HomeMy WebLinkAbout09-13-11J 1505610105
REV-1500 EX (oz-ii) (FI)
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes DEp~pTMENT OF REVENUE
PO BOX 28o6oi INHERITANCE TAX RETURN County Code Year File Number
Harrisbur , PA i 128-o6oi RESIDENT DECEDENT ~,
ENTER DECEDENT INFORMATION BELOW ,
Social Security Number Date of Death MMDDYYYY
Date of Birth MMDDYYYY
195-22-3362 06/10/2011
06/21/1930
Decedent's Last Name
Suffix Decedent's First Name
Diven MI
Mrs Betty
(If Applicable) Enter Surviving Spouse's Information Below J
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 BE
LOW
C~ 1. Original Return
O 2. Supplemental Return
O 3. Remainder Return (Date of D
O 4. Limited Estate O
4a. Future Interest Compromise (date of eath
Prior to 12-13-82)
~ 6. Decedent Died Testate death after 12-12-82) O 5. Federal Estate Tax Return Required
O
(Attach Copy of Will)
O 9. Litigation Proceeds Received 7. Decedent Maintained a Living Trust
(Attach Copy of Trust.) 0
8. Total Number of Safe Deposit Boxes
O 10. Spousal Poverty Credit (Date of Death
Between 12-31
91
O 11. Election to Tax under S
-
ec. 9113(A)
and 1-1-95)
dule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE
N
ame AND CONFIDENTIA L TAX INFORMAT ON SHOUl
DBE DIRECTED T0:
Russell T. Diven Daytime Telephone Number
(717) 545-1793
First Line of Address
128 Curvin Drive
Second Line of Address
City or Post Office
Harrisburg
State ZIP Code
I'a 17112
Correspondent's a-mail address: flameon96 comcast.net
Under Ities of perjury, I dec r at I have examined this return, including accompanying sched I
it is t rrect and complete ecla t'
REGISTER OF WILLS USE ONLY
C7 ..
..__
j ~ ! ..+~
_...
.~ ^.~
DA~LED ,..
~~'~ ~'
ion of preparer other than the personal representative is based on~ sta femen`s, and to the best of my knowledge and belief-
SIG RE nF P~AC~AI ore. ... ..,. _
SIGNATURE OF PREPARER OTHER THAN REPR ENTATIVE J U u' /~ ~ ' r / ' ~ ~"
ADDRESS DATE
PLEASE USE ORIGINAL FORM ONLY
L 1505610105
Side 1
1505610105 J
1505610205
REV-1500 EX (FI)
Decedent's Name: Betty ~. ~IVef1 Decedent's Social Security Number
RECAPITULATION 195-22-3362
1. Real Estate (Schedule A) ...............
.........................
2. Stocks and Bonds (Schedule B) ............. ..... 1.
117, 758.00
.....................
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .
2.
6,298.30
. .... 3.
4. Mortgages and Notes Receivable (Schedule D) ...
....................
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... .
4.
...
6. Jointly Owned Property (Schedule F) O Separate Billing Re
uest
7
d
I .... 5.
4,317.33
q
.
e
...
nter-Vivos Transfers ~ Miscellaneous Non-Probate Property
(Schedule G) .... 6.
41,041.12
O Separate Billing Requested..... .
7
8. Total Gross Assets (total Lines 1 through 7) ....... . _
.
79,749.69
9. Funeral Expenses and Administrative Costs (Schedule H) ... 8
249,164.44
.............
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) . .. .
9.
9, 218.00
...........
11. Total Deductions (total Lines 9 and 10) .......... ... 10.
1,303.98
....................
12. Net Value of Estate (Line 8 minus Line 11) ..... ... 11 10,521.98
................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not b 12 238,642.46
een made (Schedule J) .
..................... . .
13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .
...... .
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
14
238,642.36
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable 15.
at lineal rate X .0 45
238
642
36
,
.
17. Amount of Line 14 taxable 16
238
642
36
at sibling rate X .12 ,
.
18. Amount of Line 14 taxable 17.
at collateral rate X .15
18.
19. TAX DUE .................
....................................... .19.
10,738.91
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN
OVERPAYM ENT
O
1505610205
Side 2
150561D205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
Betty J. Diven
STREET ADDRESS
119 Easterly Drive
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 10, 000.00
B. Discount 526.30
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.
File Number r'~ /
1 / o ~o~
STATE ZIP
Pa 17050
(1) 10, 738.91
Total Credits (A + g) (2)
(3)
(4)
(5)
10, 526.30
212.61
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN " "
X IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred .......................... Yes No
b. retain the right to designate who shall use the property transferred or its income .............
c. retain a reversionary interest •••••~•~•~•~~~~~~~~~~•......... ^
.............
...............
d. receive the pr ............................................................................. ^
omise 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 "in trust for" or payable-upon-death bank account or security at his or her death?......... ^
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 v
is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. alue of transfers to or for the use of the surviving spouse
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax a to or for the use of the surviving spouse is 0 percent
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
nd the statutory requirements for disclosure of assets and
For dates of death on or after Jufy 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of a e or oun
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. g y ger at death to or for the use of a natural parent, an
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries i
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin s is 12 s 4.5 percent, except as noted in [72 P.S. §9116 a 1
under Section 9102, as an individual who has at least one parent in common wi ()( )]
9 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined,
th the decedent,, whether by blood or adoption.
COMMONWEAL?H OF PENNSYLVANIA _
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES REV-1162 EX(11-96)
DEPT. 280601 - _
HARRISBURG, PA 17128-0601
RECEIVED FROM: PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 014738
DIVEN RUSSELL T
128 CURVIN DRIVE
HARRISBURG, PA 17112
--'-"'-- fold
ESTATE INFORMATI
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ON: SSN: 195-22-3362
2111-0705
DIVEN BETTY JANE
07/20/201 1
07/20/201 1
CUMBERLAND
06/ 10/201 1
TOTAL AMOUNT PAID:
REMARKS:
$10, 000.00
CHECK#1006
INITIALS: HMW
SEAL RECEIVED BY:
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
s
REV-1502 EX+ (11-08)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Betty J. Diven 21-11-0705
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 orouertv that is ieintw_nw~oel ,.,;•M ,;..~~ ,.~ ...._.,...___~__ ____~ ._ .. _ _
-• •••-~~ ..r,...., ~~ ~i~wcu, nwvi~ auuRwndl Sfl2ei5 Oi Lne Sdme SIZe.
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
rl~T ~ T~ w
SCHEDULE B
STOCKS & BONDS
w~r,~~ yr
Betty J. Diven FILE NUMBER
21-11-0705
All Drooertv ieinflv.nu~wa ,.,o~ti ....~. _~ ______ ..
-••-• ~•~..~w vi uic aa~ilC JIL@~
REV-i5o8 EX+ (11-io)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CCTATe nr.
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
~~ ..-.. r v.. -
Betty J. Diven FILE NUMBER:
21-11-0705
Include the proceeds of litigation and the date the proceeds were received by the estate.
All ~ronerty ieintw r,u,..va ..,:.~ .._~~ _~ _______ - . .
. - -~-.._..,.,...,~~ „~ ~o~~~ ~~ ~iie same size.
REV-i5og EX+ (oi-io)
~ Pennsylvania SCI~IEDVLE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
FCTATC ne.
~....-.. ~. v ~ .
Betty J. Diven FILE NUMBER:
21-11-0705
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS
RELATIONSHIP TO DECEDENT
A• Debra D. Bowman 259 Stoner Road, Mechanicsburg, Pa. 17055
Daughter
B
C
JOINTLY OWNED PROPERTY: - I
LETTER
ITEM FOR JOINT
NUMBER TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HEL
DATE OF DEATH
u~ OF
DECEDENT'S
DATE OF DEATH
VA
j,
,q•
12/01/71 D REAL ESTATE.
Belco Credit Union Acct. 024220 Savings
VALUE OF ASSET
INTEREST LUE OF
DECEDENT'S INTEREST
40,446.83 50 20,223.42
2 A 12/01/71 Belco Credit Union Acct 024220 Checking
2,618.00 50 1, 309.00
3 A 12/01/71 Belco Credit Union Acct 024220 Certificate of Deposit
36, 071.61 50 18, 035.81
4 A 12/01/71 SHIP long term care premium refund
2,253.00 50 1,127.00
5 A 12/01/71 Frontier stock div.
8.00 50 4.00
6 A 12/01/71 Patriot News refund
133.00 50 66.50
7 A 12/01/71 Mutual of Omaha cancer ins. refund
28.00 50 14.00
8 A 12/01/71 Property tax rent rebate
250.00 50 125.00
9 A 12/01/71 Allstate car ins. refund
21.00 50 10.50
10 A 12/01/71 Medco Mail service credit
17.00 50 8.50
11 A 12/01/71 Zimmerman plumbing refund
74.00 50 37.00
12 A 12/01/71 Allstate condo. ins refund
7.00 50 3.50
13 A 12/01/71 Certificate dividend
72.00 50 36.00
14 A 12/01/71 Pennwaste refund
24.00 50 12.00
15 A 12/01/71 AAA refund
~ 6
A ia1~~ l~I
c ~ ~ ~~,~-Q~ .~~
~ 20.00 50 10.00
, ~~~~ ; ~ 1~-g9
TOTAL (Also enter on Line 6 , Recapitulation) $ ~ j~/
J
`~
If more space is needed u dd' / +
sea itional sheets of paper of the same size.
REV-1510 EX+ (08-09)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
tSTATE OF
Betty J. Diven
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-11-0705
This schedule must be completed and f~iPd if tha ~~~,.,o~ *„ ,..., ,.~ _..__~.__ .., -
--- -~._....,,.,.~., ,,, N~N~~ ~~ uiC Jdf11e SIZe.
REV-1511 EX+ (10-09)
~ ' Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Betty J. Diven
21-11-0705
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES: AMOUNT
1' After Funeral lunch Bonanza steak house
272.00
2 Funeral was prepaid
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:
3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP _ _
Relationship of Claimant to Decedent
4, Probate Fees:
343.00
5• Accountant Fees:
6• Tax Return Preparer Fees:
~• see itemized attachment
8,603.00
TOTAL (Also enter on Line 9, Recapitulation) $ 9,218.00
If more space is needed, use additional sheets of paper of the same size.
.
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
5~~~~~c i-~ ~~~~~~
~o s%s
Betty J. Diven 21-11-0705
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 • Estate Notice Paxton Herald- Cumberland Law Journal 123.00
2 Mail Verizon and Frontier Stock$18 notary$13 Transfer fee VZ $35 Fron. $20 86.00
3 Silver Spring Authority $23 6/10-30 $50 7/1-8-12 73.00
4 United Water $11 6/10-30 $16 7/1-8/12 27.00
5 Condo Fee $56 6/10-30 $119 7/1-8/12 175.00
6 Condo Special Assessment (roof) 6/10-8/12 103.00
7 Condo resale certificate ~ 50.00
8 Pennwaste trash 6/10-8/12 30.00
9 PPL $117 6/10-30 $124 7/1-8-12 241.00
10 County Prop. tax 6/10-8/12 58.00
11 School tax $46 6/10-30 $113 7/1-8/12 159.00
12 Deed Prep .79.00
13 Notary 10.00
14 Tax certification 10.00
15 Transfer tax 1,178.00
16 Reality commission 5,983.00
17 Mail Prudential Annuities 14..00
18 Mileage 400x .51= $ 204 204.00
8,603.00
If more space is needed, insert additions sheets of the same size.
REV-1512 EX+ (12-OS)
~ pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF
Betty J. Diven FILE NUMBER
21-11-0705
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical
ITEM expenses.
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 ~ Orthopedic Institute of Pa.
9.00
2 Dr. Sanford
23.00
3 Pinnacle Health
5.00
4 Sunoco Credit Card
31.00
5 Sunoco June 11
53.00
6 Sunoco June 13 check 7354
123.15
7 Verizon June 14 check 7352
23.22
8 Hair dresser June 14 check 7350
50.00
9 Meyers-Buhrig Funeral Home June 14 check 7355
602.00
10 Comcast cable June15 check 7353
43.27
11 PPL electric June 16 check 7356
130.00
~ 2 United Water June 17 check 7357
22.00
13 Penn Waste trash June 17 check 7358
44.35
14 Aetna life survivor pension return from estate account
144.99
TOTAL (Also enter on Line 10, Recapitulation) I $ 1,303.98
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
r Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
Betty J. Diven
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1~ Russell T. Diven 128 Curvin Drive ,Harrisburg, Pa. 17112
2 Scott A. Diven 5018 Medieval Drive, Conway, S.C.29526
3 Debra D. Bowman 259 Stoner Road, Mechanicsburg, Pa 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Son
Daughter
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
FILE NUMBER:
21-11-0705
AMOUNT OR SHARE
OF ESTATE
33.3333 `~~p
33.3333 ~~p
33.3333 ~l0
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
If more space is needed, use additional sheets of paper of the same size.
~~ ~ ~~
---~ :'
,
-;
~7~ t
LAST WILL AHD TESTAMENT' ~ `~ a
~
I, BETTY J. DIVEN, of 119 Easterly Drive, Mechanicsburg, Cumberland County,
Pennsylvania 17055, do hereby make, publish and declare this to be my last will and
testament, hereby revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such property passes under this
Will, shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefor, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
my death, for such period of time after my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. My Longaberger baskets, my Sylvia houses and accessories, and
my antique Lane cedar chest to my daughter, Debra D. Bowman, or if she is
deceased then to my granddaughters, Brandy Bowman and Amber Bowman;
B. My knickknacks to my granddaughters, share and share alike; and
all the
C. Rest, residue and remainder to my children, share and share alike,
the child or children of any deceased child taking the share their parent would
have taken if living.
4. I nominate and appoint my son, Russell T. Diven, to be the personal
representative of my estate, to serve without bond. If he cannot or does not serve, then
I appoint my daughter, Debra D. Bowman, to be the substitute personal representative,
also without bond.
5. I suggest that my personal representative retain the services of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28T" day of
December, 1998.
.~
`` (SEAL)
BETTY J. IV
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses. f ~,.,~ ~ _ .--, ~_ ,~-~ ~f ; ,. ^ _.
iy r .
r ~ l
•
ACKNOWLEDGMENT AND AFFIDAVIT
WE, BETTY J. DIVEN, GAY L. IRWIN and JOHN J. BARANSKI, JR., the
testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly swom, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her last will and that she had signed
willingly, and that she executed it as her free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the testatrix,
signed the will as a witness and that to the best of their knowledge the testatrix was, at
that time, eighteen years of age or older, of sound mind and under no constraint or
undue influence.
t
j/
BETTY J. IVE
G IRWIN
~,.`,
` ;" =~~~~
/ f///J// ~ ~ ~i''/
~,
JO J. B NS I, JR. '
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by BETTY J. DIVEN the
testatrix herein, and subscribed and swom to before me by GAY L. IRWIN and JOHN
J. BARANSKI, JR., witnesses, this 28T" day of De ember, 7 998.
i~
~~~~~~.
fla~ad s. Dili, Neot2try Public Notary Public
Carksle Bono, Cumberland County
MY Commission Expires Sept. 23, 2002
Member, Pennsylvania Association of Notaries
OMB Approval No. 2502-0265
.~,A1M~Nr OR h•0 11
o¢~ Gs HIJ~~ "/
y ! * ~ ttlement Statement
9~~ I ~4 A' Se
G ~ Q
9eRN pgJE~4
7, Loan Number:
8~ Type of Loan File Number:
FHA 2. ~ RHS 3. ~X Conv. Unins. 6• 5100110082
GABFAM.11-043
117,758.00
1.~
4 Q VA 5, ~ Conv. Ins.
ual settlement costs. Amounts paid toa nd by the settlement agent are s ow .
I u oses and are not included in the totals.
are shown here for inforTnatfon p ~ F Name and Address of Lender:
C. Note: This form is furnished t y9i~ paid outside the clod ng; they
Items marked (p.o•c )
E. Name and Address of Seller:
p. Name and Address of Borrower: Graystone Tower Bank
Road
Burl D. Fluharty
Betty J. given Estate
5115East Trmdle
Mechanicsburg, PA 17050
I. Settlement Date:
G property Location:
119 Easterly Drive, Unit 10
Mechanicsburg, PA 17050
Cumberland County, Pennsylvania
ary of Borrower's transaction
100. Gross Amount Due from Borrower:
I.i, Se eltt ment Agent:
GUARANTEED AB EET CT SERVICES, INC.
3813 MARKET STR
CAMP HILL PA 17011
Place of Settlement:
GUARANTEED ABC MP HILLRPA E701NC.
3813 MARKET ST,
10~. Contract sales nce
102. Personal ro e
J 03. Settlement Char es to Borrower Line 1400
104.
105.
Ad ustments for items aid b Seller in advance
106. COUN-I-Yn-OWNSHIP 08/12/11 to 01101/12
107. CITY TAX
108. SCHOOL TAX 08/12/11 to 07/01112
109. HOA Fees 08/12/11 to 10/01/11
110. S ecial Assessments 08/12/11 to 01/01/12
111.
112.
120. Gross Amount Due from Borrower
200. Amounts Paid b or in Behalf of Borrower
201. De osit or earnest mone
202. Princi al amount of new loan s
203. Existin loans taken sub'ect to
204. Lender Credit
205. Lender Credit to cure transfer tax tolerance
206.
207.
208.
209.
Ad'ustments for items un aid b Seller to
210. COUNTYlTOWNSHIP to
211. CITY TAX to
212. SCHOOL TAX
213.
214.
215.
216.
217.
218.
.05
g. Mortgage Insurance Case Number:
Seller in
August 12, 2011
117,758.00
8 Ad Usimenw rv~ ~«••••• -
COUNTY>TOWNSHIP 08112111 to 01101112
406 134.00
134.5 .
35
868 407. CITY TAX
408. SCHOOL TAX 08112111 to 07101/12 868.35
135.87
.
135.87 409. HOA Fees 08/1211,1 to 10/01/11
sessments 08/12/11 to 01 /01/12
l A
i 233.42
233.42 s
a
410. S ec
411.
412.
119,130.22
123,369.27 420. Gross Amount Due to Seller
500. Reductions in Amount Due Seiler:
2,000.00 501. Excess de osit~ see instructions
t char es to Seller Line 1400
e 8,270.34
105,982.00 ttlemen
502. S
503. Existin loans taken sub'ect to
150.00 504. Payoff First Mortgage
0.58 505. Pa off Second Mort a e
506.
507. De osit disb. as roceeds
508.
509. - - - - ~~--
r,.....~...._..~ - - t0
510. COUNTY/TOWNSHIP to
511. CITY TAX to
512. SCHOOL TAX
513.
514.
515.
516.
517.
518.
519.
8270'
219.
132.58
108
520. Total Reduction Amount Due Seller ~ •'
220. Total Paid b Ifor Borrower
Borrower
lt , 600. Cash at settlement tolfrom Seller
nt due to Seller line 420 119,1__30.-
o
300. Cash at Settlement from
ss amount due from Borrower line 120
G 123,369.27
58)
132
108 601. Gross amou
602. Less reductions due Seller (line 520) ( 8,270
(
ro
301.
302. Less amount paid by/for Borrower (line 220) .
,
69
6
~ From Seller
Cash ~X To
603 110,859.
Cash ~ From ~ To Borrower
303
.
15,23
.
.
• Paid outside of closing by borrower(s), seder(s), lender(L), or thud-pa om t
d a ipt o
l of this statement & any attachments a rred to herein
.,/~
~~A
r
e
e undersigned hereb a How
Th Seller
'C/ ' -
Borrower B tty J. Divan Estate
Burl D. Fluharty
Ph. (717)441
K, Summary of Seller's transaction
400. Gross Amount Due to Seller:
401. Contract sales rice
,rn~ parannal grOperty -
--
403.
404.
405. .. ,
anon Is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not req
' Re ortin Burden for this collection of inform trot number. No confidentiality is assured; this disclosure Is mandatory. This is designed to provide the parties to a RESPA covered transaction with Info
The Public p 9 ~
complete this form, unless it displays a currently valid OMB con page 1 Of 3 (FLUHARTY.PFD/FLUHAR
during the settlement process.
_ L. Settlement Char es $ 5,ss3.oo
700. Total Real Estate Broker Fees
Division of commission (line 700) as follows:
704. to Salzman Hugnes
UDENTIAL THOMPSON WOOD REAL ESTATE
PREP
to PR
705. DEED
706. ADD'L COMMISSION
ction with Loan $ 771 95 from GFE #1
800. Items Pa able in Conne $ (from GFE #2)
801. Our on ination char a
ints) for the specific interest rate chosen from GFE #A
802. Your credit or charge (po from GFE #3
803. Your ad'usted on ination chartoesA sisal Lo istics from GFE #3
804. A sisal fee to First American Credco from GFE #3
805. Credit Re ort to Gra stone Tower Bank from GFE #3
806. Tax service to Corelo is Flood Services from GFE #3
807. Flood certification A sisal Lo istics from GFE #3
808.A sisal Mana ement I from GFE #3
809. (from GFE #3)
810.
811.
2/din Ad
$
va0n9/01/11 20
Items Re uired b Lender to B
900
$13.792180/da from GFE #10
GFE #3
f
o
O
/
.
901. Dail interest char es from months to
remium for rom
from GFE #11
902. Mort a e insurance
r's insurance for 1.0 ears to Erie Insurance from GFE #11
1
903. Homeowne )
(from GFE #1
904.
905.
1000. Reserves De osited with Lender (from GFE #9)
74
70
1001. Initial deposit for your escrow account months @ $
000
3 23.58 per month .
$
.
1002. Homeowner's insurance months 43.28 er month 438.08
$
1003. Mort a e insurance
1004. Pro a taxes 7
000 months 28.25 er month
.
COUNTY TAX months er month
CITY TAX 8011 er month
SCHOOL TAX 3.000 months $
1005. months er month
COUN-fY/TOWNSHIP months er month
SCHOOL TAX months $ er month $
1006. months $ er month $
1007. $
1008. $ -112.98
1009. AGGREGATE ADJUSTMENT
1100. Title Charges from GFE #4
1101. Title services and lender's title insurance
1102. Settlement or closin fee from GFE #F
1103. Owner's title insurance to FIRST AMERICAN TITLE INS. CO. 949.8
1104. Lenders title insurance to FIRST AMERICAN TITLE 0 982 00
1105. Lender's title oli limit $ 117,758.00
1106. Owner's title olic limit to GUARANTEED ABSTRACT SERVICES
1107. A ent's ortion of the total title insurance remium
1108. Underwriter's ortion of the total title insurance remium tol FIRST AMERICAN TITLE INS$. CO.
1109. Nota Fee to Geor la Lldde
1110. Tax Certification to GUARANTEED ABSTRACT SERVICES, IN($.
1111. 2011/12 School Tax to Debra Basehore Wiest, Tax Collector $
1112. $
1113.
1200. Government Recording and Transfer Charges from GFE
to RECORDER OF DEEDS ~
1201. Government recordin char es ~, on nn Releases $
icv.,. ~~~••.~._. __--- 1 177.513
1204. Ci /Coun tax/stam s $ 1,177.58 $
1205. State tax/stam s
1206.
1207.
1300. Additional Settlement Charges
1301. Re uired services that ou can sho for to Silver S rin Towmshi Authori
1302. Sewer fees 711111-8/12/11
1303.
1304.
1305.
1400. Total Settlement Charges (enter on linesi tl03rym cton J and 502, Sect on
• Paid outside of closing by borrower(B), seller(s), lender(L), o -P of a e 2 & 3 of this th
By signing page 1 of this statement, the slgnatoriea acknowledge receipt of a completed copy P 9
GU
Certified to be a true copy.
Page 2 of 3
from GFE
$
____.---
.._---
~--=
49.-
,INC., Settlement Agent
HUD--
(FLUHARTI(.PFD/FLUHARTY/1~
HUD-1 Attachment
Seller(s): Betty J• Diven Estate
Borrower(s): Burl D. Fluharty
Lender: Graystone Tower Bank
ent: GUARANTEED ABSTRACT SERVICES, INC.
Settlement Ag
(717}441-1294 INC.
Settlement: GUARANTEED ABSTRACT SE FA E7011
Place of
3813 MARKET ST, CAMP HIL
Settlement Date: Augustst ~? pr,ve, Unit 10
Property Location: 119 Ea Y PA 17050
Mechanicsburg, Pennsylvania
Cumberland County,
aid B Seller In Advance (Borrower Debit) Amount
Additional Adjustments For Items P Y Prorated
Amount FromlThrou h 135.87
Descri tion 250.00 08112111 through 09/30111 135.87
HOA Fees Total Line 1091409 233.42
600.00 08/12/11 through 12131111 233.42
Special Assessments Total Line 1101410
Adjusted Origination Charge Details
Origination Charge 771.95
Origination Fee
to Graystone Tower Bank Total $ 771.95
Origination CreditlCharge (points) for the specific interest rate chosen Total $
Adjusted Origination Charges $ 771.95
Reserves Deposited with Lender
Homeowner's Insurance
3.000 at 23.58 per month
COUNTY TAX
7.000 at 28.25 per month
SCHOOL TAX
3.000 at 80.11 per month
AGGREGATE ADJUSTMENT
_ _ __~ ~ ...•.rln~~c Title Insurance Details
e-'! ~ ~ C ~
70.74
197.75
240.33
-112.98
Total $ 395.84
BORROWER J«'-"~
75.00
CPL to First American Title In
to First American Title Insurance Company 50.00
Email Document Retrieval
to GUARANTEED ABSTRACT SERVICES, INC. 949 88
Lender's title insurance
to FIRST AMERICAN TITLE INS. CO. $ 1,074.88 $ 0.0~
Total
ake false statements to the United States on this at on 101~0iar form. Penalties upon conviction can
WARNING: It is a crime to knowingly m
_ n__ _.,a imnricenment. For details see: Title 18 U.S. Code Section 1001 and e
incluae a n~~a o..~ ••••~-
(FLUHARTY. PFD/FLU HARTY/1
v~r nment. ~e aster far electronic omputershare
Yo~~r email adclr'ess can now help save the en t t~ 9
rc~mmunications using the eTree'' prr~gram and wP'll have a tree planfiet~ on your
behalf. Go to ~r~~rw.e~i-r~e.cam1Verizon to register. Computershare Investor Services
250 Royall Street
Canton Massachusetts 02021
www.computershare.com
BETTY J DIVEN
C/O RUSSELL DIVEN
128 CURVIN DR
HARRISBURG PA 17112
July 19, 2011
Company: VERIZON COMMUNICATIONS INC.
Registration: BETTY J DIVEN
Holder Account Number: 00007688709
Document I.D.: 11193WF00401877
Our Reference: VZN/0120110712/34318635/wt/20138
Dear Sir/Madam:
Thank you for contacting Computershare, the transfer agent for Verizon Communications Inc. We
appreciate the opportunity to be of service to you.
On June 10, 2011, account number 00007688709 held 170 shares. On that date, the closing price
was X35.19 per share.
Should you have other account related questions, please call us at (800) 631-2355.Our telephone
representatives are available during regular business days between the hours of 8:30 a.m. to 6 p.m.
Eastern Time. Please note that any available representative can assist you. For certain routine information,
you may call us 24 hours a day, 7 days a week and access our automated telephone service.
Sincerely,
Service Representative
Enclosure: None
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06!27!11 OC ! C" T R N CO R R
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06!30111 07/01!11 DIRECT DEP
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$972 1056023351
06/30/11 07!01!11 DIRECT DEP .
Benefits Pension
06/30/11 TFR CER SH $71.61 $41,898.73
06130!11 POST DIVS $9.98 $41,908.71
0.30110601 110630 0.30 D 40476.33
RDMP
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07!01!11
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.
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07!01!11 OC / C K TRANSFER $1,326.74 $79,235.45
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06!07!11 SD TRANS
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06!11 !11 VI ! 1 AT M W!D
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Trace # 021000023529840 ($50.00) $2,368.63 7350
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BUREAU OF INDIVIDUAL TAXES •
PO ~oX 28D6D1 pennsyLVan~a
HARRISBURG PA 17128-0601 pEpARTMENT OF REVENUE
REV-1513 EX AFP (t5-11)
BEBRA D BOWMAN
259 STONER RD
MECHANICSBURG PA 17055-9603
_•,. _,_,.... __.. .•- - --- rl~t nu. 11 il-UIUS
AND AcN 11150572
TAXPAYER RESPONSE DATE 07-29-2011
EST. OF BETTY J DIVEN
SSH 195-22-3362
DATE OF DEATH 06-10-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAYINGS
CHECKING
TRUST
CERTIF.
BELCO COMMUNITY CREDIT UNION provided the edenttmyou were ahjointoowner/be~eficiaryiof thisuaccounttaX ~ o be due h but you must he
note no
Records indicate that at the death of the above named der
deceased and any mount other than zero is reflected below on the Potential Tax Oue line.
1 f the de argent of your rel ati onshi p to t aen die i tten~caryecti onkf r~o~ _Bhe f nenci aARTnstit ut~on e atta h ai c py, tooth s„ fo m endTreturn
not y ,
_ IJ yep 4el)eve _hP_infosaation is incnrrect,_pl_ease obt_____._
it to the above address. Please call 717-787-8327 with quests-ons.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRU o thO~Sount, two
Account No . 024220 Date 12 - 01-1971 To ensure proper cre~i
copies of this notice gust accaRpany
Established peypent to the Register of Wills. Make check
Account Balance ~ 40 , 446.83 Payable to "Register of Wills, Agent".
X 50.000 NOTES If tax payments are made within three
Percent Tastable
Amount Subject to Tax ~ 20 s 223 • 42 months of the decedent's date of death.
. 0 4 5 deduct a 5 percent discount on the tax due.
Tax Rate X AnN inheritance tax due will become delinquent
Potential Tax Due ~ 910 • 05 nine months after the date of death.
PART TAXPAYER RESPONSE
. ..
1 ;~ .~
A, ~ The above information and tax due is correct.
Remit psyment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of Wills and
CHECK an official assesswent will be issued by the PA Department of Revenue.
ONE
BLOCK B. ® The above asset has been or will be reported and tax Paid with the Pennsylvania inheritance tax re urn
ONLY filed by the estate representative.
C. ~ The above informa ion is incorrec and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
a. ~ ~y
If indicating a different tax rate, Please state
PART ~ ~ ~r~~ ;_, ~~:
relationship to decedent: ~'
n if 3F? f ~ ;q A fi
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS "j '. ~~ ~~~~
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Atlount Taxable
7. Tax Rate
8. Tax Due
PART
a
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Cowputation)
Under penalties of perjury, I declare that the facts I reported above are true, correct an~
to to the best wy know dge and belief . HOME (~l~ ~ ~ ~ r
WORK t ~ ~~ ~~
_ ~ ~ Y'~^- ~'' ~~ DAT E
E SIGNATUR TELEPHONE NUMBER
1
2 ~
3 X
4 ~
S -
6 ~
7 X
8 $
--
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 pennsylvarna
HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE
REV-1543 EX AFP <05-11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 11-0705
AND ACN 11150571
TAXPAYER RESPONSE DATE 07-29-2011
DEBRA D BOWMAN
259 STONER RD
MECHANICSBURG PA 17055-9603
EST. OF BETTY J DIVEN
SSN 195-22-3362
DATE OF DEATH 06-10-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
BELCO COMMUNITY CREDIT UNION provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the SpOUSe Of the
deceased and aartmentnofoyour relationship tofthetdeceased by checkingnBox1CTin PARTllnbelowtandowritingy"spouse" intPART lust
notify the de~
If you believe he information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 117-/fi7-d327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 024220 Date 12- O 1 - 1971 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 2, 618.00 payable to ''Register of Wills, Agent".
NOTE: If tax payments are made within three
Percent Taxable X 50.000
Amount Subject to Tax $ 1 , 309.00 months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Tax Rate X . 045 Anv inheritance tax due will become delinquent
Potential Tax Due $` 58 • 91 nine months after the date of death.
PART TAXPAYER RESPONSE
TOTAL CEnter on Line 5 of Tax Computation) ~
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the b f my knowledge and belief . HOME C7/7 ~ E~ S' ~ ~ ~ ~ G/ l
~~~ ~~_,. WORK ( ~ '~ ~ l
TA R SIGNAT E TELEPHONE NUMBER DATE
-`
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
~\~' PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE NO. 21 11-0705
Pennsylvania AND AcN 11150570
DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 07-29-2011
REV-1543 EX AFP (05-11)
DEBRA D BOWMAN
259 STONER RD
MECHANICSBURG PA 17055-9603
EST. OF BETTY J DIVEN
SSN 195-22-3362
DATE OF DEATH 06-10-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
BELCO COMMUNITY CREDIT UNION provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the spouse Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line. note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect. please obtain written correction from the financial institution, attach a cop.Y to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 024220 Date 12 - 01 - 1971 To ensure proper credit to the account, two
Established copies of this notice (oust accompany
payment to the Register of Wills. Make check
Account Balance $ 36, 071.61 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 18, 035.81 months of the decedent's date of death,
045 deduct a 5 percent discount on the tax due.
X
Tax Rate .
Anv inheritance tax due will become delinquent
Potential Tax Due $ 811 • 61 nine months after the date of death.
PART TAXPAYER RESPONSE
A. ~ The above information and tax due is correct.
Remit Davment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of Wills and
C H E C K an official assessment will be issued by the PA Department of Revenue.
ONE
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state "
~
`w
"
relationship to decedent: ~ ~
~
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINT 1. Date Established 1
3
2. Account Balance $
2
3. Percent Taxable 3 X ,
f• ~.~ u... *~~ .
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 - a
~~ ~ ~ t ~ ~x- ~' a
~
6. Amount Taxable $
r
6
';
7. Tax Rate ~ X ~
8. Tax Due 8
DEBTS AND DEDUCTIONS CLAIMED
PART
nnTE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
c~_ete to the best of my knowled a and belief . HOME C / 7 ) ~/ / ~~ % 3 /
°-~.. ~ WORK ( ~ "'/ ~- /
,X A SIGNATURE TELEPHONE NUMBER DATE
TUTAL (Enter on a ne ~ or (ax (.vmpu~a~ivn~ Y
I` www belco.org
l
COMMUNITY CREDIT' UNION
Because ~c fe is for ~iviH9.
MAIN OFFICE:
449 Eisenhower Blvd.
Harrisburg, PA 17111
340 ~olNTOwNERS
2292 1 AV 0 ACCOUNT NUMBER
. XXXX71
I
~~~III~~~I~~~il~~~ll~~l~l~~l~ll~l~~~~ll~ll~~~~~l~ll~~l~~l~~ll RUSSELL T. DIVEN EXECUTOR soclALSECURITY#
BETTY DIVEN ESTATE DEBRA D. BOWMAN EXECUTOR
RUSSELL T
DIVEN
EXECUTOR
.
,
128 CURVIN DR. STATEMENT PERIOD
From To
HARRISBURG PA 17112
70111073111
r~NSncnoN E~cnuE DES~RIPTION° ~AMgUNT FINANCE ..FINES , BALANCE
• ,:,
0701 PREVIOUS BALANCE ~, = SAVINGS 5 00
0731 NEW BALANCE 5 0
OV
-- RDRAFT AND RETURNED ITEM FEES SUMMARY
-------------------------------------- - S1 -
------ SA ING S 1
I TOTAL FOR
I -- --- --
TO --
AL -- ------ -
-----
----- I THIS PERIOD
---------------I--------- I YEA -T -D TE
~,, TOTA
OVER ------------
RAFT FEES I S 0.00 ---I--
I -- ---
$ -- --
0.0 --
0 ------- -
TOTA RETU
- -- NED ITEM FEES I S 0.00
------------------------------------- I
------
-- S
---
-- 0.0
-- 0
--
-------
-
0701 PREVIOUS BALANCE S 4 S4 _ CHECKING 00
0701 PAYMENT VIA OFFICE/MAIL OPT ~-r~ x`3000 00 3000 00
0701 PAYMENT VIA OFFICE/MAIL ec~C.q +x7 00 3017 0
0705 PAYMENT VIA OFFICE/MAIL al-~rPl'~ _ N~, ~/ X2260 70 5277 0
0709 PAYMENT VIA OFFICE/MAIL
~ ~- /4 0 91
,Q,q ~ 5688 1
0711 PAYMENT VIA OFFICE/MA ~,~"c 20 76 5709 7
0712 PREAUTHORIZED WITHDRAWA 0 16800 -1 00 G~K'k 5695 7
DELUXE CHECK CHECK/ACC.
0713 DRAFT PAID 1001 ~~w~ ~~ 06 00 5589 7
0715 PAYMENT VIA OFFICE/MAIL~,/.~f~~~,~+-,-~~~, ~~`,1~, 6~27 3R 12216 5
0720 DRAFT PAID ___.. 1002 P~3,~„ -130 00 _ 12086 5
0722 DRAFT PAID ~~ -~ 1006 s _ i/-' 00 2086 5
0725 PAYMENT VIA OFFICE/MAI ~}„~~~'~~ ~~ .___ 200 00 2286 5
0725 DRAFT PAID , 1003 1/-•23 00
0726 DRAFT PAID _ ~~~Sr~,~,Ic 1007 ~ ~ -~~~~~ FO 2258 5
0728 DRAFT PAID < 1008~~, -1 99 2113 6
0731 DIVIDEND 38 2114 14
THE ANNUAL PERCENTAGE RATE IS 0.00
THE ANNUAL PERCENTAGE YIELD IS 0.00
THE ANNUAL PERCENTAGE YIELD EARNED IS 0. 8
0731 NEW BALANCE 2114 14
~*CONTINUED*~
TOTAL DMDEND TEAR-TO-DATE ,
for aN savings e~acept IRA ~~ ~
~
Dividends shown
if $10 or over
will b tOr ai IOar13.
,
,
e
for this calendar year ~ ~~ NOTICE: See reverse side for important infomnation
_ *INDICATES EFFECTIVE-DATE _ _ 0611312
I wwwbelco,org STATEMENT OF ACCOUNT PAGE
~ 1 S
,~
COMMUNITY CREDIT UNION ~~ S ~:~ d ~ ` P a~S t . ~OU.r 17 ~~X~ 1 b"e1 l1
~~ p.ayme;r~t ~ °;t ~ s easy: witk~ our
8ecacsse ~ fe is far ~ viK9. ~,
~~u sk-~p ~ pa:y.ment ~Pt~'QR• Gr,~a~ `'
MAIN OFFICE:
~~4 fior ur>le~~®~~ed expenses. ~ r r
449 Eisenhower Bivd. ~~'i4+' ~ ~t~$ ~'~ }, ~ l c ~ . ~ r n ~ , `:~ 4 ~::
Harrisburg PA 17111 ~4 "~ s '''' `~(~ ~<~~',,~. ' ` ~~ `` ~r* i~ L ~'~-
2 0 9 2 l A V 0.3 4 0 JOINT OWNERS
I~rrlllr~~l~r~llrrrll~~lrlrrlrllrl~r~~llrllrr~~rlrll~rl~~l~rll RussELL T. DIVEN ExECUTOR
BETTY DIVEN ESTATE DEBRA D. BOWMAN EXECUTOR
RUSSELL T. DIVEN, EXECUTOR
128 CURVIN DR.
HARRISBURG PA 17112
~.,.al., .',; ~}_ rte 411.. ~4~. ,.. ,.~, \'Aa~S,.1La~ , n1a, l,;S~b:~~ ,,1'M..a ..~:z r ':`:,.. a. ~ ~, .. ~ ..... ~.., .,. ~ ... , . ... .. .. .. ~ , 1 .~ ~M~1 f iti~.
0801 PREVIOUS ~~~ ~ _ SAVINGS
0812 PAYMENT VIA OFFICE/MAIL
0824 TRANSFER WITHIN SAME ACCO TO S 4
0831 DIVIDEND
THE ANNUAL PERCENTAGE RATE IS 0.25
THE ANNUAL PERCENTAGE YIELD IS 0.25
THE ANNUAL PERCENTAGE YIELD EARNED IS
0831 NEW BALANCE
11085 88
-11085 88
1
0.~5
ACCOUNT NUMBER
XXXX71
iOCIAL SECURITY #
STATEMENT PERIOD
From To
80111083111
OV RDRAFT AND RETURNED ITEM FEES SUMMARY - S1 SA ING
------------------------
------ -- --- -- -- -
I TOTAL FOR ~ TO AL
I THIS PERIOD ~ YEA -T -D T
-----
TOTA OVER RAFT FEES I S 0.00 I 5 0 0
TOTA RETU NED ITEM FEES ~ S 0.00 ~ S 0. 0
0801 PREVIO S .BALANCE ~ ~ ~ _
0805
0805 DRAFT PAID 1004
D -20 00
0811 RAFT PAID 1005 o e-
PAYM -250 00 ~~
0812 ENT VIA OFFICE/MAILL ~ •Q ~,nc
PAYMENT VIA r~/ 3 94
0822 OFFICE/MAIL ~,~.~ ~~
DRAFT 200 00 1j•
0824 PAID 100 - ;~
TRANSFER WITHIN SAME ACCO FROM S 1
110859
88 /
/
0824 PAYMENT VIA OF ~~~
08 FICE/MAIL Z ~ c
29 DRAFT PAID ~ 1010 ~'r -1 77 '~
0829 DRAFT PAID ~~ '; 10
-
0831 11
~ c.~ -1090 36
DIVIDEND
THE
ANNUAL PERCENTAGE RATE IS 0.10 47
THE
' ANNUAL PERCENTAGE YIELD IS 0.10
THE ANNUAL PERCENTAGE YIELD EARNED IS 0 9
0831 .
NEW BALANCE
5 0
110864 8
0
411
1411
S 1
211414
191414
166414
2193 8
2398 8
2274 5
113133 3
113207 3
11319216
112101 0
112104 7 i
112104f27
**CONTINUED**
TOTAL DMDEND YEAR-TO-DATE ~~ ANANCE CHARS ~~~~
fa ail savings e~ept IRA.
Dividends shown, if $10 or over, will be fOrel IOar1s.
reported to the Internal Revenue Service
for this calendar year. NOTICE: See reverse side fior important infom~ation
'INDICATES EFFECTIVE DATE
0610495
~ m~a~
Russ Divers
128 Curvin Drive
Harrisburg, PA 17112
Dear Mr. Divers:
Thank you for the opportunity to be of service to you.
Enclosed is the information requested.
Prudential Annuities
A Business of Prudential Financial, Inc.
P.O. Box 7960
Philadelphia, PA 19176
(888) 778-2888
Contract Number: 000584606
June 29, 2011
Your satisfaction is important to us. If ou have uestions,
professional or our Annuities Service Center at (888) 778-2888asRe oretsentati~ financial
to assist you Monday through Thursday between 8 a.m. and 7 p.m., and Friday betweena8 abm.
and 6 p.m. Eastern time.
Thank you for choosing to do business with Prudential Annuities.
Sincerely,
Annuities Service Center
Enclosure
Date of Death Values
Annuities aze issued by The Prudential Insurance Company of America and Pruco Life Insurance Company (In New York, by Pruco
Life Insurance Company of New Jersey), all located in Newark, NJ, or by Prudential Annuities Life Assurance Corporation,
Shelton, CT. Annuities are distributed by Prudential Annuities Distributors, Inc., Shelton,
companies and each is solely responsible for its own financial condition and contractual obligations aze Prudential Financial, Inc,
CFECCRegInfo 102009
•" ~
~~ Prudential Values
Statement
Prudential Annuities
A Business of Pnrdeatial Financial, Inc.
P.O. Box 7960 June 24, 2011
Philadelphia, PA 19176-7960
(888) 778-2888
BETTY J. RIVEN
119 EASTERLY DR Owner: BETTY J. RIVEN
MECHANICSBURG PA 17050-7935
Annuitant: BETTY J. RIVEN
Contract Number: 000584606
Contract Date: 07/15/2002
Market: Non-Qualified
~1 "You have -an , ~a
y questions, plecxre cortta~t your ~1Y~~14.11t.,~.L~.,~~NNfI~'~ Cl3RF
financial professiortdt or the Fi~ud~rritial
~! nniruties Servtee. G'enter tali free'a~ ~BSB}~ 77~~Z88S
,: .~
_ ~ :~
The values provided on this statement are calculated as of 06/10/2011. Any activity after this date is not reflected in this
statement.
If you surrender this contract you will lose the right to future annuity benefits under the contract. In addition, all or part of the
distribution may be subject to federal and/or state income tax. You may also be subject to a 10 percent penalty tax for earl
withdrawal. You may want to consult with your tax adviser if you have any questions concerning the applicable tax treatment
as Prudential cannot offer tax advice. ,
Although great care has been taken in preparing this statement, we reserve the right to amend the statement as needed. For
additional information about the benefits available to you, please refer to your original contract.
Account Summary as of 06/10/2011
In~el~t~me»t tidn
N"utr>~ber of Units
Unit :Value
Dollar AmoQnt
AST Cohen & Steers Realty 302.53569
24.425750
$7
389
66
AST High Yield Portfolio 322.38570
15.596570 ,
.
$5
028
11
AST PIMCO Limited Maturity Bond 917
51437 ,
.
AST PIMCO Total Return Bond . 12.570480 $11,533.60
1,524.74130
14.781680
$22,538.24
ZAA~
Annuities are issued by The Prudential Insurance Company of America and Pruco Life Insurance Com an !n New York, by Pruco Life Insurance Company
of New Jersey), all located in Newark, NJ, or by Prudential Annuities Life Assurance Corporation, Sh Pton, CT. Annuities are distributed by Prudential
Annuities Distributors, Inc., Shelton, CT. All are Prudential Financial, Inc. companies and each is solely responsible for its own financial condition and
contractual obligations.
*Pyramis is a registered service mark of FMR LLC. Used under license.
ValueState 92009
_......
Total: Cvnbract Fund Value: $46,489.61 ..
Surrender Value as of 6/10/2011
Contract Value $46,489.61
Misc. Fees $35.00
Surrender Charge $882.47
Recaptured Bonus $0.00
e~sh Surrender Value as a~f 06l1~/2011: ~45,5~2.14
Amount Available far Wit#>td~lrawa~l ~?'ai~l~out Surrender: Eh~>~ges as of 06/10/20
u . 11: $~,94~156..
Prudential
Russ Diven
128 Garvin Drive
Harrisburg, PA 1711 Z
Dear Mr. Diven:
Thank you for the opportunity to be of service to you.
Enclosed is the information requested.
Prudential Annuities
A Business of Prudential Financial, Inc.
P.O. Box 7960
Philadelphia, PA 19176
(888) 778-2888
Contract Number: 000613072
June 29, 2011
Your satisfaction is important to us. If you have questions, please contact your financial
professional or our Annuities Service Center at (888) 778-2888. Representatives are available
to assist you Monday through Thursday between 8 a.m. and 7 p.m., and Friday between 8 a.m.
and 6 p.m. Eastern time.
Thank you for choosing to do business with Prudential Annuities.
Sincerely,
Annuities Service Center
Enclosure
Date of Death Values
Annuities aze issued by The Prudential Insurance Company of America and Pruco Life Insurance Company (in New York, by Pruco
Life Insurance Company of New Jersey), all located in Newazk, NJ, or by Prudential Annuities Life Assurance Corporation,
Shelton, CT. Annuities aze distributed by Prudential Annuities Distributors, Inc., Shelton, CT. All aze Prudential Financial, Inc.
companies and each Is solely responsible for its own financial condition and contractual obligations.
CFECCRegInfo 102009
RECEIPT_FOR_PAYMENT
GLENDA FARNER STRASBAUGH
OneCourthousen,Syu Register Of Wills
Carlisle, PA 17013re
DIVEN BETTY JANE
Estate File No.:
2011-00705
Paid By Remarks: RUSSELL T DIVEN
HMW
Receipt Date: 6/21/2011
Receipt Time:
Receipt No.; 14:39:13
1066023
-------
Fee/Tax Description - Receipt Distribution
-
-------
------
PETITION LTRS TEST
Payment Amount
Payee Name -- ----
WILL
SHORT CERTIFICATE
JCS FEE 260.00
15.00 CUMBERLAND
CUMBERLAND COUNTY
GENERAL
FLTN
AUTOMATION FEE 40.00
23.50 CO~Ty
CUMBERLAND COUNTY
BUREAU GENERAL
GENERAL FUN
FUN
Check# 1056
T ----_-----5'_0_0_ OF R
CUMBERLAND ECEIPTS
COUNTY GENERAL UN
otal Received.
. 343 F
....... 343.50
Fax
(717) 657-3523
STATE OF PENNSYLVANIA
COUNTY OF DAUPHIN
Office 8~ Punt - (PO Box 6310) 101 Lincoln Street
Harrisburg, PA 17112
Before me, the subscriber, a Notary Public in and for the said County,
personally came Lisa M. Ca~ roes ~,vho, being duly sworn, doth depose
and say that she is ~~,$j{ of THE PAXTON HERALD, a
nev+~spaper-o~'genera~circ~~u a on`pub~tished it Hams~urg,-PennsyTvama;---- -___.
That THE PAXTON HERALD was established on the 28th day of
June, 1960, and has been published continuously since that date;
That the advertisement, of which a copy is attached hereto, was
published in the advertising columns of THE PAXTON HERALD in
all respects as ordered in the issue(s) of (D~~ 1-(p 7~ ~ a~ 1
Affiant further deposes that she is not interested in the subject matter of
the aforesaid notice or advertisement, and that the allegations in the
foregoing statement as to the dine, place and character of publication
are true.
~~ `'
(Si ture of the Affiant)
Sworn and subscribed before me this day of
~/7z
• ..
n.. wi.~ee M.a~u - ~n0 Fari bir, M..t~h,,,~ w- rn is • e~soeis
A.D.
East Shore
(717) 545-9540
(717) 545-8762
ESTATE NO?'i~E
NOTICE IS HEREBY GIVEN
have been g~ntec~in the~Es-
fate of Betty J. Divan late of
Mechanicsburg, Cumberland
County, Pennsylvania, who
died Tes~ste, June 10 2011, to
Russell~T. Diven~ '128 Curvin
Drive, Harrisburg Pa. 17112.
Ail persons indebted to the
said estate are regwired to
malae p__ and tfwge haw
ing clr dem~anris to
present the same without
daisy to the Executor named
below:
RueseltT.:Di~ren
12t; C~urvlrt Drive,
H~~ 546-1793
a,~, ~-s, 7-~s
NOTARIAL SEAL.
OAVlD M. GCILDSTEIN, Notary public
City of Harrisburg, Dauphin County
My Commission Expa'es l1Aay 26, 2014
Payable To: DEBRA BASEHORE WIEST
269 WOODS DRIVE
MECHANICSBURG, PA 17050-2635
Phone: (717) 697-1294
MAP NO: 38-23-0571-190-U10
Desc: 119 EASTERLY DRIVE
Acres .000 Deed: 0036H-00786
WESTFIELDS
UNIT 10PH2 PB57PG90
IIII Residential(Under 10 Acres)
I I~I~ AI~ ~I III ~~II III~I ~~II III I~ IIII
$1.00 FEE FOR ADDITIONAL RECEIPTS
Tax Payer:
DIVEN, DONALD G 8 BETTY J
119 EASTERLY DR
MECHANICSBURG, PA 17050-7935
Office Hours: MONDAY 9-12; TUESDAY 9-11 AM
ALSO 4/20 & 4/27,4-7PM
CALL FOR HOURS AFTER JUNE 28
PHONE (717) 697-1294
Bill No: 1457
B(II Date: 3/1/11
Control No:38004566
Assessed Value: Land: 0 Improvement: 121,400 Total: 121,400
COUNTY R/E Discount
1.90200 $226
28 Face Penalty
COUNTY LIB .
.14300 $17
01 $230.90
$253.99
MUNIC. R/E .
.80450 $95
72 $17.36 $19.10
TAX AMOUNT DUE .
$334
01 $97.67
$107.44
If Date Of Payment Is On .
$345.93
3/1 /11 thru 4/30/11 5/1 /11 thru 6/30/11 $380.53
7/1 /11 or Later
TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS
DEBRA BASEHORE WIEST
269 WOODS DRIVE
MECHANICSBURG, PA 17050-2635
TEMP - RETURN SERVICE REQUESTED
OFFICIAL COUNTY MUNICIPAL TAX BILL
l~ll~~~lllllllll~~ll'IIII1111~1'I1lI~~'~~11'III~III1~11~'I"I~'1' a~iio-2os3i
~~,~ DIVEN, DONALD G & BETTY J
119 EASTERLY DR
MECHANICSBURG, PA 170507935
111111~~11111
my Pennsylvania
TAX COLLECTOR COPY RETURN WITH PAYMENT FOR PROPER~_CR~Ep T'
IVEN, DONALD G & BE J 119 EASTERLY DRIVE
1 STERLY DR Acres .000 Deed: 0036H-00786
MECH G, PA 17050-7935 WESTFIELDS
UNIT 10 PH 2 PB 57 Pv 90
Residenfiial{Under 10 Acres)
Payable To:
DEBRA BASEHORE WIEST
269 WOODS DRIVE ~ .=
MECHANICSBURG, PA 0 f-263~j
Phone: (717) 697-12 ~~
r
Assessed Value: Land: 0
~®`~°~ co TY R/E
CO TY LIB
_ NIA. RlE
,•'~~ TAX AMOUNT DUE
If Date Of Payment Is On
87110-R-20831
Bill No: 1457
'BiIID~
Control h~o:= "' 6
MAP NO: 38-23-0571-190-U10
lmprovem~:nt: 121,400 Total: 121,400
_ Discount ~ ~ __._ Face
1.90200 $226.28 $230.90
.14300 $17.01
---~__ $17.36
.804;;0 2 $97.67
$339.01 $345.93
3/1 /11 thr 4/30/11 5~1 h 1 thru 6/30/1.1
Penalty
$19.10
$107.44
$380.53
7/1 /11 or Later
r~'~'-TA1~LE TO:
Phone: 717-697-1294
Debra Basehore Wiest Tax COII t BILL #: 1602
Phone: 717-697-1294
Debra Basehore Wiest, Tax Collector
269 Woods Drive
Mechanicsburg, PA 17050-2635
BILL #: 1602
BILL DATE:
7/1 /2011
DIVEN, DONALD G & BETTY J
119 EASTERLY. DRIVE,
MECHANICSBURG, ,,PA 1.7050
PAYABLE TO:
Debra Basehore Wiest, Tax COllector
269 Woods Drive
Mechanicsburg, PA 17050-2635
BILL #: 1602
Hours: See Reverse
Phone: 717-697-1294
NOTICE OF PROPERTY TAX RELIEF
Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property.
As an eligible homestead and/or farmstead property owner, you have received tax relief through
a homestead and/or farmstead exclusion which has been provided under the Pennsylvania
Taxpayer Relief Acts a law passed' by the Pennsylvania General Assembly designed to reduce
Your property taxes:
THIS TAX IS DUE AND` PAYABLE. YOU=ARE HEREBY REQUESTED
TO MAKE PAYMENT THEREOF.
DIVEN, DONALD G & BETTY J
119 EASTERLY DRIVE
MECHANICSBURG, PA 17050
.. - . _ -
RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMEN
DIVEN, DONALD G i!r BETTY J BILL NO: 1602
Property Location
38-23-0571-190-U 10 OFFICE HOUR S
1191=ASTERLY DRI\/E
WES~TFIELDS Jul. and Aug. - Mon. 9 am -12 pm
UNIT' 10 PH 2 PB 57 PG 90 and Tue. - 9 am -11 am
Also open 8/24, 5 pm - 7 pm
Resiciential(Under 10 Acres) and 8/31, 9 am - 5 pm
Also open by appointment; closed holid
Call for updated hours Sep. 1 -Dec. 15
Please indicate:
^ SECOND INSTALLMENT ^ SECOND INSTALLMENT WITH PENALTY
~ ~ ~ NO DISCOUNT
If paid on or before 9/15/11 $32s.s7
If paid after 9/15/11 $359.67
RETURN THIS PORTION WITH PAYMENT FOR FINAL INSTALLMENT
DIVEN, DONALD G & BETTY J BILL NO: 1602
Property Location
38-23-0571-190-U10 OFFICE HOUR S
119 EASTERLY DRIVE Jul. and Aug. - Mon. 9 am -12 pm
WESTFIELDS and Tue. - 9 am -11 am
UNI710 PH 2 PB 57 PG 90 Also open 8/24, 5 pm - 7 pm
Residential(Under 10 Acres) and 8/31, 9 am - 5 pm
Also open by appointment; closed holiday
Call for updated hours Sep. 1 -Dec. 15
Please-'indicate; ~ ....
...
- - ' ~~ • ~-
.
-
FINAL INSTALLMENT
_ _ _.. .
p ` FINAL.INSTALLMENT WITH PENALTY
~ ~ NO DISCOUNT
If paid on or before 10/15/11 $32s.s7
If paid after 10/15/11 $359.67
°'~ ~ ~ ~ ~ ~ 0/31/11 12/15/11
NO CHECKS ACCEPTED AFTER DECEMBER 15
269 Woods Drive ec or
Mechanicsburg, PA 17050-2635 BILL DATE:
7/1 /2011
DIVEN, DONALD G & BETTY J
119 EASTERLY DRIVE
MECHANICSBURG, PA 17050
PAYABLE TO:
$326.97 $326.97 $326.97
On or before 8/15/11 On or before 9115/11 On or before 10/15/11
MUNICIPAL CODE: Silver Spring Twp. BILL NO: 1
PROPERTY: 119 EASTERLY DRIVE
MAP CODE: 38-23-0571-190-U10 BILL DATE: ' .:
DIVEN, DONALD G & BETTY J
rHrHt3LE TO: Phone: 717-697-1294
Debra Basehore Wiest, Tax Collector
269 Woods Drive
Mechanicsburg, PA 17050-2635
DIVEN, DONALD G & BETTY J
119 EASTERLY DRIVE
MECHANICSBURG, PA 17050
BILL #: 1563 - ~
RETURN THIS PORTION WITH PAYMENT FOR SECOND INSTALLMENT
DIVEN, DONALD G & BETTY J BILL NO: 1563
DATE:
Property Location
3
BILL #:.1563:
BILL DATE:
7/1 /2010
PAYABLE TO: BILL #: 1563
zebra Basehore Wiest, Tax Collector Hours: See Reverse
. ?69 Woods Drive Phone: 717-697-1294
Mechanicsburg, PA 1.7050-2635
NOTICE OF PROPERTY TAX RELIEF
Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property.
As an eligible homestead and/or farmstead property owner, you have received tax relief through
a homestead and/or farmstead exclusion which has been provided under the Pennsylvania
Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce
your property taxes.
THIS TAX IS DUE AND PAYABLE. YOU ARE HEREBY REQUESTED
TO MAKE PAYMENT THEREOF.
DIVEN, DONALD G & BETTY J
119 EASTERLY DRIVE
MECHANICSBURG, PA 17050
TAXPAYER'S COPY - DO NOT RETURN
Debra Basehore Wiest, Tax Collector
269 Woods Drive
Mechanicsburg, PA 17050-2635
DIVEN, DONALD G & BETTY J
119 EASTERLY DRIVE
MECHANICSBURG, PA 17050
PAYABLE TO:
8-23-0571-190-U10
119 EASTERLY DRIVE=
WESTFIELDS
UNIT 10 PH 2 PB 57 F'G 90
Residential Building
Please indicate:
OFFICE HOURS
Jul. and Aug. - Mon. 9 AM - 12 PM
and T.ue. 9AM - 11 AM
Also open 8/25 and 8/31: 5 - 7 PM
Also open by appointment; closed holiday-
Call for updated hours Sep. 1 -Dec. 15
^ SECOND INSTALLMENT ^ SECOND INSTALLMENT WITH PENALTY
~ ~ ~ NO DISCOUNT
If paid on or before 9/15/10 ~. s
If paid after 9/15/10 .
DIVEN, DONALD G & BETTY ~~TH PAYMENT F~pLFIJy9L II~~T.yLLMENT
Property Location
38-23-0571-1 so-u ~ o OFFICE HOUR S
119 EASTERLY DRIVE Jul. and Aug. - Mon. 9 AM -12 PM
WESTFIELDS and Tue. 9AM - t1 AM
i UNIT 10 PH 2 PB 57 PG 90 ~ ~~ open 8/25:and 8/31: 5 - 7 PM
Residential Building Also open by appointment; closed holidays
Call for updated hours Sep. 1 -Dec. 15
Please indicate:
^ FINAL INSTALLMENT ^ FINAL INSTALLMENT WITH PENALTY
~ NO DISCOUNT
pal on or a ore
Pal a er .
BILL- NO: 1563
BILL DATE: .
DIVEN, DON J
~~~ ~ •4b $287.48 $287.48
On or before 8/15/10 On or before 9/15/10 On or before 10/15/10
Return bill with payment; for a receipt see instructions on reverse side.
NO CHECKS ACCEPTED AFTER DECEMBER 15
MUNICIPAL CODE: Silver Spring Twp.
PROPERTY:. 119 EASTERLY DRIVE
MAP CODE: 38-23-0571-190-U10
FAMILY SETTLEMENT AGREEMENT
Betty J. Diven Estate
We,the Benef ciaries of Betty J. Diven have been informed of the administration and final settlement of
the Estate as witnessed below We agree with the distribution of assets and release the Executor, Russell
T. Diven, from any personal liability. Should any debts or liabilities surface after distribution of assets,
each beneficiary or their heirs, will return sufficient share to cover said debts or liabilities.
1 iy,/ ) ,
sell T. Diven Executor
Scott A. Diven
i
/~'~ j~
ebra D. Bowman
~ s
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Notary ~~~~ w . ~~ p ~ ~c
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Notary - ~x+~e.i ss; o~ -
~ E,F~~reS~'1~~.V'~y
N
HIOTARIAL SEAL
LMtDASAWYER, Notary Public
Camp Hiil ~, G1un~betlartd Cpunty
nny Commis~n Expires Februatyl2, ~p13
File 21-11-0705