HomeMy WebLinkAbout02-03-12J 1505611185
REV-1500 EX (02-11)(FI)
FA Department of Revenue OFFICW-USE ONLY
Burosu of Individual Tames County Code Year FYe Number
Po sox zaoso~ INHERITANCE TAX RETURN 21 11 0672
Harisburp, PA ~~~za-oeo~ RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
172-01-0019 05162011 09091918
Decedent's Last Name Suffix Decedent's First Name M I
WISE KATHRYN K
(tf Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (Date of Death
Prior to 12-13-62)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required
death after 12-12-82)
® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of wilq (Attach Copy of Trust.)
^ 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 5dtedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTW. TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LINDA J. LUNDBERG~VP 717-73a~26S..
First Line of Address
4242 CARLISLE PIKE
Second Line of Address
P • 0 • .BOX 308
City a Post Office
CAMP HILL
State ZIP Code
PA 17011
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Correspondent's eamall address: LINDA • L U N D B E R G a P N C• C O M
Under penalties ~~rc~aro that 1 have examined this return, indudinp aceompanyirrg schedubs and statements. and to the best of my knovrledpe and belief,
ft is true, °DQI~ D~~Qr~a t~r'sPresentative is based on aM information of which proparer has arry knaMsdpe.
nn~u- ~n~rTo ~ ncmru~ c r c ~ uv± orn iou r,e,t
P • OE~BOX ~~O~SrUStOfficer ~ CAMP HILL, PA 17001-0308
SIGNATt1RE OF PREPARER OTHER THAN REPRESENTATNE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15 0 5 61118 5 oMasa~ s.aoo 15 0 5 61118 5
1505611285
REV-1500 EX (FI)
Decedent's Social Security Numb
172-01-0019
Dec.aenr: Name WISE KATHRYN K
RECAPI11jLAT10N
1. Real Estate (Schedule A) ............................ 1. 12 0 , 0 D 0.0 0
2. stocks and Bonds (Schedule B) . .. ... ... .. .. .. .. 2. 7 0 , 9 21 • 6 6
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. ~ . ~ ~
4.
5.
6.
7.
8. Mortgages and Notes Receivable (Schedule D)
Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)
Jointly Owned Property (Schedule F) ~ Separate Biling Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ..
Total Gross Assets (total Lines 1 through 7) 4,
5.
s.
7.
s. ~ • ~ 0
5 3 5 , 9 41.91
2 6 3.6 3
10 6 , 6 0 0 • 7 8
8 3 3 , 7 2 7.9 8
9. Funeral Expenses and Administrative Costs (Schedule H).. .. .. g. 5 3 , 918.8 9
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 318.6 0
11. Total Deductions (total Lines 9 and 10) , , 11, 5 4 ~ 2 3 7.4 9
12. Net Value of Estate (Line 8 minus Line 11) 12. 7 7 9 , 4 9 0.4 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) , , 13, ~ • ~ ~
14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 7 7 9 , 4 9 0.4 9
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers un Sec. 9116
~
(a)(1.2) x .o
0.0 0 15. 0.0 0
16. Amount of Line 14 xable
~
at lineal rate X .0 4
0.0 0 1 s. 0.0 0
17. Amount of Line 14 taxable
at siblingratex.l2 106,600.78 17. 12,792.09
18. Amount of Line 14 taxable
at collateral Pate X .15 6 7 2, 8 8 9.71 18. 10 0, 9 3 3. 4 6
19. TAX DUE 19
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611285 1505611285
OM4648 3.000
113,725.55
REV 1500 EX (FI) Pape 3
File Number
DeCedeniCs Com labs Address: C J, Jr b U 6 ( C
DECEDENTS NAME
STREET AIx1RESS
G7Y STATE
P ZIP
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 113 , 72 5.5 5
2. Credits/Payments
A. Prior Payments 8 6, 7 7 2. 5 6 J
13. Discount 4 , 56 6.9 8
Total Credits (A + g) (2) 91, 3 3 9.5 4
3. Interest
(3) Q • l1 ~
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Paga 2, Lie 20 to request a refund. (4) 0 ' 0 ~
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (5) 2 2 , 3 8 6.01
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 properly transfened or its incorne .... . .
c. retain a reversionary interest ............ ................ ...... .
d. receive the promise for life of either payments, benefds ar care? ............ ......
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^
without receiving adequate conskteration? ................... .......... .
3. Did decedent awn an "in trust for" or payable-upon-death bank account or security at his or her death? ^
4. Did decedent own an individual retirement account, annuity, or other non-probate property, which
contains a beneficiary designation? ........ ....... .................. ® ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Far dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of tr~sfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9118 (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)]. 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 a' after Juty 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 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 arl-individual who has at least one parent in common with the decedent, whether by blood or adoption.
OM4671 2.aDD
REV-ts02 Ex+ (01-10)
Pennsylvania
DEPAttrlrBiT OF REVENUE
NF~tIiANCE TAX RETURN
R610H1i DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF:
FlLE NUMBER:
xaTH12tlT7 K ynSE 21 11 0672
Ali sal property owned wkly or as a tenant fn common must be sported et fair market valor. Fair market value is defered as the prirx at which property
would be exchanged between a willing buyer and s willing sailer, neither being compelbd to buy or seq, both having n~aeorrable knowledge of the rebvant facts.
Real properly that k joiMlyowned wffh right of wrvivorship mwt be disclossd on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedents iderest ff owned as tenant in common. VALUE AT DATE
NUMBER DESCRIP'110N OF DEATH
1. PROCEEDS OF SALE OF REAL ESTATE LOCATED AT 211 CLARK
STREET, LEI~DYNE, PA 17043
VALUE A3 OF 05/16/11 PER ATTACHED REAL ESTATE SETTLEMENT
STATEMENT 82,000.00
2 VACANT LAND LOCATED•AT 2865 (REAR) LEWISBERRY ROAD, YORK
HAVEN, PA 17370
VALUE AS OF 05/16/11 PER ATTACHED APPRAISAL OF TERRY E.
FREEMAN, PA CERTIFIED APPRAISER.
TOTAL (Also enter on Line 1, Recapitulation.) I S
ewases z.~o If more space is needed, use additional sheets of paper of the same size.
38,000.00
120,000.00
REW1503IX+(698)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
KATHRYN K WISE 21 11 0672
All properly jointy-owned with right of survivorship must 6e disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER oESCwPTION OF DEATH
1.SECURITIE3 PER THE ATTACHED ESTATE TAX SECURITIES
VALUATION STATEMENT 63,790.07
2 PROCEEDS OF REDEMPTION OF
$ 25 U3A SERIES E SAVINGS BOND
DATED 12/1974 (BOND MATURED 12/2004) 131.59
3 $ 7000. US SERIES HH SAVINGS BONDS DATED 10/01/1995 DUE
10/01/2015
VALUE AS OF 05/16/11 $ 7,000. 7,000.00
TOTAL (Also enter on line 2, Recapitulation) I $ 70, 921.66
aw~s9a ~.aoo (If more space is needed, insert additional sheets of the same size)
REV-1507 DC+ (69~
SCHEDULE D
OF PENNSYLVANIA MORTGAGES ~ NOTES
`T " RECENABLE
EgTATE OF FILE NUNBER
KATHRYN. K. WISE 21 11 0672
N property jotntly-0arned with right of survhrorship must be disclosed on Schedule F.
3W46AC 1.000 (If more space is needed, insert additional sheets of same size)
REV 7508 EXi (17-10)
Pennsylvania SCHEDULE E
D~Atrn~+roF REVENUE CASH, BANK DEPOSITS, 8c MISC.
ANCE~ RN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
KATHRYN K. WISE 21 11 0672
Include the proceeds of litipatian and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPl10N OF DEATH
1. COUNTRY MEADOWS ASSOC. ,
REFUND DUE AT DEATH 2,006.28
2 PNC BANK
CHECKING ACCOUNT # 5140069782
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 25,273.05
ACCRUED INTEREST .40
TOTAL 25,273.45 25,273.45
3 PNC BANK
SAVINGS ACCOUNT # 5000939782
VALUE A3 OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 20,815.38
ACCRUED INTEREST .17
TOTAL 20,815.55 20,815.55
4 WELLS FARGO BANK CD #501
INTEREST PAYMENT DATED 05/05/11 4.93
5 PRUDENTIAL NATIONAL MUNI FUND DIVIDEND PAYMENT DATED
04/29/11 65.99
6 M6T BANK CD # 1269
INTEREST PAYMENT DATED 05/15/11 14.58
7 M6T BANK CD # 1300
INTEREST PAYMENT DATED 05/03/11 22.33
8 SOVEREIGN BANK CD # 1682
INTEREST PAYMENT DATED 04/30/11 25.49
9 PNC FINANCIAL SERVICES GROUP DIVIDEND PAYMENT DATED
05/05/11 87.15
10 SOVEREIGN BANK MDNEY MARKET ACCOUNT # 0273
VALUE AS OF 05/16/11 AS FOLLOWS:
BALANCE 05/16/11 10,864.34
ACCRUED INTEREST 1.19
TOTAL 10,865.53 10,865.53
Total from continuation schedules .
OW45AD 2.000
TOTAL (Also enter on line 5, Recapi
If more space is needed, use addRional sheets of paper dthe same size.
476,760.63
535,941.91
Estate of: KATHRYN K. WISE 21 11 0672
Schedule E (Page 2)
Item Value at Date
No. Description of Death
11 30VEREIGN BANK CERTIFICATE OF DEPOSIT # 1682
VALUE AS OF 05/16/11 AS FOLLOWS:
BALANCE 05/16/11 25,000.00
ACCRUED INTEREST 13.59
TOTAL 25,013.59 25,013.59
12 SOVEREIGN BANK CERTIFICATE OF DEPOSIT # 7682
VALUE A3 OF 05/16/11 AS FOLLOWS:
BALAPTCE 05/16/11 20,204.20
ACCRUED INTEREST 1.99
TOTAL 20,206.19 20,206.19
13 SOVEREIGN BANK CERTIFICATE OF DEPOSIT # 3565
VALUE AS OF 05/16/11 AS FOLLOWS:
BALANCE 05/16/ii 21,737.28
ACCRUED INTEREST 11.83
TOTAL 21,749.11 21,749.11
14 WELLS FARGO
CHECKING ACCOUNT NO1rIDER 7821
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 5.00
ACCRUED INTEREST .00
TOTAL. 5.00 5.00
15 WELLS FARGO
SAVINGS ACCOUNT NU148ER 2003
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 15,987.47
ACCRUED INTEREST .44
TOTAL 15,987.91 15,987.91
16 WELLS FARGO
CERTIFICATE OF DEPOSIT # 6862
VALUB AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BAT.ANCE 05/16/11 21,125.12
ACCRUED INTEREST 1.62
TOTAL 21,126.74 21,126.74
Total (Carry forward to main schedule) 104,088.54
Estate of: KATHRYN K. WISE 21 11 0672
- Schedule E (Page 3)
Item Value at Date
No. Description of Death
17 WELLS FARGO
CERTIFICATE OF DEPOSIT (k 0501
VALUE A3 OF 05/16/11 PER ATTACHED LETTER A3 E'OLLOWS:
BALANCE 05/16/11 30,010.88
ACCRUED INTEREST 1.80
TOTAL 30,012.66 30,012.68
18 METRO BANK
CERTIFICATE OF DEPOSIT (k 12000227
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 36,997.52
ACCRUED INTEREST 15.44
TOTAL 37,012.96 37,012.96
19 METRO BANK
CERTIFICATE OF DEPOSIT # 12000561
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 53,718.99
ACCRUED INTEREST 26.40
TOTAL 53,745.39 53,745.39
20 PROVIDER SERVICES
HOLY SPIRIT HOSPITAL REFUND 33.80
21 HIGHMARK
CANCELLATION OF POLICY PREMIUM REFUND 96.17
22 FULTON BANK
CERTIFICATE OF DEPOSIT ~ 052-0197195
VALUE. A3 Off' 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 24,371.27
ACCRUED INTEREST 206.41
TOTAL 24,577.68 24,577.68
23 FULTON BANK
CERTIFICATE OF DEPOSIT # 522-0052167
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 24,438.96.
ACCRUED INTEREST 9.04
TOTAL 24,448.00 24,448.00
Total (Carry forward to main schedule) 169,926.68
Estate of: KATHRYN K. WISE 21 11 0672
Schedule E (Page 4)
Item Value at Date
No. Description of Death
24 FULTON BANK
CERTIFICATE OF DEPOSIT ~ 522-0065951
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 28,439.45
ACCRUED INTEREST 60.36
TOTAL 28,499.81 28,499.81
25 FUI,TON BANK
CERTIFICATE OF DEPOSIT # 522-0092494
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 42,116.54
ACCRUED INTEREST 8.80
TOTAL 42,125.34 42,125.34
26 MST BANK CHECKING ACCOUNT NUIrIDER 9843038895
VALUE A3 OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 6,].95.24
ACCRUED INTEREST .03
TOTAL 6,195.27 6,195.27
27 M6T BANK '
CERTIFICATE OF DEPOSIT ~ 31003913821269
VALUE A3 OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 32,252.08
ACCRUED INTEREST .49
TOTAL 32,252.57 32,252.57
28 M&T HANK
CERTIFICATE OF DEPOSIT ~ 31003913821300
VALUE AS OF 05/16/11 PER ATTACHED LETTER AS FOLLOWS:
BALANCE 05/16/11 .31,954.70
ACCRUED INTEREST 9.67
TOTAL 31,964.37 31,964.37
29 TRAVELERS INSURANCE
HOMEOFINERS INSURANCE REFUND 527.00
30 UNITED HEALTHCARE
. MEDICAL SERVICES REFUND 34.83
31 WELLS FARGO ADVISORS
BROI~RAGE ACCOUNT #8746-7653
CASH IN ACCOUNT AS OF 05/16/11 10.66
Total (Carry forward to main schedule) 141,609.85
Estate of: KATHRYN K. WISE 21 11 0672
Schedule E (Page 5)
Item Value at Date
No. Description of Death
32 CORDIER ANTIQUES & AUCTIONS
PROCEEDS OF SALE OF PERSONAL PROPERTY 1,730.00
33 RESIDUAL ESTATE OF ROLAND K. WISE
VALUE AS OF 05/16/11 PER ATTACHED STATEMENT
A COPY OF ROLAND WISE'S WILL DATED JUNE 27, 1980 IS
ATTACHED HEREWITH 59,223.62
34 UNITED STATES HEALTHCARE INSURANCE CO~ANY
REII~ffiURSEMENT OF HEALTHCARE SERVICES PAID BY INSURANCE 181.94
Total (Carry forward to main schedule) 61,135.56
REV-1509 IX+(01-10)
Pennsylvania
De?~RTre~r aF aEVe~uE
INHERITANCE TAX.RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-0WNED PROPERTY
ESTATE OF: FILE NUMBER:
KATHRYN K WISE 21 11 0672
N an asset became jointly owned wMtdn one year of the decedent's date of death, k must be reported on Schedule C:
SURVNNG JONiT~JANI'(S) NAMgS)
A RHAN, ROXANN K
JOINTLY OWNED PROPERTY:
fiHd
NUuBER uiTTER
FoR,IDINr
TEHNIT QATE
MADE
JDM
xA:LUDEMAV:snuunDMAMD MIIBEAasx~uA
CEMFYEIGMMlERATTAp1DEEDroMJDINfLYMELDHEALE6TATE.
DATE OF DEATH
VALLEOFASSET % OF
DEC®BJT'S
iYtHi6ST DATE OF DEATH
VAUIEOF
DBCFDl3~f1'SMEREST
1 A 8/30/200 METRO BANK
CHECKING ACCOUNT NU1+~ER
536141607
VALUE AS OF 05/16/11 PER
ATTACHED LETTER AS FOLLOWS:
BAT-~*TCE 05/16/11 527.25
ACCRUED INTEREST .00
TOTAL 527.25 527.25 50.0000 263.63
TOTAL (Also enter on Line 6, Recapitulation) S 2 63.63
ADDRESS
liaATtJNSHP TO 0EC®B~tT
2825 LEWISBURY ROAD, YORK HAVEN,
PA 17370 Niece
ew4eAE z.ooo M more space is needed, use addkional sheets of paper of the same size.
REV-1510 EX+(08.09)
Pennsylvania
D6~ARTirENTOF REVENUE
W~TANCETAX RETURN
RESIDEr~rf oECEOENr
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
KATHRYN K. WISE 21 11 0672
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
NUMBE DESCRIPTION OF PROPERTY
srunEnewv~oFne~Fe~.n~RReunoraHrrooECeoE~+rAw
71'EMREOF7WM6FHtATfAdiACOPIOFTFEDEEDFORREALE6TATE
DATE OFDEATFi
VALUE OF ASSET
%OFDECCrS
INTE(2EST EXCLUSION TAXABLE
VALUE
1• METLIFE INVESTORS USA INSURANCE
COIdPANY ANNUITY CONTRACT #
A2074242 PAYABLE TO HARRY
KILLICK
VALUE A3 OF 05/16/11 PER
ATTACHED LETTER 106,600.78 100.0000 0.00 106,600.78
TOTAL (Also enter on line 7, Recapitulation) S I 106, 600.78
If more space is needed, use additknal sheets of paper d the same s¢e.
9W46AF 2.000
REV-1511IX+(1p.OGj SCHEDULE H
Pennsylvania
oEPnRn~+roF REVENUE FUNERAL EXPENSES AND
N~AITANCETAXRETURN ADMINISTRATIVE COSTS
RESD@lr INT
FrSTATE OF FILE NUMBER
r~amuAVN K WISE 21 it 0672
Decedent's debffi must be reported on Scheduts I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PARTHL+IDRE FUNERAL HIX~
FUNERAL SERVICES 6,625.47
B. ADMINISTRATNE COSTS:
1. Personal Representative Commissions: 30 ,143..00
Name(s) of Personal Representative(s) PNC BANK N. A.
Street Address 4242 CARLISLE PIKE
City CAMP HILL State PA ZIP 17011
Year(s) Commission Paid:
2. Attorney Fees: 7 , 000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 SAIDIS, SULLIVAN S RODGERS
REII+~URSEMENT OF THE FOLLOWING EXPENSES:
PROBATE COSTS 543.50
LEGAL ADVERTISING 243.30
TOTAL 786.80 786.80
Total from continuation schedules 9,363.62
awasnc z.ooo
TOTAL (Also enter on Line 9, Recapil
If more space is needed, use additional sheets of paper of the same size.
`53,918.89,
Estate of: KATHRYN K. WISE 21 11 0672
Schedule H Part 7 (Page 2)
2 VITAL RECORDS
18 DEATH CERTIFICATES 162.00
3 REGISTER OF WILLS
FEE FOR TWELVE SHORT CERTIFICATES 52.00
4 FREEI~N REAL ESTATE
REAL ESTATE APPRAISAL 200.00
5 FREEI~N REAL ESTATE
REAL ESTATE APPRAISAL 350.00
6 SES INSURANCE BROKERAGE .SERVICES INC.
LIABILITY INSURANCE ON 211 CLARK STREET, LEt~OYNE, PA 382.00
7 SES INSURANCE BROKERAGE SERVICES INC.
LIABILITY INSURANCE ON LAND LOCATED AT 2865
LEWISBURY ROAD, YORK HAVEN, PA 59.00
8 CO[+~UTERSHARE
FEE FOR REPT•~~'F'~'NT OF LOST STOCK CERTIFICATE 394.89
9 CORDIER ANTIQUES ~ AUCTIONS
AUCTION EXPENSES A3 FOLLOWS:
COtrMISSION 346.00
DUt4P3TER RENT 422.20
AUCTION ADVETISING 991.16
OTHER AUCTION EXPS. 852.50
TOTAL-EXPENSES 2,611.86 2,fi11..86
10 SELLING EXPENSES FOR REAL ESTATE LOCATED AT 211
CLARK STREET, LEI40YNE, PA 17019 AS FOLLOWS:
AUCTIONER COMM. 2,460.00
NOTARY FEE 5.00
TRANSER TAX 820.00
TOTAL 3,285.00 3,285.00
Total (Carry forward to main schedule) 7,496.75
Estate of: KATHRYN K. WISE
Schedule H Part 7 (Page 3)
11 EXPENSES FOR MAINTENANCE AND UPKEEP OF REAL ESTATE
LOCATED AT 211 CLARK STREET, LEMOYNE, PA 17019 AS
FOLLOWS:
LAWN MAINTENANCE 943.40
TRASH REMOVAL 90.00
ELECTRIC SERVICE 72.07
WATER/SEWER 331.40
REPAIRS 6 REMOVAL 300.00
TOTAL 1,736.87
12 REGISTER OF WILLS
PA INHERITANCE TAX RETURN AND INVENTORY FILING FEE
13 ESTIMATED ADDITIONAL ADMINISTRATION EXPENSES
Total (Carry forward to main schedule)
21 it 0672
1,736.87
30.00
100.00
1,866.87
REV-1512 Ex+(12-0~ SCHEDULE
Pennsylvania
oEPARiNB+rOF REVENUE DEBTS OF DECEDENT,
r~48tITANCETAXRETURN MORTGAGE LIABILITIES ~ LIENS
RESOearoECEOENr
ESTATE OF FILE NUMBER
KATHRYN K. WISE 21 11 0672
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrefmbursed medical expenses.
REM VALUE AT DATE
~gER DESCRIPTION OF DEATH
~• PNC SANK N.A. CHECKING ACCOUNT # 51-4006-9872. CHECKS
ISSUED PRIOR TO DEATH BUT HONORED SUBSEQUENT THERETO AS
FOLLOWS:
# 5642 13.75
# 5643 59.81
TOTAL 73.56 73.56
2 WEST SHORE EMS
A1~ULANCE SERVICE
06/20/11 PAID 109.87
08/26/11 REFUND 79.06
NET AIrIDUNT 30.81 30.81
3 (BRUCE SAYLOR
~~ ~~~ 140.00
4 PENNSYLVANIA AMERICAN WATER
WATER SERVICE 59.00
5 IPPL ELECTRIC UTILITIES I
ELECTRIC SERVICE 14.34
6 QUANTUM IMAGING THERAPEUTIC
MEDICAL SERVICES
06/22/11 PAID 31.48
08/29/11 REFUND 30.59
NET AMOUNT .89 0.89
TOTAL (Also enter on line 10, Recapitulation) I i 31
awasAN z.~o . If more space is needed, insert additional sheets of the same size.
REV 1513 EX+(01-10)
Pennsylvania
DEPARTMENiOF REVENUE
~...y-.".......~ r. v ear ~Du
SCHEDULE J
BENEFICIARIES
ESTATE OF: FlLE NUMBER:
KATHRYN K. WISE 21 11 0672
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal d'~sUibutions and transfers under
Sec. 9116 (a) (1.2).)
1. CARMELLA A. KILLICK SNELBAKER
2865 LEWI3H]u[2R'y RD
YORK HAVEN, PA 17370
50$ OF RESIDUARY ESTATE PER ATTACHED
STATEMENT
INVENORY VALUE: 336,313.04 Niece 336,313.04
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
[[ NON-TAXABLE DISTRIBUTIONS
A SPOUSAL DISTRIBlIT10NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
I B. ChWRfTABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
:.. -TOTAL QF PART Il
9W46AI 2.000
TOTAL.NON-TAXABLE-DI&TRIBUTIONS-ON LINE 18-OF RSV-15Q0-COVER..SHEET_. S - 0-. 00. ---
more space is needed, use additional sheets of paper of the same size.
Estate of: KATHRYN K. WISE 21 11 0672
Schedule J Part 1 (Page 2)
Item
No. Description .Relation Amount
2 HARRY C. KILLICK (D/D 10/12/11)
C/O ELYSE E. ROGERS, ESQUIRE
635 N. 12TH STREET, SUITE 400
LEt~OYNE, PA 17043
METLIFE INVESTORS USA INSURANCE
CO~ANY ANNUITY CONTRACT # A2074242
PAYABLE TO HARRY KILLICK
VALUE AS OF 05/16/11 PER ATTACHED
LETTER
VALUE: 106,600.78 Brother 106,600.78
3 ROXANN K. RHAN
2825 LEWISB'~Ry ~
YORK HAVEN, PA 17370
METRO BANK
CHECKING ACCOUNT N~A~ER 536141807
VALUE AS OF 05/16/11 PER ATTACHED
LETTER AS FOLLOWS:
BALANCE 05/16/11 527.25
ACCRUED INTEREST .00
TOTAL 527.25
VALUE: 263.63
50~ OF RESIDUARY ESTATE PER ATTACHED
STATEMENT
INVENORY VALUE: 336,313.04 Niece 336,576.67
ESTATE OF: KATHRYN K. WISE FILE # 21 11 0672
ATTACHMENT TO SCHEDULE J -BENEFICIARIES
THE ESTATE OF HARRY C. KILLICK PER THE ATTACHED PETITION FOR AUTHORIZATION
TO DISCLAIM HAS DISCLAIMED THE ESTATES INTEREST IN THE RESIDUARY ESTATE OF
KATHRYN K. WISE. AS A RESULT OF THE DISCLAIMER THE RESIDUARY ESTATE WILL
PASSTO TWO NIECES OF KATHRYN K. WISE.
CALCULATION OF RESIDUARY ESTATE
REAL ESTATE PER SCHEDULE A
STOCKS AND BONDS PER SCHEDULE B
CASH, BANK DEPOSITS, ETC PER SCHEDULE E
JOINTLY OWNED PROPERTY PER SCHEDULE F
NONPROBATE PROPERTY PER SCHEDULE G
TOTAL GROSS ESTATE ASSETS
LESS
120,000.00
70,921.66
535,941.91
263.63
106,600.78
833,727.98 833,727.98
FUNERAL AND ADMINISTRATIVE COST PER
• SCHEDULE H 53,918.89
DEBTS OF DECEDENT PERSCHEDULE I 318.60 _
JOINTLY OWNED PROPERTY 263.63
NONPROBATE PROPERTY 106,600.78
TOTAL 161,101.90 161,101.90
RESIDUARY ESTATE 672,626.08
THE RESIDUARY ESTATE IS DIVIDED EQUALLY AMONG THE DECEDENTS
NIECES AS FOLLOWS:
NAME OF HEIR PERCENT VALUE OF
INTEREST INTEREST
ROXANNE M. RHAN 50% 336,313.04
CARMELLA A KILLICK SNELBAKER 50°~ 336,313.04
TOTAL 672,626.08
cow~ormrEa<n+ of PEn~sr~var~w
D~ARMENf OF REVEIiUE
BURFJIU OF NdDIVIDUAf.TAXEB
DEPT. 280801
NARR198Ulk'a, PA 77128-0807
RECENED FROM:
PNC BANK NA
PO SOX 30~
CAMP HILL, PA 17001
REV-1182 EXi1t-96? .
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 014835
ESTATE INFORMATION: ssra: t~2-of-0ols
FILE NUMBER: 2111-0672
DECEDENT NAME: WISE KATHRYN K
DATE OF PAYMENT: 08/11/2011
POSTMARK DATE: 08/ 11 /201 1
couNTY: CUMBERLAND
DATE OF DEATH: 05/ 16/2011
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ $86,772.56
I
.I
TOTAL AMOUNT PAID;
REMARKS:
sEAL
CHfCK# 1292076
INITIALS: CJ
RECEIVED BY:
586,772.56
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
LAST WILL AND TESTAMENT
Ok'
KATHRYN K. WISE
I, R.ATHRYN K. WISE of the Borough of Lemoyne, Cumberland
County, Pennsylvania, declare this to be my Last Will and -
Testament, hereby revoking any will previously trade by me.
I - I direct the paymenir of all my just debts and
funeral expenses out of my estate~as soon as may be practical
after my death.
II - I devise and bequeath all of my estate of whatever
nature and wherever situate unto my husband, Roland K. Wise,
providing he~ survives me by sixty (60) days.
III - Should my said husband fail to be living on the
sixty-first (61st) day following my death, then I devise and
bequeath all of my .estate ~of whatever nature"and wherever
situate unto my brother, Harry C.' Killick of York Haven, Pa., or
his issue per stirpes.
IV - I direct that there be no public sale of ~my house-
hold goods and furnishings conducted from the premises.
V - I appoint my husband, Roland K. Wise, Executor of
this, my Last Wi11 and Testament. Should my said husband fail to
qualify or cease 'to-act as such, then I appoint CCNB Bank, N.A.,
New Cumberland, ~a., to act in this capacity. Neither of my
personal representatives shall be~required to post bond in this
or any jurisdiction. .
~81POLD~ $LIEE & BaY7.E7
erraaaers wt u~r
.e. w.aia seam
Page 1
IN WITNESS WHEREQF, I have ~her.eunto .s.et my. hand and seal
on this, the. "" ' "e~ - day off" ' " " ~" " ' T, 180.
r'
...... .. .. .. .. (SEAL)
athr K. W~.se .
Signed, sealed, published and declared by KATHRYN K. WzSE, Tes-
tatr.ix therein named, on. this and one '(~,) other sheet of paper
as and for her Last ~W3,11 and Testamenit in oux presence, who, in
her presence, at her request and in the presence of each 'other,
have hereunto subscribed our names as attesting witnesses.
Name A dx'ess
~~1{
Name ~ A s s
3NOL0, SUKE 6 BAYLEY
ATTORNEYS AT IAW
2109 MMIKET STREET
AMP H0.L. PENNSYlYAN1A 17011
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF' CUMBERLAND)
I~ KATHRYN K. WISE , the testatrix whose name is signed.
to the attached or foregoing instrument, having been duly quali-
fied according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it will-
ingly; and that I signed it as my free and voluntary act for the,
purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by
KATHRYN• K. WISE the testat rj,x this _ 7fi~, day
of June , 19~.
No ary Public
Thelma S. l~'kCausCa, Notary PubTt ~ ,
My Commission Ezplres July 1, 1984 ..
Camp 1181. AA £unlberFalsd County ' •
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND)
~. ~ the undersigned,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose ar~d
say that we were present and saw the testatrix sign and execute
the instrument as her Last Will; that KATHRYN K. WISE
signed willingly and that KATHRYN K. WISE executed it
as her free and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testatrix signed
the will as witnesses;. and that to the best of our knowledge the
testatrix was at that time 18 or more years of age, of sound mind
and under no constraint or undue
Siaorn to and subscribed before me
this 27th day of June , 19$0
..,
:N tary Public
Thelma S. IbtCCauslin, ~!o~ary Public
IIAy Commission Expires July 1, 1984
LAST WILL AND TESTAMENT
OF
ROLAND K. WISE
I, ROLAND K. WISE of the Borough of LeIIioyne, Cumberland
County, Pennsylvania, declare this to be my Last Wi11 and
Testament, hereby revoking any will previously made by me.
I - I direct the payment of all my just debts and
funeral expenses out of my estate as soon as may be practical
after my death.
II - I devise and bequeath all of my estate of whatever
nature and wherever situate unto my wife, Kathryn K. Wise pro-
viding she survives me by sixty (60) days.
III - Should my said wife :fail to be living on the
sixty-first (61st) day following my death, then 'I devise and
bequeath all of my estate of~whatever nature and wherever
situate unto my brother-in-law, Harry C. Kllli,ck of York Haven,
Pa., or his issue per stirpes.
IV - I direct that there be no public sale of my house-
hold goods and furnishings conducted from the premises.
V - I appoint my wife, Kathryn K. Wise, Executrix
D, SLISE 8c $1YI.EY
TTORMY6 AT LA~I
A fYt~R RIiR~.
I~ii~rYM1T1 AMG IMII
of this, my Last Will and Testament. Should my said wife fail to
qualify or cease to act as such, then I appoint CCNB Bank, N.A.,
New Cumberland, Pa., to act irz this capacity. Neither of my
personal representatives shall be required to post bond in this
or any jurisdiction.
-~~'1~
---. Page 1
IN WITNESS WHEREOF, I have hereunto set my hand and seal
on this, the ~' v day of ~' 1980..
~~ (SEAL)
Ro an ise
Signed, sealed, published and declared by ROLAND K. 'rJISE, Testa-
tor therein named, on this and one (1) other sheet of paper as
and for his Last Will and Testament in our presence, who, in
his presence, at his request and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
- (~"~~(l~O~
~LILE 8c B~YLEY I
4r:E:n :nun
.><.
FL11MtTL AML I1W
Page 2
COMMONWEALTH OF PENNSYLVANIA)
SS .
COUNTY OF' CUMBERLAND)
I~ ROLAND K, WISE , the testator-whose name is signed
to the attached or foregoing instrument, having been duly quali-
fied according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it will-
ingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by
ROLAND K. WISE the testator this 27th day
of June ~ , 19 80 .
,~J7 ~.aLcr,~-Cc,,~, .
otary Public .
Thelma S. k4cC~sren, Notary Pub!'a< ~.
My Commission Expires 1u2y i, 1984
Camp HiE, PA Cumberfa~ Couagr
D, SLfKE B BAYLEY
rroen~rs Ar uw
109 MARKET STI~ET
IU. PENNSYlYA1NA 11011
COMMONWEALTH. OF PENNSYLVANIA)
SS.
COUNTY OF CUMBERLAND)
WE, the undersigned,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose ar~d
say that we were present and saw the testator sign and execute
thg instrumeng ys his Last Wi1Rlo~thDatK• WROI~D K. WISE
si ned willin 1 and that executed it
as his free and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testator signed
the will as witnesses; and that to the best of our knowledge the
testator was at that time 18 or more. years of age, of sound mind
and under no constraint or undue influence.
Sworn to and subscribed before me
this 27th day of June , 1980
_i
N tart' Public
Tl;etma S. MsCauslin, Idnt3ry Public __
Mr Commission ExFircs )u!y 1, 198A
IN THE COURT OF COMMON PLEAS OF
YORK COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
ESTATE OF HARRY C. KILLICK, NO. 6711-1810
DECEASED
ORDER
AND NOW, this ~ day of a ~ , 2012, IT IS HEREBY
ORDERED that Roxann M. Rhan (a/k/a Roxann M. Killick) and. Ca~ela A. Killick
Snelbaker {a/k/a Carmela A. Killick), Personal Representatives of the Estate of
Harry C. Killick, deceased, are hereby authorized to execute a Disclaimer for and on
behalf of the Estate of Harry C. Killick in the form attached hereto as Exhibit "A".
BY THE COURT
~..r ~ ~ :--_ ~,
--,. ,.,,
- J.
Distribution:
Elyse E. Rogers, Esquire, Saidis, Sullivan & Rogers, 635 North 12th Street,
Suite 400, Lemoyne, PA 17043
~=
~ --
C ~+,~ ~
~.
Court Division of the Common Ple s Court or :°~. ti ~?'~;'
York Courtty, Pennsylvania this~day -'~r '~ ~=~f`:;
L. vz ~ ~ s
BRADLEY C. ACO S Clsrk of h ns' Court Q
"~+
IN THE COURT OF COMMON PLEAS OF
YORK COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
ESTATE OF HARRY C. KILLICK, N0.6711-1810
DECEASED
DISCLAIMER
The undersigned, ROXANN M. RHAN (a/k/a Roxann M. Killick) and
CARMELA A. KILLICK SNELBAKER (a/k/a Carmela A. Killick), being the
Personal Representatives of the Estate of HARRY C. KILLICK, intending to be
legally bound, make the following disclaimer:
Disclaimants hereby disclaim all right, title and interest the Estate of
Harry C. Killick may have in the residue of the Estate of Katliiyn C. Wise.
This Disclaimer is irrevocable and unqualified.
IN WITNESS WHEREOF, the undersigned have set their hands and
seals this a6 ~ ?~ day of fin v ~. rv, , 2012.
Witness
i
Wit es
~~
ROXA M. RHAN (a/k/a Roxann M.
Killick), Personal Representative of the
Estate of Harry C. Killick
~~,
CARMELA A. KILLICK SNELBAKER (a/k/a
Carmela A. Killick), Personal Representative
of the Estate of Harry C. Killick
COMMONWEALTH OF PENNSYLVANIA
L. SS
COUNTY OF ~~ mr ~ ~a nc~ .
On this, theoZ~ day of ~JQnu~ ` , 2012, before me, a Notary Public, the
undersigned officer, personally appeare~ROXANN M. RHAN (a/k/a Roxann M.
Killick), known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that she executed same for
the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and notarial seal.
N tary ublic
My Commission Expires: COMMONWEALTH OFD vANU-
(SEAL) KELLY R. HC±WELL, ~ Public
Lemoyne Boro., Cumberland County
My Commissron Exp~es r 2, 2014
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C U h~~~G1 ~~ SS
On this, the a~ day of ~a it Ua ~ , 2012, before me, a Notary Public, the
undersigned officer, personally appeare~ CARMELA A. KILLICK SNELBAKER
(a/k/a Carmela A. K;ll;ck), known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that she
executed same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and notarial seal.
COMMONWEALTH OF PENNSYLVANIA
My Commission Expires: NOTARIAL SEAL
(SEAL) KELLY R. HOWELL, Notary Public
Lemoyne Boro., Cumberland County
M Commission Expires September 2, 2014
a.es luo. u~2~2ss
A. B. Tree of Law:
DEPART~MT OF HOU89s3 6 URBAN DEVEl
U
3 01' 1.[~FHA 2[]FmHA 3.DCONV. UN91S. 4.Q1/A 6. CONV. INS.
.
. . 8. FN.E NUMBER: 7. LOAN NUMBER;
SETTLEMENT STATEMENT CT 2011-119
8. MdtTGAGE OVS CASE NUMBER:
C. NOTE: TA(e Rorrrr b linelldwd b pirr you s seNwnerrt d achsl seMOsewM msis Amewrrfspeafd b end br tlw selgaTlanf a9enl s» shown.
. llTlas mrlsd'~POCJ"wNe poldoud~fds fie abmi~ Meyare slawnllenr tbr~papo~eswrawAS notkldudsd in lht btal~
1J eNt-1nswXetsll•11
D. NAME AND ADDRESS OF BORROWER: E NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Sayereors eroMNS ConNnedbr! PNC BN1k NA., Exeeelhor d tl1e CASH TRANSACTION
LLC EstrMe d K Whe
120 CapNoi H1M Road 4242 CNNs1a PAre
Oisbury, PA 17019 Carp Hi, PA 17011
Q. PROPERLY LOCATION: H. SETTL4:MENT AGENT: 1. SEITLEIJENT DATE
271 Chek street CT La1d Selvbes Company (717) 236,5253
Lamoyrw, PA 77043 Nove!lebeT f8, 2017
CumbsAend County. Paleresylw111a PLACE OF SETTLEMENT
300 NorBr Seoaed Street, SuBe 701
Hartisbeup, PA 17101 (717) 236.5283
J.
. TION K SUMMARY OF TRANSACTION
100..
t9tOM BtNtliOYVER: 400. GROSS AtNOUNT DUE TO 3l0.LER:
101. 000.00 40f. ConlrW Sales Prke 000.00
102 Pataolpil 401 PersorW
103. Saltlenwad b eNearer 1 1737.76 4G3.
104. 404.
]OS. 405.
FaJtamsPald SaAahad~wlue FaMwrsPlYd SsMrbsdaeae
106.. owafTs>ess 1U16%1 b OU01112 41 406, oeeeTa~ws 11/18111 b OUOi/f2 41
107. Tws 11I18H1 b O11D1/12 3892 407. Texas 1fH0111 b 01A1M2 3992
t08. ~Nws 11!16/17 b 0710(/12 818.74 406. sdaolTaxes 11!10111 b ff/101H2 616.74
100. 400.
1f0. ProiaEed Reese Fees 11//8111 b 01IO1M2 2250 410. 11H 1 b 0 2
111. 411.
12 412
1201 GRf7SSAMtW1VfDUEFROMBORROWER ~ 64,8599t 420. GROSSAMOUNTDI/E705EiLER 82,922.18
PAtD Ot21N tSENALF OF BORRO1AlER: 600. REDIICTlWiS M DUE TO Bq I Fp•
201': (0000.00 50l. Exasas InWOellors
202 aa2. Sawemsnt b SeMr 1 3 .0.5
203. s b 503. Meer! b
204. 604. Fat
205.
206. I 606. MaIlwd setter 10000.00
207. 507.
206.
200. 1 509.
FarNarrs Sefp Fevleerrrs Sspsr
210.. Tares b 510. own Tars b '
211, sews b alt. Trees b
212 Taxes b 512 Srilool Taewe b
213. 513.
214. ~ 514.
215. 615.
21& 518.
217. 517.
2f8. 518.
219. 519.
220. 70TALPADBYReCJR80RROWER 10,000.00 SZ0. TOTALR~tlC710NAMOlNVrOUESEIIER 13,340.9b
300. A 600. CAtiH AT
30f. From tdorrosrN' 1 e 8465991 8D1. Brass Amorr>t Oas To SeM 78
302 Less Aneount Paid or BaroawT 10,000 802. Lass RedueBorea Dus SaON $ 73
300. CASH(X FAr>51) ( Ti?) ~RRONSR ' 74.85891 003, CASH{ X lID) ( FROM) SELLER 89,56121
,_.Y+r
~.r....r-.-....~.~....~....~.-..+..v..,-+.r..o...w.~w--o W.rw ~.y., w.a wop.y. w.w~....
ae.a~weww 1ors~c
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asairveee: IFYa11A11a11~w1apTOPeEARE11eW,ASerxssee:aPdeattaeamml sAleCTe0r1 eMYeEeraaoarYOUrllasRawaeauanomeaRaPaaleoAf071sasoaTeaweREs
owYrtw~seloxe~eaeoaree- mu~ael~u~wuwm~lov~oenee:aelndeer-AOennwmrawcaaaeaTASOr~soertwcAfeoMwwwwe. srauooewrreeovwens
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aesaaMaPrvAwulrawAMaeesrAp MtOeeaeYUAe~woTOerWtlMpeNMeaMtOpala TOrWleleuAaea aMeaMiMr rtaetteerwrYeMSCAaeMYwaMeasioan
a W.aMMeuiMelo/e+r. Fw6ffi.MriMnME/eMraAt, eedeorexasM00~0e0/a1al.CidQ+ln~Loewr.lhue~e~i~e~wawupWwb9Meef ilrya[af~fNwMUaMNMeM/eye M
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alaunw.+MahNrMewR.wemrrne»pweoerrsama.MTw.eeewe~ar~Mrewwmu~wl~w.~arosaneMs.owsesaarpraayawaaeosa.wr.we.ar. tKSleunw.
NMdrN6NlM1wwM~WMlab~lM7w.M~b~lwY waaoMMNeoweanM'OrwMeawr'aNdFa,a 1010: Fet~an Npwdw4 s»Rb Sti.
rrnapwwsMasweAaNOe..w.e.aortrww~saromKlasee wee.saa,row.os
orpeeseueater TNenXT • eale0w5wi«..ea.b.
1eNOfR/N4U.T~a OFP9rJealY,lCHe76Y iHATTMElAXeeErt Sie01MlaHOW OM TNa aTATl01ENT60rtOpaKCT TAXPAYER eOBrTIFMal101e1Uelde.
T~elpleEn, Tia11aa1!
f~a
~. sErnE~ENT cFU-RCEs
TOO. TOTALS Bsaed on PAoe S 82.000.00 5.0000 % 2.460.00 nsto rear tvao amyl
eannowrars seueirc
as
fUNpeAT Ra06AT
BETKGtarR aETiL.fJiMi
b
701.
,
800, ry~Y 111 COIJN6CTi0N WITH LOAN
f. Fee % b
802. t.0aa' % b
b
b
805. Fes b
. ee b
« b
10.
i.
>qp, REC%lllt@D BY LENDER TO BE PAID 1N ADVANCE
801. Ntt~naitF b ' f %
motes b
803.11a~eard M3S0ancs Piemitoi foi 7A b
9D1.
906:
1000. 1INTH LEi1DER
1000: lrautinoe a~ortOte S month
1003. aemTeian aloitBK i "~
ertorAll
F
u
1001. hies monl
7005. BohoWTws mon8fs i Par morMh
1 S
1007. moedhs S ~~
1008. -months i
l100.TtiL!
11D1, o< Fee b
1 ef' SHroh b
1 to
1104. b
1106.. b CT Land Servfoes
10
00
5.00
1100. b .
1107. Feaa b
rxxnbsis:
T~
7 .7
ai6owa Near rxenbers:
~
1
i
1 S 82,OD0.00 750.5
i, Land
11 CT
00
45
.
b
1200. t3dYlY b111f3AND TRAN'SF'!st CNARGEB
1201. FNS: Decd i 62.00; i Releases i 62.00
• e
1ZQ3.SWtT Retbmis 82D.00:
820.0
0
1204.
1205.
1 SOp, ADDlT) WIAL 8ETTI.E~NT CHARGES
t701. to
1 b
1700. Ts
1 f1 RMaMfon Fee b CT Land Ssrvkes
50.0
0
1J06. WstaA9wru Feb b 8orouyh of Lemoyne • 65.95
1400. TOTAL BETTLPJA®ff CHARGES on Llrles 1 Section J and 802, SacBon 1.737. 3.340.
t~
.%~~
i
4.
CerlBisd b its • trw Dopy. .
TM 3SadNdpMd Mraby admowledpe +'aosPl 01 a completed Dopy ~ paD~ 132 of 8tis a4krrterfl 3 srry s8aclnltertts referred b henlin.
I HAVE CAREFIR.tY REVB~NED TFIE NU0~15Ef11..teAAENT STATE#~IT AND TO THE BEST OF h1Y 10~lDVVLFDGE AND BELL. IT IS A TRIG AID
ACCURATE 8TA OF ALL RECEIPTS AND fyENTS MADE ON MY ACCOUNT OR BY ME IN TFBS TRANSACTK)Pl. I FURTHER CERTBY
THAT 1 HAVE RECENED A COPY OF THE HUD-1 SEITI.EMENT STATEMENT.
~e~ Seyarae Broth fan LLC SeMr PNC IcE>r ale E: oI1Calhryo K Wise
A~leu Seyrnora B . I
L'ttMs .l.rMtdber9 ~ 4#;~~a
BY;
Slum eymore
TO THE BEST OF)vAY KNOWLEDGE. THE tIl1D-1 SETTLEMENT STATEMENT VE PREP A TR TE ACCOt1NT OF THE
FIJNOS WFMCH WERE RECENED AND HAVE BEEN OR WIU. BE ~SBUR SIGNED ESE MENT OF THiS
TRANSACTION.
CT anY.
WARNgrG: Tf IS A CRWE TO KNdWOJGLY MAKE FALSE STATEMENTS STATES ON THIS OR ANY FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FD1E AND lMPR130NMENT. FOR DETAILS SEE: TITIf 18 . CDDE SECTION 3 SECTKNI 1010.
{Cr 2011d101CT 3011.tro11al
LAND APPRAISAL REPORT
w..r,
Pape B3
Beetorwr WA Cerarrs Trad 0204.10 Map Rdaarce 42-133
tiopaAy Addresa 2865 roar L Rd
(81y. York Haven Corapy Yortr Stale Pa Zip Corte 17370
Lapai Detagtion 64Z 821 Tax Assessmerk p67-39-000-PG0132-PO
Sale Prke S WA Dab d Sab WA Loan Tam WA yrs. Propaly Riphls Appraised Fee ^ Leasehold De AOrimis PU
Adwl F1aM Edda Tama S 500(est) (f~ Loaa charyes to be pdd by seer S WA Otlra sales liars WA
~ PWC Advisors Address 1600 Market St 8fh Fl PtrBa Pa 19103
Octagrrt vacant parcel Appraise Terry E. Freeman arstrrrdiarN b Apprafsaa vacant reel for H hest and Best
et vakre/Estate
LOCrrporr Urban 5uburben Real Good Avp. Fat Poor
Bub uD ^ Ova 75% ^ 25%m 75% ®lkda 25% Empbyrrmnt Stebkky ®^ ^ ^
BroaM Rde ^ Futiy Dev. ^ Rapid ^ Steady ®Sbw Convaiarce b Errrpbynrad ®^ ^ ^
AoParA' Vakres ^ kaxastp ®Stable ^ Decfirinp Convedarce b Shopping ®^ ^ ^
DarorglSupply ^ Shorla~ ®h Balance ^ Oversuppy Comrenience b Sctrooly ®^ ^ ^
Madmtirrp Time ^ UMa 3 Mos. ®4.6 Mos. ^ Over 6 Mos. Adequacy d Public Trarrsporlation ^ ^ ^
Presort Lad Use 20% i Family % 2~ Famly _% Apte. _% Condo_% Conanardal Recreational Fadities ^
brdustrial 80% Vxart _% agrYwoodedNacark lend Adequacy d Utifties ^
Charge in Pmsad lard use D Nd Ukdy ®L~aN (`1 ^ TaNnp Place (') popaty CanPatibiKy ®^ ^ ^
(* From vacant oarcek To single famiN Pmictiorr irom Debtrrapal Carditiorm , ®^ ^ ^
PredomNmnt Ocaganry ~ Dwner ^ TarNrl 0 % Vacant Pdice aM Rre Prdedion ®^ ^ ^
Stipte Famly Price Rarge S 120.000 b S 600.000 Prcdominard Vdue S 170.000 Genaal Appearance d Propapes ®^ ^ ^
$~ F~r pQe 4 yrs. t0 150 yrs. Predorrirenl Ape 30 yrs. Appeal t0 MeduR ®^ ^ ^
Conurmras kxdudirg those tacbrs. favorable a arlavaabk, aifedinp narketebBity (e.p. puMc parks. sdrods, view. noise):The eot i skuated in a rurel bca8ar but
rreaK via 83 to s schools and em eM ~rrtere. The homes h the rre hbortwod are a com tlble bk+nd of detached
. There are no adverse market trends
Dhnelrsiorra see ales area 1.5 Sq. R a Acres Comer Lot
Igelp dassifi~fOn R-1 rtssidenUai s' fpm Presets krrprovemerps ®do ^ do not codorm b zoNrrp reglaVorrs
tfphest and best use Presap use Otla s
Pubic Opmr (Descdbe) OFF SIfE k~ROVEMENiS Togo bveUsi in to the rear
~, ® Stretd Access ^ Prtbic ®Pdvate Size I for nei hbortrood
Bas ^ urooarre Solace ripM-of-vvay Stage' rear
1Nder ^ weti Maintenance ^ Pubic ®Pdvate View
San. Stara ^ seattc ^ 5ttxm Sewa ^ CurblGuka Dr~rage appears adequate
^ tkdagowrd Elect. 6 Tel. Sidawak Street b the properly halts b a lRW IdentlBed Spedal Rood Naard Area4 ®No^ Yae
lbrmMrte Ravaa6le a udaratbb krekrdrrp any append adraM easemeds, encrwclarNna, a oparr edrase car~oM): there pro ra a rent adverse easements
corrdNbns a erxxoachnemffi a easemerts a his of wa which m traverse the ed ales.
The arrderaiprred hM ra,Med pats raced adM d prepapes most sMa and pralmab b subbd end aM carebNed tlN58 b pre market arrayds. Tae desaiplon ka:kdec a dalar
a4aanNat ratiaealq mNkd rMCiM b pots kNrN d dpnfieaa Melon belaear pN edged aM eamparabk propNYes. k a sipNacNd aNn b pre eargraak properly fs ~~
b a mots bvorable pea tle aubjad pmpaty, a mica (-y adjrabMk fs made pea mduckrp pN irdcbed rake d abbCt a a sipriflcant pan b pN conpNahle is aeabr b a less
quotable 1hn the apb)eet ptopeAy, a plea (+) adprshnerl b made thus irwoeashq the indicated taken d the Subject
Reu TY q~ARABLE .1 COMP .2 COi~ 9
AAdMas 2865 (rear) L.ewisberry Rd 227 Wilis Rd Fisher Rd
York Haven Etters Etters
WA 50 000 55 000
WA
MuMN.ict Service Muki•List Service
Dale of Sob ad C + - RIPTION + - Ad RIPTIOII + -
Time Adjrrstnda WA 3/232011 6222011
1.5 apes+/- 1.38 acres t acre+/-
mss a RIVU deed btic rd -15 000 direct rd -15000
Saba a FaWrdnp
iAIICKal0r16 WA Cash Cash
+ 15000 + - 15000 + -
d Subbtt~ Net 30.0 % 35 0~ lit 273 X 40 000 Net %
Comment on Marimt Data: O two sukaDi site sales ocaxed in 18 mon ths of date of death of owner
Coarpmrrte and Condition of Appnisd: aDD. "~ "^° *r°"' .n ~rmmnriarw a einele family dwe~ra and an on ske driled wei and
asuksDb waster I
yeas fo the ales is of as described in deed which b reference is made a art hereof
Rml Recaadiatldlr (uti vve M iven to sales com rison a to value. Ad'usted sale re of iser selects a value of
t Eai1MAS! 1NE M~NMET YaleE. Aa aEFINEe, DF aaaJECT M[reE11TY •f OF 5/16 2D 11 k1 as S 36 ODD
Tefrv E Freeman 8/022011 ®Did ^ Did Nd Physirsy bsped Property
g Revkw iser d
~ Freeman Rent Esbte
Form WD - `TOTAL to YAndows• appraisal soitware by a b mode. brc. -1-800-ALAMODE
Page #F4
APPRAISAL AND REPORT IDENTIFICATION
This AppraRal Rsport ~ Do8 of the fdlowinp types:
^ Self Cordained (A writlen report prepared under Standards Ruh 2-2(a) . persuard fo the Scope d Work, as discku:ed elsewhere in this report.)
® Summary (A vrdtlen report prepared u-rder Standards Ruh 2-2(b) , parstrant to the Scope d Work as discbsed eheNdrere in this repot)
^ Rsatricted Use (A wrtear report prepared under Standards Rule 2-2(c) , persuaM to the Scope d Work as discbsed elsewhere in this report,
restricted fo the stand frrhr~ded use by the specified cfient or intended user.)
Comments on Standards Rule 2-3
I txr8ly that, to Ure bed d my bawbdpe and beta: "-'
- The stehrrwds d bd cariakrod in dls repel ua true and coned.
- The reported froyses. opkrimc, and conduslons are irited ody by the reported assumptlons and hrddnp corrdMbns and are ny personal, hnpadiai, and undased profession
analyses, opirioru, and wrrcixiars.
- f have no (ache sPecdbd) prrsed a prospec5ve irdaest M the properly trot is the sub)ed d tris mport and rq (a ttre spedfied) personal ini wdh respect to the paNes
kwolred.
- I have no bias vrftlr rasped b tle property ilal h the subjed d this report a the parties knrolved rrNlr ttrs assigmrerR.
- My erpapenrmrt in this assipmbd was not wrrdrryert upon devekrpirrq a repadng predehrrrired rewNS.
- My compenptlon Wr calplelkrp this assiperwi is not cortlnpal upon the dsvdopnrert a repor4q d a predelermirred value a daectlon in vdue iha favors the cause d the
diem, the aal0lMd d the vaMae ophdon, the aGahurrart d a stiprrlrmed result, a the occurence d a subuprrdd evat direclly related h the krYrrded use d this appraisd.
- MY analyses, opgriorre, and condrrsiorrs were developed, and ih4s report has been prepared, h contomrAy wpb the UNlonrr Standards d Professkarel Appraisal Ptadice tint w
to died a tie time tlrfe report was prepared.
- tkrbss oelerelee irrdcahd, I have m~e a personal krspactron d the propaly tirri is the subject d tlis repoA.
- Uriesa oersadse indicated. no one provided siprrfiicard real propeAy appraisal ass~rrce h the person(s) sigrdnp this certlrrration (d there are maxpbons. the rranre d e~h
trrdividrrat providrq sfpillcad real propaty appraisal assisfura h steed clsewlrero kr this report).
- llnless otherwise hrdkahd, i here perfomred no servkxs regardkrp the subject ptopedy widin the prfa ihee years. as an appraiser a in any otlrer c~acriy.
Comments on Appraisal and Report Identification
Note any USPAP related Issues requiring disclosure and any State mandated requirements:
APPRAISER:
5iprabae: _ .~ ~ _. _-
Name: Temf: Freeman
Desigrrafon; Pa Stare Certrned Aonraiser
Date Signed: 08/0?l2011
5hh Cetlficatlorr is RL-00056&L
a State Utxrae ~:
Slate: PA
f~katlon Dais d Certigcatlon or License: 8!302013
C'fiectlve Dale d ApPaisak
SUPERVISORY APPRAISER (only M required):
Sipnabxe:
Name: 8!0212011
DesipWEon:
Date Signed:
State Ca6ficadon +A:
a Stare license ~:
Sigh:
E~iradorr Date d CerlklcaUar a Licaar
Supervisory Appraiser inspeclion d Subjed Property:
^ Did Nat ^ 6derror-only imm srres4 ^ Inleda arrd Exkda
Form ID10 -'TOTAL far Windorrs' a~raisal sattwxe by a la node, inc. -1 ~OD~tLAAtt>pf
Pape ~5
Subfect Photo Paee
wA
2865 rear L.ewisbe Rd
Yak Haven York Pa 17370
PNC Advisac
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2865 (rear) L.ewisberry Rd
Sabs Price WA
Gross living Area
ToblRooms
Taal Bedrooms
Tolal Batlrooms
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Sib
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SubJect Rear
SubJect Street
Form PIC3x5.SR -'TOTAL for Windovrs' appraisal so8ware by a b mode, mc. -1.800-ALAMODE
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Jun. 20. 2011 11:16AM PNC BANK 412-705-2747
~~~
1-EADb~N6 THE WAY
June 20, 2011
Carol Koscienski
PNC Bank
Wealth Management
RE: Kathryn K Wise
SSN: 172-01-0019
DOD: 05-16-20] ]
Dear Ms. Koscienski:
No. 8468 P. 2/3
In response to your request for Date of Death (DOD) balances for the customer noted above, our
xecoxds show the following:
Checlang Account
Account # 5140069782 Established: Ol-O1-1978
KATHRYN KWISE -
DOD balance: $ 25,273.05 + 0.40 accrued interest
Savings Account
Account # 5000939782. Established: 02-13-1997
KATHRYN K WISE
DOD balance: $ 20,815.38 + 0.17 accrued interest
Investment Account
The decedent maintained Investment Account # 87542283. For further information, you may call the
Brokerage Department at 1-800-762-6111.
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any fwancial transactions or provide statements. If you need assistance with
arty o£these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office. '
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
Page 1 of 2
pp
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499 Mitchell Road, Millsboao, DE 19966 Adjustment Services
Phone 888-502-4349
Fax (302) 9342955
June 29, 2011
PNC Wealth Management
P O Bog 308
Camp Hill, PA 17001-0308
Re: Estate of Kathryn K Wise
Social Security 172-01-OOi9
Date of Death: May,16.2011
NNG liHi11K
DECEIVED
..::~ aaZO»
IM&T
CPA
Dear Sir or Madam:
Per .your inquiry on June 21,2011, please be advised that at the time of death, the above-named decent had on
deposit with this bank the following: .
1. T ype of Account Checking Account
Account Number 9843038895
Ownership (Names o, fl Katiuyn K Wise
Roxa-ut K Rhan (POA)
pp~.g Date 09/l7/06
Balance on Date of Death $6,195.24
Accrued Interest $ .03
Total $6,195.27 ------------------------------
2. Type of Account Certificate of Deposit
Account Number 31003913821269
Ownership (Names o, fl Kathryn K Wise
Roxann KRhan (POA) -
Op~g Date 11/15/99
Balance on Date of Death $32,252.08
Accrued Interest $ .49
Total $32,252.57
3. ?}ape of Account Certificate of Deposit
Account Number 31003913821300
Ownership (Names ofl Kathryn K Wise
Roxann KRhan (POA)
Opening Date 12103/99
Balance on Dare of Death $3I, 954.70
Accnred Interest $ 9 67
Total $31,964.37- -----~--------- ------------------
For any additional lnformat[on on the above accounts, indnding ownership and any changes, dosares and/or reimbursement of funds,
please ®D the West Shore Plaza OIBice at #717-731-1730.
We were enable to locate any safe deposit box for the above-mentioned decedent.
This letta~ does eat indude aup accounts to which the deceased may have been lisFed as Power of Attorney, (~stodian of TJniform Transfers,
Restive Payee, or Tras6ee under a Written Agreement
S1nCel~ly,
Tammy Spencer
Adjtlsrment Services
PNC BANK
RECEIVEQ
METRO
BANK
3801 Paxton Street 888.937.0004
Harrisburg, PA 17111 mymetrobank.com
JUN 2 ~ 2011
June 27, 2011
PNC Wealth Management
Attn: Caroi Koscienski
PO Box 308
Camp Hill PA 17001
RE: Estate of: Kathryn K. Wise
Tax Identification Number: 172-01-0019
Date of Death: May 16, 2011
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: 536141807
Date Opened: 08/30/2002
Primary Owner: Kathryn K. Wise
Secondary Owner: Roxann K. Rhan
Date of Death Balance: $527.25
Account Type: Time Deposit
Account Number: 12000227
Date Opened: 08/30/2002
Primary Owner: Kathryn K. Wise
Principal Balance: $36997.52
Accrued Interest: $15.44
Date of Death Balance: $37012.96
Account Type: Time Deposit
Account Number: 120000561
Date Opened: 03/23/2004
Primary Owner: Kathryn K. Wise
Principal Balance: $53718.99
Accrued Interest: $26.40
Date of Death Balance: $53745.39
Please feel free to contact me at (717) 412-6127 if I may be of further assistance.
Sincerely,
Diana Reynolds ~•.._
Metro Bank
Research Associate/Deposit Services
'~A
aNC BANK
RECEIVED
~lUL 0 5 2011
~~ ~~ i f1A & T'
LISTENING IS JUST THE BEGINNING." CPA
July 1, 2011
PNC Wealth Management
P.O. Box 308
Camp, Hill, PA 17001
Deaz Ms. Koscienski,
RE: Kathryn K. Wise, deceased May 16, 2011
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
DATE OF DEATH ACC
CD# BALANCE 1NT RATE OPEN ROLL OVER MATURITY
052-0197195 $24,371.27 $206.41 1.04% 2/24/03 7/24/10 10/24/11
* Titled in her name alone with Roxann K. lthan as Power of Attorney
522-0052167 $24,438.96 $9.04 0.75% 8/29/94 10/28/10 1/28/12
* Titled in her name alone with Roxann K. Rhan as Power of Attorney
522-0065951 $28,439.45 $60.36 1.09% 12/6/94 3/6/10 6/6/11
* Titled in her name alone with Roxann K. Rhan as Power of Attorney
522-0092494 $42,116.54 $8.80 1.09% 8/9/96 5/9/10 8/9/11
* Titled in her name alone with Roxann K. Rhan as Power of Attorney
If you have any other questions, please feel free to contact me at (717) 291-2436.
Sincerely,
~~~
Joshua A. Groff
Credit Confirmation Processor
CONFIDENTIAL
this infonnRtion ~ tumished ss a matter of twsin ar.»'`~-~sY
in arltMbr t0 your inquwry, +~nd is far your cmfie`~ ~~: ~~rtfy.
Ttte bank furnishing this infUmlati0n X35 ~" =~;~„rx;~~t 8r
guartMfis the accuracy, Clarlplet~ness LF g~~~+i:~1~`~~4` elf ~~~
iniortnatian Pravldsd. No ~~~+ansini~Y ~ ssia>:stt~'1 ~'
bards or arry of its c~ce~s, ertiployees or ~. ~°:' ~`~'°'on
Herein e><Pressec+- is sufx°ct to cttan~e arfthou~ rtr,+iis~e
1.800.FULTON.4 fultonbank.com
Fukon Bank, NA Member FDIC. Member of the Fuhon Financial Family.
ESTATE OF KATHRYN K. WISE
FILE # 21 11 0672
ATTACHMENT TO SCHEDULE E- BANK ACCOUNTS & MISCELLANEOUS PERSONAL PROPERTY
VALUATION OF INTEREST IN ROLAND K. WISE ESTATE D/D 07/14/02
ASSETS VALUED AS OF 05/16/11 PER ATTACHED ESTATE TAX SECURITIES STATEMENT AND
TREASURY DIRECT VALUATION STATEMENT
576 SHS CATERPILLAR INC DEL. COMMON STOCK
ACCRUED DIVIDEND PAYABLE 05/20/11
$50 U.S. SERIES EE BONDS ISSUED 12/91
TOTAL ASSETS
LESS:
EXECUTORS FEES
ATTORNEY FEES
OTHER ADMINISTRATIVE COSTS
TOTAL
VALUE OF ESTATE INTEREST A/O 05/16/11
61,441.92
253.44
67.06
61,762.42
650.00
1,500.Q0
388.80
2,538.80 2,538.80
59,223.62
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j '~SgS'7Zgg~ ~ 07:54:24 a.m. 06-30-2011 RE(;~~V~D
Metlife Investors USA c1 U L O C.1 ~ O'
P.O. Box 14593
Des Mo[nes IA 50306-3593 ~ ~ Z
~~1` ~r f ~~ CPA
June 29, 2011
TRACY MEHALICK
PNC INVESTMENTS
(814) 689-1349 (FAX)
RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT A2074242
OWNER Kathryn Wise
BENEFICIARY Harry Killick
Dear Ms. Mehalick:
We are sorry to learn of the death of Kathryn. Wise. The following information will be helpful in settling the
claim on this annuity contract.
In accordance with the policy's death benefits, the beneficiary may choose one of the following options to
settle the funds still accumulating:
1. Request a lump sum payment of the cash surrender value. This value is paid in one lump sum,
and it would include all applicable surrender fees. This settlement must be made within 5 years
from the date of the participants death.
2. Request that income begin immed#ately from any of the annuity income options described on the
enclosed list. This choice maximizes the benefits of the policy since 100% if the annuity value is
applied to produce periodic annuity income. The guaranteed period of any option selected
cannot exceed the beneficiarys anticipated life expectancy. Proof of the benefic#ary's date of
birth is required 'rf a I'rfe option is chosen. Benefit payments must start within one year from the
date of death.
Because the policy is a legal document, certain forms need to be completed and returned before
settlement of the claim can be processed. Listed below are the requirements to settle this claim.
1. A cert'rfied copy of the death certificate.
2. The original policy must be retumed for lump sum settlement. If it cannot be located, section G
on the claim form must be completed and signed.
3. The Policy Claims Settlement Form. Please complete section A. A settlement option must be
selected as well as an election regarding Federal Income Tax withholding. Please note that
section F does not apply to the settlement of this claim.
If you have any questions, please contact your representative or ca## our Customer Service Center at
1-800-284-4536 Monday through Friday between 8:30 am. and 6:30 p.m., ET.
Sincerely,
Michael Irving
Sr. Annuity Representative - Posf Issue Processing
MetLife Annuity Operations and Services
51545/2393
MefLife Investors USA
P.O. Box 14693
Des Moines IA 50306-3593
07:54:50 a.m. 06-30-2011 I~~C: ~~:i~it(
RED~~VED
~ J~!:i_ ~ 5 2011
~~~ ~~ ~~ Il ~vl Gi l
CI'A
June 29, 2011
TRACY
PNCINVESTMENTS
(814j 689-1349 (FAX)
RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT A2074242
OWNER Kathryn Wise
Dear Tracy.
Thank you for your recent inquiry regarding the contract referenced above. Our records indicate thaf the
date of death and the account value on that date are:
Date of Death: May 16, 2011
Account Value: $106,600.78
If you have any questions, please contact your representative or call our Customer Service Center at
1-800-284-4536 Monday through Friday between 8:30 a.m. and 6:30 p.m., Ef.
Sincerely,
Michael Irving
Sr. Annuity Representative -Post Issue Processing
MetL'rfe Annuity Operations and Services