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HomeMy WebLinkAbout02-03-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015544 STUM SUE A 372 BURNTHOUSE ROAD CARLISLE, PA 17015 fold REMARKS: RECEIPT TO ATTY CHECK#507 SEAL ACN ASSESSMENT' AMOUNT CONTROL NUMBER REV-1162 EX111-96) TOTAL AMOUNT PAID: INITIALS: HEA RECEIVED BY: REGISTER OF WILLS S 1, 828.69 GLENDA EARNER STRASBAUGH REGISTER OF WILLS F ~ t J REV-1500 ~` I°~-~°~ PA Department of Revenue Bureau of Individual Taxes PO BOX 280801 1505610140 OFFICIAL USE ONLY INHERITANCE TAX RETURN County Code Year File Number RESIDENT DECEDENT t'- 1 1 1 0 8 2 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 1 5 9 2 4 9 1 3 B Date of Birth MMDDYYYY 0 7 1 9 2 0 1 1 0 9 0 9 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name E V E L H O C H MI L E E K (If Applicable) Entsr Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS 0 1. Original Retum ~ 2. Supplemental Return [~ 3. Remainder Retum (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of ~ ;i. Federal Estate Tax Retum Required ® 6. Decedent Died Testate death after 12-12-82) (Attach Copy of Will) ~ 7• Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes [] 9. Litigation Proceeds Received (Attach Copy of Trust) [~ 10. Spousal Poverty Credk (date of death ~ 11'. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name S U S A N ~ Daytime Telephone Number H A R T M A N 7 1 7 2 4 9 7 7 8 0 REGISTER O USE ONti- :~ First line of address ~ ~ "''i ~ r ~ ''~' O N E I R V I N E R O W --~ ~', ~~~~ r Second line of address ~ ~-; ~.~ G? ®~ ~~ =~ ~J City or Post Office]aa - `~ State ZIP Code DATE FILED G? C A R L I S L E P A 1 7 0 1 3 comespondent'se-malladdress: susan~duncanhartmanlaw.com Under penalties of PerlurY, I dedaro that 1 have examined this return, Irxiudi aocom n it is true, coned and complete. Declaration of ~ ~ Ylnfl sdiedubs and staUements, and to the hest of k SIG RE PERSO RESP SI L FOUR FeLING RETUR N I ~~ ~ ~ ~ all IMo-mation p/ yrh1~ ~ ~~~° a^d lief, preparer has any knorNedge. ,,,,,,,,,.,,,, DATE PLEASE USE ORIGINAL FORM ONLY Side 1 L 150561014D 1505610140 J REV-1500 EX (°~-~°~ PA Department of Revenue Bureau of Individual Taxes 1505610140 PO BOX 280601 INHERITANCE TAX RETURN Harrisbu PA 17128-0601 RESIDEM~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 1 5 9 2 4 9 1 3 8 D 7 1 9 2 0 1 1 Decedents Last Name Suffix E V E L H O C H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County Code Year File Number i? 1 1 1 0 8 2 1 Date of Birth MiMDDYYYY 0 9 0 9 1 9 2 1 Decedent's First Name L E E Spouse's First Name MI K MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS 1. Original Retum ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Livin Trust 1 (Attach Copy of Will) (Attach Copy of Trust) g ~B. Total Number of Safe Deposft Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name S U S A N ~ Daytime Telephone Number H A R T M A N 7 1 7 2 4 9 7 7 8 0 REGi3TER OF WILLS USE ONLY First line of address O N E I R V I N E R O W Second line of address City or Post Office State ZIP Code I~ DATE FILED I C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: s u s a n a d u n c a n h a r t m a n l a w. c o m Urxfer Penaltles of P~1~~Y. I declare that I have examined this return, inGudinp accompanying schedules and statements, and to the beat of k k is true. correct and complete. DeGaratfon of preperer otlrer than the my nowledye and belief, SIGNATURE OF RSON RES O S E R LIN RETURN peroonal representative rs based on ali infonnatlon of which preparer has any k rbwledpe. ADDRESS ~ ~ w Y~ 12703 Foll Q r. ad Ellicott Cit SIGNATU F PREPARER OTHER T REPRESENTATIVE M D 21 D 4 3 DATE SS ~ A "~jeZ. / ~ ~~ D PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 150561014D REV-1500 EX 1505610240 Decedent's Social Security Number Decedenra Name: LEE K• E V E L H O C H 1 5 9 2 4 9 1 3 8 RECAPITULATION 1. Real Estate (Schedule A) ..................................... ...... 1. 6 7 0 0 0. 0 0 2. Stocks and Bonda (Schedule B) ...... . , • , , ................... ...... 2. 3. Closet' Heki 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. 1 4 0 9 1 4 .3 4 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .. 7. Inter-Vivoa Transfers ~ Miscellaneous N Probate Property (Schedule G> ~ ... , , 8, Separate Billing Requested .. ..... 7. 8 5 7 8 3 . 1 7 8. Total Gross Assets (total Lines 1 through 7) ................. 8 2 9 3 ..... ..... . 6 9 7. 5 1 9. Funeral Expenses and Administrative Costs (Schedule H) ............. .. 9. 1 0 7 7 ... 0. 0 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ . 10 8 3 7 .... . 2. 1 2 11. Total Deductions (total Lines 9 and 10 ) .......................... . ....11. 1 9 1 4 2. 2 1 12. Net Value of Estate (Line 8 minus Line 11) . .... , , , 13. Charitabb and Governmental Bequests/Sec 9113 Trusts for which 12 2 7 4 5 5 $ . 3 D an election to tax has not been made (Schedule J) ..... , 13 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .... 1a. 2 7 4 5 5 5. 3 0 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 0 . 0 0 18. Amount of Line 14 taxable 15. 0 . 0 0 at lineal rate x .045 2 7 4 5 5 5. 3 0 17. Amount of Line 14 taxable 16• 1 2 3 5 4. 9 9 at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable 17. 0 . 0 0 at collateral rate X .15 0 . 0 0 18, 0. 0 0 19. TAX DUE ...................................................... 19. 1 2 3 5 4. 9 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 REV-500 EX Page 3 Decedent's Complete Address: LEE K. EVELHOCH 30 PARSONAGE STREET CITY NEWVILLE Tax Payments and Credits: t• Tax Due (Page 2, Line 19) 2. Credfts/Payments A. Prior Payments 10 , 0 0 0.0 0 B, Discount 526.30 3. Interest Flle Number 21 1.1 0821 STATE PA ZIP 17241 (1) 12, 354.99 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Ftll in oval on Page 2, Llne 20 to request a refund. 5. ff Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (p) 10,526.30 (3) (4) 0.0 0 (5) 1,828.69 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" fN THE APPROPRIATE B 1. Did decedent make a transfer and: LOCKS a. retain the use or income of the ro Yes No p party transferred : ........................ b. retain the right to designate who shall usethe ro ~~~~~~~~~~~~~~~~~~~~~~~""""""""' ^ c. retain a reversions mterest; or p ~~ transferred or its income; ............................... ^ ry ~ ........................... d. receive the .................................................................... ^ promise for life of either payments, benefits or care7 ....................................................... ^ 2. If death occurred after December 12 1982 did decedent transfer property within one year of death without receiving adequate consideration? .................... . . . ....................... ^ X 3. Did decedent own an 'in trust for' orpayable-upon-death bank ar:count or securit at his or her death't ^ 4. Did decedent own an individual retirement account, annuity or other non-probate y which ^ contains a beneficiary designation? ..........................................................~~ ................................. o ^ 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 th 3 percent [72 P.S. §9116 (a) (1.1) (i)]. a use of the surviving spouse is 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)). 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 beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) p2 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+ (OJ-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE C~ I A I t UF: L E E K. E V E L H O C H FILE NUMBER: al real 2 ~ 11 0 8 21 property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable know) at ~~ Property Real property that is Jointly-owned y~ right of survhrorship must be disck»ed on Schedule F. ~ ~ the relevant facts, ITEM Attach a Dopy of the settlement sheet if the property has been mod, NUMBER indude a copy of the deed showing decedent's interest If owned as tenant in common. VALUE AT DATE DESCRIPTION OF DEATH 1• 30 PARSONAGE STREET NEWVILLE, PA 17241 67,DDD•OD [SEE HUD SHEET ATTACHED] TOTAL (Also enter on Line 1, Recapitulation) I S 6 7, 0 0 0 0 0 If ngre space a needed use addldonal sheet's of Paper of the same size. REV-1508 EX + (8-98) COMMONWEALTH OF PENNSYLVANUI INHERITANCE TAX RETURN RESIDENT DECEDENT :STATE OF _EE K. EVELHOCH SCHED~/LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 2 ITEM Include me pmoeeds of liugatbn and the Gate the C ~' 1 ~ Pr'o Jo ~ownrad wMh M of:unhron were received ~ ~ • iP must bra dhtcioad on &haduN F. NUMBER ~• PROCEEDS [SEE DOD OF F8M CHECKING ACCOUNT # 33-25849 LETTER ATTACHED] 2• PROCEEDS OF F8M C.D. # 015-2983274 [SEE DOD LETTER ATTACHED] 3• PROCEEDS OF F8M C•D. # 015-2991710 [SEE DOD LETTER ATTACHED] 4• PROCEEDS [SEE DOD OF F8M LETTER C.D. # 015-2991740 ATTACHED] 5• PROCEEDS [SEE DOD OF F8M LETTER C.D. # 015-2997403 ATTACHED] 6• PROCEEDS [SEE DOD OF MEMBERS FIRST SAVING ACCT. # 265173-00 LETTER ATTACHED] 7• PROCEEDS [SEE DOD OF MEMB LETTER ERS FIRST C.D. # 265173-43 ATTACHED] 8• AMERICAN LEGION DEATH BENEFIT 9• FAILOR-WAGN ER POST 421 DEATH BENEFIT 1D. WASTE MANAGEMENT REFUND 11. COMCAST REFUND 12. CUMBERLAND COUNTY BURIAL BENEFIT 13. LEE PROCUREMENT SOLUTIONS REFUND 14. PROCEEDS FROM SALE OF 1995 CHEVROLET 15. LIBERTY MUTUAL REFUND 16. PATRIOT NEWS REFUND VALUE AT DATE OF DEATH 16,556. 20,016.80 50,100.36 30,063.76 20,024.55 40.00 636.56 100.00 100.00 54.03 45.89 100.00 110.66 500.00 446.OD 41.40 TOTAL (Also enter nn lino G ce,..,..:...~_.:__, I _ (If more space is needed, insert additlonal sheet of the same sine) ,?u~ • OJJ Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEE K. EVELHOCH Decedent's Name Page ~ 21 11 0821 File Number Schedule E -Cash, Bank Deposits, b Misc. Personal Property ITEM NUMBER DESCRIPTION 1?• INSURANCE REFUND 18- COUNTY TAXES CREDIT [SEE HUD SHEET ATTACHED] 19- SCHOOL TAXES CREDIT [SEE HUD SHEET ATTACHED] 20- NET PROCEEDS OF ROWE'S AUCTION [SEE ATTACHED] VALUE AT DATE OF DEATH 408. 66.96 993.85 508.73 SUBTOTAL SCHEDULE E 1, 9 7 7. 5 4 GRAND TOTAL SCHEDULE E S 140,914.34 REV-1510 EX+ {48-09; - _ - pennsylvania SCHEDULE G DEPnRTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAx RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF LEE K• EVELHOCH FILE NUMBER 21 11 0821 This schedule must be completed and filed i(the answer to any of questions t through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER ~~~~ ~ ~~ ~ T1,E ~~ T-+eR RELATIpr$-yP TO DECEDENT Mp DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE OF ASSET INTEREST ~,wa,~ VALUE ~. PRUDENTIAL E~ MPLOYEE 401KSAVINGS PLAN ACCT• #30006549138 45,467.67:L00.00 45,467.67 2• PRUDENTIAL IRA ACCT• #7000104818 38,355.93:~OD•00 38,355.93 3• PRUDENTIAL MERGED RETIREMENT PLAN BENEFIT 1,959.57],00.00 1,959.57 TOTAL Also enter on Line 7, R ' ulafion s If more space is needed, use additional sheet ~ paper of the same sine. 8 5 , 7 8 3 • 1 REV-1511 FJ(+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS E K• EVELHO ~ecedarc'= debts must be reporbd on ScMduN I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: ~. AUER CREMATION SERVICES 2• PASTOR 3• CHURCH AUXILARY - FOOD 8 DONATION 4• LUNCHEON 5• WESTMINISTER CEMETERY 1 AMOUNT B• ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Sheet Address Cdy State _ ZIP Year(s) Conxnbsion Paid: 2. AttomeyFees: DUNCAN & HARTMAN, PC 3. Famiy Exempifon: (It decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State _ ZIP Relationship of Claimant m Decedent 4• Probate Fees: REGISTER OF WILLS 30.00 200.00 350.00 58.00 455.00 9,000.00 323.50 5• Acoour>tant Fees: 6• Tax Realm Preparer Fees: ~• VALLEY STAR TIMES OBITUARY 8• THE EVENING SENTIEL OBITUARY 9• CUMBERLAND LAW JOURNAL - LEGAL NOTICE 10• THE NEWS CHRONICLE - LEGAL AD 11• DEATH CERTIFICATES 12• FILING FEE If more space is rreeded, use additlonal sheets of paper of the same sire. TOTAL (Also enter on Une 9, Recapitulation) I = 1 36.00 96.09 75.00 95.50 36.00 15.00 70.09 REV-1512 EX+ (12.08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERfTANCE TAX RETURN RESiDENr oECEDENr , MORTGAGE LIABILITIES, 8 LIENS ESTATE OF LEE K. E V E L H O C H FILE NUMBER Report debt incurred by the decedent prior to death that remained unpaid at the date of death, including unroimbur d ITEM sa medkal ex pen~ee• NUMBER DESCRIPTION VALUE AT DATE 1• DEBORAH W• PIPER - REAL ESTATE TAXES OF DEATH 1,595.40 2• DEBORAH W. PIPER - PERSONAL TAXES 9.80 3• QUANTUM IMAGING 10.10 4• LIBERTY MUTUAL GROU P - HOME INSURANCE 493.00 5• CLEANING OF HOUSE 100.00 6• PPL 18.28 7• PPL 8.85 8• CENTURYLINK 2.63 9• MOWING 100.00 10. DELUXE CHECKS 34.00 11. DELUXE CHECKS 2.25 12• SOUTHAMPTON TOWNSHIP - TRASH 46.74 13. PPL 12.35 14. PPL 9.32 15• TRASH HAULING 500.00 TOTAL (Also enter on line 10, Recapitulation) ~ _ i( more space r3 needed insert additional sheets of the same size. 8 , 3 7 2 ' Continuation of REV-1500 Inheritance Tax Return Resident Dec edent LEE K. EVELHOCH DeoedenYa Name 21 11 0821 Page 2 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8 Liens ITEM NUMBER 16 • VISA PAYMENT DESCRIPTION 17. FINAL WATER 8 SEWER BILLING [SEE HUD SHEET ATTACHED] 18. REMAX REALTY COMMISSION [SEE HUD SHEET ATTACHED] 19. HOOKE HOOKE 8 ECKMAN REALTY COMMISSION [SEE HUD SHEET ATTACHED] 20- DUNCAN & [SEE HUD HARTMAN, PC ATTORNEY FEES SHEET ATTACHED] 21. TRANSFER [SEE HUD TAX ON PROPERTY SETTLEMENT SHEET ATTACHED] SUBTOTAL SCHEDULEI GRAND TOTAL SCHEDULEI AMOUNT 209.6 304.75 2,010.00 2,010.00 225.00 670.00 5,429.40 s 8,372.12 REV-15,13 EX+ (Ot-id) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~~.~.. w ~ ru ~ vr: LEE K• EVELHOCH SCHEDULE) BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS Qndude outright Sec. 91 6 (a) (sp 12j ]d~~~~ns and transfers under 1. NANCY E. GILTRUD 12703 FOLLY QUARTER ROAD ELLICOTT CITY, MD 21043 2• SUE A• STUM 372 BURNTHOUSE ROAD CARLISLE, PA 17015 3• BETSY L• HETRICK 319 EAST NORTH STREET CARLISLE, PA 17013 1/3 SHARE 1/3 SHARE 1/3 SHARE 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. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. FILE NUMBER: 21 11 0821 ~TIONSHIP TO DECEDENT AMOUNT OR SH Do Not List Trustee(s) OF ESTATE Lineal Lineal Lineal TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET If more s = pace Is needed, use addlhonal sheets of paper of the same size. } ` ~e~lttt and ~p~~' o~ Lee K. Ebelhoch I, Lee K. Evelhoch, of 30 Parsonage Street, Borough of Newville, Cumberland County, Pennsylvania, being of lawful age, sound mind and memory, and under no restraint, do publish this, my Last Will and Testament, revoking all others previously made by me. First: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, and all gifts and bequests shall be paid from the net distributable estate. Second: I give, devise, and bequeath my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, in equal shares, to my children, Nancy E. Giltrud, Sue Ann Stum, and Betsy Lou Hetrick. Third: I nominate and appoint my children, Nancy E. Giltrud, Sue Ann Stum, and Betsy Lou Hetrick, to be the Co-Executrices of my Last Will, granting to them authority to sell and convey any or al of my estate, real and personal, or mixed, upon such terms and prices as they shall deem proper, without obtaining any prior order of the court therefor. I also grant them full power and authority in the settlement of my estate, to compromise, adjust, and settle any and alt debts and liabilities due to or from my estate, for such sums and upon such terms and conditions as they shall deem best. I direct that no bond or surety shall be required of any executrix, administrator or fiduciary named herein. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will and Testament in the presence of th undersigned witnesses, on November 20, 2007. e ~.... Lee K. Evelhoc Witness ---- Witness ---- 2 Signed, sealed, published and declared by Lee K. Evelhoch, Testat Will and Testament, in the presence of us, who at his request, in his r' as and for his Last presence of each other, have hereunto subscribed our names as witnesse ce, and in the s hereto. residing at NQwville Pcnn~ residing at Newville P nn ~~~~~ •., COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Lee K. Evelhoch, Susan F. Luhn, and Robert B. Fry, the Testat whochse names are subscribed to the attached Will, bein dul or, and the witnesses do depose and say that we were present and saw the Testato alsfied according to law, instrument as his Last Will; that he signed it willingly and that he exec gn and execute the voluntary act for the purposes therein expressed; that each of us in th of Lee K. Evelhoch signed the Will as witnesses• uteri it as his free and was at that time 18 or more years of age, of sound rid that to the best of our kn wedge he influence. mind and under no constraint or undue Testator: Witnesses: Sworn and subscribed to before me, this 20"' day of November, 20 07. ... ` I, •' Nota . -,~ •~. ~. ry ublic :. _ '`• ` ^+~• .. Q " ~ , ;- 3 IO~~w Art •, ......~ { w~s~Irl~MrlI~COIM11r !ON REV-485 EX (05-04) 4 8 5 0 0 0 410 4 6 SAFE DEPOSIT BOX INVENTORY PA DepelUllenf of Revenue Soaal Security ar Death Certlticate Number Date of Death P«s! UsE Ot?tIQ~NAL FORM ONLY r.S 9 County Code 'Pear File Number a`~ -gi39 '1-iq-ao)I DeCedent'a feat Name °~ I )) ~ Q 907 / ~ v GI h o ch Sufflx First Name LCD yMI © ADDRESS OF DECEDENT STREET; ~ • 3o PacSon e..sr' tc~ ctTY: ~ t'1 Alf! ~,J K~III I I L STATE: ~ Zlp CODE: NAME AND ADDRESS OF PERSnu nen..~~«.._ ~ __ wAme: - - -^--- ~ ~~~ ~ ne ~rENING OF THE SAFE DEPOSIT BOX Ski . ., .,,., cITY: l.Gl~ (ice( C NAME. ADDRESS AND RELATIONSHIP (F ANY) TO DECEDENT, OF PERSON(S) PRESENT AT TMF anv .,ee....._ ~. NAME: STREETADORESS: Zc.t• a trJ- b. NAME. - STREETADDRE33: e. NAME: STREETADDRE3S: NAME ANO ADDRESS ot: e~~.......... clrY: - - ~ TAB' ZIP CODE: RELATIONSHIP: CITY' STATE: ZIP CODE: RELATIONSHIP: CITY' STATE: ZIP CODE: - - - • • • ~ ..vn nneRE THE SAFE DEPpSIT BOX IS LOCATED NAME: /! ~ °` J r a.C~ STREET Af'fnoece . ~ ~ • NAME OP PERSON MAKNVO T E TRY CITY: ~ ; ZIP CODE: , ~ C ' ~~ ~ CON CT TO RENT BOX - / DATE AN TIME OF LAST ENTRY ~ 70? 1 NUMBER OF BOX ~ ~ Q. 1 r+ ~ - ~~ , ~ TITLE UNDER WHICH BOX IS REQU -~- NAMEAND ADD ESS OF PERSON(S) HAVIN ESTED G ACCESS TO BOX a. NAME : ( lT ~ I r i ~ ---~.qL~~ b _v STRCG 1 AOOFlE -----~_ ~!'~ ~ Ci STREET A ~ ~ ~' ~- • ~ p ~ I ~ V Q~ ~ ~~ ~ '~ CITY DD SS: 1 - t 9 E ,~~..,.~~ sli• ~I I r Lp~ ~; 1 STATE: ZIP CODE: . CI ------- -aZ~~~r~0u~) NAME AND TRIE OF EMPLOYEE TAKING THE INVENTORY t I t SI! STATE: ZIP ODE: of a ~AC~ •31 ~ ~ f7a~ ~ WAS A WILL IN THE BOX9 ^ YES NO If Yee, a. Dab b. Name and addnee o/ PNSOnaI r of wNl: epneentHhn, If Waned In the wiN NAME: - STREETAOORESS: ---- e. Name and address of alWmey, If any ---'- CITY: STATE: _ - ZIP CODE: - _ NAME: -- ------------- __---~- _ STREET ADDRESS: -~-'------------ _-__ CITY: - _---STATE: ZIP CODE: - L 48500041046 RELATIONSHIP: LL'' 48500D41046 J REV-4195 EX SAFE DEPOSIT BOX INV iNSrRUCrioNS ENTORY Page °' I I 11) Cash: Report total only. (~) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to bed ' name of company certiflCate number, date of certiAcate, name in which stock is istered, and number of sha (3) Obligations of U.S. Government: Number of items, date of Issue, face value, names in which isle eslgnated by i.e., Jointly held, tea and class of stock. payable on death, etc. re9 red and type of ownership, I4) Bonds: Designate by name, amount, serial number, or other dealgnation. (Bearer Bonds) (S) Bank and Savinga and Loan Passbooks: State name of depositor, number of book, last date a and branch, and balance. (6) Jewelry, Coins, Stam PPearing in book, name of bank W. ManuecHpta, etc: List and describe as fufy as possible. (7) Deeds, Mortgages, Curnnt Insurance Polkles or other evidences of Indebtedness: List and describe as fuly as s i (d) All other conbnts. (9) Return completed form to: Po stile' DEPARTMENT OF REVENUE INHERITANCE TAx DIVIaION DEPT. 280801 TEM HARRISBURG, PA 17128-0801 NO ITEM DESCRIPTION ~~ _ AO d 3 I ~ ~ ~' - i~tte k. ' ~ L. ~ e ~ ~ _ t•ee K ' sc --L ~if~Qlf"t;~. c.r~~ 4ou~~a. P ~. -Lyi_ 1 ~ ,~- 1, I - ~-~_ __ ~ci.,d a fit- a. • ~ t . ~ .._.3b L~_ ~ f; ssf- TO THE BEET OF AIY :cvRD M AND 9E1. -----_ _____ Qr E PRIN7 NAME App C --------- _ ~~-- HECK APPROPRATE BOx BELOW -- PRINT iITIE ~ ~ ------------- Ex tcu}~' X a~ DATE ----____ ~ ~~~f. G~Ii~C CHECK APPROPRIATE BOO .x ----------- Ol ~ ~• 'C~1/~MOL ~ 5 ~~ ^E~~rvlatV4) ~AdminyyNylW.) ..... ~0~: Attach additions) 8'h' x 11' shssns) if necsssa a ewle R~w...r,u~. ~ ~a,~l °"'~` w ""' e~ eo,, TM Oepartr-Kxlt is auModzed by law, ~? U.S.C. §405 (c)(?NC)fi), to require d1e ~ uss duplkates of this page o/ form. ed bal to 'demo ~b ~P~sorl+l repres«+tauws of nle esmt~ C ,'awl m "'~ a~"'"a~ state tax hws. i}le pepydne„t uses the Ibib the CamlonwearMYs «~ aY abo use the ntormaepn in exdlange of tax inkxn,atiorl ~eel-lenb • wnAdenBal tax in-armalion except for ofRaal nom,... Duncan & Hartman, P.C. Attorneys at Law One Irvine Row Carlisle, Pennsylvania 17013 William A. Duncan Susaa J. Hartman Pa. Dept. Of Revenue Safe Deposit Box Unit P.O. Box 280601 Harrisburg, PA 17128-0601 RE: Estate of Lee K. Evelhoch Dear Sir or Madarn, (717) 249-7780 FAX (717) 249-7800 dhlaw@pa.net July 27, 2011 In accordance with Inheritance Tax Bulletin 2011-02 issued May 1 I, 2011, we are hereby furnishing Notice of a proposed safe deposit box entry and inventory for the safe deposit box owned by Lee K. Evelhock located at F&M Bank, 9 W. Big Spring Avenue, Newville, PA 17241. The box will be inventoried by Sue E. Stum, Executrix and Susan J. Hartman, Esquire on August 5, 2011 at 8:30 a.m. Yours truly, */~~ ~ ~~~ Susan J. Ha Attorney for t e Estate of Lee K. Evelhoch cc. F&~tii Bank. Newville. PA VERIFICATION The undersigned, hereby verifies that Notice of my proposed safe deposit box entry and inventory on August 5, 2011 has been delivered to the PA Dept. Of Revenue via United States Postal Service in accordance with 72 P.S. section 9193. This verification is made subject to the penalties of 18 Pa.C.S.section 4904 pertaining to unsworn falsification to authorities. Sue E. Stum, Executrix ~M°a~Ms~w~al~~ .~ - CAPITAL ABSTRACT CORPORATION N~ Au~,,d W~.,i,.,~,.~.r.s. nrw~ecFaa xed~+7 ~ ETi~tvEQF~(g~ 'IheLee~~ F. T41Ivi.'+CFLII~I$Z ~ ~Y~ ~~~~ 9~~ I~.wvillq PA 1'741 H~ ~'~~r"c~8',r ~t.~Ue~ac~ ~~ T~~ A Sextl~~ 17~* 4- o~ ~ ~~ ~. Oct,,, tras _____ 4~~ - 1L~ ' ~~ ------_. M -~ ~ ------~•...arvp.,w„av~7rn~a.riyihe+~"'.n.~'r'+ '°.~w""°'r..r`:i~ ---,-_- auagraMr~~~ ~~ i, ~+.~Awosnw~~ M LiS T~~B41"~Iix~.[3wN~t me,...z...~.ti _ _ _ _ z r. ^ ~ tYIMlp RI~AOM7pMOMiy tla(~ ^,p~~~~~ °~~~e~~M~b6iM~!P~!tidM~YrstlsseeYesoavtdr'lief~a~v~ °~ seotdewvi1M~11Awlntt. ~itir~ra~~tir~djrMit~~wl~~pdY~i D7d~rll~w~~~L~~'llsaY~ssdau~~fdr/wo~~r! delueerrgee node v~ vY sews a 4r uq~s ~~ ~ ~~ ~~ ~e i e MEMBERS i~ FBDBRAL CAHDIT UNION SAVINGS ACCOUNT• Account Number/Suffix Date Account Established 265173-00 Principal Balance at Date of Death 05/23/2005 Accrued Interest to Date of Death $40.00 $ ~ Total Principal and Accrued Interest $40 00 Name of Joint Owner : None CERTIFICATES OF DEPOSIT• Account Number/S~Jffix Date Account Established 265173-43 Principal Balance at'Date of Death 05/23/2005 Accrued Interest to Date of Death $635.85 Total Principal and Accrued Interest $ 71 Name of Joint Owner $636.56 None MEMBERS 1ST FEDERAL CREDIT UNION Leigh-Anne Stallings C~~~~~ Lending Insurance Support Specialist August 10, 2011 Estate of: Lee K. Evalhoch Date of Oeath: 07/19/x011 Social Security Number. 15&249139 5000 Louise Drive P.O. Bc~x 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmembers 1 st.or ~ROWE~ S AUCTION SER (RH ~CE 79L) Bill Rowe (AU 1538L) 2506 Ritner Hi hwa • 8 Y Carlisle, PA 17015 248-1978 215-1044 574-1008 Dave Roble (AU 2295L) Auction Is Action Call, "RQR,e» For Satisfaction SELLERS NAMEf~'~ ~Q,t.' ~iv~~r~,~ ADDRESS ~~`~ ~ ~•/ OTHER /-~,~v:~/ /c'a t~ r. lv !: DATE o2. PHONE AUCTIONEER 9b ~.~ CLERK °r6 ~_g - ~ ~ ~ AUCTION DATE/LOCATION I Cominiasion the Auctioneers to sell the merchandise to the to be sold ae is 8k grouped ae nec~s highest bidder by Public Auction. Merchandise tative of the merchandise ~' to obtain bide. I certify that I am the owner or authorized repreaen- from all incumbrancea. I ag°Ods and or property and have good title and the right to sell and that they are free title to the purchaser. I agr~ hold harml es he Aucltionee a agaiansganey cis of the n ~ for delivery of this agreement. a ure referred to in • .1~ --~_ AUCTION SIGNATURE _ ~ ~ ~~ S LERS SIGNATURE Total Sales (Clerking Tickets Attached) $ _ ~'~ (o ~~'` ~- ,~1` Less Sale Expense: ~.~ ~~~~ ~~ ~ ~ ~~J ~l~ i~~ it ; ------~ % Commission Auctioneer $ ~~1. ~ / r' ---------_ 9b Commission Clerks g OTHER: tt~.. _ c . ' . • 1... ~s- ~' ~ TOTAL SALE EXPENSE DEDUCTED a ~~ p ~~ SELLERS NET $ Sob ~i- Prudential SUE E STUM 372 BURNTHOUSE RD CARLISLE PA 17015 Retirement Plan Starting Your Beneficiary Pension Benefit In Pay Status Statement Date 08-09-2011 As the beneficiary of Lee K. Evelhoch, you're entitled to a benefit from the Pnudential Merged Retirement Plan. Payment Option Information for the Traditional Plan formula -Lump Sum Payment Option Information for Minimum Death Benefit (Lump Sum) You're entitled to a one-time payment of $653.19 from the Prudential Merged Retirement Plan as of August 1, 2011. For your information only, a Summary Plan Description is available upon request. Upon receipt, keep this material for your records. When Your Payment Will Be Made We'll pay the benefit to you once a certified death certificate for Lee K. Evelhoch has been received. You must provide the Prudential Benefits Center with a copy of the certified death certificate for Lee K. Evelhoch by October 6, 2011 to ensure your benefit isn't delayed in the future. Where to Send Your Documentation '~ Tease fax or mail the death certificate to: FaY: 1-847-554-1552(Outside the United States, use +1-847-554-1552.) Mail: Prudential Benefits Center P.O. Box 563996 Charlotte, NC 28256-3996 When taxing your information, do not include a cover sheet. Only fax this form, fi~llowed by the required documentation. 316000038 05434 Prudential Susan Ha ~~ e Row Carlisle, PA 17013 Dear Ms. Hartman: The Prudential Insurance Company of America 30 Scranton Off'~ce Park Scranton, PA 18507 August 8, 2011 ~.: ~~ Lee K. Evelhoch Account #: 30006549138 Please accept ow condolences on the death of yow father, Lee. It is never easy to deal with these c~umstances, and we would like to assist you with submittin the Employee Savings plan (PESP) benefits are g ~°~ fO~ tO ~~ Your Prudential processed as soon as possible. Our records indicate that you are 1 of 3 beneficiaries and are entitled to 33 1/3% of the account. The value of yow share of the account as of July 19, 2011 was 515,155.89. The dollar value of the account will fluctuate daily based on market perfon~rtance of the selected investments. A non-spouse beneficiary, has the following options with respect to settlement of the account a on the enclosed Death Claim form and a copy of the PESP Summary plan Description (SPD), in a ding • Delay Distribution and transfer the account balance to yow name (provided the account balance is greater than $S, 000.00) • Paid to you in a total withdrawal • Paid to you in a partial withdrawal (minimum withdrawal amount is $300.00) • Paid to you as a Direct Rollover to an Inherited IRA Account • Paid in any annuity form that is available under the plan (minimum purchase amount is $S, 000.00) • Paid to you in any combination of above The Hiles governing the income tax consequences of distributions from plans like :PESP are complex. Neither prudential nor any of its employees, representatives or agents can provide financial, tax or le al advice on behalf of the Plan. You are caged to consult yow own g advisor with any questions on allowances, deductions, or tax credr~that tna ~~ ~jx to Dorf articular situation before you take any action relating to Plan benefits. Y ~ Y y P To avoid delays in processing yow request, please include the following items in the self-addressed return envelope: • Completed Death Claim Form August 8, 2011 Page 2 of 2 If you have any questions, please call 1-800-PRU-EASY (1-800-778-3279) say the key words "401(k)" and follow the instructions to speak to a customer service r representatives are available Monday through Frida ex epresentative. Customer service you are hearing-impaired, cal) 1-877-760_5 166 Tele ( cept holidays), 8 a.m. to 9 p.m., Eastern Time. if holidays), 8 a.m. to 6 p.m., Eastern Time. ( ~ TTY 1i~)' Monday through Friday (except Sincerely, Dia Miller Distribution Specialist Enclosures Information regarding benefits ~~ may, be payable to you from The Prudential Merged Retirement Plan will be sent to you in a separate letter. If you do not receive this information or i Retirement Plon please call 1-800.PRU-EASY (1-800-778.3279) say the ~ words eR~i ment p ~rega~~glow the instructions to speak to a customer service representative. Customer service representatives are available Monday through Friday (except holidays), 8:00 a.m. to 6:00 p.m., Eastern Time. I _ have a teletype (TTY) line, call 1-877-760-5166, Monday through Friday (except holidays), 8.•00 a.~ top6.•00 p.~ Eastern Time. Information regarding health care and personal protection programs that maybe available will also be sent to you in a separate letter. If you do not receive this information or if you have arty questions regara~ng these benefits, please contact the Prudential Benefits Center at 1-800-PRU-EASY (1-800.778-3279) and say the key words "Health and Welfare Benefits': TM prudontlM Insunnco Company otAm~rka r Prudential oooss~a PRUDENTIAL TRUST COMPANY COST FOR THE IRA OF LEE K EVELHOCH 30 PARSONAGE STREET NEWVILLE PA 17241 Opening Balance Additions 8utmaotbns Investment Results Closing Balance Dhfidends Capital Galns Personal Petformance• 238,355.93 xo.oo xo.oo •x4,118.45 234,237.48 2229.12 x0.00 -10.74 9G 235,134.84 Zo.oo Zo.oo -2897.36 x34,237.48 x687.87 x0.00 -2.55 9L Your Representative PRUCO SECURITIE8 LLC JA80N R MILLER (717) 975-8150 Your 88N/TinB: ON FILE Your Account 7000104818 Retirement Page 1 of 4 Tool 2011 lRi4 ContrBsutlotts #0:00 8tanderdised fwd ep~rlom~eno~ ~iNspl~ by ~ y~ ~ RnaoP~osbnal a b an booed on your ~peot(io ~gy end may not nlNot overall fund per/onnenoe. the! ~Y y~ dYbe~nt ~Ow+e. end f~ Perkrnrerae fo not indbetlw d talon noub. y vi~itln9 www.pn+denlfel.oom. NoEr. Then an otMr Perwnel Per/omunw forrrwlee IMPORTANt't PIMat: t^snd tiro krsert for delafle ! gape yr,e ~~ oR tM upoondn~ tow llaoowrt, R wer~f id enwro that •~~ ~,,SnaW staprm~nt Is aoourapM errors i Your lAooouM AIIiM-bnsnos lair and lpA Fee 8waep that nest piaa~ rwlew your stabrment ^wff nadverTentl~r ocou~; mpast tour mutual iwrrQ iooount You find M and eoontaot ua if ~t I~natbn you trellwe to be lnaacurata~' it: ~ do not hetar iroin you in 30 dlrys wa wIM asaums that aN ; Infiorn~lon Is eor~tr i t• li li :I~ PRUDENTIAL TRUST COMPANY Page 2 of 4 CUST FOR THE IRA OF LEE K EVELHOCH Retirement Account Summary for the Period July 1, 2011 to September 30, 2011 ~E ,; .: . 1`otil 8hsrn Endirtq ~a~tlarti,tll Vt~1J8~ Ad4ifdotttl $41btT>6Cti0~ls $hatys PHCO VptWr P~rmancs Equity Pru Jsn Utility A Fund /: 0009 / NASD/W: PRUAX Aooount 87000104818 238,355.93 50.00 ;0.00 3,490.059 x9.81 $34,237.48 -10.74 % Total Equity : 238,335.93 20,00 20.00 534,237.48 -10.74 % Totirk• ..' .:. 231,3i'il1.09:. SO.GQ ~Q.00 5,337.48 Retirement Account Transactions for the Period July 1, 2011 to September 30, 2011 ''1 ~~ uu~~r~- fund i~:`'tx~l`n~a~oat~; pi~~tAx i A~otnl;:rrooataaeie Fatur« ~ Services: R~presentativ~: - OIVIDENO$: REINVEST CAPITAL OU11N8: REINVEST JA80N R MILLER (717) 97'5.8150 TELEPHONE REDEMPTION 8YSTEMATIC WITHDRAWAL PLAN NAV ACOOUNT Detailed Transaction Activity sales ~ Tranaactlon Dollar Shares This 8haro and/or Total Shane Date DescNptbn Amount = Transactbn X Prior - Taxes WM Owned 07/01/11 OpeMng share Balance 3,487.988 09/16/11 DMDENO -REINVEST 2229.12 22.073 210.38 3,490.059 09/30/11 Closirr8 Shan Bslana 3,490.059 Add~tft~nal Account InfOrm~tior~ _._ Retirement Account Additional Information Account Fund Nana Current Quarter 2011 w Open Date Dividaeds Capital Qalns Contritwtfons 7000104818 Pru Jen Utility A 02/03/1995 2229, t 2 20.00 20.00 ~ 2229.12 20.00 20.00 ~ The primary beneficiary for the following account is: Fund 0009 Aooount 7000104818 Sue A Slum 33.3% Nsnoy L Gilbud 33.4% Betsy L HMriok 33.3% ~ The secondary beneflcl>~ry for the following account is: ~ Fund 0009 Aaoount7000104818 Nenay L Ciiltrud, Sw A Scum, • Baby L Brandt ~- ~ PfOaotlon and your privacy, vw wiN no bn9ar dhiplay the Saoiel 8oourily nunban anrYor Tax Pa • bene8ofary inramallon, pNaw rrrRe b w at PnxNMW Mubnl Fund 8arvbea LLC, P.O. Sax fir IdaMilloatlon numbers an Mis statement M you need Eo update any of the 9868. Prwiderroe, RI 02940. 1-800•~6186t ~ ooeb of 1~ rrMrlual w~, P~ confect w M aryl of Ma above addreoeee should ba charged or deleted -• Thenk You. Please oaN us, toN-Ma. ~ a Monday thraph Friday, bedrearr 8:00 a.m. end 8:00 p.m. Eabm fkrre. e v n n N • ' ' REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedents date of death: 10 , 0 0 0.0 0 Discount: 5 2 6.3 0 Interest Table Year Days Delinquent this time period Balance Due this year Interest this period Before 1981 1982 1983 1884 1885 1986 1987 1988 throw h 1991 1992 1983 throw h 1994 1985 throw h 1998 1989 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 TOTALS Penalty Calculation If the decedents date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: