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HomeMy WebLinkAbout08-12-11 (2) 1505610101 REV-1500 °` ~°i_1°' '~ 01=FICIAL USE ONLY PA Department of Revenue p~Yl~ia County Code Year File Number otwwtneMr os ~~ue Bureau of Individual Taxes INHERITANCE TAX RETURN "~ ' ` : ° J` PO BOX 28o6oi _' Harrisburg, PA 17128-o6os RESIDENT DECEDENT 2 ` 1 ' 1 I ~0 '. 0. 5~ _ f~ ~~ .~ macs„~~aa_ r, _ ~ z ._ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ,_., 1 6 0~~ 2 0 ;_: 9 T 9 0 0~: 3 2 1, 2 Q- 1 ~ 1 1 2, 2 4` 1; 9 2 1 =~ . ~ . ., , Decedent's Last Name Suffix Decedent's First Name MI ,. .;, , r, .P~E~R'~E S I~E ~ OS~E ]PH .. .. ~ ~ ~, (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI i _ 'P E R S i ~E ; Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 3 7 9 3 2; 1' 5 ~ 4 ~' REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum p 2. Supplemental Return O 3. Remainder Retum (date of death O 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Wii!) O 9. Litigation Proceeds Received p 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION IMUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORIYIATION SHOULO BE DIRECTED T0: Name Daytime Telephone Number M a=r ,1 i~ I~`. M': c 'C a, 1 e b '7 1 7 6 9 1 ?? 7 0 _. First fine of address .2 1.,9 Eas t' M airs Str a e`t Second line of address P O~' B o s 2 3 0 City or Post Office State ZIP Code REGISTE ILLS US~C-D ~ ~~, M~ ~, Fy, ~ . ~ T .,..,. -.. ..~J _ w :y~~ ,~-. . . J ~ ~°, ~;. r i DATE FILE[if ~;~ ~. M e c h a n i c: s b'u r '_g P A 1 7' 0 5 5 Correspondent's e-mail address: Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF SON RESPONSIBLE FOR FI RETURN v DATE ADDRESS iliane W. reresie ~~ 4119.Darius D~c~E>4ola. PA 17025 SIGtV'~ O~ ~ i~1G%/ ~~~~_i~NTATIVE DATE ADDRESS Ma~~lin R• 1VIcCaleb PLE USE ORIGINAL FORM ONLY L 1505610101 Side 1 -, 1505610101 1505610105 REV 1500 EX Decedent's Social Security Number Decedents Name: Jasepb L. Pesesie 1 6 0 2 0 9 7: 9 0 _. RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0 ~0 0 a , 2. Stocks and Bonds (Schedule B) ....................................... 2. 6 7 8 "9 8 ~ 0 4 ~. , ; ~,. ',G<'- 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 ;`0 0 ,~. ~, i ti 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. •.0 0 .~~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 6 1 5 0 ~~ 3 0 1~;: 6. Jointly Owned Property (Schedule F) p Separate. Billing Requested ....... 6. ` 0 l0 0 ~, .. 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Property ~ { `" ' °'~L' ~: (Schedule G) O Separate Billing Requested........ 7. '3 4 0 ~1 1 ~9 ~5 8. Total Gross Assets (total Lines 1 through 7) ..........:.................. 8. ~ 1 1 8 0 ~6 0 '~` 2 ~9 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 1 g g g ' 7 „0 ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule i) .............. 10. ~ i 2 5 , 9 ,~ 6 ~ $ ~ 2 11. Total Deductions (total Lines 9 and 10) ................................. 11. " 2 1 4 ~' 8 Wt 3 8 6 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~9 6 5 ~ 7 ~ 6~'~4 ,3 13. Charitable and Govemmentaf 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. ~9 6 5 - 7 - 6 ~ 4 `3 .. ,_ , , r_, - -~:~ - TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ,. ,: , . (a}(1.2) x .0.~ 4 1 5 7 b `* 4 3 15. ` 0 0 0 16. Amount of Line 14 bie ~~~>- - '`'`. ' n;' ,,:~;~~ tis~ ~;~ 4 ;,~ ~~~.,~_~ ~ ,...~, ~,,. P 3 at lineal rate X .0 .;, 16. - 0 0 0 17. Amount of Line 14 taxable - ~~ ~ ~~ y ,. ;, , : b~~,~ - i k., ~ .~~„~, .,, . ~~~ .1s at sibling rate X .12 5~ 0 0 0' 0 0 17. 6' 0 0 0 0 18. Amount of line 14 taxable `- ~ ~~~..K ~~:.-~ ~'~-~ ~.k,~ t. ,~ ;x~ , ~-_ ~~~~~~_ ~~:,t-~:~~<~ __ ~~, ~-. at collateral rate x .15 ~ 5. 0 ` 0? (~ ~ 0" 0 : 18• ~ ~ ? ~ 5 0~ 0~ 0 ~~ 19. TAX DUE .........................................................19. ~ 8 1~ 0~ 0~ (~' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561015 1505610105 .V 1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0506 )ECEDENT'S NAME Joseph L. Peresie iTREET ADDRESS 4119 Daa-ius Drive ;ITY Enola STATE PA ZIP 17025 ax Payments and Credits: Tax Due (Page 2, Line 19) CredifAslPayments A. Prior Payments B. Discount Interest 315.79 ff Line 2 is 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. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 8,100.00 6,315.79 0.00 0.00 1,784.21 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 inoorr~e ~ the properly transferred :......................................................................................... ^ b. retain the right to designate who shat use the property tramerred or its income : ............................................ ^ ~] c. retain a reversionary interest; or ........................................ d. receive the promise f~ life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12,1982, did decedent transfer prgperty within one year of death without receiving adequate consideration? .............................................................................................................. ® ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank acxount or security at his or her death? .............. ^ 4. Did decedent own an individual retirement acx;ount, annuity orothernon-probate property, which contains a benefiaary designation? ........................................................................................................................ ~ ^ IF THE- ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART QF THE RETURN. or 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 percent [72 P.S. §9116 (a) (1.1) (i)]. or dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent '2 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 ing a tax return are still applicable even if the surviving spouse is they only beneficiary. a 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 peroent [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 ~2 P.S. §9116(1.2) [72 P.S. §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)(1.3}). 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. 6,000.00 (1) REV-1503 EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER - - -~--- ..........,,.,., ,. ,,~~. a..u~~~.,~~b~ ariee~s or me same s¢e) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) SCHEDULE B STOCKS & BONDS Joseph L Peresie SS~~ 160-20-9790 03/21/2011 21-11-0506 All property jointly-owned with right of survivorship must be disclosed on Schedule F. REV -1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Jos eph L Peres i e SS~~ 160 - 20 - 9790 03/21/2011 FILE NUMBER 21-11-0506 Include the proceeds of Iltlgatlon 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. Form REV-1508 EX (Rev. 1-97) • - --. -- ---.. __....,.,, ..,~ ~~ ~~~.~ ~~ a ~C game size) opyright (c) 1996 form software only CPSystems, Inc. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF Joseph L Peresie SS~~ 160 - 20 - 9790 03/21/2011 FILE NUMBER 21-11-0506 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page ~! is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER RELATAIO ACHI A COPY OFDTHE DEEDTFOR REAL ESTATESFER. VALUE OF ASSET INTEREST 1 M&T Bank, - IRA Acct . (IF APPLICABLE) ~~35004200223979, opened by 5,476.17 100.00% 5,476.17 Decedent on 03/08/2009, payable upon death to Diane W. Peresie as designated beneficiary; principal balance on D.O.D.: $5,435.05; interest accrued to D.O.D.: $41.13. 2 M&T Bank, - Checking Acct. ~~538566, opened by Decedent on 12/01/1976, Diane W. Peresie added to account on 11/02/2010; principal ballance as of D.O.D.: $4,233.70; interest accrued to D.O.D.. $ 0.01. 3 M&T Bank, - Savings Acct. ~~21000000985343, opened by Decedent on 11/01/1976, Diane W. Peresie added to account on 11/02/2010; principal balance as of D.O.D.: $27,299.08; interest accrued to D.O.D.: $ 2.99. 4,233.71 X100.00% 27,302.07 X100.00% TOTAL (Also enter on line 7, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. 3,000.00 1,233.71 27,302.07 34,011.95 Form REV-1510 EX (Rev. 1-97) REV-1511 EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS Ca r A r t yr FILE NUMBER Joseph L Peresie SS~~ 160-20-9790 03/21/2011 21-11-0506 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers-Harner Funeral Home, - funeral expense. 9 264.00 2 Wegmans Catering Service, - funeral luncheon. 246.92 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney's Fees Law Offices -Marlin R . McCaleb 4 , 850.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3 500.00 ' Claimant Diane W Peres i e Street Address 4119 Darius Drive City Enola State PA Zip 17025 Relationship of Claimant to Decedent Spouse 4. Probate Fees Register of Wills 273.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 AutoTrader.com, - advertisements to sell car. 80.00 2 Cumberland Law Journal, - advertising Letters (reimbursed to 75 00 MRM). . 3 PNC Bank, - check printing fee. 17.99 4 Register of Wills, - Short Certificates. 20.00 5 Register of Wills, - filing Inventory and Appraisal. 30.00 6 Register of Wills, - reserve for filing Account, Releases, etc. 300.00 Total of Continuation Schedule(s) 229 63 . TOTAL (Also enter on line 9, 13ecapitulation) $ 18 , 8$7.04 (If'more space is needed, insert additional sheets of the same size I Copyright (c} 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Joseph L Peresie Soc Sec ~~: 160-20-9790 Date of Death: 03/21/2011 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description ~~ Amount 7 The Patriot-News, - advertisements to sell car. 71.60 8 The Patriot-News Co., - advertising Letters. 158.03 -------------- 229.63 REV-1512 EX + (1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Joseph L Peresie SS~~ 160-20-9790 03/21/2011 21-11-0506 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 American Home Patient, - account payable, equipmemt rental. 21.74 2 Camp Hill Emergency Physicians, - account payable, medical. 33.80 3 Camp Hill Emergency Physicians, - account payable, medical. 43.21 4 Center for Kidney Disease & Hypertension, - account payable, 4.69 medical. 5 Center for Kidney Disease & Hypertension, - account payable, 25.70 medical. 6 Central PA Pulmonary Assoc. L.L.C., - account payable, medical. 3.67 7 Center for Kidney Disease & Hypertension, - account payable, 11.46 medical. 8 Holy Spirit Hospital, - account payable, medical. 12.68 9 Live-In Care of Pennsylvania, Inc./Emma Yawson, - account 1,360.00 payable, live-in care. 10 Live-In Care (Lancaster, PA), - account payable, in-home care. 240.00 11 Lung, Asthma & Sleep Associates, PC, - account payable, medical. 11.20 12 Physicians of Rehabilitation, Industrial & Spine Med., - account 2.68 payable, medical. 13 Physicians of Rehab., Indust. & Spine Medicine, - account 4.63 payable, medical. 14 Pinnacle Health Cardiac Rehabilitation, - account payable, 319.98 medical. 15 Quantum Imaging, - account payable, medical. 2.45 16 Robert J. Beaudry, Jr., DMD, - account payable, medical. 263.75 17 Spirit Physician Services, - account payable, medical. 135.64 18 Spirit Physician Services, Inc., - account payable, medical. 14.98 19 Spirit Physician Services, Inc., - account payable, medical. 5.51 Total of Continuation Schedule(s) 79.05 TOTAL (Also enter on line 10, Re (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. n) ~$ 2 , 596.82 Form REV-1512 EX (Rev. 1-97) Estate of: Joseph L Peresie Soc Sec ~~: 160-20-9790 Date of Death: 03/21/2011 Continuation of Schedule I (Debts of Decedent, Mortgage Liabilities and Liens) Item Description Amount ~~ 20 Susquehanna Internal Medicine, - account payable, medical. 24.29 21 West Shore Anesthesia Associates, - account payable, medical. 34.70 22 West Shore Anesthesia Associates, - account payable, medical. 20.06 -------------- 79.05 REV-1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Joseph L Peresie SS~~ 160-20-9790 03/21/2011 21-11-0506 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116(a){1.2)] 1 Diane W. Peresie Spouse 41,576.43 4119 Darius Drive Enola, PA 17025 2 Marie Furka Sister 5,000.00 228 Williard Avenue Butler, PA 16001 3 Edward Peresie Nephew 5,000.00 109 Horizon Drive Venetia, PA 15367 4 David Futey Nephew 5,000.00 420 Picasso Street Colorado Springs, CO 80921 5 Robert Futey Nephew 5,000.00 5252 Cottage Drive Cortland, OH 44410 6 Thomas Furka Nephew 5,000.00 263 Rattigan Road Chicora, PA 16025 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON R EV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) SCHEDULE J (Continued) BENEFICIARIES ESTATE OF JOSEPH L. PERESIE Amt. of Name and Address: Relationship Share 7 Henry Peresie Nephew 5,000.00 3815 W. Shellbark Court Muncie, IN 47304 8 David Peresie Nephew 5,000.00 3589 Orweiler Road Mansfield, OH 44903 9 Robert Peresie Nephew 5,000.00 729 Middle Ridge Drive Chesapeake, VA 23322 10 Patricia Feitknecht Niece 5,000.00 1330 Fifth Avenue Ford City, PA 16226 11 Jeanne Ipsa Niece 5,000.00 2623 King's Lane Lebanon, OH 45036 12 Judith Shuler Niece 5,000.00 307 Penn Avenue Lyndora, PA 16045 l.`/ LAST WILL AND TESTAMENT OF JOSEPH I... PERESIE I, JOSEPH L. FERESIE, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and declaring null and void any and all former Wills and/or Codicils by me at any time heretofore made. FIRST I direct my hereinafter named Executrix to pay all of my just debts, funeral expenses, inheritance taxes and costs of administration of my Estate out of the corpus of my Estate as soon after my decease as it is practical to do so. SECOND I hereby give and bequeath the surn of Five Thousand and NO/100 ($5,000.00) Dollars, each, to my sister and to each of my following named nieces and/or nephews, per capita. That is to say, in the event of the predecease of my sister or any of my nieces and/or nephews listed. hereinbelow,.thc-$5,0.0.0...0.0. bequest shall not be divided among my surviving named beneficiaries, but rather, any such share(s) shall. be distributed in the same-manner as th_e remainder of ~y estate as. set. forth below in Paragraph. FQURTH, of this 11rIy Last. Will and Testament. .My sister, nieces and nephews to wham: the: a€oresad- dstribution~ ($S,QOQ.0.0 each)-are= to be made are ass follows: 3eanie Ipsa David. Futey Edward Peresie Robert Peresie Thomas Furka Marie Furka Robert Futey Patxicia. Feithn_echt Henry Peresie David Peresie Judie S:huler 1'~~~7~ t)tfw ~~t 1-~:~ua° ! F V ! .1.L.1'. THIRD I hereby direct that any interest which I may have in real estate located at 4119 Darius Drive; i-lampden Township, Enola, Cumberland County; Pennsylvania 1?025, formerly the property of Diane W. Niedenthal, which property has, pursuant to a written pre-nuptial agreement, become our joint and marital property, shall, in the event the said Diane W. Niedenthal (now Diane W. Peresie) has predeceased me, be conveyed and/or otherwise distributed, in accordance with the "Diane W. Peresie Revocable Living Trust" dated November 10, 2008, or in accordance with any subsequent amendment, prevision, or redraft of said Tr«st. FOURTH I hereby give and bequeath- all of the rest, residue, and remainder of my Estate, whether comprised of real and/or personal property, to my wife- DIA1~1E V~. FERESIE, and in the event my said wife DIANE W. PERESIE has predeceased me, all of the rest, residue, and~rerrrainder of my Estate not heretofore disposed of, shalt be conveyed and/or distributed- in accordance with the "Diane W. Peresie Revocable Living Trustn dated November I0, 2008. FIFTH I hereby name, constitute and appoint DIANE W. PERESIE, as Executrix of this, my Last Will and Testament. In the event that rriy said Executrix should riot survive my decease or should no`t hive to complete. the settlzment of my Estate, ar otherwise be unable to serve in the capacity of Executrix,. then and in .that event. I .name,. constitute and appoint my niece,. PATRICIA. FEITLINECI-IT, as my Alternate. Executrix.. I hereby direct that no Executrix or Alternate Executrix, or- any other fiduciary as~ may be required i~ this my Last Will and Testament, shall be required to post any bond- or.give any Pa.~~e T~~, o ~~ i~'o~~t• .L.~'. security of any type for any purpose whatsoever, any law or yule of Court of the Co~nmonweaith of Pennsylvania o~ any otlt~~,~urisdiction to the Eontrary notwithstanding. My Executrix or Alternate Executrix is authorized and empowered to sell any real estate v~rhich I may o~vn at the time of my decease at either public or private sale or sales, whichever in her opinion may be in the best interest of my Estate. ~~ IN WITNESS V~HEREOF, I hereby declare this, to be my Last Will and Testament this. 'Z,°I -day of 6 c y,.~,t,~z.~ , 2014. SEAL) Jo E. resie, estator Commomvealth of Pennsylvania County of Q~..y, ~ ~.~ SS ACKNOWLEDGEMENT Before me, the undersigned,. a Notary Public,. personally appeared Joseph L. Peresie, J~nowir to me ar satisfactorily proven to be the person who subscribed his name to the above Last Will and Testament, and that he has done so for the purposes contained therein: SWDRN TO A1VD SUBSCRIBED before me, this ,~ Q'~ dcrv of C-ro B E I~ , 2010. .~ 1Vot Pu -~ (Notary Sea CD1i~Ei1.IE~NNlEA~TH QF PENNSFLTrAN1A C~UNTYO~ ~€_rl. ~~ COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CHERYL L. FERGUSON, Notary Pubic City of Harrisburg, Dauphin County My Commission Expire it 6 2Q12 Aires: APr~~ ~ ~, a ° 1 ~- AFFIDAVIT ss 1, JOSEPII L. PERFSIE, whose name is signed to the attached or foregoing instrument, having been duly qual~ed according to Ia~J, do hereby acknowledge that I signed the instrument as my .Last Will and Testament; that I signed it willingly; and that 1 signed it as my free and voluntary act for the purposes ,therein expressed' Sivorri to> or a~rrred to acrd-aElinawledgea€ before ins by JOSEPFFL. PEI~ESIE; the Testator, this d9`~' day of Oc7-o 8~2 , 2010. EAL) sep . P resie, Testator SWORN TO 141~TD SUBSCRIBED before me, this a9~" day Q -cc g ~ !L , 2f110: Notary P 'c ..(Notary 11 COIdIMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CHERYL L. FERGUSON, Notary Public City of Harrisburg, Dauphin County My Commission Expires April 6, 2012 My Commission Expires: ~~R-~ ~ t,, a~ 1~- Pa:,~-t Three of Foy{r ~.. ~~ ~ P. AFFID~AV~T COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~R~~~-t~J ss We, JOSEPH L. PERESTE, !k~-~-k S. s~ ~. U~ , and S~ ~~,~N~ ilJ~,. 1~~-r~- the Tfestator and the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that he signed it willingly and that he executed 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 eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed to and subscribed before me by JOSEPH L. PERESIE, ~~. ~. ~, ~, ~ „~ ,and ~y~,~,,~ ~ , ~~.~,f2, the Testator and witnesses, -cam this~~ -d~.y of p ~ ~1~.~ , 2010. J e .Pere 'e, testator Witness Witness SWORN TO A?VD SUBSCRIBED before me, this ~.9`+t'` day GTo ~ ZQI a. r ~' .~~ Notary P (Notary Sea COMMONWEALTH OF PENNSYLVANIA NOTARtAI SEAL CHERYL t_. FERGUSON, Notary Public City of Harrisburg, Dauphin C 2012 P~7v~ ~"~". `'r i=:-~L~r t41y Commission Expires April 6, My Conustission. Expires.• ,~ P ~t L (o , d c~ ~ ~-- G 05!N:~,~2~11 1.1':31 7174414508 ~h1ERIF'RI~~E FIhI~N(;I~',L P~~E 021't12 To Mlchaei J i3ritt~rinlFieldJAMPF ~AMPF co bcc Subject 1358953a 8 001 JOSEPH L PERESIE -DATE OF ©EAT V,~LU ES Please do not reply to this email. This database does .not s~Fport incoming mail. Please call the phone # within the letter if you require assistance. Thank you. Life Events Team RiuerSourca Llfe Insurance Company l~meripriee Financial Company 70100 Ameriprlse Flnanclai Center Minneapolis, MN 5474 Mays, za 11 MICHAEL JON BRI :r"['.AIN STE 106 4909 LtJLZSE DF. MECHANICSBIJRG, PA 17055-6900 Dear MICHAEL JON BRI'fTAIN: Thank p~ou for your rec:sat Inquiry regarding JOSEPH L PERESIE's account.. 'These are the values of the accounts as of 03 `21 J201 l . Account Information Mntusl ends Account Number 01143895266 2 002 Ol 1538952b6 i (102 iVlutual Funds Account Number 01143$95266 2 002 01L53R95256 1002 ~n~.1?;L Individual Individual Tote.[ Value # of s ar Asset Value Per Share $22,234.87 6,142.506 Q3.51 $26,883,79 6,58i,9Q3 $4A7 The date of death values provided are for estate tax purposes and are itot a velar to be paid. Acco~snts may be subject :a tnarkct fluctuation as governed by each product. Please note that t~'~e values indicated ;or ar-y Life insurance product(s) ;with the insured deceased ret7eet the gross death benefit at dace eFf death and r'ot the cash value, Values indicated far Life Insurance P*oducts with only the owner deceased reflect the cash value as of the date of death. Values for any proprietary mutual funds include accrued di~~iCends as applicable. Values provided for brokerage products are manually calculated, and should 've used as estitnatos only. 'lihc prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values av a service to its clients. Actual values used in preparation of tax returns or for planning ;purposes should be verified try your legal an~i accounting advisors. We appreciate the appurtunit;~~ to be at service to yo:z Please centact us i.f you have any q~lestionq Stnccrcly, Duch Settlements Processing Team Ameriprise Fin3nci$1 Center Schedule B.1&2 PPG Industries Inc, PPG Historical Quote -(NYSE) PPG, PPG Industries I:nc Stock Price ... Page 1 of 1 More Enter KeywDra(s} ~ SEARCH ~,._,' ~ses!n!d~ .: .... ,, G ~~ , PPG ~. Home Guobs News IndusMes Markets Historlpl Quotes BlpReports _~S Historical Otrotes tool albvrs You b look up a secudty's enact dosirp price. SiraPN type in the symbol and a historical date to view a quote artd rttlN chart for atat sectuity. ~~ Enter Symbol: ~P'P"'G"~'~ EnterDate: 3/2'1N t ~~ 1 ppG Industries Inc Mon. Mat 21.2011 Gkrxurg p:ien: - 88.56 $8.87 Ord: • 88.9x4 F!ig(+ Low 88.21 1,423,879 vc~lur,~o No Splits l Sponsored LJrtks $85/Hr Job -119 Openings. Make $85/Hr Working from Home Online. As seen on Fox and CNN. HomoJobManual.com US Oil Best Kept Secret? Not for long. Similar stocks trade at $30-$60. UTOG exploding nowt www.AmencanEnergyReport.com Two Stocks to Buy Now Get David 8 Tom Gardnel's 2 top-rated stocks free! hao•Jtwww.fool.corn Hot Stock Pick - GSLO Ail American Solar Energy! Trading, Investment, Stocks. wvrvr.GoSdarUSA.com Find a broker iII ...._. ._.._...._ ..~ arri~ . ~~~~ . (Mll~l I i ~ 'erse • __ ~_ ~ . Scoarade: S7 Trades, Free 34Day Trial. Trade wMh Fidelity Why Pay More? SwNdt Free 340ay Trir. Fast Executlons CNdt Here. to OpaortaFbuae. Click Here. liltma I A~SSd 11s:h ~~n+n+~a I I Ettas>~k i tiltlQ l.opyrpM 2011 MarkelWakh, Inc. N.riptds naerwd. ayueMp ttAs rte, you epee W the Terms of Uss and Privacy Porcw (updated 4/ai09} Intraday Data provfdad by Ttx>nron RauMrs and subled b terms or use. H{aWrical and axrerd erd-oT-day dra pmvWed by Thomson Reuters. In4aday Bra Brayed per efa~hrige requi~•rtrnla. Dow Jong Indexes (SM) from Dow Jonee 3 Compary. Inc. Atl quotes w In locr exeharpe tlme. Rer time tar sale data provided by wtsDna More Inronnatlon on NASDIW traded svmbok and Qalr usrsnt Ilnanclr stable. Intraday data Brayed to mirartea br Nadaq, and 20 mYrrtee for other exehargea Dow Jong NrdexeaSAA bom Dow Jonee 8 Compry, Inc. SEHK htraday dra N pravMed ray Thomson Reuters and a r Nar eamax,tes drays. All quotes an Mr bcal exchange IYna. Schedule B.3 http://bigcharts.marketwatch. com/historicaUdefault.asp?symb=PPG&closeI)ate=3 %2F21... 4/20/2011 ~ ___ _ , , ,;. ,. ~ RES. PHONE ..~ -~ ~ 6462 Carlisle Pike, Mechanicsburg, PA 17050 ~ : •.~ - ~~ 9 ;~ (717) 691-2000 • toll free: (888) 691-6006 CELL PHONE ,. ~- fax: (717) 691-6338 • email: premium~sutliff.net BUS. PHONE HAMMER' Sutiitfauto.com t I~ E-MAIL ~~ ~ I ! ~ ~ { ,_~ ,l-~ ~~ I' i ~ j~ ~ ~ ~ y'~1 ~ ~1' ~ DATE ~. ~/ NAME / f ~ F1RST/ /) ~/ MIDDLE yr LAST ~/~ /'~ • tp ~I(~ ~ t~ , r~~ r ~ i i ~! /~~ ll~.r`( 1.1.9t~j~'~ ~-~~/.~~'•~ l ~'1~ ~~+~(/ STREETADDRESS -CITY f STATE~~-- ZIP ^ NEW ^ DEMO BUSED ^ RENTAL ^ FLEET FOR DELIVERY ON DESCRIPTION: $ '' i STOCICNO. COL - TRIM, SALES CONSULTANT .YEAR, /~~ !i•, ~ ~~ C MOOEL~~ ~ M17I~~I VIN! ~~~ l~lv ~ ~ / ~~ ~ 1' ~~ (~ '~1 1' ~ 1 YEAR MAKE MODEL BODY ~ TITLE # VIN LAST EXPIRATION DATE MILES PLATE ~~ AMOUNT ~~ GOOD TILL CfIY STATE ZIP VERIFIED BY We Move been urwble to verity the amount owed on the vehicle being traded. Therefore, you will be " gable.for any shortage. and the. bank will refund arty excess when .the amount is verified. GM warranted items added: PURCHASER'S S16NATURE X DATE •~ 1' ~ 1 • Non-GM warranted-items added: tNSURAtrICE ~~ I TELEPHONE NUMBER WE OWE YOU: (please resolva:within 2 weeks) CITY STATE ZIP DRIVER'S LICENSE# INSURANCE EFFECTIVE EXPIRATION CONIPMIY DATE DATE ~~ COMP. DEDUCTIBLE I CHOOSE TO ^ PURCHASE OR 4 DECLINE 'EXTENDED WARRANTY PROTECTION NUMt3ER COLL. DEDUCTIBLE r CONTRACTUAL DISCLOSURE STATEMENT FOR USED VEHICLE ONLY "The inforrrraUon you see on the window form for this vehicle is part of this contract. Irr(orrrratlotr on the window fomn ovemdes any contrary provisions in the corrtract of sale." Purdraser agrees that this order includes all of the terms and condi~ons on both the face and the reverse side hereof, that this order cancels and supersedes any prior agreement and as of the date X hereof comprises the complete and exclusive statement of the terms of agreement relating to the ~ subject matters covered hereby. This order shall not become binding ~ it a ce ted y he d ~ler CASH AMOUNT OF DESCRIBED VEHICLE $ ~ ~f~/11 onus authored reoreserrtative. You. the brnrer may ancei this contract nd recei~~ a full refund am time before reoeiot of a copy of this corrtrart signed an aL>thorized dealer re re enta ~e a written notice of cancellation to the dealer Purchaser by his execution of this order LESS TRADE-IN VALUE ( ~ ~r-~mng - adarowledges that he has rem ils terms and conditions and has received,~.tru of this order. TAXABLE AMOUNT - ~ -~~'" '''"~ - $ PURCHASER'S .~ ~~f~~, ~' , 1 r SIGNA R~~~~ ~°~""` - ~ ~ / Gf"' DATE •4~-%~ !~ PA SALES TAX -~ DOCUMENTARY fEE PA TIRE AccEPi~D ~~ ~:= ~ ,~' ~,* T~, '~~~` ,~ %~~ ..,,[ATE ~` ~'~~ ~%. TAX ,:%' ' DEALER OR HI~`AtlTHbAIZED REPRESENTATIVE LICENSE TITLE ENCUMBRANCE ~ ~ 1 ~ ~ 1 FEE FEE FEE 1 i ON-LINE REG FEE NEW LICENSE PLATE • TOTAL AMOUNT INCLUDING FEES LISTED $ ~ ~ ~C/~ ~-- ~° AMOUNT OWED IN TRADE-IN ~ ~: ~~a r.wt LESS DOWN PAYMENT r- ..~ ~~ ~,~ ~. AMOUNT DUE ON DELIVERY $ ..~~., •~._ Schedule E.2 ~~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 May 25, 2011 Attorney Marlin McCaleb 219 E Main Street P O Box 230 Mechanicsburg, PA 17055 Re: Estate of Joseph L Peresie Social Security: 160-20-9790 Date of Death: March 21, 2011 Dear Sir or Madam: Per your inquiry on May 24, 2011, please be advised that at the time of death, the .above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 538566 Ownership (Names o, fl Joseph L Peresie Diane W Peresie (Added 11/02/10) Opening Date 12/01/76 Balance on Date of Death $4,233.70 Accrued Interest $ .01 Total $4,233.71 2. Type of Account Savings Account Account Number 21000000985343 Ownership (Names o, fl Joseph L Peresie Diane W Peresie (Added 11/t72/10) Opening Date 11/01/76 Balance on Date of Death $27,299.08 Accrued Interest $ 2.99 Total $27,302.07------------------------------------- Schedule G 3. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Individual Retirement Account 35004200223979 Joseph L Peresie Diane W Peresie (Beneficiary) 03/08/99 X5,435.04 $ 41.13 $5,476.17 _ _ _ __-_____-_-__ For any additional information on the above accounts, including ownership and any changes, dosur~s and/or reimbursement of funds, please call the Stonehedge Oboe at #717-1AO~t524. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as power of Attorney, Custodian of Uniform Transfers, Representative payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services Schedule G