HomeMy WebLinkAbout09-28-111505610143
REV-1500 Ex (D, _,D>
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code near File Number
Bureau of Individual Taxes DEPARTMENT Of REVENUE
Po Box.28oso~ INHERITANCE TAX RETURN 21 10 0767
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
05 23 2010 O1 17 1913
Decedent's Last Name Suffix Decedent's First Name MI
BISHOP EDNA J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C 1. Original Return C, 2. Supplemental Retum j~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~, 4a. Future Interest Compromise ~ 5. Federal Estate Ta>; Return Required
(date of death after 12-12-82)
6 Decedent Died Testate ~, ~~ (geiaoheC py Hof T~ust)a Living Trust _ ~ __ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
9. Litigation Proceeds Received ~ 10 betDwueen P2v3rt~Ca ddit,(datge5of death ice] 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION :iHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L GRIFFIE (717) 243 5551
n --
. _ _,-r
First line of address
200 NORTH HANOVER ST
Second line of address
City or Post Office
CARLISLE
Correspondent's a-mail address:
State ZIP Code
PA 17013
-- J
REGISTER OF ~L.LS USA"ANLY, -
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_,~ .
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= _~
,,
DATE FILED
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~~
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is t e, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer teas any knowledge.
SIGNA URE OF PERS9N SIBLE R FILING RETURN DATE
I ,c~~ C~.~
_. 4'ttY (~~_' c ' %Yt , C~Y:!'l"_ nson ~ ~~j_//
1882 Orchard Road, Chambersburg, PA 17202
SIGNATURE OTHER THAN REPRESENTATIVE DATE
Bradley L. Griffie 9~i'7/ / ~
~209'North Hanover Street, Carlisle, PA 17013
Side 1
15D5610143 15D5610143 J
~~~~
1505610243
REV-1500 EX
Decedent's Social :''>ecurity Number
DecedenrsName BISHOP, Edna J
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... . 1. S33 , 600.00
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ . 3.
4. Mortgages & Notes Receivable (Schedule D) ....................................................... . 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 5 , 933.12
6. Jointly Owned Property (Schedule F) U Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous -Probate Property
(Schedule G) :Separate Billing Requested............ 7. 5 , 5 94.8 9
8. Total Gross Assets (total Lines 1-7) ................................................................... .. g. 105 , 128.01
9. Funeral Expenses & Administrative Costs (Schedule H) .............................. ......... 9. .L7 , 458.03
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..................... ......... 10. 2 4 7 , 532.65
11. Total Deductions (total Lines 9 & 10) .......................................................... ......... 11 2 64 , 990.68
12. Net Value of Estate (Line 8 minus Line 11) ................................................. ......... 12. -15 9 , 8 62.67
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................................... ......... 13.
14. Net Value Subject to Taz (Line 12 minus Line 13) ...................................... ......... 14. -15 9 , 8 62.67
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
0
0 0
16
at lineal rate X .045 . .
17. Amount of Line 14 taxable
at sibling rate X .12 0 • 00 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18.
19. Tax Due ........................................................... ...................................................... . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
0.00
0.00
0.00
0.00
0.00
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-10-0767
DECEDENT'S NAME
BISHOP, Edna J
STREET ADDRESS
1 Longsdoff Way
CITY i STATE
Carlisle PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1)
Total Credits (A + B) (2)
3. Interest
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
0.00
0.00
(5) ~.00
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 :............................................................................... ^
b. retain the right to designate who shall use the property transferred or its income :................................ ir_~
c. retain a reversionary interest; oc .............................................................................................................. [_'
d. receive the promise for life of either payments, benefits or care? ............................................................ ^__ ~I
2. If death occurred after December 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? .................................................................................................................. _x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for tlhe use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. 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.
Rev-1502 EX+'~11-OS) '
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
BISHOP. Edna J 21-10-077
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 :schedule A (Rev. 11-08)
Rev-1508 EX+'(5-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF (FILE NUMBER
BISHOP, Edna J 21-10-0767
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Coins/Silver Dollars 1,071.00
2 Checking Account No. 5140343059, PNC Bank -see attached statement 3,074.39
3 Cumberland Crossing Personal Care Account refund 339.12
4 The Sentinel refund -Newspaper subscription refund 38.77
5 Homeowner's Insurance Premium refund 51.00
6 Capital Advantage Insurance Company premium refund 174.24
7 Household furnishings (auctioned) 1,184.60
TOTAL (Also enter on Line 5, Recapitulation) I 5,933.12
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
ESTATE OF (FILE NUMBER
BISHOP, Edna J 21-10-07(17
I nls scneoule must be completed and tiled It the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THELDATE OF^TRANSFERSATTACH A COPYEOF TORE DEED FOOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICAI3LE) TAXABLE
VALUE
1 New York Life Insurance Company -Annuity Policy 5,594.89 100.000% 0.00 5,594.89
No. 74 700 901 (see attached statement)
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
5, 594.89
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (10-06)
COM IN~ ERITANCECT~ RETURN ANIA
- _ RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
BISHOP, Edna J 21-10-076i'
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M R
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
3,427.22
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Jane C. Johnson
Street Address 1882 Orchard Road
city Chambersburg state PA Zia 17202
Yearls) Commission paid 4,900.00
2. Attorney's Fees Griffie 8~ Associates 5,000.00
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 544.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 3,586.31
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 17,458.03
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUME3ER
BISHOP, Edna J 21-10-07f>7
ITEM
NUMBER DESCRIPTION AMOUNT
1 Nickle Funeral Home 3,010.77
2 Rice Memorial Work (inscription) 135.00
3 Ann Smith (reception fees/fellowship meal) 281.45
4 The Sentinel -Advertising 187.E
5 Cumberland Law Journal -Advertising 75.00
6 L.W. Brodisch -Real Estate Appraisal 350.00
7 Penelec -Electric Service 107.32
8 Farmers Mutual -Homeowner's Insurance Premium 210.00
9 2010-2011 Real Estate Taxes 1,106.45
10 Ben King -Trash removal 550.00
11 Reserves 1,000.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150(1 Schedule H (Rev. 6-98)
Rev-1512 EX+~t2-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8t LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BISHOP, Edna J 21-10-07E>7
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cumberland Crossing Nursing Home - (April/May 2010 Services) 1,039.82
2 Overpayment of VA Benefits refunded 90.00
3 Expenses associated with maintenance of real estate prior to death - 7,029.75
(See attached copy of Note)
Real Estate taxes $4,825.45
Home owner's Insurance $ 840.00
Penelec (electric service) $ 364.30
Tree Removal $1,000.00
4 New York Life -Reimbursement of Annuity overpayment 91.96
5 United States Treasury -Personal taxes 2010 180.00
6 Pennsylvania Department of Public Welfare - (Medicaid -Estate Recovery) 239,101.12
TOTAL (Also enter on Line 10, Recapitulation) I 247,532.65
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
SCHEDULE J
COMMNHERITANCE TAX RET~JRNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMIBER
BISHOP, Edna J 21-10-07617
NAME AND ADDRESS OF RELATIONSHIP TO
SHARE OF ESTATE
AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
1 Patricia R. Lehman Daughter one third 0
00
373 Roxbury Road .
Newville, PA 17241 (Insolvent Es
2 Ann L. Smith Daughter one third
860 East Louther Street 0.00
Carlisle, PA 17013 (Insolvent ES
3 Jane C. Johnson Daughter one third 0
00
1882 Orchard Road .
Chambersburg, PA 17202 (Insolvent Es
Total
Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o ~r iate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
tate)
tate)
tate)
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~~
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 :schedule J (Rev. 11-08)
~~z~~ ~i1I ~n~ C~TP~t~mPnt
OF
EDNA J. BISHOP
I, EDNA J. BISHOP, of Room No. 131B, Cumberland Crossing, 1 Longsdorff
,~
`l
Way, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this to be my Last Will and
Testament, hereby revoking and making void all previous Wills and Codicils heretofore
made by me.
FIRST
I order and direct my Executor hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my
estate, including all taxes that may be assessed in consequence of my death, as soon after
my death as is reasonably possible from the proceeds and assets of my estate prior to any
other distributions. However, my Executor need not accelerate and pay those unn-latured
obligations which, in his, her or its opinion, it might be proper and more advantageous to
retain or renew and pay as they become due and payable. If I do not own a burial plot o1•
a grave marker at the time of my death, I authorize my Executor/Executrix, in his, leer or
its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my
grave, and to expend sums from my estate for this purpose.
200 NORTH HANOVER STREET
CARLISLE, PA 17013
GRIFFIE & ASSOCIATES
ATTORNEYS AT LAW
Page 1 of 8
74 NORTH MAIN STREET
SUITE 307
CHAMBERSBURG, PA 17201
SECOND
I give, devise and bequeath my entire estate of whatsoever nature and
wheresoever situate, together with all irisuran~~ proceeds thereon, in equal shares to my
children, PATRICIA LEHMAN, JANE C. JOHNSON and ANN L. SMITH, who
survive me by sixty (60) days, per stirpes. I direct my Executor/Executrix to divide
among such beneficiaries all personal property of a sentimental or family nature
(excluding cash, stocks, bonds and the like), including but not limited to jewelry,
household goods, antiques, fi.~rniture and memorabilia, in accordance with a separate
memorandum which I may place with my Will or deposit with my attorney. In the
absence of such disposition by memorandum, I direct that the said tangible personal
property be divided between my residual beneficiaries with due regard for their personal
preferences in as nearly equal shares as practical, with the value of such dispositions
being credited to the share of each respective recipient. If the said beneficiaries dc> not
.~;
~,; agree to the division of the personal property provided for hereunder, the decision of my
Executor/Executrix, including the decision to sell the property at public or private sale
and distribute the proceeds therefrom as provided hereinafter, shall be final and
conclusive on all parties.
THIRD
Any devise or distribution under this Last Will and Testament which is payable to
any beneficiary who may be under 25 years of age or, in the judgment of my
Executor/Executrix, mentally disabled, shall be held in a separate trust by my
Executor/Executrix as trustee until such beneficiary reaches 2S years of age or during
such period of disability. In the case of a beneficiary under 2S years of age, the Trustee
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street 38 N. Maim Street
Carlisle, PA 17013 Page 2 of 8 Chambersburg, PA 17201
may distribute up to one-half (1/2) of the then remaining principal and accumulated
income on the request of the said beneficiary, at or after attaining 21 years of age; and up
to the entire remaining balance of principal anu accumulated interest at or after attaining
25 years of age. During the term of any trust created pursuant to this Paragraph, the
Trustee is authorized to expend and apply so much of the net income and principal of
each such trust as the Trustee shall consider advisable for the health, maint~°nance,
support, and education (including college education, undergraduate and graduate) of each
such beneficiary until he or she attains 25 years of age, or until all such amounts are paid
out of trust. I direct that no Trustee shall be required to give or post bond for the :faithful
performance of the Trustee's duties in this or any other jurisdiction.
~= FOURTH
F ~~
w
`~ I grant my Executor/Executrix the following powers in addition to and not in
limitation of such powers as my Executor/Executrix shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect thereto;
to deposit investments under agreements and pay assessments; and generally
to exercise all rights of investors, including but not limited to, the voting of
shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real.
estate held or owned by my estate.
(d) To operate any business that I may own at my death,
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street
Carlisle, PA 17013
Page 3 of 8
38 N. Main Street
Chambersburg, PA 17201
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule ~f law in his, her or its absolute discretion,
it being my intention to give my Executor/Executrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
~~' absolute discretion.
.~~'
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
~`~ security.
(h) To compromise claims without court approval including, but not limited to,
any controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that
may pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my (;state.
(j) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt managerrcent of
the settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
GRIFFIE c$ ASSOCIATES
Attorneys At Law
200 N. Hanover Street 38 N. Maih~ Street
Carlisle, PA 17013 Page 4 of 8 Chambersburg, PA 17201
i
own right, upon such terms and conditions as to him, her or it may sef;m best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last V~lill and
Testament.
FIFTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor- shall
any beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary.
~- SIXTH
I nominate, constitute and appoint my daughters PATRICIA LEHMAN, JANE
~ C. JOHNSON and ANN L. SMITH, or their survivors, as Co-Executors of this my
Last Will and Testament. I d;rect that my Co-Executors shall not be required to give or
post bond for the faithful performance of his, her or its duties in this or any other
jurisdiction.
SEVENTH
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street 38 N. Main Street
Carlisle, PA 17013 Page 5 of 8 Chambersburg, PA 17201
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of eight (8) typewritten pages, the first five (5) of which
bear my signature on the side margin, for purpose of identification, this
~_~
day of ~,,,, rig ~ , 2002.
:~/
SS: /~ - Q ~'~
~CiLf~ try /" ~`~~' ";~ _
' EDNA J. BISH P
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street
Carlisle, PA 17013
Page 6 of 8
38 N. Main Street
Chambersburg, PA 17201
S
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
SS.
COUNTY OF CUMBERLAND
I, EDNA J. BISHOP, the Testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
~ ~
~ ~'
EDNA J. BIS OP
Sworn or affirmed and acknowledged before me by EDNA J. BISHOP the
day of / ~ ~~ ~~'~~' S~ , 2002.
Testatrix this , . ~~~
~ ,; ,~,
/~ i .~ is
~..--
r
Notanal Seal 3
Karisa J. Lehman, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Aug. 25, 2003
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street 38 N. Maim Street
Carlisle, PA 17013 Page 7 of 8 Chambersburg, PA 17201
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS.
WE, _~~~~~-, L~G~,~~ and ~~r~ ~ `~``~ ,~-~ ,
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and
execute the instrument as her Last Will and Testament; that she signed willingly and that
she executed it as her free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testatrix signed the Last V~Jill and
Testament as witnesses and that to the best of our knowledge the Testatrix wars at the
time 18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
and ~~ ~~;,~ ~, ,~Zf, ~,-Y-,~ this
'~ Notarial Seal
Karisa J. Lehman, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Aug. 25, 2003
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street
Carlisle, PA 17013
Page 8 of 8
38 N. Main Street
Chambersburg, PA 17201
lam' (/C `./" / ~' / ~ ~'' ~- ~ ~1/~c~
Ndtary Public
rrewo~s edlhons are obsolete
form HUD-1 )3/B6i rat Handbook 4305.2
A
Settlement Stateme
t
LAW OFFICES .
n
il\ Y Y 1N ~
~l` 1VIcKN~GHT' U.S. Department of Housing and Urban Developrnent
OMB No. 2502-0265
_
B. TYPE OF LOAN
WEST POMFRET PROFESSIONAL BUILDING 1. FHA 2. OFmHA 3. ^Conv. Unins.
60 WEST POMFRET STREET 4. OVA 5. OConv. Ins.
CARLISLE, PENNSYLVANIA 17013-3222
6. FILE NUMBER __
7. LOAN NUMBER
(717) 249-2353 TROSTLEC6-11
-
8. MORTGAGE INSURANCE CASE NUMBER
s orm is amts a etve you a s amen ac u se amen cos ou psi o an
C. Hole: ue marked ")p.o.c.)" w repaid outside ma closing; may era shown he tar Inrormation purpn
WARNING: It is a crime to knowingly make false statements to the United States on mis or any o y e se amen agen are s own.
aea and are not ItKwaed In me cowls. TitleExpress Settlement System
ther slmiwr Conn
Penalties u
on
nvrction can Inane a rn. and im rteonm.nt For aewas see: rue to u. s. cnde secdon toot .
p
and section mm. Printed 06/03!2011 at 10:04 JMR
D. NAME OF BORROWER: CAROLE G. TROSTLE
ADDRESS: 600 CRANES GAP ROAD, CARLISLE PA 17015
_
E NAME OF SELLER, EDNA J. BISHOP - -----
ADDRESS:
F. NAME OF LENDER: -----
ADDRESS: _
G. PROPERTY ADDRESS: 420 DRONEBERGER ROAD, Blain, PA 17006 ----
ToboyneTownship
H. SETTLEMENT AGENT: I&M REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717.249.6354
PLACE OF SETTLEMENT West Pomfret Professional Bldg 60 West Pam_fret Street, Carlisle PA 17013
I. SETTLEMENT DATE: 06103/2011 -"-
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION
:
100. GROSS AMOUNT DUE FROM BORROWER _
____
400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice
93 600.00
401. Contract sales rice _ _
93 600.00
102. Personal Pro art 402. Personal Pro art __
103. Settlement char es to borrower line 1400
3 153.47
403. ____
104. 404. -----
105. 405.
Ad~usiments for items aid b seller in advance Ad'ustments for items aid b seller in advance
109. __ 409. -----
__.-. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 96 753.47 420. GROSS AMOUNT DUE TO SELLER
93
600
00
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER _
,
.
500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De sit or earnest none
501. Excess De osit see instructions ____
202. Princi al amount of new loans
502. Settlement char es to seller line 1400 ___
1 106
45
203. Existin loans taken sub'ec( to 503. Existin loan s taken sub'ect to .
204. _,-
504. Pa off of First Mort a e Loan ___
205.
-- -
505.
206.
-
506. -----
207. -- _
507. Public Welfare d b seller
208.
---
508. ---
209.
- -
509. ----
Adjustments for items un aid b seller Adjustments for items un aid b seller
213. 513. ---
214. 514. -----
215.
515. ------
216.
-
516. _ -_-
217. _
517.
-----
218. -- __
518. ----
219. 519. ----
220. TOTAL PAID BYlFOR BORROWER 520. TOTAL REDUCTION AMOUNT DUE SELLER _1106
45
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE .
R
301. Gross amount due from borrower line 120 96 753.47
601. Gross amount due to seller line 420 __
93 600.00
302. Less amounts aid b /v for borrower line 220 602. Less reduction.amount due seller line 520 _. 1106.45
303. CASH FROM BORROWER 96 753.47 603. CASH TO SELLER 92 493.55
Previous etlitions are obsolete
form HUD-1 (3/86) ref Flantlbook 4305.2
U S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: TROSTLEC6.11 PAGE 2
SETTLrMENT STATEMENT
TitleEx ress Settlement S stem
L. SETTLEMENT CHARGES Panted 06103!2011 a
PAID FROM t 10:04 Jty1R _
P
_ __
700. TOTAL SALES/BROKER'S COMMISSION based on price $93 600 00 =
BORROWER'S AID FROM
'
Division of commission (line 7001 as follows
FUNDS AT SELLER
S
_
701. $ _-_.. to
SETTLEME FUDJDS AT
702. $ to ---- NT SETTLEMENT
703, Commission paid at Settlement - - -
800. ITEMS PAYABLE IN CONNECTION WITH LOAN -- ----
801. Loan Ori inafion Fee / ----
802. Loan Discount __ _ / -- -----
803. A raisal Fee__ ---- - ------
804. Credit Re ort --- -------
805. Lender's Ins action Fee -- -----
806. Mort a e A lication Fee -- -- - ----
807. Assum tion Fee _ - ------
808, - ------
---
810. ---
811. -- ------
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE ------
901. Interest From _ to (~$ lday ----
902. Mort a e Insurance Premum for to -----
903. Hazard Insurance Premium for to -----
904. _ -
905 - -----
1000. RESERVES DEPOSITED WITH LENDER FOR -----
1001. Hazard Insurance mo. Imo ---~
1002. Mort a elnsurance mo, Imo ---~
1003. Cit Pro ert Tax mo. !mo ---
__
1004. Count Pro ert Tax mo. !mo ----
1005. School Tax _ mo to $ Imo ---
__
1009. A re ate Anal sis Ad ustment 0.00
1100. TITLE CHARGES 0.00
---
1101. Settlement or closin fee ----
1102. Abstract or title search -
1103, Title examination - ------
1104. Title insurance binder - -- -----
1105. Document Pre aration - --- --- - -
1106. Notar Fees
- -
1107. Attorne 's fees -
includes above items No: _ ---
~ -
_ 10.00
800.00 ------
____
---------
1108. Title Insurance -
--- - ------
includes above items No:
~ -----
_
-
1109. Lender's Covera e $ NONE - ---
1110. Ownets Coverage $ 93 600.00 - -
1111. ---
-- --__-_--
1112, -__.
1113. _ --- ____
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES --
1201. Recordin Fees Deed 52.00 Mort a e Release
1202. Cit !Count tax/stam s Deed $936.00 Mort a e
1203. Stale Tax/stam s Deed 936.00 Mort a e
1204. __ 52.00
936.00
936.00 __ ____
__
-___-
1205. --- --____.
1300. ADDITIONAL SETTLEMENT CHARGES -- -` ----
1301. Surve _ -- -~- --- ___-
1302. Pest Inspection __ --------
1303. back taxes _ to TAX CLAIM BUREAU
1304. 2011 CO TWP TAXES to BARBARA•ANN HERR TAX COLLECTOR ~
1305. Clean & Green Amendment to RECORDER OF DEEDS
1306.
---
- 400.97
18.50 11106.45
____
-__--
1307. --__-
1308. -- ___ _
1400.TOTAL SETTLEMENT CHARGES (enieron lines 103 Section J and 502 Section K) _-
3153.47 -------
1,106.45
'rhave carefully reviewetl Ne MUD-t Settlement Statement and to the best of my knowletlg and belief, it is a true and accurate statement or all receipts and disbursements made on my account or by r
this/t/rn' n~syac~tion.%.ILryu/r~~M~er~ certify that I have re ei d a copy !the HUD-1 Settlement Statement.
EDNA J.B P /
9tP ~ ~~ J
Y: ,
WARNING: Ii IS A GRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HU0~1 S ement Sta ant which I hav preparetl is a true and accurate account of this transaction.
UNITED STATES ON THIS OR ANV SIMILAR FORM. PENALTIES UPON CONVICTION I have caus r will ea tha tuntls to be boned in accordance with Mis statement.
CAN INCLUDE A FlNE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 7010.
_( ~ ~~~
DATE
Jdfl. LI, LUI I I I:JUnin iivv union lit rv~ cr~r •••• ~ „~ •. ,
~PNC
January 21, 2011
Griffie & Associates
200 N Hanover St
Carlisle, PA 17013
RE: Edna J Bishop
DOD: OS-23-2010
Dear Sir/Madam:
In response to your re9uest for Date o>; Death (DOD) balances for the customer noted above, otu
records show the following:
Checking Account
Account# 5140343059 Established: 12-27-11988
EDNA J BISHOP
DOD balance: ~ 3,99b.26 non interest bearing
Please note that this office provides date of death balances for deposit accounts (JRAs, CDs, Checking and
Savings). We do not process any financial tran9ections or provide statements. If you need assistance with
any of these items, please cell 1-888-PNC-BANK {1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
This message is intended far the use of the individual or entity to which it is addressed and may
contain information that is privileged, conf dentin! and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible j'or
delivering this message to the intended recipient, you are hereby noNf:ed thpt any dissemi»ation,
distribution or copying of this communications is strictly prohibited. If you have received this
communication in error, please note me immediately by reply or by telephone at 800-76Z-1775 and
immediately destroy this faxed document.
Page 1 of 1
The Co»rpmr~~ Yorr KeepOO
NOVEMBER 2, 2010
GRIFFIE & ASSOCIATE, ATTORNEYS AT LAW
ATTN: BRADLEY GRIFFIE, ESQUIRE
200 NORTH HANOVER STREET
CARLISLE PA 17013
Annuitant(s): Edna Bishop
Policy(s): 74 700 901
Claim No.: 213514
Dear Mr. Griffie:
New York Life Insurance Company
New York Life Insurance and Annuity Corporation
(A Delaware Corporation)
NYLIR>; Insurance Company of Arizona
(Not licensed in every state)
P.o. Box 130539
Dallas, TX 75313-OS39
]-800-695-1314
iviviv. ne+rryorklife. can
Agent/Representative:
We are pleased to reply to your request for tax information on the above annuity(s).
Please be advised that Form 712 is only used in the filing of Estate Tax for Life Insurance
Contracts. However, the following information should be of assistance to you:
Annuity Policy Number: 74 700 901
Issue Date of Annuity: November 4, 2005
Value as of Date of Death: $5,594.89
Beneficiary(s): Jane C. Johnson
We hope this information will be helpful to you. If you have any questions, please
contact us at the toll-free number above.
Sincerely;
Customer Service Claims
cc Terry Urich v39
Lowell Frantz v3 9
NOTir
Edna .l. Bishop of Cumberland Crossing One Longsdorff ~%a}~. Carlise_ Pennsrl~°ar:iia
'`Maker'~_ promises to pay, or directs her estate to pay_ ;lane C. Johnson of l ~tl? Or;;:tiard
Road. Chan~hersburg. Franklin Count}~. Pennsvh~ania, an~~ and al] sums that she ad~.~~a~~ces
for real estate taxes, real estate insurance, and routine maintenance for the property
owned b~~ me in Perr~• County, known as the "Cabin'' from the date o1~ signature of this
document b~~ me forward. It is anticipated that my daughter, cane C. Johnson, shall assist
me financially b}~ paying the taxes, insurance, and routine maintenance costs on the
cabin. as it is my desire to retain that real estate for my eventual return. or in the
altenlative to retain ownership of the property. so that at the time of my death it is
available for distribution to my heirs or for sale by my heirs, as they might desire. In
discussions with my daughter, Jane C. Johnson, we have agreed that she will establish a
separate real estate checking account. into which she will place her own funds solely for
purposes of malting payments of the aforesaid expenses associated with maintenance of
the cabin property. She shall retain receipts for the payment of expenses associated with
maintenance of the property as aforesaid. In the event I accrue additional income or
assets that allow for me to reimburse Jane C. Johnson for these expenses. I will do so
prior to my death. In the event that there is no proof available of me paying said
reimbursements to my daughter. I direct that my estate shall consider the expense that she
incurs in maintaining the property, as an expense of mine and; therefore. of my estate, to
be paid as all of my just debts are paid.
In the event that there are not sufficient assets to compensate my daughter. Jane C.
Johnson, for these expenses. I specifically direct that the sums due to her ma~~ be
collected as a secured indebtedness against. the aforementioned real estate.
Interest shall not accrue on any such indebtedness; rather. only the face of amount paid
for maintenance of the property in the manner here and before described shall be due.
IN WITNESS WHEREOF, Maker hereby sets forth her hand and seal the day and
year hereinafter written, hereto. Legally binding her, as well as her estate. her
heirs, executors, and assigns.
1 :.. '~ l r
-i ~ ~ --~
( !_~,~ / ,,.~ °=° Date EDNA .l. BISHOP
,-
(__~;, ,-
Sworn and subscribed to
Before nne this J'~?~'+ day
of .'~ 2006 Imo/
'" __ ~-c-d--~_L ~yL~
N ota~`}' ~ j
NOTARIAL SEAL
ROBII~1. GOSHDRN, NOTARY PUBLIC
CARLISLE BORO„ CUM6ERLAND CDLINTY
MY COMh91S510N EXPIRES APRIL 17 2007