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Home My WebLink About07-18-11 (2)1505610143 REV-1500 Ex `°'-'°' PA De artment of Revenue OFFICIAL USE ONLY p pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTNENT OF REVENUE Po Box.2sos01 INHERITANCE TAX RETURN 21 10 1072 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206 32 4186 10 18 2010 12 25 1920 Decedent's Last Name MCDONNELL Suffix Decedent's First Name THOMAS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) x^ g Decedent Died Testate (Attach Copy of Will) ~ ~• (Alta heCoMaiof Trust a Living Trust PY ) 9. Litigation Proceeds Received ~ 10. Spousal Povert Credit date of death between 12-31 ~J1 and -1-95) 3. Remainder Return (date of death MI C MI pnor to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9t 13(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY R DUFFIE (717) 761 4540 First line of address 301 MARKET ST Second line of address PO BOX 109 City or Post Office State ZIP Code LEMOYNE PA Correspondent's a-mail address: REGISTER~{IA~ILLS USE ONLY -r; r:-r -r- n r.- _iJ ~` r` _ ~'_ ~ ~ ~ r-` C :r O =r- E FILED ~i C ^~ i__ 1 r..._ 1 r..t r ~l --r~ Under penalties of perjury, I declare that I examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true rrect and complete. De IaraC o preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF ON RESP E O FILING RETURN DATE (~' ~ Anthony F Thomas ADDRESS 643 Stratford Wood oad Matthews NC 28105 SIG E OF ARE HE HAN REPRESENTATIVE DATE ~_ JERRY R. DUFFIE ~~/f~~16// 1 MARKET ST.. LEMOYNE. PA Side 1 1505610143 1505610143 -1 J REV-1500 EX 15D561D243 Decedents Name: McDonnell, Thomas Ci RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... 2. Stocks and Bonds (Schedule B) ............................................................................ 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 7. Inter-Vivos Transfers & Miscellaneous inn; Probate Property (Schedule G) u Separate Billing Requested............ 8. Total Gross Assets (total Lines 1-7) ..................................................................... Decedent's Social Security Number 206 32 4186 1. 127,000.00 2. 3. 4. 5. 6,458.71 6. 7. $. 133,458.71 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, 13< Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12• Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 0.00 16 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 . at sibling rate X .12 . 18. Amount of Line 14 taxable 3 91.7 4 10 7 18. , at collateral rate X .15 19. Tax Due .................................................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 11,005.64 15,061.33 26,066.97 107,391.74 107,391.74 0.00 0.00 0.00 16,108.76 16,108.76 Side 2 15D561D243 150561D243 J REV-1500 EX Page 3 File Number 21-10-1072 Decedent's Complete Address: DECEDENT'S NAME McDonnell, Thomas C STREET ADDRESS 211 Cumberland Drive CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 16,108.76 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Rage 2 Line 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ 6, ~ Q$.76 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ ^x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: . The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1502 EX+~11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER McDonnell, Thomas C 21-10-1072 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McDonnell, Thomas C 21-10-1072 Include the proceeds of litigation and the date the proceeds were received by the 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 2010 Federal Income Tax Return Refund 171.00 2 PNC Checking Account No. 5140040154 4,834.77 3 Refund to Account 23.14 4 Residence located at 211 Cumberland Drive, Cumberland County, PA -Reimbursement for 327.89 payment of County Taxes ($281.69) and Sewer payments ($46.20) 5 State Farm Home Owners Insurance Policy -Refund 484.07 6 Fidelity Investment Pension Payment 590.74 7 Fidelity Investment Pension Payment -Adjustment to Overpayment 27.10 TOTAL (Also enter on Line 5, Recapitulation) I 6,458.71 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COM INHNERITANCEDT~ RETURNANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF I FILE NUMBER McDonnell, Thomas C 21-10-1072 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 4,324.00 Street Address City State Zio Yearlsl Commission paid 2. Attorney's Fees JOHNSON, DUFFIE, STEWART 8~ WEIDNER 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 315.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,866.14 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 11,005.64 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER McDonnell, Thomas C 21-10-1072 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eg nses 1 Myers-Harner Funeral Home H-A Other Administrative Costs 2 Cumberland County Register of Wills Office -Additional Short Certificates 3 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return and Inventory 4 Doug Usko -Repair/Maintenance to Bathroom Floor 5 HandySide, Inc. - Repair of HVAC & Plumbing to 211 Cumberland Drive 6 Reserves: Additional Miscellaneous Expenses 7 The Cumberland Law Journal -Notice of Estate Administration 8 The Patriot News -Notice of Estate Administration H-B7 4,324.00 4,324.00 8.00 30.00 588.98 738.27 250.00 75.00 175.89 1,866.14 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (~2-06) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McDonnell, Thomas C 21-10-1072 Report debts incurred by the decedent prior to death that remained unpaid at the data of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bonnie K. Miller, Treasurer -Property Taxes for 211 Cumberland Drive 580.88 2 Brandon Merritts -Snow Removal for Property 120.00 3 Brandon Merritts -Snow Removal at Residence 40.00 4 Brandon Merritts -Landscape Maintenance for 211 Cumberland Drive 90.00 5 Camp Hill Emergency Physicians 29.66 6 Crestwood Mangement LLC 23.14 7 Edward E. Lamarque MD -Account No. 259 43.81 8 Edward E. Lamarque MD 325.86 9 Fidelity Investment Pension Payment -Reversal due to decedent's death 590.74 10 Heritage Medical Group 69.36 11 Housecalls Rx -Account No. 00000043700 40.50 12 Housecalls Rx 40.94 13 Jennifer Jones -Lawn Care for 211 Cumberland Drive 80.46 14 Jennifer Jones -Lawn Care for 211 Cumberland Drive 113.00 15 Lawn Care for Property located at 211 Cumberland Drive, Cumberland County, PA 80.00 16 Lawn Care for Property located at 211 Cumberland Drive, Cumberland County, PA 100.00 17 Lower Allen Township -Sewer & Refuse 84.25 Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 10, Recapitulation) 15,061.33 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER McDonnell, Thomas C 21-10-1072 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 18 Michael J. Lawler NP -Doctor's Office ~ Account No. 0000043700 176.95 19 Pennsylvania American Water Co. 43.97 20 Pennsylvania American Water Co. 16.53 21 Pennsylvania American Water Co. 34.31 22 Pennsylvania American Water Co. 15.90 23 Pennsylvania American Water Co. 14.26 24 Pennsylvania American Water Co. 13.50 25 Pennsylvania American Water Co. 13.50 26 Pennsylvania American Water Co. 1.5.40 27 Pennsylvania Power 8~ Light 23.14 28 Pennsylvania Power & Light 23.14 29 Pennsylvania Power & Light 61.65 30 Pennsylvania Power & Light 81.33 31 Pennsylvania Power & Light 68.25 32 Pennsylvania Power & Light 53.18 33 Pennsylvania Power & Light 46.77 34 Pennsylvania Power & Light 17.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ (6-96) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER McDonnell, Thomas C 21-10-1072 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 35 Pennsylvania Power & Light 18.35 36 Quantum Imaging & Therapeutic 10.54 37 Remaining Medical Costs 1,053.95 38 Residence located at 211 Cumberland Drive, Cumberland County, PA -Settlement Charges 9,783.85 relating to the Sale of Real Estate. A copy of the Settlement Statement (HUD-1) is attached to this Return 39 Special Event Emergency Medical -Account No. 10-142597 43.03 40 State Farm Home Owners Insurance Policy 59.16 41 State Farm Home Owners Insurance Policy 59.16 42 State Farm Home Owners Insurance Policy 59.16 43 State Farm Home Owners Insurance Policy 59.16 44 State Farm Home Owners Insurance Policy 59.16 45 State Farm Home Owners Insurance Policy 59.16 46 State Farm Home Owners Insurance Policy 59.16 47 State Farm Home Owners Insurance Policy 59.16 48 State Farm Home Owners Insurance Policy 59.16 49 UGI 13.56 50 UGI 35.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER McDonnell, Thomas C 21-10-1072 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 FJ(+ (11-08) SCHEDULE J COMINHRESIDENTDEC DENI~NANIA BENEFICIARIES ESTATE OF FILE NUMBER McDonnell, Thomas C ~ 21-10-10 72 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do o List Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal ~ distributions, and transfers under Sec. 9116 a 1.2 Mary P Thomas Friend Entire Estate 107,391.74 643 Stratford Woods Road Matthews, NC 28105 Total 107,391.74 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ESTATE OF THOMAS C. McDONNELL SCHEDULE OF EXHIBITS EXHIBIT A Last Will and Testament for Thomas C. McDonnell signed and dated February 28, 2005. EXHIBIT B HUD-1 Settlement Sheet for Sale of Property located at 211 Cumberland Drive, Lower Allen Township, Camp Hill, Pennsylvania sold on July 8, 2011. EXHIBIT C Date of Death Valuation for PNC Checking Account. 449953 } hw .~ ,,~ -~ ,,, c 2 A' 1~~ ~ ~ Y }~ x I F ~,LL r y _~ y i T yS 2~ ,,T: K- 0 1 }~~ 1~ ~tJ ',y ~. ~~ y '~~~ ~~, a' r; ~.S~c-R3 ;~ 1 r t5r~ { .~',r '+ ~ :~ ~?' f _ 4~ r w i' y ry w '` i I .Y i ~y-:: f , ~ + f ~.th :~. y~'t. ~, J'~ ke. 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J 4 f 3 ~ R s y A fr is ~ . f ~` ~~ k ~` * E ~ ri ~ i - f a ~ +" ~ - .. i w - ~ ~ ` Z ~ J G _ ~ `9 i. .i c ~, s,. t X ~~ y k a t .~ ,~,, ] .. iti ~~ ~ ~ _ t~ ~ . j N ~ µ +, t r ~ r 4 1 j ~ ~ .,..c ~ 'r r - y 'Y A ~j ' 't'' ~ ~ T ' . V t »' ` ~ .a ., ..~ Y J. - A f ~ ~ f 4 ._ ~~. ~ h ] 1 :.ZS y* } f I r •i ~~ t~Y4 + '~ ~ ~ ~ ~~ ~+,{t ~ I r ~. ~ 1 -t S . J . ~ F J .'' ~ i . i r a, y ~ i v ~ ~'~ J; o-. ~ ~a_. 2~ ". ~ _ ~a 3+ T 4; ~ ~' M ~ ~ ~ . >r w ~ '~,^ ~ ,f'~ ; :~ ~ ~ ri ~~ h._ 4 ~ T ~ _ _ t ~ ~ ~, ~~ ~ 4 ~~ • C' t ' s ~ d f ~ ' .Y~,. ~ y~ r t _ I r c -. ~.~ s at ~ ~ a , ,, j T ~ t '? ~' E, 7 ~" '` 1 ~ ,w • ~ i ~ A~ ' j ~ , t d t ~ ' "~ ' a - ~ f ` ' ~ x ~s~ ~ ~~ n ~ ~ i, R ~ ~ ~ ~ Y'R - i~ ~ t. , ~ ,c~ ,: ~c , 4~ ' ) ~, ~ ~ ~ C ~}t ~~ f, ~ ~~ ; ci ~ 4 f 'fi ' ~t ~ s ~ M t ._ . '. ~ r ; ~ Y~ ~ l~ s~ w, ...~ A ~ F- 4 n { I r S, ~ ~ T .. _ ~ i V ~ % Y ~~ - ~ ,4~~~ ` y ~ ..±V+ S". ~ 1~ l ~ 'k ' An ~} 1 ; ~ Z '~ ~.ISC i _ 5 r_^ Y _ <t r 3 , r ~ ~ ~ ; .dam - f e ~~i OF THOMAS C. McDONNELL I, THOMAS C. McDONNELL, of mower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I direct that all my legal debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid, unless otherwise provided, from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. I bequeath my automobile, household goods and personal effects and other tangible personalty of a like nature (not including cash and securities), together with any existing insurance thereon, to my friend, MARY P. THOMAS. In the event my friend, MARY P. THOMAS, shall .predecease me, I bequeath such tangible personalty and insurance thereon, to her then living issue, per stirpes, in as nearly equal shares as practicable. I devise and bequeath the residue of my estate of every nature and wherever situate to my friend, ~~A.RY P. THfI~_t~AC_ ChnJlri r~~i friarZrti ~~ARZ' P, TH~Ai1.A~, nradacgace me, I devise and bequeath the residue of my estate of every nature and wherever situate to her then living issue, per stirpes. IV. I direct that all taxes assessed in consequence of my death of whatever nature and whatever jurisdiction imposed shall be paid from my residuary estate as part of the expense and administration of my estate. v. I appoint my friend, ANTHONY F. THOMAS, Executor of this, my last Will. Should my friend, ANTHONY F. THOMAS, fail to qualify or cease to act as Executor, I appoint my friend, MARY P. THOMAS, Executrix of this, my Last Will. VI. I direct that my Executor or his successor shall not be required to post bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2 Pry day of ~,~ ,3,P ct.4 R ~' , 2005 (~ ~ ,~ `- ~~ ' °" ~~~il ~"~G~LC~ (SEAL) THOMAS C. McDONNELL Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses -2- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: I, THOMAS C. McDONNELL, Testator,' whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~pjg;~t'rj~ ~r~ ~~~~7~4'Gefi.~. THOMAS C. McDONNELL Sworn or affirmed to and acknowledged before me, by THOMAS C. McDONNELL, the Testator, this day of ~ l`)/11~ ~1 , 2005. ~i'~~i~ ~ ~-/~G~t~~c~- Notary Public Notarial Seal Lon A. Richard, Notary Public Lemoyne Boro, Cumberland County My Commission Expires Nov. 12, 2006 Member, Pennsylvania Association of Notaries -3- ____._. _ _ -v- __ ~--- ~, ~ t = -, -- ; , =- -- _ , 1 ,_ _ ,. , . AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, J2UF)Cr~- h1- ~~Q11~~land ~i`1~ H- P~r~~h~~~~l~` ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the foregoing instrument as his Last Will and Testament; that he 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 that time at least 18 years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by ~~~~'~- ~~ • ~-t-~~l~C-ei~ and ~0.~ 1 ~ • w~ C ~' f J r. ,witnesses, this ~~ day of I-~ht~IG~rl~ 2005. ~~(~, ~~~ Notary Public Notarial Seal ____ Lon A. Richard, Notary Public Lemoyne Boro, Cumberland County MY Commission Expires Nov. 12, 2006 I Member, Pennsylvania Assxiati~~n Cif Notaries 244870 -4- _ .~_. ~. =_ ~ - _ - - ~ ~. ~~ , , 1.' c~ ~ O r Z m N ~ O z ~ ~ z rn°~~ C7 mmcn7 ~ N a -i m ~ ~ ~ ~ a -~ z_ ~ D p --~ y x H ~ O ~ ~ g ~ y r r ~~ ~~ ;. _ ~__ _. ,_ -: . ~: -* ~_ ~_ , . !` t _-~ ~ } F ~ ~ ] ' f~ \ - ~ ~ -` to ~ r r t ~ _ ~~ - ~~ - t ~ .. ....:.a.~ _ - ~ ~. . , . ~ .. f., 0 - },4f ~:, i,r ~_ ~ ~_ _ ~ R ~~, J y.: '1S ti r wg }. f ~' v f i ,; y "„ ~ `r y~: V ~. ~ § _ . 1' <.~ Y ~ ~6 ~ iW . 1 .h ` - f' } -' K~; ~~" ~k 2 w: i] _ ~'%~ ~~ ti Y. Yw-~ .: t g+ ~i ~'' x-- ~ q ~~T 4 ~`;. ~T =i { r ~.J ~ :). Y T' ~~ Y j;': 1 ~ '44 }h ~ ~j j, r::: ...Its, >~°-- ~~. 5 ~- ~ .'~ -J '~.L ~ .~ ~.• ~ - 1 I. ~T~ t r~' V ~~Y~ ^ L 1•` ~~ ~ R t zs ~ ~ , $ } ^~ ,~9' 1- ~~ ~ '-J..T.~ ~~' k .!. .~ tV . k k t t v~ _ n _ `~ t ,F I ~ t } " . t, ~ y f~ ._ ~2 ~ . ~~ 1 ~;`: , v 3,'~ l~. t ~~ - {u i'. ~ t z 1 f '~ ~ ~ l: (t f ~ ~.; ;r r y ,~'- ,] ~~ ~~ i 5 4- ;r~' ~.~'. {' ..._ T ~ ,~ ~ ~t 1 ~ 1~' -r4 . ~~ , .~ T 4~ . ~Y ~{ } ~ ~tr4, 4 ~1, ~,Y ~ ' ~ n ~. ht , y~.. v `r y ~' `4t N = .,~ i , k'~ yy'~'. t "~ ' i<. Y~ _ k x' ' c+~ ~ a { ~~+c ;t3 l t L R~ vmn npprwm nu ~w~-,,..... A. Settlement `'-~tement (HUD-1) FINAL Fle Number. 7. Loan Number. 8. Mortgage Insurance Cese Number: 6 1,~ FHA 2.Q RHS 3.0 Conv. Unins. . 11 319 0322990334 4.QVA 5.^Conv. ins. C. Note: This form is tumished to grva Ya a staemem a cerel settlartwnl wets. nr+rauunts Paid to end M a,a settlement agent ere shown. Items marked hoen here tar hiormaiond purposes atd ere net included n the totals. ' are a "(p.o.cJ" was paid outsitle the clasirq; atel Name 8 Address of Lender. F D. Name & Address of Borrower. E. Name & Address of Seiler: THE ESTATE OF THDMAS C MCDDNNELL . Homesale Lending, LLC JAMES P. SHIELDS, CYNTHIA C SHIELDS Matthews, NC 26105 643 Stratlord Woods Rd. 13675 Technology Ddve, Eden Prairie, MN P.D. Box 111, Lehman, PA 16627 , 55344 G. Property Location H. Settlement Agent N I. Settlement Date: 0710812011 Disbursement Date: 07/08/2011 211 CUMBERLAND DRIVE, LOWER ALLEN ~ LJ ~~ own ~~e717-671.9676 Feu 717571.9676, TOWNSHIP CAMP HILL. PA 17011 Harrisburg, PA 17112 . Lower Allen Township Place of Settlement 4~9 Lingleslown Road, 717571-9676 Fax 717571.9676, TkleExpress Printed 07/06/2011 at 2:58 pm Hardsbu , PA 17112 by BM HUD-t Page 1 of 9 Previous editions are obso ate ~ ees - ~roa,.' od ~ m F~wanua Fia'>r°°k 8enaces U~ouP rind at Fund ~L 701. 53,176A0 t tl ~~ ant ~~F`le ant ers a ty 02 53.175.00 to :...Gu mmrssrenP at se men! ( 2ta.w ro er ro ruden' mes naves Group _ oiidiEtlon u d .,.:: 5495.00 (from GFE #1) ~ • Our odgkra8on cher9e 801. B02 Your rxedit or charge (poGds) for the sperXrc interest rate cMsen 5244.48 (fran GFE #2) 739.48 803. our ad)usMd odpiratbn charges Orom GFE A) Bpd, Appr~sal fee ro RELS ValuaBon 5380.00 P.O.C. (from GFE #3) 13 84 . 805. GedB report to REL.S Cm6l 51.00 P.O.C. 8 (Irom GFE #3) BDG Tax service to from GFE #3 807. Flood cer00catbn to from GFE #3 808. ro FgpO,n.alfa#{d'~")1 ~'b L' kAet;~FbeF,ald'fn~AtlZsnce,~ I-mliFESiu1 l~~ 285.4%. 901. Daily Interest cheryes fmm fmm 07!0812011 buW0VP11~Si2.uouvitlay 90 Mortgage Gisurarrce premium for months to (from GFE #3) (imm GFE #11) 364.00 903. Homeowners insurance for 1 b Weslfreld Insurance Co. ~ ~~ b from GFE #71 ;4000wJtesecves'Ib'. ' oskeC':,w{tti?l,'e"d'd~r - . - - ~ ~ (tram liFE SnI 1,147.35 1001. Iniflal depostt toryourescmw account 1002. Homeowners insurance < mon8ls S 30.33hnonM 5121.32 to Homesale Lendin LLC 1003. Mortgage Insurance months S O.OOhnonih S to WELLS FARGO BANK NA 1004, property taxes montlis S O.OOhnonlh 5 to WELLS FARGO BANK NA 1005. County taxes 5 months S 49.34hnonN 5246.70 to Ffomesale Leridi .LLC 1006. Assessments 73 months S 82131month 51,067.69 b Fiomesele LeMin ,LLC ' LLC 1007. Agpegate Adlustmem 5.288.36 to Homesale Lerb 7700 T711e Char. es ~ ~ fmm GFEfF1 1.199.75 arw 11 1. Itle services antl rantlers utk s sW 1102 Settlement a cbsing fee b S from GFE#5 137.06 1103. Owners GUe insurance - 1104. Lenders tltle Insurance 5846.75 110.5. Lenders tltle policy tlmil 597.790.00 landefs Policy 1106. Owners tltle policy Gmtt 5127,000.00 Owners PoIbY 1107. Aganrs portion of the Wtal tltle Insurance premium 5875.59 1108. Underwriters porlbn of the total tltle insurance Premium 5108.22 1109. . ... : r. .. :. .. ...-,_ -. nster•,;Cfia es '4'-~s°C~,'ik ~'~~„~ °` 12Q0'Gwemmer4~Yte an~7~ia• rmmur•E#7) 227.00 - ( 5 1201. Government recording charges 1202 peed 565.00 Mo 5110.00 Release S to Rearder o1 Deedm GFE #8) 1,270.00 5 1203. Transfer taxes 1204. CitylCourrty taxlstamps Deed 51,270.00 Mo S to Recoder of Deeds 1,270.00 1205. State Taxlstamps Deed 51,270.00 Mo S to Recorder of Deeds 7p6. Deeds Mort S to 552.00 b Recoder of Deeds 1207. Record Assignment '~~99-Addf6~- ~;~.af)faafirr~..Ch ih BS - - ~~ (1r0ni uF n4/ 1WW Required servrces that You can shoe for 1 ' . i Flood Ltle of Loen to WF Fbod Services 579.00 P.O.C. B i ax rrvice lee to WF RE EST Tax Svs ~•~ 0. . re ax rt Fee fo Homesale Settlement Services, Inc. p. 1305. Notary to No Pubik: 50. 1306, ewer i 11- to Lower Allen Townshl Autlwd 49.8 0 rash 7l1 b Lower Allen Townshl AuN ' 43 .00 .Home arranty ro American Home Shield 95.00 n to Mike Shoe home Ins clbns 85.0 1 10, mbirp B b Hand aria 5 76272 9,015.00 .w~rawrrarn~llf i t t 'PaW outside of cbsirp by (B)arowar, (S)atler, (L)ender, (Unvestor, Bro(IC)er, "CredB hY lender shown on page 1. "'Cred¢ oy seirer snowi~ u.. vaw ~• HUD-1 Page 2 of 4 Previous editions are ohso ate rC ~ ..._. 4:HU64T~rfe'tJub7ber ~... - ... ,. ,. .. -. ~... ~, ~ ~ :; ctid.F~lN~gmate .,HUDo-1, 739.48 495.00 44.48 244.48 gg3,g6 739.48 1,2 0.00 1, 0.00 HUD-1 Page 3 of 4 Previous ediUOns are obsolete ,~ .~ . 3:;~`e:4;i~Ri ~tGood3Ebit(i~Esdnrate 'r'%; ;~':~"-HUO:f:= " -.,~-. .: -~ '- 2,171.83 1,14)35. . gJ~Ae .:.. .... ... ~ ... .:.. 2.06 89. ._ . .. - -~~ 400.00 364.00 .. ..~ ,., -_._.. ..-. ., .. .. ._. ,`.TKO's. _ ..y~,~ ' __ ,~ !F Note: If you have any questions about the Saganenr ~;nasgas mw ~~ ~ w,,,, .~.-- _.. _..- .-.., , ~'~-y/may/,,~~~ ~ ~~~~~~ CYNTHI~C. SHIELDS t..+" r~ THE ESTATE OF THOMAS C. MCDO f LL A~u { ~f The HUD-1 Settlement StAemerV which I hew prepaad H a tore and accuate account d ihts trauaction. I haw caused ar wi4 cause the 1urWs b be distnssed st eccordatce wiN Nis statement DATE SETTLEMENT AGENT CONVICTION CAN INCLUDE A FME iAND MPMRISONMENT FAOR DETAILS SEE TITLE 18DUSACODE SECT ONRt W ANDIS CTION^1010NALTIES UPON HUD-1 Page 4 of 4 Previous editions are obsolete • H ~ `ERTIFICATION OF BUYER AND SELLER I haw careAUsY reviewed sra HUD-1 Settlement Stelana : d W iha bat d my latvwledge aid belief, d is a true and accurate std. c d all receiPis attl dabursemeras made an mY accaart a M me N this 6'aneactiort I furNx cartftY Net 1 have teceiiwd a mpY d Uwa HU0.1 SeWement Statement. 11 - r • Name of Bormaer ~ ~ ~.of Seger. File Number. Prepared 07A82011 a1 258 pm Note: Thia page displays an Itemlxatlon of the ersdtts shown In section200 of the HUD-1 Settlement Statement This page ccompanles but is not a part of the HU0.1 Settlement Statement If a discrepancy exists, the information on the HU0.1 Settlement tatementepplies. f Credit CredBs • Name of Borrower. Name of Seger. JAMES P. SHIELDS THE ESTATE OF THOMAS C. MCDONNELL CYNTHIA C SHIELDS File Number. 11-319 Prepared 07A8/2011 at 258 pm n of the adjusted origination charges shown in section 800 of the HU0.1 SettlementStatemen ti i sa o ote: Thia page displays an item K a discrepancy exists, the information on the HU0.1 nt Statemenrt tl . eme Is page accompanies but la not a part of the HU0.1 Set ettlement Statement applies. eorrowr Sellr Your Loan Originatlon Charge ur angina n arge qg5 W grower rq, lee - to Webs Fa Bank. NA. S to = 0.008orrower 802 Yaur rxedit or charge (poiros) torthe spec8k: gderest rate chosen qq4 48 Bamwer charge on Inl to Homesale Lendi , LLC S 739.48 0~~' 803. Your adJusled cdginalbn charges _ 1 • Neme of Seger. File Number: Name of Borrower. THE ESTATE OF THOMAS C. MCDONNELL 11-319 JAMES P. SHIELDS CYNTHIA C. SHIELDS Prepared 07A82011 at 2.58 pm HUD-1 Page 1 of 1 previous a i[lons are obso ate Note: Thia page displays an itemisaton of the charges shown on Iine 1101 of the HUD-1 Settlement Statement 7ms page >aecomoanles but is not o part of the HU0.1 Settlement Statement If a discrepancy exists, the information on the HU0.1 Settlement a$ ~y ~~~ e3 } r ~` { ~' ~ { ~ ~- yf ,r~ ~. ~~ ~~ v. ~. x= Yr 't j ~ F` x s A ~' .~ ~ ~t ~` ~' k iti *, ~ l ~ ;y a ~. _ ~ x~ ~ ay x A7 %= ~, v ~} 4C ^ 1 ~ ~' y~a Y- J y*"_ ~n ~ `y y Y JcW ~ ~ ~ ~ 4 ~ ~ ~ ~ ~-: ~;~4 ~~ ~, ~ s ~r ? r~ E 4~1 1 y ' ~ . ~<' ~ nt` ~ ~ t~„~s~ s `w` 5; ~ r: t~ r ~~SYY H 4> i w~ s t,; , C 4 i ~~ ~ ~^~. ~ *~ n f7 _ ~ ,~ ~ ~;3i~ 1 y y 4 } ~'. ~~ ~ s ~ p ~ ~ ;. { ~~ ~ h ~ n S w "~ ~~ + M 6+ rN ~' Y ~~ .. rV ~ !4Y, ~ ;~' ~ ~ ~~ 'yv~ R ~ ,• t ~ ~ ;fi ~ ti_ ~ ~ h ~ ` ~_~ ~~~ "' a~, f' >r- z ~ ` -+ T { 'r. ,; h ~ M .S ~~ 1 , ~ Si ~. C i. - w ' k ~{ t- y 9r s; ~ > } f k t ,`. ~ ~h. ~ ~~ '`' F t a L: k ': ai t~ 4 ~' ~. ,; L n ~ I iy' ~„ 1. ~^ ~t 'f ~ : ~y7 Y 4 L .~ri` wj if w `.° ~" i ' ya Y ~t .~ y 5 r •° ~` c ~y~~tis}y4 yy; r ~~ ~~ 4~ ~ ~ t<l~ ~~"ZSk ::r ~ w1 h ~' $ ~ ~ _ 3tit•, 1,: ~~c.' ~. fir, ~ c ~,. y w. .iii t+a~7E1/ l~`~7.y, + ~ A f `~ ~ , ~,~ 1~i tlj ~I 'N 5 ,~ 4 T` r ~ ~~f y'~i~~' I ~~ F ~~ ~ v, ~~ ~ .~ r l l ~ -_`r ~.~. r ti ,. t _ V S J\ x f ~'1M~ .i. i ,yam r r': FxAi"' ~ w ¢ .r.. ,~ a~ .fix ~ ~I ~ r I,. P f~.,~r ~~ y., ~ f ~ ~ {> v i;f fY'' `~ '' l fe '` ft4~` K Y ... ~ ~ fy~r ~, ~i 7~ ~ .~ ~ ~~,~sR ~ ~,;~a,~,~f t Y ~ ~~b,~5~7~4'.rc '+ ~ ! ~` ~ ~ ~ ~ t ~' t. ~ l a r ' ~ m~ ~ I b .' a ~ a. ~ ~~ n ~iW ~b ~ _ } ,i. ~ tl ~ w ~ ~~~ ~ u . Y l: tr '~ ~` ,~ ~ r ~ , ~ _ 5 ~ ~ ~° x ~, r ~~ >« ~Y ~ t• ~^' ~M T > ~ ~~ 5 * t 4i ? ~~ Y ~~+ ~ ~ ~ ~~'"~ .a`~+~ ~ ~' ' w t v j 'a~.as~ b~ - ~'-E -r y4~~ ~' ~ { 1 ~ 7 ~+ ~a ~~ rte, ~ ,'~y-3j, rv. ~ ~ ~ ~ ~ s ~'~ ~, t ~~"" ~ ~ ~ i ~, y s~ ,n.. , ' r ~ ~x K -_y t ~~~ ~ ~. S,C x it ay ~ -~~nij _-f ~, ~:~, ~ ~., l k ' `^ 4~A ~ h.+^ ~ yFa ~ wy ey _ NC K ~ ~: r ~ i. ' ~["~N: 4 S~y ~: 1 rnti ~, ~ ,~ _ ~"'~, ~ 1 ~ ",. !_ ~~s~. t~, ~ .. Dec, 30. 2010 10:48AM PNC 6ANK 412-705-2747 ~PNC December 30, 2010 Ms. Dana L Wieseman Johnson Duffle Stewart & Weidner P.C. 301 Mazket St P O Box 109 Lemoyne, PA 17043-0109 1tE; T C McDonnell SSN: 206-32186 DOD: 10-18-2010 Dear Ms. Wiesman: No, 6423 P, 1/1 In response to your request for Date of Death (DOD} balances for the customer noted above, our records show the following: Checking Account Account # 5140040154 Established: 10-01-1960 T C MCDONNELL DOD balance: $ 4,834.77 + 0.02 accrued interest lnterest paid 01-01-2010 tkuru 10-18-2010 $ 2,52 XTD Please note that this office provides date of death balances for deposit accounts (IIZAs, 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 local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it rs addressed and may contain information that is privileged, conf dential 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 arty dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. . Page 1 of 1 WADE D. MANLEY JERPY R. DOPFIF, F,LIZABETH D. SHOVER RICHARD W. STEWART ANDREW P. DOLLM.AN LAW OFF I C E S EDM11L'ND G. Mti'ERS SARAH E. HOEFMAN DAVID W. DTLUCE ~ ~~~~~ CAROLYN B. MCCLAIN JOHN A. STATLER ~ JEFFERSON J. SHIPMAN JEFFREY B. RETTIG ~~~~~ OF COUNSEL KEVIN E. OSBORNE HORACE A. JOHNSON MARK C DUFFIE L. ROY WEIDNER. JR. JOHN R NINOSKY MICHAEL 1. CASSIDY F. LEE SHIPi~IAN MELISSA PEEL GREEVY (1965-2006) July 14, 2011 Register of Wills Office `~ ~ ~~. ~ ~` Cumberland County Courthouse ~ -„ ~ c~ - r s=~.! One Courthouse Square z~ - ', ~'_. Carlisle, PA 17013 ~ ~_ cn ~, a~ RE: Estate of Thomas C. McDonnell ~U -n _: .~., Date of Death: October 18, 2010 ~ ~ ~~~ ~~~ Your File No. 21-10-1072 --~ p ~ ~ ~f~ `n ~ Our File No. 9114-1 -~ Dear Register: Enclosed for filing please find the following documents for the above referenced decedent: 1. 2 Original PA Inheritance Tax Returns. There is Inheritance tax due in the amount of $16,108.76. 2. Two copies of Page 1 of the Pa Inheritance tax return, which we ask that you time-stamp and return to us in the enclosed envelope. 3. Inventory 4. Check in the amount of $30.00 representing the filing fee for the Inheritance Tax Return and Inventory. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. Very truly yours, OHNSON, DUFFIE, STEWART &WEIDNER ~ ~~,~. Dana Wieseman Estate Administration Paralegal Enc. c: Anthony F. Thomas, Executor :449983 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL@JDSW.COM JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. ~' o lI u'+ m W ~? ca} gy Imo' C ~ ~s~5 c ® ' ~. N • M ~ ~ ~ C.? 4.~ `~~~ Q ) ~ C!~ - ~' (~ t.i.? },~j ~ ~ 4~. '1'`~ ~ ~/ ~~~rr~~ ~/ // ~ 1,~ ~~ 1 J ~' i .1 .~ -ate ~~ i' 7 a ~i t/? y Q ..~ V ~II ~I J Vl v .-~ 0. a, ~ % ~ O O ~ y. M rr ~/ O M 0., ..7 w ~ ~~ w "'w I~"'~ O `~ O H W O 2 U = ~ O U ~ O z N ~_ ~ W O O N U p ~o=a o z ~ a W ~ ~ J O v~i m U ~ c~~w~ ~ U O U