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HomeMy WebLinkAbout08-19-111505610143 REV-1500 Ex (o,_,o> OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 0044 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 172 38 8712 11 28 2010 Decedent's Last Name HOPPLE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Date of Birth 06 19 1950 Suffix Decedent's First Name MI SUZANNE M Suffix Spouse's First Name Mt Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ :i. Federal Estate Tax Return Required ^ g Decedent Died Testate (Attach Copy of Will) ~. Decedent Maintained a Living Trust (Attach Copy of Trust) _ 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. between P2 3rt~J1 a dt~(datge5~f death ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL 7'AX INFORMQ0.'~ION SHOULQ'EE DIRECTED TO: Name Daytime Tele~~nje Numb~__ _~ r JEFFREY E PICCOLA ESQUIRE 7:17 23i;~77 '-= ~ ~' s +~ e .; REGISTEI~`F~LS U5~ ONLY; ; _ ; r.~ , ~~ y First line of address .''~ ~ __~' ~ - _-7 4..~T -~-~n l 315 N FRONT STREET ~ -~ ° ~' r` ~..• i Second line of address ~`' - ' City or Post Office HARRISBURG State ZIP Code PA 17101 DATE FILED Corr~spol~dent's a-mail address: Unde nalti of perju , I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tr corre and co lete. Declaration of preparer other than the personal representative Is based on all informati~~n of which preparer has any knowledge. A E OF RSON R PONSIBLE FOR FILING RETURN DATE Jeffrey E. Piccola, Esquire A RE ont treet H isbur PA 17101 SIGNATUR PREPA ER OTHER HA REPRESENTATIVE DATE ` Jeffrey E., Piccola, Esquire ADDRESS 315 . F nt Street, Harrisburg, PA Side 1 1505610143 ],505610143 J REV-1500 EX Decedent's Name: Hopple, Suzanne M. C)ecedent's Social Security Number 172 38 8712 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 3 2 9, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3, 5 0 0. 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 63 7 , 5 4 3 . 4 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8~ Miscellaneous f~on; Probate Property arate Billing Requested Se 7 ............ p (Schedule G) ^ . g. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 9 7 0, 0 4 3. 4 2 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 117 ,153.37 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 31 ,16 6. 8 0 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 14 8 , 3 2 0.17 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 8 21 , 7 2 3 . 2 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. - 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 8 21 , 7 2 3 . 2 5 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 • 0 0 16. at lineal rate X .045 17. Amount of Line 14 taxable 723.25 821 17. at sibling rate x .12 , 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 • . 19. Tax Due ...................................................................... .......................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 0.00 0.00 98,606.79 0.00 98,606.79 Side 2 1505610243 :1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0044 DECEDENT'S NAME Hopple, Suzanne M. STREET ADDRESS 4790 Augusta Drive CITY Mechanicsburg STA"fE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 105,000.00 4,930.34 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 98,606.79 109,930.34 11,323.55 Total Credil:s (A + B) (2) (3) (4) (5) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TIHE 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 :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one ye;~r of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his ~~r 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 C~ 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 i:~ 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 dE~cedent, 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 Hoppie, Suzanne M. 21-11-0044 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined :~s 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-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Series HH Bond -Serial No. D6403209HH 500.00 2 Series HH Bond -Serial No. M9112047HH 1,000.00 3 Series HH Bond -Serial No. M9112048HH 1,000.00 4 Series HH Bond -Serial No. M9112049HH 1,000.00 TOTAL (Also enter on Line 2, Recapitulation) 3,500.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 Include the proceeds of litigation and the date the proceeds were received by the est~lte. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Sovereign Bank -Checking Acct. No. 0571138195 6,698.78 2 Sovereign Bank -Money Market Acct. No. 2334082821 19,454.47 3 Sovereign Bank -Certificate of Deposit No. 0575545686 48,936.61 4 Sovereign Bank -Certificate of Deposit No. 0575545694 101,047.82 5 Sovereign Bank -Certificate of Deposit No. 2335538118 58,769.54 6 Sovereign Bank -Certificate of Deposit No. 2335539058 100,838.75 7 2006 Toyota RAV4 -see Kelley Blue Book value attached 15,050.00 8 Personal Property -Household furnishings, jewelry, personal effects, etc. 12,000.00 9 Capital Blue Cross -Williamsport Ambulance reimbursement 870.00 10 Churchville Cemetery Association -burial plot 750.00 11 Discover -refund 51.32 12 PA American Water 12.37 13 Real Estate - reimbursement on sale of real estate -real estate taxes, sewer, Etc. (see copy 750.86 of settlement sheet attached) 14 Traveler's Insurance -automobile insurance refund 156.00 15 Traveler's Insurance -refund 9.00 16 Fidelity Workplace Services -see copy of date-of-death letter dated March 1, :t011, attached 80,561.43 I Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recatpitulation) 637,543.42 (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-1508 EX+ (6-98) ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COMMNHERITANCE Tq~P RETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 13,940.56 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Jeffrey E. Piccola, Street Address 315 N. Front Street city Harrisburg state PA zio 17101 Year(s) Commission raid 2011 33,000.00 2. Attorney's Fees Boswell, Tintner &Piccola 25,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zin Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 766.50 5. Accountant's Fees 6. Tax Return Preparer's Fees BOSWeII, Tintner &Piccola 2,500.00 7. Other Administrative Costs 41,946.31 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 117,153.37 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 Hopple, Suzanne M. 21-11-0044 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Jacqueline M. Perchinski -reimbursement for funeral flowers and programs 641.29 2 Neill Funeral Home -funeral 11,265.00 3 Neill Funeral Home -additional funeral expense 38,27 4 Romberger Memorials -gravemarker -1/2 deposit 998.00 5 Romberger Memorials -gravemarker -remaining balance 998.00 F~-A 13,940.56 6 Other Administrative Costs Boswell, Tintner 8~ Piccola -disbursements 35.16 7 Boswell, Tintner &Piccola -RESERVE 5,000.00 8 Comcast -final bill 329.39 9 Cordia -final telephone bill 18.26 10 Cumberland County Law Journal -legal advertising 75.00 11 DaFlure Heating & Cooling -service/maintenance on furnace 504.52 12 DaFlure Heating 8< Cooling -service/repairs 460.95 13 First National Bank -return item charge 12.00 14 First National Bank -checks 15.90 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 ITEM NUMBER DESCRIPTION AMOUNT 15 Crandon Farms -association dues -Jan. Feb. 356.00 16 Grandon Farms -association dues -Mar. 178.00 17 Grandon Farms -association dues -Apr. 178.00 18 Grandon Farms -association dues -May 178.00 19 Grandon Farms -association dues -Jun. 178.00 20 Grandon Farms -association dues -Jul. 178.00 21 Grandon Farms -association dues -Aug. 178.00 22 Hampden Township -water/sewer -Jan. Feb. Mar. 165.01 23 Hampden Township -water/sewer Apr. May Jun. 150.00 24 Hampden Township -water/sewer -Jul. Aug. Sept. 150.00 25 Jeffrey E. Piccola -reimbursement for vehicle title transfer 22.50 26 Michael Langan, Treasurer -tax certification 10.00 27 Michelle Hoffman -clean property 550.00 28 PA American Water -Nov. Dec. Jan. 132.34 29 PA American Water -Feb. 32.75 30 PA American Water -Mar. 33.57 31 PA American Water -Apr. 31.99 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 ITEM NUMBER DESCRIPTION AMOUNT 32 PA American Water -May 31.99 33 PA American Water -Jun. 32.80 34 PA American Water -Jul. 32.85 35 PPL -Dec. Jan. 412.70 36 PPL -Feb. 122 79 37 PPL -Mar. 134.28 38 PPL -Apr. 98.95 39 PPL -May 118.11 40 PPL -Jun. 87 18 41 PPL -Jul. 115.32 42 PPL -Final Bill 58.52 43 Real Estate -Administrative expenses for sale of real estate (see attached settlement sheet) 28,321.86 44 The Sentinel -legal advertising 208 78 45 Traveler's Insurance -homeowner/vehicle premium 611.90 46 Traveler's Insurance -automobile personal liability insurance 49.28 47 Traveler's Insurance -homeowner's insurance 94.08 48 Trimmer Home Inspection -repair property damage 1,300.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 ITEM NUMBER DESCRIPTION AMOUNT 49 Trimmer Home Inspection -home inspection 320.00 50 UGI -Dec. Jan. Feb. 292 22 51 UGI -Mar. 104.24 52 UGI -Apr. 99.32 53 UGI -May 40.30 54 UGI -June 23.59 55 UGI -July 24.69 56 UGI -Aug. 24.40 57 UGI -final payment 32 82 t~-B7 41,946.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 _` DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hopple, Suzanne M. 21-11-0044 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 BonTon 927.60 2 Boscov's 784.68 3 CitiBank - AT&T Universal Card -partial payment 4,000.00 4 CitiBank - AT&T Universal Card -final payment 22,000.00 5 Cumberland County Tax Claim Bureau - 2010 real estate taxes 992.13 6 PA Department of Revenue - 2010 state income tax 38.00 7 Publishers Billing Association -Nursing 2010 magazine 22.97 8 Sovereign Bank -Checking Account #571138195 59.90 Checks issued prior to death but honored subsequent thereto CK 121710 59.90 9 Susquehanna Health - co-pay 100.00 10 Talbots 394.41 11 U.S. Treasury - 2010 federal income tax 781.00 12 Verizon -final bill 196.11 13 Williamsport Ambulance -transport 870.00 TOTAL (Also enter on Line 10, Recapitulation) ( 31,166.80 (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-1513 EX+ (11-08) SCHEDULE J COMMNHERITANCET/~P RET RNANIA BENEFICIARIES RESIDENT DECEDEN ESTATE OF FILE NUMBER Ho ple, Suzanne M. ~ 21-11-00 44 NAME AND ADDRESS OF RELATIONSHIP TO SHAI~E OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) o t Tru I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Michele M. Farver Sister 1/6 ~~f residuary 1075 Ross Circle estalte Napa, CA 94558 2 Camille E. Mansuy Sister 116 ~~f residuary 2604 East Hills Drive estate Williamsport, PA 17701 3 Francine L. Mansuy Sister 1/6 ~~f residuary 9663 Devedente Drive estalte Owings Mills, MD 21117 4 Matthew Michael Mansuy Brother 1/6 ~~f residuary 2630 W. Pueblo Avenue estate Napa, CA 94558 5 Kathryn M. O'Connor Sister 1/6 of residuary 4604 Bedford Blvd. estate Wilmington, DE 19803 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO l-AX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1:500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Suzanne M. Hopple 11/28/2010 172-38-8712 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Jacqueline M. Perchinski Sister 1/6 oiF residuary estate 145 Union Avenue Williamsport, PA 17701 Total 1 ~TAtM~Nr~yo OMB Approval No. 2502-0265 a~ G~ ~ * ~' ~ A. Settlement Statement (HUD-1) =e ~t G9~~tH oeJ~~~ B. Type of Loan 6. Fde Number. 7. Loan Number: 8. Mortgage Insurance Case Number. 1. ~ FHA 2. ~ RHS 3. ~X Conv. Unins. MCCALL 0287582522 4. Q VA 5. ~ Conv. Ins. C. Note: This form is famished to give you a statement of actual setNement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)"were paid outside the cbsing; they are shown here forinformatanal purposes and are not induded in the totals. D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: RAYMOND L MCCALL ESTATE OF SUZANNE M HOPPLE WELLS FARGO BANK NA 4790 AUGUSTA DRIVE 4790 AUGUSTA DRIVE 101 NORTH PHILLIPS AVENUE MECHANICSBURG, PA 17050 MECHANICSBURG PA 17050 SIOUX FALLS, SD 57104 G. Property Location: H. Settlement Agent: 1. Settlement Date: 4790 AUGUSTA DRIVE SEASONS SETTLEMENTS INC MECHANICSBURG, PA 17050 August 11, 2011 CUMBERLAND County, Pennsylvania Ph. Place of Settlement: of Borrower's transaction mar S J K. Summary of Sellefs transaction y um . ower: B f D 400. Gross Amount Due to Seller: orr rom ue 100. Gross Amount • 000.00 329 401. Contract sales rice 329 000.00 ce 101. Contract sales , 402. Personal r 102. Personal r r Line 1400 w B t 14849.30 403. orro e o 103. Settlement Char es 404. 104. 405. 105. id b Seiler in advance A ustments for items id b Seller in advance A ustments for items 106. C' /Town Taxes 08/1?Ji 1 to 01/01/12 310.14 406. C' /Town Taxes 08/12/11 to 01/01/12 310.14 to 407. Cou Taxes to 107. Cou Taxes to 408. SCHOOL TAX to 108. SCHOOL TAX EWER AND TRASH 8/11-9/30 98.33 409. SEWER AND TRASH 8111-9/30 98.33 109. S 410. 110. 411. 111. 412. 112 ss Amount Due from Borrower G 120 344,257.77 420. Gross Amount Due to Seller 329,408.47 ro . half of Borrower B i d 500. Reductions in Amount Due Seller: e or n 200. Amourtts Pai t 10000.00 501. Excess d it see instructions mon 201. D it or earnes ns b f ' 200.00 263 502. Settlement char e, to SeAer Line 1400 18,321.86 new a al amount o 202. Princ t to ' k , 503: Existi loaf s taken sub'ect to ec en su 203. Existi loans ta DIRECT BILL CREDIT 204 9,330.37 504. Payoff Fist Marta e . 505. Pa ff Second Mort a e 205. 506. DEPOSIT TO HOWARD HANNA 10,000.00 206 207 507. D ~ disb. as roceeds 508. 208. 509. 209. A ustments for items un aid b Seller A ustments for items un aid b Seller 210. C' Town Taxes to 510. C' /Town Taxes to to 511. Coun Taxes to 211. Coun Taxes TAX 07/01 /11 to 08/12/11 342.39 512. SCHOOL TAX 07/01/11 to 08/12/11 342.39 212. SCHOOL 513. 213. 514. 214. 515. 215 516. 216. 217. 517. 518. 218 219 519. 220. Total Paid b /for Borrower 282,872.76 520. Total Reduction Amount Due Seller 28,664.25 300. Cash at Settlement fromlto Borrower 600. Cash at settlement b/from Seller 301. Gross amount duefrom Borrows line 120 344 257.77 601. Gross amount dueto SeNer Gne420 329 408.47 302. Less amount b /for Borrower f ne 220 ( 282,872.76 602. Less reductions due Seller one 520 ( 28,664.25 303. Cash ^X From ~ To Borrower 61,385.01 603. Cash a To ~ From Seller 300,744.22 The undersigned hereby acknowledge receipt of a completed copy of this statement & any attachments referred to herein Borrows Sef ~ L. Settlement Charges 700. Total Real Estate Broker Fees $13,255.00 Division of commission (ine 7001 as foNows: Paid Fram Patl From Borrower's Seller's Funds at Funds at Settlement Settlemerrt 13.25! 7~• 705. BROKER FEE to WEICHERT REALTORS FIRST CHOICE 250.00 800. Items Pa able in Correction with Loan Our or' ination char a Indtxies Oti ination Point $ 3,082.00 801 $ 3,082.00 from GFE #1 . Your creditor chage (pobts) for the spedfic interest rate chosen 802 $ (from GFE #2) - . 803. Your adjusted origination charges from GFE #A 3,082.00 00 385 804. raiser! fee to RELS VALUATION from GFE #3 . 00 11 805. Credit R rt to RELS CREDIT from GFE #3 (from GFE #3) . 806. Tax service to (from GFE #3) 807. Fbod certification to (tram GFE #3) 808. 809. $2632. AND PROCESSI (from GFE #3) (from GFE #3) 810. fram GFE #3 811 900. Items R wired Lender to Be Paid in Advance 901. Daily interest cha s fram 08/11/11 to 09/01/11 21 @ $31.550000/day (from GFE #10) 662.55 902. Mort a e insurance remium for months to 903. Htxneowner's bsurancefor 1.0 ears to STATE FARM INSURANCE from GFE #3 from GFE #11 542.00 from GFE #11 904. (from GFE #11) 905. 1000. Reserves De osited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1,080.70 1002. Homeowner's bsurance 4.000 months @ 45.17 per month 180.68 1003. Mort a e insurance months @ $ er month $ 1004. Property taxes $ C !Town Taxes months @ $ per month Assessments months @ $ per month r 1005. ~" CO TW P TAX 8.000 months @ $ 66.43 per month $ 531.44 1006 . SCHOOL TAX 3.000 months @ $ 248.64 per month :~ 745.92 1007 . 1008. AGGREGATE ADJUSTMENT $ -377.34 1009 $ . 1100. Title Char s (from GFE #4) 2,218.38 1101. Titleservices and lender's title insurance 1102. Settlement err cbsin fee $ Owner's title insurance to from GFE #5 1103 . 1104. Lender's title insurance to $ 1105. Lender's title pc emit $ 263,200.00 Owner's title lic limit $ 329,000.00 1106 . A ent's n of the trial title insurance remium $ 1107 . Underwriter's n of the trial title insurance emium $ 1108 "` ' . 460.95 REPAIRS to TED BALDWIN 1109 . 1110. 1111 . 12 . 11 113 . 1 TAX CERT to SEASONS SETTLEMENTS INC 1114 10. 0 . 1115. 2011 SCHOOL TAX to MICHAEL LANGAN, TAX COLLECTOR 2,983.67 91 876 WP TAX to MICHAEL LANGAN, TAX COLLECTOR . 1116. 2011 CO T 10.00 1117. SELLER NOTARY to SEASONS SETTLEMENTS INC 419.00 1118. HOME WARRANTY to HSA 1200. Govemment Recorcing and Transfer Charges Government reoordin cha es to Recorder's Office from GFE #7 1201 225.00 . 1202. Deed $ 65.00 Mortgage $ 160.Q0 Releases $ Other $ r taxes (from GFE #8) f T 1203 rans e . 290.00 3 City/County tax/stamps $ $ 1204 , . State tadstam $ $ 1205 . TRANSFER TAX to Recorder's Office 1206 3 290.00 . 1207. 1300. Additional Settlement Char R wired services that u can sh for from GFE #6 1301 . TAX SERVICE FEE to WF REAL ESTATE TAX SERVICE 1302 100.00 . 1303. FLOOD LIFE OF LOAN CERT to WF FLOOD SERVICES 19•~ 04 . 13 1305. 1400. Total Settlement Char es enter on lines 103, Section J and 502, Section 14849.30 18 321.86 By signng page 1 of This statement, the sgnaAories acknowledge receipt of a completed copy of page2 & 3 of this three page statement. . 2006 Toyota RAV4 -Private Party Pricing Report -Kelley Blue )Book Page 1 of 3 ~: Kelley Blue Boak SEARCH r IIIE IkL`SIEL) KESULKC! .. Used Cars ..., ,,, ~,, ,. - ~ . ~.. r 1 ~::, Used Car `Jalues ~ Search Used Car Classifieds ~ Certified Pre-Owned ~ Com pare Vehicles ~ Perfec[ Car F inder ~ MosC Researched Vehicles ~ CARFAX Vehicle History Welcome Back ~ :~~ 'i ~ C ~ ~ r;t~ Ac~orn~t ~ ~~9y r.I;_; ZIP Code- ~ ~,nr~~ ~n .., .. ru~i P-1ir:71~~1 Al~,r, 1_~S i ~ ~ ~r 'ri ~r..~ ..~,_.._ „. r ; n o o O , ~ `,. . ~.~~~~~~~,r ~~,n .. ~ r~ ~ nlti~. l w~,~ News ~ ~ ~ .. / ~,. ~~„ is ~~`r `:f ~ k(f 'sill H'~:L f' ,;,, ~ , , ilr~livnrv hr' 01 D.,' li ,,rn rli;.ilr~r ... Ins :lel ails 'nlt 1. t,~ILC G i rF,, ~ ,~:~~ i _~~.~ir~ EXPLORE ESCALAOE~ VIEW CURRENT OFFERS LOCATE A UEALERr I~lu me =- Uscc! Car> =~ Suvs ? T~gy~ta > 42AV4 > 1()x_6 '~ Sport Utility 4D 2006 Toyota RAV4 Sport Utility 4D i>rivate Party Value BLUE BOOK' PRIVATE PARTY VALUE ~.' ~ _~ r .t-1 ' _~ _ _ l rt ~~i 11 ~ Condition ~~~ ~ (' r , ~,; ~i r~ , ._ ... ~ , ; r~.,. ..,., rr ' ,.,~~, i,,;l,,,~, Good ~~, _,;., -,• f~.r , F~:'~1 Yr1U' fIr'r'~ C-.i~ ~~,r l ~, ~~T ~T~~: CARFAX Record Check VIN: r~l~~ `,'ii~l~ No Pr„nl~.r.,~ Value ', , y ; ., $15,050 f'owcred nv O~OGi~x ' ;uggesfed Re:arl Value Shopping Tools ,,. ~ i i~~ ~ _~ n~ . ~ 1~. .. ~i, ..... I r .,_. Morf.~ _.. ,r, -.- .. ' "'~`'r Average Consumer Rating (361 Reviews) i2cad iZeviews t ~ - ~ ~„its ' rrl ': 4.5 out of 5 kr ic:v the 200(1 toyota RAVE - Print For Sale Syn rr,-~~' Slrare with Fnends ~(IICr~s C;et up-to-date Live ToOlkit value"`~' Vehicle Highlights Mileage: 47_,200 Get Your Toolkit Engine: 4-Cyl, 7_.4 Liter Transmission: Manual, S-Spd Find The Right Car Drivetrain: 4WD Compare Used vs. New $15,000 to $20,000 Selected Equipment Change Equipment Both New and Used Standard Traction Control Power Ooor Locks Dual Air Bags SUV Stability Control Tilt Wheel ABS (4-Wheel) Air Conditioning Cruise Control Roof Rack To View List, Click power Steering AM/FM Stereo Privacy Glass Power Windows MP3 (Single Disc) Steel Wheels View Another Vehide Select Year... Blue Book Private Party Value Kelley Blue Book Private Party Value is the amoun t a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "AS Is" and carries no warranty (other than any remaining factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditi ons. This value may also ~.r ~r~a•r', ry C:'teC;ory be used to derive Fair Market Value for insurance and vehicle donation c;, r_i,..t•,rlr_ 'iP r ,d~ Purposes. s , # ~? Save Vehr„le -Print rns_ui r. ir_.t rtH~:k ^ >.. Estimated Payments 5278 /mo @ 3.42% APR car L ~i Pr: Jvdned I o~rl 3 r~9''% .4Pk r r r.~L~ ~~ ,dir ~ rr+re. < <: , F~ ii,~,ur~ir~~r: PR©Gf~ElJ/UE Ente, ZIP cede ' The (Name Your Price'" Tool. Only from Progressive. -1 $99 ~J ~~ ~r . ///t I t ~' O- . t;~~ http://www.kbb.com/used-cars/toyota/rav4/2006/private-party-value/pricing-report?condi... 12/ 15/2010 - - - -- 2006 Toyota RAV4 -Private Party Pricing Report -Kelley Blue Book Page 2 of 3 Vehicle Condition Ratings Check Vehicle T~it_le Ili ;C,u.~~ r;:. _;Ir;~t, ::a f. ~}.i?fit.. • Looks new, is in excellent mechanical condition and needs no reconditioning. • Never had any paint or body work and is Free of rust. • Clean title history and will pass a smog and safety inspection. • Engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. • Complete and verifiable service records. Less than 5% of all used vehicles fall into this category. Good $15,050 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor (if any) blemishes, and there are no major mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. i-;¢;, • Some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. • Clean title history, the paint, body and/or interior need work performed by a professional. • Tires may need to be replaced. • There may be some repairable rust damage. • Severe mechanical and/or cosmetic defects and is in poor running condition. • May have problems that cannot be readily fixed such as a damaged frame or crusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of these vehicles varies greatly. A vehicle in poor condition may require an independent appraisal tc determine its value. Pennsylvania 12/15/2010 Accurate Condition Appraisal Cl~,~nge Cnncliticn~~ Accurately appraising the condition of a vehicle is an important aspect in determining its Blue Book value. Taking our 16 question condition quiz will ensure you know the correct condition rating. NEXT STEP 2010 Kelley Blue Book Co., Inc. /all rights reserved. t2/10/Z010-IZ/t6/Z010 Edition. u The specific infomaation r~guired to determine the value for this particular vehicle was supplied vy the person generating (his report. Vehicle valuations arc opinions and may vary from vehicle to vehicle. Actual valuations writ vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or' omissions. (v.10122) Featuring ;fll.' I. ,1 ;1 i~ ~i,v Inp ~, i~ lCil l L('~C R -.?Ie U<rl is A:varcl ~. '.u C.orify C,ar_, t,i ,7'.r s3(i'! 10 (: UCI Car; I.!r. ri c~r 5123K Il~r~s Weel<s 5 ~~ea[ (:ai Uc-;~'~< About KBB r;l ~~:ii !i5 r ..tar; '; . (+~~~<~..: IA,) f9ed=~ ~c ~crt~~.i.~,7 ""k~nrl I'nv,7r~, `iitC t='~^ 7{-'~" ~i~t ~' ir,~rlen't~rk s Ti~rrn5 c7f Sf r~i;.e © 1995-2010 Kelley Bfue Book Co., inc. 5~~~:ii~e~~,5 'i r;~u~r it ,; http://www.kbb.com/used-cars/toyota/rav4/2006/private-party-value/pricing-report?condi... 12/ 15/2010 MoD V~-~"`' J ~-.Fide/i m INVESTMENT S March O1, 2011 Boswell Tintner & Piccola 315 North Front St Harrisburg, PA 17101 Key Reference Information Document Reference: Authorization dated 02/22/2011 Re: Suzanne Hopple Plan Sponsor: Holy Spirit Health System Fidelity Reference Number: W006852-24FEB 11 Case/Cause No: To Whom It May Concern: This letter acknowledges receipt of the document referenced above. Fidelity Workplace Services, LLC ("Fidelity") provides administrative recordkeeping services to qualified employee benefit plans which are maintained by plan sponsors and are subject to the Internal Revenue Code of 1986, as amended, and the Employee Retirement Income Security Act of 1974, as amended. These services are provided in accordance with the administrative procedures and plan rules established by the Plan sponsor. Enclosed please find the following information in response: • A copy of Ms. Hopple's statement for the Holy Spirit Plan This is the only information requested for Suzanne Hopple that Fidelity Workplace Services, LLC has in its records and it is being provided in lieu of a personal appearance. If further assistance is required in this matter, please submit your request in writing to the following address: Fidelity Workplace Services, LLC PO Box 770003 Cincinnati, OH 45277-0070 Enclosure: Statement for Suzanne Hopple Sincerely, Fidelity Workplace Services, LLC Qualification & Compulsory Processing ~A emu. f_ _ij r ~ ~ .. ! gg t Fidelity Workplace Services, LLC PO Box 770003 Cincinnati, OH 45277-0070 W006852-24FEB 11 Page 1 of 6 Print This Page ~~s~ ~ll~~'~~ ~: ix..rs,~rtKT. Holy Spirit Hospital Retirement Savings Statement SUZANNE HOPPLE "~ Customer Service: (800) 343-0860 4790 AUGUSTA DRIVE MECHANICSBURG, PA 17050- Fidelity Investments Institutional Operations Company, Inc. 82 Devonshire Street Boston, MA 02109 Your Account Summary Statement Period: 11/28/2010 to 11/28/2010 Beginning Balance $80,561.43 Ending Balance $80,561.43 Additional Information Vested Balance $80,561.43 Your Personal Rate of Return This Period ~'~% Your Personal Rate of Return is calculated with atime-weighted formula, widely used by financial analysts to calculate investment earnings. It reflects the results of your investment selections as well as any activity in the plan account(s) shown. There are other Personal Rate of Return formulas used that may yield different results. Remember that past performance is no guarantee of future results. Your Asset Allocation Statement Period: 11/28/2010 to 11/28/2010 https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 Page 2 of 6 Your account is allocated among the asset classes specified above as of 11/28/2010. Percentages and totals may not be exact due to rounding. The Additional Investment Information section lists the underlying allocation of your blended investments. Account Value Statement Period: 11/28/2010 to 11/28/2010 This section displays the value of your account for the period, in both shares and dollars. Holy Spirit 401(k) Shares Shares Price Price Account Value Account Value Investment as of as of as of as of as of as of 11 /27/2010 11 /28/2010 11 /27/2010 11 /28/2010 11 /27/2010 11 / 28/ 2010 Blended Investments* X80,561.43 $80,561.43 FID Freedom 2010 5,998.617 5,998.617 $13.43 $13.43 $80,561.43 $80,561.43 Account Totals X80,561.43 X80,561.43 Remember that a dividend payment to fund shareholders reduces the share price of the fund, so a decrease in the share price for the statement period does not necessarily reflect lower fund performance. *You have invested a portion of your account in Blended Investments. Blended Investments generally invest in a mixture of stocks, bonds and short-term investments, blending long-term growth from stocks with income from dividends and interest. Please refer to the Additional Investment Information section to see how your blended investments are allocated across the three asset classes. Please refer to NetBenefits and other Plan information, such as your SPD, for a description of your right to direct investments under the Plan. For information on any plan restrictions or limitations on those rights visit NetBenefits and click on "Plan Information". To help achieve long-term retirement security, you should give careful consideration to the benefits of awell-balanced and diversified investment portfolio. Spreading your assets among different types of investments can help you achieve a favorable rate of return, while minimizing your overall risk of losing money. This is because market or other economic conditions that cause one category of assets, or one particular security, to perform very well often cause another asset category, or another particular security, to perform poorly. If you invest more than 20% of your retirement savings in any one company or industry, your savings may not be properly diversified. Although diversification is not https://plansponsorservices3 OO.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 ^ Stock Investments ($40,Z80.7Z}, 50.00% ^ Bond Investments {$3Z,ZZ4.57}, 40.00 i8 Short-Term Investments {$8,056.14}, 10.00% Page 3 of 6 a guarantee against loss, it is an effective strategy to help you manage investment risk. In deciding how to invest your retirement savings, you should take into account afl of your assets, including any retirement savings outside of the Plan. No single approach is right for everyone because, among other factors, individuals have different financial goals, different time horizons for meeting their goals, and different tolerances for risk. It is also important to periodically review your investment portfolio, your investment objectives, and the investment options under the Plan to help ensure that your retirement savings will meet your retirement goals. Visit the Department of Labor website http://www.dol.gov/ebsa/investing.html for information on individual investing and diversification. As of Your Contribution Elections as of o3/oi/ZOll This section displays the investments in which your future contributions will be invested. Holy Spirit 401(k) Your Current Investment Elections as of 03/01/2011 All Eligible Sources EMPLOYEE DEFERRAL Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% EMPLOYER MATCH Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% ROLLOVER-401(K) Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% EMPLOYER DISCRETIONARY Investment Option Current Blended Investments* FID FREEDOM 2010 100% https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 Page 4 of 6 Total 100% AGE 50 CATCH UP Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% ROLLOVER-457(6} Investment Option Current Blended Investments* FID FREEDOM 2015 100% Total 100% ROLLOVER-AFTER TAX Investment Option Current Blended Investments* FID FREEDOM 2015 100% Total 100% ROLLOVER IRA Investment Option Current Blended Investments* FID FREEDOM 2015 100% Total 100% 403(8) ROLLOVERS Investment Option Current Blended Investments* FID FREEDOM 2015 100% Total 100% ROTH DEFERRAL Investment Option Current https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 Page 5 of 6 Blended Investments* FID FREEDOM 2010 100% Total 100% ROTH AGE 50 CATCH-UP Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% ROTH ROLLOVER Investment Option Current Blended Investments* FID FREEDOM 2010 100% Total 100% Your Contribution Summary Statement Period: 11/28/2010 to 11/28/2010 Holy Spirit 401(k) Employee Employer Contributions Deferral Employer Match Discretionary Period to date Vested Percent Total Account Balance Total Vested Balance $0.00 100% $41,724.77 $41,724.77 $0.00 100% $33,821.35 $33,821.35 $0.00 100% $5,015.31 $5,015.31 Your Account Activity Statement Period: 11/28/2010 to 11/28/2010 Use this section as a summary of transactions that occurred in your account during the statement period. Holy Spirit 401(k) View Detailed Transaction History for Holy Spirit 401(k) Employee Employer Activity Deferral Employer Match Discretionary Total Beginning Balance $41,724.77 $33,821.35 $5,015.31 $80,561.43 Vesting Percentage 100% 100% 100% Vested Balance $41,724.77 $33,821.35 $5,015.31 $80,561.43 Ending Balance $41,724.77 $33,821.35 $5,015.31 $80,561.43 https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 . Page 6 of 6 Your Account Information As of 02/28/2011 Holy Spirit 401 (k) General Information Status Code Deceased Additional Investment Information As of 03/01/2011 Use this section to determine the asset allocation of your blended investments. Blended Investment Stocks Bonds Short Term FID Freedom 2010 50.00% 40.00% 10.00% Blended investments generally invest in more than one asset class. The blended investment asset allocation above reflects the stated neutral mix or, if not available, the asset mix reported by Morningstar, Inc. for mutual funds or by investment managers for non-mutual funds. Print This Page RAW ~'~ pr~~dec# by ~~~ ~ v Y K# f Y Q N T M © 1996-2011 FMR LLC. All rights reserved. Terms of Use https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online_statement_detail.... 03/01 /2011 Trusted Advisors for Generations March 8, 2011 Boswell, Tintner &Piccola Attn: Jeffrey Piccola 315 North Front Street Harrisburg, PA 17101 Re: Account #2473-9908 To Whom It May Concern: ,.~ ` ' .33 ~1~c~~t `~rcl Strcel Suites 2(ll ~-1'illi<tllls~x~rt, P~-~ li7O1 SOU.(~)2.(~(_)<<1 \~'\~ ~~'.~~llll le'~'.COil? I am writing this letter to you in response to your letter dated February 22, 2011. I have included answers to the questions that you needed answered for the deceased-Suzanne Hopple. 1. Registration: Suzanne M Hopple Bene, Helen Rutledge (Deed IRA)JMS LLC Cust FBO 2. Account was opened on 1 /06/2006 3. There wasn't an ownership/registration change within 3 years prior to her death 4. Interest Rate isn't applicable 5. Withdrawal amount-$4,679.31-Her Minimum Distribution Requirement-$519.92 sent to the IRS for Federal withholding this was done on 12/27/10. 6. 11/30/2010 Account Value-$137,021.35 7. No interest accrued up to the Date of Death -11 /28/ 10 8. We currently don't hold any stocks and/or securities for the decedent. Please feel free to contact me @ 1-800-652-6639, if you have any other questions or need any further information, I will be glad to assist you in any way. Sincerely, B any L. Bair SRPCA to WP-07 ~~lnncv ~I~)~)t~c>mer~~ Sc~>tt l.t_< !~Iembe~r::~1~SF. • FINRr1 • SIPC ~~ji~ ~Jnbettture Made the 12 th day of November, 2003 between the ~~jt[rt~jb[IIt QCttttttti'p ~~~Otf~tlOtt ,Grantor and Suzanne M. Hopple Of _4790 Augusta Drive Mechanicsburg., Pa.17050 Grantee: WITNESSETH That the said Grantor, in consideration Seven Hundred Fifty and 00/100 Dollars paid by the said Suzanne M. Hopple the date of execution hereof ,the receipt of which is hereby acknowledged, the said Granter does hereby grant unto the Grantee, h heirs and assigns, the exclusive and entire right of interment, or sepultre, in the following burial property, which title is vested in the said Grantor in the Churchville Cemetery, situate in Swatara Township, County of Dauphin, Commonwealth of Pennsylvania, described as follows: Section 5 lst. Addition Lot #159 North Row-14 (2) Graves together with all ways, rights, remedies, privileges, appurtenancesthereto belonging or any wise appertaining This conveyance, in all right, title and interest hereby granted in the property above described, is subject to all laws and ordinances, and to the following conditions, reservations restrictions and rules and regulations, and the Grantee, by the acceptance of this Indenture, covenants and agrees that: . (a) No sale or transfer of said burial lot or right of interment, shall at any time be valid without the permission of the president and managers of the said Association, signified under their corporate seal, duly attested and entered upon the books of the Association. (b) Grantor, at the expense of Grantee and is the charge against the above described burial lot, may repair or remove any memorial or other marker foundation that is improper or offensive, or which has become dangerous or unsightly; they may bring to grade any sunken graves; they may remove any tree or other vegetation or object or embellishment that becomes unsightly or dangerous. (c) Grantor shall not be liable for loss or damage caused by an active God, common enemy, thief, vandals, strikers, malicious mischief makers, unavoidable accidents, right or order of any military or civil authority. (d) The enumeration herein of certain conditions, reservations, restnctions and rules and regulations shall not be considered as the only limitations, but hereafter Grantee shall be subject to the restrictions and by-laws in effect at this time, or created hereafter, by the president and manager of said Association. IN WITNESS WHEREOF, the said Churchville Cemetery Association have caused their corporate seal to be hereto affixed, the day and year first above written. CHURCHVII.LE CEMETERY ASSOCIATION President Secrets ~""- " Sovereign Bank ESTATE OF Suzanne M Hopple SOCIAL SECURITY #: 172-38-8712 DATE OF DEATH: November 28, 2010 Account #: 0571138195 Type: Checking Open date: 9/25/2000 In the name of: Suzanne M Hopple or Stephen Michael Hopple Date of Death Balance: $6,698.74 Int.(YTD) from 1 /1 /2010 to 11 /3/2010 $1.69 Accrued interest to date of death: $0.04 Other Info: Account #: 2334082821 Type: Money Market Open date: 10/4/2006 In the name of: Suzanne M Hopple Date of Death Balance: $19,449.21 Int.(YTD) from 1 /1 /2010 to 11 /3/201 C- $147.28 Accrued interest to date of death: $5.26 Other Info: Account #: 2334086711 Type: Money Market Open date: 12/8/2009 In the name of: Suzanne M Hopple Date of Death Balance: $0.00 Int.(YTD) from 1/1/2010 to 6/18/201() $654.98 Accrued interest to date of death: $0.00 Other Info: closed 6/18/10 for $148,664.73 -$100,000.0() deposited into 0575545694 $48,664.73 deposited into 0575 545686 Account #: 0575545686 Type: CD Open date: 6/18/2010 In the name of: Suzanne M Hopple Date of Death Balance: $48,888.42 Int.(YTD) from 1 /1 /2010 to 10/31 /2010 . $223.69 Accrued interest to date of death: $48.19 Other Info: Account #: 0575545694 Type: CD Open date: 6/18/2010 In the name of: Suzanne M Hopple Date of Death Balance: $100,861.74 Int.(YTD) from 1 / 1 /2010 to 10/31 /2010 $861.74 Accrued interest to date of death: $186.08 Other Info: Page 1 of 3 ESTATE OF Suzanne M Hopple SOCIAL SECURITY #: 172-38-8712 DATE OF DEATH: November 28, 2010 Account #: 0578246761 Type: IRA Open date: 9/10/2010 In the name of: Suzanne M Hopple Date of Death Balance: $54,511.39 Int.(YTD) from 1 /1 /2010 to 10/31 /2010 $94.36 Accrued interest to date of death: $53.73 Other Info: Beneficiary: Estate of Suzanne M Hopple Account #: 2335538118 Type: CD Open date: 12/17/2005 In the name of: Suzanne M Hopple Date of Death Balance: $58,661.31 Int.(YTD) from 1 /1 /2010 to 10/31 /2010 $1,032.56 Accrued interest to date of death: $108.23 Other Info: Account #: 2335539058 Type: CD Open date: 9/12/2006 In the name of: Suzanne M Hopple Date of Death Balance: $100,571.89 Int.(YTD) from 1/1/2010 to 9/13/201() $1,443.85 Accrued interest to date of death: $266.86 Other Info: Account #: 2338219195 Type: IRA Open date: 5/31/2002 In the name of: Suzanne M Hopple Date of Death Balance: $0.00 Int.(YTD) from 1/1/2010 to 9/10/2010 $403.70 Accrued interest to date of death: $0.00 Other Info: closed 9/10/10 for $54,417.03 transferred into 0578246761 Account #: 2335463366 Type: CD Open date: 1/5/2004 In the name of: Suzanne M Hopple Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 12/9/09 for $50,003.25 deposited into 2334086711 Page 2 of 3 ESTATE OF Suzanne M Hopple SOCIAL SECURITY #: 172-38-8712 DATE OF DEATH: November 28, 2010 Account #: 23 3 5463 3 82 Type: CD Open date: 1 /5/2004 In the name of: Suzanne M Hopple Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 12/9/09 for $50,003.25 deposited into 2334086711 Account #: 2335463390 Type: CD Open date: 1/5/2004 In the name of: Suzanne M Hopple Date of Death Balance: $0.00 Int.(YTD) from to Accrued interest to date of death: Other Info: closed 12/9/09 for $50,003.25 deposited into 2334086711 Account #: _ In the name of: Other Info: 233-216 Type: Safe Deposit F3ox Open date: 10/6/2003 Suzanne M Hopple located at: 168 South 32nd Street, Camp Hill, PA 17011 (717)737-2323 Page 3 of 3 Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 9 .~ .y .a 0 .~ r 0 v Y m y d O t .~ v v v 0 `u '7 n a 0 0 :~ c w 0 eo .~ `u O v 0 c n `o e 9 L 7 d 3 O T C L 3 Y C a q O .~ February 8, 2011 Boswell, Tintner &Piccola Counselors at Law P.O. Box 741 Harrisburg, PA 17108-0741 RE: Estate of Suzanne M. Hopple Date of Death: November 28, 2010 Dear Mr. Piccola: Per our request, enclosed please find the account information as of the date of death Y for the above-named decedent. For your information, accrued interest is not include in the date of death balance. Please feel free to contact me if I can be of any further assistance. Ve truly yours, ,~ ~'~1,t,~~.__ ~ -- Linda Spavento Team Leader 617-514-5189