HomeMy WebLinkAbout01-12-12 (2)150561D105
REV-1500 ex `°z-1'' `~'
PA Department of Revenue pennsylvarda OFFICIAL USE ONLv
ate,*~E County Code Year File Number
Bureau of IndividuaLTaxes a~ INHERITANCE TAX RETURN
PO BOX 28oso~ ~ I I ~ ~-
Harrisburg, PA 1128-o6oi RESIDENT DECEDENT
MMDDYYYY Date of Birth MMDDYYYY
03/30/1957
Suffix Decedent's First Name MI
Susan E
Spouse's Last Name Suffix Spouse's First Name MI
_ _. ,_ _,
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
__
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum
O 4. Limited Estate
~ 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
O 2. Supplemental Retum
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust.)
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
8. Total Number of Safe Deposit Boxes
O 11. Election to Tax under Sec. 9113(A)
(Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
:John Ramey (717) 802-8808
REGISTER OF USE ONUFa
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San Mateo PA ' 94402
Corrospondent's e-mail address: ramey.john(t~gmail.com
Under penalties of perjury, l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, and complete. ration of preparer other than the personal representative is based on all information of which preparerfias any knowledge.
SIGNA F P SLaM. PONSIBLE FOR FILING RETURN .DATE)
181GIounds Road #2, San Mateo, CA 94402
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: Susan E.Ramey 477-54-5741
RECAPITULATION
1. Real Estate (Schedule A) ............................................. L 174,500.00
2. Stocks and Bonds (Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) ........................... 4
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. '.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ',
(Schedule G) O Separate Billing Requested........ 7. ',
8. Total Gross Assets (total Lines 1 through 7) ............................. 8.
9. Funeral Expenses and Administrative Costs (Schedule H} ................... 9.
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10.
11. Total Deductions (total Lines 9 and 10) ................................. 11.
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ........................ 13.
8,140.21
103,562.75
286,202.96
42,395.30
2,992.49
45,387.79
240,815.17
1,300.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 239,515.17
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 - ___ _
16. Amount of Line 14 taxable ___...__ ..__.__.. ._....___.. _. __..___m. _,_~,,,,,... _....____..._.._____ _-.,._,.._.._
at lineal rate X .i) 45 239,515.17 16, 10,778.19
17. Amount of Line 14 taxable
at sibling rate X .12
: 17.
_
__.__..__..
.
18. _, ~ _._e_ _~ _.,~~~_ .__~....._
Amount of Line 14 taxable ....
_ _..~ ~ _~, .. , ._..._
_,..~..._..
at collateral rate X .15 18.
19. TAX DUE .........................................................19.'
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
10,778.19
O
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credfts/Payments
A. Prior Payments
B. Discount
3. Interest
7,000.00
368.41
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1)
10,778.19
Total Credits (A + B) (2) 7,368.41
(3) 41.94
(4)
(5) 3,451.72
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ................................................................................... ....... ^
b. retain the right to designate who shall use the property transferred or its income ..................................... ....... ^
c. retain a reversionary interest ....................................................................................................................... ....... ^ ~
d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................................... ....... ^
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ....... ....... ~ ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ................................................................................................................. ....... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994, and before Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1 }].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (11-08)
pennsy~lvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEbENT
ESTATE OF FILE NUMBER
Susan E. Ramey 21-10-1274
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 that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 ~ Primary Residence situate at 1292 Summit View Court, New Cumberland, PA 17070 174,500.00
Tax Parcel Number 13-25-0008-312
Sold to thrid party July 29, 2011 (See Settlement Statement HUD-1 attached)
TOTAL (Also enter on Line 1, Recapitulation.) $ 174,500.00
If more space is needed, insert additional sheets of the same size.
REV-i$D8 EX+ (ii-io)
~ pennsytvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCMEp1~LE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Susan E. Ramey 21-10-1274
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must L-e disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIf~TION OF DEATH
1. Metro Bank checking account number 536788318, opened 0813012004 3,514.84
Date of death balance $3,514.84 (see letter attached).
2. Metro Bank savings account number 627048705, opened 0211212009 125.37
Date of death balance $125.37 (see letter attached).
3, ',Sale of Decedents 2001 Toyota Rav4 vehicle to Bobby Rahal Toyota 4,500.00
6711 Carlisle Pike, Mechanicsburg PA 17050 (see attadied).
TOTAL (Also enter on Line 5, Recapitulation) $ 8,140.21
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (OB-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Susan E. Ramey 21-10-1274
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(TF APPLICABLE)
TAXABLE
VALUE
i• `Metro Bank checking acxount 833112151 opened 09/30/2009 fbo 2,872.31 100 2
872.31
-John P. Ramey (son) and Mark B. Ramey (son). (see letter attached). ,
2 'Fidelity 401(k) -Shoemaker 8 Alexander Companies 401(k) Plan 17,116.30. 100 17,116.3(
'Beneficiaries: John P. Ramey (son) and Mark B. Ramey (son) (see letter).
3 Life Insurance - BCS Life Insurance Company Policy No. 8858 25
026.97 100 ' 0.0(
Beneficiaries: John P. Ramey (son) and Mark B. Ramey (son) (see letter). ,
4 Long Term Disability Policy - UNUM Life Insurance Company of America 22,093.92 100 0.0(
`Policy No. 302965-0001. Lump payment to Mark B. Ramey (son) $6,995.04
:and monthy benefit payable to Mark B. Ramey (son) $629.12 per month for
24 months ($15,098.88) (see letter).
5 NEF Agents' Retirement PIan~01A Plan 385006-01 (see lettedstatements) 83,574.14 ' 100 83
574.1
Beneficiaries: John P. Ramey (son) and Mark B. Ramey (son). ,
TOTAL (Also enter on Line 7, Recapitulation) $ 103,562.75
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OP REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Susan E. Ramey 21-10-1274
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Parthemore Funeral Home -Funeral home and creamation services in New Cumberland, PA 2,480.47
2.' 'Mankato Mortuary - Burial occured in Mankato, MN per Will instructions 4,531.37
s. Delta Airlines -Transportation costs to/from out of state burial site per Will instructions 1,353.80
e. ADMINISTRATIVE COSTS:
1, Personal Representative Commissions:
Name(s) of Personal Representative(s)
__. ___
Street Address
City ..._.__ _.. _ _ State ZIP _ _ ._.
____
Year(s) Commission Paid:
2. Attorney fees:
1,092.69 '
3,500.00
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation,)
claimant Mark B. Ramey
Street Address 1292 Summit View Court
city _New Cumberland ___ state FA_ zIP 17070
Relationship of Claimant to Decedent Son (lived with Decedent until passing)
4. Probate Fees: 403.50
5. Accountant Fees: 350.00
6. Tax Retum Preparer Fees:
~• Fees from sale of Real Estate (see A and HUD attachments) incl broker commissions, buyer credits, etc 21,909.93
B. 'Appraisal Solutions, Brett Lechthaler -Real estate appraisal 300.00
s.' Properly Management, Inc -Home Owner's Association dues #h0330-101292 902.38
~ o. UPS -Shipping and notary fees 949.87
~ ~ .' Shearer Security Devices -Crack home safe 159.00
t 2. ':Metro Bank -Fee to crack lock on safe deposit box 150.00
TOTAL (Also enter on Line 9, Recapitulation) ~ 42,395.30
If more space is needed, use additional sheets of paper of the same size.
Rev-1511 Schedule H -Continued
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
Estate of Susan E Ramey, File No. 21-10-1274
13. Tim Snow -Independent plumber for home repair 195.00
14. GEICO Insurance Agency Inc -Home insurance policy #986732008-633-1 340.00
15. Pennsylvania Power & Light -Home utilities, account #03572-20056 996.56
16. American Water -Home utilities, account #24-1620891-2 178.63
17. Verizon -Home utilities, account #717770131183586Y 1187.10
18. Suburban Propane -Home utilities, account #2028-000095837 418.96
19. Lower Allen Township -Sewer and refuse fees, account #1125340-0 103.95
20. Lower Allen Township -Property taxes, map #13-25-0008-312 892.09
REV-1512 EX+ (12-08)
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF _ _ _ - - FILE NUMBER
Susan E. Ramey 21-10-1274
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 • US Bank Credit Card -Balance on account #4623028904000643 2,407.34
2. ' FIA Visa Credit Card - Balance on account #4313077089796546 49.15
3." Alexander Building Construction -Medical /COBRA benefits expenses owed to former employer 536.00
TOTAL (Also enter on Line 10, Recapitulation) $ 2,992.49
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (O1-10)
pelnnsylvania SCHEDULE ~
DEPARTMENT OF REVENUE BENEFICIARIES
INHERTfANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Susan E. Ramey 21-10-1274
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).J
1. :John Ramey.18Mounds Road Apt#2, San Mateo, CA 94402 Son $119,757.585
2. !Mark Ramey. 574 Pinecrest Road, Woodland Park, CO 80863 Son $119,757.585
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
St. Theresa's Catholic Church, 1300 Bridge St, New Cumberland, PA 17070 500
2. ,Smile Train, 41 Madison Ave, 28th Flr, New York City, NY 10010 500
3. 'Cumberland Valley High School, 6746 Carlisle Pike, Mechanicsburg, PA 17050 300
TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # 1300.00
If more space is needed, use additional sheets of paper of the same size.
~l
OF
SUSAN E. RAMEY
I, SUSAN E. RAMEY, of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do make, publish and declare this to be my Last
V4'll and Testament, hereby revoking and making void all previous Wills and Codicils heretofore
made by me.
I declare that I am a single woman and that I presently have two (2) children whose
names and dates of birth are as .follows: JOHN PHILLIP RAMEY, born October 22, 1985 and
MARK BRYANT RAMEY, born May ~4, 1987. All references in this I.,ast Will and
Testament to my children. are references to JOHN PHILLIP RAMEY and MARK BRYANT
RAMEY, and any and all other children hereafter barn to or adopted by me, unless specifically
stated otherwise.
ARTICLE I
FUNERAL EXPENSES
i order and direct my personal representative hereinafter named to pay all of my just
debts, funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death. as reasonably possible. However, my personal representative need not
accelerate and pay those unmatured obligations which, in his ar her opinion, it might be proper
and more advantageous to retain ar .renew and pay as they become due and payable. It is my
desire that upon my death, my body will be cremated and any costs will be expended from my
estate for this purpose. I also wish to have one of my family members take my remains to be
Page 1 of 12
,~
buried in Calvary Gernetery in Mankato, Minnesota, in the plot where my father is buried.
ARTICLE II
SPECIFIC BEQUESTS
l give, devise and bequeath the following property with. all insurance proceeds (hereon as
follows:
(a) One (1) pair of diamond eamngs to my son, JOHN PHI.LLIP RAMEY.
(b) One (l) pair of diamond earrings to my son, MARK BRYANT RAMEY.
(c) The sum of Five Hundred Dollars ($500.00) to ST. THERESA'S CATHOLIC
CHURCH, New Cumberland, Pennsylvania.
(d) The sum. of Five Hundred Dollars ($500.00) to THE SMILE TRAIN, 41
Madison Avenue, 28`h Floor, New York, New York 10010.
(e) The sum of Three Hundred Dollars ($300.00) to the CUMBERLAND VALLEY
HIGH SCHOOL as a college scholarship to be distributed to a gifted student with financial
needs.
(e} In the event I do not possess the above referenced property at the time of my
death, my estate shall not be obligated to obtain these items, and all of said bequests shall. lapse.
ARTICLE III
PERSONAL PROPERTY
1. I give and l~queath my household. furnishings and tangible- personal property
identified in the most recently dated separate writing in existence at my death, which is. signed by
me and describes the items .given with reasonable certainty, to the persons specified in that
writing. It is to be conclusively presumed that l .have left no separate writing if one has not been
found by or delivered to my personal representative within thirty (30) days after my death.
Page 2 of 12
,~..~~`
2. T give all of my household furnishings and. tangible personal property not
effectively disposed of by any separate writing referred to above nor elsewhere in this Will.
(whether by omission or because I have left nn valid separate writing), in equal shares to my
children, JOHN PHILLIP .RAMEY and MARK BRYANT RAMEY, provided they survive
me by thirty (3~) days, per stirpes.
3. Any devise or bequest of personal property to my children, JOHN PHILLIP
RAMEY and MARK BRYANT RAMEY sha11 be contingent upon. the directive that my former
spouse, FHILLIP II RAMEY, his employees, successors or assigns shall at no tame have
possession, control or any rights with regard to any personal property passing to my sons, JOHN
PHILLIP RAMEY and MARK BRYANT RAMEY, under this, my Last Will and Testament.
ARTICLE IV
.RESIDUE
I give, devise and bequeath the rest, residue and remainder of my estate, whether real,
personal or mixed, of any nature whatsoever and wherever situated, in equal shares to my
children, JHHN PH.ILLIP RAMEY and MARK BRYANT RAMEY, provided they survive
me by thirty (30j days, per stirpes. It is my express intent that the portions of my estate passing
to my children, JOHN PHILLIP RAMEY and. MARK BRYANT RAM. EY, shall. be held in
trust as per Article V.
Any devise or bequest to my children, JHHN PHILLIP RAMEY and. MARK
BRYANT RAMEY, regardless of the type of property, shall be contingent. upon the directive
that my former spouse, PHILT..IP H, RAMEY, his employees, successors or assigns shall.. at no
time have possession, control or any rights with regard to any personal. property .passing.. to my
sons, JOHN PHILLIP RAMEY and MARK BRYANT RAMEY, under this, my East Wili and
Page 3 of 12 '~``
Testament.
ARTICLE V
TRUST
I appoint my son, JOHN PHILLIP RAMEY, to serve as the Trustee of this `Trust, which.
shall be held, administered and distributed as follows:
A. It is my express intent that the portions of my estate passing to my children,
JOHN PHTLLIP RAMEY and MARK BRYANT RAMEY, shall be held in trust as per this
provision. Until my children have attained the age or circumstances of full distributian as per the
distribution provisions, below, the Trustee shall pay to or apply :for the benefit of such child, so
much of the net income and so much of the principal. from his Tnist estate as the Trustee, in his
discretion, deems necessary for my children.'s support, health, maintenance and sums as needed
for the purchase of a .primary residence. Should the income be insufficient to provide such
children with adequate support, health. maintenance, or sums needed for the purchase of a
primary residence, the Trustee .may invade the principal. of the Trust for these purposes. The
trustee shall accumulate and add to principal any net income not distributed to each child. during
the year.
R. The Trustee shall accumulate and add to principal any income not distributed
during the year. The Trustee is expressly instructed to be very conservative in making
investments with. same being as safe as possible. The "Trustee shall also take all steps necessary
to ensure that my former spouse, .PHILLIP H. RAMEY, his employees, successors or assigns
shall. at na time have possession, control yr any rights with regard to any property, regardless of
the type of property, passing to my sons, JOHN PHILLIP RAMEY and MARK BRYANT
P;AMEY, under this, my Last Will and Testament.
C. It is my intent that the portions of my estate passing to my children as per this
Page 4 of 12
1~`''
Trust provision shall be distributed as follows:
i. if my son, JOHN PHILLIP RAMEY is less than Twenty-Eight (28) years old at
the time of my death, all but Twenty Thousand Dollars ($2Q,000.00) of the
portion of my estate passing to my son, JOHN PHILLIP RAMEY, shall be
distributed to him when my estate is probated. The remaining Twenty Thousand
Do.l.lars ($20,000.00) shall be held intrust as per this provision. My son, JOHN
PHTLLIP RAMEY shall be entitled to a distribution of Ten Thousand Dollars
($10,000.00) on the anniversary of my death; and the entire amount of his Trust
share shall be distributed an the second anniversary of my death, or on or about
the date he attains Twenty-Eight (28) years of age, whichever is first to occur.
2. Tf my son, MARK BRYANT RAMEY is less than Twenty-Eight (2$) years old
at the time of my death, Twenty-Five Percent (25%) of the portion of my estate
passing to my son, MARK BRYANT itA1VIEY, shall be distributed to him when
my estate is probated. Thereafter my son, MARK BRYANT RAMEY shall be
entitled. to a distribution of Thirty-Three Thousand Dollars ($33,000.00) an the
anniversary of my death each year until the entire amaunt of his Trust share is
distributed, ar on ar abaut the date he attains `T'wenty=Eight (28) years of age,
whichever is first to occur.
D. Should either of my children die prior to the termination of his Trust, the balance
of his Trust, after payment of any funeral and burial expenses shall be distributed to his surviving
issue, per stripes. If my child should die and no issue survive. him, then. the balance of the Trust
shaIl be added pro rata to the Trust. estate set aside far my other surviving. child, per stripes. If
such child should die and no issue survive him and the share of the Trust set aside for my other
child has been distributed in full, Then the Trustee shall distribute the balance to my surviving
child or to his issue, per srirpes.
Should all of my children predecease me or die prior to the termination of this Trust none
of then is survived by any issue, then the balance of the Trust estate shall be divided and
distributed to my sister, CATHERINE J. WALSER, presently of 13974 615' Avenue,
Mapelton, Minnesota, per stripes, such that any issue. shall represent and take their deceased
parent's share. Should my sister, CATHERINE J. WALSER, predecease me and leave no
surviving issue, then the balance of the Trust estate shall. be distributed to my mother, LOTS M.
n
Page 5 of 12 `~ ~
NEUBERT. Should my mother, LOIS M. NEUBERT, fail to survive me by thirty (30) days,
then the balance of the Trust estate shall be divided in equal .shares to my nieces and nephews,
JESSICA JACOBStJN, ANDREW WALSER, EMILY CALDWELL, LAURA
CUNSOLUS, ROBERT WALSER, NICHOLAS WALSER, and MEGAN WALSER, per
stirpes.
ARTICLE VI
TRi7ST PQWERS
In order to carry out the purposes of the Trust established by this Will, the Trustee, in
addition to all other powers granted by this Will or by law, shall have the following powers over
the Trust estate, subject to any limitations specified elsewhere in this Will:
i. Ta retain any property, pending distribution hereunder, to invest in or
purchase any property without restriction to legal investments for fiduciaries, to distribute
property in kind, to compromise claims, and to sell any property at public or private sale;
ii. To hold shares of stock or other securities in nominee .registration farm,
including that of a clearing corporation or depository, or in book entry form or
unregistered or in such other form as will. pass by delivery;
iii. To engage in litigation and compromises, arbitrate or abandon claims;
iv. To make distributions in cash, or in kind at current values, or partly in
each, allocating specific assets to particular distributes on a non-pro rata basis, and for
such. proposes to make reasonable determinations of current values;
v. To make elections, _decisions, concessions and. settlements in connection
with all income, estate, inheritance, gift or other tax returns and the payment of such.
taxes, without obligation to adjust the distributive share of income or principal of any
person affected hereby;
vi. To borrow money from any person including any fiduciary acting
hereunder, and to mortgage or pledge any real or personal property;
vii. To manage, control, repair and improve all estate property;
viii. To procure and carry at the expense of the estate, insurance of .the kinds,
forms and amounts deemed advisable by the Trustees to protect the estate and the
Page 6 of 1.2 G1~-`
Trustees against any hazard;
ix. To employ any attorney, investment advisor, accountant, broker, tax
specialist, or any other agent deemed necessary in the discretion of the Trustee; and to
pay from the estate reasonable compensation for all services performed by any of them;
x. To conduct alone or with others any business in which I am engaged or in
which I have an interest at my death, with all the powers of any owner with respect
thereto, to invest other property held hereunder in such business and to organize a
partnership or corporation to carry on such business;
xi. To do all the acts, to take all the proceedings, and to exercise all the rights,
power and privileges which an absolute owner of the property would have, subject
always to the discharge of it fiduciary obligations; the enumeration of certain powers in
this Will shall not limit the general or implied power of the Trustees; the Trustees shall
have all additional powers that may now or hereafter be conferned on the Trustees by law
or that may be necessary to enable the Trustee to administer the Trusts in accordance
with the provisions of this Will, subject to any limitations specified in this Will.
ARTICLE VII
ALTERNATE TRUSTEE
In the event of the death, resignation, renunciation or inability of my son, JOHN
PHILLIP RAMEY, to act as Trustee, then I appoint my sister, CATHERINE J. WALSER, in
his place and stead with the same powers, rights, discretions, obligations and immunities.
ARTICLE VIII
PERSONAL REPRESENTATIVE
A. I appoint my son, JOHN PHILLIP RAMEY and my friend, LINDA A.
CLOTFELTER, as co-personal representatives of this Will. In the event of my son, JOHN
PHILLIP RAMEY'S, death, resignation, renunciation or inability to act in that capacity, then I
appoint my sister, CATHERINE J. WALSER, as the alternate co-personal representative of
this Will in his place and stead.
B. No bond or other security shall be required of aay Personal Representative
appointed in this Will.
Page ? of 12 -J'
C. I grant my co-personal representatives the following. powers in addition to and not
in limitation of such powers as my personal representative shall hold. by law and I direct that the
act of one co-personal representative shall be sufficient to carry out an act:
(i) To retain all. property received including the stock of any corporate
fiduciary acting hereunder, provided such property remains productive.
(ii} To join in any corporation, partnership, .recapitalization, merger,
reorganization. or voting trust plan; to delegate authority with respect thereto; to deposit
investments under agreements and pay assessments.;: and. generally to exercise all rights of
investors, including but not limited to, the voting of shares.
(iii) To manage, operate, repair,. improve, .mortgage or lease on any terms any
real estate held or owned by my estate.
(iv) To operate any business that I may own at my death.
(v) To invest any fiznds of my estate in any stocks, bonds, notes or other
seccirites or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his or her absolute discretion, although my
co-personal representatives are expressly instructed. to be very conservative in making
investments with same being as safe as possible, providing such investments do not
unnecessarily prevent the prompt settlement of my estate.
(vi) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner -.and on such terms and
conditions as my personal. representative shall see fit in his or her absolute discretion.
{vii) To borrow money for the payment of taxes or for any other proper
purposes in the administration of my estate, and to mortgage or pledge estate assets as
security.
(viii) To compromise claims without court. approval including, but not limited
to, any controversies with the United States of .America or the Commonwealth. of
Pennsylvania concerning estate and inheritance taxes on any interests that may pass under
this my Last Will and Testament.
(ix) To distribute in cash or in kind upon any division. or distribution of my
estate..
(x) To undertake any and all acts deemed necessary and proper by my
personal representative far the proper, advantageous and prompt management of the
settlement of my estate.
Page 8 of 12 ~;~~£--
(xi) In general, to exercise all powers in the management of my estate which
any individual could exercise in the management of similar property owned in his own
right, upon such terms and conditions as to him or her may seem best and to execute and
deliver all instruments and to do all acts which he or she deems necessary or proper to
carry out the purposes of this, my Last Will and Testament.
ARTICLE IX
SPENDTHRIFT CLAUSE
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shalt any
beneficiary have the power in any manner to charge or encumber his or her interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any manner
while in the possession of my personal representative for the liability of such beneficiary.
ARTICLE ~
SURVIVAL
if .any pmvision of the Will or of any codicil thereto is held to be inoperative, invalid or
illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully
operative and effective so far as it is possible and reasonable..
ARTICLE XI
PAYMENT OF TAXES
All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature,
together with any interest and. penalties thereon, payable. by reason of my death and imposed
with respect to any property, whether or not disposed of by this Will, shall be paid as soon as
practicable out of the residue of my estate.
Page 9 of 12 ~'
~~~
~'~
1N WITNESS WHEREOF, I hereunto set my hand to this my Last Will. and Testament
this ;~ day of February, 2010.
WITNESSES:
SUSAN E. RAMF,Y~ tf ~
Page 10 of 12
~;,„~--
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLYANiA
COUNTY OF CUMBERLAND
SS.
I, SUSAN E. RAMEY, the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law,. do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I
signed it as my free and voluntary act for the purposes therein. expressed.
SUSAN E. RAlV1EY
Sworn or affirmed and acknowledged before me by SUSAN E. RAMEY, the testatrix
this day of February, 2014.
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~ 311VM: CtNr~tRtAND ~ N ARY PUBL
~1h- Gwnm Egsir*t Fwb i ~. 70t 7
Page 11 of 12
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY- OF CUMBERLAND
SS.
._..~...
VVE, 15~:,~.,.. and tZ~e.~ ~.c~-z't' ~~..Z ~ ~ ,the
witnesses whose names are attached to the foregoing document, being duly qualified according
to law, do depose and say that we were present and saw SUSAN E. RAMEY sign and execute
the instrument. as her Last Will and Testament; that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein expressed;, that each.. subscribing witness in
the hearing and sight of the testatrix signed the Last WiII and Testament as witnessed and that to
the best. of our knowledge the testatrix was at the time 18 or more years of age, of sound mind
and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by ~~~'~~ ~~ ~,~~ 1-~ and
^4 }
~~~ ~~`~ ~ ~~p ~ this _ fr~tr• day of February, 2010.
tMARON A p~AFfER
NoMiy h+bNo
'i~M: ~~~ NO RY PUBLIC
~-~a, spa.. E.e ~a. its
.Page 12 of 12
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LINDA A. CLOTFELTER
5021 EAST TRINDLE ROAD, SUITE 100
MECHANICSBURG, PENNSYLVANIA 17050
telephone (71 X796-1930
August 9, 2011
Bureau of Individual Taxes
Inheritance Tax Division
Dept. 280601
Harrisburg, PA 17128-0601
facximile (71 X796-1933
REc Susan E. Ramey Estate
Decedent's Last Address:
1292 Summit View Court
New Cumberland, PA 17070
Date of Death: December 17, 2010
Social Security Number: 477-54-5741
Estate EIN: 27-6992499 PA No. 21-10-1274 Cumberland County
Deaz Agent:
Please be advised that the undersigned represents the Susan E. Ramey Estate, referenced
above. As you can see from the date of death the Pennsylvania Inheritance Tax Return is due
August 17, 2011. We are writing at this time to request an extension of time to file the
Pennsylvania Inheritance Tax Return. Although the accounting of the Estate is almost complete,
there is some outstanding information needed in order to finalize the Inheritance Tax Return.
Furthermore, due to travel obligations the executor is unavailable to execute the return within the
appropriate time limitations. Thus, an extension is needed. We truly hope to have the return
prepared in the very neaz future. Additionally, please be advised that the Estate has made a pre-
payment of Seven Thousand Dollars and No Cents ($7,000.00).
Please let us know if this written request is deficient in any way to formally request an
extension of time to request an extension of time to file the Inheritance Tax Return in this Estate.
Also, we will gladly provide you with any additional information you may need pending the
filing of the tax return. We look forward to hearing from you regazding this matter.
Very truly yours,
.~
r ~ ~
~inda A. Clotfelter, Esquire
`~..
Cc: John P. Ramey, Executor (via email only)
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~ « ~` ~ A. Settlement Statement (HUD-1)
Gq~N 0lJ4g~
B. Type of Loan
OMB Approval No. 2502-0265
1.O FHA 2. Q RHS 3. OX Conv. Unins.
4. Q VA 5. Q Conv. Ins. 6. File Number:
FREAR 7. Loan Number.
7700348525 8. Mortgage Insurance Case Number.
C. Note: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked (p.o.c.)"~n3 paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name and Address of Borrower. ~
Susan J. Frear
1222 Edinburg Circe
New Cumberland, PA 17070 E. Name and Address of Seller:
John P. Ramey, Executor
of the Estate of Susan E. Ramey F. Name and Address of Lender:
MNET MORTGAGE CORP
805 ESTELLE DRIVE, STE 201
LANCASTER, PA 17601
G. Property Location:
1292 Summitview Court
New Cumberland, PA 17070
Lower Allen Twp, Cumberland Co. H. Settlement Agent: 23-2402316
PURITY ABSTRACT COMPANY
3329 MARKET STREET
CAMP HILL PA 17011 Ph. (717)737-8359 I. Settlement Date:
July 29, 2011
Place of Settlement:
3329 MARKET STREET
CAMP HILL PA 17011
J. Summary of Borrower's transaction K. Summary of Sellers transactlon
100. Gross Amount Due from Borrower: 400. Gross Amount Due~to Salter.
101. Contrail sales -rice 174 500.00 401. Contrail sales rice 174,500.00
102. Personal ro 402. Personal ro
103. Settlement Cha es to Borrower Line 1400 5,986.34 403.
104. 404.
105. 405.
Ad uatments for items id Seller in advance Ad ustments for items id Seller in advance
106. COUNTYlTOWNSHIP 07/29/11 to 01/01!12 293.73 406. COUNTYITOWNSHIP 0729/11 to 01/01/12 293.73
107. CITY TAX to 407. CITY TAX to
108. SCHOOL TAX to 408. SCHOOL TAX to
109. 3RD QTR SEWER/REFUSE 0729/11 to 10/01!11 72.31 409. 3RD QTR SEWERIREFUSE 0729/11 to 10/01/11 72.31
110. 410.
111. 411.
112. 412.
120. Gross AmounfDue from Borrower 180,852.38 420. Gross Amount Due to Seller 174,866.04
200. Amounts Psid Or In Behalf of Borrower BOO. Reductions in Amount Due Seller.
201..Oe sit or earnest none 1,000.00 501. Excess de sit see instructions
202. Princi al amount of new loans 139,600.00 502. Settlement cha es to Boller Line 1400 16,185.84
203. Existin loans taken sub ed to 503. Exiatin loans taken sub eilto
204. BORROWER'S DEPOSIT W! LENDER 400.00 504. Payoff First Mort a e
205. 505. Pa ff Second Mo a e
206. 506.
207. 507. De osit diet. as roceeds
208. 508.
209. SELLER ASSIST " 5,300.00 509. SELLER ASSIST "` 5 300.00
Ad ustments for items un id Seller Ad ustments for items un id b Seller
210. COUNTY/TOWNSHIP to 510. COUNTY/TOWNSHIP to
211. CITY TAX to 511. CITY TAX to
212. SCHOOL TAX 07/01/11 to 0729111 107.09 512. SCHOOL TAX 07/01/11 to 0729/11 107.09
213. 513.
214. 514.
215. 515.
216. 516.
217. 517. DOOR REPAIR to RMF PROPERTY SERVICES 50.00
218. 518. A!C INSP to PAUL SHERIDAN 267.00
219. 519.
220. Total Paid Ifor Borrower ~ 146,407.09 520. Total Reduction Amount Due Seller 21,909.93
300. Cash at Settlement from/to Borrower 800. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120 ` 180 852.38 601. Gross amount due to Seiler line 420 174 866.04
302. less amount aid b/for Borrower Iind 220 ( 146,407.09 602. Less reductions due Seiler (line 520 ( 21,909.93)
303. Cash ~ From ~ To Borrower 34,445.29 603. Cash a To ~ From Seller 152,956.11
L_ Settlement Chases
700. Total Resl Estatie broker Fees $ 10,230.00 said From Paid From
Division of commission (line 700) as follows: 6«ro~uera SeNds
701. 5 115.00 to Cantu 21 Piscioneri Rea Inc Funds ~ Funds at
702. 5 115.00 to Remax Real Associa es ~
703. Commission aid at settlement 10 230.00
704. BROKER FEE to REMAX REALTY ASSOCIATES 195.00
705.
706. ADD'L COMMISSION to CENTURY 21 PISCIONERI REALTY, INC. 295.00
707.
708.
709.
710.
711.
712.
800. Items Pa able in Connection with Loan
801. Our or ination cha e $ 895.00 from GFE #1
802. Your credit or charge (points).for the specific interest rate chosen $ -1,000.00 (from GFE #2)
803. Your adjusted origination charges from GFE #A -105.
804. sisal fee to KOPPENHAVER APPRAISALS from GFE #3 "" 395.
805. Credit Re ort to KROLL FACTUAL DATA from GFE #3 61.03
806. Tax service to (from GFE #3)
807. Flood certification to LPS NATIONAL FLOOD (from GFE #3) 10.
808. FNMA LQI Update to KROLL FACTUAL DATA (from GFE #3) '` 11.51
809. (from FE #3)
810. (from GFE #3)
811. (from GFE #3
900. Items R wired Lender to Be Paid in Advanee
901. Daily interest charges from 07/29/11 to 08/01/11 3 ~ $18.170000/da (from GFE #10) "` 54.51
902. Mo a e insurance n3mium for months to from GFE #3
903. Homeowners insurance or 1.0 are to STATE FARM INS from FE #11 1 POCK
904. from GFE #11
905. (from GFE #11)
1000. Reserves De ited wkh Lender
1001. Infial deposk for your escrow account
omeowne s insurance mon s per mon (from GFE #9) 414,!4
1003. Mo a a insurance months $ er month $
1004. Property taxes $
COUNTY TAX months ~ $ per month
CITY TAX months (~ $ per month
SCHOOL TAX months ~ per month
1005. $
Citylfown Taxes months (~ $ per month
Assessments months $ per month
1006. COUNTYlTWP TAX 6.000 months ~ $ 56.15 per month $ 336.90
1007. SCHOOL TAX 2.000 months ~ $ 114.32 per month $ 228.64
1008. $
1009. AGGREGATE ADJUSTMENT $ -261.35 "`
1100. Title Cha ea _
1101. Title services and lender's tkle insurance ( m P.11-133 .1,319.88
1102. Settlement or Gosin fee $
1103. Owners title insurance to FIRST AMERICAN TITLE INS. CO. from GFE #5 REISSUE 1 .50 _
1104: Lenders title insurance to FIRST AMERICAN TITLE INS. CO. 1,152.88
1105. Lenders title oli limit $ 139 600.00 5011342-003003
1106. Owners title oli limk $ 174,500.00 5011442-002207
1107. A ant's rtion of the total title insurance remium to PURITY ABSTRACT COMPANY $ 1,113.$2
1108. Underwriters rtion of the total title insurance remium to FIRST AMERICAN TITLE INS. CO. $ 196.58
1109. ATTORNEY'S FEES to ATTORNEY LINDA A. CLOTFELTER 3,270.52
1110. lax Cert fee- to PURITY ABSTRACT COMPANY 10.00
1111. 2011 SCHO L TAX to BONNIE K. MILLER, TR SURER 1,371.79
1112.
1113.
1114. RESALE CERT FEE to PMI 150.00
1115.
1116.
1117.
1118.
~ 1200. Government Recording and Transfer Charges
~ 1202. Deed $ 62.00 Mortgage $ 84.00 Releases $ Other $
19nR Tran¢for Mvo¢ to RFr'f1R11FR r1F r1FFr1R lfrnm C;FF itRl 1.74$.00
ADDENDUM TO SETTLEMENT STATEMENT (HUD-1)
(1292 Summitview Court, New Cumberland, PA 17070 )
The following is a breakdown of Seller credit of $5,300.00
ORIGINATION FEE 895.00
APPRAISAL 395.00
CREDIT REPORT 61.03
FLOOD CERT 10.00
FNMA LQI UPDATE 11.51
INTEREST 54.51
INITIAL DEPOSIT OF ESCROW ACCOUNT 414.44
TITLE INSURANCE 1319.88
OWNER'S TITLE INSURANCE (PARTIAL) 157.50
RECORDING FEE 146.00
TRANSFER TAX 1745.00
HOA INITIATION FEE (PARTIAL) 90.13
TOTAL: 5300.00
SUSAN 1. FR R
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ES ATE OF SUSAN E. RAMEY
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3801 Paxton Street
Harrisburg • PA • 17111
mymetrobank.com
888.937.0004
April 19, 2011
Linda A Clotfelter
5021 East Trindle Rd Ste 100
Mechanicsburg, Pa 17050
RE: Estate of: Susan E Ramey
Tax Identification Number: 477545741
Date of Death: December 17, 2010
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the individual listed
above. We are able to provide the following:
Account Type: Checking
Account Number: 536788318
Date Opened: 08/30/2004
Primary Owner:. Susan E Ramey
Date of Death Balance: $3,514.84
Account Type: Checking
Account Number: 833112151
Date Opened: 09/30/2009
Date Closed: 12/22/2010
Primary Owner: Susan E Ramey
Date of Death Balance: $2,872.31
Account Type: Savings
Account Number: 627048705
Date Opened: 02/12/2009
Date Closed: 01/31/2011
Primary Owner: Susan E Ramey
Date of Death Balance: $125.37
Please feel free to contact me at (717) 412-6126 if I may be of further assistance.
Si rely,
amela Li t
Savings/CIF A ciat
Metro Bank
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04/19/2011 TUS 12:25 FAB 6109415525 Shoemaker Construction X002/006
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AL ANDER
Building Construction Co.
April 19, 2011
Linda A. Clotfelter, Esquire
5021 East Trindle Road, Suite 100
Mechanicsburg, PA 17050
Re: Susan E. Ramey
Dear Linda:
It was nice speaking with you #oday. Below is the information you requested in regard to Susan
Ramey.
Fidelity 401 k account balance on 12/17/2010=$17,116.30 (see attached statement)
Life insurance policy issued by BCS Life Insurance Company, Policy #8858, value on
12/17/2010=$25, 026. J7.
:~
Long Tenn Disability Policy issued by UNUM Life Insurance Company of America,-Policy -
#302965-0001 (value on 12/17/2010), lump sum survivor benefit paid to Mark Ramey ii7'the~ ' ~ ~ . •
amount of $6,995.04. In addition to the lump sum survivor benefit, Mark will receive a montftly ~ - •=
benefit payable for two years. The amount is $629.12/month which is payable from 12/17/2011) -
unti112/16/2012.
If any further information is needed, please do not hesitate to contact me.
Sincerely,
Alexander Building Construction Co.
a~
Christina J. Le ox
Human Resouces Manager
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31S Vaughn Street • Flarrisburf;, PA 77170
Phone: 777-"2'34-7041 • fax: 717-234-1527
www.alexanderhuikling.iµ om
New England Financial
A Subsidiary of Metropolitan Life Insurance Company
One Financial Center-21~ Floor
Boston, MA 02111
(617) 578-3724 (Phone) (617) 261-9823 (Fax)
mmcdevitt@metlife.com
Maureen A. McDevitt
Field Benefits Administration
September 6, 2011
John Ramey
1292 Summitview Ct
New Cumberland, PA 17070-2233
Dear John:
We extend our sympathy to you and your family at this time on the death of your
mother, Susan. This letter is to provide you with the information on the benefits
your mother was entitled to as a QDRO recipient.
Agents' Retirement Plan:
As of August 29, 2011 the balance in the account is $84,436.27 and Mark B
Ramey & John P Ramey -Sons -Equal Shares are the named beneficiaries
under the plan.
Agency Employees Retirement Plan:
Susan would have participated in this plan at age 65. There is no benefit
remaining under this plan.
Enclosed are instructions and the form for the benefit listed above. Please return
this form directly to me with the enclosed label.
If you have any questions, please feel free to contact me directly at
(617) 578-3724.
Sincerely,
Maureen A. McDevitt
Field Benefits Administration
Enclosures
mbank.
FIe~Perks.
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January Statement for activity from Dec. 21, 2010 through Jan. 19, 2011
SUSAN E RAMEY
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Activity Summary
Previous Balance .................... $1,441.60
Payments ................................. $857.34CR
Other Credits ........................... $55.30cR
Purchases ................................ $120.91
Balance Transfers ................... $0.00
Advances ................................ $0.00
Other Debits ....:....................... $857.34
Past Due Amount .................... $35.00
Fees Charged :........................ $35.00
Interest Charged .................... $7.79
ew aiance ..........:................ 1, 50.00
Revolving Line of Credit......... $24,500.00
,Revolving Line Available........ $22,950.00
Statement Close Date ............. Jan. 19, 2011
Days in Billing Cycle ............... 30
. atc~- ~~~~'
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Inquiries: 1-877-978-7446
sNK s 12 Page 1 of 3
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Payment Information
New Balance ........................... $1,550.00
Minimum Payment Due (Current Month) $73.00
Minimum Payment Due (Past Due) $35.00
Total New Minimum Pa
ment Due $108
00
y
.
Payment Due Date .................. Feb. 16, 2011
Late Payment Warning: if we do not receive your
minimum payment by the date listed above, you may have
to pay up to a $35.D0 Late Fee.
Minimum Payment Warnin~• If you make only the
~ minimum payment each period, you wilt pa more in
interest and it will take
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For example:
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Only the mirnmum 4 years $1,777
a ment
$47 3 years $1,726
(Savings= $51)
If you would like information. about credit counseling
services, call 866-951-1391.
To reduce or avoid paying additional tees and interest charges on your purchase balance, pay the total new balance of $1,550.00 by
02/16/11. Any cash balance or balance transfer balance will continue to accrue daily interest unfit the date your payment is received.
Continued on Next Page
_ _ _
Please detach and send coupon with check payab/e fo: U.S. Bank
embank.
To change your address or for
Cardmember Service please call:
1-877-978-7446 Every Hour! Every Day!
000098302 1 AB 0.360 106481925184840 P
01462302890400064300D0108000001550005
SUSAN E RAMEY
1292 SUMMITVIEW CT
NEW CUMBERLND PA 17070-2233
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Your Account Number: 4623 0289 0400 0643
Total New Balance: ~ $1,550.00
Mlntrnurn Payment Due: $108.00
Feb. 16, 2011
U.S. Bank
P.O. Box 790408
St. Louis, MO 63179-0408
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VISA~GNATURE
SUSAN E RAMEY
Account Number: 4313 0770 8914 8060
January 16 -February 15, 2011
Fidelity Investments.
Investment Rewards
Account Information:
wwav.i'iacardservices.com
Mail billing inquiries to:
F1A Card Services
P.O. Box ].5026
Wilmington, DE 19850.5026
Meil payments to:
FIA Card Services
P.O. Box 15019
Wilmington, DE 19886-5019
Customer Service:
1.800.342.2309
(1.800.346.3178 TTY)
New Balance Total ..........................................................................$49.15
Current Payment Due ......................................................................$15.00
Past Due Amount ............................................................................$23.91
Total Minimum Payment Due ............................................................$38.91
Payment: Due Date ........................................................................3/14/11
Late Payment Waming: If we do not receive your Total Minimum Payment by
the date listed above, you may have to pay a late fee of up to $35.00.
Total MiAimum Payment Waming: If you make only the Total Minimum
Payment each period, you will pay more in interest and it will take you longer
to pay off your balance. For example:
.Only the Total I 2 months I $49.70
Minir~ium Payment
ff you would like information about credit counseling services, call
1-866-3005238.
Previous Balance .............................S54.60
Payments and Other Credits ..................-6.09
Purchases and Adjustments ....................0.00
Fees Charged ....................................................0.00
Interest Charged ...............................................0.64
New Balance Total .............................$49.15
Credit Line ......:...........................$20,000.00
Statement Closing Date ...................2/15/11
Days in Billing Cycle ..................................31
Tinnsec0iorr
~~ Postir>~
~~ De~P~A Reference Account
Number Number Amount
Toml
Payments and Other Credits
01/25 01/25 INTEREST CHARGE ERROR CORRECTION 9738 -5.36
01/25 01/25 INTEREST CHARGE ERROR CORRECTION 9739 -0.73
-$6.09
Interest Charged
02/15 02/15 Interest Charged on Balance Transfers O,Op
02/15 02/15 Interest Charged on Cash Advances p,00
continued oil neM page...
14 OOD04915000038910002835800D4313077089148060
FIA CARD SERVICES Account Number: 4313 0770 8914 8060
P.O. BOX 15019
WILMINGTON, DE 19886-5019
i~~~ir~i~~ill~'111~~~'~I~~II~~I"illl~lll'llll'I~~~Ill~ll~~i~l~ New Balance Total $49.15
...............................................................
Total Minimum Payment Due ................................................. 38.91
Payment Due Date ...................................................03/14/11
SS 0218 VT 664 628 1 07065 ti601 AT 0.357
SUSAN E RAMEY Enter payment amount
1292 SUMMITVIEW CT
NEW CUMBERLAND PA 17070-7233
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FAMILY SETTLEMENT AND FINAL RELEASE
IN THE
ESTATE OF SUSAN E. RAMEY
KNOW ALL MEN BY THESE PRESENTS, THAT WHEREAS, Susan E. Ramey,
late of Lower Allen Township, Cumberland County, Pennsylvania, deceased, died on December
17, 2010, testate.
WHEREAS, Letters Testamentary were granted to John P. Ramey, on December 29,
2010, with same having been filed in Cumberland County, Pennsylvania, to Estate No. 21-10-
1274;
WHEREAS, the said personal representative has gathered the assets of the estate of the
said decedent and the assets consist of personal property to a total value of $182,644.89, as set
forth in Exhibit "A", which is a statement of account of the said personal representative, and
which is attached hereto and made a part hereof, and marked Exhibit "A' ;
WHEREAS, the debts and deductions amount to $53,191.18, leaving a balance for
distribution of $129,453.71, also as set forth in the statement of the said personal representative,
which is attached hereto and made a part hereof, and marked Exhibit "B' ;
NOW THEREFORE, KNOW YE, that we, John P. Ramey, Mark B. Ramey, and
authorized agents of St. Theresa's Catholic Church, The Smile Train, and Cumberland Valley
High School, being the heirs of the said decedent, and being the individuals entitled to inherit
under the Last Will and Testament, do hereby acknowledge that we have this day had and
received from the aforesaid personal representative, in full satisfaction and payment of all sum or
sums of money, legacies, bequests, and devises as are given, devised and bequeathed to us by the
said Last Will and Testament, which amount we have received this day, and which is the amount
set opposite our names in the table and schedule of distribution in said statement attached hereto
and marked Exhibit "C' ;
AND, we do hereby stipulate that in order to avoid the expense and time involved in the
filing of a formal account and schedule of distribution, we agree that no account is necessary and
we hereby agree and consent to distribution being made without the filing of an account and
schedule of distribution, the same to be with the same force and effect as if it had been filed and
confirmed by the Orphan's Court Division of the. Court of Common Pleas of Cumberland
County.
THEREFORE, we do hereby remise, release, quitclaim and forever dischazge the said
personal representatives, their heirs, executors, administrators and assigns, of and from the said
estate and from all actions, suits, payments, accounts, reckonings, claims and demands
whatsoever, touching upon the estate of said decedent, and we do further hereby covenant and
agree that we will contribute my shaze of the estate to satisfy any and all claims, demands, suits,
or causes of action which may be successfully prosecuted against the said estate or the aforesaid
personal representatives after the signing, sealing and delivery of this family settlement
agreement and final release.
IN WITNESS WHEREOF, we have hereunto set my hand and seal this 8th day of
December, 20I I.
\l7iTATCC~ r i w ~rrr. c•m_
JO . RAMEY
MARK B. RAMEY
ST. THERESA'S CATHOLIC CHURCH
THE SMILE TRAIN
By.
CUMBERLAND VALLEY HIGH SCHOOL
f+0 D
i~ ~~
LAST AND FINAL ACCOUNT OF THE
ESTATE OF SUSAN E. RAMEY,
LATE OF LOWER ALLEN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA
DATE OF DEATH: DECEMBER 17, 2010
PRINCIPAL ACCOUNT
DEBITS:
Your Accountants charge themselves with the following:
Real Property
Residential Real Estate
A. 1292 Summit View Court
New Cumberland, PA 17070
Personal Property
Checking Account -Metro Bank
B• Account No. 536788318
Date of death value: $3,514.84
Savings Account -Metro Bank
C• Account No. 627048705
Date of death value $125.37
D.
Toyota Rav4 vehicle sold to Bobby Rahal Toyota
E• Interested accrued on Estate balance
Checking Account -Chase Bank
Account No. 944325323
TOTAL PRINCIPAL DEBITS:
$ l 74,500.00
$ 3,514.84
$ 125.37
$ 4,500.00
$ 4.68
$182,644.89
EXHIBIT A
CREDITS
Your Accountants ask credit for payments made from Principal Account as follows:
Description Amount
1. Pazthemore Funeral Home -Funeral Expenses $2,480.47
2. Mankato Mortuary -Funeral Expenses $4 531.37
3. Sale of Real Property Fees -Agents fees, buyer credits, etc. $21,909.93
4. Appraisal Solutions -Real Estate appraisal $300.00
5. Property Management Inc - HOA $902.38
6. Jeffrey Updegraff-CPA $350.00
7. United Pazcel Service -Shipping and notary fees $949.87
8. Delta Airlines -Executor travel $1,353.80
9. Shearer Security Devices -Property repair $159.00
10. Tim Snow -Plumbing repair $195.00
11. Traveler's Insurance -Property insurance $340.00
12. Alexander Building Construction -Benefits back payment debts $536.00
13. US Bank -Credit cazd back payment debts $2,407.34
14. FIA Visa -Credit card back payment debts $49.15
15. Comcast -Property utilities $373.40
16. Penn Power & Light -Property Utilities $996.56
17. American Water -Property Utilities $178.63
18. Verizon -Property Utilities $1,187.10
19. Suburban Propane -Property Utilities $418.96
20. Lower Allen Township Taxes $892.09
21. Lower Allen Township -Sewer & trash utilities $103.95
22. Metro Bank -Fee to open safe deposit box $150.00
23. Register of Will, Agent -Pennsylvania Inheritance Tax $10,778.19
24. Probate fees $405.30
25. Law Firm of Linda A. Clotfelter -Estate administration $992.69
26. Law Firm of Trucker Huss -Estate counsel $100.00
TOTAL: $53,191.18
EXHIBIT B
RECAPITULATION
Principal Debits $ 182,644.89
Minus: (A) Administrative Expenses ($49,842.60)
(B) Last Debts of Decedent 3 348.58
SUBTOTAL: ($53.191.18)
Minus specific bequest of personal property
TOTAL BALANCE OF CASH ESTATE $ 129,453.71
ASSETS AVAILABLE FOR
DISTRIBUTION
NON-PROBATE AND JOINT PROPERTY
Description Treatment
A. Checking Account -Metro Bank By operation of law, decedent's
Account number 833112151 ownership interest passed to
Date of death value $2,872.31 named beneficiaries on date of death
FBO account naming
John P. Ramey and Mark B. Ramey
B. Fidelity 401k Retirement Plan By operation of law, decedent's
Account Z19-263168 ownership interest passed to
Date of death value $17,116.30 named beneficiaries on date of death
Naming beneficiaries John P. Ramey
and Mark B. Ramey
C. New England Financial Retirement Plan By operation of law, decedent's
Plan 385006-01 ownership interest passed to
Date of death value $82,048.30 named beneficiaries on date of death
Naming beneficiaries John P. Ramey
and Mark B. Ramey
EXHIBIT B
PROPOSED DISTRIBUTION
The Personal Representative proposes distribution of the Total Balance for Distribution to the
following heir as described:
l . Check donation to Smile Train $500
2. Check donation to St. Theresa's Church $500
3. Check donation to Cumberland Valley High School $300
4. Distributions to son John Ramey as instructed by Decedent $64,076.85
5. Distributions to son Mark Ramey as instructed by Decedent $64,076.86
TOTAL DISTRIBUTED $ 129,453.71
EXHIBIT C
04/19/2011 TUS 12:25 Fi'-R 6109415525 Shoemaker Coastructioa
X003/006
Page 1 of 4
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SHOEI~AAKER & ALEXANDER COMPANIES
A01(K) PLAN
SUSAN RAMEY
1292 SUMMIT VIEYV COURT
NEW CUMBERLAND, PA 17070-
Your Account Summary
Beginning Balance
Change in Market Value
Ending Balance
Additional information
Vested Balance
Dividends & Interest
Your Personal Rate of Return
This Period
Retirement Savings Statement
'Q Customer Service: (800) 835-5097
Fideifty Investments Institutional
Operations Company, Inc.
82 Devonshire Street
Boston, MA 02109
Statement Period: 12/17/2010 to 12/17/2010
;17,032.66
$83.64
;17,115.30
$17,116.30
$58.27
0.5%
Your Personal Rate of Return is calculated with atime-weighted formula, widely used by finanaat
analysts to calculate investment earnings. It reflects the resutts of your investment selections as
wet! as any activity in the plan account(s) shown. There are other Personal Rate of Return
formulas used that may yield different results. Remember that past performance is no guarantee
of future results.
Your Asset Allocation
Statement Period: 12/27/2010 to 12!17/2010
https://plansponsorservices300.fidelity.com/plansponsor/sponsor/online statement detail.do 4/19/2011
Cert%ftcate of A:ctcn,owted~ein~nt
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personally appeared Y K~
whop ved to cne on the basis of satisfactory evid to be the ~ etso whose nam~
is/ subscribed to the withia instxument and acknowledg m that h~JskQirey.
executed the s ~ e ici.hisl~~:~authorized capacity ~, and~t~tat bye his(h cr
signatus on the iFtstrumeAt the person~Qr entity upon behal~of which the perso~
acted, executed the iustr~ztx~ent. //
I certify ender the PEAIAL'TSC OF P~ER.IURY under the taws of tfi~ State of California
that the foregwing. paragraph is true and correct.
WITNESS 1~ HAND ~~~ OFEICIA_L SEAL.
Signature ~/~~ ~M - ~----- ~ - SHRt1T BHALLA ~~
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On this ~~~ day of ( ~k.1 e ~ 20 1 ~~ before me, the
undersigned officer, personally appeared -1 ,known to me (or
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On this day of 20_, before me, the
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and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public (SEAL)
STATE OF ~~ ,
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On this Z 3 day of T~~a~..16~/ 20!/, before me, the
undersigned officer, personally appeared _~d~N ,~~ ~~/~~s ~. ,known to me (or
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On this ~ day of (~u~cv.~L~ 20 tt , before me, the
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NOTARY PI~lIC-5'rATE aF NEW YORK
No. OiTW6234288
QualHied In Queers CaiMy .~
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STATE OF
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On this day of 20_, before me, the
undersigned officer, personally appeared ,known to me (or
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On this ia~^ day of ~ec~mb~_rr 20 ii, before me, the
undersigned officer, personally appeared fh~chae i 17 i e FFenbach ,known to me (or
satisfactorily proven) to be the individual whose name is subscribed to the foregoing instrument,
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IN WITNESS WHEREOF, I hereunto set my hand and official seal.
co~oNwr-are of P~rwsnvnNa
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STATE OF
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On this day of 20_, before me, the
undersigned officer, personally appeared ,known to me (or
satisfactorily proven) to be the individual whose name is subscribed to the foregoing instrument,
and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public (SEAL)
1300 Bridge Street
New Cumberland, PA 17070
(717)-774-5918
Fag (717) 774-5915
February 14, 2011
John P. Ramey
270 East Lane #2
Burlingame, Ca. 94010
Deaz John,
Thank you so much for the contribution of $500.000 to the Memorial Fund of St.
Theresa Parish in memory of Susan E. Ramey.
It will be placed in the Memorial Book located in the Narthex of the Church.
Sincerely,
ev. J. Michael McFadden
Pastor
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BETHESDAMLSS[ON
Ms. Susan Ramey
1292 Summit View Ct
new Cumberland, PA 17070
Dear Ms. Ramey,
January 12, 2011
Men's Shelter
Women and Children's Shelter
Youth Center
Medical Clinic
Mobile Street Ministry
Outreach Ministries
Thank you for your 12/23/2010 gift of food and other assorted items to Bethesda
Mission.
The thoughtful generosity expressed by your gift is making it possible for us to
feed, clothe and shelter our homeless and hungry neighbors during these cold days and
nights. Neighbors who would have nowhere else to go without the services your support
makes possible. You aze such a blessing to those whom we serve here at Bethesda by your
faithful prayer and financial assistance!
For all that you mean to those we serve, and for all that you mean to the boazd,
staff, and volunteers at the Mission, we're deeply grateful. Thank you, dear friend, for
your partnership with us and we look forward to your continued support.
May God bless you and yours in this New Year!
Working Till He Comes,
~~~
Chuck Wingate
Executive Director
Blessed is he who is generous to the poor -Proverbs 14:216
P.O. Box 3041, Harrisburg, PA 17105-3041
tel: 717-257-4442 ~ fax: 717-257-5486 ~ email: info~vBethesdaMission.org ~ www BethesdaMission.org
Kids are full and focused.:thanks ~ to you.
Thanks to your generosity, many Central Pennsylvania
children are getting healthy after-school meals.
You're providing hope in the form of food to
thousands offamilies, individuals and seniors
in need through your gifts to the Food Bank,
Thank you for yourcornpassion
Date .~`~ ~-~ ~
Name - -_ ~~~~^~ /~~-~.t ~
Business/Organization
Address ~°2 ! ~ ~,K,~.t , ZZ y `E~'`l 1
City ~E`'`~ ~~~E~~~ State ~ Zip !7 -
Items Donated
Total Weight of Donation ~'~'Z ~°v,tJ) S
~~~s~ ~ ~
Received By
CENTRAL
PENNSYLVANIA
FOO1D BANK
Donation Receipt
CFTITRAL
PE]~il~AA
FCOD BANK
No Ona Should Ba Hungry
December 27, 2010
Susan Ramey
1292 Summit View Drive
New Cumberland, PA 17070
Dear Susan:
- - __ - -
On behalf of the many families who will benefit from your generosity, thank you for your food
donation of 252 pounds to the Central Pennsylvania Food Bank. Your support will have an
impact on many people needing food assistance.
Given the current state of the economy, everyone is feeling the pinch of rising costs.
Unfortunately many working families -oftentimes single-parent families -are finding that their
income is just not enough to make ends meet. More than ever before, many are turning to the
Food Bank and its member agencies for assistance.
Because of generous donors like you, the Central Pennsylvania Food Bank is able to distribute
approximately 1 million pounds of food and grocery products each and every month, which is
equivalent to approximately 750,000 meals. We distribute food to 550 food pantries, soup
kitchens and shelters that directly feed people who are hungry in 27 central Pennsylvania
counties.
If you would like more information about the Food Bank, contact me at 717.564.1700 or
khanna@centralpafoodbank. org.
Sincerely, ~' .~ ~ ~
~, ~o~~
~ ~ ,
Kendall Hanna
Executive Director
The official registration and financial information of the Central Pennsylvania Food Bank may be obtained from the
Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.
3908 Corey Road • Harrisburg, PA 17109-5929 717.564.1700 FAX: 717.561.4636 www.centralpafoodbank.org
A United Way Program Partner
THE SALVATION A-.RMY
RECEIPT FOR DONATED GOODS
To:
Date: `~ ~ ~ ~ ~~ 0
This evil) acknowledge, WITH THANKS, the donation of the listed articles or goods to The Sal~•ation Arm~• to assist in the
furtherance of its rehabilitation program for men and women.
i
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (MS-368) for fair
market ~•alue will be supplied on request. Contributions are deductible for income tax purposes to the extent allo~~•ed b~~ la~~.*
HARRISBURG, PA
Address of Center
Signature of Administrator
or Representati~•e
• COTE: Due to the record keeping and rtporting requirements imposed b~~ the lntemal Revenue Sen•iet.'tht Sal~~ation Artm• requests all donors..ho
will require the Salvation :~mt.• to execute a Form 8283. "\on-cash Charitable Contribution." for contribution o~•er SS.000 to present such forms fur
exeeudoe at the time of the donation. the Sal~•ation Arm~~ ~-ill' not be able to execute such forms at am' time thereafter if the donated property cannot be
traced. The Salvation .army is required to report to the Internal Re~tnue Service the sales proceeds of an}' single item for ~~hich the donor chimed a
deduction of more than 5=0~) and or ~~hen the donor has contributed more than 5'.000.
Description of Articles: ~ -
THE SALVATION ARMY
RECEIPT FOR DONATED GOODS
To:
Date: ~! '~~'~y
This will acknowledge, WITH THANKS, the donation of the listed articles or goods to The Salvation Arm~• to assist in flee
furtherance of its rehabilitation program for men and women.
Description of Articles:
Condition:
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (;v1S-36B) for fair
market value will be supplied on request. Contributions are deductible for income tax purposes to the extent allowed b.' la~~.*
BARRISBURG, PA
Address of Center
Signature dministrator
or epresentative
• \OTE: Due to the record keeping and repotting requirements imposed b.• the Internal Rt~tnut Stn•ict.'tht Salvation Arm}~ requests all donors ah.~
will require the Sal~•ation ~rrtn• to extcutt a Forth 8283. "Aon-cash Charitable Contribution." for contribution o~tr SS.000 to present such forms fur
execudot at the time of the donation. the Sal~~ation Arm~~ ~~ ill not bt able to txtcute such forms at an. time thereafter if the donated proptrt~ cannot ht
traced. Tht Salvation .~;ttt~ is required to report to the Internal Re~enut Strict the salts proceeds of am• single item for ~~hich the donor ctaimtd a
deduction of more than 5=00 and or ~~ hen the donor has contributed more than 5~.001-.
THE SALVATION A1tMY
RECEIPT FOR DONATED GOODS
To: Date: ~ °" ~•'" l ~
This will acknowledge, KITH THANKS, the donation of the listed articles or goods to The Salvation Arm~• to assist in the
furtherance of its rehabilitation program for men and women.
Description of Articles:
Condition:
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (MS-36B) for fair
market value will be supplied on request. Contributions are deductible for income tas purposes to the extent allo~~~ed b~~ la~-.'
HARRISBURG, PA
Address of Center
Sig lure dministrator
or epresentative
• \QTE: Due to the record keeping and reporting requirements imposed b~• the Internal Revenue Stn•ict. the Salvation Arm}~ requests all donors eha
will require the Sal~~ation Army to extcute a Form 8383. "\~on-cash Charitable Contribution." for contribution o~~er SS.000 to present such forms for
extcudot at the time of the donation. tht Sal~~ation Army ~~ ill not be able to execute such forms at am time thereafter if the donated property cannot be
traced. The Salvation .4rrm is requirtd to report to the Internal Rt~enue Service the sale; prorecds of an.• single item for ~~hich the donor ctsimed a
deduction of more than 5500 and or ~~ hen the donor ha; contributed more than S~.000.
THE SALVATION ARMY
RECEIPT FOR DONATED GOODS
To: Date: ~~ f ~c.~
This will acknowledge, WITH THANKS, the donation of the listed articles or goods to The Sal~•ation Army to assist in the
furtherance of its rehabilitation program for men and women.
Description of Articles:
Condition:
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (MS-36B) for fair
market ~•alue will be supplied on request. Contributions are deductible for income tax purposes to the extent allowed b~• law.*
HARRISBURG, PA
Address of Center
tg a Administrator
or Representati~•e
• `OTE: Dut to the record kteping and rtporting requirements imposed b~• the Internal Recenut Strvict.'tht Sal~~ation Arm}• request; all donors who
will require the Salvation Arm~• to extcute a Form 8283. "\on-cash Charitable Contribution." for contribution o~~er SS,000 to prtstnt such forms fur
extcudoe at the time of the donation. the Sal~•ation Arm~~ w ill not bt able to execute ;uch Corms at am' time thtrtafttr if the donated propem cannot be
traced. The Satiation .asm~ is required to rtport to the Internal Revenue Senice the sale; proceeds of am•singlt item for which the donor cl:timtd
deduction ~f more tha^ 5~0~) and or when the donor ha; contributed more [han S=.U00.
THE SALVATION ARMY
RECEIPT FOR DONATED GOODS
To:
Date: ~ ~ / U ~~
This will acknowledge, WITH THANKS, the donation of the listed articles or goods to The Sal~•ation Arrm• to assist in the
furtherance of its rehabilitation program for men and women.
Description of Articles:
Condition:
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (MS-368) for fair
market ~•alue will be supplied on request. Contributions are deductible for income tax purposes to the extent allo~~•ed b~• la~t,.*
HARRISBURG, PA
Address of Center
~~~/
Signature of Admirnstrator
or Representati~•e
• \OTE: Due to the record keeping and reporting requirements imposed b~• the Internal Revenue Sen•iee.'the Sah~ation Artnc requests all donors who
will require the Salvation :amt}• to execute a Form 8283. "\on-cash Charitable Contribution." for contribution over SS.000 to present such forms fur
execudoe at the time of tht donation. the Sal~•ation Arm~~ w ill not be ably to execute such forms at am' time thereafter if the donated property cannot be
traced. The Salvation Arm is required to rtport to the Inttmal Revenue Senice [hc sales proceeds of an}~ single item for which the donor claimed a
dedurtiun of morn than 500 and or when the donor has contributed more than S=.UOIt.
THE SALVATION ARMY
RECEII'T FOR DONATED GOODS
To: ~ 1.~~ C~ I~/Y,ti, ,i,f
Date: ~~~~~°~
This wilt acknowledge, WITH THANKS, the donation of the listed articles or goods to The Salvation Army to assist in tltz
furtherance of its rehabilitation program for men and women.
Description of Articles:
Condition:
Valuation of gifts in kind are the privilege and responsibility of the donor. A Salvation Army Valuation Guide (MS-36B) for fair
market value will be supplied on request. Contributions are deductible for income tax purposes to the extent allowed by' la..'.'
BARRISBIIRG, PA
Address of Center
' attire of Administrator
or Reprtsentativt
• \OTE: Due to the record keeping and reporting requirements imposed b~~ the Internal Rttenut Serviet.•the Saltation Arm.' requests all donors echo
will require the Saltation Arm~• to teecute a Form 8283. "\'on-cash Charitable Contribution." for contribution ot•er SS,000 to present such forms for
exeeudoe at the time of the donation. the Saltation Anm• Mill not be able to execute such forms at am' timt thereafter if the donated property cannot ba
traced. The Saltation artm~ is required to report to the Internal Rtttnue Stnice the salts proceeds of am' single item for ~thich the don~x claimed a
deduction of more than SSUc) and or ~~hen the donor ha; contributed more [han SS.000.