HomeMy WebLinkAbout09-09-111505610149
EX {01-10)
REV-1500 OFFICIAL USE ONLY
pennsylvania
p[+AiiMCNI QI RCV[FJL County Code Year File Number
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 21 10 12 3 D
Harrisburg, PA 1 71 2 8-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
579 48 4700 12 12 2010 09 16 1932
Suffix Decedent's First Name MI
Decedent's Last Name D
Patricia
Kmetz
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI
Spouse's Last Name
Spouse's Social Security Number THIS RETURN MUST BE ER OF W LLSCATE WITH THE
REGIST
FILL IN APPROPRIATE OVALS BELOW
Q 2. Supplemental Return G~ 3. Remainder Return (date of death
~ 1. Original Return prior to 12-13-82)
Q 4. Limited Estate L~ 4a. Future Interest Compromise (date of C7 5. Federal Estate Tax Return Required
death after 12-12-82)
7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
~ 6. Decedent Died Testate 0 (Attach Copy of Trust)
(Attach Copy of Will)
Q 9. Litigation Proceeds Received ~ 10~ betweenP 2 31y 91r anld(~-1e95)death 1~ 11' (Attach Sch. O) nder Sec. 9113(A)
CORRESPONDENT -This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to:
Daytime Telephone Number
Name 717 612 5800
John E• Slike, Esquire
REGIS'E')~,~B.~WILLS USE-ONLY :.
~ ^" t
~.
First line of address `'~ '~ m I ~ ,-,~"
'' £l'3 ~ 3.~?
Saidis, Sullivan & Rogers ~-`'~=c;~ ~-~-. ;_;
-, C} -`f t - ~ ,
°- r-t
Second line of address _._~ ~ Q.-- ~ ~~ ` .j
635 North 12th Street, Suite 400 -~° ~-'~~
'DATE FILED °~`
City or Post Office State ZIP Code
Lemoyne PA 17043
Correspondent's a-mail address: ~Sllke ssr-attorne s.com
Under penalties of perjury, I declaeclahati n of the prepa er o'ther than perso'nalaepresentat vess based on al nformation of wh ch preparerfhas any knowledge belief,
it is true, correct and com~l~t~. ~ DATE
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~ ~ /~
t. ~ / ~ / i~
1 .
ADDRESS / ~~
O . ~ ~~ + DATJ
SIGNATUR O~P,REPAREROTH~THAN R PRE ENTATIV /,°/ ~ /~~
ADDRESS 35 orth 12th Sfireet, Suite 400
Lemo , PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610149 15056101,49
J 1505610249
Rev-1500 EX
Decedent's Name: PetriCia D. Kmetz Decedent's Social Security Number
579 48 4700
RECAPITULATION
0.00
1. Real estate (Schedule A) • • • • • • • • • • ............................... 1'
0.00
2. Stocks and Bonds (Schedule B) •••••••••••••••••••••••••••••••••••'
2
0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • • • • • • 3.
0.00
4. Mortgages and Notes Receivable (Schedule D) • • • • • • • • • • • • • • •
4
85, 571.05
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) • • • • • • • 5•
105,900 •75
6. Jointly Owned Property (Schedule F) O Separate Billing Requested • • • • • • 6•
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ], Q , 9 51.2 6
(Schedule G) 0 Separate Billing Requested • • • • • • 7.
202, 423.06
8. Total GrossAssets(totalLineslthrough7)••••••••••••••••••••••••••••
8
13,759.93
9. Funeral Expenses and Administrative Costs (Schedule H) • • • • • • • • • • • • • • • • • • 9•
618.37
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) • • • • • • • • • • • • • 10.
14 , 378.30
11. TotalDeductlons(totalLines9and10) ••••••••••••••••••••••••••••••
11
188,044 •76
12. Net Value of Estate(Line8minusLinell)...•••••••••••••••••••••••••• 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which Q • Q Q
an election to tax has not been made(Schedule ))••••••••••••••••••••••• 13.
188,044 •76
14. Net Value Subject to Tax (Line l2 minus Line l3) ••••••••••••••••••••••• 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 Q• Q Q
15 Q. Q Q
(a)(1.2) X .00 .
16. Amount of Line 14 taxable 18 8 , 0 4 4 •7 6 16 8 , 4 6 2 •01
at lineal rate X .045 .
17. Amount of Line 14 taxable Q • Q Q
17 Q . Q Q
at sibling rate X .12 .
18. Amount of Line 14 taxable Q • Q Q
18 Q . 0 0
at collateral rate X .15 .
8, 462 •OL
19. TAX DUE .................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
1505610249
Slde 2
1505610249 J
Rev-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
Patricia D. Kmetz
STREET ADDRESS
418 East Green Street
CITY
Shiremanstown
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Prior Payments 8, 500.00
B. Discount 447.36
Total Credits (A + 6)
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.
(3)
(4)
(5)
0.00
485.35
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;•••••••••••••••••••••••••••••"""" Q
b. retain the right to designate who shall use the property transferred or its income; • • • • • • • • • • • • • • • • Q
c. retainareversionaryinterest;or •••••••••••••••••••••••••••••••"""""""""" Q
d. receive the promise for life of either payments, benefits or care? • • • • • • • • • • • • • • • • • • • • • • • • • • • Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year
of death without receiving adequate consideration? ••••••••••••••••••••••••••••"""""' Q
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? • • [~
4. Did decedent own an individual retirement account, annuity, or other non-probate property,
which containsabeneficiarydesignation? ••••••••••••••••••••••••••••""""""""' ~ Q
IF THE ANSWER TO ANY OF THE ABOVE GIUESTIONS 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. Sect. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 9116(1.2) [72 P.S. Sect. 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. Sect. 9116(a)(1.3)]. A sibling
is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Fle Number
21 10 1230
ZIP
17011
STATE
PA
(1) 8 462.01
(2) 8, 947.36
REV-1508 EX+(6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENTDECEDENT
FILE NUMBER
ESTATE OF 21 10 1230
Patricia D. Kmetz
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
ITEM DESCRIPTION
NUMBER OF DF~4TH
1 M&T Checking Account 51941023 6,845.68
Per 02/17/2011 letter
Interest on above item accrued as of decedent's death 0.01
2 M&T Bank Savings Account 15004208619039 3,275.11
Per 2/17/11 letter
Interest on above item accrued as of decedent's death 0.02
3 AmeriChoice Savings Account 17753 (01) 6,714.68
Per 01 /7/2011 letter
4 AmeriChoice Savings Account 17753 (02) 10,757.55
Per 01 /07/2011 letter
5 AmeriChoice Money Market Account 17753 (18) 18,077.57
Per 1 /7/2011 letter
11,124.01
6 M&T Bank CD
Per 02/17/11 letter
Interest on above item accrued as of decedent's death 37.55
7 AmeriChoice CD 17753 (62) 17,418.62
Per 1 /7/2011 letter
8 Misc. Household Items 2,175.00
1,200.00
9 Jewelry
107.30
10 Nationwide Insurance
11 SBC Card Refund 111.15
12 Patriot News Refund 151.80
13 2005 Chevrolet Malibu LT Maxx Hatchback 7,575.00
Per kbb.com
TOTAL (Also enter on line 5, Recapitulation) 85,571.05
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+(01-10)
Pennsylvania
REPARIMENF Of R~YfNUF
INHERITANCE TAX RETURN
RESID ENT D ECED ENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF:
Patricia D. Kmetz
If an asset became jointly owned within one
SURVIVING JOINT TENANT(S) NAME(S)
FILE NUMBER:
21 10 1230
of the decedent's date of death, It must be reported on Schedule G.
ADDRESS RELATIONSHIP TO DECEDENT
A. Michele A. Sironen 300 Chatsworth Street Daughter
Cary, NC 27513
e
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OFPROPERTY. INCLUDE NAME OF FINANCIAL
ITEM FOR JOINT MADE INSTITUTION AND BANK ACCT NUMBER OR SIMILAR IDENTIFYING
NUM. TENANT JOINT NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
1 A 12/2005 480 total shares of IBM in Fidelity Investment
account Z19-298271 joint with Decedent's
daughter, Michele A. Sironen with rights of
survivorship
Total value $69,394.80
2 A 12/2005 Pru Jen Utility CI A Fund #0009 joint with
Decedent's daughter, Michele A. Sironen
1224.747 total shares
3 A 03/08/0 418 E. Green Street, Shiremanstown, PA
17011 joint with Decedent's daughter, Michele
A. Sironen
%OF DATE OFDEAIFi
DATEOFDEATH DECD'S VALUE OF
VALUE OF ASS ET INTEREST DECEDENT'SINTEREST
69,394.80 50.000 34,697.40
12,406.69 X50.0
130,000.00 X50.0
6,203.35
65,000.00
TOTAL (Also enter on Line 6, Recapitulation) I 105,900.75
If more space is needed, use additional sheets of paper of the same size.
REV -1510 EX+(08-09)
~ pennsylvania
(7}PAFil"~S€N(Qf REVFNtlF
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
FILE NUMBER
ESTATE OF 21 10 1230
Patricia D. Kmetz
. . ~,._ ~ :..~_ ___....,..,. ~..., ..c ~„ems*~,,.,~ ~ rhrnuah a on Haas three of the REV-1500 is yes.
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
`,' Pennsylvania SCHEDULE H
app""~~'~"~ °~ a~vF""~ FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENTDECEDENT
ESTATE OF
Patricia D. Kmetz
ITEM
NUMBER
FILE NUMBER
21 10 1230
Decedent's debts must be reported on Schedule I.
DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 Funeral luncheon
2 Malpezzi Funeral Home
($7,584.97 minus $100 VA payment)
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
4.
5.
6.
City State Zip
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
See schedule attached
TOTAL (Also enter on Line 9, Recapitulation)
If more space is needed, use additional sheets of paper of the same size.
634.50
7,484.97
4,270.00
365.50
1,004.96
13,759.93
Estate of: Patricia D. Kmetz
Schedule H, Part B -Administrative Costs
Miscellaneous Expenses
Item
Number Description
7 Cumberland County Register of Wills, filing fee
8 Wachovia Bank, check order
9 Michele Sironen, travel expenses
10 NC DMV, transfer car
11 Michele Sironen, reimbursement for travel expenses to PA
12 Saidis, Sullivan & Rogers, out of pocket expenses (Cumberland Law
Journal $75.00/Sovereign Bank date of death research fee $20.00)
13 Saidis, Sullivan & Rogers, out of pocket expenses
14 Saidis, Sullivan & Rogers, out of pocket expenses
TOTAL. (Carry forward to main schedule) ..... .
Page 2
21 10 1230
Amount
30.00
23.00
200.00
268.60
200.00
95.00
182.82
5.54
1,004.96
REV-1512 EX+(12-08)
r` _ pennsylvania
aFPARTMEN6 Qf REVtNUE
INHERITANCE TAX RETURN
RESID ENT D ECED ENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTA 1 t car
Patricia D. Kmetz 21 10 1230
~___.~ ~_~.,. ~..,.....~ ~., ae..~e..+.,.i~r *~ ripath that remained unsaid at the date of death, including unrefmbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsyluania SCHEDULE J
f3EPAR7MEN~ of RfVfNUE
INHERITANCETAX RETURN BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF:
Patricia D. Kmetz
NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY
z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).]
Michele A. Sironen
300 Chatsworth Street
Cary, NC 27513
FILE NUMBER:
21 10 1230
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trust s OF ESTATE
Daughter
188, 044.76
ENTE R DOLLAR AMOUNTS FOR D ISTRIB UTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18 OF R EV-1500 COVE R SH E ET, AS APPROPRIATE.
zz NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
If more space is needed, use additional sheets of paper of the same size.
l~
- ---- - _-
_. -
i
~0 ~ 0 ~3~C ! 5 P~ ~~ G 7
~;! ERI ~
~'- ~~_ ~ _
LAST ~7ILL AND TESTAMEN
OF
PATRICIA D. KMETZ
~TZ of the Borough of Shiremanstown, Cumberland
~'~='?`P-1 CIA D
_ __ .~_ -his to be my Last Wi11 and Testament,
- - -- . _ - ,.._..--. ~c-._.~_ ..
-_ - I direct the payment of all my just debts and funeral
estate as soon as may be practical after my death.
expenses out of my
II - I devise and bequeath all of my estate of whatever nature
wherever situate unto my husband, Michael J. Kmetz, providing he
;~~d
survives me by sixty (60) days.
III - Should my said husband fail to be living on the sixty-
-- _- r~._st' day following my death, then I devise and bequeath all of
- - - - -_ )
- _ __ ~ e and N=herever situate unto my daughter,
_;-_-=-_-_ --- _=ronen, or her issue per sti rpes.
Iv - I appoint my husband, Michael J. Kmetz, Executor of this,
Will and Testament. Should my said husband fail to qualify or ~
my Last
oint my daughter, Michele A, Sironen, to
~ cease to act as such, then I app
ersonal representatives shall be
act in this capacity. Neither of my p
i
required to post bond in this or any jurisdiction.
1 ' ~ _~~.~- _1-~-' Pct C~ e 1
! ~'
`~. ~ t"
(lam i
:F:':OLU &:.SLi1~:E, A~rro~tr~EYS-n~r-t.~~~, z~u~, ~~~,r«t_~ STREE"f. CAMP ~-~i~_i.. ~';~, ~ ~o~ i
~'RFOF, I have hereunto set my hand and seal on this
day of - ''" ..,.
:' ;'
_._.
~° •_
Patricia D. ~:m~tz
(SEAL)
- d sealed, published and declared by PATRICIA D• ~~Zandeforther
S1gne other sheet. of paper as
therein named, on this and one (1)
ast Will and Testament, in our presence, who, in her ptossubscribedeour
L
request, and in the presence of each other, have hereun
names as attesting witnesses.
*~
/~G. ~~
;; Address
;;
~~
Name
~- ~
~ ~ ~
~ ~~~
~d~ress
Page
v_ _:,_ -
~, ...
respectively,
~}sE~ tre undersigned, the testatrix and the witnesses,
_;~,.~^~; r ~;TJ2s arm signed to the foregoing instrument , being first duly
--~_-- - _~ ~_r~:r.,~_ ~e~=tee to the undersigned authority that the testatr
_ ~~~_-- ~ ~"- - _~. ~, _ _~~~ ~;~~n} as her Last Will and Testament an
_ - :, .~:~~ - ~~'~`".-.~ --,~. _ _ _ - - ~~-~-~~ a_rio t'_1e1" to sign for
1.~, ~~.- - "; ~„_ , ~ :_ _- ~~~. ,l a _ _ - ^ / - _ '~ `- - = " ~ _ - a?"y act f o r
-_.. .:w ~,___ _ - . - - - - _ _ _ _ _ ~ ~__ ` ~a~._~ of the witnesses , in the
~_'-- _~~---~_ --~--_-- -~_----__--;es~.a~rix signect the will as witnesses ant-
- - ~ - - - ~ ~ ^ r_ }~:nowledge the testatrix was at that time
= - - - ~ bes~ o= ~.rlei
~+ _ _ ~ee~-: r-years of age or older , of sound mind, and under no constrainT
;,r undue influence .
-' Testatri.~ ~~.
,
~
~~
~.
Witness
%y
,.
_- ,
Witness
~ ~S, ~.
~.:-. ~~
-~~ ~ ~ .
Notary Public
--______
~a~-;-~ }-ill' ~ ~ . y' !~ubitc
tJ1'• rJ~i;;Liu1~1.~:'' r::+UfJtli
A T) 1.1 !"~ 1 f~~ t' r r r ri r
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SIRONEN MICHELE A
300 CHATSWORTH ST
CARY, NC 27513
---- fold
REV-1162 EX(11-96)
N0. CD 014115
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SSN: 579-48-4700
FILE NUMBER: 2110-1230
DECEDENT NAME: KMETZ PATRICIA D
DATE OF PAYMENT: 03/ 1 1 /201 1
POSTMARK DATE: 03/1 1 /201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/ 1 2/201 0
REMARKS: RECEIPT TO ATTY
SEAL
CHECK# 1016
101 ~ $ 8, 500.00
TOTAL AMOUNT PAID:
INITIALS: CJ
RECEIVED BY:
$ 8, 500.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
1~1/18~T ~-a~
499 Mitchell Road, Millsboro. DE 19966 Adjustment services
Phone 888-502-4349
F ax (302) 934-2955
February 17, 201 1
John E Slike Esquire
Saidis, Sullivan and Rogers
63~ North 12th Street Suite 400
Lemoyne, PA 17043
Re: Estate of Patricia D Kmetz
Social Security: 579-48-4700
Date of Death: December 12, 2010
Dear Sir or Madam:
Per your inquiry on February 16, 2011, please be advised that at the time of death, the above-named decedent
had or deposit with this bank the following:
Ti~pe of Account
Account Nuranber
Ox~nership (Names ofl
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
51941023
Patricia D Kmet~,
Michelle A Sironen (POA)
1228/78
$6,845.68
$ .01
$6, 845.69
2. Type of Account
Account Number
O~~nership (Nannes o,~
Opening Date
Balance on Date of Death
Accrued Interest
Tutul
Savings Account
15004208619039
Patricia D Kniet~
Michelle A Sironen (POA)
04/27/92
$3, 275.11
$ .02
$3, 275.13
3. Type of Accou~u
Accoiuit Numher
Ow~zership (Names ofl
Opening Date
Balance on Date of Death
Accrued Interest
Total
Certificate of Deposit
_31003916012378
Patricia D Kmet~
Michelle A Sironen (POA)
04/02/07
$11,124.01
$ 37.55
.. ................
$11,161.56
For further account information, closures and/or reimbursement of funds please call the Mechanicsburg Office at #717-255-2031
We were unable to locate an}~ safe deposit box f'or the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers,
Representative Payee, or Trustee under a Written Agreement
Sincerel}~,
V' ~
f __s~i-r) Csa.~
Tammy Spencer
Adjustment Services
eriChoice
FEDERAL CREDIT U N I O N
Building Relationships For Life
J anuar}~ 7, 2011
SAIDIS, SULLIVAN & ROGERS
635 North 12''' Street, Suite 400
Lemoyne.. Pa 17043
ATTN : Kimberly A. Hamilton
Re: The Estate of Patricia D. Iunetz
Ms. Hamilton.
The decedent had one member- number 17753 titled Patricia D. Kmetz. This account included a
regular savings, (suffix O1) opened April 6, 1978, asub-share savings, (suffix 02) opened
~ 001 and a 60 month
January 7, 1982, a money market savings {suffix 18) opened May :t9, ~ ,
share certificate (suffix 62) opened January 10, 2008. This was an :individual account.
Date of death balances were as follows:
Savings - $6,714.68
Sub Share Savings - $10,757.55
Money Market - $18,077.57
Share Certificate - $17,418.62
The account was closed by Michelle Annette Sironen on December 15, 2010 with a check made
payable to the Estate of Patricia Kmetz in the amount of $52,968.42. I have included a copy of
the check and a copy of Patricians final account statement for your reference.
Should you need any further assistance, please feel free to contact me directly with any concerns
you may have.
Sincerely,
~.
Bonnie R. Seagraves
Operations Specialist
Phone (717) 591-1282
Fax {717j 697-3713
Email bsea~raves~clJ,americhoice.or;:;
Main Office: ?1 75 Bumble Bee HollUw Koad • Mechanicsburg, PA 17055 • Phone: 1.717 697-;474 • Fax: %71 7~ 697-7"13 ~`
Website: www.americhc~ice.org ~`~
Equal ~~
-_ -_----_- Opportunity . r
NC~M LENDER cRr'lll7 U
i'JU~' '~ ' _ ~ ~ '
LENDER _._._.__.. ___._-_.
?005 Chevrolet Malibu -Trade In Value, blue book value - Kelle}% Blue Book Page 1 of 2
~ ~~ ~u ~~-
Send to Printer
THE T`Rt15TE13 RE~I~~RCE
..___. w.. __,:~~.~___..~:.~
ttl~.ca~
..~ fi
a;~vf:~rtisentc:~nf.
Condition Value
Exeellent $8ra50
Good $7,575
(Selected)
1=air $f,80~
Vehicle Highlights
Mileage: 13,500
Engine: V6, 3.5 Liter
Transmission: Automatic
Drivetrain: FWD
Selected Equipment
Standard
Tra;:ticn Control Cruise Control Leather
Air Conditioning AMJFM Stereo Power Seat
Power Steering CD (Single Disc) Rear Spoiler
Power VJindows Dual Air Bags Alloy VVhe~els
Pr;wer Door L.oC:ks Side Air Bays
"Tilt LNheei Af3S (~+-Wheel)
Blue Book Trade-in Value
Kelley Blue Book Trade-In Value is the amount consumers can expect to receive from a
dealer for atrade-in vehicle, assuming an accurate appraisal of the vehicle's condition,
mileage and features. This value will likely be less than the Private Party Value because the
reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing
business.
Vehicle Condition Ratings
Excellent
$8,454
l..~lp~'~ .?CVJ, IS li? E_'XCEilenL rl"IeClli3rll:~ai CUndltlOii and neeas nC reCOnditioninci.
• fvc•v~r ftad any G~ain`i ar f)t~dy work and is frf,c of rust.
~1er~n title history and NJIIi pass u scoot, ~nc1 safety ins;~ection.
i_rlt)InE' Cornpai'tnlent 15 Clean, VdICn no fluid IeakS arld i5 free Of arty Lt'ear or'
~lt5ltTiE'. (Jt'.fP.CtS.
C:otr3p~ete and verifiable service record:>.
Close Window
httn://www.kbb.com/used-cars/chevrolet/malibu/2005/trade-in-value/pricing-report?condit... 1 /14/2011
advertiset~enC
2005 Chevrolet Malibu LT MAXX Hatchback 4D
BLUE BUUK® TRADE-IN VALUE
2005 Chevrolet Malibu -Trade In Value, blue book value -Kelley Blue Book
:_ess tha%~ ~°~~~ o` all used vehicles fail into this category.
{+~" Good (selected) $7,575
•~ Free of any major defects.
• Clean title history, the paints, body, and interior have only minor (if any)
blemishes, and there are no major mechanical problems.
• Little or no rust on this vehicle.
• Tires match and I?ave substantial tread wear left.
• A "good" vehicle will need some reconditioning to be sold at retail.
Most consumer owned vehicles fall into this category.
FDIC
~"-~r$Q~
• •' ~~orr:c: rnEiCi?a~?icai 0; C;C)5rnet3C: Cle•`E Ct.S at'fG neii'd~i 5@3rVICir3g "i)lJt t~ citli; Iri
reasortable (~tu~nirrg condition.
s '~iei)fl f'ItiC-' t)ISt_)ry, t.i'':C? ~)~31r3t; bOCiy :tir3Ci/«i" InI.C':ril)r net; f. w()r'{~: per{'C)rrT•.Cd t)y i~
ij("C3 (~C ~; SiOntll .
w iY~f_':i I7):iy nn;; [: 1.:, :)t= ?"{~~%It!c"., ,,.
• `: f rP, nli:3V [:)C' CiC}rT)' ':`'p"x.311`%1T)ie t"uSt dc3rn:.i.JC'..
~"oo;r ~~~
~,...,~,
A:^ . ;~C?VerEt n"lechat3lC:r.31 at?Ci%Or C;O srnet.iC dE'fects arld Is Itl p0f)r I"k.lrlfling cf)ndition.
. tfc;y have problen?s that cannot be readily fixed such as a dar;tacJed frame c)r a
rl.lstrlc;-thro(.igh t.}oE.iy.
• 3r"at?dcd title {salvage, flood, et.c.) or ut?substantiates: mileage.
1'.csiiE,~% '~IC)E3 t%E)C}k (:iC)C'.i; nOf at.t.elYti.)l tO rf:'.j:)C)rt:rl Vaii)c', f:+Cl i3 "pai)r" VE:'.t?IC:.I t)E'Cai.ltit; tElt:`.
uaiu G` ti1eSE' VE:hiCieS VUr'!f_'s cJr'edt.iy. A V?iliCle iii poor' CUI?dit.lOn n?ay' r'GCif)Ir': atl
iT3CJf't)E:`.nCJf:'.t?irlpj}I"<i152)! t:{) fiC'.'•a:'.rn"lirlr` It:S V<)il.l ,
* Pennsylvania 01/14/2011
ici 2011 Kelley Blue Book Co., Inc. All rights reserved. 1/14/2011-1/20/2011 Edition. The specific
information required to determine the value for` this particular" vehicle was supplied by the person
generating this report. Vehicle valuations are opir)ions and may vary from vehicle to vehicle. Actual
valuations will vary based upon market conditions, specifications, vehicle condition or other particular"
circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction.
This report is intended for the individual use of the person generating this report only and shall not be
sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.
(v.11013)
httn : //www. kbb. com/used-cars/chevrolet/malibu/2005/trade-in-value/pricing-report?condit
Page 2 of 2
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M Historical Prices ~ International Business Machines Stock -Yahoo! Finance Page 1 of 1
IB
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International Business Machines Corp. (IBM)
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Start Date: Dec 10 2010 Eg. Jan 1, 2010 r_; Weekly
~;_; Monthly
End Date: Dec 13 2010 ,;-;Dividends Only
Get Prices
I=first ~ Previous ~ Next ~ Last
__ _...... ._
;
Prices CJ~
~Q
~'
~
~ Adj
Date Open High ~ Low Close Volume Close'
Dec 13, 2010 145.14 ,145.40 144.21 144.28 4,741,000 144.28
2010
Dec 10 144.88 s' 144.95 143.73 144.82 3,503,800 144.82
,
' Close price adj to for dividends and spl its.
~ Fi
I ~ t '•+t~ rst ~ Previous ~ Next ~ Last
'~": Download to Spreadsheet
Currency in USD.
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At 10:56AM EST: 'I GO.15 '~ 0.52 {0.33%)
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http://finance.yahoo.com/q/hp?s=IBM&a=11&b=10&c=2010&d=11&e=13&f=2010&g=d 1/25/2011
P~uden~ial
0002041
PATRICIA D KMETZ
MICHELE A SIRONEN JTWROS
418 E GREEN STREET
SHIREMANSTOWN PA 17011
Your Representative
PRUDENTIAL INV MGT SERVICES LLC
None
Your SSN/Tin#: ON FILE
Page ~ of 4
Your Account
280912323~~ Non-Retirement
(Mutual Fund Statement -January 1, 2010 to December 31, 2010
z
4th Qtr
z
0 Uct 01.2010 to Dec 31, 2010
r
° Opening Balance
$11,818.81
$0.00
o Additions $0.00
Subtractions
Investment Results +$821.74
Closing Balance $12,640.55
Dividends $73.19
$0.00
Capital Gains
Personal Performance' +6.95
.~
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0
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0
0
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~ oo°io
LL 'Calculated using adollar-weighted rate of return method fo o h fipancial pro~fessio nal orlby v sibn y ww~n.prudentialccom cNote :There are otherfperson al perfo mance formula
w Standardized fund performance is available by speaking with y
a that may yield differeni figures, and past performance is not indicative of future results.
White we make ever~l attempt to ensure that y.ou
,~
o .Reminder: You can access your tax :fiarms' through .statement is accurate, ;errors ::may inadvertentfq occur
Prudential Online Account' Access. Also, read 'the 'please review our. statement thoi•oughiy and contact us'i
enclosed newsletter for :information on the;tax forms you - you find any 'information you believe to be inaccurate, l
o may receive to help prepare you for tax time, we do nat'hear from you in 30 days; we will assume that a
1(ear-to-Date Investment ,tA~iocation
Jan 01, 2010 to Dec 31, 2010
Page 2 of 4
F'ATRICI~. C' h<MFTZ
fvIICH~LE ~- SIRONEN JTWROS
Nnn-RE?ifirPm~nt Account Summary for the Period January 1, 2010 to December 31, 2010
Equity
Pru .ien Utility CL A
Fund # 0009 /NASDAQ PRUAX
Account#2809123238
Tota! Equity
Non-Retirement Total
I ~ '' Total '; Share ~ Ending Personal
Opening - ~ ~ i ~ >Per~ormanee"
<Value_ ~ Additions ,..Subtractions Shares i Price '~ Vaiue
$11 ,045.04 $0.00
$11,045.04 $0.00
$~1;oas,a4 $a;aa
$U.00 1,232.022 $10.26 $12,640.55 +14.45
$0.00 $12,640.55 +14.45 °ra
$0;00 $12,64fl55
Non-Retirement Account Transactions for the Period January 1, 2010 to December 31, 2010
~Pru Jen Utility CL A Fund #: UOd~ /NASDAQ: PR.UAX ,.,Account #1$09123238
Features & Services:
DIVIDENDS: REINVEST CAPITAL GAINS: REINVEST
TELEPHONE REDEMPTION TELEPHONE EXCHANGE
Detailed Transaction Activity
'
' Sales Charges
his
T
Dollar Shares Share andlor Total Shares
Transaction
Amount = Transaction X Price - Taxes W/H Owned
Date Description
1,203.163
01/01/10 Opening Share Balance
$69.84 7 .616 $9.17 1,210.779
03/19/1 0 DIVIDEND -REINVEST
67 `.1.610
$51 $9.21 i 216.389
.
06/18/10 DIVIDEND - REINVEST
$78.82 (3.358 $9.43 1 224.747
09!17/10 DIVIDEND -REINVEST
$73.19 7.275 $10.06 .022
2/17/1 0 DIVIDEND -REINVEST ~ 1,232.022
12/31/10 Closing Share Balance
?~IS~,~~
t ~+ 1~ ~ ~ . ~o r
1 Prices PRUDENTIAL JENNISON UTILITY FUN Stock -Yahoo! F... Page 1 of 1
PRUAX Historica ~
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Prudential Jennison Utility A (PRUAX)
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i~: Daily
Start Date: Dec 10 2010 Eg. Jan 1, 2010 ~; Weekly
Monthly
End Date: Dec 13 2010 r;;- Dividends Only
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First ~ Previous ~ Nex# ~ Last
Prices
Adj
Date Open High Low Close Volume Close'
0 10.09
Dec 13, 2010 10.15 10.15 10.15 10.15
0 10.05
Dec 10, 2010 10.11 10.11 10.11 10.11
"Close price adjusted for dividends and splits.
First (Previous ~ Nex# ~ Last
~'` Download to Spreadsheet
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ance.vahoo.com/a/hp?s=PRUAX&a=11 &b=10&c=2010&d==11 &e=13&f=2010&... 1/25/2011
httn://fin
OMB Approval No. 2502-0265
~== ~-;
~~
i= x ~~~it~ ~`"~~ A. Settlement Statement (HUD-1
~,;
.-.
6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
1 . ~ FHA 2. ^ RHS 3. ~ Conv. Unins. PY011 81 000004236 4460828322-703
4 _ ^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked
^(p.o.c)" were paid outside the Dosing; they are shown here for informational purposes and are not included in the totals.
E. Name & Address of Seller: F. Name & Address of Lender:
D. Name & Address of Borrower: Michele A. Sironen Ornatown Bank
Jason W. Hemperly 26f15 Philadelphia Avenue, Chambersburg, PA
853 Lindsey Road, Carlisle, PA 17015 17201
G. Property Location:
418 E. Green Street
Shiremanstown, PA 17011
Parcel 37-23-0555-326, Shiremanstown
Borough
H. Settlement Agent: I I. Settlement Date: 07/29/2011
Pyramid Land Transfer LLC Disbursement Date: 07/2912011
26 West High Street Carlisle, PA 17013
Place of Settlement: TitleExpress
26 West High Street Carlisle, PA 17013 Printed 07/2912011 at 9:12 am
by RLM
t.
400. Gross Amount Due to Seller 150,000.00
100. Gross Amount Due from Borrower 150,000.00 401. Contract sales price
101. Contract sales price
103. Settlement charges to borcower (line 1400)
104.
105.
Adjustments for items paid by seller in advance
106. Cityltown taxes to
107. County taxes 0712912011 to 1213112011
108. Assessments 0712912011 to 0613012012
109. 3rd Qtr Sewer 07129!2011 to 0913012011
110.
111.
112.
120. Gross Amount Due from Borrower
200. Amounts Paid b or in Behalf of Borrower
201. Deposit or earnest money
202. Principal amount of new loan(s)
203. Existin loan s taken sub echo
204.
206.
207.
2DB. Seller Assist
7,078.14 ~ ~ 403.
405.
Adjustments for items aid b_ y seller in advance
406. Cityltown taxes to
263.05 407. County taxes 0712912011 to 1213112011
1,643.45 408. Assessments 0712912011 to 0613012012
34.78 409. 3rd Qtr Sewer 071'1.912011 to 0913012011
410.
411.
412.
159,019.42 420. Gross Amount Due to Seller
500. Reductions In Amount Due to Seller
1,000.00 501. Excess deposit (see instructions)
146,197.00 502. Settlement charges to seller (line 1400)
504. Pa off of first mortgage loan
505. Pa off of second mortgage loan
506.
507.
7,572.42 508. Seller Assist
509.
209.
Adjustments for items un aid b seller
Adjustments for items un aid b seller 510. Cityltown taxes to
210. Cityttown taxes to
511.
County taxes to
211. County taxes to
512.
Assessments to
212. Assessments to
513.
213.
514.
214. 515.
215.
516.
216.
511.
217.
518.
218. 519.
219.
154,769.42
520.
Total Reduction Amount Due Seller
220. Total Paid b /for Borrower 600. Cash at Settlement bolfrom Seller
300. Cash at Settlement iromlto Borrower
42
019
159
601 Gross amount due to seller (line 420)
301. Gross amount due from borrower (line 120) .
, .
Less reductions in amount due seller (line 5
302. Less amounts paid bylfor borcower (line 220)
154,769.42
602.
Seller
~] F
^
h Xn From To Borrower
C 4,250.00 603. rom
Cash X~ To
wretl to wr
t ~e
303.
Ine FuD~
lne lo'm
aeroeme as
w i2epo~Ong yurtlen N' In's coeecbon o1,MOrmaUpn n esUmeteO et 37 m!nNea per resopnee
a ea it O~epa e e cu'•enti tl OMN wnVO~ numoa No wnlitlentmnly n esewetl. lrne M
y y.o~
m pmceas vl
an0 raporbnp In
br W'¢cl~np re evnrig
wWaure ,a mentlelury Trna o tlee~gnetl
e tlata lore
b provitle !r
y
agency mey not w~~ecl Ima'nlormeLOn, anti you ere no
ya pe~l~ea b e RES VA wve~atl ~e'neclgn vel!r'nlo,maLan tlunng yle
263.05
1,643.45
34.78
151,941.28
14,867.68
7,572.42
22,460.10
151,941.26
22,460.10
129,481.18
HUD-1
Page 1 or 4
Previous editions are obsolete
Total Real Estate Broker Fees 58,855.00
700 Paid From Paid From
'
. Borrower's Seller
s
Division of commission line 700 as follows Funds at Funds at
625.00 >o RemaxRealry
701. $4
,
to Help U Seil Detwiler Settlement Settlement
702. $4,230.00 8,855.00
703. Commission paid at set0ement
704. ~
Items Pa able in Connection with Loan
600
.
801. Our origination charge (Includes Origination Point 0.000% or $0.00) $961.88 (from GFE #1)
Your credit or charge (points) for the specific interest rate chosen $
802 (from GFE #2)
. (from GFE A) 961.88
803. Your adjusted origination charges (from GFE #3) 425.00
804. Appraisal fee tD Central Penn A sisals
Credit report to CBC INNOVIS
805 (from GFE #3) 12.65
.
Tax service to Orrstown Bank
806 (from GFE #3) 75.0(
.
807. Flood certification to CBC INNOVIS (from GFE #3) 10.00
806. to
900. Items R wired b Lender to be Paid in Advance
53001day
0712912011 to 08!0112011 @ $18
f
!from GFE #1D)
55.59
.
rom
901. Daily interest charges from (from GFE #3) 1,447.50
902. Mortgage insurance premium for months to De t of HUD (from GFE #11) 375.00
903. Homeowner's insurance for ears to Erie Insurance
904. months to from GFE #11
1000. Reserves De osited tMth Lender
(from GFE #9)
546.60
1001. Initial deposit for your escrow account
1D02. Homeowner's insurance 4 months $ 31.251month $125.00
1003. Mortgage insurance months $ 137.721month $
1004. Pro ert taxes months $ Imonth
1005. County taxes 7 months $ 93.751month $656.25
1006. Assessments 3 months $ 148.301month $444.90
~nrn een.nnata Adiusimant $-679.55
1200. Government Recordin and Transfer Char es
00
140
1201. Government recording charges $ (from GFE #7) .
1202. Deed $54.00 Mort a e $66.00 Reiease $ _.
(from GFE #8)
1,500.00
1203. Transfer taxes $
1204 CirylCounry taxlstamps Deed $1 500.00 Mortgage $__
1,50D.00
1205 State Taxlstamps Deed $1 500 00 Mortgage $ __
1206 Deed $ Mort a e $ Release $
.
1207. Parcei Identification Fee $20.00
1300. Additional Settlement Char es
(from GFE #6)
13D1. Required services that you can shop for
1302 to
.
1303 PesURadonMome Inspections to Inspection Center $415.00 P.O.C.(B")_
1,779.5
1304. 2011-12 School Taxes to Jud Prowell 399.00
1305. Home Warranty to First American
745.00
1306. Radon Mitigation to Mike Sheet Home Ins action 5.0
1307. Tax Cert Fee to Saidis Sullivan & Ro ers
675.00
1308. Property Services Reimbursement to Ga Muccio
739.09
1309 Electrical Services to R.L. Snelbaker Inc.
285.00
1310 , Replace Floor joists to SPS Pro a Services Grou
,.tea ,.
rulO ty ~,t nay as
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'Paid ou4side of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. "'Credit by seller shown on page 1
Previous editions are obsolete Page 2 of 4
Good Faith Estimate MUD•1
Com orison of Gootl FaithEatimata GFE and HUD•1 Bhsr es HUD•1 line Number
iChar es ThatCannottncreaee # 601 1,036.88 961.88
Our origination charge 0.00 0.00
YpurCretlitpr charge (points) for the specibc interestrate chosen # 803 1,036.88 961.66
Your adjusted origination charges # 1203 1,500.00 1,500.00
'?.Transfer taxes
Cha es-That in Total CannotincreaseMoreThan 10% # :1201
Government recording charges ~ 804 '
ApPraisatfee # tiDS
Creditreport # 606,
Tax seNice # BO7
Flood ceriificatiom # 902
Mortgage insurance premium # .1101
Title services-and lender's title insurance # 1.103
nw~Rrk title insurance
Char es That Can Chan e # .1001
Initiatdeposit fpr,yourescrow account # 901 $18.53001c
Qaily intarestchargesfrom q 903
Homeowner's insurance
Gootl Faith`ts6mate HUD•1
2 874 97 546.60
55.59 55.59
600.00 375.00
Loan Terms
Your initial loan amount is
$146,197.00
Your loan term is 30. years
Your initial interest rate is
4.6250%
Your ihibal monthly amount owed for pnncipal, interest, and any mortgage
i $889.36 includes
X^ Principal
s
.insurance X^ Interest
X^ Mortgage Insurance
X^ No. ~ Yes, it can rise to a maximum of %. The first change
Can your ihterest rate rise? will be on 1 I and can change again every years after / I .Every change
date, your interest rate can increase or decrease by °k. Over the life of the loan, your
interest rate is guaranteed to never be lower than % or higher than °~
e?
c
X^ No. ~ Yes, it can rise to a maximum of $
e ns
Even if you make payments on time, can your loan balan
can your monthly amount owed for
nts on time
m X^ No. ^ Yes, the first increase can be on / 1 and the monthly
,
e
Even if you make pay
.principal, interest, and mortgage insurance rise? amount owed can rise to $
The maximum it can ever rise to is$
X^ No. ^ Yes, your maximum prepayment penalty is $
Does your loan have a prepayment penalty?
X^ No. ^ Yes, you have a balloon payment of 9. due in
Ooes your loan have a balloon payment?
years on I 1
Total monthly amount owed including escrow account payments ~ You do not have a monthly escrow payment for items, such as property taxes
ay these items directly yourself.
must
Y
'
p
ou
s insurance.
and homeowner
X^ You have an additional monthly escrow payment of $411.02
that results in a total initial monthly amount owed of $1,162.66. This includes principal, interest, any
mortgage insurance and any items checked below:
X^ Property taxes ~ Homeowner's insurance
Flood insurance ^
n n
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
HUD-t
Page 3 or 4
Previous editions are obsolete
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belie(, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. 1 further certify that I have received a copy of the HUD-1 Settlement Statement.
Jason W. Hemperly
Michele A. Sironen
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be
disbursed in accordance with this statement.
DATE
SETTLEMENT AGENT
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
HUD-1
Page 4 of 4
Previous editions are obsolete
Sovereign Bank
ESTATE OF Patricia D Kmetz
SOCIAL SECURITY #: 579-48-4700
DATE OF DEATH: December 12, 2010
Account #: 0578245938 Type IRA -Open date: 6/19/2007
In the name of: Patricia D Kmetz
Date of Death Balance: $10,948.53
Int.(YTD) from 1 /1 /2010 to 11 /30/2010 _ . $107.40
Accrued interest to date of death: $2.73
Other Info: Benif. Michele A Sironen
Page 1 of 1
Law Offices of
SAIDIS, SULLIVAN & IZOGERS
A PROFESSIONAL CORPORATION
635 NORTH 12TH STREET, SUITE 400
ROBERT C. SAIDIS LEMOYNE, PENNSYLVANIA 17043
DANIEL L. SULLIVAN TELEPHONE: (717) 612-5800 - FACSIMILIE (717) 612-5805
ELYSE E. ROGERS EMAIL: attorneyQssr-attorne sy com
JOHN A. FEICHTEL www.ssr-attorneys.com
DEAN E. REYNOSA
TODD F. TRUNTZ
MARYLOU MATAS
JASON E. KELSO
September 8, 2011
CERTIFIED MAIL R/R/R
Register of Wills of Cumberland County
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Patricia D. Kmetz
Date of Death: December 12, 2010
File No. 2011-1230
Dear Madam:
Enclosed herewith please find the following:
1. Pennsylvania Inheritance Tax Return (in duplicate);
2. Inventory; and
3 Check in the amount of $30 for your filing fees.
CARLISLE OFFICE:
26 WEST HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
Of Counsel
JOHN E. SLIKE
JOHN B. LAMPI
REPLX TO LEMOXNE
~ 7 ~~ 61=8
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c.~~~„ mssr-attorneys com
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Please time stamp the enclosed extra copy of this letter. A return envelope is
enclosed for your use.
If you have any questions or require additional information, please do not
hesitate to contact me.
Sincerely yours,
~~
Cayl D. Swindler
Legal Assistant to John E. Slike
cjr
Enclosures
cc: Michele A. Sironen
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
~
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COUNTY, PENI'~~:,~A1~1IA~ ; , ~ ? , . r,
COMMONWEALTH OF PENNSYLVANIA 1 SS CL~R~( (~F
COUNTY OF CUMBERLAND f File Number 2Q11-1230 A ,
Personal Representative(s) of the Estate of Patricia D. Kmetz
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Dece~i~~I Awned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the er-d of this inventory.
I verify that the statements made in this Inven- ~~G,h e~~ ~` _~~ ~,,.~ ~ ~~
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of ~ ,
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) John E. Slike
(Supreme Court I.D. No.) 6262
(Address) Saidis, Sullivan & Rogers, 635 North 12th Street, Suite 400, Lemoyne, PA 17043
(Telephone) 717-612-5800
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
December 12, 2010 418 East Green Street, Shiremanstown, PA 17011 579-48-4700
FIGURES MUST BE TOTALED I
M&T Checking Account 51941023 6,845.68
Interest on M&T Checking Account 0.01
M&T Bank Savings Account #15004208619039 3,275.11
Interest on M&T Bank Savings Account 0.02
AmeriChoice Savings Account #17753(01) 6,714.68
AmeriChoice Savings Account #17753(02) 10,757.55
AmeriChoice Money Market Account 17753(18) 18,077.57
M&T Bank CD 11,124.01
Interest on M&T Bank CD 37.55
AmeriChoice CD 17753(62) 17,418.62
Misc. Household Items 2,175.00
Jewelry 1,200.00
Nationwide Insurance 107.30
SBC Card Refund 111.15
Patriot News Refund 151.80
2005 Chevrolet Malibu LT Maxx Hatchback 7,575.00
(Attach additional sheets as needed)
TOTAL: I 85,571.05
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election ~~f the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ~' 3301(b))
Form RW-09 rev. 10.13.06
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