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11-30-11 (2)
1505610143 REV-1500 Ex(D,_,D> OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code rear File Number Bureau of Individual Taxes oErnRTMENT OF REVENUE Po Box.28oso1 INHERITANCE TAX RETURN ;21 11 0583 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 193 12 8216 05 06 2011 05 15 19'.6 Decedent's Last Name Suffix Decedent's First Name MII BOWERS IRVIN >~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name hhl HOOVER BETTY Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death aver 12-12-82) ^ 5. Federal Estate Tax Return Required g Decedent Died Testate ~ Decedeppt Maintained a Living Trust 8. Totaf Number of Safe De (Attach Copy of Will) ^ (Attach Copy of Trust) pOSlt BOXES ^ 9. Litigation Proceeds Received ^ 1 D, S ousai Poverty Credit date of death 11. Election to tax under Sec. 9113 A b/°tween 12-31 51 and -1-95) ^ (Attach Sch. O) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL 'fAX INFORMATION SHOULD BE DIRE TED TO: Name Daytime Telephone Number JERRY A WEIGLE ESQUIRE 717 532 7388~~_ First line of address 126 EAST KING STREET Second line of address City or Post Office SHIPPENSBURG State ZIP Code PA 17257 __ REGISTER Dg~II~S USE ONLY -~ _,_ „~~ r. i ~__ _:1.7 C.> a "> :=: _ . -r,, C..) ;", - :~J D r , ', `:. DATE FILED ~:r; 7 j -'; ~~ -n -~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and b lief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~YYI . s~cz_ -~~ e. I~o~~,,.,.Q.p.~ M. Sandra Kempf / / ~~- /! ADDRESS / SIGNATURE PRE ARER OT THAN R E NT D TE Jerry A. Weigle Esquire ~~ ~2 2 --~ ADDRESS 126 East King Street, Shippensb a, PA 1505610143 Side 1 1505610143 ~..- ~1 V(.G'- 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: B~We~S, Irvin W. 193 12 8216 RECAPITULATION 1. Real Estate (Schedule A) ..................................................................................... .. 1. 16 6, 0 0 0. Q 0 2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 35 , 682 . f~l 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ...................................................... .. 4. 5 Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ............. .. 5. 64 6 , 3 8 4 . 6j 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 116 , 665 .2~ 0 7. Inter-Vivos Transfers & Miscellaneous I~nq Probate Property ', (Schedule G) u Separate Billing Requested........... . 7. ^ I 757 , 607 . ':I $ 8. Total Gross Assets (total Lines 1-7) ................................................................... .. g. 1 , 722 , 339. >~ 9 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 5 9 , 0 05.41 $ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 7 , 831.8 5 11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 6 6 , 8 3 7 . 33 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12, 1 , 655 , 502 . 56 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14, 1 , 655 , 502.5116 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable !, at the spousal tax rate, or transfers under Sec. 9116 $ 8 $ 62.5 0 (a)(1.2) X .00 r 15. 0 . a 0 16. Amount of Line 14 taxable 1 5 6 6 at lineal rate X .045 , 640.0 6 16. 70 , 4 98 . 8~0 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0 , 0~0 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 0 . OO 19. Tax Due ................................................................................................................. . 19. 7 0 , 4 9 8 . 80 I 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. I ll Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0583 DECEDENT'S NAME Bowers, Irvin W. STREET ADDRESS 518 West Main Street CITY Walnut Bottom STATE PA ZIP 17266 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 65,000.00 3,421.05 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 70,498.80 Total Credits (A + g) (2) 68,421.05 (3) (4) a (5) 2,07.75 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN T'HE APPROPRIATE BLOCK 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ~ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ C~ i 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ~ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE (3 AND FILE IT AS PART OF THE RETURN. for dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. ', For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural patent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ' Rev-1502 EX+(11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT i ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 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 6e exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is Jointly-owned with right of survivorship must be disclosed on schedule F. to nwic aHaw i~ neeueu, auumunm payer of uie carne size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) ~ Rev-1503 EX+ (6-98) SCHEDULE B f STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Irvin W. FILE NUMBER 21-11-0583 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT OF DEA ATE H 1 100 shares of Banco Santander, SA 11.67 1, 67.00 2 639.361 shares of General Electric Capital Corporation 25.785 16,85.92 3 20 shares of Knouse Foods Cooperative -liquidated 6!15!11 100 2,00.00 4 655.611 shares of Morgan Stanley Capital TR III 24.450 16,29.69 TOTAL (Also enter on Line 2, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 35,482.61 Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bowers, Irvin W. Include the proceeds of litigation and the date the proceeds were received by the e:;tate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. FILE NUMBER 21-11-0583 ITEM NUMBER DESCRIPTION VALUE AT OF DEA ATE H 1 Checks on hand at date of death -including certificate of deposit interest checks, annuity X34.73 distribution, and medical refund check 2 Consumer Reports Magazine -refund '~ 22.00 3 County Tax Proration at real estate settlement ~87 27 4 Credit Card -points refund '93.77 5 Hartford Life Insurance Annuity -annuity distributions credited to M & T checking account 1,89.46 after date of death and before closing of account i 6 Highmark -health insurance refund 85.62 1 7 Lititz Insurance -refund 54.00 8 School Tax Proration at real estate settlement 2,75.47 9 Citizens Bank Certificate of Deposit 51208 20,00.00 Accrued interest on Item 9 through date of death 119.53 10 Citizens Bank Certificate of Deposit 64560 37,867.00 Accrued interest on Item 10 through date of death 1110.79 11 Citizens Bank Certificate of Deposit 93405 50,Ob0.00 Accrued interest on Item 11 through date of death 39.99 12 Citizens Bank Checking Account 63800 ~t0.00 Total of Continuation Schedules See attach~d a es ' TOTAL (Also enter on Line 5, Recapitulation) 646,34.60 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Revl. 6-98) ' Rev-1508 EX+ (8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 ITEM NUMBER DESCRIPTION VALUE AT ATE OF DEA H Accrued interest on Item 12 through date of death 0.00 13 M 8~ T Bank Certificate of Deposit 01460 85,x43.86 Accrued interest on Item 13 through date of death 408.68 14 Orrstown Bank Certificate of Deposit 33705 11,x00.00 Accrued interest on Item 14 through date of death ' 25.74 15 Orrstown Bank Certificate of Deposit 35091 75,00.00 Accrued interest on Item 15 through date of death ' .73.46 16 Orrstown Bank Certificate of Deposit 36372 25,400.00 Accrued interest on Item 16 through date of death ',17.98 17 Sovereign Bank Certificate of Deposit 34636 10,x00.00 Accrued interest on Item 17 through date of death ' .11.32 18 Sovereign Bank Certificate of Deposit 56644 15,Op0.00 Accrued interest on Item 18 through date of death 7 17 19 Sovereign Bank Certificate of Deposit 64614 - In Trust For M. Sandra Kempf, daughter 95,Ob0.00 Accrued interest on Item 19 through date of death X16.62 20 Sovereign Bank Certificate of Deposit 71718 99,99.00 Copyright (c) 2 002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ' Rev-1608 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 ITEM NUMBER DESCRIPTION VALUE AT BATE OF DEATH Accrued interest on Item 20 through date of death 77.69 21 Sovereign Bank Checking Acount 05731 -various certificate of deposits interest credited 492 37 prior to closing . 22 Wells Fargo Certificate of Deposit 1658 50,000.00 Accrued interest on Item 22 through date of death 87.14 23 Wells Fargo Certificate of Deposit 4267 50,000.00 Accrued interest on Item 23 through date of death 1 ~ 24 Wells Fargo Checking Account 5938 25 1995 Ford F150 Regular Cab -proceeds of sale 7/13/2011 813.00 26 2003 Cadilac DeVille Sedan -proceeds of sale 7/13/2011 3,700.00 27 Personal Property -gross proceeds of public sale 7/18/2011 11,679.50 TOTAL (Also enter on Line 5, Recapitulation) I 646,384.60 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ' Rev-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Betty K. Hoover 518 West Main Street Spouse Walnut Bottom, PA 17266 B. M. Sandra Kempf 520 School Lane Daughter Rehoboth Beach, DE 19971 C. Hoover/Kempf JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE 01= DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 B 09/30/2008 M & T Bank Certificate of Deposit 01189 - 20,000.00 50.000% 10,000.00 opened 8126/08 with M. Sandra Kempf, daughter B 09/30/2008 Accrued interest on Item 1 through date of 11.68 50 000% 5 84 death . . 2 B 09/30/2008 M 8< T Bank Certificate of Deposit 01212 - 60,000.00 50.000% 30,000.00 opened 9130108 with M. Sandra Kempf, daughter B 09/30/2008 Accrued interest on Item 2 through date of 6.45 50.000°/a 3.23 death 3 C 07/06!2007 M 8 T Bank Checking Account 40082 - 70,457.73 33.333% 23,485.91 opened 10/4/82; made joint with Betty K. Hoover spouse, on 7/6/07; and made joint with M. Sandra Kempf, daughter, on 10/4/82 C 07/06/2007 Accrued interest on Item 3 through date of 3.64 33.333% 1.21 death 4 B 11/04/2004 Sovereign Bank Checking Acount 05731 - 2,~I53.34 50.000% 1,376.67 opened 11/4/04 joint with M. Sandra Kempf, daughter Total of Continuation Schedules See attached a es TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 116,665.20 Form PA-1500 Schedule F (Rev. 6-98) ' Rev-1549 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE 01= DEATH VALUE CIF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST B 11/04!2004 Accrued interest on Item 4 through date of 0.00 50.000% 0.00 death 5 B 07/20/2007 Wells Fargo Certificate of Deposit 0128 - 30,000.00 50.000% 15,000.00 jointly owned with Sandra Kempf, daughter B 07/20/2007 Accrued income on Item 5 through date of 41.60 50.000% 20.80 death 6 B 07/20/2007 Wells Fargo Certificate of Deposit 0262 - 20,000.00 50.000% 10,000.00 jointly owned with Sandra Kempf, daughter B 07/20/2007 Accrued income on Item 6 through date of 7.41 50.000% 3.71 death 7 B 07/20/2007 Wells Fargo Certificate of Deposit 3846 - 30,000.00 50.000% 15,000.00 jointly owned with Mary Sandra Kempf, daughter B 07/20/2007 Accrued income on Item 7 through date of 5.18 50.000% 2.59 death 8 B 07/20/2007 Wells Fargo Certificate of Deposit 8976 - 15,000.00 50.000% 7,500.00 jointly owned with Mary Sandra Kempf, daughter B 07/20/2007 Accrued income on Item 8 through date of 54.80 50.000% 27.40 death 9 C years Wells Fargo Checking Account 5938 -jointly 12,'713.20 33.333% 4,237.73 owned with Betty K. Hoover, spouse, and Sandra Kempf, daughter Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-7509 EX+ (6-98~ t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF Irvin W. LE NUMBER 21-11-0583 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) ' Rev-1510 EX+ (6-98) SCHEDULE G _ INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bowers Irvin W FILE NUMBER , . 21-11-0583 This schedule must be completed and filedrf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE DATE OF DEATH VALUE OF A % CIF DECD'S INTEREST EXCLUSION (IF APPLICABL TAXABLE . SSET E ) VALUE 1 Hartford Life Insurance Annuity 712657712 - 70 256 92 beneficiary M. Sandra Kempf, daughter , . 70,256.92 2 Hartford Life Insurance Annuity 712661658 - 127,248.20 127 248 20 beneficiary M. Sandra Kempf, daughter , . 3 Hartford Life Insurance Annuity 712796205 - 40 716 45 beneficiary M. Sandra Kempf, daughter , . 40,716.45 4 Western National Annuity 5FP11460 -beneficiary M. 58 509 24 Sandra Kempf, daughter , . 58,509.24 5 Western National Annuity AN201049 -beneficiary M. 229 575 06 Sandra Kempf, daughter , . 229,575.06 6 Western National Annuity FJ220337 -beneficiary M. 122 554 17 Sandra Kempf, daughter , . 122,554.17 7 Orrstown Bank Certificate of Deposit 41141 -made 61,500.00 100..000% 3,000.00 58 500 00 joint 3!29111 with Mary S. Kempf, daughter , . Accrued income on Item 7 through date of death 136.48 100.000% 0.00 136.48 8 Orrstown Bank Certificate of Deposit 41143 -made 50,000.00 100.000% 0.00 50 000 00 joint 3/29/11 with Mary S. Kempf, daughter , . Accrued income on Item 8 through date of death 110.96 100.000% 0.00 110.96 TOTAL (Also enter on Line 7, Recapitulation) I 757,607.48 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) ' REV-1151 EX+~10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS tSfATE OF Bowers, Irvin W. Debts of decedent must be reported on Schedule I. ITEM N MBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) FILE NUMBER 21-11-0583 AMOUNT 9,255.30 Street Address City State Zip Year(s) Commission oaid 2. Attorney's Fees Weigle & Associates, P.C. 37,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. Probate Fees 1,193.50 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 11,056.68 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 59,005.48 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Bowers, Irvin W. FILE NUMBER 21-11-0583 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Church of the Brethern -funeral reception 250.00 2 Fogelsanger-Bricker Funeral Home 9,005.30 H-A 9,255.30 Probate F 3 Register of Wills, Cumberland County -Letters Testamentary and Short Certificates 1,193.50 H-B4 1,193.50 Other Administrative Costs 4 Cumberland Law Journal -advertising Letters Testamentary 75.00 5 Expenses of public sale of personal property 4,087.82 6 Linda K. Klein -notary fee 26.00 7 M. Sandra Kempf -executrix expenses through 9/15111 including air fare, automobile travel, 4,033.11 tolls, food, and lodging 8 News Chronicle -advertising Letters Testamentary 104.75 9 Real Estate Settlement Expenses -including attorney fees ($235.00) and realty transfer tax 1,895.00 ($1,660.00) 10 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 11 Register of Wills, Cumberland County -filing Family Settlement Agreement 100.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued I ESTATE OF Bowers, Irvin W. FILE NUMBER 21-11-0583 ITEM NUMBER DESCRIPTION AMOUNT 12 Sovereign Bank -account verification fee 20.00 13 Steve Bender -trash removal from residence 300.00 14 Steve Bender -trash removal from residence 300.00 15 Weigle & Associates, P.C. -reimbursement for postage, xerox copies, and long distance 75.00 telephone calls 16 Wells Fargo -account verification fee 25.00 H-B7 11,056.68 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ~ Rev-15'12 EX+t12d1$) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Irvin W. FILE NUMBER 21-11-0583 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Betty Hoover -reimbursement for car insurance 460.00 2 Capital One 453.64 3 Century Link 33.15 4 Century Link 33.15 5 Century Link 19.87 6 Donna Brobst, Tax Collector 2,503.58 7 Kuhn Communication 37.96 8 Kuhn Communication 37.96 9 Kuhn Communication 22.46 10 M & T Bank Checking Account 40082 -check written prior to date of death clearing bank 220 , after date of death .00 11 PP&L 142.99 12 PP&L 103.61 13 PP&L 93.15 14 PP8rL 76.75 15 Sovereign Bank -checking account overdraft fees and deposit to cover NSF checks writt en prior to date of death 816.66 16 Sovereign Bank Checking Acount 05731 -checks clearing after date of death 2,753.34 I Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Rec:apitulation) 7,831.85 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) ' Rev-1512 EX+ (6-981 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS continued ESTATE OF Bowers, Irvin W. ITEM NUMBER 17 Sprint FILE NUMBER 21-11-0583 DESCRIPTION VALUE AT DATE OF DEATH 23.58 TOTAL (Also enter on Line 10, Recapitulation) I 7,831.85 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) ' REV-15'13 EX+I~~-08) COMMONWEALTH OF PENNgYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Bowers, Irvin W. 21-11-0583 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOU NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT of ; ~ (Words) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Gwendolyn D. Aboutboul 78 Glade Circle East Granddaughter Specific Bequest Rehoboth Beach, DE 19971 2 Lee-elle Aboutboul c/o Gwendolyn D Aboutboul Great- Specific Bequest . 78 Glade Circle East granddaughter Rehoboth Beach, DE 19971 3 Noa Aboutboul c/o Gwendolyn D Aboutboul Great- Specific Bequest . 78 Glade Circle East granddaughter Rehoboth Beach, DE 19971 4 Betty K. Hoover 102 Cottage Road Spouse Joint Assets and Shippensburg, PA 17257 Specific Bequest 5 M. Sandra Kempf 520 School Lane Daughter Joint Assets and Rehoboth Beach, DE 19971 Residuary See continuation schedule attached Continuation Enter dollar amounts for distributions shown above on lines 1 Total 5 throu h 18 on Rev 1500 cover sheet as a ro I NON-TAXABLE DISTRIBUTIONS: II , . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTI ON TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABI Copyright (c) 2009 form software only The Lackner Group, Inc. NT OF ESTATE ($$$) 50,000.00 30, 000.00 30,000.00 88,862.50 1,406,640.06 50,000.00 1,655,502.56 ONS ON LINE 13 OF REV-1500 COVER SHEET Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Irvin W. Bowers 05/06/2011 193-12-8216 Item Name and Address of Person(s) Share of Estate Number Receiving Property Relationship (Words) 6 Richard T. Kempf Grandson Specific Bequest 520 School Lane Rehoboth Beach, DE 19971 Amount of Estate (S~~) 50.000.00 Total 50 000 00 1 LAST WILL AND TESTAMENT I, IRVIN W BOWERS, JR., presently residing at 518 West Main Street, Walnut Bottom, South Newton Township, Cumberland County, Pennsylvania 17266, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any tune heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and fizneral expenses as soon as may be convenient after my decease. SECOND. I give and bequeath the full sum of Seventy-Five Thousand Dollars ($75,000.00), any vehicle that I own at the time of my death and any household contents and appliances located in my home that belong to me to my beloved wife, BETTY K. HOOVER, absolutely. THIRD. I give and bequeath the full sum of Fifty Thousand Dollazs ($50,000.00) to my granddaughter, GWENDLYN D. ABOUTBOUL, presently residing at 78 Glade Circle East, Rehoboth, Delaware 19971, on a per stirpes distribution basis. FOURTH I give and bequeath the full sum of Fifty Thousand Dollazs ($50,000.00) to my grandson, RICHARD T. KEMPF, presently residing at 520 School House Lane, Rehoboth, Delawaze 19971, on a per stirpes distribution basis. FIFTH. I give and bequeath the full sum of Thirty Thousand Dollars ($30,000.00) to my great-granddaughter, LEE-ELLE ABOUTBOUL, presently residing at 78 Glade Circle East, Rehoboth, Delaware 19971, on a per stirpes distribution basis. SIXTH. I give and bequeath the full sum of Thirty Thousand Dollars ($30,000.00) to my great granddaughter, NOA ABOUTBOLTL, presently residing at 78 Glade Circle East, Rehoboth, Delaware 19971, on a per stirpes distribution basis. SEVENTH. I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, M. SANDRA KEMPF, presently residing at R.D. 3, Box 23, Towanda, Pennsylvania 18848, on a per stirpes distribution basis. -'`~~ ~~.- cc:'• /~-~-~- (SEAL) WEIGLE S~ ASSOCIATES, P. C. -ATTORNEYS AT LAW - ]26 EAST KING STREET - S~HIPPENSBURG, PA 17257-1397 EIGHTH. In the event that any beneficiary of this my Last Will and Testament is under the age of eighteen (18) yeazs, I then give and bequeath said beneficiary's share to and appoint as Trustee of any property which passes under this Will or otherwise, M. SANDRA KEMPF, AS TRUSTEE, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches the age of 18 yeazs, with the following powers in addition to those presently given by law: A. The power to expend the income towazds the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power to expend the principal, within tlhe discretion of the said Trustee, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; C. The power to sell any and all real estate, within the discretion of the said Trustee; D. The power and obligation to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of 18 yeazs, without the necessity of a formal adjudication of the Trustee's Account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; E. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, nor to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively; and F. In the event the above-mentioned person is unable; to accept the position of Trustee, I then name, constitute and appoint GWENDLYN D. ABOUTBOUL, as Trustee, with the same powers hereinbefore stated. ~t --- ~~ ' C~c-w-~~ ~ _ ~ (SEAL) WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - :SHIPPENSBURG, PA 17257-1397 NINTH. I nominate, constitute and appoint my daughter, M. SANDRA KEMPF, to be the Executrix of this my Last Will and Testament; if she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint my daughter, GWENDLYN D. ABOUTBOUL, to be the Executrix of this my Last Will and Testament. TENTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ELEVENTH. I hereby direct that all federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of administration of my estate and that such be paid out of the rest and residue of my estate. TWELTH. I direct my Executrix to retain the services of JERRY A. WEIGLE, ESQUIRE, with offices presently located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, IRVIN W. BOWERS, JR., have hereunto set my hand and seal to this my Last Will and Testament, written on tl}ree (3) pages, the first two pages signed for identification only, this ~ 7k day of ~ ,,~ /~/ , 2007. ~.I,-,,.-_-- ~ • ~. ~..~.` (SEAL) WEIGLE 6c ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other., we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, IRVIN W. BOWERS, JR., the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by IRVIN W. BO RS ,the Testator, this ~~ day of , 200 ~~ Deny a w Shippensburg, Ay Comn•usson sip otary Public nberland Courrty Octotpr 7, 2010 II - WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - °~HIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS r _ l ~~iC~ E~ , and ~ GXc~Z~Cr-~ ~J I I ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw IRVIN W. BOWERS, JR., the Testator, sign and exe:cute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. :... ~~ Sworn or affirmed to and subscribed befor_ ____ by ~~~r !-C' c~~l~ ~~r and ~ ~ GX D~~.s~-~ ~ . ~ ~.~~ l w~1 sses, this ~j (~j day of (~,~~ , 2p(17. ;uT6e N07ARIAL SEAL ~'J`" ~nY A• Weigle, Notary Public ~;,, Shippensburg, PA Cumberland CoUrrty ' MY Commission Expires Octo~r 7, 2010 °'.,- ... _,~;. WEIGLE & ASSOCIATES, P. C. -ATTORNEYS AT LAW - 126EAST KING STREET - :SHIPPENSBURG, PA 17257-1397 A _ ~etzt~ernenl: U.S. l7eparfnsrk of Fbusirtg rirrJ Urban Devdopn~rtt rnn an,rrr,,al nh ~5o2_o2s5 o. I - 1. 0 FHq 2. ~ Frrf-lA 3. 0 Canc. Uryrs. 6. File Norther 7. Loan N~rri~' B. tAxtgage Insurance C:~se Nunt>er 4. VA 5. Cam.lrs. 112282SNYDER 6 I6 llnl B~)T%!B ~ gB Il~e~~i]~I~.~t~ G Nate: Ibrrs rtarkatl "(µcc)" vere paitl wsida Ur tlosirp; Nryrs slnen hse for 4dmtaUm purposes ^rda^ roc Intl Wmd In ihm tabls WoRNNG: Ills s virtu b Iavi.r51Y arose Wee WelerTQLS b the UNktl Saks m 1HS a^rrY dFv'firtgr fc rn Por~elGas upon oonNdim oen irKiude a firo e~tl irrrnmrrrerV- For aeldls e^a:'nue tB U. S. fade 5edim tOD1 ^rd serum 1oto. Primed 08llOG?011 x:06:00 RLH D. NAIvE CF I3JRRGNER Ryan K Snyder and VVettdi J. Martin ADDf~SS: 797 Walnut om Shi PA 17257 E ty4NE OF SELLER Estate d Irvin W. sowers Jr. ADDRESS: F. NAIvL- OF LET~fft ADDf~SS: G. PROP6~TY ADCRESS: 518 W. Main Street, Shippersbury, PA 172'71 South Newtown TownsM H. SETT1FNEt~lf ACi3J1': South Central Horne Settlerrerrts, Inc., Telephorte: 717.532-?387 Fax 717.532-6552 PIACF OF SEflLElvlrMM': 126 East 16 Shi PA 17257 I. SE rfLEtvt3J1' D4 013x1 1 J. SUMMARY OF S 1RANSACiION: K OF 5E11.67'S 7RAPlSAICTION: 100. GROSS AMDIINT DUE FROM BOIZROJI52 400. t;FtOSS AMOUNT DUE TO SELL92 101. Cordr-dctsales 'ce 1 ODD.DD 401. Cariradsales 'oe 1 000.00 102. F~Sartal 40;2 Plgsonal 103. SelUerrertt ~ 1o tlarvner' irre 140D 277.00 403. 104. ~. 105. 4~• latrretrts for hens 'd seller I n adrerxe Pde far Items 'd seller f n adusnoe 107. Count faces 08r101111012131h11 106, SctadTaxes 08MN11to06l3N12 187.27 215.47 407. taxes 08N0111to12131l11 408. SdrodTaxes 0811N11toD613N12 167.27 2,215.47 109. 409. 110. 410. 111. 411. 112 120. GROSS ANIDIINT DUE FROM BORRCy11VER 200. AI410l.~fTS PAID BY ORON 891ALF OF BOR 170739.74 IZONIi6i 412 420. GRDSS AMDUNT DUE TO SELLER 1 46274 500. FiEUUCf10NS IN AMOUNT DUETO Sf71.6t 201. oreamest 1600.00 501. Excess t seehstrudias 1600.00 202. Prind anwt d new I 502 to seller ins 1400 1895.00 203. Exisli I s taken 'ectw 503. I echo 2D4. 504. of Frst Lear 205. ~. 206. ~. 207. 507. 20B. 279. ~. ustmertts for items u 'd seller Ad'ustments for items 'd seller ~3, 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. P19, 220. TOTAL PAID 6Yl FOR BOf~VH2 300. CASK AT SETIL.BV~IT FROM ORTO BORR 1 60D.00 C11N~t 519. 520. TUiAL fiI~TION ANIDUNT Dl~ SELLER 600. CASH AT SETILHtIB~IT TO OR FROM SELLE 1495.00 R 301. Cross amotnt due Iran lxxrvaer 'ne 1 17(1739.74 601. (~ artntnt due to seller ins 1 46274 302. Lrss arrntrAs txxramer ins 1600.00 reduction arrdrrt due seer ins 18,495.00 303 CASH FROM BOiR 154139.74 603. CASH TO SELLER 1 961.74 ne~ggv ~ pa~oralhers~andlm~Wll h. MrP®tln mWjau I~ a~u WrnWk ngn~id b ha aP~ ~tl Vn I~ W~nmrU~iW Il ~ r~ialbhs~mn repaMd~'aCortraa 916~PAm tlm~ei mkk^ IWan, fro acvv mrcYSiss Yr C'yovc RomedsdWatr~Fs~oddtm. yar ru Comer, ~~ha s~l~lc~r'Wmtl'~P~^s~ irtPmetl~b+'w~Pkl~+Y~1~bm~ea sieuerl~Y ~imws~il^imlr~rrry ~aclwgat~jer WaMlfimion nul ~fualim TN s~ r•>Ewn~wurx;noor~ss seu r~cs> rrlor>E wroseas SE11.Hi(e) 81Gt147URE(sl: I _ _._. _. ~.I I I~TIT STA~iF711FaTT rn~,,.,.~~ celne.,,o.a ogre.., a;..r~ na~~nmi ~ .y na.m of u L SET'TLf3JQJT (~iARGES PAID FROM _ -- PAID FROM 700. TrJTAL SQLES^3R0l~R'S CONMSSION based on 'De 51 000.00 0.000= BORROV~EFYS SELLER'S avisionofmmnssirn Iine700 asfdlans: FUNDS AT FUNDS AT 701. $ to SEf'11.ENpdT SE~-fLgvB,IT' 702 ~ to 703. Gxrmssim 'd at Settlement 800. TTf7VtS PAYABLE IN CONNECTION Vu1H LQ4N BD1. I.D211 Ql 'nallCfl 'ee ~. Loan a5COlIlI % ' 803. 'sal Fce 604. QL'd•It 805. 606. 807. 609. 609. B10. 811. ' 900. ITEMS REQUITE QY LF1JDBi TO BE PAID IN ADWANCE 901. Interest Flom to b 902 Irsuaxe Premium far 0 nplrt to 903. Iia7ard Irsurarae, Plerrium Tar 0 to 904. 905. 1000. RESERVES DEP051TED WITH LHJDB2 FOR 1001. Flarard IrslrarDe mo. hm 1002 Ntxt Irsurance mn. hro 1D03 Tax mn hro 1004. l'ax mn hro 1005. Sdad Tom; mn. hro 1009. Arrdl 's Ad' 1100. Tf TLE CHARCaES 1101. SelUement or Oosi Fee to South Central Fbnte Settl Inc. 555.00 1102 True Seaoh w induded In LJne 1701 1103. 1104. 1105. 1106. 1107. s ices to Wei e 8 Associates 235.00 Includes above items No: on of of Sate and Deed 1109. T1Ue Inwartce Includes stove Items No: 1109. Lerd~s 1110. O~nr~s 1111. 1112 1113 1200. GCN~fJIV6JT RECORDING AND 7RANSFB2 t2iARGES 12(11, Remrci Foes Deed fi200 • Release 620D 1202 a Deed 660.00 1660.00 1203. Stale T Deed 660.OD • Mart 1660.00 1204. Dead 1205. Deed • Release 1300. ADDRIONAL SET11~4F]rTT (~1ARGIES 1301. 1302 1303. 1304. 1305. 1306. 1307. 1308. 1400. TOTAL SE~II_BUETTT' CIiARGES enter an lines 103 Sedian J and 502 Sedim 277.00 1895.00 Fl1D CERnFlCAT10N CF 9IIYERAND 6ELLER I hna ea~afJy iwnvnad Ur FUJ61 SdUrmY 61d~aar'tl and btlr bcd drty~bDc sd hclld, it h a true fd raf W ddmerU of dl lealplc erld Jc4carenls ad+m Iro+9o~ltl ar byrre in tlicbvsad~,l~or{/l~l f-~u~rU~r"r'~aUy 1F/r/t re®I ^ ao/p~ of tlv FKJD7 SeWanrrt 9tllmrnl _ Ryar~C ~J~1 V~PPNNC+' m ISA CRNE 7D WJaNNGLY M41~ FALSE ¢1'ATBvEtdT6?Ol1~E u FIA1 BdtlrferY SYdeiifml W ids I h ~e prcfara V a cus s~tlcmnr ~r° d Uis 4sirdim WiFD STATES CN'IWS ORANY SIMVIR FORM PENa1'nES UPON COMACTION I wanretl cWll orasUrf acbb ~~rd Wlh lhic demrta~L CAN It~CI110EARNEAIm IhPWS'OFfuGNi. FOR DETAILS SEETTLE 1tl: ~ ~ \ ^/O~~/~ US. CODE SFLIICN 10D1 N.D S6CT10N 101. 9y G y ` _ N H ~ ` y ~ w ~ ~~aSS~BS$g~ ~~ ,~ `` © - ~ ~ ~ =w o ~ ~ I- Qw' ~. 'C C O c rn`8igg8~S8$8~ '; ~'3 ~ ~ ~ ririoooccoooor~ ~~viv-rav-~e-eriv-N~ ~ U o s .. ~ . ~ ~ ~ j ~ (n ~ O U y p ~ ~ N U1 ~ °' ~ ~ ~ - - o y o >°, L w (Q ~ O m ~ ~ y N t > ~ W ~ t U y C> ` ~ C N U ~ R ~ o ~ C~C t a ~ N d U C _ ~_ ~ N d ~ 1 G ~ C d d' .II L L N W~ -O w ~ N O w ' C G V 9 N L .r V N ~p ~ w- O N ~ U =' La v~ E9 S p ~~ ~ ~ ~ ~ O y d~ V v i ~Q y a o U ~ O r O yy o g °' ~~~~z~ ° - " ° ~ - E c ~z o a ~ ~ ~ n 'a > O a m - • o - °~ c Z c ~ ~ ~ ~ . ° ;~ ~ O m ~ _. ~ N o W -0 ~ _ C O U t w U O ~ ~ ~__ O D) -p O +-~ C ~ ~ • • ~ tf~ _ ~ tSi ~ ~- 'O O O ~ U ~ m ~• ~ a U U U O ~ ' O ~ • ~ d d ~ l0 Y O L ~ N ' C O ~p ~ c- .-- ~ ~p 8 ~ O i ~ O O k = L 2S ~ ~ ~ ~ rnrnN n ~ 55 0 2 _ C O O O ~r~j = ~ f6 tq C o ~ • O tll .O+ U) ~ L 7 W O 00 t CO T O U Q O ~ m y a `° ~ r - V V ~ 3 a o °' w - Q o ~m ~ °D v ~ O f0 tQ d C ~~ O 2 ~ ~ \~ ~ p U 7~ q L d ~ y L ~ a~i s `c ~ .O1 C ~' c~ -Q :J ~ -N h C ~ Q p Zp~ Li C 6>U W e (~ •~ ~ ~ ~ • o ~ O ~ O C~ o o m a o ~ ~ ~ w 'w ` c ~ E w N N K d• • • ~• U N O y O O O '~ `p c N L Q ~? N e __ _ _ - ,0. ZJl_~ 4; 11~N;p~ INtLLSrRKUURUVI~UKS~F$ v~iUV. 7ryv r, r. Ii W. 80~~ matte og: IiriA F • 13oN9):6 eccrnmt: 2630-9931 Daft oP peaih; 05/06/2011 05f06/2011 R¢p+»;t lie: Ue=e o£ DaflC-L 10mber of securiti.ss~ 2 valuation Dais: 2socessin9 Date: 08/10/2011 pile zA= 3.690-9934 16eari a-~d,fos x~ and. 2nt :ecuritY ~j,ygs~eats ptprael5 Ga11e Shares 3ee~i=°y Eigb/ASk I.o W18~ .~~ ~- Os Pet ~S~PT1Qn .~.-~ sir" ` :) ~ 639.363 G "~ C~ COA4 (869622527) - p~8 6.625s ptev Yolk StiOGk S~tCt+an°e 25.47000 25.70000 B/L 25785000 15,985.92 05/06/207.1 11 655.6x- ~~ sra1~Y ~' ~ 7~ (1178602091 cAr esCO 6.zst peW Yolk stock 1Exohen9e 24.86000 245000 Fl/L 24,450000 16.029.69 as/9s/aozi - ,~~- ~ g?2,515.61 50.00 =ptal Value: Fotdl ~L113:.: Ro1ra1: 832,515.61 PCxC>:elio 6~d~°=es Titled: IRQI19 71 90i0+[ts 518 a » ST gp~7,yf,T BOTTOM PA 3.7266 AoootSilC Was apeaed ou 01/30/2004. ~ ~gnnvitiesl~sacaaoe AaanitY and F~nsariee v-..lees and all stflYaceonnt in~azmaoioa is P=e'ided di.~ect1Y iz~ the insnsar.cx comp~.ea. P19aee coneKSs AY WOatesn Hattonal Li£e 2271 South East 29t7s AvG Amarillo, :i: 94103 800-;Z4-Q990 Fage 1 with ?,~hCCYLl, a pso3oct of sscase Valuations 8 Psiczug Sys-,e~o,,znc. if yoU ?isv'e 9te$tions, Thie most WA6 pzoduced 3?e8as epataeC tivP 9y2CCt~ as IBZB) 313-6300 ox wv.evps7o.com. I,Reczszoa 7.2. AUG-10-2011 03:44PM From: ID: Pose:005 R=9S% FOODS M. Sandra Kempf 520 School Lane Rehoboth Beach, DE 19971 June 15, 2011 Re: KF #06700 -Irvin W. Bowers, Jr. and M. Rachel Bowers Dear Mrs. Kempf: i Enclosed herewith please find Check #7431 in the amount of $2,000.00. This check, payable to Irvin W. Bowers, Jr., represents redemption of Krouse Foods Cooperative, Inc. Preferred Stock Certificate #6175 for twenty (20) shares. Please feel free to call if you have any questions. Very truly yours, Enc. KNOUSE FOODS COOPERATNE, INC. Mary J. Myers Assistant Secretary MUSSELMAN'S ~ LUCKY LEAF ~ APPLE TIME 9 SPEAS FARM ~ LINCOLN 800 Peach Glen-Idaville Road I Peach Glen, PA 17375-0001 I Phone (717) 677-818] I Fax (717) 677.7069 Citizens Bank°° JUN 1 7 201) June a 3, 2011 Weigle & Associates PC Attu Jerry A Weigle 126 East King St Shippensburg PA 17257-1397 Estate of IRVIN A BOWERS Date of Death: May 06, 2011 SSN: 193-12-8216 Dear Sir/Madam: One Citizens Drive ROP 112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 Ueceaer_t Account REF#: 495210 Account Number 6200663800 Account Title Irvin W Bowers Date O ened 12/12/2002 Account T e Checkin Princi al Balance as of DOD $20.00 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $20.00 YTD Interest to DOD $ .00 Citizens Bank~Y Account Number 624096456() Account Title Irvin W Bowers Date O ened 12/13/2002 Account Type Time De osi~ts Princi al Balance as of DOD $37867.00 Interest from Last Postin to DOD $10.79 Account Balance as of DOD $37877.79 YTD Interest to DOD $82.89 Citizens Bank° Account Number 624675120~> Account Title Irvin W Bowers Date O ened 9/21/2005 Account T e Time De osiits Princi al Balance as of DOD $20000.00 Interest from Last Postin to DOD $19.53 Account Balance as of DOD $20019.53 YTD Interest to DOD $131.27 ~~ Citizens Bank~° Account Number 6250393405 Account Title Irvin W Bowers Date ened 5/2/2007 Accaunt Type Time Deposits Princi al Balance as of DOD $50000.00 Interest from Last Postin to DOD $39.99 Account Balance as of DOD $50039.99 YTD Interest to DOD $862.56 ~~!~ ~1~~oC1 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Weigle and Associates PC 126 East King Street Shippensburg, PA 17257-1397 Re: Estate of Irvin W Bowers Social Security: 193-12-8216 Date of Death: Mav 6 2011 Phone 888-502-4349 F ax (302) 934-2955 May 26, 2011 Dear Sir or Madam: Per your inquiry on May 20, 2011, please be advised that at the time of death, the ;above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names o, f) Opening Date Balance on Date of Death Accrued Interest Total Checking Account 97140082 Irvin W Bowers Jr Betty KHoover M Sandra Kempf 0128/08 $70,457.73 $ 3.64 --------------------------- $70,461.37 Cert~cate of Deposit 31003918501460 Irvin W Bowers Jr 07/10/08 $85,043.86 $ 208.68 $85,252.54 3. Type of Account Certificate of Deposit Account Number 31003918501212 Ownership (Names ofj Irvin W Bowers Jr M Sandra Kempf Opening Date 09/30/08 Balance on Date of Death $60, 000.00 Accrued Interest $ 6.45 Total $60,006.45-------------------------------- 4. Type of Account Certificate of Deposit Account Number 31003918501189 Ownership (Names ofl Irvin W Bowers Jr M Sandra Kempf (Beneficiary) Opening Date 0826/08 Balance on Date of Death $20, 000.00 Accrued Interest $ 11.68 Total $20,011.68 ------------------~--------- For any additional information on the above accounts, induding ownership and any changes, dosures and/or reimbursement of funds, please call the Walnut Bottom Office at #717-532-2414. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not indude a~ aawunts in which the deceased may have been listed as Power of Attamey, (~stodian a~f Uniform Transfers, Representative Payee, or Trustee under a written Agreement Sincerely, Tammy Spencer Adjustment Services I~ ORRSTOWN sawx A Tradition of Excellence Jerry A. Weigle, Esquire Weigle & Associates, P.C. 126 East King Street Shippensburg, PA'17257 Fax:532-5289 May 24, 201.1 Re: Estate of Irvin W. Bowers Social Security Number 193-12-8216 Date of Death 5/6/11 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CERTIFICATE OF DEPOSIT Account No.- Account Type- Date Opened- f Joint Account (name/date)- Balance- Accrued Interest- Account No.- Account Type- Date Opened- Joint Account (nam$/date)- Balance- Accrued Interest- 30036372 120 Month Income 10/30/86 No $25,000.00 $17.98 4000033705 60-119 Month Income 7/10/09 No $11,000.00 $25.74 . Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- 4000035091 60-119 Month Income 9/25/09 No $75,000.00 $73.46 Account No.- 4000041141 Account Type- 60-119 Month Income Date Opened- 3/29/11 Joint Account (name/date)- Mary S. Kempf- 3/29/11 Balance- $61,500.00 Accrued Interest- $136.48 Account No.- Account Type- Date Opened- Joint Account (name/date)- Balance- Accrued Interest- 4000041143 60-119 Month Income 3/29/11 Mary S. Kempf - 3/29/11 $50,000.00 , $ 110.96 F Best Regards, Vr~~ ~^ ~• Jil R. Worthington Deposit Processing Clerk . ~, ~' Sovereign Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 'E 3 9 5 8 3 m .~ t Y E Y 3 June 7, 2011 Jerry A. Weigle Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257-1397 RE: Estate of Irvin W. Bowers Date of Death: 05/06/2011 Dear Sir or Madam: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, ~~~~ Donna M. Long Lead Specialist Phone: 617-514-~ Fay;: 617-533-193 , Sovereign Bank ESTATIi; OF Irvin W. Bowers SOCIAL SECURITY #: 193-12-8216 DATE OF DEATH: May 6, 2011 Account #: 3531005731 Type: Checking Open date: 11/4/2004 In the name of: Irvin W Bowers or M Sandra Kempf Date of Death Balance: $2,753.34 Int.(YTD) from 1/1/2011 to 4/26/2011 _ $p,22 Accrued interest to date of death: $0.00 Other Info: Account Closed 06/01/2011 Account #: 3535164614 Type: Time Deposit Open date: 12/22/2004 In the name of: Irvin W Bowers ITF M Sandra Kempf Date of Death Balance: $95,000.00 Int.(YTD) from 1/1/2011 to 4/30/2011 _ $622.02 Accrued interest to date of death: $46.62 Other Info: Account Closed 06/01/2011 Account #: 3535171718 Type: Time Deposit Open date: 9/5/2007 In the name of: Irvin W Bowers Date of Death Balance: Int.(1'TD) from 1/1/2011 to Accrued interest to date of death: _ Other Info: Account Closed 06/01/2011 4/30/2011 $77.69 $1,036.91 Account #: 3535156644 Type: Time Deposit Open date: 11/4/2004 In the name of: Irvin W Bowers Date of Death Balance: $15,000.00 Int.(~'TD) from 1/1/2011 to 4/30/2011 _ $95.74 Accrued interest to date of death: $7,17 Other Info: Account Closed 06/01/2011 Account #: 3385034636 Type: Time Deposit Open date: 12/17/2001 In the name of: Irvin W Bowers Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2011 to 4/30/2011 _ $151.18 Accrued interest to date of death: $11.32 Other Info: Account Closed 06/01 /2011 ' Page 1 of 2 $99,999.00 v ~ b ~ ~ ~ a ~ ~ N n 4~. 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Q ++ ++ " V U ~ O .~,.~, - - - - - 1995 Ford F 150 Re lar Cab -Trade In Value, blue book value -Kelley Blue Bo... Yage 1 of 3 .~~ ~ ~@IiByBil~ B~Ok iHFTitIISTfi) RFS[1lIQCF -- ~ SEARCH riome New Cars Certified Pre-®v~~ned Used Cars Research Reviews & hievl~s Dealers & I:fventory EJsed Cars For Saie Loans & Insurance Used Car Values ~ Search Used Car Classifieds ~ Certified Pre-Owned ~ Compare Vehicles ~ Perfect Car Finder ~ Most Researched Vehicles ~ CARFAX Vehicle History Welcome Baek ~ Sign In ~ Create Account ~ My KBB ZIP Code: 17266 Recently Viewed You Might Also Like Free Dealer Price Quote 1 9%A PR* n_Cftx..esSl News More Car News 2023 CADILLAC CrS SPOP,T SEQAN ~ °^ • "~ • FOB OUALI=IED BUYERS 1D Coolest Cars under $18,000 `Lmgtli of canract IinNed. Xot a'vailx6k rdth cone other aNers.. sat: Tal~edNirery tr.+Ui311L. See dealer hr details. Avoid the Ripoff: Know Your EXPLORE THE CTS -:~ VIEW ALL DEFERS )? 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Local Listings: o Search Ford FS5O Regular Cab Search all Cars For Sale near 17266 SEARCH News, Reviews & Top 205 10 Coolest Cars Under $18,OD0 10 New Names for 2011 Chrysler Pays Back Taxpayers Even Earlier - AOL Autos 2011 Best Redesigned Vehicle Who Really Wins? Detroit vs Japan, Korea and Europe for Fuel Economy Advantage - AOL Autos Average Consumer Rating (495 Reviews) Read Reviews L: 5.3~.3`r ~.. 4.$ OUt Df 5 Review the 1995 Ford FS5O Regular Cab Vehicle Highlights Selected Equipment Change Equipment Standard XL Power Steennq Steel Wheels Air CondiQioninq AM/FM Stereo Mileage: 140,918 Engine: V8, 5.0 Lrter Transmission: Automatic Drivetrain: 2WD Save Vehicle ~ Print =,~ Email ~ B]DChIRPJC f _ Q- - uverusemenc ~~-. _, ~6 ld ~-~ Or Search by Category Or Change ZIP Code CARFAX Record Check ~~ Powered by ~?4a!wfJa[i VIN: -_ - http://www.kbb.com/used-cars/ford/fl 50-regular-cab/1995/trade-in-value/pricing-r... 5/22/2011 ~~~~ Motor Vehicle Administration 6601 F~tdve h~6ghway, N.E Glen Burnie, Maryland 21062 VR-181 (11-10) Please describe the vehicle being/ sold Body Style >+J ~ ~ ~ •. Vehi i/We do hereby If to: Name of buyer(s) of ~ " S ~ / : 1 ~.~; ~r~ odel 001 / ~f ~ ~f ,~a For the total sum of $ ,which has been received. This ~ represents the mutualy agreed upon purchase price of the vehicle, between both the buyer(s) and the seller(s). The reason the vehicle may be purchased for a price less than the fair market value is as follows. ~ ;~ To the best of my knowledge, the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked: ~j ^ 1. The mileage is in excess of its mechanical IimRs. odometer reading ~ t ~ ( (no tenths) ^ 2. The odometer reading is not the actual mileage. Warning- Odometer Discrepancy Please notarize your sale. A second space is provided for notarizing an additional party to the transaction who may not be present at the initial notarization. ft is not necessary to require two notaries ff one will suffice for all parties. Uwe certify under penalty of perjury, that the statements made are true and correct to the best'of my/our Imowl~dge, information and belief. I understand that giving a false statement(s) is a misdemeanor and subject to fines not exceeding $500, imprisonment for not more than 2 months or both. This _ ~ ~ day of --~ ('~` L (year) ~ ~ ( ~ Seller(s) signature(s) J Seller(s) printed name(s) v Subscribed and sworn to before me: This - day of (year) Notary Public signature Notary Public printed name My Comrnission Expires This ~ day of _y ~.~ (year) ~ v r' Buyer(s si nature(s) t. B er(s),printed name(s) Subscribed and sworn i:o before me: This day of _ (year) Notary Pubfic signature Notary Public printed name My Commission F~cpires Place Seal Here Place Seal Here For more infpnnation, please call: 1-800-950-1 MYA (168 (to speak with a customer senrice representative), From Out-of-State: 101-729-4550, TTY for the hearing impaired: 1-800-492-4575. Vsit our website at: www.MVA.Maryfand.gov ~I ~ 79() West High Street Carlisle, PA 1701 3 X717) 532-4~~7 Steve Ege 717-385-5438 Cell ~ Chris Bream 717-2Zt~-1 °?~? ~'ui SELLERS IaTA1~IE ~s ~ ~~ C~ ~ //l ~ v,~ ,,~ l ~wr-,-s Dr1TE 7 ~ % ~ ,~/ ,~iL°sI3RESS_ ~ ~ c5 ~~ 6,~~ ~ Lc. ,~e f~~~ l,L ho~~~ /~e~z< P1=IOI~IE OTHI/R ~ q ~ ~ / ~ o Z Z t~ ~ Z-7~ d A'~~.JCTIC)NEER ~% 3 5 AUCTION 1-DATE/LC~CATI©N ~ ~ ~ .,,t /~~, {~ ' ~, z .~` C:LERK ~% ~ESC~tTI'T`iQl°~ ~~ ERC.~l`eII3~~=~, Commissio.=Z the Auctioheers to sell the rerchandise to the highest bidder by Public Auction. 'v4erdZandise to be.>old as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized representa- tive of the merchandise, goods and/or property and have good title and the right to sefi and that they are free from: a.ll incurnbrances. I agree to accept all responsibility for providing merchantable title anti fc>r delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this ag,~reement, Trash fee applied if applicable. AUCTION SIGNATURE _ r SELLERS SIGNATURE F ~ ~ ~ ~Q '.i~>tal Sales (C.:Ierking Tickets Attached] $ Less Sale Expense.: / ~1 ~~____.._ ~%, C~;ommission Auctioneer $ ~Gl ~ (~ ~~- ~/, ~ ornrnissiori. Gl.er.ks $ C~"1'Hk.li.: TC~iTr.l_, S,4I,F I;XPE NSE DEDUCTED $ SELLERS NET ~ ~ ~°I I A~~CTIO'_~1 SIGNATURE Jtttie ?Z, 2~)1 l Weigle &. Assc~ciat~5, PC Attorney Jerry Wei~Zle l36 .l ast :[Cing Street Shippen.sburg, I'A 17'25'-l3~)7 ~~a.x: '~17 532 529 i~.~~ l~drt~'~rd T:.~if~ June 22, ZO11 Weigle & Associates, PC Attorney Jerry Weigle 126 East King Street Shippensburg, PA 17257-1397 Fax: T17 532 5289 Re: Hartford Annuity Contract # 712796205 Decedent: Irwin W Bowers Dear Attny Weigle: Thank you for your correspondence regarding the above annuity contract, ~ar~forc~. fife The death benefit payable under this contract is not considered "life insurance" reportable on IRS Form 712, (life insurance statement). Please find the below information irI response to your request. Contract Number 712796205 t Owner Irwin W Bowers DeceAG°nt Irwin W Bowers Social Security Number XXX-XX8216 Date of Death May 6, 2011 Cash Value on the date of death $40,716.45 *The Death Benefit Value on the date of death displayed above may include a Death Benefit Adjustment as outlined in the Annuity Contract. This figure is being provided for illustration purposes and is not equivalent to the final death benefit. The death benefit will be calculated on all contracts associated with this client the day we receive the certified death certificate. Once the death benefit is calculated, the benefit amount remauis invested and is subject to market fluctuation until oomplete settlement instnictions are received. If you have any questions or concerns, please feel free to contact your investment professional, or one of our annuity specialists by calling 1-800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m. and Friday from 9:15 a.m. to 6 p.m., Eastern Standard Time„ We will be happy to assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, P Nash Investment Product Services ICS Annuity Benefit Services Team Hartford Life and Annuity Insurance Company Hartford Life Insurance Companies 1 Griffin Road North Windsor, CT 06095 - 1511 Toll Free 1 800 862 6665 Investment Product Services Mailing Address: P.O. Box 5085 Hartford, CT 06101.5085 online. hertfordlife. com JtLn.e 22, 201 f H~rtfc~rd..[~if~ Weigle c~ As::aciates, PC: At#.orney Jerry Weigle l2fi .~~st ~C.tn.~; Street Shippen.sbur~, I',A 172,57-1;3~'~ ~'ax~ 7'17 S32 S2S~7 June 22, 2011 JERRY A WEIGLE WEIGLE AND ASSOCIATES PC 126 E KING ST SHIPPENSBURG PA 17257-1397 Re: Annuity Contract: AN201049, FJ220337, and SFP11460 Contract Owner: Irwin W Bowers, Deceased Dear Mr. Weigle: JUN 2 7 2011 Thank you for your recent inquiry regarding this annuity contract. We would like to take this opportunity to respond to your request. The accumulated value of contract AN201049 as of May 6, 2011, the date of death is $225>,575.06. The named primary beneficiary is M Sandra Kempf, daughter of the deceased. The accumulated value of contract FJ220337 as of May 6, 201 1, the date of death is $122'.,554.17. The named primary beneficiary is M Sandra Kempf, daughter of the deceased. The accumulated value of contract SFPl 1460 as of May 6, 2011, the date of death is $58,509.24. The named primary beneficiary is M Sandra Kempf, daughter of the deceased. We appreciate the opportunity to assist you. Should you have any questions, please contact our Client Care Center at 1-800-424-4990. Sincerely, Angeaa urlong Annuity Claims Department WESTERN J NATIONAL Life Insurance C o m p a n y PO. Box (371 Amarillo, Texas 79105-0871 1.800.42~l.4990 Expenses to Settle Irvin Bowers Estate (through 9/22/11) 5/7/11 Drive Sandra to airport and return 70 miles @ $0.50/mile $35.00 5/7/1:1 Air transportation Naples, Florida to Baltimore, Maryland $212.70 5/7/11 Vehicle miles Baltimore to Shippensburg, PA plus travel 5/7 to 5/12 to make Funeral arrangements 400 miles@ $0.50/mile $200.00 Meals @$30/day for 12 days while in Shippensburg $360.00 Car transport for Richard from Naples, Florida to Shippensburg, PA S/7 and 5/8/11 1296 miles @ $0.50/mile $613.00 Lodging 5/7/11 $85.00 Vehicles miles traveled to perform duties as executrix ,' Car transport Shippensburg, PA to Rehoboth, DE 5/18/11207 miles @ $0.50/mile 2 vehicles = 414 miles $207.00 Tolls $6.00 5/31/11 Travel to Walnut Bottom, PA to close Mr. Bowers CD accounts at Orrstown, Citizens, Sovereign, Wells Fargo and M&T banks and meet with Attorney Weigel to pick up Short Certificates. Go to Registrar of Wills in Carlisle, PA to obtain 4 more short certificates . Mileages for entire trip 529 miles @$0.50/mile $264.50 Tolls $4.00 Meals for 4 days @ $30.00/day for 2 people (exec and spouse) $120.00 June 19, 2011 Rehobath, DE to Shippensburg, PA to meet with Attorney J. Weigle .Sign documents regarding sale of house. Begin clean out of home. June 22, 2011 return to Rehoboth, DE Round trip miles 445 miles @$0.555/mile $246.98 Meals for 3 days @ $310.00/day $90.00 Tolls (Sunday $4.OOIY Wednesday $2.00) $6.00 6/29/11 Rehoboth Beach to Shippensburg and return 462 miles @0.555/mile Tolls Food 7/12/11 Steve Bender trash removal from Bowers residence 7/10/11 to 7/19/11 Rehoboth, DE to Shippensburg, PA to clean out house, Meet with auctioneer and plan removal of household contents to auction site. Tolls Mileage 465 miles@0.555/mile Food 9 days @ $30/day 6/22-7/21 Telephone charges (extra cost) 7/26-7/29 Round trip Rehoboth Beach to Shippensburg and Return 1:o move furniture ti auction site Tolls Mileage 436 miles@0,555/mile Food 2 days @ $30/day 8/7-8/10 round trip Rehoboth beach DE to Walnut Bottom and return To remove trash and vacuum interior of house, auction contents of house, Close on sale of home 514 W Main St Walnut Bottom PA Trash removal and vacuuming of interior of house Tolls Mileage 436 miles@0.655/mile Food 3 days @30/day Total cost to date for epcecutrix and spouse i $256.41 $4.00 $36.00 $300.00 $8.00 $258.08 $270.00 $104.48 $6.00 $241.98 $60 $300 $ 6.00 $241.98 $90 $4,633.11 Previously reimbursed for trash removal (Steve Bender) -$600 Wrote reimbursement check on estate account 8/15/11 check 131 Balanre -4033.11 $0.00 i . .. lRVIN W' aowERS Account # 3531005731 M SANDRA KEMPF Balances Beginning Balance ~ $6 321:27 Current Balance $0:01 DepositslCredits + $2,248.74 Average Daily Balance $1 210.86 Withdrawals/Debits - $8,570.00'- , Interest :Paid this. Period ` _ $ 0.01 Annual Percentage Yield Earned 0.01% Earned this Perod $ 0.01 Paid Last Year $4 60 .Paid Year~To-Date $.0:23 . 'The interest earned and the interest paid may differ depending on when interest is credited to your account Overdraft/Returned'~ Item Fee Summary Fee description Total for this statement aeriod Total vaar rn Aato Total Overdraft Fees $70:00 $70:00 Total Returned Item Fees $0.00 $0.00 Checks Posted Check # Date Paid Amount Reference 513 04!29 $5 000 00 977151900 514 05/10 $3 000 00 971393510 3 Check(s) Posted = $8,500.00 Check # Date Paid / Amount Reference '' 515: 05/11 _ $500.00 983811520 An asterisk (*) indicates a skip in sequential check numbers. An (E) indicates check was converted to an electronic item. Account Activity Date Description Additions Subtractions Balance 04-27 Beginning Balance 04-29 CHECK 513 "' $6,321.27 $5,000:00 $1,32127 05-02 TIME DEPOSIT CREDIT 3535171718 $259.23 $1 580.50 .05-02 TIME DEPOSIT CREDIT 3535.164614 $155.51 , $1 736.01 05-02 TIME DEPOSIT GREDIT 3385034636 _ $37.79 , $1,773.80 US TR .A SSA pai;e z o>~~ 11 ~-~ I r ~0 3 ~ ~~ ~ -~" ,~ ~` `~~ ,753.34 n up J ~~~<~~ ~.G ~~~,~ . -~'~ ~ sF ~ 3s3lnns73r