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HomeMy WebLinkAbout09-12-111505610101 REV-1500 Ex t01.1°' ' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~"AA,ME~. County Code Year File Number PO Box zso6ol ~ INHERITANCE TAX RETURN Harrisburg, PA 1')328-0601 RESIDENT DECEDENT ~- ~ / b © ~ ~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI ~{ o C ~ A-N 1~ BF TT y ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number C N~QCES E ~~ /EL [~S i~ i ~, 7 76~ o~a4 First line of address (o CZ©uSFk i20.¢o Second line of address N/ /-~ City or Post Office State /fly etl/~,~// Cs~u,e~ G~l+ ZIP Code REGIST~OF WILLS USE•ONLY _a-f .X'] ~ ~ r.~ s_~i _. ~-:i- - -. ~-~ _~ ~` ~7 r.,~ i~ --= '~ ~- . f, `-; _ ~, _ _. .- .._. ,~TJ ~~ .... .. 7. . ~ } ~~ i"~ DATE FILED .-, `'f~ ~ `: l ~ ~ ...7 ~ f L ~j cr Correspondent's a-mail address: Ceti ~ e~~S 3 ~ C®/YICaS t• h~ 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. SIGNATURE OF PER ON RESP NSIBL F FILING RETURN DATE x ~ 98 i~ ADDRESS ~RNFS ~ ~. H RTZLEn ~~D ~ / 7ha%~~.5'0~ Lane, /1~PC1Qn~cs ur~, ~i¢ /lass SIGNATUR PREP ER OTh}~R THA PRFS NATIVE DATE ADDRESS ~y/TZL~ ~ S ~~~ ~ ,~,~ 6 ~LYlS4' ~Qpzd~ h'JPC 2It rCs 4~, ~~ / 7DSS PLEASE USE ORIGINAL FORM ONLY 1505610101 Side 1 1505610101 ~' ~i 1505610105 REV-1500 EX Decedent's Social Security Number ~/-. Decedent's Name: ~ e L 1 (~ J', H o I Iu, n d ! 7 S 2 0 S! s' (o RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. j ~'~' 7 .~ 8 7 • SD 2. Stocks and Bonds (Schedule B) .................................... ... 2. l ~ (O , (F O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. , O ~ 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. ^ O 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. j ~ 2 '~ -'' ~ „ (0 3 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .... ... 6. 3 I 3 $ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - - (Schedule G) O Separate Billing Requested..... ... 7. 2' 7 3 O ~„ ~ „ 7 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. ~ 3 Q ~ p & , 3 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 02 ~ 9 9 ~ ~ Z ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 3 7 Z • 6 . 1 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. a~ 3c y• ~9 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ C ~ ~ ~ 3 • ~ g 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. ~ ~ p 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. S~ ~ 6 (~ 3 , [f 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 .00 . ~ D 15. . C Q 16. Amount of Line 14 taxable ~ - - at lineal rate X .0 ~ 3 S S (o / 7 • ~ ~' 16. / (~ O O 2 . 8-i Q 17. Amount of Line 14 taxable - at sibling rate X .12 , ~ .: Q 17. 18. Amount of Line 14 taxable ~° ` - -~~°"~-x ~ ~ ~~ = ~~ °a - at collateral rate X .15 j S 3 ' O ,?~ 5 ~'(~p `~ 18. ~ ~2 ' 8' ~. 13• I 3 19. TAX DUE ....................................................... ..19. ,, .3 ~ ! ~ . ~ ' g 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 013916 HARTZLER ERNEST B 1617 THOMPSON LANE MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: Ssrv: 175-20-5156 FILE NUMBER: 21 10-1 140 DECEDENT NAME: HOLLAND BETTY J DATE OF PAYMENT: 01 / 2O/ 201 1 POSTMARK DATE: 01 / 1 9/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /04/2010 REMARKS: RECEIPT TO ATTY CHECK# 0991 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $4,750.00 TOTAL AMOUNT PAID: INITIALS: WZ REV-1162 EX111-96) $4,750.00 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1500 EX Page 3 Decedent's Complete Address: File Number 2'/ - / Q - ~~1~ DECEDENT'S NAME !' el]'y ,J'. moo!/arty/ STREETADDRESS /6 /7 7~iosn~soh Lane iYle~Q,ylicsbur9 - - _ _ - -- STATE ~ A 'ZIP ?' / 7o sS Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments ~~ ,s o p A. Prior Payments _~__ ~___ B. Discount - ~ aSD • ° ° 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) ~'J; oOO.pO '~ 9s i~. ~ 33, a36, os Make check payable to: REGISTER OF WILLS, AGENT. _ __ _ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ........ ...... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................................. ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after 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 use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-150 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Bitty ~: Nolla~t~l a~-~o - i~~o All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER t DESCRIPTION OF DEATH ~ . /~/~ ~'121~ Cerl~Qiri ~vT o f 9r'Olchl~ GGN.tt~ ~ / M~Jr vc~ ~yleh/ts ~e~on e/r~~ecl`edsC./ir/~1cte i~ die Tirii~s~ GD`/er ~~~N, ~klL~ D/ C Gt Ott ~i"ld n~ QiX.~ (.OilrllZAh wea/~/ of ~~a y/v~,~ ~ ham;~~ a-h ~a%~ss D~ /lD /7 ~~ZO/X~SDyt ~he . ~c°C~/Q/l/'CSbllr9~ ~~ /BOSS J ~Sa, c/ ~o%1-r.Ses ~ihr2 ~oeC. J`~ cu /~ cue v~ Sep Fr~eSt ~ f/~~tz/er, fir' ~//er dc~sC~"•~o~ioh fee ~'Pc9' ~ ~i~, h~arfzler~iffa~~/ ~P~~ ~~c1 was reCo/~e~ as -~s'fi'untC/l1~ Nom- ao// /~S/3 c.; ~ ofiSce ~~' die ~eCor~er a~' ,z~e~s ~ an~~r C'ccm ber/Qrr~/ ~~,t~, f e~~s~/~a~ua,ati ~n~ 2~, za~~ ~ulGa~'an is bft.seal on C~Mlae,rla„tAl Co /~scsx~ v~.lu~ QS D d•D.CI. of ~~(~ D70. °O h'ta~'fi ~r .~ ~e CoM.maH F , P y ~ le./el r47,o w~rcl~ as oT d.o.d• was 1, 2S - I `l7, s87.SD See C'op~ o~' reftl esta-I~ -f ~C b ~ Il;nf w; I-~i Q sscssme~ ~i 9 ure ct,~t4~~.heot h el~ , TOTAL (Also enter on line 1, Recapitulation) I $ `L~ ~'~ S" Ff 7 S-D (If more space is needed, insert additional sheets of the same size) TAXING AUTHORITY: WEST SHORE SCHOOL DISTRICT TAX YEAR: 2010-11 REAL ESTATE TAX NOTICE LOWER ALLEN TOWNSHIP PAYABLE BONNIE K. MILLER, T/C (717) 975-7575 PROPERTY ID TO: 2233 GETTYSBURG ROAD 13100258045 CAMP HILL, PA 17011 TAX SCHOOL • • • - . . RATE 10.81 ONOR BEFORE REBATE DATE ON OR BEFORE FACE DATE AFTER PENALTY DATE REBATE 1,149.45 BY 09/01 /2010 1,149. FACE 1,172.91 BY 11/01/2010 72.91 PENALTY 1,290.20 AFTERII/01/2010 1,290.20 TO: HOLLAND, LOY V 8 BETTY 1617 THOMPSON LANE MECHANICSBURG PA 17055 ~~ ~ `~~. FOR: 1617 THOMPSON LANE BILL DATE - 07/01/2010 DELINQUENT BILLS ARE TURNED OVER TO TAX CLAIM ON 12131/2010 ASSESSED VALUE 118,070 HOMESTEAD EXCLUSION 7,522 FARMSTEAD EXCLUSION 0 NET ASSESSMENT 110,548 TAXING AUTHORITY: WEST SHORE SCHOOL DISTRICT TAX YEAR: 2010-11 PER CAPITA TAX NOTICE PAYABLE BONNIE K. MILLER, T!C (717) 975-7575 LOWER ALLEN TOWNSHIP TO: 2233 GETTYSBURG ROAD CAMP HILL, PA 17011 ID# 013002156 SCHOOL • • • TAX PER CAPITA PER CAPITA ON OR BEFORE REBATE DATE '~, 511 679 ON OR BEFORE FACE DATE AFTER PENALTY DATE REBATE 4.90 4.90 BY 09/01/2010 .80 FACE 5.00 5.00 BY 11/01/2010 .00 PENALTY 5.50 5.50 AFTER 11/01/2010 11.00 TO: HOLLAND BETTY J. 1617 THOMPSON LANE MECHANICSBURG PA 17055 h -r T^ ; 1 I i 'v. .. , ... ~ :. ~ i BILL DATE - 07/01/2010 BILL # 030786 _ UNPAID TAXES WILL BE SENT TO DELINOUENT COLLECTOR ON 12/1!2010 TAXPAYER'S COPY ~as~3 5 IlVllllllll Tax Pazcel No. 13-10-0258-045 THIS INDENTURE Made the ate, day of ~~ in the year two thousand and eleven (2011). BETWEEN ERNEST B. HARTZLER, as Executor of the Estate of BETTY J. HOLLAND, also known as BETTY HOLLAND, deceased, late of the Township of Lower Allen, Cumberland County, Pennsylvania, Grantor, and the same said ERNEST B. HARTZLER, single man, of the same said place, Grantee. WHEREAS, the said BETTY J. HOLLAND, a.k.a. BETTY HOLLAND, was vested in her lifetime with title to the premises hereinafter described, in the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said BETTY J. HOLLAND, a.k.a. BETTY HOLLAND, departed this earthly life, testate, on the 4th day of November, 2010, and Letters Testamentary were duly issued to the said ERNEST B. HARTZLER, by the Register of Wills of said Cumberland County, docketed to No. 21-10-1140; and WHEREAS, the premises described more fully at large hereinbelow were specifically devised in the duly probated Last Will and Testament of the said BETTY J. HOLLAND, a.k.a. BETTY HOLLAND, which is of public record in the file docketed to No. 21-10-1140 aforesaid, in Item 2 of the said Last Will which reads in pertinent part as follows, to wit: "I give and devise my residence dwelling, real estate, and all improvements thereon, to my trusted friend, ERNEST B. HARTZLER, who is currently living in said residence dwelling which has an address of 1617 Thompson Lane." The said ERNEST B. HARTZLER, shall also sign hereinbelow as specific devisee for record title purposes. NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said ERNEST B. HARTZLER, as Executor of the Estate of the said BETTY J. HOLLAND, a.k.a. BETTY HOLLAND, deceased; as aforesaid, for and in consideration of the sum of ONE and No/100ths ($1.00) DOLLAR and other good and valuable considerations, to him in hand paid by the said Grantee, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bazgained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in him vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, and by virtue of his own inherent powers and authorities vested in him by the laws of this Commonwealth, does grant, bazgain, sell, alien, release, and confirm unto the said Grantee, his heirs and assigns: ALL that certain lot of ground and the improvements thereon erected situate in the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, bounded and described as follows, to wit: BEGINNING at a point in the center of a public road at the corner of lands now or formerly of E. J. Kinter; thence along said lands now or formerly of E. J. Kinter, North 3 degrees 45 minutes East, a distance of four hundred fifty (450) feet to a point; thence in a westerly direction along lands now or formerly of Daniel Z. Hertzler, a distance of two hundred (200) feet to a point; thence further along said lands now or formerly of Daniel Z. Hertzler, South 3 degrees 45 minutes West, a distance of four hundred twenty-eight (428) feet to a point in the center of aforesaid public road; thence along the center of said public road, South 74 degrees 45 minutes East, a distance of two hundred one and two-tenths (201.2) feet, more or less, to a point in the center of said road, and at the place of BEGINNING. BEING THOSE SAME premises aforesaid which Samuel Roy Weaver, widower, by his deed dated December 9, 1970 and recorded December 10, 1970 in the Recorder of Deeds Office in and for Cumberland County in Deed Book "X," Volume 23, Page 87, granted and conveyed unto Loy V. Holland and Betty Holland, his wife. The said Loy V. Holland predeceased his wife, whereupon full and absolute title vested in the said Betty Holland by virtue of the laws of the Commonwealth incident to tenancies by the entireties. The Estate of the said Betty Holland, deceased, is the Grantor herein. THIS TRANSACTION IS REALTY TRANSFER TAX EXEMPT AS BEING A TRANSFER FOR NO OR NOMINAL CONSIDERATION OF PROPERTY PASSING UNDER A WILL FROM A PERSONAL REPRESENTATIVE OF A DECEDENT TO A BENEFICIARY UNDER THE WILL AS PART OF THE DISTRIBUTION OF AN ESTATE PER THE REALTY TRANSFER ACT SECTION 1102 C.3(7) AND REG. 91.193(B)(7). TO HAVE AND TO HOLD the said message or tenement and tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said Grantee, his heirs and assigns, to and for the only proper use and behoof of the said Grantee, his heirs and assigns, forever. AND THE SAID GRANTOR, Executor, his heirs, successors, and assigns does covenant, promise and agree to and with the said Grantee, his heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Executor of the Estate of BETTY J. HOLLAND, a.k.a. BETTY HOLLAND, deceased, Grantor herein, has hereunto set his hand and seal the day and yeaz first above written. Signed, sealed and delivered in the presence of: ~~ F.'t1~~{v ~~~-.~ ~~ ~, / (SEAL) ERNEST B. HARTZL R, Executor of the Estate of BETTY J. HOLLAND, a.k.a BETTY HOLLAND (SEAL) ERNEST B. HARTZL R, in his capacity as specific devisee herein, for record title purposes COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) On this, the o~c ~ day of ~Q , A.D. 2011, before me the undersigned officer, personally appeared ERNEST B. HARTZLER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same in the capacities therein set forth and for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public CERTIFICATE OF RESIDENCE rtes "y COAAAAO LTH F PENN8YLVANIA NoLArI 8rrl Charlr~ @. Shlrkla NI, Noury public Monror iWp Cumbrnrne County CO1111tbrMIQf1 ~ ~ dunM 20 4012 Mrrtltlaf; I HEREBY CERTIFY that the precise residence of the Grantees is: 1617 Thompson Lane, Mechanicsburg, PA 17055 ~~~~~2~ ~,ci 2~~~4 Attorney for Grantees ~y(~ ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 201112513 Recorded On 4/29/2011 At 11:08: 14 AM * Instrument Type -DEED Invoice Number - 86104 User ID - MSW * Grantor -HOLLAND, BETTY J * Grantee - HARTZLER, ERNEST B * Customer -CHARLES SHIELDS * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $23.50 JUSTICE RECORDING FEES - $12.50 RECORDER OF DEEDS PARCEL CERTIFICATION $10.00 FEES AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 WEST SHORE SCHOOL $0.00 DISTRICT LOWER ALLEN TOWNSHIP $0.00 TOTAL PAID $63.00 * Total Pages - 5 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA ay or cu~yes 0 RECORDER O D EDS t~ao * -Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 0000TH IIIIIIIIIIIIII IIIIIIIIII REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT tS lAl t ~r FILE NUMBER 13~tt-~ ~: ~ollc~,vtd z~-io - ~~~co All property jointly-owned with right of survivorship must be disclosed on Schedule F (n more space is needed, insert additional sheets of the same size) MFC Historical Prices I Manulife Financial Corporation Stock -Yahoo! Finance New User? !2cgister Sign In -. Help Make Yl My Homepage Search Dow * 0.05 Nasdaq ^~• 0.35% NEwt HOME iN'.3~ ~ ir};~ NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES 7/12/11 1:46 PM tAai! `Ay Y' Yah>c' Search Web _. ._.._._...-..__. _....... -~~ GET QUOTES ;-, - - Manulife Financial Corporation (MFC) At 1:31PM EDT: 'I 6.78 ~ 0.0T (0.42%} MFC ~~ TRAt~~' -~ can nrt ~covr,rr IStOrICB 1'ICeS Get Hlstorlcal Prices for: ~~ GO?- Set Date Range ';Daily Stag Date: Nov _: ~ 4 2010 Eg. Jan 1. 2010 Weekly End Date: Nov : ~ 4 2010 Monthly ~~ ~,E",.Dividends Only _~ <Get Prices 7 Firsl ~ Previous ~ Next ~ Last Prices Date O en Hi h ow Close Volume Adj Close' Nov 4, 2010 13.10 14.29 13.10 14.13 10,507,700 13.81 '~'Glose price adjusts rvidends and splits. First I Previous ~ Next ~ Last / `f. 2 g ''I`kfDownload to Spreadsheet ~3 2 D Currency in USD. a ~ ,39 ; z = r3,~o Copyn 7ht ~~ 2C? ~ 'fahoo! Inc. AA rights reserved. Privacy Policy -About Our Atls -Terms of Service - CopyrighVlP Policy -send Feedback -Yahoo! 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International historical chart data. dairy updates, fund summary, fund per!ormance, dividend data and Nlomingstar Index data Gravided `JY Morningstar, Inc. http://finance.yahoo.corn/q/hp?s=MFC&a=10&b=4&c=2010&d=10&e=4&f=2010&g=d Page 1 of ] REV-1508 EX • 1~-9~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $ MISC. INHRESIDENT DECEDENT RN PERSONAL PROPERTY ESTATE OF ~ e~y J, ~Dl I ~ ~ FILE NUMBER Z _ ~O - ~ ~ O Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION ~1 OF DEATH 1. Z nNer- ~'D r V D~ 1 ~flri S o ~ ~ eXS o n a. ~ iFG (S ee [L s/tl Geed) ~ 3 ~ ~ ~ ~i~. Sb a- pue ~cw-k sowings A-~#: No_ sooo lozq ~~~} 3_ T~ t-. a.ccr. fD d,o_d_ oti ..L Teti ~t/o. z ~ 37 yz~. So (fee l,NC ~/a/~a~;o,~ ~e~er o~clredJ oS ~ ~ T ~~~ /~_ C~ecK.n~ ~: No. 983 8y~ s6zl ~ 13, 3a~, 40 /3_ ,/~CCr~ i/1~ ~ d.o.a~ nrl Z,~Cni /~. . D¢ C~. C'erfi ~.e~ o~ DCnOSit /I/o, o3/DD 3 9/3 ~ZD 930 .+" $zi is /~ t. ~ d ~'h o,Q! oy Lfzyr C r. ,~ ce , st L / p/ ~cSP~i i"Q`~~~/O~1 ~e!/Cr D~Q~C~e~~ r3~ S, ~ 9~6 t~hev~/Q f Sedan Y/N 1 G18 ~. sL Po ~-R 18't 216 ! / ' ~ 3 q oor Qpr~~e S C , DDO. o0 . ~ • C~; fi Zu~s 13arr~ C'~ieck; ,fit: No. 6/ 00 7~5 ~/(o s~ 3 S / 7 ~~, At'C'n ~o d.0•d. on Z'~Yt~o S. 7 ~. ~;fizP,~1s ,8itx/C T.~,te ~Jas,t ~/o. 62S D~f7 ~/A7 ~. 00 v = ~ 3a, a c{d. 7S' /. n t. ,~eCr. ~ 4~.o,c~ on ~~ g See /.~a.~tks !/a,iurc~ioH a/efai/S ~ac~c4/) ~ Z9. /7 ~o. P ~ ~ ca,r ~,Su,t~, a.¢~ ate, ~! ~ 313. ~o TOTAL (Also enter on line 5, Recapitulation) I $ ~ O ,~, 9 7 ~ `3 (If more space is needed, insert additional sheets of the same size) BETTY HOLLAND ESTATE INVENTORY Schedule E LIVING ROOM 2 End tables $ 12.50 2 Matching Lamps $ 6.00 Misc. knick-knacks $ 20,00 3 Seat couch with cushions $ 27.50 Oblong Coffee table $ 25.00 Curio cabinet with figurines $ 250.00 Round small table and tamp $ 30.00 Grandfather clock- recent vintage $ 65.00 Cushion Upholstered Chair $ 10.00 Upholstered rocking chair $ 7.00 Bookshelf and old encyclopedia set $ 8.50 2 Disparate wooden chairs $ 8.00 Small wooden chest 6,00 SUBTOTAL $ 475.50 DINING ROOM China closet with assorted contents $ 425.00 Teacart with tea set $ 250.00 2 Rocking chairs $ 40.00 Oblong dining room table & 6 chairs $ 300.00 Buffet $ 65.00 Punch Bowl set $ 200.00 2 Small table lamps $ 8,00 Small nightstand $ 10.00 3 Small cuckoo clock (only 1 works) $ 35.00 Corner cupboard $ 75,00 Assorted dishes, etc $ 150.00 Sewing machine 50.00 SUBTOTAL $1 ,608.00 KITCHEN Trash compactor $ 25,00 Refrigerator, Dishwasher, stove $ 95.00 Kitchen table and 6 chairs $ 45.00 Misc. kitchen utensils & flatware, etc. 35.00 SUBTOTAL $ 200.00 Page 1 BEDROOM #1 Chest of drawers, bureau, night stand $ 110.00 3 Table lamps $ 23.50 Small Cedar chest $ 80.00 Old desk with misc. knick-knacks $ 450.00 Old bed $ 30.00 Small bookcase and odd books 12.00 SUBTOTAL $ 705.50 BATHROOM Waste can $ 0.50 Hamper 3,00 SUBTOTAL $ 3.50 BEDROOM #2 Bed $ 30.00 2 night stand with 2 lamps $ 28.00 Bureau with 2 lamps $ 80.00 Stand up chest of drawers $ 85.00 Chest of drawers $ 90,00 Misc. knick-knacks 22.50 SUBTOTAL $ 335.50 ATTIC 2 Old bed stands $ 15.00 Old sofa bed $ 10.00 Old luggage $ 10.00 Old beat up desk $ 8,00 Misc. X-mas decorations, toys $ 26.00 Old pedal sewing machine 37.50 SUBTOTAL $ 106.50 BASEMENT (Mostly everything is decedent's boyfriends') GARAGE (All outside tools, lawnmowers are decedent's boyfriends') PORCH Porch Furniture SUBTOTAL 50.00 $ 50.00 GRAND TOTAL $ 3, y8 `l..~ o Page 2 ~a~, L~, LUI I Z;4brm rNU tsA~~ 411-IU7-Z/41 Q PNC January 28, 2011 Charles E Shields III Esq. 6 Clouser Rd Mechanicsburg, PA 17055 RE; Betty J Holland SSN: 175-20-5156 DOD: I 1-04-2010 Dear Mr. Shields: No. X416 r, ~ In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checltang Account Account # 5140027224 Established: OS-O1-1960 ERNEST B HARTZLER BETTY JANE HOLLAND DOD balance: $ 7,443.51 non interest bearing Account # 5140027232 Established: 02-01-1963 ERNEST B HARTZLER BETTY JANE HOLLAND DOD balance: $ 3,432.69 nos interest bearing Savings Account Account # 5000629434 Established: 01-29-1996 BETTY J HOLLAND DOD balance: $ 37,421.50 + 0.05 accrued interest Interest paid O 1-0I -2010 thru 11-04-2010 $16.28 YTD Please note that this office provides darE of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any flnxncisil transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 2 Jan. Ltl~ LUI I L.40riVl rlul, fSAluf< 41L-IU7-L 141 No, ~41b r. L This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileget~ confidential and exemptfrom disclosure under applicable law. ff 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 not fed 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 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 v •• p~~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Charles E Shields III 6 Clouser Road Mechanicsburg, PA 17055 Re: Estate of Betty J Holland Social Security: 175-20-5156 Date of Death: November 4. 2010 Phone 888-502-4349 F ax (302)934-2955 January 26, 2011 Dear Sir or Madam: Per your inquiry on January 14, 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: l . Type of Account Checking Account Account Number 9838443621 Ownership (Names ofl Betty J Holland Opening Date 01/10/OS Balance on Date of Death $13,300.90 Accrued Interest $ .04 Total $13,300.94 2. Type of Account Certificate of Deposit Account Number 31003913820930 Ownership (Names ofl Betty J Holland Opening Date 08,/31/99 Balance on Date of Death $14,821.15 Accrued Interest $ .30 Total $14,821.45 Citi~+ens Bank August 2, 2011 Attorney Charles E Shields, III 6 Clouser Road Mechanicsburg PA 17055 Estate of BETTY J HOLLAND Date of Death: Nov 04, 2010 SSN: 175-20-5156 Dear Sir/Madam: One Citizens Drive ROP 112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667, option 2. Sincerely, ,.rte: Pamela Breton Decedent Account Processing REF#: 505555 a~ Citizens Bank Account Number 6250472127 Account Title BETTY J HOLLAND Date Opened 3/28/2007 Account Type Time D osits Principal Balance as of DOD $30248.75 Interest from Last Posting to DOD $29.17 Account Balance as of DOD $30277.92 YTD Interest to DOD $884.59 citizens Bank° Account Number 6100715116 Account Title LOY VINCENT HOLLANDBETTY J HOLLAND Date Opened 1/19/1979 Account Type Checkin Principal Balance as of DOD $355.17 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $355.17 YTD Interest to DOD $ .14 REV-,5os Ex . n-sn . SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF .$ ~y ~, ~ b `[ nttd FILE NUMBER ~l _ !D _ /! ~D Han asset was made joint within one year of the decedents date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS I RELATIONSHIP TO DECEDENT A' ~r>lesf B. ~-~artzler 1 bl7 I ~I.v~t~t~soN 1-4.ne IYl ec.It am,i c s b ~.~, ~ , ~~ /7p sS %~ . 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 % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. S/i~60 PN~ C'he~k~n /4c~e~: No, .~/~ oo~ 7x ~.~ ~ pr;hc:(~al ~ 7, ~!'f3.5/ d.o. d. Ya.l-t~ >~7, ~f ~f3. S~ SD9o 711 3, -121.76 „,~~_ ;„r. Imo.-.-~ a?. ff. s/i/63 PNC C~~%n5 At'C;f /vo, S/~ Doz 7,Z 32 d.o.a! value - Pr%nc:/era/ ~3, y31, 6q r-on_ inf : dCu~%~ ~ 3. zf3 x.19 r! S~~o ~ 1, 716.3 s (see va/ua1:on s/ieef f--o~r oNe ~ ~R ~ TOTAL, (Also enter on line 6, Recapitulation) S S~ ~{ 3 g. ~ ~ (If more space is needed, insert additional sheets of the same size) REU4510IX+(157) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON•PROBATE PROPERTY ESTATE OF ~2f1 \j. yellRh~ FILE NUMBER a/ _/O- //gyp This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCWDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTANDTHE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~. /J-(~ STR-TE P~EFER~2€~ /~Lc~FdR~'IffNC>~" X170 B'Ul. y3 /DO~o -b - x/70, ~/•v3 ~¢~vNylTy No_ ~~ /8y a-/3 92 (i4.) 1 amela J' Coo peer , dak~~'~.+- ~'/y~~ ~,~.~ Suzanne I11. ffl~x ~ da.u~f~+-~ ~t/`l~ '~) $ev~.-ly 5au~flo ~ vlaur~hl'~r ~ ~~~ (ScG va/u a {z'on a f~a chcd~ a . /JCL s7ATE ,o~eE~-cn,e~v t~Rl=~~z~r~ ~NiYUITy ~O. (9,¢ /~~ q~5 7z ~lo~, a?o.31 loojo --o- ~lo2,zZO,3! (8) ~'uz~nne n1. l7eck~r, dak~hfie.,- (y3) ~,~ ~~,~y ~.wllo, da~~tifi~ ~~ ~ (SCL Y!{/LCQI~O/j QJj-RGl1~) C~E/!I(Fo No(-F: TKFRE criERE soxE ~/ScREP~/ ~ ~o ,dENEF/C/~¢R y /NFo,~ nf~TiaM As FIRS/ P~Zo/~D ED Ta !15 !3Y ,4t[. - S7ATE; G1Po~ FuR- Ts,EEi~ /NYEST/G,4 T/o/% /~C [ ~ ST.4-TF DET~i~f- /N~, .BitS~.~ oN i2ES'ar1T Ta T.f~~/1 f/.sjp0 Copy Fig Es, THif-T ,BEjrE72Gy SA-uLLU ~.fS //oT ~ ~6S~GH.4T~ rB~NEFi~//~~y on/ TF/j1 2, ~ ,C~oliE- TNE" P~,2Ti~-S HA-~/E /1?/~-DE /~PP~vPR~~T~ ~,TirsTi~~~vTS /IS T (~ ~ sT~lTE LEi~t~ Fie o~ C2YsT~K TOTAL (Also enter on line 7, Recapitulation) (If more space is needed, insert additional sheets of the same size) a~3,o~-.7'~ Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 November 26, 2010 Charles Shields 6 Clouser Road Mechanicsburg, PA 17055 Re: Betty Holland Contract No: GA18421392 Dear Mr. Shields: Allstate. Yau`re in good hands. We received a request to complete IltS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: November 4, 2010 Annuity Value as of Date of Death: $170,801.43* Cost Basis: $150,000.00 Named Beneficiary: Suzanne Decker, Pamela J. Cooper, Robert E. Holland, Beverly Saullo *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24694. Sincerely, Crystal J. Parish Sr. Claim Examiner Allstate Life Insurance Company P.O. Box 94212 Palatine, IL. 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 November 26, 2010 Charles Shields 6 Clouser Road Mechanicsburg, PA 17055 Re: Betty Holland Contract No: GA18491572 Dear Mr. Shields: ~~ AI Istate.~. You`re in good hands. We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: November 4, 2010 Annuity Value as of Date of Death: $102,220.31* Cost Basis: $100,000.00 Named Beneficiary: Suzanne Decker, Pamela J. Cooper, Robert E. Holland, Beverly Saullo *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24694. Sincerely, Crystal J. Parish Sr. Claim Examiner ~~ ~ 3~ ~~',~, Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 Allstate:R. You`re in good hands. March 2, 2011 Charles Shields Charles Shields, Attorney at Law 6 Clouser Road Mechanicsburg, PA 17055 Re: Betty Holland Contract No: GA18491572 Claimant(s): Suzanne Decker, Pamela J. Cooper, Robert E. Holland Product Type: Fixed Annuity Tax Type: Non-Qualified Dear Mr. Shields: Thank you for submitting claim documentation for the above-referenced policy. We regret to inform you that Beverly Saullo is not a named beneficiary to this policy; therefore, we are unable to honor your request for claim payment. This contract was issued in Illinois. Rule 919 of the Rules and Regulations of the Illinois Department of Insurance requires that our Company advise you that if you wish to take this matter up with the Illinois Department of Financial and Professional Regulation, Division of Insurance, it maintains a Consumer Division in Chicago at 100 West Randolph Street, 9'~ Floor, Chicago, IL 60601 and in Springfield at 320 West Washington Street, Springfield, IL, 62786. We apologize for any inconvenience you may have experienced. If you have any further questions, please contact our office at 1-877-499-6418 and a representative will be happy to assist you. Sincerely, Crystal J. Parish Sr. Claim Examiner REV-151? EX+ (?2-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES He INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER a~_ /O-!/~O Q~ ..7: fro//tine Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ? n-ye~ ~wneral ~-lomG o~ hr-e~hwri-csbur~ - I;.IIy pt~pa,d 2. FKnrral Mca,l I lila~e. ~I t S. 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) EMeS+ 8. F~,cNfzle.r- Social Security Number(s)/EIN Number of Personal Representative(s) Street Address ~(°~7 ~~toirirJaon La.~ City ~~~gQM.ICSbt-try( State pA' Zip ~7 ~~~ Year(s) Commission Paid: 2. Attorney Fees ~nrlc,5 E. ~1,1~1ds "~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant /1/0 ONE" ELlls/~ G Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Q.NG~ pt'G~nr~ tsSue ~~ J 1 1.. /' 'Sh°rt Cp~^It n~C~~ 5. Accountant's Fees }~ark F~nA.nCra-I +~~ rne~~~esbu.r~ .~„- ~,g,; Ib'Fo PA- CFO 6. Tax Return Preparers ~ Fees "F~A.rk ~-ti(lA'bc-i~ ryr ~py~ ~ pg. w~ e~, ~s/,m,) 7. ~ cl a/i fi oda/ c5/iorf ' C'erfi /] La.~<s ~S~/z P~zoii~ ~. ~dre~~isi%~y urn bc~lanq~ ~~/ T urea( 9. f~dre~fi's;rrd' C'kt/•'s/t S~ghi~c/ /o • /~do%~/~oaa ~ ~Oro~deife fte _ ~ey.S~Cr o~ dv.%/s 11. ~'.%'~,9 Fee ~+ ~Qcg,'Skr o~ w, '//s sec ~o~~a ..s~~f1 ~~, 6 90. as ¢~ Z, SDO. o0 NoN~' ~ 157,.SD ~~ y0, 00 ~ y7Soo ~` ~; OD 1'75., o0 ~/~fS. o~ ~aao.ov r~so~ TOTAL (Also enter on line 9, Recapitulation) I $ ads 99~. ZO (If more space is needed, insert additional sheets of the same size) ES7: D~ ~E 7Ty T ~OLL/tN.D _ ~/[-ENO . Zt' --/D `// ~~ __ .- _ /2. .~ason _ o~kn-~k ~ 'fLe_ 14~6s,~nact' -{»r (ltca.l ~st~ ¢,3S:oo _ /3 ~ ~e~mbµrscr»c-tits ~"~ C'-hwrl~5 ~. _~h~elds_ ' i ~, _wr .e.e.~f~.Fie~( ma,~h'ays, _ _ lY. ; _ ~vcC (~/t~c ~NC__ /~iyk Ar-e~ _ _ _ _ - __ _ fo7.oo /~-. IQ~iM~urSen~uJ~s ~o Ghar'~cs ~• ;~h~ <,{ds _ ~1 -(vr_ _ S~trirt cer~-I~'co~cs ~ l 2.00 lZ ; Costs QSSnCartr~ _WrNi `~'G of /IlghuL'~~ ~irl2jtGim~_~111Y6 ~. ~. ?r,dd-n~ Foes _ _ ~8,~y_ 13. .~'+w-tiholder SarYict ~Y.cs __ __ _ _ _ _ ~/S, o~ _ l~ '~~iMlriil'~I~A~t~tiL U ~/'ACSt_ ~. n[Er~'L~Er' 7D1' QCla~t /. ~L~j C_P.~`r'. ~GcLI"e S ~r. _ _ for _V /~fm/laa~, dEc~asca! _ _ _ _ _ X 6 Y•o 1 _ _ _ __ _ : ~i%h6KrSC/a-E~ _~_ ~l1~tr/ts E'. Sh,'~a~S 1~__~r _ _ rccar~lny_ _7~`d_ _ I _ _ -_ ___ ____ I _ _ _ _ _ _ _ _ __ 1 _ __ _I _ - _ _ _ _ _ __ _ _ _. _ t _ _ _- __ __ _ _ i __ __ _ __ _ _ __ __ _ _ _ _ _ __ _ _ _ _ _ __ ~`6 3. ao __ _ __ __ -_ Transaction ID: V99-1358252-1 Date/Time Requested: 7/12/2011 (a) 2.27 pm Certificate Type: DEATH Name on Certificate: LOY V[NCENT HOLLAND Father's Name: JACOB M HOLLAND Copies: 4 Carrier: UPS NEXT DAY AIR Delivery Telephone(s): (717)766-3696 / (717)766-3696 Ship To: ERNEST B HARTZLER 1617 THOMPSON LANE MECHANICSBURG, PA 17055 VitalChek Receipt I IIIH 111111 IIIII IIIII Ills IIII II~i Hill VIII IIIII IIII II i N IIII 'authorization Code: 035472 AVS Response: Y LN-Check Response: Request Fee this Item: $ 36.00 Other Agency Fees this Item: $ 0.00 Nandlin Agency Other VCN Fee Fee g Carrier Fee Request Fee Agency Fee Total Fee $ 10.00 $ 0.00 $ 18.00 $ 36.00 $ 0.00 $ 64.00 -i /ii Please Note: The 'Check Date,' noted below, represents the settlement date of this transaction. Under normal market conditions, sale transactions are traded 3 business days prior to the "Check Date". ~~~ `~ BNY MELLON SHAREOWNER SERVICES .«=_~~s.:~~{.ter:: ~:~e_m: - .. ._; ~:_:-„ --~~ rt4=,,.- ..._~,_.~=~_:1_=-- ~-,~~-~~;~~ ~_-~~~:: ~.:.-:::nom _ __ -- - - :, Login to Investor ServiceDirect~~ ar www.bnvmellon.com/shareownerlisd Iu-I ~ 51, certify. RETAIN FOR YGUR RECORDS - SHAREHOLDER OF ~ DESCRIPTION MANULIFE FINANCIAL CORPORATION SHARES SOLD INVESTOR !D CUSIP ~ ACCOUNT KEY ;CHECK NUMBER -CHECK DATE CHECK AMOUNT 125279965183 ~ 00175056501R70 ! HOLLAND--BETTJOF00 7676667 j 07!22/2011 $840.19 SHARESlUNfrS SOLD I PRICE PER SHARE (S) TRADING FEES PAID BY SERVICE FEES PAID BY 72.0000 16.6633859 ._ GROSS PROCEEDS ;TAX WITHHELD COMPANY ;SHAREHOLDER I COMPANY ;SHAREHOLDER $1,199.76 $335.93 $0.00 ' $8.64 $0.00 $15.00 - __ NET PROCEEDS ;SHARES HELD BY PLAN $840.19 ~ 0.0000 PLEASE DETACH BELOW CHECK NUMBER: 767 • • ~ ~ t • a ~ • ~ • u ~ d~l~~II~b'1\~Ie\aild[~71_\~~P/e~1~aAJe\:1 d I~]~~7e~ll~dCa3>~~~~I~lr CHECK DATE CHECK NUMBER ~'4~ ;. 07/22J2011 7676667 433 - P:o BOX 3525 >PAYABLE AT s. HACK~NSncK, N~ oleos-s2zs THE BANK OF NEW YORK MELLON IN U.S. DOLLARS PAY *k*..*+*~*xx:,~~~*.**""""'*'*3840.19 ~s AUTHORfZED 51GNATlJRE , REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~~-~y ~-. Ho~~~d ~_F~~NU ~~u0 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER / DESCRIPTION OF DEATH 1. ~ .5. Trca.sw^y -~-' PeXSc-,~ ,,nCIDrn@ -~,~ ~a9.01J ~. HCR /112d,~ca~) 5erv;~tS cr~' Il'tanor CaL.rt >~o. o0 3. -Yl ar-~ r ~.aLrG~ H~ I I ~3 b, o 0 ~, ~i/1h4,C~L ~fCLY~li1 NoS~tJir'k~ t/$ }i7/ 5 Lower ~¢~len Twp., C/y1s ~(co,oo to - 17r. ~Qrr y I JC . G u.-s~ w~~~ 30.00 7, /!-ed ~ ca/ 8;l/; n~ ~'cr~ri cts ~/a. 00 S. %~;n~ado l~ltalh~i ¢`f3.9g TOTAL (Also enter on line 10, Recapitulation) $ I 3 7 a, ~p 9 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 3~-tt-y J. ~-lol~a,+--d z!-~a - ~~~o 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)] t. ~rhtg~ ~. I-IarfZle,r Ti^-ct1c~ spec~{,c. devise aF 16 (~ -T~wtvt P s o n L..atn ~ -'ta.i e sfa#~ p~ ~r ~t m eels o~', ~~ b u~ , P~ ---ro~s~' a aF Itsf w'. rl, su. 587. ~ X14 7 1. 'P~e~arly Saullo C ~ ~~.uq~~ ~J , ~/ _t_- /~ i"1GI l~Srd u+ ° our 70 (05 Red ~''1 ` (Ylel~ow~e, F!_ 32940 3, Pamela ~. Cooper duk ht'er ~~4 net resrdue ~~ r~l~ ~ ~n Y11 a.rt~~ T~~~1lsburq, ~~ I-t o14 `~'. Suzanne -'Y1. Decker d~ht-cr yc~ net- r~s~cfr{e 1~ 2 L-a~casfcr ~/e-. Enola, P~ I`1o2s ]~obet'f' E. }-lollavr~b ~5 on y~ nef' res-c(uE 3 Gln ~.b ra ,~ o a.c! rnea,a~~ ~Sb~~ , P~ I,osb ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF BETTY J. HOLLAND 1, BETTY J. HOLLAND, an unremarried widow, currently of 1617 Thompson Lane, Mechanicsburg, Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Wi11 and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I give and devise my residence dwelling, real estate, and all improvements thereon, to my trusted friend, ERNEST B. HARTZLER, who is currently living in said residence dwelling which has an address of 1617 Thompson Lane. FOR PURPOSES OF CLARIFICATION: I am aware that by making this gift in the form of a specific devise that it will have priority in the distribution of my Estate. Also, in order to eliminate any argument or confusion among my beneficiaries as to my understanding or desires in this respect, I direct my executor to pay from the residue of my Estate all death taxes associated with the value of this item of property. Additionally, I specifically direct that all debts, costs, charges, Executor's commissions, attorney's, appraiser's and accountant's fees, and other expenses and the like that would typically be taken against the value of this property are also to be paid from the residue of my estate. In the event my said trusted friend, ERNEST B. HARTZLER, has predeceased me this devise shall go instead to my grandson, MICHAEL VINCENT SCHATT, upon the same terms and conditions as are above set forth. In the event he has also predeceased me, this specific devise shall go instead to my grandson, ERIC BENJAMIN DECKER, upon the same terms and conditions as are above set forth. In the event that he has also predeceased me, this specific devise shall go to his parents, GEORGE and SUZANNE DECKER, by the entireties, upon the same terms and conditions as are above set forth. 3. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath to my four (4) children, in equal shares, per stirpes, as follows, to wit: BEVERLYSAULLO PAMELA COOPER SUZANNE DECKER ROBERT HOLLAND +r ~ ~~e..,c. 4. I nominate, constitute and appoint my trusted friend, ERNEST B. HARTZLER, to be the Executor of this my Last Will and Testament. In the event that he is unable or unwilling to act as Executor, I appoint my daughter, SUZANNE DECKER, to be Executrix in his place and stead. In the event that she is unable or unwilling to act as Executrix, I appoint my son, ROBERT HOLLAND, to be Executor in her place and stead. In the event that he is unable or unwilling to act as Executor, I appoint my daughter, PAMELA COOPER, to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. 5. In the event that any of the beneficiaries named herein shall undertake to contest this, my Last Will and Testament, in any way, form or manner whatsoever, and over any item or thing whatsoever, I direct that the share given in my Estate herein to him/her shalt be forfeited and shall be considered to be a gift to the other non-contesting beneficiaries named herein to be equally divided among them. I further direct that, in so faz as I am legally authorized to do so, my said Executor and his/her counsel to seek the payment of any and all attorney's fees, expert fees, and the like, and court costs incurred in a defense of this, my Las[ Will and Testament, from such contest or similaz proceeding. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~~`• , A.D. 2007. - ~ (SEAL) BETTY J. HO LA Signed, sealed, published and declazed by the above-named BETTY J. HOLLAND, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. F/~~~~- - ~~.~