HomeMy WebLinkAbout04-0849 PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
Register of Wills for the .
., Deceased. County of Ct~nn/oe.r]a, nd in the
Social Security No. 7/7 - 12 - ~,~2/~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executor' named
in the last will of the above decedent, dated
and codicil(s) dated ~b$~r~ /7, ,ZOO~' '
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
.Decendent was domiciled at death in ~'~t.t~ht, t'/a.~td County, Pennsy, lvania, with
~ last family or principal residence at ~of' g/. ~M~/ ~ , ~n~~
(list street, number and muncipality)
Decendent, then ~ ~:~ d~
' 5 ~ ~-V ~ ~ ~ ·
Except as follows, decedent d~d not marry, was not ~ivorced~nd did not have a child 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 f~llows:
(If domiciled in Pa.) All person~ property $
(If not domiciled in Pa.) Personal property ~n Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylva~a .... $ ~ p6~.~-
situated as follow~' ~6T N, /71~er
WHEREFORE, petitioner(s) respectfully .request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
'~ ~ " ~5 :'5 ~ ~. . ,
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
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 well and truly administer the estate according to law.
or
~e~ore me t~is :Se { ~ aav of. ~ ~ue,~ ~ ~ ~/I~
REGISTER OF WILLS OF C~(/Y/~Cfd/_~AL~ COUNTY
OATH OF SUBSCRIBING WITNESS
~a subscribing witness to the will presented herewith,4eaeh~being duly qualified according to
law, depose(s) and say(s) that fl/~' ~
C°/'/'4tZ,M~'~' /e'. ~~dN present and saw
the testat~ , sign the same and that ~ signed as a witness at the
request of testatD~ in ~ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before .~ ~
me this day of ~r/~ ~
(Name) ~t~ ~
(Address)
Register
(Add~s) t.~
REGISTER OF WILLS OF ~ ~EWg~ ~TCOU~Y "
OAT~ OF NON-SUBSCRIBING WITNESS
~E?a
subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that
- ]~ familiar with the signature of ~a/mer
testatO~ of ~ :ubacri~ing witnesses to~ the~
..... - ~ed herewith and
(~dk~
that ~e believes the signature on the ~n the handwriting of
to the best of ~'~ knowledge and belief. ~/
Sw°rn to or affirmed and sUbscribed before
me this _ ~ay of 0~~ ~ (Name)
(Address)
Register
(Nam0
(Address)
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat in h~. presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of (Na r~
(Address)
Register ::
(Address)
REGISTER OF WILLS OF C q/~7~L~A/_~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
X~e ; S familiar with the signature of C~/mer
codicil
testat.O~ of (one of the subscribing witnesses to) the ~will presented herewith and
~codicil
that ~g believes the signature on the will is in the handwriting of
to the best of ~g~ knowledge and belief.
Sworn to or affirmed and subscribed before (~
me this day of L~a~'i~ ~wr~ rName)
(Address)
Register
(Name)
(Address)
his is u) ccn/!'y that the information here given is correctly copied from an original certificate of death duly filed with me as
l~,)cal RcgisU:H. Tae original certificate will be fl3rwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Local Registrar
P 10667297
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
,.'£,F,,~, CERTIFICATE OF DEATH
~,A,:~,~ , Chalmer H Kaufman
FATHER'S ~ME (~t, M~e,
,~i~ .................. fman
I'~M~NI~ NAME (f~~ ~] IDA L. Kissinger
~ ............ I
. .EmO~O. ~smo. ' ~~i~Burg, Pa 17055
? 21b. · 214. ~ Pa 1 7~
~S~ [~;'% Atl AUfOPSY
~Jzsa J2~ J uJ~CEOFINJURY-A ~me.f~m slr~ fa~oq o~ce" ' ILOCAT n- ~, -'- ..... ~-
:' II r CERTIFIERIChe~O~) , 130e. [~ / · [ /
~:] ............................
LAST WILL AND TESTAMENT OF CHALMER H. KAUFMAN
I, CHALMER H. KAUFMAN, of the Borough of Mechanicsburg, 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, I give, devise and bequeath to my beloved wife, LILLIAN M. KAUFMAN, to
her own use and benefit absolutely.
3.
In the event my said wife, LILLIAN M. KAUFMAN, should predecease me or die at
about the same time I do, such as in an accident or disaster common to both of us, then I direct that
my said estate be divided and distributed as follows after the payment of all death taxes, fees, costs,
expenses and the like have first been deducted therefrom:
A.) Three (3%) per cent thereof to the Upper Strasburg Pennsylvania Methodist
Cemetery Association;
B.) Seven (7%) per cent thereof to Mechanicsburg Wesley United Methodist
Church. This is a conditional gift in that those funds so given shall only be used for
building and grounds improvement and maintenance. The acceptance o
testamentary gift shall be considered an acknowledgment of and agreement to be
bound by these conditions by the recipient.
C.) All the then remaining balance is to be divided among my three (3)
daughters, to wit: LUCILLE MORRETT, GEORGIA HELLER, and: c~
DOLORES BRANDT, in equal shares, per stirpes.
4.
I nominate, constitute and appoint my wife, LILLIAN M. KAUFMAN, to be the Executrix
of this my Last Will and Testament. 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 daughter,
LUCILLE MORRETT, to be Executrix in her place and stead. In the event that she should be
unwilling or unable to act as such Executrix, I nominate, constitute and appoint my daughter,
GEORGIA HELLER, to be Executrix in her place and stead. In the event that she
should be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my
daughter, DOLORES BRANDT, to be Executrix in her place and stead. The order of the
alternates selection has been based upon the respective proximities of geographic location as of the
date of my will and is not to be taken as a measure of my opinion as to anyone's personal
capabilities and abilities, believing that my said daughters are equally capable. 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 ~ day of
~, A.D. 2000.
LMER It. KAI)FMAN/
Signed, sealed, published and declared by the above-named CHALMER H. KAUFMAN,
as and for his Last Will and Testament, in the presence of us, who at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
2
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Chalmer H. Kaufman
Date of Death: September 9, 2004
WillNo. Admin. No. 21-04-0849
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
September 24, 2004:
Name Address.
Lucille Morret 24 Big Horn Avenue, Mechanicsburg, PA 17055
Dolores V. Brandt P.O. Box 9269, Myrtle Beach, SC 29578
Georgia L. Heller 860 Green Springs Rd., Hanover, PA 17331
Upper Strasburg Pa. Methodist
Cemetery Assn. c/o Kenneth R. Kaufman Box//37, Upper Strasburg, PA 17265
Wesley United Methodist Church Filbert & Simpson Sts., Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: September 27, 2004
ch '' CHARLES E. SHIELDS, III
eq 6 Clouser Road
c~ Mechanicsburg, PA 17055
,~': ':: ~ ,,~ Telephone: (717) 766-0209
~ ~ ~ ~. ~-~ Counsel for Personal Representative
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004693
MORRETT LUCILLE
24 BIG HORN AVENUE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $12,825.00
ESTATE INFORMATION: SSN: 717122628
FILE NUMBER: 2104 0849
DECEDENT NAME: KAUFMAN CHALMER H
DATE OF PAYMENT: 12/06/2004
POSTMARK DATE: 1 2/04/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 09/09/2004
TOTAL AMOUNT PAID: $12,825.00
REMARKS: LUCILLE MORRET
CHECK# 112
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
CHARLES E. SHIELDS, III
A TTORNE Y-A T-LA W
6 CLOUSER ROAD
Corner of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK TELEPHONE (7t7) 766-0209
(1912-1991) FAX (717) 795 7473
December 3, 2004
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, Pennsylvania 17013
Attention: Vicky
In Re: Estate of Chalmer H. Kaufman, deceased
File No.: 21-04-0849
Dear Vicky:
Please find enclosed Check No. 112 in the amount of $12,825.00 for estimated Inheritance
Tax ~k~r thc estate of Chalmer H. Kaufman.
Thank you for your kind attention to this matter.
Very truly yours,
Charles E. Shields, III
Attorney-At-Law
CES:slk
Enclosure
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Chal.rrer H. Kaufman
Date of Death:
09-09-04
Will No.
Admin. No. 21-04-0849
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:
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.
(J(~~
Signature
Da te: March 8, 2005
Charles E. Shields, III, Esquire
Name (Please type or print)
(',I
....!
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717 ) 766-0209
Te 1. No.
Capacity:
Personal Representative
X
Counsel for personal
representative
(MAH:rmf/AM3\
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REV-1500 EX (6-001
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICiAL IfSE Cf'jLV
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FILE NUMBER
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE YEAR
~~J!L~
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
K All F MAf\l1 CHit l. mE/( fl.
SOCIAL SECURITY NUMBER
7/7 - /:l
.:(t,28
DATE OF BIRTH (MM-DD-YEAR)
CJ?- /:<. -/7/~
DATE OF DEATH (MM-DD-YEAR)
~7 - t/9 - c?~t:?-f
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
III //1
IX! 1. Original Return
o 4. limited Estate
[81 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
I 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
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NAME Cflll-/2LES
E: SIf/E"LDS 7lL
COMPLETE MAILING ADDRESS
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~FeijAN/CS8U~6i~A
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FIRM NAME (If Applicable)
TELEPHONE NUMBER
7/7- 766 - 0:1...09
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) 1 d.. 7 Cf, SO tJ. pt)
(2) f 73 '-If? 93
r
(3) 0-
(4) 0
(5) ~ /,2 ~ 7 b.3. 0 i
(6) D -
(7) -0-
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., OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Soie-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
8. Total Gross Assets (totai Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(9)
(10)
~
351 li/. 29
.,. S03. 57
(8)
l' LfJ'.z 753.0/
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(11) 35: "8'1. 8~
(12) ,. <{ I.{ 7 , f) 6. 1, I 'S
(13) 30,/ 000.00
(14) f Lf 17~ ,,(,/. IS-
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
,0
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xO "1-5" ,.
(16) /?,. 7~ P. ()(g
x .12 (17) 0
x .15 (18) 0
(19) ., I~ 7 ~ 8'. t)(q
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK '-IERE F 'OU ,~RE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS ;)08' ;V, /1/~HK€ T ST:
. -- ..
CITY /l1E~IIAAI/csJ5tt/(G- I STATE ~A I ZIP /7t:JSS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
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Total Credits (A + B + C )
3. Interest/Penalty if applicable
D. Interest
E. Penalty
{)
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Total Interest/Penalty ( 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
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.
(1 )
(2)
(3)
(4)
(5)
(5A)
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B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred atter 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
No
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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 perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
f/A nOS's
DATE
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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 P.S. 99116 (a) (1.1) (i)l.
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. 99116 (a) (1.1) (ii)].
The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1 )].
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. 89116(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- 1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICiAL USE C"JLY
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FILE NUMBER
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RESIDENT DECEDENT
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COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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SOCIAL SECURITY NUMBER
7/7 - l:l
DATE OF DEATH (MM-DD-YEAR)
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DATE OF BIRTH (MM-DD-YEAR)
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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!Xl 1. Original Return
D 4. Limited Estate
~ 6. Decedent Died Testate (Attach ccpy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach ccpy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior 1012-13-82)
D 5. Federal Estate Tax Return Required
I 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
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FIRM NAME (If Applicable)
TELEPHONE NUMBER
7/7- 766 - 0:1..09
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(1) 1;;;. 7 Cf, S7J tJ .11)
(2) f 73 4i'1.93
I
(3) 0-
(4) 0
(5) f. /:l 't 7'J. of
(6) D -
(7) o -
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OFFICIAL USE ONLY
(9)
(10)
~
35/ li/. 29
~ Sl;3, 57
(8)
Jt L/,f.z,7S3.tJ/
(11)
(12)
(13)
15
35". "8'1. 84
~ <f L/ 7 I f) 6. f, I OS
30" OOO.DO
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
1 Lf /7 "'I. IS"
J
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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rate, or transfers under Sec. 9116 (a)(1.2)
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x .0 ~S- (16) ~/7., 7(, 4>>, ()(g
x .12 (17) 0
x .15 (18) 0
(19) ., I Jj 7(, 8". Oh
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK '-lERE F "OU ,~RE REQUESTING A REFUND OF AN OVERPAYMENT
~ ~";'~: ~.:" '17}.~"'~-J':"'~!f~1w~.,~; ~~.~ ~("t~?<"'" ,..,. ~~ ~""~A~~~:~.on~~~"7 '" l
~ln",';.ti .'. ~~~~oWit.~l~'i~~~~~~:t""~.m.."'~,~'~'l 1-"'"'1""",,' "'~\~'~4O;;:~W~WIt~
Decedent's Complete Address:
STREET ADDRESS .;208' jl/, /JI~HK€ T ST
- .
CITY /J1E~IIAAI/CsJ5t(/Yrr I STATE /lA I ZIP /7 t'JSS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
~ 1:2/ i~f. pO
:il r.7S.CTO
Total Credits ( A + B + C )
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
t)
(J
(3)
(4)
(5)
(5A)
(5B)
Total Interest/Penalty ( 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
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.
~
I 8". 7'8'. of,
, J 3 5'otJ, CD
J
'?
~ ~ 6 8: 0"
o
~ s: :?(,J'. Pb
.3. ~I
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
5;1.7/.'7
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
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
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? ........................................................................................................................ D
No
lZl
[Z]
~
~
~
~
~
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 perJury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and complete.
Declaration of preparer other than the personal representative is based on all infonmation of which preparer has any knowledge.
fJA nOS'S-
DATE
t.}"/I)J-
r.j/f./llr
DATE
/7 rJS',s-
~::5Z:t~~.}~ifij;:tft~W1~;~i;~;~~I{}!:!:;~~~~:p.i:~"f.,~\g~:i~~::j:~~iwA~~~~~~~;1~~.~~,JWJ1,. _f~,...J_....~...,'""'~..._,__._ _~~~:~*lflRli'_1
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 P.S. S9116 (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% [72 P.S. S9116 (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 natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 PS. s9116(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%, except as noted in 72 P.S. S9116(1.2) [72 P.S. S9116(a)(1 )].
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. 89116(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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
H"-RRISBURG,'PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MORRETT LUCILLE
24 BIG HORN AVENUE
MECHANICSBURG, PA 17055
____un fold
ESTATE INFORMATION: SSN: 717-12-2628
FILE NUMBER: 2104-0849
DECEDENT NAME: KAUFMAN CHALMER H
DATE OF PAYMENT: 12/06/2004
POSTMARK DATE: 12/04/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 09/09/2004
REMARKS: LUCILLE MORRET
CHECK# 112
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: VZ
RECEIVED BY:
TAXPAYER
REV-1162 EX(11-96)
NO. CD 004693
AMOUNT
--------
I $12,825.00
I
I
I
I
I
I
I
I
$12,825.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1502EX-(1-97) ~
, ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
K II /) F mil-iii"
e fI/!-L/J1 E7e
FILE NUMBER
Z/- tJLf - 3'"'19
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
survivorshiD must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
H.
R~s;cJ~nt;d Dwe.J1,'flj HOIA5C. UVJ1d Jor t1)f ~rou.ncl sitLltJ..,j-~ in
~ ""B:>ro '^j [" 0.(. 111 ech an; cS b u. rg I C\"..I'Y\ be.r Icvttd (1 u.-n ~ J
Pe.nnsylvtlJtla) ha,VI't~ M1 ttddress of dog N. market st.
~(}lcI /fa tl I'I'su/f pf nn tJ/Jel1 anc! jlJub/ic J/cldl1
fJr()eeS5 t(; Ldrry h. 8rennernarJ) Sl2fflement oecurri'?j
/)/1 /lprll f; ;ZOoS'.
(see ~,oy tfJ/ Exeeurtix Deed w Je1fleAte4t o>JeJ
p 7f 4' c/;e/ here/;)
~
/(es;/e/Jn/t/ lJltle/l1l fhtt,je ~ ~I tJ!rLlZ'til/d s;/ua!e
;n ~ t]p;,Uj" f)'I.lI1echll/J/esPH~/ 'l'UI11 kr!tucl
& hllf, ~/JII sy 1J'/tJtL4' J 44Y/7/"" M"I H5f · f 2:Zo
/1/, /)JRr.fe1 eft - cfo/t/ 4'J a reJ't{ /f t?f aR Pf7M aHd'
lu b//c /;;c/d;1I fJr/)ce~5 ;; N/!hR/J1 /I. ~"cI/;~
tt1td A't/~ J. 6-IPod t'rt;, IzlLj!UbllCl ClItt/ U!,k/ I);' /flay-
/i'. ~DOS.
/
(See ~f1r #1 E'xeeutr/,x iRed an/ ~tI!e/JfMI Jkl
d IIz-tcha/ M,J.e~ J.
~
/1./7 S/)O. tJO
,
-!
J 3,2/ootJ. tJtJ
$ ~ 7 a: en/'<. t1 0
TOTAL (Also enter on line 1, Recapitulation) 0{ /, JI./V
(If more space is needed, insert additional sheets of the same size)
c~....
........
~ ;,.It-tf-
Tax Parcel Number:
THIS INDENTURE
MADE THE 'iJlliday of ~
five (2005).
, in the year of our Lord two thousand and
BETWEEN
LUCILLE MORRET, as Executrix of the Estate of CHALMER H. KAUFMAN,
deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania,
Grantor,
and
LARRY W. BRENNEMAN, of 6121 Haymarket Way, Mechanicsburg, Cumberland,
Pennsylvania, Grantee.
WHEREAS, the said Chalmer H. Kaufman, was vested in his lifetime with title to the
premises hereinafter described, in the Borough of Mechanicsburg, County of Cumberland and
Commonwealth of Pennsylvania; and
WHEREAS, the said Chalmer H. Kaufman, departed this earthly life, testate, on the 9th day
of September, 2004, and Letters Testamentary were duly issued to the said Lucille Morret, by the
Register of Wills of said Cumberland County, docketed to No. 21-04-0849; and
WHEREAS, the lands herein-mentioned were not specifically devised:
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Lucille Mon'et,
Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED FORTY-SEVEN
THOUSAND FIVE HUNDRED and No/I00 ($147,500.00) DOLLARS, and other good and
valuable considerations, to her in hand paid by the said Grantees, at and before the ensealing and
delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened,
released, and confirmed, and by these presents, by virtue of the power and authority in her vested by
the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release,
and confirm unto the said Grantee, their heirs and assigns:
ALL THAT CERT AIN PARCEL of land situate in the Borough of Mechanicsburg, County of
Cumberland, and Commonwealth of Pennsylvania, being bounded and described as follows, according
to that celiain FINAL SUBDIVISION PLAN FOR CHALMER H. KAUFMAN prepared by
Charles W. Junkins, Professional Land Surveyor, as revised on May 24, 2002, and as recorded in the
office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, on June 20, 2002 in
Plan Book 85, Page 82:
BEGINNING at a Rebar (set) at the easterly legal right-of-way line ofNOlih Market Street (having a
fOliy-nine (49) foot right-of-way) and also being at the southwesterly corner of Lot No.1 as shown
and designated on the aforesaid FINAL SUBDIVISION PLAN, thence along the southerly line of
said Lot No.1 North 81" 29' 45" East 174.43 feet to a Rebar (set) at the westerly legal right-of-way
line of Foundry Alley (having a fourteen (14) feet right-of-way, previously described as twelve (12)
feet), thence along the said westerly line of Foundry Alley South 10" 36' IS" East 134.54 feet to a
D=J....n..~ In.....4-\ ....+ +1........ ..........-4-1............................._1... .........._............. ......C' 1~.._...1~ _____. _d .C'_u______I_ ~.r T_ T""'1 "r- T"lo T"""o.
i
208 NOlih Market Street.
BEING PART OF those same premises which the Pennsylvania Railroad Company by its deed dated
January 19, 1960 and recorded in the Recorder's Office aforesaid in Deed Book "Q", Volume 19,
Page 193, granted and conveyed to Chalmer H. Kaufman and Lillian M. Kaufman, his wife. The said
Lillian M. Kaufman departed this earthly life on December 26, 2000, whereupon full and absolute
title to the said premises vested in the said Cha1mer H. Kaufman by the laws of the Commonwealth
of Pennsylvania incident to tenancies by the entireties. His said estate is the Grantor herein.
TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments
and premises hereby granted and released, or mentioned and intended so to be, with the
appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and
behoof of the said Grantees,their heirs and assigns, forever.
AND THE SAID GRANTOR, Executrix, as aforesaid, her successors and assigns does
covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents,
that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises
hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in
title, or otherwise howsoever.
IN WITNESS WHEREOF, the said Executrix of the Estate of Chalmer H. Kaufman,
deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written.
Signed, Sealed and Delivered
in the Presence of:
~ (SEAL)
LUCI L MORRET, Executrix of the
Estate of CHALMER H. KAUFMAN, Deceased
, ...
U.S. Department of Housing
and urban Development
CLECKNER & FEAREN
Attorneys at Law
119 Locust Street
Harrisburg, PA 17101
(717) 238-1731
FAX: (717) 238-8481
A. Settlement Statement
B. T e of Loan
1. 0 FHA
4. 0 VA
. Note:
2. 0 FmHA 3. 0 Con. Unins.
6. File Number
7. lOll" Number
8. Mortgage Insurilnce Case Number
D. Name and Address of Borrower E. Name and Addreu of Seller F. Name ~lnd Addren of lender
LARRY W. BRENNEMAN ESTATE OF CHALMER H. KAUFMAN NATIONAL CITY BANK OF INDIANA
6121 HAYMARKET WAY 3232 NEWMARK DRIVE
MECHANICSBURG PA 17050 MIAMISBURG, OH 45342
G. Property location H. Settlement Agent
DENNIS J. SHATTO, ESQUIRE
208 NORTH MARKET STREET I. Place of Settlement J. Sett\ement Date
MECHANICSBURG, PA 17055 CLECKNER & FEAREN APRIL 8, 2005
119 LOCUST STREET Disbursement Oate
HARRISBURG, PA 17101 APRIL 8, 2005
J. Summary of Borrower's Transaction K. Summarv of Seller's Transaction
100. Gross Amount Due From Borrower 400. Gross Amount Due From Seller
101. Contract Sales Price 147,500.00 401. Contract Sales Price 147,500.00
102. Personal Prooertv 402. Personal Prooertv
103. Settlement Charaes to Borrower (line 1400 5,867.31 403
104 404
105 405
Adjustments for Items Paid by Seller in Advance Adjustments for Items Paid by Seller in Advance
106. City/Town Taxes 406. City/Town Taxes
107. Countv/Munic. Taxes 4/8/05 to 1 2/31/0 475.00 407. Countv/Munic. Taxes 4/8/05 to 12/31/05 475.00
108. Assessments 408. Assessments
109. School Taxes 4/8/05 to 6/30/05 425.99 409. School Taxes 4/8/05 to 6/30/05 425.99
110. Water Rent 410. Water Rent
111. Sewer Rent/Trash 4/8/05 to 6/30/05 115.58 411. Sewer Rent/Trash 4/8/05 to 6/30/05 115.58
112 412
120. Gross Amount Due From Borrower 154,383.88 420. Gross Amount Due To Seller 148,516.57
5. 0 Conv. Ins.
This form is furnished to give you a statement of actual costs. Amounts paid to and by the settlement agent are shown.
Items marked ("p.o.c. ") were paid outside the closing; they are shown here for informational purposes and are not
included in the totals.
mounts al IV r n e a 0 orrower e uctlons In mount ue 0 e er
201. Deoosit or Ernest Monev 1,000.00 501. Excess Deoosit
202. Principal Amount of New Loan(s) 118,000.00 502. Settlement Charaes to Seller (line 1400) 2,247.14
203. Existina Loan(s) Taken Subiect To 503. Existina Loan(s) Taken Subiect To
204 504. Payoff Of First Mortaaae Loan
205 505. Payoff Of Second Mortaaae Loan
206 506
207 507
208 508
209 509
Adjustments for Items Unpaid bv Seller Adiustments for Items Unpaid bv Seller
210. City/Town Taxes to 510. City/Town Taxes to
211. County Taxes to 511. County Taxes to
212. Assessments to 512. Assessments to
213. School Taxes to 513. School Taxes to
214. Water Rent to 514. Water Rent to
215. Sewer Rent to 515. Sewer Rent to
216 516
217 517
218 518
219 519
220. Total Paid By/For Borrower 119,000.00 520. Total Reduction Amount Due Seller 2,247.14
200 A
P 'd B 0 I B h If f B
500 R d
. A
D T S II
I
CLECKNER & FEAREN
Attorneys at Law
119 Locust Street
Harrisburg, PA 17101
L. SETTLEMENT CHARGES PAID FROM PAID FROM
@ BORROWER'S SELLER'S
700. SALES/BROKER'S COMMISSION based on orice $ % FUNDS FUNDS
lOT. T otaITommlsslon paid by seller
Division of commission as follows: ~
702. $ to
703. $ to
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN.
801. Loan Oriaination Fee %
802. Loan Discount %
803. AODraisal Fee to
804. Credit Report
805. Lender's inspection fee
806. Mortoaoe Insurance aoolication fee to
807. Assumotion/refinancina fee
808. Aoolication fee to PREMIER FUNDING, INC. 300.00
809. Processino fee to PREMIER FUNDING, INC. 150.00
810. Administration fee to NA TlONAL CITY BANK OF INDIANA (NCBIJ 410.00
811. Flood Cert. to FIRST AMERICAN FLOOD DATA SERVICE 7.50
812. Wire fee to
813. Tax Service fee to LANDAMERICA 77.00
814. Exoress Mail to FedEx 15.00
815. Mortaaae Broker Fee - POC bv NCBI to PREMIER FUNDING $1,180.00
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE.
901. Interest from 04/08 to 4/30 @ $17.78 408.94
902. Mortoaoe insurance premium for mo. to
903. Hazard insurance premium for vrs. to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR:
1001. Hazard insurance 2 mo. @ $31.25 62.50
1002. Mortoaoe insurance mo. @ $
1003. Citv Drooertv taxes mo. @ $
1004. Two. & Countvtaxes 2 mo. @ $53.91 107.82
1005. Annual assessments mo. @ $
1006. School taxes 10 mo. @ $154.25 1,542.50
1007. Flood insurance mo. @ $
1008. AGGREGATE ACCOUNT ADJUSTMENT -101.20
1100. TITLE CHARGES:
1101. Settlement or closino fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document preparation to
1106. Notarv fees to
1107. Attorney's Fees to -
{includes above items No.:
1108. Title insurance to CLECKNER AND FEAREN
(includes above items No.: 1001-1105
1109. Lender's coveraae $107,500.00
1110. Owner's coveraae $
1111. Endorsements 100, 300 & 8.1 150.00
1112. Closino Protection Letter to FIDELITY NATIONAL TITLE INS. CO. 35.00
1113
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino fees: Deed $ 38.50 Mta $66.50 Release $ 103.00
1202. Citv/countv tax/stamps: Deed $ ; Mortaaae $ 1,475.00
1203. State tax/stamps: Deed $ ; Mortaaae $ 1,475.00
1204. Recordina Fee for Stipulation Aaainst Liens
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev to
~~~
Tax Parcel Number:
THIS INDENTURE
MADE THE l<i~ day of
five (2005).
~
, in the year of our Lord two thousand and
BETWEEN
LUCILLE MORRET, as Executrix of the Estate of CHALMER H. KAUFMAN,
deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania,
Grantor,
and
William H. Goodling and Kelly J. Goodling, husband and wife, of 395 Alison
Avenue, Mechanicsburg, Cumberland County, Pennsylvania, Grantee.
WHEREAS, the said Chalmer H. Kaufman, was vested in his lifetime with title to the
premises hereinafter described, in the Borough of Mechanicsburg, County of Cumberland and
Commonwealth of Pennsylvania; and
WHEREAS, the said Chalmer H. Kaufman, departed this earthly life, testate, on the 9th day
of September, 2004, and Letters Testamentary were duly issued to the said Lucille Monet, by the
Register of Wills of said Cumberland County, docketed to No. 21-04-0849; and
WHEREAS, the lands herein-mentioned were not specifically devised:
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Lucille Monet,
Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED THIRTY-TWO
THOUSAND and No/I00 ($132,000.00) DOLLARS, and other good and valuable considerations,
to her in hand paid by the said Grantees, at and before the ensealing and delivery hereof, the receipt
whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by
these presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the
Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said
Grantee, his heirs and assigns:
ALL THA T CERTAIN PARCEL of land situate in the Borough of Mechanicsburg, County of
Cumberland, and Commonwealth of Pennsylvania, being bounded and described as follows, according
to that certain FINAL SUBDIVISION PLAN FOR CHALMER H. KAUFMAN prepared by
Charles W. Junkins, Professional Land Surveyor, as revised on May 24, 2002, and as recorded in the
office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, on June 20, 2002 in
Plan Book 85, Page 82:
BEGINNING at an iron pin where the easterly legal right-of-way line of North Market Street
(having a forty-nine (49) foot right-of-way) meets the southerly legal right-of-way line of East
Factory Street (having a thirty-four (34) foot right-of-way, previously described as thirty four and
five tenths (34.5) feet), thence along the said southerly line of East Factory Street North 81' 29'
45" East 176.55 feet to a P.K. nail (set) at the westerly legal right-of-way line of Foundry Alley
(having a fourteen (14) foot right-of-way, previously described as twelve (12) feet), thence along the
said westerly line of Foundry Alley South 10' 36' 15" East 81.85 feet to a Rebar (set) at the
.. .- . . .1 ro .11 ,......,...._.... ~.... r-........___....__.........-_....__....
BEING IMPROVED with a dwelling house and other outbuildings and being known and numbered as
220 North Market Street.
BEING PART OF those same premises which the Pennsylvania Railroad Company by its deed dated
January 19, 1960 and recorded in the Recorder's Office aforesaid in Deed Book "Q", Volume 19,
Page 193, granted and conveyed to Chalmer H. Kaufman and Lillian M. Kaufman, his wife. The said
Lillian M. Kaufman departed this earthly life on December 26, 2000, whereupon full and absolute
title to the said premises vested in the said Chalmer H. Kaufman by the laws of the Commonwealth
of Pennsylvania incident to tenancies by the entireties. His said estate is the Grantor herein.
TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments
and premises hereby granted and released, or mentioned and intended so to be, with the
appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and
behoof of the said Grantees,their heirs and assigns, forever.
AND THE SAID GRANTOR, Executrix, as aforesaid, her successors and assigns does
covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents,
that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises
hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in
title, or otherwise howsoever.
IN WITNESS WHEREOF, the said Executrix of the Estate of Chalmer H. Kaufman,
deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written.
Signed, Sealed and Delivered
in the Presence of:
-i-{!Mrk5 ~, ~/cl/s?I1
>I Lu.e;/Ie lJ16rtef (SEAL)
LUCILLE MORRET, Executrix of the
Estate of CHALMER H. KAUFMAN, Deceased
COMMONWEALTH OF PENNSYL VANIA)
SS:
COUNTY OF CUMBERLAND
)
On this, the I ~ day of , A.D. 2005, before me a notary
public, in and for the Commonwealth of Penns ania, personally appeared LUCILLE MORRET,
known to me (or satisfactorily proven) to be the person whose name is subscribed as Executrix of the
Last Will and Testament of Chalmer H. Kaufman, and acknowledged that she executed the same in
such capacity.
IN WITNESS WHEREOF, I hereunto set my hand an official seal.
N~ry Public
My commission expires:
(SEAL)
CERTIFICATE OF RESIDENCE
I do hereby certify that the precise and exact post office address of the within Grantee is:
3c1.5" M'7M~, /t1f.dUICSIH7/ p:J.;if /7t!Js-5
Attorney for Grantee
A. Settlement Statement
U.S. Department of Housin~
and Urban Development ~
,r
OMS No. 2502-0265
B. Type of Loan
1. 0 FHA
4. OVA
2. 0 FmHA
5. 0 Conv. Ins.
3. [g] Conv. Unins File Number
27104-P
Loan Number
Mortgage Insurance Case Number
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.o.c" were paid outside of closing; they are shown here for informational purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: WILLIAM H. GOODLING KELL Y J. GOODLING
395 ALISON AVENUE, MECHANICSBURG, PA 17055 395 ALISON AVENUE, MECHANICSBURG, PA
17055
E. NAME AND ADDRESS OF SELLER:
THE ESTA TE OF CHALMER H. KAUFMAN
220 NORTH MARKET STREET, MECHANICSBURG,
PA
INTEGRITY BANK
,PA
F. NAME AND ADDRESS OF LENDER:
G. PROPERTY
LOCA nON:
220 NORTH MARKET STREET
MECHANICSBURG, PA
H. SETTLEMENT AGENT: CEDAR CLIFF ABSTRACT AGENCY, INC.
PLACE OF SETTLEMENT:
TIN: 23-2133165
I. SETTLEMENT DATE: 05/18/2005 I RESCISSION DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 5132 000.00 401. Contract Sales Price $132,000.00
102. Personal Property 402. Personal property
103. Settlements charges to borrower: 403.
(from line 1400) $4,335.88
104. 404.
105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. City/town taxes to 406. City/town Taxes to
107. County Taxes 05/18/2005 to 12/31/2005 $287.28 407. County Taxes 05/18/2005 to 12/31/2005 $287.28
108. Assessments 05/18/2005 to 06/30/2005 $118.80 408. Assessments 05/18/2005 to 06/30/2005 $118.80
109. 409.
110. SEWER/REFUSE PRTH 5/18/05T06/30/05 $22.36 410. SEWER/REFUSE PRTH 5/18/05T06/30/05 $22.36
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER: $136,764.32 420. GROSS AMOUNT DUE TO SELLER: $132,428.44
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money $10,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) $122,000.00 502. Settlement charges to seller (line 1400) $1,320.00
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR 51~2.DDD DD 520. TOTAL REDUCTIONS ,,,, ,:)"'11 ""
-------.--
HUD-1 (Rev. 3/86)
L.
OMB No. 2502-0265
SETTLEMENT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM
BASED ON PRICE $132,000.00 @ %= BORROWER'S SELLER'S
FUNDS FUNDS
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: AT AT
701. to SETTLEMENT SETTLEMENT
702. to
703. to
704. to
705. Commission paid at settlement
706.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN:
801. Loan origination fee % to INTEGRITY BANK
802. Loan discount % to INTEGRITY BANK
803. Appraisal fee to: E.J. KOPPENHAVER $300.00
804. Credit report to: INTEGRITY BANK
805. Lender's inspection fee INTEGRITY BANK
806. Mortgage insurance application fee to INTEGRITY BANK
807. Assumption fee INTEGRITY BANK
808. COMMITMENT FEE-INTEGRITY BANK $1,220.00
809. DOCUMENT PREP FEE-INTEGRITY BANK $250.00
810, FLOOD SEARCH FEE-INTEGRITY BANK $15.00
900 ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE'
901. Interest from 05/18/2005 to 06/0112005 @ /day
902. Mortgage insurance premium for mos. to
903. Hazard insurance premium for yrs. to
904. Flood insurance premium for yrs. to
905.
1000 RESERVES DEPOSITED WITH LENDER'
1001. Hazard insurance months @ per month
1002. Mortgage insurance months @ per month
1003. City property taxes months @ per month
1004. County property taxes months @ per month
1005. Annual assessments months @ per month
1006. Flood insurance months @ per month
1007. months @ per month
1008. months @ per month
1009, Aggregate Accounting Escrow Adjustment
1100 TITLE CHARGES'
1101. Settlement or closing fee to
1102. Abstract or title search to
1103. Title examination to
1104. Tille insurance binder to
1105. Document preparation to
1106. Notary fees to CASH $15. 00
1107. Attorney's fees to
(includes above items Numbers: )
1108. Tille insurance to CEDAR CLIFF ABSTRACT AGENCY, INC. $916.88
(includes above items Numbers: TITLE INS-RE-ISSUE )
11 09. Lende~s coverage $122,000.00 ( $122,000.00 )
1110. Owne~s coverage $132,000.00 ( $132,000.00 )
1111. ENDORSEMENTS-IOO, 300, 900 $150.00
1112. INSURED CLOSING LETTER $35.00
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES:
1201. Recording fees: Deed $38.50 ; Mortgage $52.50 ; Releases $91.00
1202. City/county tax/stamps: Deed $1,320. 00 ; Mortgage $660.00 $660.00
1203. State tax/stamps: Deed $1,320.00 ; Mortgage ; Other $660.00 $660.00
1204. RECORD ASSIGNMENT OF RENTS-CUMB CO $23.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES:
1301. Survey to
1302. Pest inspection to
1303.
1304.
1305.
1306.
1307.
~ - --- -- ~- --- --
-,~".,,~, .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
I( IItlF/IIJ!./fh ellA-Lmae I-/.
FILE NUMBER
;Z;- o. If- 8'1'1
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
/6g e~l"hft'ctlfetl .shAres of Fool L,c-kerl Me., 6JHfIJ1/Jn Smck
//1 ~ "-At P/ ~ ~I/"tv/~:r!
VALUE AT DATE
OF DEATH
ItJo5l. F. /{/, wpplk/prM &. n. t:/.
YOI7(, 15"8'
/7 sh.
Is s/"
'1:/ .sit.
rSlIAle
5>;'//971 )'tJl c1b/'It?
g-J, 1/918 Y()lq~ Slfo
~/~~ 8~/h7~6q
StUII~
~4A1e.
8'1151,. kI"!tv,,ji ~rp. 5/.3Jjlf'llJ wee 39"5
r: N. Jf/~pl/(/prrh a. <f U/I//J/w,;olh d>rp. SwdCs ~ Foot
Locker, ;r" e.
.:2. 'PIAn 1)iv,'dend Re.;nveshnent .s::>ho.res ~f Foot L-()cJ~erl .J..nc.
IS I. 1'/8'9 st,. &/H/tJ0I1. (stJ!!, prJl'}totr.f alfttchul) ~
Ct(.$/!/ /I/~. ~r p, w. U/pP/w~r~ (;, /s 9 ?Prtfl It) t,
e/(S/FJ A/P. ~r /(/PP/tVP/'1h ~7' /s 9Rt? tFr.3 If) 2-
{oJ: hOIi.: a eJf'l of ~ c.ontemfbra.n~oLC.s cl)ta-~mtnt is atfa.cheol
L;II;al'1 /)1. Ka.uht411 d;e.cI 1~-2~-ZGOo whe~Vl ~([ +;+te. -fz:>
~se shCd1~'S ve:!.hcJ In N.r Sl.t.t'v;V;t1j spouse, ChaJme.r H.
-4<ti.lJ..fWJan, ~ de.c~dent nerei~).
1/aluaf/o/l.s ,,{ shares t>>1 d.(),e/, :
hi ~;):2,bS" /0 ~/.'1tJ IIi/e. r ~iJ.J.,;Z7 ~
(see hi.sf,;r;c,tLl ~O.telYlent frol'H )/ahDD hi,Qn~,4./
31'1.31 s-h=
~ 1tac.hd )
.,
711.2./'
/
3.
NIFw YbRJ< LIrE INy;'SThtENT mIrNIt6-FIY/ENI I LLC
10010 Hji, 'fie.ld Col"'poro.:re .~"d B FWnd
(5e.e VtLlu.o.h'oYl h-~Wl JatMsD~ ~f IVy L.'Je a1tAc.hd)
1t
/Die) 3 fa 7. 77
TOTAL (Also enter on line 2, Recapitulation) $ 73, 4 g f. 73
(If more space is needed, insert additional sheets of the same size)
FOOT LOCKER INC.
AUTOr.ATIC DIVIDEND REINVESTMENT AND CASH PAYMENT PLAN
STATEMENT OF ACCOUNT
Tile Bank of New YOI1\, Administrator
P.O. Box 1958
Newark;NJ 07101-9774
SEQ#
01
002394
Answers to many questions and requests are
available by visiting The Bank of New York's
website at: http://stockbny.com or
Email at:Shareowners@bankofny.com
LILLIAN M KAUFMAN
H KAUFMAN JT TEN
208 NORTH MARKET
MECHANICSBURG PA
& CHALMER
1-866-857-2216
ST
17055-3341
Company Number
Account Number
Record Date
Payment Date
3225
0000358259
10/15/04
10/29/04
Next Anticipated Investment Date MONTHL Y
CURRENT DIVIDEND PURCHASE INFORMATION
Plan Record Date Posrtion
Held B-1 You In Certificate Farm Held By Plan
Administrator
Rate
Grass Dollars
Paid
Service
Fees
Tax
Withheld
Net Dollars
Reinvested
Total
168
151. 8189
319.8189
.0600
19.19
.00
.00
19.19
YEAR. TO,DA TE TRANSACTIONS
Transaction Date Transaction Description Transaction Dollars Price per Share Transaction Shares Total Shares Held By Administrator
BALANCE FORWARD 149.4087
J 1/30/04 COMMON DIVIDEND 10.08 24.7332 .4075 149.8162
Jl/30/04 PLAN DIVIDEND 8.96 24.7332 .3623 150.1785
J4/30/04 COMMON DIVIDEND 10.08 24.2410 .4158 150.5943
04/30/04 PLAN DIVIDEND 9.01 24.2410 .3717 150.9660
Q7/30/04 COMMON DIVIDEND 10.08 22.4400 .4492 151.4152
'J7/30/04 PLAN DIVIDEND 9.06 22.4400 .4037 151.8189
LO/29/04 COMMON DIVIDEND 10.08 24.2000 .4165 152.2354
10/29/04 PLAN DIVIDEND 9.11 24.2000 .3764 152.6118
IF YOl HAVE ANY QUESTIONS REGARDING YOUR A( COUNT, PLEASE CALL OUR OLL FREE ~UMBER
OR VI ~ IT OUR WEBSITE. REMINDER: TO FURTHER EXPEDITE YOUR TRANSACT! ON REQUEST USE
THE IE AR OFF STUB ATTACHED BELOW.
YEAR.TO.DATE SUMMARY
,;ROSS DIVIDENDS I TAXES WITHHELD I CASH CONTRIBUTIONS I SERVICE FEES I TOTAL FUNDS INVESTED I ADDITIONAL INCOME I FAIR MARKET VALUE
76.46 I .00 I .00 I .00 I 76.46 I .321 7,758.81
. DETACH HERE .
TRANSACTION REQUEST FORM - PLEASE KEEP THIS FORM FOR FUTURE REQUESTS
D
D
Sell PI.ln Shares (Enter Number of Whale 'hares)
If 'All' ie entered. Parllcipation in the plan "nil be
termin~ted. .Shares vnll be saki subject to the
Terms and Conditions Detailed in the Plan.
lsoue Plan Shares (Enter Number of Whale ,hares)
If 'AII" Is entered. Parllcipation in the plan "nil be
termlnatsd. A certificatel:nll be issued in
Registered holder(s) name.
CIIIIIIJ
CIIIIIIJ
D
Certificate Transaction -
Mark this box and
complete th" oth",. sidEl
of form. 00 not SiQn
the Cerbficate(s) -
DIVIDEND ELECTION
rM,'rk this box ,1nd ,11so
91r.tion box /]q/o1V1
D
AddItional Purchase,
Automatic Monthly
Deductions. Mdrk this
box <1nd camp/lItEl thEl
other sids of form
D
D
o
D
Reinvest All
Dividends
Pav Cash
Dividends
.Address Chanae
M,lrk this box and camp/lite
thq. oth9r stde ot lorm
D
0ptional C.1";h Contribution Amount Enclosed
.411 Pavm€lnts must be In U.S. Dollars
Dra':m on ~ U.S. Bank 0300 Payable to
The Bank of NA\./ York.
G[[Tl,[[]J.DJ
D
L
$20.00 MINIMUM PAYMENT
$60,000.00 MAX PER YEAR
RetnVflst Dividends. on
Shares :Jnd
Pay Ca~h' Dividend!.
on Remaining Shares
- REQUESTS MUST ISIGNATURE
SIGNED BY M.L I
:STERED e,Wl'JERS
. SIGNATURE
I
i
I DATE
I
DAYTIME TELEPHONE NO.
I (
,tilAKE rJO t.1ARKINGS BELOW THIS LINE)
3225
1002
0000358259
.5
J0000002000
Your Plan St:3tement provides you with a record of yourculTent dividend purchase act.ivity, year-to-date. transactions, and year-to~date summary. To request a transaction. complete
the tear-off form at the bottom of the statement and mall It to us. Most request transactions, such as selling shares. Issuing a certificate and terminating dIVidend relllvestment ate :>!so
available online arvia the automated telephone system. For secure transactions, visit http:'www.stockbny.com. Webs!te access is restricted to PIN holders. Log on to receive your
PIN. Transactions are also available by calling the toll free number on the front of this statement. .
If you wish to transfer your reinvestment shares to another person, please call us at our toll-free telephone number listed on the front of this statement for transfer
Instructions and a stock power form. If the person receiving the shares wishes to enroll in a reinvestment plan. please request a reinvestment enrollment form and
mail the completed form to The Bank of New York along with Ihe transfer instructions.
A GUIDE TO UNDERSTANDING YOUR STATEMENT OF ACCOUNT
· Record Date: The date you must officially be the holder of the stock in order to be entitled to receive a dividend.
· Payment Date: The date on which dividends are paid.
. Next Anticipated Investment Date: The next date on which your optional cash payment can be invested to purchase additional shares.
CURRENT DIVIDEND PURCHASE INFORMATION
The information in this section only pertains to those shares enrolled in the Plan.
· Enrolled Record Date Shares - Held By You In Certificate Form: The total number of shares held by you which were enrolled in the Plan on the record date.
· Enrolled Record Date Shares - Held By Plan Administrator: The total number of shares held for you by the Plan Administrator, The Bank of New York.
· Enrolled Record Date Shares - Total: Represents the total number of enrolled lecord date shares.
· Rate: The amount of the dividend paid per share.
. Gross Dividends Paid: The combined total of Enrolled Record Date Shares held on record date multiplied by the rate.
· Service Fees (If Any): The amount of service fees deducted from your dividend as indicated in the Plan prospectus.
* Tax Withheld (If Any): The amount of income taxes withheld from your dividend payment prior to investment.
* Net Dollars Reinvested: The amount available for investment after deduction of service fees and taxes.
YEAR-TO-DATE TRANSACTIONS
* Transaction Date: The activity date in your Plan account. Purchase and sale activity reflects the trade date not the settlement date. The trade date is
usually 3 iJusiiless days I='rial ta the :;;ettleiToent date.
* Transaction Description: The type of activity that took place in your Plan account.
· Transaction Dollars: For purchases, it is the net money invested after deduction of service fees and taxes. For sales, it is the net proceeds after deduction
of fees and commissions. See Plan prospectus for fee information.
· Price per Share: The price per share, adjusted for brokerage commissions, used in the transaction as outlined in the Plan prospectus.
· Transaction Shares: The number of shares added to your Plan account.
Total Shares Held By Administrator: The cumulative total of shares held for you by the Plan Administrator.
YEAR-TO-DATE SUMMARY
· Gross Dividends: The gross dividends paid for the year on Plan shares plus any amount indicated in additional income.
* Taxes Withheld: The total amount of taxes withheld from dividends prior to reinvestment, if any.
· Cash Contributions: The total amount of optional cash invested after deducting any commission andlor fees.
· Service Fees: The total amount deducted as outlined in the Plan prospectus.
· Total Funds Invested: The total net dividends and net cash contributions.
· Additional Income: The amount of brokerage commission paid on your behalf. This amount is income and will be reported to the Internal Revenue
Service on Tax Form t099-DIV.
" Fair Market Value: The market value of the total shares in the Plan as of the last dividend transaction date listed on the front of this statement under
"Year- To-Date Transaction" section.
IMPORTANT TAX INFORMATION
iT! the case of those shareowners whose dividends are subject to Federal income tax withholding, the appropriate amount of taxes were deducted
:: YTl the gross dividends paid on enrolled shares held as of the record date.
SSE THE PROSPECTUS FOR FURTHER INFORMATION.
TRADING ACTIVITY
T:. e Plan Administrator may use BNY Brokerage Incorporated, a wholly owned subsidiary of The Bank Of New York Company Inc.. for trading activity
. "lder the Plan on behalf of Plan participitants. BNY Brokerage receives a commission in connection with the transaction it processes.
", vou have any questions about your account. contact our Investor Service Center or email us.
Str~et
. Change of Address Request_
Fill in New Information (PI.a.. Print)
. DETACH HERE .
Certificate Transactions
Sell Certificate Sh.lle.. Enter Number of Whole ,hare.. (Enclo.e
CertiooatEtE.((.) \'"th fElqUes.t.) Do not Sion the CQrtiflCat~(:. Shar8s \'.;11 ~
be Gold S1Jbject to the terms and condItion. Oel,"IOO in the Pl.:m. ~
D
Str8At (~ont)
r,ity
D
Dppo~.it Cprtiflcat~ Share!". For Safeke"ping. Enter NumbElr of
Whole ~h.1re$ (1:.111'::10$9 Cl?ortificate(s) ',',ith reqIJE?5t). Do not Siqn
thE! C~rtifrcatQ. Trle (.ha,,,!. will be depm:.ited into the J:~an.
The Di'J~iend ell?Cban will not chanae, unleG!3 the
Dividend Election on the R9vars9 f,lch~; if. filled out.
ITllIIJJ
State
Lip Code
ITIIIJ
Automatic Monthly Deductions
OJ
Bank Routinq
(ABA) Number
1_ i
T ~lc.r'hon't NlIrn~r Durrrlq 8m:IrH.~.$ hour!,
Note: To CIFH'1l19 Tho. Arlrlr~t'.jo;_ All P.Mi::;ter~ O','mer(!;)
i.1ud Sian on the Front of the Form V/herb lndic.:,t~.
Cl.c('ount
Number
L
DolI;;r
.lrllount
,
I
SI
':hp(':kina
'::''--<:'Ollr.t.
~"ctn'~4
oidl'<d Ch.d,
'"1
Savin05 /l.r_~cotjnt
Enelof.€:! DflPOf.lt ~;lIp
FL: Historical Prices for FOOT LOCKER INC - Yahoo! Finance
1/6/05 11:03 AM
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Start Date: I Sep , ~l [D'g 1200i Eg. Jan 1, 2003
End Date: I Sep , ~ I RO I?OO.
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SET DATE RANGE
IGet prices.j
First I Prey I Next I Last
PRICES
Date Open High Low Close Volume Adj
Close*
10-Sep-04 22.50 23.25 22.48 23.16 602,000 23.10
9-Sep-04 22.53 22.65 21.90 22.48 770,800 22.42
* Close price adjusted for dividends and sp ItS.
First I Prey I Next I Last
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Page 2 of2
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REV.l508 EX + (1.97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INH~~~i~~~~ DTtc<E~g~~RN PERSONAL PROPERTY
ESTATE OF KAUF/JfA-NJ CHIfLIJ1Et? H. FILE NUMBER 2/-64- t?t.l9
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F.
ITEM V ALUE AT DATE
NUMBER DESCRIPTION OF DEATH
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.. .._/1<<! _ _ ~'bert -7-. /._ _ d/1t.. _ Sb~ft/~1ft-- ~_~ . ~ttd.. Ye c (!,. ye.d __ _.
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.~.. -- .._--.....,~ .__.~-_.-...- -.---'-_.--- --. ..n____.__..___ __.... .___'__,_.._.____..__.'____". ._~___.._..._._._.._..___..____..__ 0_ .....___._.._.__.._...._..._._.___. ______
t: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
October 27,2004
CHARLES E SHIELDS III Esq
6 CLOUSER RD
MECHANICSBURG, PA 17055-9735
Estate of CHALMER H KAUFMAN
Date of Death: September 09, 2004
SSN: 717-12-2628
Dear Sir:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his date of death.
The decedent had 4 active accounts at the time of his death.
Responsible Branch:
Mechanicsburg Branch # 292
2 West Main St
Mechanicsburg, PA 17055
(717) 766-4743
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884.
Sincerely,
r~4'~
Philip Lynch
Operations Services
.~ CITIZENS BANK
Account Number 6140-724384
Account Title CHALMER H KAUFMAN
Date Opened 3/3/1998
Account Type Time Deposits
Principal Balance as ofDOD $16,185.29
Interest from Last Posting to DOD $5.25
Account Balance as ofDOD $16,190.54
YTD Interest to DOD $251.34
I
I
.~ CITIZENS BANK
Account Number
Account Title
Date Opened
Account Type
Principal Balance as ofDOD
Interest from Last Posting to DOD
Account Balance as ofDOD
YTD Interest to DOD
6140-746396
CHALMER H KAUFMAN
9/17/1999
Time Deposits
$15,005.66
$31.57
$15,037.23
$338.79
,
.~ CITIZENS BANK
Account Number 6140-767903
Account Title CHALMER H KAUFMAN
Date Opened 6/13/2000
Account Type Time Deposits
Principal Balance as ofDOD $10,098.86
Interest from Last Posting to DOD $15.30
Account Balance as ofDOD $10,114.16
YTD Interest to DOD $126.24
I
.~ CITIZENS BANK
Account Number 6100705935
Account Title CHALMER H KAUFMAN or LILLIAN M
KAUFMAN
Date Opened 6/6/1966
Account Type Checking
Principal Balance as ofDOD $60,931.59
Interest from Last Posting to DOD $.00
Account Balance as of DOD $60,931.59
YTD Interest to DOD $107.46
I
.~ CITIZENS BANK
Account Number 00600029200012808
Account Title CHALMER H KAUFMAN or LILLIAN M
KAUFMAN
Date Opened 4/28/1989
Account Type Bank Deposit Box
Closed 10/06/2004
I
I
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;.,...f......k;,;,,:.o\.- . " I. .
Fulton Bank
CAPITAL DIVISION · LANCASTER/CHESTER DIVISION
DROVERS BANK DIVISION · GREAT VALLEY DIVISION
(717) 291-2437
October 4, 2004
Charles E. Shields, III
6 Clouser Road
Comer of Trindle and Clouser Roads
Mechanicsburg, Pennsylvania 17055
Dear Mr. Shields, III:
RE: Chalmer H. Kaufman, deceased September 9,2004
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
CD # 643-0017237, open 8/12/1997, rollover 8/12/2004, matures
2/12/2008, balance $8,000.00 and accrued interest $17.57; paying
2.86%, joint with Lillian M. Kaufman.
If you should have any further questions, please do not hesitate to contact me.
Very truly yours,
~~+r
Karen D. Hillegas
Credit Inquiry Processor
~tjNFIDENTIAL
is Infurmetfen i$ h:.Jr~ as a matter of bu;;>inM-<3 '
. "nswer to V:OUf ip'Qu~rYJ ~nd is for y"ur c.onlidentiai
, responsib'i1i~~/ is ;j:,';urned by thi& bank !if ;HIY tjf
'. I,OI!1!()r1 h:~n'ln c;xoresseo is;uhiectto chan':i; wifh"
POBox 4887
Lancaster, PA 17604
fultonbank.com
1-800-FULTON-4
tICYI-25- 2004
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o PNCBAl\K
November 26,2004
Ch<lrles F. Shields, ill
6 Clouser RD
Mp.t":h:;m1f~<;hllrg. PA 1 iOSS
RE: Estate ofChalrnf':T H Kautinan. (Deceased)
SSN: 717.12-2628
DOD~ 09/09/2004
Dear: Mr. Shields
In respon:sc: (0 yuur n::l.jul;;:,L iUl i)At'(.. of Ucath b411Qnoc:3 for'tbe CU&tvlll...... uu(<!'d "hnv,",. "'"r
records show the following:
Certificate of Deposit
Aocount#31300236796
EstablIshed 08/19/2003
CHALMER H KAUFMAN
DOD balance: $10,160.68 +. $993 accrued interest
Please note that this office only provides date of death balances for deposIt accounts
(IRAs, CDs, Checking and Savings accounts). We do not proce.ss any tiuBucial
tranSa4:tioDs or provide statements. If you need assistance with any of these items,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Banl< branch
oftlce.
Sincerely,
q~~,l1L--
Jessica Scheller
1-800.762-1775
Pi -PFSC.04-F
500 tirst Ave.
Pirtsburgh P A 15219
:v1ember FDIC
DEe 06 2004 11:55RM CALL CENTER
717 530 2524
p. 1
,--~
ORRSTOWN BANK
December 6,2004
TO: Charles E Shields III
Attorney At Law
6 Clouser Road
/vlechanicsburg, P A 17055
FROM: Timmhea Moose
Cust Servo Op,
PO. BOX 250
SHlPDENS8URG PA 17257-0250
RE: ESTATE OF Chalmer H Kaufman
DATE OF DEATH: September 8, 2004
IT is HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOLLOWING ACCOUNTS WITH ORRSTCWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO, TITLE OF ACCOUNT DATE OPENED PRINCIPAL & AQCRUEDJNTEREST
SAVINGS ACCOUNTS
ACCOUNT NO, TITLE OF ACCOl1t.!I DAT~Qfe;.NEQ eRI,~glpAL & i:\_QQBJJJ:D INTEREST
CERTJF1CATES Qf.-m:.PPSIT
ACCOUNT NO, TITLE Of I\CQOU_~.I gATI;_QPENED PRINCJEAL ,3< 6.9CR11fPH{r~REST
No acccunts with Orrstowr Bank
X:i:'j~'S BANK
Customer Receipt
Please be sure to enter thIs
transaction In your records.
Transaction
Description
Date
Account Number
Amount
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Funds from your deposit may not be available fO( Immediate w1thdrawat All transactions are subject to
F064M 1104 verlflcatlon as outlined In the rules and regulations of the Bank. Member FDIC
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December 9, 2004
Charles E Shields, III
6 Clouser Rd
Mechanicsburg Pa 17055
RE: Estate of Chalmer H Kaufman
Social Security #: 717-12-2628
Weare unable to locate any active or closed accounts under the name of the above
mentioned decedent's social security number. If you feel he/she had accounts with our
institution, please provide us with an account number or the name of a possible joint
account holder. Thank you.
Sincerely,
fft0 QJStA
Erin E Warts
Sr. Services Rep.
P.O. Box 1711. HARRISBURG. PeNNSYlVANIA 17105-1711
Toll Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waupointbank.com
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APPRAISAL
Personal Property of C'#JLI16 fl.. /-<..A-(/;=~fJ ~ST/jTC-
Appraised by Chuck E. Bricker AU094-L
ITEM
0,)
/6t Of)
Sb.ou
,J... D (l \J
#tJ 8 ~ )1Af/c..cT 6(, NECK/I;, lOA,
Date I 0 - ,)-.cr - () <..f
ITEM VALUE
tv/V SWC=EjJc!<- ~ 00
SE /0, Of)
ON p,; 17 t: 6 l--
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,.2 577)VI:-S
tv ELL- ,Punt'
VA t- v L<-5
:l 1<lcfl.v'.! 1(..f#wE~5
)'Q
3d o. (j iJ
rKoofW t:>y f?Dom ftl>D/T1DNA-L fr'Pf!<./l-If,AL
L1VI NG ROOM
Old TV console-gutted of TV & speakers
used as a stand in living room $25.00
Old VCR $ 7.50
End table & light $15.00
Rocking chair with seat pad $ 8.00
Old wooden elyphant with broken tusk $ 2.00
Candy dish $ 1.00
Table lamp $ 6.00
Picture with 2 dogs $ 2.50
Norman Rockwell reproduction of
"Saying Grace"
Picture of C C -1 RR Locomotive
SEWING ROOM
Miscellaneous Train books
4 Reproduction silkonettes of old
trains in frames
BED ROOM
Old wooden bed
Small desk & lamp (no chair)
20 BED ROOM
RR picture "Crossroads of Comerce"
Old wooden bed
Old dresser with mirror
Old set of drawers
Old tin carrier with wood handles
KITCHEN
Used small TV
BASEMENT
Hand made small wooden display case
with Shirley Temple cups
Folding table
Old Craftsman hand tool box &
miscellaneous hand tools
(Cf)nfinued
$ 3.25
$ 3.50
$ 5.00
$12.00
$60.00
$22.00
$ 3.50
$45.00
$50.00
$50.00
$ 4.25
$ 8.00
$40.00
$ 4.50
$17.50
p.2. ku())n By ~hl1
Parents diplomas No value
7D7?l-t::. YALflE -~Y.15.$V
REV-1511 EX+ (12-99) "
*
, .
ESTATE OF
ITEM
NUMBER
A.
B.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
K;lIAFJJfJ~ (!1I4-LIJIE,k' /I.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
/rlYBfS FuAlIiA!At Hp/J1E~ /N~ of /JIEC!/T/!.lVICS,6'uIf1G" /A
fI,4bt.t> ANt> PAT L.acnAll3Atf6H ~,/I T71!9IJil>A/AICC ~ SING/NG
DAJ'E/v,DI')A!rS :Z:~L//lN OJ'E7tI,,//Vt!. - FUI'fIEJ8IH. /h€AL
I/IIS(!!t/l1n/)A! OF 7Om.8S71Nt/G" -~y GR/fAlIT&- tVt)~
fJ/f/Jt€LHS FLJ?AJE7e~ -Fu#ERm.. FLOaJc:7ZS
~E/MI3l.{~EMerr 70 Lu CILl~ trJPIU2€T Felt. kDV!l-N(!1:' PAaTi/fl
PIf'/tYlGNt 7lJ I'11VEJfS FtlNEJeAi. f{()IHG~ /AI~.
ADMINISTRATIVE COSTS:
.:<.
3.
if.
s:
b.
1. Personal Representative's Commissions
2.
Name of Personal Representative(s) L U C I LtG d/tJR/lET
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address .;( f/ ./3IG II IJ.e1fl A-JI &:::
City 1J15t!HAAJICSAvJeG
State r::'A- Zip 170SS"
Year(s) Commission Paid:
Attorney Fees (!/I/I/lLE.5 E. 5111Et..tJS J11..
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
4.
5.
6.
7.
~.
If.
I~;
If;
Claimant
/V~#"E
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees ItH.A' ;/'Ij:/lA/ /ssue ",I- short eerf;/;'ca.fes
Accountant's Fees ~
JANEr /!J1lA-CI<I3 ILL I H f ~ RJLoCl', fJ!= /lUFf!.HIM/lC$-
Tax Return Preparer's Fees I3ttl((;. ~ CLOSE -ouT /P,/IJ, 11/1 Y'~ /P~I, ;0.1- 'II, €r(!.
/It/veri,S,,,! l'n eUIHW/and tau) .Ji:,urna./
IMvert;s;"J In {I",./;sle c5i!/It/ne/ ~h/.//Ir,~r
7r,'- t!PfU1ty .#;S/rad ~. - ~~ 4-6sIHd / Jan:h
/l-clt:I,'';' 'II/la/ jJ~64/e ne.
r//illj Fee.- r;/lhJ J;,her. ~)(
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
..:2/- t:J 4l- t:flf9
AMOUNT
1
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Myers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania 17055
(7] 7) 766-3421
Fax (7 I 7) 795-7291
A standard of excellence in Central Pennsylvania since 1910
Friday, September 10, 2004
Mrs. Lucille E. Morret
24 Big Horn Avenue
Mechanicsburg, Pa. 17055
Dear Mrs. Morret,
Thank you for selecting our funeral home to provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the services for:
Chalmer H. Kaufman
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LESS: Credits granted
LESS: Total Payments
CURRENT BALANCE
cfL.~ 7 1.. c.
/1'11.. . -
.....,,'-1..":...
/;ia< ft
$11,080.63
1,695.00
930.00
$8,455.63
Credits Granted: $1,695.0 Package Price Discount
Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days.
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
A/~~/
/)ya.- tj/ c;J) 1. (JaJZ,.-'
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Thank !JOU for !Jour
thoughts, pro!Jers ond kindness
during this difficult rime
From the fomi1!J of
C~ /)(~
p. .2. 9-8 ~ ~v~
/r--P- ~ fr'............ ~
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ROBERT E.
LUCILLE E. :ORRET
24 BIG aRRET
MECHANICS::N AVE.
Pa G, PA 17055 r-;; .~
y to the /' D C-j I
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PNC Banlc N
Central PA.A 040
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Davenport's Italian Oven, Inc. Invoice
. ,
5220 Simpson Ferry Road I DATE 1- INV~CE #
Mechanicsburg, PA 17055 I I 1
i 9/13/2004
-......,
I BILL TO I
t Lucille Morret I
For Funeral Luncheon of Chalmer I
I
Kaufinan I
I
i
--~----
I P.O. NO. I TERMS . PROJE~
I
! I I
I I ----------
QUANTITY DESCRIPTION RATE AMOUNT I
! I
25 Dinner Buffet (Chicken Piccatta., Baked Penne, Salad Bread, and Beverages. Coffee 10.95 273,75
service)
4 Kid Buffets 4.95 19.80
1 Service Charge 49.90 49.90
1 SalesTnx 17.61 17.61
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FOR j(.el'm b u('~ ;=0 ({ FUN -e rvt- '- e.'1,f-R 'f.JS.e.5
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U.OOOCP,f:aIl. 1:0 3f:a0 7f:a. 501: I; 20033....111; 311a
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EBY GRANITE WORKS
P,O. Box 187
Newville, PA 17241-0187
Phone; 717-776-5113
INSCRIPTION FORM
Date /0- s-O$L
~ L..- /
== ~d~.<tAIP;;;~7."~_4
:late of Death (~~-C 9 / ~ ?JL'P4L
Jther name on marker ~./ /~ ,/??,
--=-- .,
Location in cern.
Type of Letters c:S; b,e g
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Person ordering ~./~~
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Address q?- ~. Ae:'-v,!
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PAMELA'S FLOWERS
439 N. ENOLA RD.
ENOLA, PA 17025-2128
(717) 732-1257
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ACCOUNT NO.
232
Kermit E. Heller
860 Green Springs Rd.
Hanover, PA 17331
PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
AMOUNT
E:NCLOSED $
;;(. 3?' jtJ
SACTION DATE I DESCRIPTION I DEBITS I CREDITS I BALANCE
09/13/2004
Kaufman # 62565
238.50
238.50
1
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2921
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PAY TO THE(f. /Pz- L 0 ~ I $23?~ ..~
ORDER O~ --'- - ~---a
:7~ 1~~ ~ Cr>>- 19~ pvf 'f~OLLARS 61 == I
ESTATE OF CHALMER H KAUFMAN ~(../ ~ / _ d/h L l !.
ESTATE OF LUCILLE MORRET, ADMINISTRATOR ( ~- ~'L~- ~ rot9~WATOR 11.00.'
24 BIG HORN AVE ,
FOR MECHANICS BURG PA 17055 -: ~ ~~~~~~TATlVE .
Fu /'1 ~ r ~ L- r;tll"'''' [ So L """" ;
II-aDO 1.0 1./1- 1:0 ~ I;O? I; ~DI: I; 200:1:1.... q I; :1"-_ _~~
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Pennsylvania
NO.
101
DATE
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238.50
0-30
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31 - 60
-150.36
OVer 60
-146.07
Thank you for your Business
96931
REORDER FROM:zLANO FORMS. P.O. BOX 202. DAYTON. ON 45401 CALll-800-228-9367
"11 Z111fl')4-m.O?
PRINTED IN u.:
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
REV-1512 EX' (1-97)
ESTATE OF
.1~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
CH A L /J1 Elf!. r/.
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETUR~I
RESIDENT DECEDENT
K AU I="IJ1A-N,
DESCRIPTION
AMOUNT
3-
'i
!J)Esr~ll= L~ G tULIP J Au To IAJStlllA.IIICG f1 /l.E f'VIILul1 :])U~
e~ r#L~C; or {!NeCKs U1A2/ rrG7/l/ /3en;~ -PA-Te:- OF
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TOTAL (Also enter on line 10, Recapitulation) $ 5"'0..3. S 7
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (1-97)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
K A-U F It1 fl-tJJ CH AL/J/ 1::7f! 17.
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
1. LILC/I.Le /J1pJ€,eET
;(1./ 13/(; Hp/ZN ~nf.J /JIct:/lA4I/CS8t1/fG,/ /1/9
17~5"S
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P. P. 190)( 9.:1.9, /l/YA'7Z~ ~EAeH. Sc... 2.9578
DAtl~HrE,e
3. GEPIl'G/A L. h'_LL&e
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L> A tt t;N Te-;ff!
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AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. UPf'1iN S7/iAStJU/lt;. PENNA /YJe m~L>IST CemETeJeV /f.sM
0/0 ~E/Y#E7N ~ K/luF'/JI.II-Al/ .d~x #37/ UPPER S7h'AS/3ttRC-/
;//1 /7:16~
.;? UJi:.5Ley u/WTeiJ h1E7HO.IJ/ST (!JIUR{!.#
FILJB~T t- ~/81P.s#N srs,./ /HGC/t',4..()/CSLJu,e6,/ PA /7t:JSS
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lOt 000. ~o
;4
':;0, 000.00
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ .30, 000. 00
(If more space is needed, insert additional, sheets of the same size)
'>
.
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2004-00849 PA No. 21-04-0849
Es ta te Of: KA UFMAN CHALMER H
(Last. First, Middlel
Late Of:
MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 717-12-2628
WHEREAS, on the 15th day of September 2004 instruments dated:
November 3rd 2000 October 17th 2003 were admi tted
to proba te as the last will and codicil of KAUFMAN CHALMER H
(Last, First, Middlel
la te of MECHANICSBURG BOROUGH, CUMBERLAND County,
who died on the 9th day of September 2004 and
WHEREAS, a true copy of the will &codicil as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
MORRETT LUCILLE AKA LUCILLE MORREI'
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 15th day of September 2004,
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
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1,AST WILL AND TESTAMENT OF CHALMER H. KAUFMAN
I, CHALMER H. KAUFMAN, of the Borough of Mechanicsburg, 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, I give, devise and bequeath to my beloved wife, LILLIAN M. KAUFMAN, to
her own use and benefit absolutely.
3.
In the event my said wife, LILLIAN M. KAUFMAN, should predecease me or die at
about the same time I do, such as in an accident or disaster common to both of us, then I direct that
my said estate be divided and distributed as follows after the payment of all death taxes, fees, costs,
expenses and the like have first been deducted therefrom:
A) Three (3%) per cent thereof to the Upper Strasburg Pennsylvania Methodist
Cemetery Association;
B.) Seven (7%) per cent thereof to Mechanicsburg Wesley United Methodist
Church. This is a conditional gift in that those funds so given shall ~iY be 118d for.
-' ..c:,.
building and grounds improvement and maintenance. The acceptand'ri of this C/1
iTl
-;:;
testamentary gift shall be considered an acknowledgment of and agreement to...be
VI
bound by these conditions by the recipient. -0
L,0
C.)
All the then remaining balance is to be divided among my three (3)
(Ji
0',
daughters, to wit: LUCILLE MORRETT, GEORGIA HELLER, and
DOLORES BRANDT, in equal shares, ver stirpes.
4.
I nominate, constitute fd appoint my wife, LILLIAN M. KAUFMAN, to be the Executrix
. .
'II ~
should be unwilling or unable to act as such Executrix, I nominate, constimte and appoint my
daughter, DOLORES BRANDT, to be Executrix in her place and stead. The order of the
alternates selection has been based upon the respective proximities of geographic location as of the
date of my will and is not to be taken as a measure of my opinion as to anyone's personal
capabilities and abilities, believing that my said daughters are equally capable. 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 ~ day of
~ ,AD. 2000.
~/k<-~~~
ALMER H. KA FMAN
(SEAL)
Signed, sealed, published and declared by the above-named CHALMER H. KAUFMAN,
as and for his Last Will and Testament, in the presence of us, who at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
~/~42-
,~~
CDARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Carner ofTrindle and Clouser Roads
. '~:MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
..-
,',\
June 17, 2005
TELEPHONE (717) 766-0209
FAX (717) 795-7473
Via C rtified Mail
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, P A 17013
Re: Estate of Lillian M. Kaufman
No. 21- 04-1091
DOD: 12/26/2000
Estat of Chalmer Kaufman
No.2 -04-0849
DOD 9/9/2004
Dear Register of Wills:
.
,
Please find enclosed for filing 2 copies of the Inheritance ax Return for the Estate of
Lillian M. Kaufman and 2 copies of the Inheritance Tax Return D r the Estate of Chalmer
Kaufman. Additionally, we are enclosing Check No. 1453, in th amount of$5.00 for the
difference in the filing fee of Lillian M. Kaufman.
y
Thank you for your kind attention to this matter.
Very truly yours,
c~s,
Attorney-At-Law
CES/mjj
Enclosures
.~7!L
II
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CWUSER ROAD
Co",,,r ofTrindk and C/ous", Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
June 14,2005
Via Certified Mail
Register of Wills
Cumberland County Court House
I Court Square
Carlisle, P A 17013
Re: Estate of Lillian M. Kaufman
No. 21- 04-1091
000: 12/26/2000
Estate of Chalmer Kaufman
No. 21-04-0849
000: 919/2004
Dear Register of Wills:
We have received an Extension of Time to File the Inheritance Tax Returns in these two
estates. We will be sending the required documents in the very near future for filing. At this
time we are enclosing the required payments concerning the Inheritance Tax Return for the
Lillian M. Kaufman Estate and the Chalmer Kaufman Estate to be clocked in at your Office.
Checks regarding the Lillian M. Kaufman Estate are as follows: Check No. 146 in the
amount of $7.00 for additional probate and Check No. 147 in the amount of$IO.OO for the filing
fee.
Checks regarding the Chalmer Kaufman Estate are as follows: Check No. 149 in the
amount of$15.00 for the filing fee, Check No. ISO for additional probate, Check No. 151 in the
amount of$5,268.06 forInheritance Tax due and Check No. 1450 in the amount of$3.61 for the
Interest Due on the Inheritance Tax.
Thank you for your kind attention to this matter.
Very truly yours,
~tufh f~~
Charles E. Shields, III
Attorney-At-Law
c..
CES/mjj
Enclosures
(,)
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
__u____ fOld
ESTATE INFORMATION: SSN: 717-12-2628
FILE NUMBER: 2104-0849
DECEDENT NAME: KAUFMAN CHALMER H
DATE OF PAYMENT: 06/15/2005
POSTMARK DATE: 06/14/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/09/2004
NO. CD 005435
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3.61
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1450
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$3.61
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1 162 EX(11-96}
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
__uu__ fOld
ESTATE INFORMATION: SSN: 717-12-2628
FILE NUMBER: 2104-0849
DECEDENT NAME: KAUFMAN CHAlMER H
DATE OF PAYMENT: 06/15/2005
POSTMARK DATE: 06/14/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/09/2004
NO. CD 005436
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,268.06
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$5,268.06
REMARKS:
CHECK# 151
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
June 10, 2005
Telephone
(717) 787-3930
FAX (717) 772-0412
CHARLES E. SHIELDS, III
A TIORNEY AT LAW
6 CLOUSER ROAD
CORNER OF TRINDlE AND CLOUSER ROADS
MECHANICSBURG, PA 17055
Re: Estate of CHAlMER H. KAUFMAN
File Number 2104-0849
Dear SIR/MADAM:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before 12/09/05. Because Section 2136
(d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be
granted that would exceed the maximum time permitted.
Cr")
U,
)., sincereIY~.-/ .
~?~./~
Claudia Maffei, Sup~r
Document Processing Unit
Inheritance Tax Division
....
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ni'.il/i!!;)" T\ r -"Ire (" NOnCE OF INHERITANCE TAX
BUREAU OF INDIVIDUALr,[~9"J)tu ,Ji--,v._ ,.JjIPPRAISENENT, ALLDIlANCE DR DISALLOWANCE
~~~~T=~oIA)( DIVISION,. ,'---" ',' . (" OF DEDUCTIONS AND ASSESsnENT OF TAX
HARRISBURG PA 17128-0601
09-05-2005
KAUFMAN
09-09-2004
21 04-0849
CUMBERLAND
101
APPEAL DATE: 11-04-2005
( See rwerse side under Objections)
Amoun1: RemiUedl 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 +-
REV:is47-iX-AFP-ioj:osi-NOTicE-OF-iNHERiTANCE-TAX-APPRiisEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
CHALMER H FILE NO. 21 04-0849 ACN 101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
?f\~~ ~C"O - /I
...\J"" '.c._. ._
PH :2: ! I
CLEF; \
err
CHARLES Er~HIELDS III
6 CLOUSER ~RD
MECHANICSBURG
PA 17055
ESTATE OF KAUFMAN
*'
REV-15~7 EX AFP (06-05)
CHALMER
H
DATE 09-05-2005
If an assess..n1: was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflec1: figures 1:hat include 1:he 1:o1:al of abb re1:urns assessed 1:0 da1:e.
ASSESSMENT OF TAX:
IS. ~unt 01 Line l~ at Spousal rat. (IS)
16. A~t 01 Line 1~ taxable at Lin..l/Class A rat. (16)
17. AIIount of Line 14 et Sibling ...te (171
18. Amount of line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
I
TAX RETURN liAS: I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate ISchedule Al
2. Stacks and Bonds (Schodula BI
3. Closely Held stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule DJ
6. Cash/Bank DepositslHisc. Personal Property (Schadule El
6. Jointly Owned Proparty (Schodule FI
7. Transfers {Sch~le Gl
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. FUleral Expenses/Ad... CostsIHisc. Expenses (Schedule Hl
10. Debts/Mortgage Liabilitias/Liens (Schedule II
II. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
NOTE:
T
DATE
12-04-2004
06-14-2005
06-14-2005
NUMBER
C 004693
CD005435
CD005436
INTEREST/PEN PAID (-I
675.00
.00
3.61-
~
I I CHANGED
III
(21
(31
(41
IS)
(61
(7)
279,500.00
73.489.93
.00
.00
129.763.08
.00
.00
(81
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this forn with your
tax p.yllttllt.
482,753.01
~1i.~R4 RIl
447,068.15
30,000.00
417 ,068.15
1191=
.00
18,768.06
.00
.00
18,768.06
(9)
1101
35,181. 29
503.57
1111
1121
113)
(141
18,768.06
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYIlENT IS REl\I.IIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERS!; S,TDI=' n~ TUT~ .,....._ ..--- _u_______
(Schedula .n
.00 X
417,068.15 X
.00 X
.00 X
00 =
045 =
12 =
15 =
AMOUNT PAID
12,825.00
3.61
5,268.06
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrind/e and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
December 21, 2005
Register of Wills Office
Cumberland County Court House
1 Courthouse Square
Carlisle, Pennsylvania 17013
Re: Estate of Chalmer H. Kaufinan
Admin. No. 21-04-0849
Dear Register of Wills:
Please find enclosed two copies of the Status Report for the above referenced Estate.
Note: the administration of this Estate is not yet completed. Please clock-in both copies and
place one in my mailbox for me to pick up at a later date.
Thank you for your kind attention to this matter.
Very truly yours,
~t~
Charles E. Shields, III
Attorney-At-Law
CES/mjj
Enclosures
- .J
STATUS REPORT UNDER RULE 6.12
Name of Decedent: (! ff1fLlnB7<
Date of Death: C;jq/OLf
Will No.
II. KrtuI=M~N
Admin. No.
~ / -0 '-f -0 FI/-'7
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 y:.
2. If the answer is No, state when the personal
representative re~sonably believes that the administration will be
complete: wi, Cl b (}-){)n~s (? rno..yI4e)
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 X
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.
Date:
, 2..-/2..11 O~-
~p~~
Signature
Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
(717 ) 766-0209
Tel. No.
Capacity:
Personal Representative
x
Counsel for personal
representative
(MAH:rmf/AM3)
V~.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
SHIELDS CHARLES EDWARD III ESQ
SIX CLOUSER ROAD
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Date: 8/27/2007
MECHANICSBURG, PA 17055
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RE: Estate of KAUFMAN CHALMER H
File Number: 2004-00849
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS 1 COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
9/09/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~~u~~
(J
Glenda Farner Strasbaugh
Clerk of the Orphans 1 Court
cc: File
Personal Representative(s)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 8/27/2007
MORRETT LUCILLE
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24 BIG HORN AVENUE
MECHANICSBURG, PA 17055
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RE: Estate of KAUFMAN CHALMER H
File Number: 2004-00849
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Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
~s per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
9/09/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~tIL~))/J-~
~ (.. ,/
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OFC U PI t3E1t..tA-AJ..D COUNTY, PENNSYLVANIA
Name of Decedent: ellA-t"MEJe ft. ,Kit U FM ".111
Date of Death: CJ /9 lot! File Number: ~Ol) ~ - /)0 K 1/9
Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. C8'Yes 0 No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. lfthe answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . . . DYes ~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? ............................... ~Y es 0 No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
0(//1'
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SignalUre of Person Filing /his Form
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Capacity: DPersonal Representative ~Counsel
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Name of Person Filing /Izis Form
(P (!/uUSd Itd
Address
IJ1tMIUI;t$/u'1I;1A /7Ps5
'117- "1~' -/)'/,df
62 :2/ Wd OS :JnV LOOZ
Telephone
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