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Home My WebLink About04-0816PETITION FOR PROBATE and GRANT OF LETTERS Estate of H~1~1 '~. ~IXZ ~:~ also known as Social Security No. I7 6~- -7o~ 7g~6z Deceased' The petition of the undersigned respectfully represents that: Your petitioner(s), who i~m,e 18 years of age or older an the executor in the last will of the above decedent, dated and codicil(s) dated To: Register of Wills for the County of Commonwealth of Pennsylvania in the pamed (state relevant circumstances, e.g. renunciation, death of executor, etc,) Decendent was domiciled at death in ~R,~ ,a~°-~,4~ , County, Pennsylvania, with h~r~ last fa,milyor, principal residence at ~'6/ Ce~oda~t~e~ ,4~e, ~a~-/,~le, (list street, number and muncipality) Deqendenh then ~ ×ears of aue, died , , . ,~q.~/~4/ 2/, ~t/..~00~ , at ~'~'/ (~nod~aui~w[ .~z~.. (~'/A~/~ [.4/a,/Pl~d/a~ Except as follows, decedent dtd not marry, was not dtvorced and dtd not have a chtld born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (lf not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania n a{~ , .t $ situated as follows: ~/ ~q~ o~*//~£ ~e., ~'/~/e~ d WHEREFORE, petitioner(s) respectfully,re~qpest(s) She probate of the last will and codicil(s) presented herewith and the grant of letters (testamem"~y; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~/gh~t3~d-W.0 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will w~ruly/a~i~e~r he estate according to law. Sworn to or affim~ ~d subscribed ~ ~ ~ ~egisted t No. Estate Of ' ,~¢~ ~ ~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS the reverse side hereof, satisfactory proof having been presented be!t0~e me, IT IS DECREED that the instrument(s) dated described therein be admitted to probate ~d f~(record as the last will of ~d Letters ~e hereby ~anted to ~ c::~c~) , in consideration of the petition on FEES Probate, Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ TOTAL Filed ..~. 5..~,': .~ ................. ATTOIIi~[E,¥ (SUp.- C4. I.D. No.) ADDRESS PHONE REGISTER OF ~g,LLLS OF ~ COUNTY (each) a subscrib[~ess to the will pre~i~herewith, {each) being dul~fied according to the testat, , sign the same and t~ ~'~ signed asa witness~ the request of testat_ in h presence a~h~the presence of each)(in the presence of the Sworn to or affirmed and subscrqb~l before ~ ~ me this daS~ '~'~Name) '~ Register ~.. ~ ~ ~ (Name) ~ REGISTER OF WILLS OF ~t~ m~/~tO_~h..I COUNTY OATH OF NON-SUBSCRIBING WIT ~1~. SS c~ ~: ~:& ~ ~ -0 ~ -~ t ~ :~ :!:: :':' ~ a subscriber hereto, (e. ac, b) being duly qualified according to law, depose(s) and say(s) that /'/&- /-~ familiar with the signature of ,. ca/ici', testat~;~ of (ane of th~_,~,~..;~; ......... ..... ,~ .... ;, ...... ,,.~, the will presented herewith and that /-/~ believes the signature on the will is in the handwriting of H~z~' ~. to the best of . .J'J/g knowledge and belief. . mff~this ~--7~rd day of ~" .4~_hltq/f ~/7 RegiSter ~~ (Name) (Address) REGISTER OF WILLS OF O u r~t3t:tez~,~2) COUNTY OATH OF SU~S~2RIBING WITNESS (Address) ,.(..~w~) a subscribing witness to the will presented herewith, (c,~,.h) being duly qualified according to law, depose(s) and say(s) that A/~- A~ff' present and saw the testat ~ ~ , sign the same and that ~he signed as a witness at the request of testat~i g in h e~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). /~ - Sworn to or affirm,d and subscribed before me this~ ~ day of ~: ~ ~ Register REGISTER OF WILLS OF COUNTY . (each) a subscriber hereto, (&s~h) being duly qualified a~rtYlng to law, depose(~nd say(s)that Nxfamiliar with the signaturLN~f ~x , ~ Ngodicil N thatx%%,, ~the Fgnatme on thee codicil the handwriting of to the best of%nowledge and belief. %~ % Swor~ or affirmed and sub. bed before % %.. me this x.,% ~ % (Name) N'x~x, ress) Register (Name) (Address) his is lo certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be lbrwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P ~0589887 Local Registrar AUG 2 4 2004 No. Date Helen COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL NECOR~ CERTIFICATE OF DEATH ; ;, :, (Coroner) A Sixler ,.Female 1,. 174 - 20 - 7854 87 Cumberland Worker Sep. 14, 1916 North Mtddleton 661 Conodogutnet Avenue ~"'"~"~' ,,. White Crystal ~[~ ~, 180 ~us ~d; ~c~cs~rg, PA 17050 ~ 8/26/2004 rl~d Valley ~. Gr~. lw, ~rlisle, PA 17013 FD 012633 L ~g B~ers ~eral H~, Inc., ~lisle, PA 661 Conodoguinet Ave. PA 17013 E- Armolt L. August ~1, 2004 Chronic Obstructive Pulmonary Disease Remote MI's~ CABG August 23, 2004 Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050 LAST WILL AND TESTAMENY OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middieton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revolting and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soo~ ~ter m~decea0~ ~ the same can conveniently be done. ~'~ ~ ,,, ~ 2. ? t All the rest, residue and remainder of my Estate, real, personal and ~ixed, wh~tsoevee~ .~, d wheresoever situate, shail be divided and distributed as follows: .r~ :: ..~ A. One Third (1/3) thereof is to be divided equally ~r sti .rpes amongst the children of my deceased son, Chester H. Sampson, to wit: DebraTe~rEyck, Susan Schwamberger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per sti _rpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be E~xecutrix in his place and stead. In the event that she should predecease me or for any mason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I Imve hereunto set my hand and seal this ,2'7~'~ day of HELEN A. BIXLER Signed, sealed, published and declared by the above-named t-~J .EN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as w~tnesses. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. TO THE REGISTER: Helen A. Bixler August 21, 2004 Admin. No. 21-04-0816 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court was served on or mailed to the following beneficiaries of the above-captioned estate on October 28, 2004 Name Harry L. Sampson Deb TenEyck Susan Schwamberger Gregory Sampson Address 180 Konhaus Road, Mechanicsburg, PA 17050 220 S. West Street, P.O. Box 206, Valley, NE 68064 1579 N. Main Street, Fremont, NE 68025 108 E. Vass Street, Valley, NE 68064 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: October 28, 2004 CHARLES E. SHIELDS, III 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Repres~htative J~E~ A. BALOGH. MN GARY W. RECKER - DC, EL, J/, MN, WI* CREDITOR S RIGHTS SPECIALIST AJ~RICAN BOARD OF CERTIFICATION CHELSEA A, WHITLEY- MN, WI ANGELA M. HORN ~ MN MICHAEL D. JOHNSON -MN MARY ELLEN WEEMAN - KS, MN, MO THERSlA O. LEE -MN CHAD J. BOLINS/(E. MN STEV~N M. TOMS - MN MICHAEL L MCCAIN - MN JOHN E. OLCHEFSKE - MN JASON R. FOSTER - MN MEAGAN M. PROBST - MN MICHAEL J. DOUGHERTY - MN MICHAEL D. BOLINSKE - MN, OR REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 BALOGH BECKER, LTD. ATTORNEYS AT LAW SEND ALL wRrrTEN REPLIES 'ro: 41 $00LSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEEHONI:' 763-852-8440 FAX 763-852-8499 TOLL-FREE 877-768-4494 ARIZONA OFFICE: 64 E. BROADWAy ROAD SUITE 175 TEMPE, AZ 85282 DIANA THEOS - AZ, CO SANDRA TANG - AZ, CA OF COUNSEL: LtTOW LAW OFFICES, P.C. (IowaI LUSTIG, GL~,SER & WILSON, P.C. (MASSACHUSED'S) 11/16/04 Re: In the Estate of Probate Case No. 2104816 "~ Social Security No: 174207854 ~ .~ Last known residence: ~ ! Our Client: 180 KONHAus RD MECHANICSBURG, PA 17050 ~', CITIBANK USA, N.A. (SEARS ROEBUCK & CO) Account Number: 8060516074297 Amount of Debt: $ 503.91 HELEN A BIXLER Dear Sir or Madam: Enclosed please fred a ' · . Cre&tor's claun to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll flee at 1- 877-768-4494 Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. 5367 I1/15F2004 122~095 COMMONWEALTH OF PENNSYLVANZA Zn Re: The Estate of: HELEN A BIXLER Deceased NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUSin.mm~ ORPHANs' COURT DI'VZSZON Court File No: 2104~816 TO: THE CLERK OF THE ORPHANs' COURT DTVZSZON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's name: CITIBANK USA, N.A. (SEARS ROEBUCK & CO) C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY#200 MINNEAPOLIS, MN 56422 877-768-4494 3) Creditor listed below is the Owner and holder of a claim in the amount of 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 18o KONHAUS RD MECHANICSBURG, PA 17050 6) Date of Death: o~21/04 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured On behalf of the claimant, I do solemnly declare perju~ that they Information .... an~rm under the penal 'e~ ~.u rep?sentati n~ a herein re tru'e an~tlcgrr-'ec tO the best of my knowle~qe, Information Name 1~ KONHAUS Address MEOHANICSBURG, PA 17050 IN RE ESTATE OF: HELEN A BIXLER AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with res ect to th decedent. Your Affiant is familiar with th ....... P e ~,o~ I~COFOS an(1 acco regmar part of his/her duties unts and reviews them as a The Decedent purchased merchandise in the amount of $ 503.91 account number 8060516074297 Further your affiant sayeth not evidenced by .The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. ,, ' ~ ~ge~a M. Horn ~ Michael D. Jonson ~ M~ Ellen Weem~ Thersia O. Lee - - Chad J. Bolinske ~ ~ 4150 Olson Memohal Highway, Suite 200 / Mi~eapolis, ~ 55422-4811 Subscribed and sworn before me STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen A. Bixler Date of Death: RI71/?nn4 Will No. Admin. No. 21-04-0816 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No x 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: not vet determin8<1 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Da te : February 18, 2005 ~f./tJ0___. Signature Charles E. Shields, III, Esquire Name (Please type or print) 6 Clouser Road, Mechanicsburg, PA 17055 Address I 717 I 766-0209 Te 1. No. Capacity: Personal Representative (~" .~' :' I ,.,.,-< .~ x Counsel for personal representative (MAH:rmf/AM3) o Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 274 3/29/2005 Helen A. Bixler 21-04-0816 CHARLES E SHIELDS III 6 CLOUSER RD oop MECHANICSBURG, PA 17055 Checks should be made payable to the Register ofW/ills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE GIARLES E SHIEWS, III, ESQ. 6 aOUSER RD InvoiceNo: Invoice Date: Estate of: Estate No: 296 4/7/2005 21-04-0816 HELEN A. BIXLER Bill To: JA MEGIANIC5BURG, PA 17055 Qty 2 Fee Description Short Certificates Fee Total 4.00 $8.00 Total: $8.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE a-IARLES E SHIELDS, III, ESQ. (, CLOUSER RD InvoiceNo: Invoice Date: E state of: Estate No: 296 4/7/2005 21-04-0816 HELEN A. BIXLER Bill To: JA MEo-IANICSBURG, PA 17055 Qty 2 Fee Description Short Certificates Fee Total 4.00 $8.00 Total: $8.00 ~ ~h.e c\.z '* 11.4\\ 1,:.0 .J~~' O1ecks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 0- May 23, 2005 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 Telephone (717) 787-3930 FAX (717) 772-0412 CHARLES E. SHIELDS, III ATTORNEY AT LAW 6 CLOUSER ROAD CORNER OF TRINDLE AN CLOUSER ROADS MECHANICSBURG, PA 17 55 Dear SIR/MADAM: Re: Estate of HELEN A. BIXLER File Number 2104-0816 This is in response to our request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with ction 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended or an additional period of six months. This extension will avoid the imposition of a penalty for f ilure to make a timely return. However, it does not prevent interest from accruing on any tax remaini g unpaid after the delinquent date. The return must be f led with the Register of Wills on or before 11/21/05. Because Section 2136 (d) of the 1995 Act allows f only one extra period of six (6) months, no additional extension(s) will be granted that would exceed t e maximum time permitted. , C'..l 1-..... '---" Sincerely, f}, _~_ . ~ia Maffei, Supe r Document Processing nit Inheritance Tax Division -{... ~S (..,) f'0 C> Register of Wills Cumberland County Court House 1 Court Square Carlisle, P A 17013 CHARLES E. SHIELDS, III A TTORNEY-A T -LA W 6 CLOUSER ROAD Corner ofTrindle and Clouser Roads MECHANICSBURG. PA 17055 GEORGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795-7473 May 24, 2005 Register of Wills Cumberland County Court House I Court Square Carlisle, PA 17013 Re: Estate of Helen A. Bixler No. 21-04-00816 _.C', Dear Register of Wills: 1'\,) c) Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Helen A. Bixler Estate as well as Check No. 124, in the amount of$5,497.70 for Inheritance Tax due, Check No. 122, in the amount of$155.00 for additional probate, and Check No. 123 in the amount of$15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, ~f~:iZL Charles E. Shields, III CES/mjj Enclosures V' REV-150ilH(6.00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 w >- ~g(l) u"'''' w"U ,,00 u"'"" ..'" .. " INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) B I'/. LER H€LeN #. OF;=1CiAL USe ONLY ---------,.._"._--,-----,._~._-_._,-~ FILE NUMBER ~L --pJ./ 0 0 8" 1 {, ----- COUNTYCOOE YEAR NUMBER SOCIAL SECURITY NUMBER /74 ~ .zo 7J'SL/ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date ofdealll prior 10 12.13.82) D 5. Federal Estate Tax Return Required CJ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A} (Attachsch 0) z o < ...J ::::l l- e: <( u w IX: z o < I- ::::l a.. :E o U >< ~ .j- DATE OF DEATH (MM-DD-YEAR) 05'- 21- ~I)L/ OATE OF BIRTH (MM-DD-YEAR) " ? - /~- /9/6 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) AJ/A ~ 1. Original Return D 4. limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) D 9. litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12.82) D 7. Decedent Maintained a living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (daleo/death between 12-31-91 and 1-1-95) >- z w o z o .. '" w '" '" o u NAME (! II /l-Ir! L ES E: SH / E ?DS 7Jr FIRM NAME (If Applicable) AliA TELEPHONE NUMBER 717- 766 - 020'1 COMPLETE MAILING ADDRESS & C Lo U &EIt JZ.])_ ME CfI,4A/I{!S.8UR6-, ;:7/1 /7o->J' 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) If / os, f)f)() Y l-ftJ .?- f't) o o J 3{', 7S't. S9 o (1) (2) (3) (4) (5) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule OJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) (6) (7) o 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) f / '1 tJfI $", 'to ;#'Q3/,9/J (9) (10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0 x.olL.. rate, or transfers under Sec. 9116 (a)(1.2) (15) 16. Amount of Line 14 taxable at lineal rate ". /2Zj/1/.O'f x o 1f.5 (16) 17. Amount of Line 14 taxable at sibling rate 0 x .12 (17) "8. Amount of Line 14 taxable at collateral rate 0 x 15 (18) 19. Tax Due (19) 20,U CHECK HERE IF you ARE REQUESTING .. ~EFUND OF AN OVERPAYMENT > > B.._i....II\'..Ji4A1!11 OFFICIAL USE ONLY I"''') {,,', r...,) CJ (8) 1- /'I- Z, / (, 3, <09 (11) (12) (13) f/'!.9'17.30 ~ / 2 z., ) 7/. 0'1 - 0- t /2Z,/7/,o'i (14) CJ -f. 5, Lf'l7. 70 o o ~ S, '1'17. 70 1*" Decedent's Complete Address: STREET ADDRESS ~ (,/ ~IVPj)()1t(lilIE' r AilE. , CITY e,l/ II!LlS I.G I STATE ~A I ZIP I 7 tJ /3 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) " S; '197.70 " tJ Total Credits (A + B + C) (2) ?' S, '197.71) tJ 3. InteresUPenally if applicable D. Interest E. Penally tJ I) TotallnteresUPenally ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (3) 0 (4) 0 Ii' (5) 5, Y'77,7t> (5A) 0 (5B) 7' s, '1'77.70 5. 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. 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;.......m.. ............................................................................. D t81 b. retain the right to designate who shall use the property transferred or its inceme; .................................... 0 ~ c. retain a reversionary interest; or......................................... ................. ............................. .................... ......... 0 IZl d. receive the promise for life of either payments, benefits or care? ............. ................................................. ...... 0 ('g] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................... .............................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ...... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation? .... .............................. .......................... ......................................................... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, 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. DATE S12;-/t>.>- SIGNATUREpF x AD R . If~ ok//< Nil-liS If!:;., SIGNATURE 0 P PARER X ADDRESS (!H,ff(!t.E:S ;::: SH/CZD.5 ~ E.. <:1'. &. c.LP//Sd If A , J11G't'.NAAJ/dSAU/26-,,&7./1 17lJSS ~1!!IlL.~ n1l"tigdiK.",'":"';Ii\F>,'.i5'ii);~'IJl7i1",:~~~.",''','''''....~~'';~ __ ,,__.~.';,,_,~_rii;ll""'- J 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 3% [72 PS. 99116 (a) (1.1) (i)J. /7tJ.s1) It 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% [72 P.S. g9116 (a) (1.1) (ii)]. The statute does not exemot 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 natura! parent, an adoptive parent, or a slepparent of the child Is 0% [72 P.S. 99116(a)(1.2)]. The tax rate Imposed on the net value of lransfers to or for the use of the decedenl's lineal beneflclanes is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. The tax rate Imposed on the net value of transfers to or for the use of the decedent's siblings IS 12% [72 P.S. 99116(a)(I.3)J. 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. '''''~lEX''''97I. COMMONWEALTH OF Pi:NNSYLVANIA iNHERrr ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /.?J u X LEII?J liEf Fill ~. SCHEDULE A REAL ESTATE FILE NUMBER 21 -() '1- 6'/6 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 survivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1(6" At PK.PJ1J~ A'T'/ LPI!A TED ,4 T CAItL./SU: (1'//)/!rH /J(/.!XDLE?ON (!OtlIYnj /E AM'/? ,RJ,e ))€7?!/C-Ei) ,2)ESeA?//?77P#, S€F; {!oJ7}' ~ })ECb ~ JUAlE ,g.,J /97/ g~p,(" E /-'PL..2'1'". /A'6~ S7S.4 TQf"C'#t!!2l. / ; , /r/G~LE t'. Lf/xcee /RE.l)Ee~EtJ J)E(!EZ)SVT 4GZt=/;f/. {,t:/ C't>1l/6j)<J~/'(/Nt: T /;-j/6'., 7P/UA/S#/p) / t!ttd/6E/?t:./lAi.L) &6:-, /fzSc;;=;-,e .1:>. o..i). f/f'LIN!T/PA/' ~;P}, <:J,c J/~ / E /IN..IfJC7rlT,L .4SS0e/.#T6J .J1t"d/-f'A"/S~ .#77,-?'C!/V67J #.g~ PteoPF~ ry /VIfS SUf3St.=tftlENTL. V .s,~ /?'" e 4-/[CT/~A1 S"EF ,1-S5oR.TE}) I(E;.LEivRNT /T€d/S L/ST€V "'/1/ Se#t=.z>ULES c ", IV j) fl. F JD ~ 000. DD TOTAL (Also enter on line 1, Recapitulation) $ IDS-; (JOt). ,.. (If more space is needed, insert additional sheets of the same size) . r--j, .-'.") d \,[1.5 ::) JOI.A.T-WarrlLDtI' D...s. Sbort FonD, A~ of lUll. H_rr U.il. Jail.. In41Aft"- P.. ~bi~ 1Bttb, MADE THE 30th day of of our ~rd one thoU3and nine hundred seventy-one. June in the, llear BETWEEN DONALD E. MOFFITT, unmarried, of North Middleton Township, (R. D. II 2, Carlisle), Cumberland County, Pennsylvania. party of the first part, atltl MERLE C. BIXLER and HELEN A. BIXLER, husband and wife, North College Street in the Borough of Carlisle, Cumberland County, parties of the slO.c.ond part, w ,,-' ~lI'J"" :~~ 1.<.0.... \..(,_ OWXo<l.'-- lu.~gi:~t'..1- u o..q:"\\J.::J" ~ i:;:~o::i:_:'~ '""'" z,... '" ....J oa:-o(<f)~~ ........ ........... .J- - ;~I2~~~~!r._ t!~!~ ~~~!~e-,~~i~~ ~~ _~~~_~~~~_s~~~_ _ _ _ ___ __ _ _ _ _ _ ____ _ _ _ _ -Dollar.., in hand l;otid, the ~ipt whereof is hereby acknowledged, the said grantor does hereby grant and convey to the said grantees, their heirs and assigns, as tenants by the entireties, Grantor , of 228 Pennsylvania, Grantee s : ALL those certain lots of ground situate in North Middleton Township, Cumberland County, Pennsylvania, being known and numbered as Lots Nos. 127, 128, 129 and 130, on the Plan of Meadowbrook Park, which Plan is recorded in the hereinafter named Recorder's Office in Plan Baol.< 2, page 96, and containing a total of One Hundred Sixty (160) feet in front along the Northern line ,of Thirty (30) feet wide Conodoguinet Avenue and extending Northwardly therefrom at an even width a distance of One Hundred \100) feet. BEiNG the same premises which Bertha M. Lefkowsj<i, unmarried, by deed datcd June I, 1970, and recorded June 3D, 1970, in the Office of the Recorder of Deeds in and for Cumberland County at Carlisle. Pennsylvania. in Deed Book flail Vol. 23, page 732, granted and conveyed to Donald E. Moffitt, Grantor herein. t . f ,: h')~'/{L- S~h.ol Disl. Curnlo. Co., P. 'OW"'" 0.7)11. li.. ).l(~dz;;.... Cumb. Co., Po. ',;,:'~";~-i;'f1'; ii,~"i!Wl) \.' ,ry"'1>,." .,~~ , ~1' ' ~i"?( M i ~k~o!Z:-~J1i,' l~/.}~~~ ~ A..... milt. Tru,l.r T... O!l7.~/;J~ :l.( Am'./.:'" ~ f' ~(') ,4- ) 0 rJ-/j>~d- ~.....b. e.., Oi.t. ("'...1 .",. '-"" $i~ "al w..t. Tunl/.r T IX 00" 7.,M...'lI.. Am'.. /??,.:fJ (;i /4/ ,I" j/J nz;-~ ~,.""b. c.. Old. enl "a' ~ 8ooKl24r.icE 395 AND the .aid fl1YIntor hereby covenant S and agreeS that generally the property hereby eonveyed, he wt1l warrant IN WITNESS WHEREOF, .aid grantor has hereunto .et the day and year first above written. ."~~ ~~:,:~.'::'"'" I ~~t~~~~-=--=-~~ =="~~~==\ ======~===~~ his hand and .eal I do hereby certify that the precise residence and complete post office address of the within named grantee is 228 North College Street. Carlisle. Pennsylvania 17013. ~)....),...., Attorney for Grantee ,.,:',.... State of Pennsylvania l.., day 0' June . 1971 . be'ore me, County of Cumberland On th;., tM 30th the undersigned officer, personally appeared Donald E. Moffitt. unmarried. known to me (or satisfadorily proven) tt) be the per80n 'whose name is subscribed to the within instrument, and acknokledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and offiew.1 8eal, _,,_..__,~:_,~~,..~:::'::'1.,,_,,_,__,_,_,,~":~'~:. I . ? " ,,' ~ .......' ^', "Il)" . '.7.(1'0, Notary...Eublk..c.arJistd:l.lWllWaod.,.C.Ql.l~n_.__._....:_~_.;:_~.,..1"t'f").~'" .J. ", My CQmmiU\Qt;\ uwes p..\l&U~t 16, 1'311 Tit!~~{ {)}]tce;'.' \: \.. ,:> ~ ~.~.' ~ .,1.:;;~~~.~r 'J~;.; j - "~!i I'''' ':":\.:;::.:'7,t-/~:.' ..' 800K D4r.icE 396 --, i ., I \ I i I I I \ \ I I ! I i \ I 1 I I , , i I \ 1 Mark E. Hilbert & Associates ESTIMATED SITE VALUE . . . . . . . . . . . . . . . . . . . . . . . _ $ ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS: 40 000 Comments on r- site value, squal estimated ramah In the reprodu Residential Cc referenced. FileNo. . . estimate, ~,M d ~mHA, the 04-359M1 M 04-~<;a'11 M Valuation Section UNIFORM RESIDENTIAL APPRAISAL REPORT Dwelling , 960 Sq' Ft @$ 57.81 _ 8sm!. 960 Sq. Ft. @$ 16.51 . Front Porch . Gaage/C<l'jlOrt ~Sq.Ft @$ 11.21 T olal Estimated Cost New Less PhYSiCa!~'i Fu~~tio'n~I' f . External . Dep-edation $2,231 I ' I Depreciated Value of Improvements . "As_is" Value of Site Improvements. tNDtCA TED VALUE BY COST APPROACH. ITEM I SUBJECT 661 Conodoguinet Avenue Address Carlisle PA 17013 Proximity 10 Subiect Sales Price Price/Gross Liv. Area Data and/or Verification Sources VALUE ADJUSTMENTS Sales or Financing Concessions Date of Salemme Location LeasehotlI'ee SIToIe Site View Oesinn and Anneal QJ"'" of ConsUudion Ane Condition = $ 55,498 = 15,850 = 2,000 = 6,457 = $ 79,805 Est. Remaining Econ, Life: = $ 2,231 - $ 77 574 Estimated rem, = $ 5,000 - $ 122600 COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 6 Gobin Drive 170 810serville Road 140 Greenview Drive Carlisle PA 17013 Carlisle PA 17013 Carlisle PA 17013 ~1.28Miles+l- 0.94 Miles +1- 2.47 Miles +1- $ Estate $ 115750 $ 118000 ~ $ 0.00 III $ 111.30 III $ 100.34 III $ ~ Inspection C.P.M.L. C.P.M.L. C.P.M.L. Insoection Tax-Records Tax-Records Tax-Records DESCRIPTION DESCRIPTION I + (-}$Adjustmenl DESCRIPTION I +(.)$Mustment DESCRIPTION I +(-)$Adjustmenl 2DOM : 41DOM : 28DOM FHA : Conventional: Conventional 06/30/04: 07/23/04: 07/27/04 Suburban' Suburban' Suburban Fee Simole: Fee Simole: Fee Simple 0.33 Acres +1-: 0.50 Acres +1-: 0.43 Acres +1_ Residential' Residential Residential Ranchl Averaae : Ranchl Averane : Ranchl Averaae : Vinyl : Vinvl : Aluminum 44 Years' 35 Years' 24 Years Averaae : Good : -7 500 Good /i!~ III & Swift f!-I /JJU b$ 3re :r~.;~t~ ~~'-'''VllllL; lITe IS 30-35 Years. Suburban Fee Simole 0.47 Acres +1- Residential Ranchl Averaae Aluminum 26 Years Averaae -7,500 Above Grade Total' Bdrms' Baths Tolal ' Bdrms' Baths : Total' Bdrms' Baths : ~ Room Count 6: 3: 1.00 6: 3: 1.00' 5: 3: 1.50' -1,500 Gross LlVlna Area 960 SaH 1,040 SoH : 1 176 SaH: -4 300 . Basement & Rnished Full Full Full: Full Rooms Below Grade Unfinished Unfinished Unfinished: Partiallv Finished: . Functional Utllitv Averaae Averaae : Averaae : Averaae : Heatlna/Coollna 011 FHA I CIA Oil FA I CIA: Elec Rad I None: +3000 Elec HP I CIA : . Enerav Effident Items Averaae Averaae ' Coal-Stove -1,000 Coal-Stove ' Garaas/Caoort Det 2-Car Garee 1- Car Caroort: +4,500 1-Car Garaae : +2500 2-Car Garaae : Porch, Patio, Deck, Porch None : +2,000 Patio ,+1,000 Porch I Deck : Fireolace(s), etc. None None ' None : Fireolace: Fence, Pool, etc. None None : None ' None : Water Purifcatn Yes No : -5,000 No : -5000 No : NetAdl!tota!) X + - '$ 1'500~X - '$ 12800MtX - '$ Adjusted Sales Price of Como arable $ 117,250 $ 105200 $ Comments on Sales Comparison (lncludmg the subject property's compatibility to the neighborhood, etc) See Attached Addendum. Total' Bdrms' Baths : 4: 2: 1.00: 1,120 SoH. : -3200 -3000 -1000 -3,000 -3500 -5,000 26 200 94,800 ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 Date, Price and Data None None None None Source foqxior sales NI A NI A NI A NI A .;thinveaofaa<<aisal Owners Deed C.P.M.L/Court House C.P.M.L/Court House C.P.M.L/Court House Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any prier sales of subject and compa-ables within one yefi' of the date of appraisal: The sales comoarison aooroach carries the most weiaht in determlnina market vaiue as it is based on historical information and Is not as subiective as the income aooroach. INDICATED VALUE BY SALES COMPARISON APPROACH. . . . . . . . . . . . . . . $ 105,000 INDICATED VALUE BY INCOME APPROACH flf AoDlicable) Estimated Market Rent $ NI A IMJ.X C<ass Rent MultiDller NI A = $ This appraisal is made (KJ "as is" 0 subject to the repairs, alterations, inspections cr conditions listed below U subject to rompletion per plans and specifications. Condit~nsofAppraisal: The aooraiser assumes a marketable title and that eauioment associated with the imorovement is in workino order. Final Reconciliation: The market aooroach reinforced bv the cost annroach is a oood indicator of fair market value. The fact that the seller is or is not Davina anv oortion of the c10sina costs has no effect on this annraisal. . DATE OF DEATH AUGUST 21, 2004 ~ The purpose of this appraisal is to estimate the market value of the real property that is the subject of this report, based on the above conditions and the certification, contingent and limiting conditions. and market value definition that ere stated in the attached Freddie Mac Form 439/Fannie Mae Form 10048 (Revised 6/93 ). I I lWEI ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THAT is THE SUBJECT OF THIS REPORT, AS OF Auausi?,i 2004 . (WHICHISTHEDATEOFINSPZCTIO AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ 105,000 . . APPRAISE~ . ~L2 ;/ _ A .; SUPERVISORY APPRAISER (ONLY IF REQUiRED): Sianature ""~CJPI ....?L ,7 Signature Name Mark E. Hilbert /. Name Date Report Signed November 18, 2004 Date Renort Sinned State Certification # RL~000388-L State PA State Certification # Or State License # RB029755A State PA Or State License # ODid ODid Not Inspect Property State State Freddie Mac Form 70 6.93 PAGE20F2 Pmduced u^iogACI sollwar., 600.234.8727 WWIIaciw.b.cam FannieMaeForm1004 6-93 Mark E. Hilbert and Assoc. Mark E. Hilbert & Associates 04-359M 1 M File No. 04-359M1 M APPRAISAL OF , ; ~, :.,<i.- ",....- '/~ ,F,. LOCATED AT: 661 Conodoguinet Avenue Carlisle, PA 17013 FOR: Charles E. Shields, III 6 Clouser Road Mechanicsburg, PA 17055 BORROWER: Helen Bixler (Estate) ASOF: November 18, 2004 BY: Mark E. Hilbert Mark E. Hilbert & Associates L____ Mark E. Hilbert & Associates Mark E. Hilbert & Associates 04-359M 1 M Prooertv Deseriollon UNIFORM RESIDENTIAL APPRAISAL REPORT File No. 04-359M1M Prooertv Address 661 Conodoauinet Avenue Citv Carlisle State PA 7",Code 17013 leQal Description See Attached Deed Countv Cumberland Assessor's Parcel 'No. 29-Hl-1384-015 Tax Year 03-04 RE. Taxes $ 1243 EST Special Assessments $ NIA Borrower Helen Bixler (Estate) Current Owner Estate of Helen Bixler Occuoant: r l Owner I Tenant IX I Vacant .. PropertvriQhtsappraised IXI FeeSimnie I I leasehold r ProiectTvne II PUD I \ Condominium IHUDNA onlv\ HOA$ N/A /Mo. NeiQhborhood or Proiect Name North Middleton Townshin Man Reference N/A Census Tract 119 Sale Price $ Estate Date of Sale N/A DescriptiO!) and $ amount 0-1 loan charQesJconcessions to be paid byseUer N/A lender/Client Charles E. Shields, 111 Address 6 Clouser Road, Mechanicsbura, PA 17055 Appraiser Mark E. Hilbert Address 219 East Main Street Mechanicsbura PA 17055 Location W Urban ~ Suburban -0 Rural Predominant Single family housing Present land use % land use change Bu\\\up 00ver75% 025-75% 0 Under 25% occupancy r{~~crE ~~f One family ~~ 0 Not likely 0 Likely Growth rate 0 Rapid (K] Stable 0 Slow 00 Owner 100 Low 10 2-4 family 6% 0 In process Properly values 0 Increasing 00 Stable 0 Declining 0 Tenant ~O Hinh 40 Multi-family 3% To' Demand/supply ~ Shortage ~ In 00"'''' HO CMrsupply GJ Vacant(0-5%) ~redominant riUi' Commercial 1 % MarketinQtime I I Under 3 mos. IXI3-6mos. Over 6 mos. I I Vacanllover5%\ 125 -T 30 V, Land \ 13% Note; Race and the racial composition of the neighborhood are not appraisal factors. Neighborhood boundaries and characteristics: SUbject Property is located along Conodoguinet Avenue in the township of North Middleton, : Cariisle Pennsvlvania, Cumberland Countv. . Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, ate.)" . The subiect Drooertv has aood access to area emDlovment and amenities. --, - Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time _ - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, elc.)' Finaneinq is readily available fram a variety of sources and with improvinq markets, sellers are not required to offer sales or financinq related concessions, r . Project Information for PUDs (If applicable) -. Is the developer/builder in control of the Home Owners' Association (HOA)? U YES lXJ NO Approximate total number of units in the subject project N/A Approximate tolal number of units for sale in the subject project N/A Describe common elements and recreational facilities: N/A Dimensions See Attached Tax-Reoort Topography Basically Level Site area 0,47 Acres +/- Corner lot TI Yes 0 No Size Typical for area Specific zon'lng classification and description ResidentIal Shape Rectangular Zoning compliance (K] Legal rO Legal nonoon~ing (Grandfalhefed use) U Illegal [J No zoning Drainage Appears adequate Hiqtlest & best use as improved: IX I Present use I I other use (exolaln) N/A View Residential Utilities Public Other Otf.site Improvements Type Public Private Landscaping Adequate Electricity [R) 20D-AMP Street Macadam 8 0 Driveway Surface Macadam Gas 0 Pro Dane Curb/gutter None 0 Apparent easements Typical-Utili\L, Water 0 Private Sidewalk None 0 FEMA Special Flood Hazard Area U Yes /Xl No Sanitary sewer 0 Private Street lights None HOD H FEMA Zone 11 C.n Map Date 04/01/82 Storm sewer n None Allev None FEMA Man No. 420367# ,__ Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconform'lng zoning, use, etc.): There are no apparent adverse easements, encroachments, sDecial assessments or zoninQ that would have a neQative impact on the value of the .._ subiect Drooertv, subiect however to reservations easements conditions and rinht of wa of record. GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT No. of Vnl\s One Foundation Block Slab tJo Area Sq.Ft. 960 No. of Stories 1-Story Exterior Walls Aluminum cmMSpace No % Finished Unfinished Type (DeI.lAtt.) Detached _ Roof Surface Comoosition Basement Full Ceiling Joist Design (Styie) Ranch Gulters & Dwnspts. Aluminium Sump Pump None Walls Block Existing/Proposed Existin!=) Window Type Double-Huna Dampness None noted Floor Concrete Age (Yrs.) 26 +1- Storm/Screens Thermo/Yes Settlement None noted OutsideEnlIy Yes EffectiveAae Yrs.) 8~10 Manufactured House Yes Infestation None noted . ROOMS Faver livino Dinina Kitchen Den Familv Rm Rae. Rm, Bedrooms # Baths : ~I!!enl __.__ __,_, fii-Level1 1 [!J Level 2 m J;I Finished area above arade contains: . INTERIOR Materials/Condition Fioors w/w crntlvnvl/ Ava . Walls Drvwall I Averaae Trim/Finish Wood / Averaae Bath Floor Vinvll Averaae Bath Wainscot FiberaJass / Ava Doors Hollow-Core I Ava I--- [---- laundrv 1 1 1 3 6 Rooms; 3 Bedroom~s); HEATING KITCHEN EQUIP. ATTIC Type FWA Refrigerator [] None Fuel Oil Range/Oven (R] Stairs ConditiooA va. Disposal 0 Drop Stair COOLING Dishwasher 0 Scuttle Central CIA Fan/Hood 1RJ Floor Other None Microwave Ox Heated ConditionAva. WasherlOruer IX I Finished AddilJonal features (special energy efficient items, etc.): None Noted 1 Bathls\: AMENiTIES Fireplace(s) # ~ Palio Deck Porch F rant Fence Pool 960 Sauare Feet of Gross Livina Area CAR STORAGE: None 0 Garage Attached Detached Built-In Carport Drlvewav o ~ R 4 o o o ~ R INSULATION Roof Ceiling Unknwn Walls Floor None Unkmmn o 1RJ Unknwn [R) __0 o ___0 Olller Sto Area SaH 960 960 #ofcars 2 Condition of the improvements, depreciation (physical, functional, and external), repairs needed, quality of construction remodeling/additions, etc.: New car~._ recentlv installed in the livina room and hallwav. Garaoe roof should be repiaced shows signs of age. Water purification syslem installed to control the odor of the sulfur cominq from the well water. . Adverse environmental conditions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the immediate vicinity of the subject property: There are no visible or apparent adverse environmental conditions that would neqatively impact the value of the subiect DroDertV. FreddieMacForm70 6-93 PAGE 1 OF 2 ProducedusingAClsoflware.600.234.BI21www.adwebcom Fannie Mae F0rm 1004 6-93 Valuation Section Mark E. Hilbert & Associates UNIFORM RESIDENTIAL APPRAISAL REPORT --- 40 000 04-359M1 M File No 04-359M1 M Comments on Cost Approach (such as, source af cost estimate, site value, square foot calculation and for HUD, VA and FmHA, the estimated remaining economic life of the property)~ In the renroduction cost of improvements, Marshali & Swift Residential Cost Handbook and local contractors are referenced. 77,574 5,000 122600 Estimated remainino economic life is 30-35 vears, COMPARABLE NO.2 170 Bloserville Road Carlisle PA 17013 ~- 115 750 ~>'! $ $ 100,34 ill ,i> C,P,M.L. Tax-Records DESCRIPTION I + (-) $ Adjuslmenl 41 DOM Conventional 07/23104 Suburban Fee Simnle 0,50 Acres +/- Residential Ranch/ Averaoe : Vinvl 35 Years Good COMPARABLE NO 3 140 Greenview Drive Carlisle PA 17013 2.47 Miles +/- 118,000'" $ i $ 108.04 ill C,P,M.L. Tax-Records DESCRIPTION I +(-)$Adiuslment 28 DOM Conventional 07/27/04 Suburban Fee Simple 0.43 Acres +/- Residential Ranchl Averane : Aluminum 24 Years -7,500 Good ToI.al' Bdlms I Balhs : 5: 3: 1.50 I 1 176 SaH : -1,500 -4,300 Tolal' Bdrms: Baths : 4: 2: 1.00: 1,120 SoH. : Fuli : Partialiv Finished: Averaoe : Elec HP / CIA : Coal-Stove ' 2-Car Garaae : Porch I Deck : Fireolace ' None : -5,000 Na : 12,800 I 1+ Ixl- :$ &0,,,21.7% 105,200 Net: '21.7%_ $ See Attached Addendum, 121000 .- -7,500 -3,200 -3,000 -1,000 -3,000 -3,5QQ. -5,000 26,200 9,!c/)QQ ~- iTEM SUBJECT COMPARABLE NO, 1 COMPARABLE NO, 2 COMPARABLE NO, 3 Date, Price and Data None None None None Source far pnor sales N/A NIA N/A NIA v.ilhinve.-ofamya5al Owners Deed C,P,M,UCourt House C,P.M.UCourt House C,P,M.UCourt House Analysis of any current agreement of sale. option, or listing of the subject property and analysis of any fXior sales of subject and oomparables within one yeEl" of the date of appraisal' The sales comoarison aooroach carries the most weioht in determinino market value as it is based on historical information and is not as subiective as the income annroach. INDICATED VALUE BY SALES COMPARISON APPROACH ,$ 105,000 INDICATED VALUE BY INCOME APPROACH Ilf ^nnlicable\ Estim~ied 'Ma;;e; R~nt' $ . NI A /Mo, x Gross Rent Mullialier NI A - $ This appraisal is made 1KI "as is" 0 subject to the repars, alterations, inspections or oonditions fisted below U subjecllo oomplelion per plans and specificaHons, ConditionsofAp~aisal: The appraiser assumes a marketable title and that equipment associated with the improvement is in working order. ESTIMATED SITE VALUE. . , ~ $ ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS: , , Dw~ling 960 Sq. Ft. @ $ 57 ,81 ~ $ 55.498 Bsm\. 960 Sq. Ft @$ 16,51 = 15,850 . Front Porch ~ 2,000 I Gcrage/Cc:rpcrl ~ Sq. Ft. @$ 11.21 = 6.457 . Total Estimated Cost New ::: $ 79,805 Less , Physical .oj Fu~~tio.n~1 I' . External Est. Remaining Econ. Life: . Dep-eaaiion $2,231 I = $ 2,231 Depreciated Value of Improvements . . = $ "As-is" Value of Site Improvements ::: $ INDfCATED VALUE BY COST APPROACH. , - $ ITEM SUBJECT COMPARABLE NO.1 661 Conodoguinet Avenue 6 Gobin Drive Addless Carlisle PA 17013 Carlisle PA 17013 Praximilv to SUbiect.,: ,,",,'J 1 ,28 Miles +1- Sales Price $ Estate' ',:''':llf,i,,:'2 $ PricelC'iass L.. Area $ 0,00 ill $ 111,30 ill Data and/or Inspection C.P.M.L. Verification Sources Insnectian Tax-Records VJ\LUEADJUSThENTS DESCRIPTION DESCRIPTION 1 +(-)$Adjuslmenl Sales or Fil'laflcing 200M Concessions FHA Date 01 SalelTime 06130104 Location Suburban Suburban LeasehoklFeeSmJe Fee Simnle Fee Simple Site 0.47 Acres +/- 0,33 Acres +/- V1ew Residential Residential Desiqn and Appeal Ranchl Averane Ranchl Average : QuailvofConstrucfun Aiuminum Vinvl : Age 26 Years 44 Years ' Condition Averaae Averaae : Above Grade Total: Bdrms ~ Baths Total: Bc\I'rns I Baths : ~ Room Count 6: __3: 1.00 6: 3: 1.00: Gross LiviM Area 960 So.rt. _ 1 ,040 SqH. : ~ Basement & Finished Full Full : Full ~ Rooms Below C'iade Unfinished Unfinished' Unfinished Functional UliHIv Averaae Averaae : Averane . Heating/Coolina Oil FHA I CIA Oil FA I CIA: Elec Rad I None : . tneravEffidentltems Averaae Average : Coal-Stove Garage/Carpart Det 2-Car Game 1- Car Caroort' +4,500 1-Car Garaae Porch, Patio, Deck, Porch None \ +2,000 Patio Fireplace{s), etc, None None _ I None Fence, Pool, etc. None None : None Water Purifcatn Yes No : -5 000 No NetAdi(tatal) [e,:"":,.",,, xl + '$ 1,500 I .x _ i $ Adjusted Sales Price 1- -C'e '.]'~G1iJ~ of Comparable I. . ..... Net:'i,3~/,,'i'\ $ 117,250N~tl"" $ Comments on Sales Comparison (including the subject properly's compatibility to the neighborhood, etc. ): +3 000 -1,000 +2,500 +1,000 Final Reconciliation: The market approach reinforced by the cost approach is a ~wod indicator of fair market value. The fact that the seller is or is not navinn anv nortion of the c10sinQ costs has no effect an this aooraisa!. . ~ The purpose of this appraisal is to estimate the market value of the reat property that Is the subject of this report, based on the above condlt\ons and the certrtication, contingent and limiting conditions, and market value definition that;:r-e stated in the attached Freddie Mac F0Ill1439IFannie Mae F0Ill11004B (Revised 6/93 ) I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THAT IS THE SUBJECT OF TI11SREPORT, AS OF November 1 B, 2004 . (WHfCH IS THE DATE OF INSP'ZCTlO~ AND THE EFFECTIVE DATE OFTHIS REPORT) TO BE $ 105,000 ' APPRAfSE~ . ~a 1'. _ " SUPERVISORY APPRAISER (ONLY IF REQUIRED): Sianature '''~~I . #'~ 7" SIQnalure Name Mark E, Hilbert / T Name Date Report Signed November 18, 2004 Date Report Signed State Certification #- Rl-000388-l State PA State Certmcation # Or Stale License # RB-029755-A Slale PA Or State License # r(~ddi<3Macr{l(m 70 G-S~ PAGE20F2 ProdLJcCdu,lngACI .oflwale.!lQ02346l27www.adw<lb.com Mark E. Hilbert and Assoc, ODld ODld Not Inspect Property Slate State -- Fannie Mae Form 1004 6-93 Mark E. Hilbert & Associates 04-359M 1 M File No 04-359M 1 M ......... INVOICE ......... File Number: 04-359M 1 M November 18, 2004 Charlie E. Shields, III Attorney-At-Law 6 Clouser Road Mechanicsburg, PA 17055 Borrower: Helen Bixler (Estate) Invoice # : Order Date: Reference/C ase # : PO Number: 04-359M1 M November 02, 2004 04-359M 1 M 04-359M1 M 661 Conodoguinet Avenue Carlisle, PA 17013 Appraisal $ $ Invoice Total State Sales Tax @ Deposit Deposit $ $ ($ ($ Amount Due $ Terms: Balance Due upon Receipt of Invoive; 15% fee if paid 30days past receipt. Please Make Check Payable To: Mark E. Hilbert & Associates 219 East Main Street Mechanicsburg, PA 17055 Fed. 1.0. #: 23-2391423 TO INSURE PROPER CREDIT PLEASE RETURN A COpy OF THIS INVOICE WITH PAYMENT 300.00 300.00 0.00 ) ) 300.00 Mark E. Hilbert & Associates """''''''''''9''. COMMONWE'ALTH OF PEMNSYLVANlA INHERITANCE TAX RETURN RESIDENI DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF G/xLElt., IIEu:-/'! 4: FilE NUMBER .:21- tJ7"-8"/' All property jointly-owned with right of survivorship must be disclosed on SChedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH nl!-ry ('{O) SJ"lf~~ pf #t &hfl1lM S/Pck of Tk PADO//)c (j,"'IJl1/J/eS; -Zic. f!.ttSIP AI~. 7/'!O:21= /0 '1 Vo./Uo. Hun 01.14: (d.D..!. t/21/0'l) ~Ju>/,,</- h,' ~/o..3'! /e "1. 'lS"] rt ,. , '119. lID 'iiJ:l3/19f/ h," /0,.33 /" /0.1'1 (su i//I/kR/Jl:J/J cI,,'& p.//tf;,u/ ,q.#;?ckol) -;-'1- =: ~o. 22 X 'fO~ ~ 'Il9f. fO TOTAL (Also enter on line 2, Recapitulalion) $ '-I /J?, 1'0 (If more space IS needed, insert additional sheets of the same size) . , PNX: Historical Prices for THE PHOENIX CO INC - Yahoo! Finance Yahoo! Mv Yahoo! M2l! ~~:~~~ I , , YJ\.:aOO', FINANCE Sian In New User? Sian Uo 5117/059:13 AM I Search J Finance Home ~ ~ Tuesday, May 17, 2005, 9: 12AM ET - U.S. Markets open in 18 minutes. To track stocks & more, Reaister Quotes & Info Enter Symbol(s;;): I e.g. YHOO, ^DJI - Phoenix Companies Inc (PNX) _"""""'1.; $, ',rai:l_2~ Active Trader $"'71 Scottlade' I I $7 Online Trades No Inactivitv Fees! Flat rate. "':O.~9 lntemE!t equity trades AMERHRADE ~^: 30 Free Trades ~ Svmbol lookup I Finance Search May 16: 11.20 0.00 (0.00%) Free Trades Get Historical Prices for: ~ Historical Prices SET DATE RANGE @Daily o Weekly o Monthly o Dividends Only Start Date: I Rug End Date: [ Rug ~ 1120 1200' Eg. Jon 1, 2003 ~ 11231200, I Get Prices 1 First! Prey I Next I Last PRICES Date Open High Low Close Volume Adj Close' 23-Aug-04 10.21 10.38 10.14 10.31 230,000 10.16 20-Aug-04 10.00 10.39 9.95 10.20 375,200 1005 ... Close price adjusted for dividends and splits. Fllst I Pre\' I Ne,,\ I Losi A Download To Soreadsheet ;j Add to Portfolio "0' Set Alert 3 Emarl to a Frrend hllp:/lfinance.vahoo.com/q/hp?s=PNX&a=07 &b"'20&c=20Q4&d=07&e=23&f=2GCl4&g=c. ADVERTISEMENT ING.~vDIRECT SH~'~ VfJlJf Mmt"'Y t.1ll-Tli:.l..rrDIC Pagelof2 PNX: Historical Prices for THE PHOENIX CO INC - Yahoo' Finance 5117/059:13 AM Get,Historical Prices for Another Symbol: C[$ Svmbol Lookup Stock Screener . 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Illlp;!/fil1anc~.yahoo_c()miq/hp'_)~'=PNX&a'=07&b=20&c=2004&d=07&e=23&f=2004&g=d l'age2of2 ''''''''EX,''..nw COMMONWEALTH OF PEiNNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 13 /XL~ f!G~FN #. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER .21-04- J'/6 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUIVivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. :1... /YI F T 13/J.A1/( /9.) Check,,:! ,fut. A'~. .;( 35" 17IP 11'7 13) .znt. t1e~rULc/'; <<,.".d'. "n /km A. c.) elt~d;J ,fee/. #,. 7J'3 ~9' J'S'tJ/ J:>.) Jnt: ut'rJ{",! h ~o.d'. _ ;kAt e. (.see f1i/uttl;"'/1 /effir q#ttcht'c/) V~ ~ /JfJitd /h.hM'~ ;;h.fqr. d.. ikGJ tfe-h.-.nd J?elire/JIt/lf th~hl ~YHlMt ~~AI -1M-Lj't? tJ1Pdf J'<<1/J/Mt e/lhryt';" B;xler Yo SfU"~.Y A-/'~4 by :JH.shce Ii../" 1>. ~rrt'oj, duckd 'ZO, cJ/-t?QO",/o~-()3, e.l1/ ~ 1.:2./;5/03 ''I /I, 411l'ltl1f 01' ~ 1172,1'17. Cintt'erf/fffenf c/rc<Ul1- S/;mte5 4I(d IUf!N'c/J1/ 7h ,,/I /'t'<rSMAf.,k tUttI olV7t! lf3,kpem.l>,nf, /h;:s ficlj/HMt /;'5 "" P'"jqe ;;/, Ze7CP, /1:r ~u ""jt:<<sr/nr ~ /fjs70~ M'd 16,,/ lHerr J' ?if,s enr ~t!4AU.f c,//uhl.k, J{lt' iV;11 h~ Cl Htf/(lk/J1M~j ~htrn ami ~t'.St abdr:.nwtt /)1 !/lM$1 .s: TliFm,5 ~ &€lJIT oN ~G of J!E1ft. EiSTAlir'- A. flro-ra./''c11 01 ~ lint/A ~. j,~ *''' ,;. fJrb-ra!JPI1 PI seA""j /axes. /'/;e '1/)9 (~1: al?T7ZENBVT c9fEl?T "f~r!/IaJ //G'lEIO) 6. fJrucee/s ;....,'" .Yelle d-' ,#oJMO/r,y ~ ZJeflul.i /I"c;I,;,n Jerf//a, "'/ &rj,sk/ /.4. (sa ,/Me,..,/ ~1t-/lft'At ":/;~d ft;""" ~n& q#qdtett' ) 7 f?trf'41 Al!.fttrA pi ~/IIePkJl/U'; --41s. /?w/t{Hl /;041 cJlut ~/J1 F;-r~ .ur/ &.ftltt/!p &At;P4/tf/ ~ 3 2Z. 27 ~ ,Of ~ 33; ~l'1. d'S" ~ II. oS- 3. " ';?tJl:,f) 'I 7f/13. 7S" f. 0."'0 ~ ell,;.3. 7'1 !' ,;''t'.? SI /' I, l'Is. Sf) %77. '18 TOTAL (Also enter on line 5, Recapitulation) $ 31::>, 7S9. 5'1 (If more space IS needed, Insert additional sheets of the same size) .selfE./), ~., ~/Jt'rl 10. 6ST nOF . 6/XL.f::---z<,/,ICZG7/l'd. . s:. dle~.1 1M ?et;ftJ~q/ ~ /"$. /(Jf/tJ .4km 7. 4e5J1dM /.3/t(~ el'PfLEren;IILll1 &k/ M lJ(alztd!o[<?Q1'{4"H~Q/',;tJ/'t'Hf. Ifldm/u w,./,,; je:~-iR/1e t?1t/.k,,(fel'!,~ hdl'lw'en.. .2j-O'l,f/6 ~ d,o~_. ~ / !>6. 3'7 ....-..._-_._--._,.~,....._. "'(,.SlJ 'jZ _. .d.o..]7 n. _ H . _ _ Jl'q;'Q:t'i7 1> 3{' 75~ Sf ----.-...--,1_..___._.__.__~_._,.,_...- . 1(.. . / -? r'j,~ 'J ,. w ~ ~ ~1.&,r Barik )'N \.1;t.:!I,_L I~Jl.'" \I,,:',;:('r:' 1',<;;",;-" ~<..Ji" ..k j ','1.. .L, F~l',: "'1--"'{)5-",,:P~ l h;u'I(,,\ r s{}Jdo.... I..~ I .\((orn,-'\ .\.t L;.",\ h C}/.I\l.'d.'l RiI:uJ \Jech;lI1H..':,hur~" IJ \ t "'055 e, ;\( . U!Jl!:.,!lf/)_,~,:/!jl' -/iII;."::L ,-....'l;l;" ~ I' "I ;.~\JHn' Jee J n .__: ',;~ J 4 :-.~ :-; p "::', : ~ ,"" --r.'.;: . ~ '1..1 Per 'vi.1ur ':lQUlfV J~(t:..;J '~'.Jvcrnbc!' i)'i. ~U(\.;.. P;C,J."",: ''l~ ::\1'.:5("':': iJIJ.L '.~t "l1e :~nw ')(ikJlh rh~ J~:-'-c'V~"I\,irr:: j ,L~C'(';ij~,,~ :~,l(1 'm ,k9,):,II, \.lln :~.:; h.,I.!':\.; \h,: :i:,!!UV,lfl'.:' k;;:i!!ltJJ :1,:".':'-';; '\Ufflr,' I 'fl.'!'l(,~:7,il:!; .'... ,'U1I'" :,1'~ '!I,':.' ('.~;(c ',i,;.:,'.-; '!i :J~" U,-'dll" i ...","t ~i~',': in; /,',.',':,1 ;,_, '!.-fl( Ie ;.n/ 'i'!!; ~". .,;' ,~,~'-' I,'.',' ,,1'.. n_", "(' <'-"nu' - .' ~/, .' -J/j '-II'i'" I . ,~':.:~ 'e1 .", ~ '{({,r,"" .' :-'.. \' -"';" '.'1,1) ,;~..: i ".' ''J,. '{'l',i"" . r,~' .::\l'tlHl;.' ll',[l'..r......lIn. ';{.'nr''''"- ;IHl,..r- 'L'lf,,[,\,,""~l1-( '11'11.' '11,11 "{.:;,',"/ )..-_' i:J 'I{" I)" e" ",I ee .c \;,....t1".. ."" III ~ e, ion"':! tlon ., ' ),".: ':~' '.'\il ' ~ 1 (' :'"11...lt' V".-, Hf\l'l . -,~U1- ~ ... A. Settlement Statement U.S. Oepartment of Housing and Urban Development ~ ,r OMB Approval No. 2502-0265 B. !~E~_~!::~~~ : 6 ::A ~. 6 ;:~~n: 0 Conv unlns.16 F"'N"mb~' --L~nN~;;;' __J M"~:"n,~,~,,c,,~N;.mb~~ _-- C. Note: This form is furnished to give you a statement of actual settlement costs, Amounts paid to and by the settlement agent are shown. Items marked "{p.D.C.}" were paid outside closing; they are shown here for informational purposes and not Ln~lud~g lDJ:he !QLC!~____ G, Properlyl-ocalioll 661 Conodoguinet Avenue ::::::;'::',"::. r""-"^'~~ -- - IH s~~~mentAgen{ R~~ald 0 Butler - - -~ - ~ PlaceOfSetllement -..----- CS;:itlemer.\Date D. Name and Address of Borrower John T. Norman Carlisle PA 17013 500 N. Third Street, 12th Floor Harrisburg PA 1710i 3/28/05 Disbursement Date lo\: Block: ~: ~~":,_~~~_~f Bo~ro~~'~_!!ans~~~~___ ~~fg~ Amou~~ Oue.!:!~~ Borfow~r 101~_ ConJr~~~~~E.r:!~~ 1 02 f'~~9~_~1 E!:~.e~~Y 1 03 ~ettle~~~_t~harg~~ t.?_ bor~?~~_\~ine _l~~5!l 104 105 K. ~~~!!1~~!Y_ of _~~~~~'_~_!!~~_~ctl~n _~QQ: ~r~!.~!!lllunt D~e To Se!!~_ ~!QQQ:QQ i9_~:__~~~~~liatesp'rice_ ___,.. ._.. ~___ __ ~-_~-_ ___-- _-~~-~?'~QO-OO _ __~Q~:.JJ5lrs~n~E!:Qf:l~r.!'i_~~____ , 1,190,50 403. 404 -~---~- ~----~ 405 -- -- _~g;~_~!.'!l_<<:!1~_!~.! ~~p~ .e~~l!Ey~~~~_i~ ~~~~_!lE~_ 106 City!!~~_ laxes __ ~l?~05~_~!Q ~~~ ~!05 __~_~~stmel'!!!__for items ~ ~1_5elle!!!! ad~~~_~__ 223.79 49_~:_g!ty!!~n_.!?_~~~3/2~~__!2_!2/31(~__ 223.79 to to to to to to 407 CounJy I_axes _~__ _____ 408. ~sessm~~__ 248.51 409. ~~hool !.~~es __}!~BfO~_ 410. 411 to to to 6/30/05 248.51 -----"'-_._~-~ 107 ~ou~!~xe5________ 108 _~ssess~~,!~__ 109 School taxes 3/28/05 110 111 112 113 114. 115 to to to 6/30105 ------~---._--- ~ to ._-----~ -------------- to 412. 413 414. 415. to -.- -------_.._---~ to to to 200, Amou~~ Paid By Qr L~ Be~~_Q! ~~~___ 201 !?~~~_~earn~!'!l.2...n~~ 202 ~!~r:!~f@l ~!!1ouf!!~!lew ![J"~_~~L 203 _~xistinil~~l~l!aken sub~<::.~ !'?_ 204_ 205 206 207 208. 209 --I ---~-- ~~ 86,662.8Q 42ft Gross Amount Due To Seller ._ ~~!l._ ~!~~~!!ons!l!~!!1ountQue To Se~ 85,472.30 120. Gross Amount Due From Borrower ___~~_~gQ.QQ ~Q!._ ~l5~~~s_~Q.Q~!t_~!Q~~ction.!1.___ _~_____~._ ~~:-SeIlIElIl!':::!l.~ charge~!Q. selle~_Qi!le 14001.__ ?g~_~~~~9. !2~~(~l~!:!1_~bject !2____._ _____ _~___ ~4 t'~~~f.!_~~~~~~!!~.o~rt9~!a~..!9~~___ 505. ~~Q!! g!~~~~~~nortgag~ Joan___.________ 506. - ~g? _ 8.50p,00 1.145~3 508. 509. __~l!:!!:!.l!!.ents !~~!!_~_I"!1_~~'_!Paid~y seller_ 210 ~~~~wn _tax~___ to 211 gQt,!,n.~y~xes____ to _!o_dj~_~l!!~~!.s!9_r_!!~!!l:!~I!!!~ ~y 5eller.___~__ 510. g!'i!to~~ taxes to _______ _ 511 _ ~Q~~!Y~~~__ _--.!.~..~____ ~!~~~ss~~m~..!~___~ to 213 to ~!~ to 215 to ~1~. to 217 to 218 to 219 to 51 ~:l\sses~~ent~ 513. ~1:l:: ~!~-- 516. 517. 518. ~-~ 10 to to to to to to 10 300, _~~~~_.A..! ~eh~~~!!! f!g~1:!2 ~f'!~~~r_ ~ !:-_ Gros~_~f!1ount duefIom bo~ (line 1 ~l 302, _!:~~ ~mou!!! paiQ~}'!!2!_borrow.~~ {line 220~. 8,500.00 520. Total Reduction Amount Due Seller 600. f~sh At E!!t1e(tl~!!!!~f!E.1!l Selle~. ..___~, ___ 86&.62.~9_?_~~: _~r~s a~?,~_~_~ue_!9_~~ner i!!!:!.~~4201 __~_____ ~!~OO,Qg) ~Q?.:__~~~?__~~~~9.~s in~~!:. due se!!.~~_(!!Q.~~QL___ 9.645.83 220. Total Paid By/For Borrower _ 85-172.30 __ll.6~~83 ) 303. Cash 129 Fcom o To Borrower 78,162.80 603. Cash 129 To o From Seller 75,826.47 SUBSTITUTE FORM 1099 SELLER STATEMENT The intormatlon contained in Blocks e., G, H, and I and on line 401 (or, line 403 and 404) is importanltax information and is baing furnished to the Internal Revenue SeNice, If you are required to file a relurn, a negligence penally or other sandion will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported_ if this real estate is your principal residence, liIe Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6232 and/or Schedule D, Form 1040). YOll are required 10 provide the Settlement Agent (no-mad above) with your correctlaxpayer identification number, It yuu do not provide the Settlement Agent with your correcllaxpayer identification number, you may be subject to civil or criminal panaltlas imposed by law. Under pena\\ies of perjury, \ certily that the number shown on Ihl)' statement is my correctlaxpayer identification number. (S;;lte?SSign/~~~.:!...~5'<f~n r !:::. Set~~~~~ Chatge~_ 700. l'?~<!~_ S"~!i!!!"oker'~ ~il!!lrnjssj~ bas!!~g~ pri~~J Q!,:,isio!1 '1f_ Co~!!,issLo_fl {!i':l-~ !Q91_~.~_ f~!19~~: _85,000Q(j<1!! .. --. %:= 0.00 Paid From Bonower's Funds At Settlement Paid from Seller's Funds At Settlement 701 ~ 702. ~ 703 ~~I!lmi~~i~~~~ ':!t fl_eJ!IE>~~~_r1t 704 BOO. ltem.!_t~~~!l Co,!!,~~~_~~n ~~!!! Lo~!!__ B01 ~oar1 C2riginati~~fee 802. loan Discount -'-- ta to % % 803 Aepr~saJ Fe~ ~Q~ CredJ~ ~~~r! 805 !-'~~r:l~(:>_I.n.~f3~!igr'_ Fee_ 806 M()r~~9.~ !~sur~~e Applic~ion Fe~. ~I?_ 807 AssulT!e~!~!! f~~ 808 809 810 811 812 813 ~Q: Item!_~equired ~ lender!~~!~aid._!!J_~~~~l!ce 901 1nieres\ fr~m to ta ta _ _ .~_~clu~ 1~_~J.~~_i_~~!~~~.~j.n.l!~1_ ._____ @L_ -----(~------- _ffionth!!2.._________ _y~ars_!2._ y~~r~ Ig .~f-= gQ~. . MOI1gage !!lsuranc~ ~~mju~ !Qf 903. !1~~~~~l!1s11ra!:s:~l'!em!wn for 904 905 ! 000. ,,!!~!!,yes _Q.~posited !"'!_~~~ Len~~ 1001 Hazard insurance 1 ~----_..__._---- 1002_ ~~~~ge jns~~~____.:'. 1 1 1 1 1 1006 __!!l2!!~!1!@$ ._ _ '!I~!"!\~~@l. __!!!2f!!~s@$___ monlh~~ ~.2!'.ths@l__ _ _!f1-9-f!!~2-@j"_ .~~~!- _ _ __~~_~nth_.__ ~~f!l.~.!h________ ____~.~l"!1ontt!______ __________ ..____~~!l1.2~J~__~"______ _______ .e~_ mo'!.!!1~___~__ __ _2~~_f!lonth__. _._~_I"!'_l?_f!~___ 1003 City QJ:2E~rty taxes. 1004. Ca':J.Q~Jo'.E~~.e.~_rt}' laxe~ 1005_~n_~~!~~~?~f!l~~~~__ 1007 1008. A re ale Accounlin Ad'ustment 1100. ~!!\e Chafg~!l: 1101 ~~t1lem.~~ ~~_~~sinQ !t3~ 1102. ~~~~!..Q!.!!~~l?~~h 1103 T~~ ~~aminatiof! 1104 Tille insurance binder .....~--_.._----- 1105 _g().s:~~ent.prepar~!!.~n_ 1106 N...e!ary fee~ 1'\07 A\tarr\~t2f~_ (Includes ~9.~l~!n~~!1~!?~!~..: 110B Ti~l~ !!!.~~nce__ {!~~l!!e..e~ abo~~J~~~ f!~~.!?~~ 11 09 _~end~'~ co~~r~fl~ 111 0 q~()~.!:'~ ~q~~~~ 1111. 1112 1113. !2GO, G()~~!nmen\ Recording ,md Transfer Charges ta ta 10 ~~_~~_h<.!~ f~m ___ ta ta 300.00 ."...---------".-----..- -..---- to Cash ta 2.00 2.00 _1 ta .l .L ~ 120!.c._~cor~J;! fees: Q~~_j 1202. ~~!y!coun!Y_~~stamps: .~eed J...._ 1203. ~I~~ tax/stamps: Oee~ t_ 1204 1205 1300. ~dditianal ~!l:..t!I~_l!I~!!t ~harg!!. 1301. ~_~f\I~'i \0 1302 f'~~ ~n~~!!c,J!1. _!2. 1303. _?PO~Eou~!YJtow!lsh.lp T~.<.!!_~~~~ ~~x~_ 38.50 !._!v1ortga.fl~__ t_ _850.QQ ;~rtgage___.t____ 850.00 !...!V1artJ!<;IJ!~____L__ .__--.i~eleases _ ~_l_ 38.50 ----- 850.00 .~-_.._-- - 850.00 -------.- 293.83 -----_. ~----~._~_.._-- 1304 1305 1306. 1307 1308. 1400. Total Settlement Charges (enter on Jines 103, Section J and 502, Section K) CERTIFICATION ! have carefully reviewed the HUD-1 SetlJement Statement and to the best of my knowledge and belief, it i on my account or by e in s transaction_ I further certify that I have received a copy of the HUD-1 Settle <". . ' ~~r_~_X_C:C:.. Seller 1,190.50 1,145.83 Seller tl;~;I~~ accurate statement of all receipts and dIsbursements :nkme~ ~ _ __ Banawe, ,,-' ~hn T. N~rman Borrower To the best of mrtkn ledge t~e O~ be disbursed by \ ders>>^e. p. L.(, . --- .----... -----. -----..------ Ronald D. Butler etllement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will of th s l\eme(\t of this tra,nsaction. ~ /" _ .._____ Settlement Agent "___--3/~rL~_ __.~___ Date WARNING: II is a crime to knowingly make false statements to Ihe United States on this or any other simi(<Ir form Penalties upon convictiorl carl include a fine and imprisonment For details see: Tille 18 U_S_ Code Section 1001 and Section 1010. U_S_GoveRNMENfPRINTlNGOFFICE: 11110U-544-245 From DEHART'S AUCTION SERVICE 1554 HOLLY PIKE CARLISLE PA 17013 Helen bixler estate breakdown Household items sold 1,845.50 Real estate sold 85,000 Commison on household 738.20 Commison on real estate 1,700 Advertising on real estate 160.00 Total expenses 2,598.20 Minus 1,107.30 Grand total owed to dehart's 1,490.90 r., ,.... I LOT # ::;;1'?c -xq DATE 102-.;2)-&"1 . Q) RECElVED BY: - -.- ..... ..... . - _.... .... _n_n ....__. ~$'GNMENT'eoNTRAcTANo-SEfJiTt~l' , ! \ --~ I.~I ~ .-/~--;>"'- CONSIGNOR'S NAME // . /7/-"f''' , , 'r..:c ADDRESS ,~ / < d "- ;:/.,-- /' - ---r./..-r ,...- /' _0." 1:' ':/ //-' c' 5 elf ?' ~//_-./'- ..' //.~ L.:4 ~ .. j ~/ .~ /'i ~ ..:--? < "./ /. / / '-/ / Y d :>/ /?c:,: --""'-<-- ..) /-~ ; / ,:> I), PHONE / /' ~ ZIP CODE / -7 u 5 'G) aUANTITY DESCRIPTION OF CONSIGNED ITEMS I QUANTITY DESCRIPTION OF CONSIGNED ITEMS \ ) ,~ ~ , <- / - J "/ ., 7 U I l...j:.~ " '--::/'........ ~- - j c?< , , " J f , .. ~ !.:!:i-,-,t --- ,. \ ., . '. .-<~ C./- ,- 'I. , , , ^, , .' " .. .. , , , ! / .c- , , , - {' , " , " j u - '-<A......./ , ~ ,- ..' , ;:su ,. / I ) '- , ""., {,.' L t c..-',../t /-- ! .:::;.~....c - , i ! , . /,.., i'c,'-; / I J Pc 1/'1.. ;;> C/ T, ,c , C"'- "'"/ " I , -- ,c'-- -, /' - - ..-.J' , .) /"-;;/:;/ ..5 - " , L .. " iC/C/{"....-1 'j , / ,~ -<, , , , , - 1 I .- .' , ',' s- , ,.- ~"-' , , -- " /t --- I & 1 (-c" ~ Id >I/C? )"S/:]- C/L ri.//1 ~~ 'i\....' '- ,.'- , '>"'1/ -~.,~ I / I 'r,!-I S 1,4- ;/ i -- , , 7j:J1 f! A-- /; , J '-" '~ I " - <;.~ ,r ') -1.//1 , (,-("'" CE:J,.c...'1_ {' }J ,eo" - - -, , , Ii , ~ {, J ,- ;/(";- -' ,,- - " - " , :11 0;: /...,- /)/'1 ,-:-5Sc:"-. S" , , , i rj . ,- J 'i,/vl/L:,./-"I_______ I ;q 7'?' I < ;(/ , ,,;. --;/"I / ., ) ,- c !-,+,----::) '~ i.( , ; i~~-D~'__ , i~C'~_ . i.;;~,;J r.:--; /.::::..--- Q .) ,1.-':._ : '- -.?/l < ::- , \ '."/v , ! '- -''''V\ , ,) (' '- ~t""/t/-:-j5 '- ~,'~~) , :) ,1) ~ - "-- ~. ~-\ , 'A , , C../!..:. I 'T ~ C- .-',>, /'1-/ ::, ("- ------ " '- , \ (_:.>~, , ; i,1, ," - (:...>....,1 /''''-'~ :(/1...../} -le ," " -- '- - - , i - 1 , ,-- - - 1= - ! " -- , '- ,~ " ..;./..... , , , \//'\ ) , /_lCi../j - Jc I.J , " '."".~ , '-- - " , i ,,'1 ~ 1 , /,.., " J , i':':'fl 1,9/>/:- , , . - , ',' ' . " , .' , ~ , -- I, - .) ,HEET # OF_TOTAL SHEETS AlL ,'-e. ~d Sl!IlI'J,\llf!!IlIIi'JI, ~=1l.1IIl1I'(._E$, , , (consiqnor, hereby commission you to sell the items listed above & on 'ne atlacned sheets to the highest bidder by puolic auction. I cenitv that I .am the owner of the above listed items and have good title and the right '0 selllhem. I certify thallhe items listed are free trom all incumbrances. agree to accept all responsibility for proViding good title and tor delivery ,)1 tille to tile purchaser. it is agreed that the consignee IS not responSIble 'or the loss ,of any Item due to tire, theft, damage, etc. I understand that I ---___'~, commiSSion Will be deducted from the gross sates lr nw ,terns. -"No Bid" items will be disposed of at the discretion at the \lJclroneeriAucllon House, Payment will be made 10 the conSignor within ___ days from dale of sale ., ~.ru---~ ...~.... . Date" ...... Sf. $'I $I $It l1lIIIIlIIIL . '::onslgnor Signature cttllmllHe;' ~'1r -".- late ~uctloneerlAuction ;~lalt Sianature -fl.JEj..::~C~"~ 3E--...,;MENT .;:;P'" -- ~ BI'xb __~ II- , p~ ~ '" '*' f~/"''''/f~ /1 ~ ~tt1 tt4 (\,.0 '" J.p Ji-t '" 1-:, ' i,..J- ~ ,b M" "" n ,/./1 -1-1. . ~,P eJ '" 'k ~ /; ~ "'" .wi lI,ifMflPU \. . .L.: ,,,./i; '1.':: ,Ac;. ~#jd;,u- ,/A"'m ~T ~." d'-r ' ,..." d.. \ ~~ ? (-1W _tJ,pIwl-~ '.1 ' ,.c '7 _~/fih . t[~5 nit t r; - 1 \ C, }, 1 I 5 c. 6 8 6 .' t, ~I (, 6 6 n II 1 0 5' 3 Cl 0 '.I 155 9 a 1 5 1 4 \] / '15 1 Of 9 'J ~ :; 6 4 5 4 9 .~ I /, .. \1 5 , 1 0 9 " 4 1 ;< 3 4 0 I, I " 4 5 d 2 " \3 5 0 Z'-9.y ti '\ - 2 '9 3"" b'l 2 9 3 1\ 1\ ? 3 a ;< 1, ? 0 0 , 6 I,) ; 1 3 ') 1 I \I 4 4 a ;, 3 (. 1 19.0t5 ;, - <<Y""""""". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /1/ ,,-,(] )I. A. CJ X u::-r<., E; LG7)I n: SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ;2/- tJ7f- ?/6 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fl.LNfi"/U+L lulls ?R.€PIf I b /}T e;;tvlA/(; BRoT#E7(S /)~ a;f-.eUSLG, AI. - 1>- :2 EVJ/N(;. 1I~5. Fltl'lEIeAL H.mE hi/ sc.. FI(IV~A-L Gf:X/;J€"'SE"S ~il , fJt<t=p/!-,1) A-u-PwMCE JIll 7. SD 3. WIWI'IG #'55, FL4~ ,t:i./l I="N~ 1. , Y37.IO Jel-lbllAH$ W/TNBse;, r<€: (!a.75 of Se7eYIc.c ~ 7s.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ;( Name of Personal Representative (s) f//f,UY L SA'/Jl~Ph (.,'U,.7~ Social Security Numbens) I EIN Number of PelSonal Representative(s) 1'19- .JtI-.f2.f38 Street Address Ifo Kt7IM'APo ;lj). City /}1E(!IIAAJICU3<<IfG State ~/! Zip 17IJSQ Year{s) Commission Paid; .;J.oo S- 2. Attomey Fees CII/l-IlL€.J E. SIf/€L.1JS 1lI: 'j( t.,M(".7~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ;1/19#': Street Address II/ME City State Zip Relationship of Claimant to Decedent Probate Fees aHd pr1'n~/ ;,sstle of skrt eerfdiceo1?s ;< 4. los: /)0 5. Account.nfs Fees } Crou/s ~ "",' flayrl/l ~nus, -I S.2tf.;. Ai'! Sf., ~ 6. Tax Return Preparers Fees &.rI/sk, ""~ I1PI ~ ,(;r Ct'Pse 1/(1 /PfI.?, At 1'17, Sr. =rc. 3 at'. PP /(elu,." IP/FI.;JJ'/ 'fit ..me eo';'",. 7. I/tltI/hpl1t1/ Inhale fees ,- / ::is". OD Y. If,/ '//h" IIt,1 skd C'erf;icafcs " 9.00 '1, /f,/ ,;,-;, PIt,,/ s/uJrf euftl,c..fes ~ J>. 00 IR. hl/n; I?e fir J;,1te rdfllfa ~ ;(eN J'h. ~/.s: 60 II, ne ;Z,r JtZ /!UPUl1t (eol>.....) I 'to. oD / 12. ,4'/rerhsi1/ '(lI.{/IIber/tt1u/ Law JOtfrltA; 7 s: Ot) ( C#'/J r//I/{o,) -$ /3. /Jrlyertls l/if (!"r/'s/~ Sell!;l1t / /p7 99 TOTAL (Also enter on line 9, Recapitulation) $ tCJ ,O(,!;. 40 (If more space IS needed, Insert additional sheets of the same size) .seffGf), /f. /~/lf'tl. ;~.sT. of /JIXLa; lIael /I: Ii. IJJtlrK ~. II/I/Jert { 4ssoc$. . Red E1rJi 4//'4,sal /s jJ;J +t.- . , Ir:... f1 j1 -f L 17. fJ f1 fL It... ~/';f' /V~ dJ;.':p7P.sa! I 17 · " IYn ':<0.' Pi/fL. ~' flfJ I-L .;;;. Ifem,} ,,/ d~tt'ttd;'J1 M (/Ja~ ~/ real e.rfau h> John ;: /!I"rn14n~ , Se (/Ionent Itdtt' "11 /J;1/J"Ut 21; Zct?5: i ..f-. I/;/-""f he. //nt IIP~. ~ NJ : 4l'. If",,/ EsTaf; 7ntHStlr k ,,/ 1%"" <wk AQ. -4M 1:2LJ3 If'SOolJfJ .t!. Jpos GItAI/~dt)1 ~eAl Es14~ ~. L,fie 1303 ~:<t.3.i3 (,fC:E lIun .sET7Z~ntE'JI/ o7);li'Ehf'GY/ 47?;fI'!MflJ 7:P SV'm. E) :;3.. &hIlJISS/d/lS t al!ttl'f; #lIclJtJ;1 c$l"J/1ce d' 6lr/-Jk; /# " , A. {h,RisS;M M o'd; &1 ~/tply (~~ J'I/~, ~'z>) .&. r1AS'1/;ss/',pn ~ rVtJ ,,/ real e:sfa~ (?gs, 000. DD) . e. l(e/mbHI'SMIMt ~r werl,sJ7 WI J"t'P1 e.mite , (.see /):JI"r!'; dtlklllt'/Ji &ckd ~ sckci E.) :Jr. 7ri- 4ttHIj ,.f.bslrAcf ~~ ~ File :ie/tJ"d Ut jJMflA.rl-h'oH .,{.r rM~ ~ ~6r/ Esjale fJ {J tL t!la1!/1! / LPc/cs d If,"se #,J" S~c/.mfy fl/(J"I"gS. (See Sk!;h1Mr cr!IP.&kt:l) ;;7.. ;1~j9fes, /6Sh,{/ (!uf,'hetl /Tia;I/"?$/ ejz. (esh'm.) d?1-of/-,J'/1d ;<'~,M !" St., lfS ,z'lf. 'II ~ Y.7./~- ~ 10.97 ,K'~/. Z3 ~ ~o, '1/ ~~ .s-8 fl 73<f.2o ~ j 700.00 / ~/6{). PO -<5. ~;. . 'II 3. SlJ I" 17. ?'1 ~?'J'. $V f 3~. /0 -,;~";,r2~~.iJ\~~~~~~{ff~~dfil&.ti4~~~~~~~:'Ei~~~~~~~ .... ~Sf~."".... ~I 1:r~Y: ~ _, ,.~~,,t7"5t'-J'1'..!''' DOli f,}~ ,1IiircJ 6O-\273/;~ ~:'Ih"';;:;::'; Wcu-r flHk~f;:;; \ $ 37/ J U G~~~~A~A~ ~I /()CJ -()"II"" &J PNC Bonk, NA 040 Premium j~?t Central P A Plan }", #e/i'iV j,)c/er ruV'/u~) . '. ~ . -~-M' 1:0:1.:1.27:181: 5.1,0051, g I, :III' 1,1,.1,:1 ,,'000000:17.0," 4443 oPRINljT<Mg;SSP ;'I",'a","_"H",,,a,, ~ ~'~ " -;;-.' ' g)"'-' 01 "< -;;:;J .. =', :~. (l) 0 ....,. 1':1 (:) Oc.,<) tm'O ,. m ',,) r,) r.:::;.. C) 0:-1 ..:., ,,--~.-" t".~... '.<J ,..-,- (.0 '5 ~. ~Z .J) ",- ;;;:;",- ~~:i"~~\i~l- 2/ ~)'~~=6 -~/-: ~- ~ ::;:~,:~~,'t:t~_~~,~~~S;;~~~~~';;~~~~~\:':\~,_~::;.'~:~:~, --r.""'~",,""' ':~.,:~':.""~,--,-,, "", ,.- -" ',,'- "'''''''l'':'~'''''''''_'':''''e~""",,,,,,,,,,,,,,,,,_,,__, <,"':.Y,.: ._'.r"._'--._..' ','~'''','''''''''''' '," ,.' -',~'._',.~ .,,,.,,.,...,"', '" . \""!!',i'H, ;"'it,:"y,:>,/"",,:,,;,,~\~~"_lf_'''':>''''':'},',,,~''-'-, &i ;'_""'_'-""'\.;,._,:':""'_,,," Harry L. Sampson Norma J. Sampson ,i I BO Konhaus Rd I .? W Mechanicshur.. PA 17050-3126 'D . PT..;!O )..tj(1 'f ~~ . I' Ph '2'17.69'2'-8841' nil' -..I 6O-1273/~~~ -..J'", C '-i II 1~ ~"~:;::;~~fj~ ij!/M.iY;};~$ J/7S-d . (>~ ,,L<< '~<h- =-----:-do Dol/"" 6l ;:=::::' G PNCBAN< PNC Bank, N.A 040 Premium Central PA " Plan _' 17 '~ IJ;i-L.:Iu~w.f... .fln. 1:0'1 I. '1 I. 27'181: S I.L,ODSL, "II., '111' 4607 J' 77 i /j .,',/!~~@~ / L,bO 7 ,1'00000 I. I. 7 SO" """"""'''''" 1:0'11.'11.27'181: SI.L,OOSL,qL,'1~ L,b07tOOOOOI.1.7S0t --- - -- .--- ---------- - -~ - - -- -- ----- - - " ,,~ -..- -" ---- - - - - - - - ~ - - . -- - -- -- -- OfiE:3~3e16~)722 ~ :::l <0 o:r a2j' ~... ;;< ll(' ;p-g ~!$ _0 'J: :::l ,"'!: i 0518.142' _1 47 09=:'6.2004 C-<~_i i iJ00040 F'RB-- PH I LPJ ENT =:-'7.~ 9 TF~:C::::J/' ~ 9 ~c'K:::: I;;' , -, ,." '"\. ... 4"~!"'4"'h10f3Q "','7]',:;t ::i~., ".... !_':, ",;:,r .:f-~ .....::J', ':'::"~_- ';-1;.1. ~':~.','~. '-~~~~-$...-..e~:..~1:V l:t~~ ':i .-4 a.~~:~--:3c.:.5, f1 \:~IE.~ '~'_~ ~ _~. :9~ ._' .~~' P!l":. Oh.C~~ 24 7~74 4~=_~:,,5~1;:~~:!t" ~.~~ - .,....,. ---'-- 09282t~4 h~~? E~lZ63 "' '" :.i-2:~~16-2~~~~~iZd;;::r::7L3?i!.Ij,:~.:~tlT:;:LS'~'~~'~~~E~J!?~~~ A ~.2'S'::~ _ ~f.5"""r!!!'" - 1'J'''~9CI ~ !"a;, f)~~_''97..d._rt1'~1'7''5tJ-f1'2tf' ~(j 0111 '1J' dC-I J/y, <I "f.'-V'''''''' 'S ~ $ --t ~ ,- \tj'.:'~":~': ~,_ 'J ~" Q/>._ / '.~Ci /:::" / rc-~ -d ~-rA _ Do/1m); G Pl\lCBAN< PNC Bank, N.A 040 Premium Central PA Plan ) / / Ii. '/ ,--. "'<<aN"/ .f,',,/i-PlPN pixler ::'erVlcr'~_ 1:0,1.,1.27,81: Sj,l,ooSI,CjI"II" 4445 60-1273/313 106 Od rD ll~a..~~ I, I, I, 5 ."0000007500.'- 'C"""'."''''''''.n cP"'f!GTl!,!ETSSf> _.-> :.;::., -- ;...., '-'~ ...,. " -, I '."-' \";\ "-) ?RGC:ESSED - - ~,~[~~rm-lAL T ')9 !O~~~~ ,-....."-> J1e32004 PK~11 ~;3T7S -~-- --- + .. ------~- - -- - - -- - - - -- -- _ __ u _~ _ - --------- -- - - - . .. - - - - _.~ - - .-" ..;;..-:..,.; _.-' ----- kl' \ Jf...S ~'~0 () ~e~ 0o~o:. 1:> ~o ~e LOWE'S CRRLISlE, PR (]11)258.1100 -SRLE- SRLES .: S1710BB1 707570 08-17-04 1179BO PROTECTO TULIP EN 45.75 3 i 15.25 SUBTOTRL: 45.75 TRX 3B550: 2.75 INVOICE 04119 TOm: 48.50 8RLANCE OUE: 48.50 CRSH : 100.00 CHRNEE : 51. 50 1110 TERMINRL: 04 08/21/04 13:06:09 1~~~~~IIII~~~llmlilllllll~~ THRNK YOU fOR SHOPPINE LOWE'S RECEIPT REQUIREO fOR CRSH REfUHO. CHECK PURCHASE REfUNOS REQUIRE 15 OAY WAIT PERIOO fOR CASH BACK. RE'I!,\SI2EX.i\-'.I\ 'i-),. ~2i :t. ~, h , . ", ':l~"'. .....;1"'- , ' ~" ?- COMMONWEALTH OF PENNSYL'ljAN1A INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS /fEtaf 4: FILE NUMBER 13/1{~ .:z; -~'1- J>/6 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT ::;, ), 'f 5. 6. 7 1. 1. SirA-IfS ;:J,.eC=.41/EJ( t!.II;ejJ, ~(!I!r,.yp ,f'C? ~OS/t. C7'129 7, debt e,;/et,?p.l'l "foul' of ,tkfi,yk &~~rJ 4'd., 4' ~//J?dU/P~J; 4'4 (sa S/?!le4ft'llt 411<<cAuI) fY? fL, ..5~ k4/iP/1f:- ~r/( /(JJts'k: .l)/s/pspl c"r/,',s/e ck/JbJ1e/ ~Mf;Pdp ,&/I-?;; t:A.e'T tftl'd lJlln6u7 !J1/4t D4UpllJ/1 t!;1 & ~b>,f, 9/ ~S?62 ':z 7. .3l/ ~/ /3. .3/ ~ /~ 00 :r,,: f~ ~ It) 7. /)0 /65". /2 I (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 10, Recapitulation) $ ?31. '1 () MINNESOTA OFFICE: JAMES A. BALOGH - MN GARY W. BEGER - DC, Fl, IL MN, WI'" .CREDITOR'S RIGHTS SPECIALIST AMERICAN BOARD OF CERTIFICATION BALOGH BECKER, LTD. ATTORNEYS AT LAW ARIZONA OFFICE: 64 E. BROADWAY ROAD SUITE 175 TEMPE, AZ 85282 DIANA THEOS - AI, CO SANDRA TANG - AZ, CA r"- '~"1 CHELSEA A'. Wi1ITlEY - MN, WI ANGELA M. HORN - MN MICHAEL D. JOHNSON - MN MARY ELLEN WEEMAN - KS. MN, MO T\-1ERS\....O.lEE-MN CHAD J. BOLlr~SKE - MN STEVEN M. TOMS - MN JASONR. FOSTER-MN MEAGAN M. PROBST- MN MICHAEL J. DOUGHERTY- MN MICHAEL D. BOLINSKE- MN, OR Jill M. GEMlO- MN EMilY l. F\NGER- MN ANDREW S. MILLER- MN KAMILlE R. DEAN - CA SEND ALL WRITIEN REPLIES TO: 4) 50 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8449 FAX 763-852-8499 TOll-FREE 877-768-4494 OF COUNSEL: llTOW LAW OffICES, P.e. (IOWA) LUSTIG, GLASER & WILSON, P.c. (MASSACHUSETTS) February 14, 2005 Re: Estate of: Our Client: Account No: Unpaid Balance Due: Balogh Becker Account No: HElEN A BIXLER SEARS (CITIBANK USA N.A.) 8060516074297 $508.91 1243621 Dear CHARLES SHEILDS ESQ: We filed 0 proof of claim in the amount ot $508,91 in the Estate of the nome listed above some time ago, At this time, we are requesting the status of the disposition of the Estate, Please complete the coupon below and return it in the enclosed envelope, If you hove any questions or if you need to make payment arrangements, call us toll-free at 1-877-768- 4494, Cordially, Balogh 8ecker Ltd. Attorneys at Law This is an attempt to collect a debt and any information obtained will be used for that purpose, This letter is from a debt collector. IONBALOOl76tJ .UDetoch Lower Portiml and RelUm Wllh Payment." IIIDI I.alai 1110 mllllllllllD liD 1IIIIIIIIa Dill 1111I ~"IIII~ lllllllllllalllllllll!! 11111 11111 1m 1111 LAW FIRM OF BALOGH BECKER, LTO 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 ADDRESS SERVICE REQUESTED Account #: Balance: 8060516074297 $508,91 SEE REVERSE SIDE February 14, 2005 BALOGH BECKER, LTO 4150 Olson Memorial Highway Suite 200 Minneapolis MN 55422-481 ) 111.IIIIIIIIIIIIIIIIIIII.llll1l1l1ll1l1l1l11l1,II'llIwlIlIll 1243621-7613 1145376 28905 11111111111111111111111,llllllIllIIlulllll.l.IIIIIIIII...I.1I CHARLES SHEILDS ESQ 6 Clouser Rd Mechanicsburg P A 17055-9735 Estate ot: Executor: Date ot Estate conclusion: Date of Dispersal: Amount of Dispersal: Other: >>> Please enclose a copy of the inventory with the coupon <<< "-""...~-----_._.~"--,~--~--- REV.''''''.''"''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF t3IXLE7(/ II~LEJV /I. FILE NUMBER RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions) 1 17/1~,<lY L. S/!,1/jJo/'tJlv' /?tJ Kp/'IfI/fU5 !fA, /!1FeH-4A//osIiUle6) /Jt! /7tJ~ $t!N .2. DE&A'/I/I.K. 72E7V€Y(!K &:-e/M.I> (YI/LL> /? t'. ,&, X Of,p(Q .;('Cjo -S(). tV~ST S r. /'HL.:./:Y.- N€ bJ't'6f/ ..3. SUS4!'1 SIV/UJ.#/lf15F/(GG7< (l,;{/flVl>eHILL> /599 /11. ##//1/ r4€/1f.<?/VT AlG ~?tJ::ls , ~ {;/lE6-o~y ~/J(/lSt?A/ 64/tN..oCHILb /tJ,f €. j/ASS; s-r. J/.#UEY, AlE 6?t?&.S' .;ll- ,ps<' - cf/6 AMOUNT OR SHARE OF ESTATE ;;<'/3 Yq % ;/9 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON.T AXABLE 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) LAST WILL AND TEST AMENf OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (1/3) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chester H. Sampson, to wit: Debra TenEyck, Susan Sehwamberger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per stirpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .27;( day of ~A.D.2004. 7I-t~/YL d. i~~ (SEAL) HELEN A. BIXLER . Signed, sealed, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. LAST WILL AND TEST AMENT OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (113) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chester H. Sampson, to wit Debra TenEyck, Susan Schwam berger, Gregory Sampson. B. Two Thirds (213) thereof to my son Harry L. Sampson, per stirpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .27,( day of ~A.D.2004. 7//~/VL d. iA-~ (SEAL) HELEN A. BIXLER . Signed, scaled, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. LAST WILL AND TEST AMENT OF HELEN A. BIXLER 1, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. Alllhe rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (113) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chester H. Sampson, to wit: Debra TenEyck, Susan Schwam berger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per stirpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27,( day of ~A.D. 2004. 7//4/VL d. i~~ (SEAL) HELEN A. BIXLER . Signed, sealed, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. . LAST WILL AND TESTAMENT OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and TeSlament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (1/3) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chester H. Sampson, to wit: Debra TenEyck, Susan Schwamberger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per stirpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27,( day of ~A.D.2004. ;{tA/VL d. i.-<.-~ (SEAL) HELEN A. BIXLER . Signed, sealed, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. . , LAST W1LL AND TEST AMENT OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (113) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chester H. Sampson, to wit: Debra TenEyck, Susan Schwam berger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per stirpes. 3. 1 nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, ] nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ..27;;( day of ~A.D. 2004. 71d:/VL r;Z. ih~ (SEAL) HELEN A. BIXLER . Signed, sealed, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. . ~ LAST WILL AND TEST AMENT OF HELEN A. BIXLER I, HELEN A. BIXLER, of 661 Condoquinet Ave, Carlisle, (North Middleton Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. Alllhe rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, shall be divided and distributed as follows: A. One Third (1/3) thereof is to be divided equally per stirpes amongst the children of my deceased son, Chesler H. Sampson, to wit: Debra TenEyck, Susan Schwam berger, Gregory Sampson. B. Two Thirds (2/3) thereof to my son Harry L. Sampson, per stirpes. 3. I nominate, constitute and appoint my son, Harry L. Sampson, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter-in- law, Jean Sampson, to be Executrix in his place and stead. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my grandson, Jeffrey A. Sampson, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .27;( day of ~A.D. 2004. N.//:/VL a. i~~ (SEAL) HELEN A. BIXLER . Signed, sealed, published and declared by the above-named HELEN A. BIXLER as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 nu_u_ fold ESTATE INFORMATION: SSN: 174-20-7854 FILE NUMBER: 2104-0816 DECEDENT NAME: BIXLER HELEN A DATE OF PAYMENT: 05/31/2005 POSTMARK DATE: 05/31/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/21/2004 NO. CD 005377 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,497.70 I I I I I I I I TOTAL AMOUNT PAID: $5,497.70 REMARKS: CHECK#124 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS D[(YIDncC\ nr:F,rr: ,~r BUREAU OF INDIVIDUAJ.;,/UlIEl>) 'J' ,,"'- 'jr INtERITANCE TAX DIIJISIO""~ :'"', ;~: 1 C!-:: PO BOX 280601 ' , HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ~r."""!0"0 P' , 24 LU~0 ,',L.oJ J i: -I: DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-22-2005 BIXLER 08-21-2004 21 04-0816 CUMBERLAND 101 APPEAL DATE: 10-21-2005 ( See reverse side under Objections) AIIIoun't RElIIi't'tedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REY:is47-Ex-AFP-ioi:osi-NOTICE-OF-INHERITANCE-TAX-APPRAISENENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HElEN A FILE NO. 21 04-0816 ACN 101 Ci~_. Cr: OD'"'-' ">.:'" r...,-., ;)"":1".,'- ' ,J '. CHARLESCE!' SHIELDS III C,\ 6 CLOUSER RD MECHANICSBURG PA 17055 ESTATE OF BIXLER DATE 08-22-2005 I~ an assess.en't was issued previoUSly, lines 14, lS and,or 16, 17, 18 and 19 will r~lec't ~igures 'tha't include 'the ~o~al o~ Abb re~urns assessed 'to da'te. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15) 16. ABount of Line 14 tax8bl. at Lineal/Class A rat. (16) 17. ""aunt of Llna 14 at Sibling rata 1171 18. Aaount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due TAX RETURN WAS: (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estste ISchedule AI 2. Stocks and Bonds (Schedule BI 3. Closely Held Stock/Partnership Interest (Schedule CJ ct. Mortgages/Notes Receivable (Schedule OJ S. Cash/Bank DepositsIMlsc. Perso~l Property (Schedule El 6. Jointly Dwned Property ISchedule FI 7. Transfers (Schedule Gl 8. Totel Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl 10. Debts/MOrtgage Liabilities/Liens (Schedule Il 11. Totel Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts 14. Net Value of Estat. Subject to Tax NOTE: (91 1101 I CHANGED III 121 131 I'll (51 161 (7) 105.000.00 408.80 .00 .00 36.759.59 .00 .00 (81 00 = 045 = 12 = 15 = 1191= *' REV-1547 E~ AFP (16-D5) HELEN A 19,065.40 931. 90 1111 1121 1131 1141 (Schedule ..JJ .00 X 122,171.09 X .00 X .00 X NOTE: To insure proper credit to your account I sublli t the upper portion of this for. with your tax P&yaent. 142,168.39 19.997 30 122,171. 09 .00 122,171.09 .00 5,497.70 .00 .00 5,497.70 TAl( C DITS. P IT l+, ANOUNT PAID DATE NUNBER INTEREST/PEN PAID (-I 05-31-2005 CD005377 .00 5,497.70 BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-01-2005 TOTAL TAX CREDIT 5,497.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. 7.53 TOTAL DUE 7.53 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL OUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE A REFUND. see REVERSE SI:DE OF THTIl::. ~nD" I:'nD 'l'u,...._........._.._ , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 H_n_n fOld ESTATE INFORMATION: SSN: 174-20-7854 FILE NUMBER: 2104-0816 DECEDENT NAME: BIXLER HELEN A DATE OF PAYMENT: 08/29/2005 POSTMARK DATE: 08/26/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/21/2004 NO. CD 005731 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7.53 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: C E SHIELDS ESQ CHECK#1475 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $7.53 GLENDA FARNER STRASBAUGH REGISTER OF WILLS CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CWUSER ROAD Corner ofTrindle and Clouser Roads MECHANICSBURG. PA 17055 GEORGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795.7473 August 25, 2005 Register of Wills Carlisle Courthouse One Courthouse Square Carlisle, PA 17013 ....., C:~ <,:::::J GT> Attn: Vickie C) ~.~ ('; --1 ~710 :~ G~) "j \.0 Re: " -',,'--, Estate of Helen A. Bixler File Number 21 04 2004 ->. ,'; N \.0 Dear Vickie: Please find enclosed the Inheritance Tax balance sheet and check number 1475 in amount of $7.53 in payment thereof on the above referenced estate. Please call if you have any questions. Thank you. Very truly yours, ~f~1? Charles E. Shields, III CES/dab Enclosure -":~J ; ~-il I:'-~ '-,C) , j) C":) rT) i:'::> ,~~ -;") . 'Tl ':') C";--' 08-22-2005 BIXLER 08-21-2004 21 04-0816 CUMBERLAND 101 APPEAL DATE: 10-21-2005 ( See reverse sidjy under Objections) Amount Remitted[7 7.5:3 I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS - REV: i547 - E;( AFP - i 03:05) - NOTicE-oF - iNHERiTANCE-TAX - APPRAi:sEMENT~ - ALLoNANci:- OR- - - - - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HELEN A FILE NO. 21 04-0816 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX RFrn~,(1!LLOIIAHCE OR OISALLOIIANCE ';::~''9t:'Dn<<-"oi!S AND ASSESSHENT OF TAX _; ~_: _:.~ -. .. ;_ I , .' -, ". i ", 1',- , Z005 A,UG 29 :,1111: 29 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CHARLES E SHIELDS 6 CLOUSER RD MECHANICS BURG ClIFZ OF Or:;,!)!, ,~""'I :'IT III--f ,,'" , v."."" G" PA 17055 ESTATE OF BIXLER '* REV-1547 EX AFP (06-05) HELEN A TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 08-22-2005 I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will ~e~lect ~igur.. that include the total at ALL returns assessed to date. ASSESSMENT OF TAX: 15. AMount of Line 14 at Spousal rat. (15) 16. A.aunt of Line 14 taxable at Lineal/Class A rat. (16) 17. Amount of Line 14 .t Sibling rat. (17) 18. Anount of Line 14 taxable at Collateral/Class 8 rat. (18) 19. Principal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks _ Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. "ortgages/Notes Receivable (Schedule D) S. C.shlBank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Totel Assets (1) (2) (3) (~) (5) (6) (7) 105,000.00 408.80 .00 .00 36.759.59 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/"isc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental BequestSi Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax (9) (10) 19,065.40 931.90 Ill) (12) (13) (l~) NOTE: .00 X 122,171.09 X .00 X .00 X 00 = 045 = 12 = 15 = (19)= NOTE: To insure proper credit to your account, s~it the upper portion of this for. with your tax p&yllent. 142,168.39 19 .997 ~n 122,171.09 .00 122,171. 09 .00 5,497.70 .00 .00 5,497.70 TAX CRED'T": r"on...' ,., AHOUNT PAID DATE _BER INTEREST/PEN PAID (-) 05-31-2005 CD005377 .00 5,497.70 BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-01-2005 TOTAL TAX CREDIT 5,497.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. 7.53 TOTAL DUE 7.53 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIDNAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) . ! 1 ~ '\', "_ f I. ~, ! 1i l " , ~, ' \ ,; , III i iCE OF Jr vn LS J 29 fill i :2') CLW aDDu:' iol i'r' Cli" " /'~"";'\ I_~'- '- - f -~. '~;..., /."" .. ,--, I" ~ '-' \>. ~Lf' \~--.,! ,;, '" 'I ~'~--', )-~/~ i: <:....-' , V'l V'l o r-- ~ s ~ :t Qjro-g :a~O rJJ';;:~ u.5 ' $-0 >,<1) '" <I) '" ~ E g a 0-- ..ct::U U-<-.o ;t bll ... ;:; ~ u '2 '" .<: u <I) :; <V ... ell ::l IDe; 'Jl (f) C') .~ 6 ~o >€::l~ <v>::l 0 ,_.... o,s<l: "",0,,"'0.. 01,...'-J:J ,- <V 0- >_<v".9,! 'Jl 'Jl '-' 'Jl C "51 .~ <D .~ ;::Q)COcco <(o::uou ('.1 ifl (.) f') I (') .:-., () r.... '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~~~~~N.~A~~~ TAX ~"'S],A'IT.tMEN-pjgF ACCOUNT REV-1607 EX AFP (03-05) -"j ,~AT~ estNrE OF DATE OF DEATH FILE NUMBER c-OUNTY ACN 09-26-2005 BIXLER 08-21-2004 21 04-0816 CUMBERLAND 101 HELEN A CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG PA 17055 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- ... INHERITANCE TAX STATEMENT OF ACCOUNT .** ESTATE OF BIXLER HELEN A FILE NO.21 04-0816 ACN 101 DATE 09-26-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-22-2005 PRINCIPAL TAX DUE: 5,497.70 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-31-2005 CD005377 .00 5,497.70 08-26-2005 CD005731 7.53- 7.53 TOTAL TAX CREDIT 5,497.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 .. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) c~ - STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen A. Bixler Date of Death: August 21,2004 Will No. Admin. No. 21-04-0816 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No )( b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. ~I!~ Signature Date: 1~//3;/""S r- Charles E. Shields, III, Esquire Name (Please type or print) (..-, Ll ~"- t? ,- o~ 6 Clouser Road, Mechanicsburq, PA 17055 Address r-- C_' t..~ '--.-.' (717 ) 766-0209 Tel. No. _....c.; Capacity: Personal Representative (~...; x Counsel for personal representative (MAH: rmfl AM3)