using the enclosed envelope. Make you check payable to Country Meadows Associates. Statement questions contact Karen 717-975-3434 For pharmacy questions please contact "Alert" direct at 1-800-266-9954 Amount Enclosed Resident Name: Rhea Ledebohm Account#: 88178 Rt~' ..-. E - ~;`~'. .. pennsylvania INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Rhea L. Ledebohm 21-10-1179 NUMBER ', NAME AND ADDRESS OE PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I ' TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Wilmer Bender, 758 Winesays Circle, Howard, OH 43028 Brother 10% 2 ' Robert Bender, 47 Crest Avenue, Macedon, NY 14502 Brother ' Ool° 3. Kathryn Sullivan, 41 Turner Street, Quincy, MA 02169 Sister 10% 4. Brian Bender, 17981 Market Street, Williamstown, PA 17098 Nephew 5°10 5. David Bender, 105 East Street, Wiconisco, PA 17097 Nephew 5% 6. ~ Charles Bender, 222 Meal Drive, Carlisle, PA 17013 Nephew 5% 7. ~ Karl M. Ledebohm, PO Box 173, New Cumberland, PA 17070 Nephew 2®°10 8. James H. Bailey, III, 3820 Centerfield Road, Harrisburg, PA 17109 Nephew 35% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND 60VERNMENTAL DISTRIBUTIONS: 1. Community Aid, 4883 Carlisle Pike, Mechanicsburg, PA, Clothes Donation TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $ If more space is needed, use additional sheets of paper of the same size. 621.00 621.00 BYBEL RUTLEDGE LLP r~'I"I'ORNEYS r~T Lr1W 1017 IVlumma Road, Suite 302 Lemoyne, Pry 17043 July S, 2011 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse 1 Courthouse Square Room 102 Carlisle, PA 17013 Re: Inheritance Tax Return Estate of Rhea L. Ledebohm File No 2010-01179 Our File No.: 194-001 Dear Ms. Strasbaugh: 'Telephone: 717.731.1700 I~ay: 717.731.8205 ;-,-, c_~. -T' v c=- T_, -'~Z,, 1~W _ .;-~ r-n t ,-;C7~ i -y ~~~ - _. .~ -- :r~ ~'~ O r _ --, c l'IA OVERNIGHT MA11, Please find enclosed an original and two (2) copies of the inheritance tax return with supporting documentation on the Estate of Rhea L. Ledebohm. Enclosed is an additional copy of this letter and tax return which we ask that you time- stamp and return to our office in the enclosed self-addressed stamped envelope. If you have any questions please contact the undersigned. Thank you. Resp ctfuily, t Bybel Rutledge LLP By L. Renee Lieux LRL/djw Enclosures cc: ,Tames H. Bailey, III, Executor From: (717) 731-1700 L. Renee Lieux Bybel Rutledge LLP 1017 Mumma Road Suite 3D2 Lemoyne, PA 17043 Origin ID' GTYA fro Ship Date. 05JUL11 f~2a ActWgt 1 0 LB ~s9 CAD 1 0 0 749 7 1 871NET3180 Delivery Address Bar Code SHIPTO: (7171240-6345 BILLSENDERLc02K I IIIIIIIII IIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIII Glenda Farner Strasbaugh Cumberland County Register of Wills 1 COURT HOUSE SQ CUMBERLAND COUNTY COURTHOUSE CARLISLE, PA 17013 Ref# 194001 Invoice # PO # Dept # TRK# 7972 7121 7089 [ozol 16 GTYA 17013 PA-US MDT IIII ~I~~~E~R~~~S'k~~'~~~~ I~lr~h~~9~li II ~p 4r~F~ F r~~_~ aT~~ j0p6 U cur label to your laser or inkjet printer. ...~ ~zontal line. ~ ~- , ...y pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned. .. ,.7.... _ - trrad.drdf;, (., ,, cottit rrs '.. Use of this system ccostitutes your agreement to the service conditions in the current FedEx Service Guide, available on fedexcom. 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