HomeMy WebLinkAbout09-02-11 15056101,40
REV-1500 EX ~°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 6 6 3
ENTER DECEDENT INFORMATION BELOW
SoClal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 2 0 7 2 7 8 7 0 6 0 3 2 0 1 1 0 9 2 3 1 9 1 8
Decedent's Last Name Suffix Decedent's Firs t Name MI
E V A N S H O R A C E W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
^X 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust 0
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-f12)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SIHOULD BE DIRECTED T0:
Name Daytime Telephone Number
G E R A L D J S H E K L E T S K I E S Q 7 1 7 7 7 4 7 4 3 5
~:
REGISTER OF If6Nt'~S USE ONLY -- ~;
~ -
~) r? i
First line of address - ::_~
4 1 4 B R I
D
G E S T '~ -
'` -"
.
Second line of address ::,
. ,; ;
--
P- 0 B O X E
,.
-i ~ - ~'-
_ ~ ~+
` ,
City or Post Office
State ZIP Code DATE FILED
-
- - _~ _
N E W C U M B E R L A N D P A 1 7 0 7 0
Correspondent's a-mail address: W e S h e k a~ C 0 m C a S t• n e t
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAINRFS OF PERSON RESP NSIBLE FO~FILIp~G RETURN w DAlE
JAIV`1;,CE CAROL EVANS 75 SAM_ SNEAD CIRCLE, ETTERS PA ~ 1719
SIGNATU~~PAFj6R~OJyFE~.~~lt ,tj~ap E TIVE CIATE
GERALD J• SHEKLETSKI, ESQ•414 BRIDGE ST•, NEW CUMBERLAND PA 17070
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
150561024D
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: H O R A C E W• E V A N S 2 0 2 0 '~~ 2? 8 7
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1.
2. Stocks and Bonds (Schedule B) ...................................... 2
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5. 1 5 1 0 6 9 . 2 6
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 1 0 13 0 1 2 D
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested . .... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 1 6 1 13 7 0 4 6
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 1 4 :3 8 8 . 1 2
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10.
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 4 .3 8 8 . 1 2
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 1 4 7 4 8 2 . 3 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... .... .. 13. 1 D D D . 0 D
14. Net Value Subject to Tax (Line 12 minus Line 13) ............... .... .. 14. 1 4 6 4 8 2 . 3 4
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 .000 D D D 15. D. D D
16. Amount of Line 14 taxable
at lineal rate X .045 1 3 6 4 8 2 3 4 16. 6 1 4 1. 7 1
17. Amount of Line 14 taxable
at sibling rate x .12 1 0 0 0 0. 0 0 17. 1 2 0 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 D D O 18. D. O D
19. TAX DUE ............................. .... .. 19. ~ _3 4 1 ~ 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 1505610240
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 0663
DECEDENT'S NAME
HORACE W• EVANS
__
STREET ADDRESS
824 LISBURN ROAD APT• 204
THE WOODS AT CEDAR RUN
CITY I STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount 3 6 7. 0 9
3. Interest
4. If 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.
5. 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)
Make check payable to: REGISTER OF WILLS, AGENT
(1) 7, 341.71
367.09
0.00
6,974.62
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 : ................................................................ ...... ^ Q
b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ Q
c. retain a reversionary interest; or ........................................................................................... ..... ^ 0
d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................. ..... ^ Q
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? .... ..... ^ Q
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
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the uses of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except: as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
CASH
BANK DEPOSITS
& MSC.
COMMO NWEALTH OF PENNSYLVANIA ,
,
IN E
RN PERSONAL PROPERTY
REST ENT
DECEDENT
ESTATE OF FILE NUMBER
HORACE W• EVANS 21 11 0663
Include the proceeds of litigation and the date the proceeds were received by the estate.
A ll property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT 10,664.58
171030-00
2• MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT 136,605.95
171030-05
3• THE WOODS AT CEDAR RUN REFUND CHECKS (2) 3,798.73
$2,173.73 + $1,625.00 = $3,798.73
TOTAL (Also enter on line 5, Recapitulation) I $ 151 0 6 9 • 2 6
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
HORACE W• EVANS 21 11 0663
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Sctledule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.JANICE CAROL EVANS 75 SAM SNEAD CIRCLE DAUGHTER
ETTERS, PA 17319
B.
c.
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET /a OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTERESI
1. A. 07-07 PNC BANK CERTIFICATE OF DEPOSIT 8,069.17 50• 4,034.59
ACCOUNT #5140487044
2• A•B• 01-92 PNC BANK CHECKING ACCOUNT 13,533.22 50• 6,766.61
#51,40487044• EVELYN D• EVANS
DIED IN 1994, WHEREUPON TITLE
TO THE ACCOUNT VESTED IN HER
SURVIVING SPOUSE, HORACE W• EVANS
(THE DECEDENT) AND JANICE C• EVANS
(THE DAUGHTER OF EVELYN D• EVANS
AND THE DECEDENT, HORACE W• EVANS)
BY OPERATION OF LAW•
TOTAL (Also enter on Line 6, Recapitulation) I $ 1 D , 8 01 • 2 D
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
HORACE W• EVANS 21 11 D663
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PARTHEMORE FUNERAL HOME AND CREMATION SERVICES, INC• 5,142.70
B.
ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2 Attorney Fees: GERALD J • SHEKLETSKI, ESQ • 7, 900 •00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
5.
6.
7.
8•
9•
10•
11•
12•
13•
14•
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: LETTERS TESTAMENTARY
Accountant Fees:
Tax Return PreparerFees:
LEGAL ADVERTISING - THE SENTINEL
LEGAL ADVERTISING - CUMBERLAND LAW JOURNAL
SPARTAN PHARMACY
WEST SHORE EMS
DONALD D• DINELLO, DMD
FUNERAL LUNCHEON
FILING FEES - INHERITANCE TAX RETURN AND INVENTORY
ADDITIONAL PROBATE FEE
89.50
189.54
75.00
63.55
120.72
373.00
174.11
30.00
230.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 14 , 3 8 8 • 12
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+ (Ot-10)
Pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
HORACE W. EVANS ~ ~1. 1.1. I'll.h~
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. JANICE CAROL EVANS Lineal 71,141.78
75 SAM SNEAD CIRCLE
ETTERS, PA 17319
2• SCOTT W• EVANS Lineal 60,340.56
35 SOUTH 6TH AVENUE, SECOND ST•
COATESVILLE, PA 19320
3• KELLY EVANS Lineal 5,000.00
2330 BLOSSOM ST•
COLUMBIA, SC 29205
4• JEAN EATON Sibling 2,000.00
1896 VILLA COURT
LANCASTER, PA 176D3
5• MARY FOLLET Sibling 2,000.00
2467 DAVENPORT LANE
BALDWINSVILLE, PA 13027
6• OWEN EVANS Sibling 2,000.OD
3100 TERWOOD ROAD APT• K117
WILLOW GROVE, PA 19090-1422
7• CYNTHIA EVANS Sibling 2,OOD•00
1066 FOULKEWAYS
GWYNEDD, PA 19436
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. PINE STREET PRESBYTERIAN CHURCH 500.00
310 NORTH 3RD STREET
HARRISBURG, PA 17101
2• DOWNTOWN DAILY BREAD 500.OD
310 NORTH 3RD STREET
HARRISBURG, PA 17101
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ;s 1 , 0 0 0 • 0 D
~r more space Is neeaea, use aaaluonal sneers of paper Dr the same s¢e.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
HORACE W. EVANS 21 11 0663
Decedent's Name Page 1 File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustees) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
8- BETTY DOUGAN Sibling 2,000.OD
P•0• BOX 2674
PALM SPRINGS, CA 92263
t
4
LAST WILL AND TESTAMENT
OF
HORACE W. EVANS
I, HORACE W. EVANS, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I: I direct that my Executrix hereinafter nam:.ed shall pay all
my just debts and funeral expenses as soon as conveniently may be done
after my decease from the residue of my estate.
ITEM II: Upon my death, I direct that my mortal rem,ai.ns be cremated
and there be no public viewing of my body.
ITEM III: I make the following specific bequests:
A. Five Thousand ($5,000.00)Dollars to my granddaughter,
KELLY EVANS.
B. Two Thousand ($2,000.00) Dollars to my sister, JEAN
EATON.
C. Two Thousand ($2,000.00) Dollars to my sister, MARY
FOLLETT.
D. Two Thousand ($2,000.00) Dollars to my brother, OWEN
EVANS.
E. Two Thousand ($2,000.00) Dollars to my sister-in-law,
CYNTHIA EVANS.
Page 1 of 5
F. Two Thousand ($2,000.00) Dollars to my sister-in-law,
BETTY DOUGAN.
G. Five Hundred ($500.00) Dollars to PINE STREET
PRESBYTERIAN CHURCH, of Harrisburg, Pennsylvania.
H. Five Hundred ($500.00) Dollars to DOWNTOWN DAILY BREAD,
of Harrisburg, Pennsylvania.
ITEM IV: I devise and bequeath the rest of my estate of every
nature and wherever situate, in equal shares to such of my children,
JANICE CAROL EVANS and SCOTT WAYNE EVANS, as survive me. Should any of
my children predecease me, I devise and bequeath the share of such child
to his or her issue, per stirpes; and should any such child of mine
leave no such issue living following my death, I devise and bequeath the
share of such child to my issue, per stirpes.
ITEM V: I appoint my daughter, JANICE CAROL EVAI~IS, Executrix of
this my last will. Should my daughter, JANICE CAROL EVANS, fail to
qualify or cease to act as Executrix, I appoint my sari, SCOTT WAYNE
EVANS, Executor of this my last will.
ITEM VI : No fiduciary act; pn hc~rc~,.,,~1,,,., .. i.. _, , ,_
bond or enter security for the faithful performance of his or her duties
in any jurisdiction.
Page 2 of 5
IN WITNESS WHEREOF, I, HORACE W. EVANS, have hereunto set my hand
and seal this Z ~ day of 2009.
-, / ~ . ~ ~~
~~
HORACE W. EVANS
SIGNED, SEALED, PUBLISHED and DECLARED by HORACE W. EVANS, the
Testator above named, as and for his Last Will and Testament, and in the
presence of us, who at his request, in his presence and i.n the presence
of each other, have subscribed our names as witnesses.
Witn s
itn~ss
Address
~11'~ r~r~-c.. 5~;~~~ ~-~~vl ~~
Address
Page 3 of 5
~i
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, HORACE W. EVANS, the Testator whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executes! this instrument
as my last will; that I signed it willingly and that I signed it as my
free and voluntary act for the purposes therein contained.
.-,
s'
~~~ ~ ~ ! ~ z,~, tom,
HORACE W. EVANS
Sworn to or affirmed to and acknowledged before me by HORACE W.
EVANS, the Testator, this ~~ day of ~.~.~
~, 2009.
Notary Public
COMMONWEA 'LYNN VANIA
~}JZ~A
CAROL L. TROXEII, Notary Public
New Cumberland Boro. Cumberknd Co.
MY Commission Expires Dec. 27, 2009
Page 4 of 5
1
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
and U~,~,~~r Pc, (Y~o,,•
~~ /
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testator sign and execute the instrument as his
last will; that Testator signed willingly and that he e}:ecuted 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; that to the best of our knowledge, the Testator was at that
time eighteen or more years of age, of sound mind and under no
constraint or undue influence.
'~%~~
Witnes
~~__.
ess
Sworn to or affirmed to and acknowledged before me by
~~ ~.i+ ~1~1s'l~ ' ~ ~ ~
witnesses, this day of
COMIVIONWEAl1N OF PENN511VAIVIA -_~_
NOTARIAL $E ~
CAROL t. 7ROXELL,, Note
New Cumberland 6oro. Cumberland Co.
Mf+ Commission Expires Dec, 21, 2009 Page 5 o f 5
and n, -er q, ~~
200'x.
Notary Public
J~~~, 5. 20" 'O:ObAM PNC BANK 412-705-2747
~~~
i~~1'k~ VIIAY
July 5, 2011
Grerald y Shekletski, Esq.
Stoxte Lai'aver & Shekletslti
414 Bridge St
POBoxE
New Cumberland, PA 17070
}ZE; Horace W Evans
SSN: 202-07-2787
DOD: 06-03-2011
Dear Mr. Shekletslci:
No.9?~4 P, 1/2
In xespoz~se to youx xequest for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account # 31600314768 Established.: 07-OS-2007
HOIZACE W EVANS
JANICE C EVANS
DOD balance: $ 8,069.17 + 0.00 accrued interest
Interest paid 01-01-2011 thru 06-03-2011 $10.09 YT'D
Checking Account
Account # 5140487044 Established: O 1-271992
HO1tACE w EVANS
EVELYN D EVANS
JANICE C EVANS
DOD balance: $ 13,533.22 + 0.20 accrued interest
Interest paid 01-01-2011 thru 06-03-2011 $ 2.58 YTD
Please note that this office provides date of death balances for deposit accoumts (11tAs, 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 1-588-PNC-BANK (1-888-762-2265) or stop by your local PNC: dank branch
office.
Sincerely,
National Financial Services Center
PNC Bardc, N.A.
Member FDIC
Page 1 of 2
J u,l. 5. 2011 ' 0 ; ObAM PNC BANK 412-705-2747 N'o, 9244 P. 2/2
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileger~ confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited If you have received this
communication in error, please notify me immediately by reply or by telephone at SDO-762-177 and
immediately destroy this faxed document.
Page 2 of 2
MEMBERS 1St
FEDERAL CREDIT UN[ON
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Estate of: HORACE W. EVANS
Date of Death: 06/03/2011
Social Security Number: 202-07-2787
171030-00
09/26/1997
$10,664.42
$.16
$10,664.58
None
171030-05
09/26/1997
$136, 601.46
$4.49
$136,605.95
None
BERS 1ST1 fFE_DERAL~C/R(E`,DIT UNION
Danielle A. Kline
Lending Insurance Support Specialist
June 16, 2011
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 w~uu:membersl st.org
~u~y
FIRST NATIONAL BANK OF PA
HARRISBURG, PA
THE WOODS AT.CEDAR RUN/GCCC ~
6600 BROOKTREE RD., STE. 1000 1J 80-1809/433
..WEXFORD, pA 15090-9205 ( ~ 7~29~2~1 ~
~V
nR~FRnFE Janice Evans ~ $2,173.73 f
Two Thousand One Hundred Seventy Three Dollars and 73 Cents
DOLLARS
Janice Evans
75 Sam Snead Circle F ~,~~s~~,9
Etters PA 17319 F
,- ,~, - ~~
MEMO ~~~~:
"".-
u' 206911' x:04 3 3 1809 2~: 9 504060 511'
THE WOODS AT CEDAR RUN/GCCC
2069
,, w.: . , •: ~ ~,.
@ C -` ~.. ~
~yigitiarn ~ iiat~,, , ': ~~~ Check'-Date t
`boCUri~~,n~Nu...lie~
ZZWCR-0014 Janice Evans P0000000000003068 7!29/2011 2069
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RESIDENT REFUND 7/29/2011 $2,173.73
$2,173.73 $0.00 $2,173.73
$2,173.73 $2,173.73 - $0.00 $2,173.73
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