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10-21-11
15056051047 REV-1500 EX (06-05) PA D t t f R OFFiCiAL USE ONLY epar men o evenue Bureau of Individual Taxes County Code Year File Numher Po sox 280601 Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN _ RESIDENT DECEDENT ~ / ~~ -y G~B. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ gy ~ ~ G~-~~ ~-~ ~~~~- ~ Z ~~~y ~ De~~r~i~nt s ~~sl Name suffix D~cedenYs First Name MI ~S' o,o ~ ~~y o Std/ 2.1~-'~ l (If Applicable) Enter Surviving Spouse's Information B elow Spouse's Last Name Suffix Spouse's First Name MI Spo~rs~ s Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1 Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number w r s .~~7V ~~ ~s ~l ~ ~6~ ~G~1 Firm Name (If Applicable) ~~ ~ r ~ ~ ]~ ~-./J/ C ~ ' ' ~ ~~'~ REGISTER OF WILLS USE ONLY " / / RECORDED OFFICE OF First line of address RI~:GISTI?R OI~ WI1,1S ~~- f /f./ L,~ S~ 2011 OCT 21 Second line of address CLERK OF ORPHANS COURT' (~~ ~ ~~ ~ 4 ~ CUMBI?127,AND COURT, P,1 C, itJy or Post Office ~Y/2. L / s ~C State ZIP Code ~ DATE FILED Correspondent's a-mail address: Under penalties of perjury, I dec 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 comple . D claration of reparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE~PERS~N PQf~16 - OR FILING RET~yRN---~ DATE ~._,. U .~... ~~ ADDRESS ~~ ~~, ~E ~ ~ ~~ ADDRE~ ~ /~ _ ~ ~~ ~~ //~~ PLEASE USE ORIGINAL FORM ONLY v Side 1 15056051047 15056051047 J REV-1500 EX Decedent's Name: ~~~ RECAPITULATION 15056052048 YU~ ,S%~ii~~~ Ijj Decedent's Social Security Number ~9~~ ~~~ 1 . Real estate (Schedule A) .......................................... ... 1. l cj ~ ~i~!~. 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. ~~~' f 8~ G~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. ~ 3~(j ~`~~ 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 2.~1 ~~~`--'~ _ ~ ' 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. " G~ 1 ~ ~ ~~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. / / 3 / ~~ G/~ / ( 11. Total Deductions (total Lines 9 & 10) ................................. .. 1L ~ ! ~~0.~ 3 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. /g y~ f~ ~ / L `~ ~ 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) ...................... .. 14. ` V ~ Sg , TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES / 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. 17 Amount of Line 14 taxable at lineal rate X .0-~~ ~~C~ ~'ISQ ~ /-~ A v / 16. ~ ~ ~ ~~ J . mount of Line 14 taxable at sibling rate X .12 17 ~ 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ....................................................... .. 19. f ,,. ~- 7 ~• ~/ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 15056052048 J REV-1500 EX Page 3 Decedent's Complete Address: File Number UtGtUtN I "5 NAMt STREET ADDRESS CITY S/.uC, I STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ~~y'~ C. Discount ~~~ `~~ ~~~ ~ ~ 2~'tJ --_- Total Credits (A + B + C ) 3. Interest/Penalty if applicable ` ~' D. Interest _ __ -- -- E. Penalty _-_. Total Interest/Penalty (D + E ) 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. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (2) ~_ 3"~~,~ ~~~ a, o~ (3) (4) (5) (5A) (56) 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 inwme of the property transferretl :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percen# [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 zero (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 twenty-one 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 zero (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 four and one-half (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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. I, SHIRLEY H. SOPRANO, of Carlisle Borough, Cumberland County, ~~ Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I give, devise and bequeath all of my estate of every nature and wherever situate in equal shares to such of my adult children, daughter, JANELLE MAKOWSKI, and sons; EUGENE A. SOPRANO, ANTHONY M. SOPRANO, and DANIEL V. SOPRANO, as survive me by thirty days. I1. Should any of my said adult children predecease me or die on or before the thirtieth day following my death, I give, devise and bequeath the share of such child to his or her issue per stirpes living on the thirty-first day following my death. III. Should any of my said adult children who have predeceased me or died on or before the thirtieth day following my death leave no such issue living on the thirty-first day following my death, I give, devise and bequeath the shares of them to my other children or to their issue per stirpes'living on the thirty-first day following my death. IV. Any share of my estate which may become distributable to a minor may be held in a federally insured savings account in the name of the minor, and marked not to be withdrawn until the minor attains the age of 18 years or on order of a court of competent jurisdiction. ~~~~~ V. All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate ,.. and shall be paid out of the principal of my estate without apportiorunent or right of reimbursement. VI. I appoint my son, DANIEL V. SOPRANO, executor of this my last will. Should my son, Daniel V. Soprano, fail to qualify or cease to act as executor, I appoint my daughter, JANELLE MAKOWSKI, executrix of this my last will. VII. I direct that my executor or his successor executrix shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 'i;4~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this~~' day of~~3~~-- 200.5. SEAL) HIRLE H. SOP O The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, SHIRLEY H. SOPRANO, was on the day and date thereof signed, published and declared by SHIRLEY H. SOPRANO, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto /G 6~ ' J ~?.-- . ~~i~ ~. "~ f / ~3~~~ ~a~a /~'7j~1~..~reNN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO: CD 006042 DANIELS WILLIAM S ONE W HIGH STREET STE 205 CARLISLE, PA 17013 fold ESTATE INFORMATION: ssN: i 94-26-6571 FILE NUMBER: 2105-0782 DECEDENT NAME: SOPRANO SHIRLEY H DATE OF PAYMENT: 1 1 /30/2005 POSTMARK DATE: 1 1 /30/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/30/2005 REMARKS: W DANIELS ESQ CHECK#1607 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 57,800.00 TOTAL AMOUNT PAID: INITIALS: VZ REV-1162 EX(11-96) $ 7, 800.00 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) N0. CD 006785 SOPRANO DANIEL V 363 WHISKEY SPRING RD BOILING SPRINGS, PA 17007 '------- fold ESTATE INFORMATION: ssN: ~s4-2s-s57~ FILE NUMBER: 2105-0782 DECEDENT NAME: SOPRANO SHIRLEY H DATE OF PAYMENT: 06/02/2006 POSTMARK DATE: 06/02/2006 COUNTY: CUMBERLAND DATE OF DEATH: 08/30/2005 REMARKS: CHECK#137 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 586.98 TOTAL AMOUNT PAID: $86.98 INITIALS: JA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER 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 REV-1162 EX(11-96) NO. CD 006784 SOPRANO DANIEL V 363 WHISKEY SPRING RD BOILING SPRINGS, PA 17007 -------- fold ESTATE INFORMATION: ssrv: isa-2s-se7~ FILE NUMBER: 2105-0782 DECEDENT NAME: SOPRANO SHIRLEY H DATE OF PAYMENT: 06/02/2006 POSTMARK DATE: 06/02/2006 COUNTY: CUMBERLAND DATE OF DEATH: 08/30/2005 REMARKS: CHECK# 138 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5 240.00 TOTAL AMOUNT PAID: 5240.00 INITIALS: JA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (12-85) s ~~`; `_ SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. i G~2~s~~ ~r~o-!~ C y/ G'C~h-i~r~~~~ ~ ~°r'~~ ~ ~ i "~~ ~ ~ 1J ~~~ - ~ ~ GL .....--- TOTAL (Also enter on line 1, Recapitulation) $ ~~~ ~G• CG (If more space is needed, insert additional sheets of same size.) s ,,..., . A. L-VLVJ B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.OFHA 2.QFmHA 3. QX CONV. UNINS. 4. QVA S.~CONV. INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT N 1 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by fhe settlement agent are shown. ' Items marked [POCJ" were pald outside the closing; they are shown here for informational purposes and are not included in the tofa/s. 1.0 3/98 (11853.1.JOHNSON.PFD/11653.1.JOHNSON/10) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Lynn R. Johnson Estate of Shirley H. Soprano Countrywide Home Loans, Inc. 150 W. Lowther Street Hampden Center, 4830 Carlisle Pike, Ste. D-16 Carlisle, PA 17013 Mechanicsburg, PA 17050 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: 114 West Willow Street Martson Deardorff Williams & Otto Carlisle, PA 17013 October 28 2005 Cumberland County, Pennsylvania PLACE OF SETTLEMENT , 10 East High Street Carlisle, PA 17013 J. SUMMARY OF BORROWER'S TRAN SACTION K. SUMMARY OF SELLER'S TRA NSACTION 100. GROSS AMOUNT DUE FROM BORROWER: ~~~~ ioo,uuv.w 4u i. ~omraci sales rnce 138,000.00 102. Personal Pro a 402. Personal Pro ert 103. Settlement Char es to Borrower Line 1400 4,453.26 403. 104. 404. 105. 405. I I 106. Count /Tw .Taxes 10/29/05 to 01/01/06 77.67 406. Coun !Tw .Taxes 10/29/05 to 01/01/06 77.67 107. School Taxes 10/29/05 to 07/01/06 714.22 407. School Taxes 10/29/05 to 07/01/06 714.22 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411, 112. 412. >20. GROSS AMOUNT DUE FROM BORROWER 143,245.15 420. GROSS AMOUNT DUE TO SELLER 138,791.89 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 1,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans 110,400.00 502. Settlement Char es to Seller Line 1400 8,858.36 203. Existing loan(s) taken subject to 503. Existin loans taken sub'ect to 204. 2nd Mort a e 27,600.00 504. Payoff of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. 207. 507. De osit disb. as roceeds 208. 508. 209. 509. 210. Count /Tw .Taxes to 510. Coun /Tw .Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 139,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 8,858.36 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 143,245.15 601. Gross Amount Due To Seller (Line 420) 138,791.89 302. Less Amount Paid By/For Borrower (Line 220) ( 139,000.00) 602. Less Reductions Due Seller (Line 520) ( 8,858.36 303. CASH (X FROM) ( TO) BORROWER 4,245.15 603. CASH (X TO) ( FROM) SELLER 129,933.53 The undersigned hereb acknowled~je receipt of a completed copy of pages 1&2 of this statement & any a achments/~erred to rein. Borrower ~,~ _ _ /J ~_~ _ ~ Seller .'~ ' / / ~~ ~ _ ~'1 H. HUD-1 (3-86) RESPA, H84305.2 Panty 7 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price ° PAID FROM PAID FROM Division of Commission line 7OO 8S FOIIOWS: BORROWER'S SELLER'S 701• $ 6,900.00 to Dawn & Associates Realty FUNDS AT FUNDS AT 702' $ t0 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. Settlement Fee to Dawn and Associates Real 6,900.00 175.00 175.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 0.0000 % to 802. Loan Discount % to 803. Appraisal Fee to Countrywide Home loans, Inc. 320.00 804. Credit Report to Countrywide Home Loans, Inc. 35.00 805. Flood Check Fee to Landsafe Flood 26.00 806. Tax Service Fee to Count ide Tax Service 90.00 807. Document Preparation to Countrywide Home Loans, Inc. 400.00 808. 809. 810. 811. 90 .ITEM RE UIRED BY LENDER TO BE PAID IN ADVAN E 901. Interest From 10/28/05 to 11/01/05 @ $ 19.280000/day ( 4 days %) 77,1 2 902. Mortga a Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 ears to Allstate $421.19 POC 904. 905. 1000. RESERVE DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months $ 35.10 er month 105.30 1002. Mort a e Insurance months $ er month 1003. Count /Tw .Taxes 10.000 months $ 36.92 er month 369.20 1004. School Taxes 6.000 months $ 88.67 er month 532.02 1005. Assessments months @ $ per month 1006. months $ er month 1007. months er month 1008. A re ate Anal sis Ad'ustment months $ er month -463.63 11 0. TITLE CHAR ES 1101. Home Ins ection to BIS Home Ins ection Service POC 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Nota Fees to 1107. Attorneys Fees/Deed Prep. to Humer & Daniels POC includes above item numbers: 1108. Title Insurance to La ers Title Insurance Com an 1 048.75 includes above item numbers: 1109. Lender's Coverage $ 138,000.00 1110. Owner's Coverage $ 138,000.00 1111. Endorsements 100/300/900 to Lawyers Title Insurance Company 150.00 1112. Closing Service Letter to Lawyers Title Insurance Company 35.00 1113, 1200. G VERNMENT RECORDING AND TRANSFER CHAR ES 1201. Recording Fees: Deed $ 38.50; Mortgage $ 115.00; Releases $ 153.50 1202. Cit /Count Tax/Stam s: Deed 1,380.00• Mort age 1,380.00 1203. State Tax/Stam s: Revenue Stam s 1,380.00; Mort a e 1,380.00 1204. 1205. 1 00. ADDITIONAL ETTLELiENT CHAR ES 1301. Surve to 1302. Pest Ins ection to BIS Home Ins ection Service POC 1303. Final Water/Sewer to The Borou h of Carlisle Acct. #05023A 32.36 1304. Overni ht Fees Pk s to Martson Deardorff Williams & Otto 20.00 1305. Termite Treatment to Interstate Termite & Pest Control 371.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 4,453.26 8,858.36 oy ~iynniy NayC I of uus siaiernent, ine signalones acKnowieage recelpc or a compieteo c y tpage 2 of this two p statement. ~~ / 6 Certified to be a true copy. artson Deardorff ' i o Settlement Agent ( 11853.1.JOHNSON / 11853.1.JOHNSON / 10 ) REV.130i EXa 12•Y~ GOAIMONWEAITH OF PEA INHERITANCE TAX E RESIDENT DECED l ss:~ `~S~CHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type_ ESTATE' OF T FILE NUMBER (All property jointly-owned with the Right of Survivorship must b~ disclosed on Sch~dul~ F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH. ~ ~, G ~- , / - / -- 06 ~' - Gc'c- ~-~ ti ~~ ~S~rz•.~r t ,S-, 2~- j' cf ~v,0 , ~ o/,c , ~'Jr,~ rr, i ~c. iyj ~~%?v y3~.S ~', y ~.z~ sue-/~ . ~y 9 0 3~5, 03 ~~~ ~ ~~ 8 ,2C~', O G ~ ~-/, 3 ~ /~y~~'~ ~~m~~~~s ~~/GD, c^ip /G, /YJ G m GGs~e..S ~tl~ ~ ~ 9 3 Z 'Z 3 ~ ya , $Q G/~ . yi 22 2~ G, ll, ~~~ ~3~~ ~~ TOTAL (Also enter on line 5, Reca itulation) $ /~ (Attach additional 8Vi" X 11" sh~~ts if man space is n~edsd.) - St MEMBERS 1St FEDERAL CREDIT UNION N A m Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 1190 1 AV 0.278 2379-1190 Irr~lllrrrlll~~rllrrrlrrrllrrlr~l~lrllr~~rl~l~~ll~~~rll~lrrlrl SHIRLEY H SOPRANO C/O DANIEL SOPRANO 363 WHISKEY SPRING ROAD BOILING SPRINGS PA 17007 Statement of Accounts Sep 01, 2005 thru Sep 30, 2005 Account Number: 49322 Account Balances at a Glance: Checking : 0.00 Savings : 0.00 Certificates : 0.00 Loans: 0.00 Money Management : 0.00 Page : 1 of 2 Members 1st Federal Credit Union was voted as "SIMPLY THE BEST CREDIT UNION" by the Harrisburg Magazine Reader's Poll. Thank you for voting. CHECKING ACCOUNTS 11 -CHECKING Date Transaction Description Additions Subtractions Balancet Sep 09 Balance Forward Sep 01 Withdrawal Transfer 2,340.80- 1,500.00 To ESTATE OF SHIRLE X~CXXX)OOCX Share 11 Sep 02 Deposit Transfer 1,500.00 3,000.00 From ESTATE OF SHIRLE XX)CXX)CX)O(X Share 11 Sep 02 Check 005314 Tracer 0902005135 99.95- ~ 2,900.05 Sep 06 Withdran~ial ACH AD&D800-252-2148 4.50- ~ 2,895.55 TYPE: INS PREM ID: 1621282786 DATA: 1671 050906 FEDERAL Sep O6 Check 005318 Tracer 0906007309 1,193.00- /~ ~ 1,702.55 Sep 07 Check ~9 Tracer 0907021787 26.37- 1,676.18 Sep 07 Check X31 Tracer 0907024097 197.08- Y 1,479.10 Sep 14 Withdraw i Transfer To Share 00 1,479.10- 0.00 CHECK/NG Closed »'»rn~ ~ the final statement presenting information on this product"' '»» P/ease retain this final statement for tax reporting purposes "" CHECK SUMMARY Check # Amount Date Check # Amount Date 005314 99.95 Sep 02 005318* 1,193.00 Sep 06 005316* 197.08 Sep 07 005319 26.37 Sep 07 » Astetzsk next to number indicates skip in number sequence 4 Checks C/eared for 1, 516.40 WITHDRAWALS AND OTHER GHARGES Date Amount Descrption Date Amount Description Sep 01 2,340.80 Withdrawal Transfer Sep 14 1,479.10 Withdrawal Transfer Sep 06 4.50 Withdrawal ACH 3 Withdrawals and Other Charges for 3, 824.40 nn ~ sTm - - - Continued on following page - - - ~~St MEMBERS I" 2380-1190 Sep 01, 2005 thru Sep 30, 2005 Account Number: 49322 Page : 2 of 2 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Sep 02 1,500.00 Deposit Transfer * SAVINGS ACCOUNTS ~' 00 -REGULAR SAVINGS A Date Transaction Descri tion Additions Subtractions alanc Sep 07 Ba/ante Forward 4 22 1 Sep 01 Deposit 877.86 ~ , 5,100.47 * VISA CREDIT Sep 01 Withdrawal Transfer 4,000.00- 1,100.47 To ESTATE OF SHIRLE XXX)OOOC~CX Share 00 Sep 01 Withdrawal Transfer 1,075.47- 25.00 To ESTATE OF SHIRLE XX~OC~OOCX Share 11 Sep 14 Deposit Transfer From Share 11 1,479.10 1,504.10 Sep 14 Withdrawal 1,504.10- 0.00 REGULAR SAV/NGS C/osed * * *This is the final statement presenting information on this product* * * * * * P/ease retain this Tina/ statement for tax reporting purposes * YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 39.44 11 CHECKING 0.55 Total Year To Date Dividends Paid 39.99 NOTE: Total includes closed shares M 1 ST09 Kelley Blue Book -Trade-In Pricing Report -Buick, Century Page 1 of 2 Quick Dealer Price Quote Search Used Car Listings Lis t~Si=E} C,~k~ta Pennsylvania • September 22, 2005 1990 Buick Century Custom Sedan 4D v Engine: V6 3.3 Liter Trans: Automatic Drive: FWD Mileage: 126,000 Equipment Air Conditioning Power Steering Power Windows ~l[iE BOOK lstr ~a~~ 1:~~ For one love Search Listings for This Car appear on l cars.com, F List Your Car For Sale Online popular we Quick New Car Price Quote P Free CARFAX Record Check Auto Loans from 4.99% APR `-- ads Insurance Quote Payment Calculator Power Door Locks Cruise Control AM/FM Stereo Consumer Rated Condition: Fair "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history ,the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Trade-In Value List Your Car For Sale Online $310 Trade-in Value is what consumers can expect to receive from a dealer for atrade-in vehicle assuming an accurate appraisal of condition. 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. ~~~ ~T~~, Get New Car Pricing °' ~ _ http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;702003;PA041 &17013;+t&278;Buick;19... 9/23/2005 ' ~ ~ '' ,, THE l'Itl~'r~l~ RL~S[7L1RCE: Kelley Blue Book -Trade-In Pricing Report -Buick, Century Page 2 of 2 Copyright ©2005 by Kelley Blue Book Co., All Rights Reserved. Sep-Oct 2005 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions 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.05094) http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;702003;PA041 & 17013;+t&278;Buick; l 9... 9/23/2005 Kelley Blue Book -Trade-In Pricing Report -Lincoln, Continental Page 1 of 2 ~ ~II~l~ ~Gt ~" '~ -Enter a ~+IC~I tea get star (En-te'r a VIN l 1. ___._ .... ._ Quick Dealer Price Quote Search Used Car Listings Lis U~ii=t3 G{l~ Pennsylvania • September 22, 2005 1994 Lincoln Continental Executive Sedan 4D • wr ..., y .~~:' ~~ Q Engine: V6 3.8 Liter Trans: Automatic Drive: FWD Mileage: 69,000 Equipment Air Conditioning Cruise Control Power Steering AM/FM Stereo Power Windows Cassette Power Door Locks Dual Front Air Bags Tilt Wheel ABS (4-Wheel) Search Listinos for This Car List Your Car For Sale Online Quick New Car Price Quote Free CARFAX Record Check Auto Loans from 4.99% APR Insurance Quote Payment Calculator Leather Power Seat Alloy Wheels Consumer Rated Condition: Excellent "Excellent" condition means that the vehicle looks new, is in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or body work and is free of rust. The vehicle has a clean title history and will pass a smog and safety inspection. The engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. The vehicle also has complete and verifiable service records. Less than 5% of all used vehicles fall into this category. Trade-In Value List Your Car For Sale Online $1,850 Trade-in Value is what consumers can expect to receive from a dealer for atrade-in vehicle assuming an accurate appraisal of condition. 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. ~T ~~ Get New Car Pricing ~IUF Bt}QK list Maus' ~la~ For one IoH appear on I cars.com, F popular we ads ~i ..........Enter a to Ge Enter a b Thy me http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;550621;PA041 &17013;+t&39;Lincoln;19... 9/23/2005 ill ' ~ ~ ~:~, ` THE ~t~r'firE? ItE~QUIICE r»„~! .~ -~ .;.»z. Kelley Blue Book -Trade-In Pricing Report -Lincoln, Continental Page 2 of 2 a Copyright ©2005 by Kelley Blue Book Co., All Rights Reserved. Sep-Oct 2005 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions 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.05094) http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;550621;PA041 &17013;+t&39;Lincoln;19... 9/23/2005 REV-1510 EX ~ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF ~., FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ~. ti ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRREIATICNSHIPTODECEDENTANDTHEDATEOFTRANSFER. ATfACHA WPY OF T H E D EED FCR REAL ESTATE. DATE OF DEATH VA L U E O F A ET SS % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE R 7- E ///~ - > / 7 S/ ~~j7 ~ / / ' ~./7- ~~ l g 'S .~ ~? ~' ` do 3 __ ~ ~ o~ ~ 7`-G ~ ~ .~ ~,~~~~~y,3 ~ y~,S~y ~O~o ~ s ~- 9/ 3 3 /G,1.5~~ . ~ 5 TOTAL (Also enter on line 7, Recapitulation) I $ G ~ ~~ T ~ `~ J (If more space is needed, insert additional sheets of the same size) TIAA CREF FINANCIAL SERVICES FOR THE GREATER GOOD' October 17, 2005 Daniel Soprano 363 Whiskey Springs Road Boiling Springs, PA 17007-8505 Dear Daniel Soprano: ~/ We have received notification of the death of Shirley hI Soprano and you are listed as the V beneficiary ~er TIAA-CREF fixed and/or variable annuity con'kracts. The following lists the total -CREF retirement annuity accumulation for which you hwe bee;1 named benefic as of the participant's date of death. Value as. of Auaust 30, 2005 TIAA Traditional. Account $6"0.36 TIAA-CREF Variable Accounts $ 0.00 TOTAL $68.36 Please keep in mind that the Internal Revenue Service has certain regulations about the time period during which benefits must be paid (or a 50% excise tax could apply). We have enclosed the following information to help answer any questions you may have: • Single Sum Payment ... At a Glance, which provides answers to frequently asked questions about the payment. • Prospectuses for the TIAA-CREF variable annuity accounts (all states but California) • A Prospectus for the CREF variable accounts (California only) • TIAA-CREF Quarterly Performance card • After the Death of a Loved One, which describes the important steps you may need to take after the death of a family member or friend. TIAA-CREF Individual & Institutional Services, LLC Member NASD, SIPC. Headquarters: 730 Third Avenue, New York, New York 10017-3206 Tel: 212-490-9000 ;,~+. ?;aa cret ore 370 17th Street. Suite 200. Denver. CO 80202-5602 For your convenience, we have listed the materials you will need to provide to receive your benefits: ® Request for a Single Sum Payment form ® A certified copy of the participant's death certificate ® Marital Status Verification ^ Mandatory State Tax Form You should keep in mind that the total value of your accumulation may change between the date of death and the date you receive the payment. The TIA.A Traditional amount (if any) will continue to increase as it is credited with interest earnings. The value of any accumulations in the TIAA-CREF variable annuity accounts will fluctuate based on the investment experience of the accounts. If you have any questions or need assistance completing the forms, please call our Telephone Counseling Center at 800 842-2776. Our Consultants are available Monday to Friday from 8:00 a.m. to 10:00 p.m. and Saturday from 9:00 a.m. to 6:00 p.m., ET. Sincerely, ~"'` Bruce Austad Service Representative Beneficiary Services Enclosures ERISA Note: The Employee Retirement Income Security Act (ERISA) of 1974, as amended, states that a surviving spouse may be entitled to as much as half of the accumulation in the original participant's contracts, if the contracts were part of a retirement plan from a private employer and participation in the plan occurred on or after August 23, 1984. Therefore, if there is a surviving spouse and the contracts are subject to ERISA, the benefit may be reduced. This provision applies only to the retirement annuity accumulation and does not apply to the ATRA benefits. Daniel V Soprano 363 Whiskey Springs Rd Boiling Springs, PA 17007 Shirley H Soprano, Deceased /~ Contract No. 7005578079 J/ Claim No. CL 047717 October 20, 2005 Dear Mr. Soprano: It has been our privilege to serve you by handling the claim for the contract listed above. We have completed our processing and have paid the death benefits representing the full and final settlement to your Immediate Benefit Account. To help you take maximum advantage of your settlement, we have enclosed a brochure which explains all of the benefits and features of this checking account. Separately, you will receive a checkbook which will allow you to write checks from this account. We believe you'll find that this is an easy way to access these funds. After careful review, we have determined the total value of the claim as follows: Contract Value at Date of Death + $ 47,524.38 (or due proof on some variable contracts) less Total Indebtedness Repaid - $ 0.00 less Surrender Charge (if applicable) - $ 0.00 Total Death Benefit _ $ 47,524.38 As beneficiary you are entitled to 25 percent of the total death benefit. The breakout of your share of the claim is shown below. Your Share of the Death Benefit + $ 11,881.10 Plus Interest Payable from the Termination Date to Payment + $ 6.51 less Taxes Withheld - $ 365.15 Total ZLIC Fund Deposit Amount _ $ 11,522.46 For tax purposes, the payment to your Convenience Fund is considered a distribution. The total taxable amount is $3,657.96 and the Social Security number on this record is 162-48-1304. If you have any questions, please feel free to contact the Claims Department at 1-888-397-8485, option 1. We will be glad to assist you in any way possible. Sincerely, ~ ^\ ~1" `~ Ted Nelson Y~ Claim Examiner Kemper Investors Life Insurance Co. KILLH Administrative Office: 2500 Westfield Dr., Elgin, Illinois 60123-7836 300M (11/04) Daniel V Soprano 363 Whiskey Springs Rd Boiling Springs, PA 17007 Shirley H Soprano, Deceased Contract No. 7005579133 ~/ Claim No. CL 047717 Dear Mr. Soprano: October 20, 2005 It has been our privilege to serve you by handling the claim for the contract listed above. We have completed our processing and have paid the death benefits representing the full and final settlement to your Immediate Benefit Account. To help you take maximum advantage of your settlement, we have enclosed a brochure which explains all of the benefits and features of this checking account. Separately, you will receive a checkbook which will allow you to write checks from this account. We believe you'll find that this is an easy way to access these funds. After careful review, we have determined the total value of the claim as follows: Contract Value at Date of Death + $ (or due proof on some variable contracts) less Total Indebtedness Repaid - $ Less Surrender Charge (if applicable) - $ Total Death Benefit _ $ 16,158.15 0.00 0.00 16,158.15 As beneficiary you are entitled to 25 percent of tree total death benefit. The breakout of your share of the claim is shown below. Your Share of the Death Benefit Plus Interest Payable from the Termination Date to Payment less Taxes Withheld + $ 4,039.54 + $ 2.21 - $ 403.95 Total ZLIC Fund Deposit Amount _ $ 3,637.80 For tax purposes, the payment to your Convenience Fund is considered a distribution. The total taxable amount is $4,041.74 and the Social Security number on this record is 162-48-1304. If you have any questions, please feel free to contact the Claims Department at 1-888-397-8485, option 1. We will be glad to assist you in any way possible. Sincerely, -~ J ~ ~~°' Ted Nelson Claim Examiner Kemper Investors Life I~nsuran~~ Co KILLH A ministrative ice: 2500 Westfield Dr., Elgin, Illinois 60123-7836 300M (11/04) ..~~~.~ KCV-III [J[~ (7-881 t- SCHEDULE H FUNERAL EXPENSES, COMMONWEA H OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI@ase Print or Type ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: ~. I /~_/„,J i,- /~.-,rte ~ ~ / ~~~~ ,?y0~/ o~ B. Administrative Costs: 1. Personal Re resentative Commissions ` ~ Z - ~~ -~3yy Social Security Number of Personal Representative: I ~ I c' ~ - Year Commissions pajd '~aC ~-' vT ~~ ~~'~i~LJ'" " 2. Attorney Fees /~ /r7t r ~ C~v//L L S' Jd / /~ 3. Family Exemption ~//~ Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees ,/~! Jr r~ ,'',c ,--. ada,e.! .+4s.:d,~'ds" ,rte ,~P' t C. l MiscellaneLLous Expenses: / ~ ~/V.~ r f r f / r . ~-6-' ~~"1' r ~~q •c. ~ L~'v ~ u i^ N ~ / rr* U t C ~J, ~~ ~ T`~ . ~ ~ , . - v 2. 7`iC` .~~-.c. fi... ~ ~o~'r.t r ~~,T~.., 6~ lJ~,~l.~ rI / Z- Z ~ '~~ 3. ~C-~.~ r T~ !ut c~f~ c.~. s.L r- 's r" c. ,, .~„ ~ fs / ~ n/ ~yi 4. ~L M ~ F- ~ /~ s'~ ~ /~''~ C.-~.x 9. X13' 5. r~C7f/~rtJ'~ ~.vY..c._.,~`r-c r ~ 0~ ~j~s~~-/~ ~t_.t_ h'1 ~-•/,T" ~GO~~ GAG 6. ~i t , / ~ TOTAL (Also enter on line 9, Recapitulation) $ ~,,,~ ~. L~:'f GO (~- (If more space is needed, insert additional sheets of same size:) > REV-1512 EX• ~1-97~ SCHEDULE I COMMONWEAUM Of -ENNSnVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS P~@QS@ Pflfit Of TyP@ ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT ,. ~~~ ~- ~9.~s~~~s~,~~~ ,~~..~~ 7"y ~ ~a~m, ssic~I G, 9cd, aU - ~ „~~ ~~~ , ® .3 ~/, oD ~, sr~n, ~, r f .~ ~~ ~ ~.~ ~~~, ~ w v ~ ~, ~/ _. /G , ~~s ,~' ~~w ~ ~~ ~ 8, ~,~ ~,~ c1•~ ~. s~~-,~ ~, ~, , ~~ ~~ ~ s, i 93, d~ /1J ,~i r.~ ~.. ~i~c~r Gr.ss / ` 'g /iv'S, ~Y~~it/»'I /i u`~ TOTAL (Also enter on line 10, Recapitulation) I $./~~ ~~ (j ' i (If more space is needed, insert odditionol sheets of same size.) -~ REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES tsrarE of ,~ FILE NUMBER 2 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~G~~~, ~~- 337~~ z ,~~ ~-~~ ~. s~,~r<L ~, U s ~~, ~y~7r C~~~~~~~' ~~~ ~ Say Colorl.~?~ ~2;,~~J;a ~G`i~ i ~ i' ~,~ 3 ~~~~ w~;~l~v s~ ~ ~~/ 1 ~ ~S m y ~~ ~~-~~~,? ~?~' , .~~~ W~~s~~ ~ s~,,,,; '`~'~ ,~ ~., r ~'! ?707 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)