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HomeMy WebLinkAbout10-27-111505610143 REV-1500 Ex (01-10) ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes DEFARTMENTOFREVENUE County Code Year File Number Po Box.2aosol INHERITANCE TAX RETURN 21 11 0245 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198 22 8467 02 11 2011 02 03 1929 Decedent's Last Name Suffix Decedent's First Name MI BURKETT MARGARET M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI BURKETT CLARENCE Spouse's Social Security Number THIS RETURN M UST BE FILED IN DUPLICATE WITH THE R EGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW L~ 1.Original Return ~ 2. Supplemental Return f J 3 Remainder Return (date of death _ prior to 12-13-82) J 4. Limited Estate ~~ 4a Future Interest Compromise (date of death after 12-12-82) II Federal Estate Tax Return Re IrJ 5. quired ,~ 6. Decedent Died Testate (Attacn Copy of wiu) , ~ Y Decedent Main ained a Living Trust (Attach Copy o~Trust) 0 -- _ g. Total Number of Safe Deposit Boxes L~ g. Litigation Proceeds Received ~; 1 C. Spousal Poverty Credit date of death between 12-31-91 and t<-1-95) L ~ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARIELLE F HAZEN ESQ 717 540 4332 First line of address 2000 LINGLESTOWN ROAD Second line of address SUITE 202 City or Post Office HARRISBURG Correspondent's a-mail address: mhazen@hazenelderlaw.com State ZIP Code PA 17110 '~~ ' '•; ~.-~_ _~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE I ~~~ -Q Qc l ~01.,~- Deborah Troutman ~%~ ~ 024/~ a nRFCC i SIGNATURE OF TIVE 2 Marielle F. Hazen, Esq. REGISTER OF WILLS USE ONLY ~~ ') _ ,- -- , ;L~ -- - -, , . 1_ ~ ~, DATE FILED - DATE -// 2000 Linglestown Rd, Suite 202, Harrisburg, PA Side 1 L 1505610143 1505610143 J J 15D561D243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Burkett, Margaret M. 198 22 8467 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 125 , 000.00 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. 6 , 055.92 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous fyszq-Probate Property (Schedule G) ^~ Separate Billing Requested............ 7• 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 131 , 055.92 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 3 9 , 4 72.81 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 2 , 695.97 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 42 , 168.78 12. Net Value of Estate (Line 8 minus Line 11) ................................. .. ....................... 12. 8 8 8 8 7 14 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 Tax (Line 12 minus Line 13) ............................................... ~ 4, $ $ , $ $'7 _ 14 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 .o0 2 9 , 2 95.71 15. O . 00 16. Amount of Line 14 taxable at lineal rate x .045 58 , 591.43 1s. 2 , 636.61 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate x .15 1, 0 0 0. 0 0 1 s. 15 0. 0 0 19. Tax Due .................................................................................................................. 19. 2 , 7 8 6.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L 15D561D243 15D561D243 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Burkett, Margaret M. STREET ADDRESS 8 Neponsit Lane CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest File Number 21-11-0245 STATE ZIP PA 17011 (1) 2,786.61 0.00 2,786.61 Total Credits (A + B) (2) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 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 :.................................. c. retain a reversionary interest; or ............................................................................................................... _ x d. receive the promise for life of either payments, benefits or care? ................. ~ a . ........................................ . 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? ................ . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after 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)j. . 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+(~~-08) ~,. COMMON W EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Burkett, Mar aret M. 21-11-0245 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. ~~~ ~~~~~~ aya~o ~, neeaea, aaamonal pages Di the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-7508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEOENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Burkett, Margaret M. 21 11 0245 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Prop sale -School Taxes, 8/2/11 - 7/1/12 - as per attached HUD-1 Settlement Statement, 1,082.02 Line 409 2 Real Prop sale -Sewer, 8/2/11 - 10/1/11 - as per attached HUD-1 Settlement Statement, Line 67.79 410 3 Real Prop sale - Co. Taxes, 8/2/11-1/1/12 - as per attached HUD-1 Settlement Statement, Line 260.61 407 4 UGI refund from final bill 23.02 5 United Healthcare Svs. Inc. premium -refund of premium and funds received after 35.00 termination date 6 Verizon refund from final bill 8 42 7 PNC Bank Checking Acct. No. 5005710653 3,165.83 8 PNC Certificate of Deposit No. 31900338569 1,019.51 9 Personal Property - Rowe's auction Service -See sale statement attached 393.72 TOTAL (Also enter on Line 5, Recapitulation) 6,055.92 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form Pq-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10-05) COMMONWEALT OF PENN YLVANIA INHERRITAN E T RETggUURN RESIDEN DE~EDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS t5 TATE OF ret M. FILE NUMBER 21-11-0245 Debts of decedent must be reported on Schedule I. ITEM N M DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Deborah Troutman Street Address 1 O'Donnell Court city East Haven state CT ziq 06512 Yearls) Commission paid 2011 80 2012 2. Attorney's Fees Hazen Elder Law 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State zlq Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 2,474.31 7, 633.87 6,800.00 323.50 22,241.13 TOTAL (Also enter on line 9, Recapitulation) I 39 472 81 Copyright (c) 2009 form software only The Lackner Group, Inc. AMOUNT Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF ret M. FILE NUMBER 21-11-0245 ITEM NUMBER DESCRIPTION F AMOUNT 1 uneral Expenses Gingrich Memorials -cost of headstone and engraving 2,360.00 2 Malpezzi Funeral Home -Total bill $11,126.32. Of this amount $11,112.01 was pre-paid by life insurance from Fidelity & Guaranty Life Insurance 114.31 H-A Other Admini t ti C 2,474.31 3 s ra ve osts Bill Stauffer Lawn care -maintain while real property is for sale 400.00 4 Bonnie K. Miller, real estate taxes for 2011 - maintained while real property is for sale 623.86 5 closing costs on sale of real estate - as per attached HUD-1 Settlement Statement, line #502 and 513 14,649.20 6 Cumberland Law Journal -estate notice 75.00 7 Hazen Elder Law -disbursements 5.59 8 PA American Water -utility -utility maintained while real property is for sale (June -August, 2011) 113.68 9 PP&L Electric -utility maintained while real property is for sale (July, 2011) 71.15 10 Register of Wills -additional short certificates 20.00 11 Sentinel -estate notice 230.02 12 Stephen Brink Construction -repairs to house -repairs to real property for sale 5, 535.00 13 Tammy S. Himmel -cleaning -assistance to help cleaning out house for sale 310.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF M. FILE NUMBER 21-11-0245 ITEM NUMBER DESCRIPTION 14 Travelers Ins. - -homeowners insurance maintained while real property is for sale 15 UGI Utilities -utility maintained while real property is for sale (June -August, 2011) H-B7 AMOUNT 39.25 168.38 22,241.13 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 . DEBTS OF DECEDENT , MORTGAGE LIABILITIES, & LIENS C OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burkett Mar aret M FILE NUMBER , . 21-11-0245 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 AARP MedicareRx Preferred -medical 2.30 2 American HomePatient -medical 12 89 3 Associated Cardiologists -medical 70.04 4 Hazen Elder Law -Legal fees outstanding as of date of death . 229.00 5 Heartland Pharmacy of PA -medical 95.75 6 James R. Harty, MD -medical 44 07 7 Manor Care nursing home 944.88 8 Messiah Village Home Care -housekeeping 16.96 9 Onsight Health Care LLC -medical 25.66 10 Pinnacle Health Emergency -medical 43.98 11 Pinnacle Health Hospitals -medical 1,100.00 12 PNC Bank -check printing fee 17.99 13 Quantum Imagining -medical 1.83 14 Smith Radiology, Inc. -medical 1.84 15 West Shore EMS -medical 88.78 TOTAL (Also enter on Line 10, Recapitulation) I 2 695.97 (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) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Burkett, Mar aret M. 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 Clarence Burkett 17 South High Street, #15A Mechanicsburg, PA 17055 2 Marilyn Eberly 203 Coover St. Mechanicsburg, PA 17055 3 Deborah Troutman 1 O'Donnell Court East Haven, CT 06512 4 Stephanie Troutman 6 Stanford Dr. Highland Mills, NY 10930 FILE NUMBER 21-11-0245 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Spouse 11/3 of the Residue Friend Specific Bequest of $1,000.00 Child 1/3 of the Residue Child 11/3 of the Residue I ~ Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS v i.a~ yr rArc i n - trv I tK I U I AL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 20 1 1- 00245 PA No . 21- 1 1- 0245 Estate Of : MARGARET M BURKETT (First, Middle, Lastl Late Of : LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: 198-22-8467 WHEREAS, on the 23rd day of February 2011 an instrument dated September 23rd 2008 was admitted to probate as the last will of MARGARET M BURKETT (First, Middle, Lastl late of LOWER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 11th day of February 2011 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: DEBORAH TROUTMAN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 23rd day of February 2n7 7_ * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ,~ Last Will and Testament of MARGARET M. BURKETT c~ .~:. -' _ --rn R~ ~~ `--~t~ 7 i ~ ~- '- .~ - ~,. ,;:~~ ~- ~~ I, MARGARET M. BURKETT, of Camp Hill, Cumberland County, and Commonwealth of Pennsylvania, make this my Last Will and revoke any and all of my prior Wills. ARTICLE I. DEBTS AND EXPENSES. I direct my Executor to pay all my just debts, funeral expenses, and expenses of the administration of my estate from my residuary estate. ARTICLE II. SPECIFIC BEQUEST OF PERSONAL ITEMS. I specifically give, devise and bequeath to the following individuals the items set forth opposite their names as follows: Clarence Burkett Luggage, oriental rugs, drapes, microwave and cart, his mother's dishes, and kitchen table and chairs. Stephanie Troutman Small antique silver pitcher, Princess House pitcher, Princess House glasses and serving plate, dressers with mirrors, lead crystal lamp purchased by her father, blue set of dishes purchased by myself and her father, silver chafing dish, cookware, and my deceased son, Rick's, items. Deborah Troutman Antique tea cart anc~ silver tea set, all artwork, including paintings done by me, rock maple colonial desk with bookcase, all of my jewelry, Canon camera and accessories, Hitchcock chairs, and crystal pitcher with glasses. If my husband, CLARENCE BURKETT, does not survive me for a period of thirty (30) days, I hereby direct that all items above bequeathed to him be given to my daughters, m Burkett will 9/22/08 #502196 STEPHANIE TROUTMAN and DEBORAH TROUTMAN, or the survivor of them, and divided between them as they shall decide. If either of my daughters, STEPHANIE TROUTMAN or DEBORAH TROUTMAN, does not survive me for a period of thirty (30) days, I hereby direct that all items above bequeathed to my deceased daughter be given to her sister. ARTICLE III. PERSONAL AND HOUSEHOLD ITEMS. I direct that all of my household furniture and furnishings, books, pictures, silverware, wearing apparel and all other articles of household or personal use or adornment, not otherwise bequeathed, be transferred according to a list which I intend to attach to this Will. If there is no list, or to the extent that any. such items are not included on the list, then such personal and household items shall be sold and added to the residue of my estate or in the alternative added, in whole or in part, to the residue of my estate as my Executor in his sole discretion may determine. ARTICLE IV. SPECIFIC MONETARY BEQUEST. I hereby devise and bequeath the sum of One Thousand Dollars ($1,000.00) to my good friend, MARILYN EBERLEY, of 203 Coover Street, Mechanicsburg, Pennsylvania 17055. ARTICLE V. RESIDUE AND REMAINDER. All the remainder of the property, both real and personal, that I may own or that I may be entitled to dispose of at the time of my death shall be sold, and the proceeds shall be divided into three (3) equal shares. I give, devise, bequeath, and appoint one (1) equal share to each of my daughter, STEPHANIE TROUTMAN, my daughter, DEBORAH TROUTMAN, and my husband, CLARENCE BURKETT; ,If any of the above-named beneficiaries predecease me or fail to survive me for a period of thirty (30) days, his/her share shall be divided equally between the remaining named beneficiaries. ARTICLE VI. APPOINTMENT OF EXECUTOR. I appoint my daughter, DEBORAH TROUTMAN, to be Executor of this my Last Will. In the event that she is unable or unwilling to 2 act or to continue to act in said office, then I appoint my daughter, STEPHANIE TROUTMAN, as alternate. Any reference to "Executor" in my Will shall be deemed and taken to include each and every person or party named or appointed to serve as the personal representative of my estate, whether there is one or more than one. Also, any reference to the masculine in my Will as it relates to my Executor shall also include the feminine and the neuter wherever necessary. In the event that a co-executor is unable or unwilling to act or to continue to act in said office, then the other(s) may serve or continue to serve without the need for the appointment of another co-executor. Also, in the event that co-fiduciaries have been named for one or more of the fiduciary positions above, then a decision of the said fiduciary shall be made by a simple majority of the co-fiduciaries. ARTICLE VII. WAIVER OF BOND. To the extent that such requirements can legally be waived, I direct that no Executor named in my Will or any persons succeeding in that office, whether in the Commonwealth of Pennsylvania or elsewhere, shall ever be required to post any bond or give any security in connection with his duties. ARTICLE VIII. EXECUTOR'S POWERS. In addition to powers given him by law and by other provisions of my Will, my Executor shall have the following powers, applicable to all property held by him, and these powers shall be effective without court order and until actual distribution: A. To sell at public or private sale, mortgage, exchange, transfer, or lease for any period of time any real or personal property and to give options for sales, exchanges, or leases for such prices and upon such terms or conditions as he deems proper. No purchaser shall be held liable to see to the application of any purchase money; 3 B. To retain any and all of the assets of my estate, real or personal, in the sole discretion of my Executor, without being restricted to investments authorized for Pennsylvania fiduciaries and without regard to any principle of diversification or risk; C. To delegate discretionary powers to agents, remunerate them, and pay their expenses; D. To collect rents and other proceeds from real estate, paying all carrying charges and making such repairs as he may deem proper, all without the necessity of obtaining leave of any court; E. To carry on any business owned or controlled by me at the time of my death for whatever period of time he shall think proper, with full powers in the property, including the power to borrow and to pledge assets contained in my estate as security for said borrowings; F. To exercise any rights or elections to pay death taxes in installments and to make interest payments on such installments as a charge against the principal of my estate; and G. To disclaim on my behalf any interest as my Executor deems advisable. All the foregoing powers, together with those granted by law to executors, may be exercised by the Executor named in my Will and by all persons succeeding in said office, including administrators with Will annexed. ARTICLE IX. APPORTIONMENT OF TAXES. All taxes payable by reason of my death, together with any penalties thereon, shall be paid out of my residuary estate, without reimbursement from or apportionment among the beneficiaries, recipients, or owners of such property for any such taxes, penalties, or interest. 4 IN WITNESS WHEREOF, I, MARGARET M. BURKETT, the Testatrix, have to this my Last Will, typewritten on five (5) sheets of paper (incl,~ding the witnesses' signatures), of which this is Sheet No. 5, set my hand and seal this ~ day of , 20 ~~ . ;,' - (SEAL) ar aret .Burkett - SIGNED, SEALED, PUBLISHED, AND DECLARED, by MARGARET M. BURKETT as and for her Last Will, in the presence of us, who at her request and in her presence and i the presence of each other, have hereunto subscribed our names as witnesses this ~ day of 20 OS~ . Witness ,, .n .. ADDRESS Lr' ~f' Town and State ADDRESS C~{ ~,' H/~ `, ~,~ Town and State 5 ACKNOWLEDGMENT COMMONWEALTH OF PEE"N.N~+SYLVANIA COUNTY OF ~~i'I°c-[LCD-C~`"C.~ .SS I, MARGARET M. BURKETT, 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. ~ ~~ ~ (SEAL) Margare .Burkett `` - Sworn to an subscribed before me t is day of 20 D,~ Nota Public` My Commission Expires: (SEAL) COMMONVlIE_ AL T N OF PENNSYLVANIA ~~ PJotarial Seal ~' Jean Mai ° Vargas Fcschi, Notary Publ'tC Sustluahanna Temp.; Cauphin County My Co~ru•,~ission c,.pires Jan. 14, 2010 Member, P2nrsvwania Association of Notarial AFFIDAVIT COMMONWEALTH OF PEN~NSYL//VANIA COUNTY OF (.~-%1(-~CU'd~~-C :SS.: We, ~C~NADtrr'~ ~'AUc=n and ~y,~-~ Ccfct~~~-~n~c/G/~ the Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, MARGARET M. BURKETT, sign and execute the instrument as her Last Will and Testament; that Testatrix signed willingly and that she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Witness Sworn to m~#his ry Pu :ribed before day of _~, 20 My Commission Expires (SEAL) Wi ss CO~sMOi~i~4r~Ai_ i H OP PENNSYLVAfvi~1 Notarial Seal I ~ Jean P~?ariE~ Vargas Foschi, Notary Public ~ ~.«~-:ni+ehanna T~r;p.: Dauphin (',ounty My (:~.sr;rr_;nsion z ;tires .;an. 14, 2010 t•n=re;~ , °sn~~-vfv;. ;in ?s:_i~^,ietion of Noft;~i~; 502196v1 ~~ ~~ ~7 . ~~u.~~e~ ~~ ~ 9 ~,; -- / ~^ --~.~ j~ r ~ y ,, , ~ ~. ,,., .., --a- .~: ~ ~, L, .~ ~` ~'L~.caL `~ a.~' ~c~- C~ c ~ ~~k~'K~c?C.R. r ~L!D ssiit3oN l~ U61ig!~oss~ siuenl~Ssuu9d'J8gw9{!~ O LOZ `b t ''.~'f s`"i;~-'`S ueissiwwo~ RW i(;Uf10~} iJiiy~C18(J `'?~M,!,, ~l.IUEt~211~j ollgnd tie;oy `iycso~ se6.le~ 3usy~ usa~ leag IeualoN tllNt//1lASNN3d d0 N~. lb'~~UINOWWO~ Neta:Sal Sea' „ean ~l12flG' ~Jal~~ Foschi, itiatzry Public i Su."gtlehanna T~rep., Qauphin Couniy I My C:~;nm~s:~icn Expires Jan. 14, 2010 Membsr, Pennsylvania Assaciation o. i1at;-,~i5 From; 08!02!2011 16:19 ,1`255 P.002/003 ~Z1dEN7pR y ~ o¢ r OG~ OMB Approval N0. 2502-0269 A * t ~ ~ ~ r MUp.1 A. Settlement 5tatetnent (HUd-1) ~ GR@~ 0~~`O~ B.Typlt of Loan PuOC 1 014 3, ~ yF1A 2. ^ AHS 3. pCenV. Unln;. 1 ~ ^ VA 5, ^ t.gnv, Ins, 6• FIIq Number; 7, Lonn NtImDCf; 8. Mortgage Insurance Case Nu mbef; 401101200-5% 507005 :. Npte, Thls form k furnlahed m pivc you a statement at ocean! :ettlameni cores. Ameynt. Dalq to end Ironer marked °{p,o.c.P Ware ptrld outilde the cln l h q4d-OBy4203.703 by rho cattlnmene agent ore sho meals. wn, s np; t ey one mown hem for Informational purpOSes sno era net Incluped In the 7. Nams an0 Adtlrrea of Monawer E. Nemn and AgArefi 07 Seller F. Name and Addrraa of Lnnper ULIE FI55EL 28 W. HARR158URG STREET AP't C. i2tL5BUAG,'OA'37059`-- _..__._ _ _.. DEBORAH TADU1'MAN, EKECUTRI% OP YltE CARDINAL FINANCIAL COMPANY ESTATE OF MARGARET M, BURKETT, 1K/A q}g ]RGISSOP1y1Lt.E ADA0 - _.___ __ MA P0 LiOxY ,. ti97 RLAAETII:TII~JTMAN 8 NEPONSIT LANG WARMINSTEN, PA 38974 CAMP MILL, PA 37011 , Prgp01'!y IANf1011 NEPONSIT LANE, 1MP HILL, PA 17011 SUNTY: CUMBERLAND ,RCELID: 13.25.0032.124 ~WNSMIP: LdWt:R ALLEN TpWNSHIP H. sstelamen! Agent SECURED LAND'I'RANS(i2RS, LLC 485 ST. JOHNS CMUkCH ROAD , SHIREMANSTOWN , pA 17011 Phone ; (717) 901-8342 /lope Of SattlYntnnt 3915 MARKET STREEY CAMP N1L4 PA 17011 K. Summa of salter" 400. Creaa Amount PYO t0 St 1. saslWmont pa DO OA/02/2011 Diaburamm~nt DatO 06/02/2011 410. r a,w nWiC uyly / AY9 / SCPq 103,9500/atf for OB 02111 m 10/Dll1S 36779 ) svv. IteduetlOAa In Amoune pun t0 Seller I out. excess O oslts SOZ, Settlement Cher to Seller 509. Ex loans tak4n subsetta i6 508.64 504. 505. 56. 507. 5D8. sD9. AO ODtme,lta 10r Items Y,t )d b tlellnr 5 0. Ta%es 511. COUn Tsxns 512. Aadesemente 513, SallerAeslse 2 ti40.5e 514. 515. Ili. 517. 516. 519. 520. Tofai Rsduedoe Amount Dus 3silsr ZO 140.20 600. Cacti at Sstpsmsnl t0/frerq 9slitr 601. G,os.; amount due m seller Ilne 420 ti02. lrs reduetlerLt in ameuni due seller Ilne 520 126 420.d2 tiOS. Cosh X TO From Syllrr 20 149.20 fha p RapoNnB BurtlaA or 1hH eolbdlgn I rmau0n ly M, gnptnp at 96 minWt par iasponm (or so0sdinp, rouls~vlnp, snd mpOAltp Ihr E9ti cGbcl INa kgormatlon, and sw nol ngWwd itl ea, l tO / l ~ tl I 106,261,22 . TNY agahcy may,bt p s l xa wm~ YtNYaa 0 O SpkYs a q,nentyv0lkl pMtl carKrol numbm. No cenfannUallty Is assured; lhts dlscJ~uro is m01Wib 'fhla k Ass ry• ipnad la provide lha psnks [o r RESPA Corao4 YanaaetanwlMfnfama0on sump Iho snlaomonl prooe:s . "'~ ~ ! lnltbl; .,. summa or Borrower's Tralrizaction 100. Gress Amovtu ova from aorrowsr 101. Contract Sales PMee 125 000 00 SD2. personal Pro . 303, Suttlenbnt cha r3 t0 bartawer bee 14D0 3 496,14 104, iD5. Ad ustmant for Items ale b seltar In a0vane^ 106, Ci oWn Taxes 107. Coup Taxec 625.8300 r 08 02 1 L m 01 01 12 0 260,61 3 . Assessments 109. Scheel }axes 11BS,690D OB 0 11 t0 07!03 1 . 1 D82,02 110. sewer antl Refuse (1up / Auy / Sepe) 503.9500lgtr for 08 02 11 eo 10 01 11 f67.79 323. 13:. 120. Grass wmou0! Due from iPwoWYl 129 616.56 200. Ameutttc Pald by er Ws BshAl/ Of Oorrowar 2D7. De -IC Or earnest move 1 000.00 202, Prlncipsl Loan Amount from Cerdinal Plnanclal [om n 3121,D31,DD 203. BlN1tl leans token cue eet t0 204. Grant htrm PHFA 1 000.00 205. 20d. 20%. 2De. 209. wd urtm^nta for (lame uh a70 b i^lrer 210. own Tbxec 211. Caun Taxes 212. Asscsmenis 71 elkr Asslzt 3 fi40,56 X14. 215. 216. 217, 218. 214. 220, Total Pab b /wr eorrowo- 127 475.5[1 9DD. Gsh bt SctGement t'rosn/to aarrownr h03. Grose amount duo efOm bWrOWOr Nee 13 129.Ba6.56 302. L.asa amounts Id r borrower tine 220 127.471.56 803. CeIiM1 X From To eombwcr ~2,s7>e.pq L0/Z0 3rJCd S~-Idt11.S R7.>=:/ f~Ab~ Gil. T.G : Ri T iGt7. /7.Gf /Rp f rorr. 08/0212011 16:79 #255 P.0031003 Irndrr'a wWrrrrirrd>, On HUD, ~ ~~~~ ~~~~~~~~~~ ~.R e.. ~~~ ~~~~ wrma iwwv ~ vux ~' ptr09B rAnlOU ybur lender. 9a111emant agaM k mtreapon;Ib10/rr egntenl of 1'he xeder'x and 6orrower'x rlpnalurrr hrrwn aekrwwiadpa Nrir epprevat and xipnyy Ndr undenlrndlnp ihpl tp% Ond InxVfbntlr prorbllOnr bntl rbrtlrvex rre traced on epurOq torth0 preoD4lrA) year ar ~upppddoed by rihOra erntlmrtetl rar tee aurrpntypOr, rnd h p10 ovbnl Of any Gtenryr rbr the cunrnk Yrer, aA nrracsuy adfuslments wyt Oo n1A00 Ortwoon b0lrowOr pnA wAgrdhabgy, Any Oggqt tlW4lqugnttp%rY ormorlgtlpr pryoKr WNI Or premp0y ruknburaed la Ihr settlement agem by mo yof>vr, 1 havr aarWry rbvfrvwd thrr HUD•1 Srtlgrngnt 8atwnbntrntl to Ihr boAt of ny knewkdpe and brGrf, it la bue and oaaumpo gtptemon( or sp roeelylr rnd Jiaburameentn made an my sac0urrt ar bb-y~me >n Nls bensadlrn. 1 fuller certlly Net I have rocalved a W py of No HUO.t &Oltlbmbn) St0lvror~l, eU Rti ~~ 9Ef.6ER6 Julb ~ M rOt M, Yrgylm n W r o~ gyrkrlt f~rrh 7~ n, fxr/tlut~_ lC >!,C~l' , The M .+ SetVemynl Slrtrmrnt f hrvr prsprrrd Ir b NM bnd aCW fAlr btxeunl vi Ihlx irerawclbn, I have cnuned or wtll cause tho fund: to bq dl;ayrsbtl In 0000!0 0 thr6 OIOtOmenl ttl M ~rrn1 P4l0 berovzq++ L0/E0 3~JCd S3~dalS 8Z8L88bE0Z Z9~9Z TTOZ/Z0/80 ~~ree t ;decking Account Statement PNC Bank For the period 01f21/3011 to 02!1712011 000039 MARGARET M BURKETT 1 ODONNELL CT EAST HAVEN CT 06512-4214 F'NCBAN Primary account number: 50-0571-0653 Page 1 of 3 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to PNC Bank Online Banking at pnc.oom. 'a Forcustomer service call i-888-PNC-BANK Monday -Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espafiol, 1-866-KOLA-PNC MoringT Please contact us at 1-888-PNC-BANK Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 'Visit us at pnc.com ~' TDDtermnal: 1-800-531-1648 •. - Fr+~r Ch~~idrrg, A~icount Summ~llr For bearing unpaired clients only y Aocotant number: 5b-(3571-01;53 Margaret M Burkett Overdraft F'tofection Provided By: XX)CX)OOCX5080 Bal~l~l~e Siulrrl~ltn~r~ Begihning Deposits and balance Checks and other Ending other additiohs deductions balance 3;564.03 1,216:00 1,632.19 3,1'1.$4 Average monthly Charges balance and fees 3,718.48 17.99 Fransacti S on ummary Checks paid/ Check Card POS witfidrawats Check Ca-d/BankcarcJ signed transactions POS PIN transactions 5 0 0 Total ATM PNC Bank transactions ATM transaction Other Bank s ATM transactions 0 0 0 I~c>iivify 6etail leposits and Other Additio ns ate Amount Description There was 1 Deposit or OtherAddition x/03 1,216.00 Direct Deposit - Soc Sec totaling $1,216A0. US Treasury 303 XXXXX846 7A hacks and Sub~etitutn Chet:ks ask mbe_ r Date Reference Amount paid number Check Date Reference $1 1,144.'78 0 82 2/09 oss2il5oi "umber Amount paid number 83 20•~ 02/04 5Y1865740 1 83 15'$4 1585 12.89 02/09 071782ssi . 02/09 0865798'74 400.00 02/11 osssss5so yap in checksequence There were 5 checks listed totaling $1,579.60. PNDMLT01-JOB 10008-N40-NNNNNN-002-000062 Free Checking Account Statement For the period 01/21/2011 to 02/17/2011 For 24-hourinformation, sign onto PNC ~ankOniine Banking MARGARET M BtJRK~TT on pnc.com. Primary account number:50-0579-0653 Account numbers 50-0572-0653 - continued " Page ? of 3 ~. r ~~. -._ , . ,. ~ ~,d.-~ ~. _o ..~ n ..o~~... .._..,~,~. Online and ~ectronic Rankin Deductions - _ ~ ~ _ 1`he~re was 1 Online or l:lecxrone Banking Date Amount Description Deduction totaling $3.70. _A. ._ 02/07 34.70 Duect Payment.- Premium L1hg Ovavtions XXXXXX9751 ~__ Outer Deductions _,_:_.. . _ .. _ There was 1 Other Deduction totaling Date. Amount. Description $17.99. 02/17 . -.17.99.Check Printing Eee ' Daily Balance-Detail Date balance Date balance Date 01/21 3,5.64.03 02/04 4,760 Q3 02/09 Balance Date Balance 3 565._ 83 02/17 3 147 84 02/03 4, 780.03 02 f 07 4, 725.33 02/ 11 , . , . 3,165.83 For the loth consecutive yearn P.~T~.presents th~.Philad~lphia-international Flower Sh©w, lvlarch 6-1-3,.at the IPSnnSylV,allia Convention-Center. Tickets for the show can be purchased at select PNC branches. For more infocrnation; visit theflowershow.com: FORM166R Accn.,t I..yrrry Certificate of Deposit Detail Branch/Cort Cent~ri WINDSOR PARK (-- Statute ACTIVE Customerfi 000003900141223 Sub-Ovner: REGULAR Balance fn~em.aUarr - __ _._ ., Mcount Titiq and Addnwu.. _ _. __. - -.__ .. _.. - _._ - Opanlnq Amounts X1,000.00 ' Le al T1Hlf t - MARGARET M BU RKETT 9 1 ODONNELL CT i Addre ssr EAST HAVEn, CT 06512-4214 Curtest Balanai X1,019.87 '~ - -- . ~ - ~(+j Accrued lnteres6 50.03 6ta0emant In/aenratlon _. .. - - - _-. i Last InhrertP tAmtr ym f0.13 ...__. _ ~ - ~ - - Last Interest Pym< Dates 03/03/2011 (-j Penaky Am ousts f0.39 : I~ Int Pald YTOr f0.39 Int Pald Pnar Year: 52.99 (-) Withholdings X0.00 ~ Int Payment Metfiodr CREDIT CD Cndked to Account Ii i ' (-j A[P Ad]urtmenti fO.OD '~ ' AIP-Amount: j0.00 v Today's Clo sun Bali X1,019. $1 ~ qIP NeM Int Pymt Dater 00/00/0000 ~I_. .. __-__. ___._... __._._-.. _. ___. -. _.: _~__ AIP Next Ins Amounts f 0.00 __. . Hiac infarn.auon - _.. _:_ . ~ Rad infwmaliou~:- - ~ ._ _-._..__ .__- _ _.. Purdrare Dahi 02/03/2009 .~ Base RaLr 0,13300 Maturity Dates 0$/03/2013 ~ j;; (+) Package Ben efitr 0.00000 Terms I'3 1 ~~'j (+j Bonue Pointri 0.00000 M nual % Yields 0.13300 Lsst Redefined Dates 07/D9/2009 ~I ~ Interest Rate Usedi 0.13300 Last Rate Ch angai 00/00/0000 3arvice Requests ^J Accourtt Ust r, :,. 8888888829 PHONE & ONLINE BANKI ACTIVE a 431196310139$060 POINTS V[SA ACTIVE 31900338569 FIXED RATE CD ACTIVE s 4430470007372813 PNC CHECK CARD ACTIVE ~ - Add New 8ervlce Request AtcOUfit: Related Customers ALL ACCRUED INT ADJUSTMENT MARGARET M BURKE~2J0311929 F-N 198 ' •~ ~y"Start Genesis-Products.., _,~. ~.~ ~ ~ Service Browser_ ~ Releasky Account,.. ~ ,~ LOG - Xnet SYste,.. I ;war > Leglestown in b.,.~ fl~ FebumY In franc , i ~ J :~ ~ ~tj ~,.~ 1125 AM R4WE'S AUCTION SERVICE ~Rl~ 79L) 2505 Ritner Highway Carlisle, PA 17015 Dave Rowe (AU 2295L) Bill Rowe (AU 1538L) 249-1978 697-4794 249-2677 Auction Is Action Call "R.owe" For Satisfaction SELLERS NA'_bIE ADDRESS OTHER AUCTION DATE!LOCATION DESCRIPTION OF MERCHANDISE I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this agreement. AUCTION SIGNATURE Total Sales (Clerking Tickets Attached} ~ Less Sale Expense: o;Q Commission Auctioneer $ _1"°"'"~ _ % Commission Clerks ~ OTHER: __ _ _ r '~C"~~u epos ~c ~" ~,-~- ~4 SELLERS SIGNATURE DATE PHONE AUCTIONEER ~' CLERK °'~ TOTAL SALE EXPENSE DEDUCTED ~ SELLERS NET ~