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Home My WebLink About04-0865REGISTER OF WILLS Of CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of .JAMES CHAMBERS BUSH No.l~" also known as , Deceased Social Security No 192-30-6142 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE "A" OR "B" BELOW:) ] A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut Decedent, dated and codicil(s) dated named in the Last Will of the Continued on a Separate Pa,~e ,;2~ "~7 Except as follows, Decedent did not man% was not d~vorced and d~d not have a child bom or adopted after execution of th~'l:~cumenta offered for probate: was not the victim of a killing and was never adjudicated incapacitated: , f,O , ] B. Grant of Letters of Administration ' -;~ :~ * (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minbe .ta.ta~, r% ,:.~ Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived byC~e following spouse (if any) and heirs: I Name Relationship Residence Carol A. Blanck Sister 422 Orchard Lane Manheim~ PA 17545 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County. Pennsylvania, with his/her last family or principal residence at 143 W. Vine Street (Shiremanstown Borough), Shiremanstown, Pennsylvania (list street, number and municipality) Decedent. then 68 years of age, died Sept. 15 , 2004 .at Lower Paxton Twp., Dauphin County, Pennsylvania (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ ~.._ OO~ t '"'" (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Va ue of rea estate in Pennsylvania ..i~~. ............................................................................. $ ~'~ ~O ~;b, Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Carol A. Blanck 422 Orchard Lane~ Manheim, PA 17545 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed Carol A. Blanck before me this 22nd day of September, 20,04 ~ DECREE OF REGISTER Estate of JAMES CHAMBERS BUSH Deceased also known as Social Security No: 192-30-6142 Date of Death: 09/15~2004 AND NOW, September ~,'~;~. 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary I'~ of Administration c.t.a.d.b.n.c.t, pendente ~; durante absentia; dur~,e ~inoritate are hereby granted to Carol A. Blanck "~ in the above estate and that the instrument(s), if any, dated ..r ' described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... Short Certificate(s) ............... Renunciation .......................... Affidavit ( ) ....................... Extra Pages ( ) .............. Codicil ................................. JCP Fee ................................. Inventory & Tax Forms ............. Other ...................................... TOTAL ............................. RW-7A Attomey Attorney: J. David Young, Jr. I.D. No: 39136 Address: Young & Young, Attorneys-at-LawI P. O. Box 126 Manheim PA 17545 Telephone: (717) 665-2207 DATE FILED: 09/22/2004 105.1 ~2 REV. 8/88 (FEE FOR THiS CERTIFICATE $2 00) WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH T 5737228 Sept 16,2004 Name of Decedent James Chambers Sex male Social Security No. 192-30-6142 Date of Birth June 6, 1936 Birthplace Bush Last Date of Deat~:ePt- 15~2004 Camden, NJ Place of DeathC°mm' Gen. Race white Occupation Dir. Human Resources Armed Forces? (Yes or No) yes Decedent's Marital Status never marriedMailing Address 143 W. Vine ST. Shiremanstown, PA Informant Carol A. Blanck Funeral Director Theodore Beck Name and Address of Funeral Establishment Buch Funeral Homer 21 Market Sq., Part I: Immediate Cause Osteopathic Hosp. Dauphin Lower Paxton Twp Pennsylvania (a) (b) Cardio pulmonary arrest Manheim, PA Interval Between Onset and Death (c) (d) Part Il: Manner of Death Natural Accident [] Suicide [] Renal failure (ESRD), Severe CAD Other Significant Conditions Homicide [] Pending Investigation [] Could not be Determined [] Describe how ~njury ciCcurred: ~,., Name and Title of Certfier Pravin Gadani MD Address 30 E. Shady Lane Enola PA (M.D., D.O., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the StateVital Records Office for permanent fil~ ~~_,~ 36_342 Sept.16, 2004 178 N Main Manheim REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JAMES CHAMBERS BUSH Date of Death: 09/15/2004 WillNo. 2104-0865 Adm. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 0912712004 : Name Address Carol A. Blanck Susan Bush Conyac Edwin M. Bush, Ill 422 Orchard Lane, Manheim, PA 17545 140 Bradwick Circle, Debary, FL 32713 105F East Villa Capri Circle, Deland, FL 32724 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Continued on a Separate Page Date: 09/27/2004 (Si~(~mre) / Name: J. DAVID YOUNG, OR., ESQ. Address: 44 S. MAIN STREET, P.O. BOX 126 MANHEIM PA 17545 Telephone Capacity: (717) 665- 2207 X Personal Representative Counsel for Personal Representative LAW OFFICES YOUNG AND YOUNG 44 SOUTH MAIN STREET P.O. BOX 126 '<D MANHEIM, PEN~'Syr}'-VANI'~'''''17545 CUMBERLAND COUNTY cOURTHOUSE REGISTER OF WILLS OFFICE i cOURTHOUSE SQUARE CARLISLE PA 17013 CUPlBERI~AND COUNTY Transmittal Payment of Inheritance Tax Name & Address of Attorney of Record/Financial Institution: J' David Young, Jr. Young and Young, Attorneys-at-Law P. O. Box. 126, Manheim, PA 17545 Name ofDecedent(last, first, middleinitiat) Bush, James Chambers File Number (if probate has begun) Date of Death: Social Security: Amount: 2104-0865 September i5~ 2004 192-30-6142 $44,887.50 ($175,000 0 12% less 5%) ($175,000 @ 15% less 5%) If probate has not commenced or if this is a non-probate estate, additional information listed below is required. Residence at Death (City, borough or township) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11-96) NO. CD 004661 YOUNG DAVID J JR 44 SOUTH MAIN ST MANHEIM, PA 17545 .... laid ESTATE INFORMATION: SSN: 192-30-6142 FILE NUMBER: 2104-0865 DECEDENT NAME: BUSH dAMES CHAMBERS DATE OF PAYMENT: 11/23/2004 POSTMARK DATE: 11/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/1 5/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $44,887.50 TOTAL AMOUNT PAID: $44,887.50 REMARKS: SEAL CHECK# 103 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1470 EX (6-88) INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER DOROTHY J. BROWN 2103-0865 REVIEVVED BY CHARLES WRIGHT ACE 101 SCHEDULE NO. EXPLANA?ION OF CHANTE$ Forwarded to Post Assessment Review Unit in reference to the reduction to the tax rate. ROW Page 1 LAW OFFICES YOUNG AND YOUNG 44 SOUTH MAIN STREET P.O. BOX 126 MANHEIM. PENNSYLVANIA 17545 (717) 665-2207 J, DAVID YOUNG. JR, SUSAN YOUNG NICHOLAS jd@lawyeryoung.com synichotas@lawyeryoung.com COUNSEl- J, DAVID YOUNG February 17, 2005 FACSIMILE (717) 665-2422 , , Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of James Chambers Bush Estate No. 2104-0865 Gentlemen/Ladies: f\'.'\ Enclosed are the following documents for the above estate: - Original and one copy of the PA Inheritance Tax Return - Original Inventory - Check for the balance of tax due in the amount of $4,569.19 - Check in the amount of $105.00 for additional cost of Letters Testamentary - Check in the amount of $28.00 for Inventory and PA Inheritance Tax Return filing fees Thank you. Sincerely, fl)f-r// J. David Young, Jr. dIp Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 AEV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE ANO ESTATE TAX OFFICIAL RECEIPT YOUNG DAVID J JR 44 SOUTH MAIN ST MANHEIM, PA 17545 -------- fold ESTATE INFORMATION: SSN: 192-30-6142 FILE NUMBER: 2104-0865 DECEDENT NAME: BUSH JAMES CHAMBERS DATE OF PAYMENT: 02/23/2005 POSTMARK DATE: 02/22/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/15/2004 NO. CD 004981 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,569.19 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#147 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $4,569.19 GLENDA FARNER STRASBAUGH REGISTER OF WillS ~- , ' , (- - ;~, i'_.:\ - .~\ /'" , i t~: '0,,;, r- )c.Vf )1\L1..~ ,\~ d -~ - _,{) ?t~ '''~''~t~~' "1:~. ~:~ \;}":^' , ....,,\f\ :0... V' )N r- ,N r ~ lOa> '" :p",0- Q..~!: \0 \ : ~~ /~ff. ",nO ~ .. i ",00 ,,,,,00<10 ,,",0'" " ~"""''C'"'''' 11\" L ' ;.:r >, v '"" '" on i~~ -:h >;;'o'~~~~ _?:".,-..t!{ ~ ~::;1,xe: ;1J ..."..o? " ~ ", >ll ;;l ,..>;;1::0;1:: '--j ......~;... ~-;;o Z o </, 0 '<I >-" if) ~ "" "" w-l </) :::> OW :cu ;.---' ",,,-w-l :::>,,-'" 00"" U :::> </)OM >---'1.11..--4 ;.--" 0 Zl-'4w.-1t- ::J>U1~ o :::> uw.-04 o:c"- C> ;.- :z:o:::.o::w.J <(w::J...-l .-JI-00 O::if)wr-I w--' -' :E.~wa:::: ::J\,.&.J:Z.4: uo:::OU o '"" \\'\'"""" <.F \ \1 " 1 \~-'_ ~ \ \,i RE\!.~OOEX+(&-OO) NA? D . REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.(1601 OFFICIAL USE ONLY FILE NUMBER 21 -0 4 0865 ""'CciUNrlcoo[''" ---vEA~ - - NUMiiER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W o W CJ W o BUSH JAMES CHAMBERS DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 192-30-6142 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :::s:;:$(J') 0"'''' wg,o :I:"g o 0. III 0. < 09/15/2004 06/06/1936 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) D 3. Remainder Return (date of dealh prio..-to 12-1J..82) D 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach SchO) N/A [XJ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy oITrusl) o 10. Spousal Poverty Credit (dateofdealh Oetween 12-31-91 and 1-1-95) I- Z W C Z o 0. '" W '" '" o o THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND. cONFiDENTIAL tAX INFORMATION SHOULD BE DiREcTED TO: NAME COMPLETE MAILING ADDRESS J. David Youn Jr. Es uire p, 0, Box 126 FIRM NAME (If Applicable) Youn and Youn Attorne s-at-Law TELEPHONE NUMBER 717 665-2207 Manheim PA 17545 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inler.Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) z o i= cl: ...J ::l l- ii: cl: CJ W 0:: z o i= cl: I- ::l D.. :E o CJ >< cl: I- v- 125,0000Q[ 1 09,522.99 r~) I I OFRtCtAL USE ONLY _.'1 127,303.78 0.00 X ~(15) 0.00 0.00 X .045 (16) 0.00 250,582.39 X .12 (17) 30,069.89 144,995.32 X .15 (18) 21,749.30 (19) 51,819.19 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < I.- " 105,587.06 L_ 467.41383 25,184.38 46,651.74 (11) (12) (13) 71,836.12 395,577.71 0.00 (14) 395,577.71 Decedent's Comolete Address: STREET ADDRESS 143 West Vine Street CITY I STATE I ZIP Shiremanstown PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Crooit B. Prior Payments C. Discount (1) 51,819.19 0.00 44 887.50 2 362.50 Total Credits (A + 8 +C I (2) 47,250.00 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 5. TotallnteresVPenalty ( D + E) It Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 4. 0.00 4,569.19 4,569.19 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decooent make a transfer and: Ves No a. retain the use or income of the property transferred; ........................................................................... 0 1KI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 1KI c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1KI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 [Z] 3. Did decooent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 1KI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 1KI 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. L' 2/17/2005 " PA 17545 DATE 2/17/2005 PA 17545 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposoo on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (al (1.1) (ill For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (al (1.1) (iill. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use at the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6~98) * SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BUSH JAMES CHAMBERS 21 04 0865 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a w;UJng buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real nroneriv which is iointlv-owned with rinht of survivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Real estate with improvements thereon situate at 143 West Vine Street, in the Borough of Shiremanstown, County of Cumberland, PA, and more fully described in a Deed dated March 2, 1984 and recorded March 6, 1984 in the Recorder of Deeds Office Office in and for Cumberland County, PA, in Deed Book 0, Volume 30, Page 1017 - sale price VALUE AT DATE OF DEATH 125,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 125000.00 REV-1503 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF BUSH JAMES CHAMBERS FILE NUMBER 21 04 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0865 ITEM NUMBER 1. DESCRIPTION $14,800 U.S. Savings Bonds, Series EE (POD Edwin M. Bush,deceased 3/15/90 - father of James Chambers Bush) VALUE AT DATE OF DEATH 18,072.48 2. Smith Barney Account No. 724-10734-1-5-410 91,450.51 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 109522.99 REV-150B EX + (6-9B) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BUSH JAMES CHAMBERS FILE NUMBER 21 04 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0865 VALUE AT DATE OF DEATH 22,481.56 451.46 11,874.13 2,042.35 1,970.32 3,077.24 2,000.77 33,860.77 14,040.25 18,764.40 1,179.55 4.13 451.52 52.50 2.83 14,550.00 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 12. 13. 14. 15. 16. DESCRIPTION Citizens Bank Checking Account No. 6100893006 Miscellaneous receipt - Citizens Bank Checking Account No. 6100893006 Government Securities Investment (G) Fund - Thrift Savings Plan No. 192306142 Members 1st Federal Credit Union Checking Account No, 10989-11 Members 1st Account No. 104914 (not on date of death balance letter) Members 1 st Federal Credit Union Savings Account NO.1 0989-00 Members 1 st Federal Credit Union Life Savings Account No. 5876-04 Members 1st IRA Savings Account No. 10989-10 Pacific Life Contact No. VA97441450 Sun Life Financial Contract No. 79-7900-206694 U.S. Office of Personnel Management - final annuity payment AT&T - refund Blue Ball Nationai Bank - refund of mortgage escrow account Central Penn Auto Club - refund from cancellation of membership Com cast - refund from cancellation of service Proceeds from sale of tangible personal property TOTAL (Aiso enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 127 303.78 Continuation of REV-1500 Inheritance Tax Return Resident Decedent BUSH, JAMES CHAMBERS Decedent's Name Page 1 21 04 0865 File Number Schedule E - Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. Tangible personal property, taken in kind - appraised value 500.00 SUBTOTAL SCHEDULE E 500.00 GRAND TOTAL SCHEDULE E $ 127,303.78 REV-1510 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BUSH JAMES CHAMBERS SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 04 0865 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIRRELATIONSHIPTO DECEDENT AN 0 DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE (IF APPLICA8LE) 1. Great West Retirement Services Plan #98978-01, 105,587.06 100. 0.00 105,587.06 Commonwealth of PA Deferred Compensation Program - Beneficiary: Carol A. Blanck, sister TOTAL (Also enter on line 7 Recapitulation) $ 105587.06 (If more space IS needed, insert additional sheets of the same size) REV.1511 EX + (12.99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BUSH JAMES CHAMBERS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 0865 ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. Buch Funeral Home, Inc. 4,224.04 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Carol A. Blanck 0.00 Social Security Numbe~s}/EIN Number of Personal Representative(s} Street Address 422 Orchard Lane City Manheim State PA Zip 17552 Year(s) Commission Paid: 2. Attorney Fees Young and Young, Attorneys-at-Law 7,800.00 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Letters of administration, short certificates, Letters fee 228.00 5. Accountanfs Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Department of Vital Statistics - death certificates 63.00 8. Recorder of Deeds - copy of Cumberland County deed 10.00 10. Register of Wills - short certificates 27.00 11. Cumberland County Law Journa - estate notice 75.00 12. The Sentinel - estate notice 64.49 13. Bank of Lancaster County - estate checkbook charge 15.50 14. Central Penn Appraisers - real estate appraisal 300.00 15. Easy Siders Home Improvement Company, Inc. - soffit repairs to sell residence 303.30 16. Witman Auctioneers, Inc. - tangible personal property appraisal 583.00 17. PPL - electric service 141.67 18. Virginia Stauffer - housecleaning services 520.00 19. Ron Neufeld - painting/papering residence in preparation for sale 200.00 TOTAL (Also enter on line 9, Recapitulation) $ 25184.38 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent BUSH, JAMES CHAMBERS Decedent's Name Page 2 21 04 0865 File Number Schedule H . Funeral Expenses & Administrative Costs. 87. ITEM NUMBER AMOUNT 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. DESCRIPTION Kreamer Bros. Glass, Inc. - window repairs UGI - gas service PA American Water Company - water service Shireman Gardens HOA - homeowner's association fee George Dimoff - reimbursement for fireplace remote control Lower Allen Township - sewer service WSI - Mid Atlantic - trash service John Blanck - reimbursement for shipping costs to beneficiary TDB Enterprises - snow removal Expenses per real estate settlement: Realtor's commission Transaction fee Document preparation Notary fees Transfer tax Home warranty Resale certificate Register of Wills - additional cost of Letters of Administration Register of Wills - filing Inventory Register of Wills - filing PA Inheritance Tax Return Young and Young, Attorneys-at-Law - notary fees Recording Account and Release 108.24 320.55 107.85 61.00 227.90 24.00 32.12 112.72 20.00 7,500.00 125.00 75.00 10.00 1,250.00 409.00 35.00 105.00 13.00 15.00 3.00 75.00 SUBTOTAL SCHEDULE H-B7 10,629.38 ~ REV-1512 EX+ (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BUSH. JAMES CHAMBERS FILE NUMBER 21 04 0865 Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Members 1st Federal Credit Union - deduction of membership fee from account proceeds 25.00 2. Biue Ball National Bank - mortgage balance 42,688.36 3. WSI - Mid Atlantic - trash service 31.65 4. Allstate - car insurance premium less refund 28.45 5. PPL - electric service 33.26 6. Lower Allen Township - sewer service 24.00 7. Verizon - telephone service 14.09 8. American Water Company - water service 28.50 9. Checks paid after date of death from Citizens Bank Checking Account No. 6100893006 111.23 10. Holy Spirit Hospital - professional services 29.20 11. U.S. Treasury - 2004 individual income tax due 3,620.00 12. PA Dept. of Revenue - 2004 individual income tax due 18.00 TOTAL (Also enteron line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 46651.74 .REV_1513EX.{'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER BII"H lAME" rHAMBI=R" ~1 04 ORRii 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 distributions, and transfers under Sec. 9116 (aJ (1.2)] 1- Carol A. Blanck Sister 1/2 of residue 422 Orchard Lane, Manheim, PA 17545 Children of Edwin M. Bush, Jr., deceased 8/25/01: 2. Susan Bush Conyac Niece 50% of 1/2 of residue 140 Bradwick Circle, Debary, FL 32713 3_ Edwin M_ Bush, III Nephew 50% of 1/2 of residue 105F East Villa Capri Circle, Deland, FL 32724 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. None 0_00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1- None 0_00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) ~JAN/28/2005/FRI 02:41 PM / / A. e.ut.ment8tMemont SECURED LAND FAX No. 717 591 8506 P.002/003 +/~A'- - ! u.s. o.,.rtment or Hou.lnfll and UrbM DweIopment OMBApptO\l8l No. 2002.lJ2ef eo Type of lMrt 1.[ JF"" ~[IFmHA 3.[ }Conv.Unlns. 6.fIeNumb.-: 7. loan Number: 18.~ItISUl'Il'lCeC8leNurrber: 4. VA. 5. Conv.t1I. """""25-TK C. NOTE: TIiIS NOTE ~ FURNISHED TO GIVE YOU A STATE:MENT QF ACTUAl Sf!T1\.!t.tENT COSTS. AMOIJJlfTS PAlO TO AND 8'1' THE! SETTLEMENT AGENT ARE SHOWN. rrEMS MARKED -(p.O.C,r WERE PAID OUTSIDE: THE CLOSING; THEY ARE 61-l0WN H~ FOR INfORMATIONAL PURPOSES AND NOT INCLUDED IN"...E TOTAlS. D. Name .nd Addr'tu or BomMer I E Name IInd AcIdfM11 oI8e11er IF. HiUM *l1d Ad.... of Lender DUSTIN K. POTTEIGER AND ERICA^' CAROL A. BJ.ANa<. ADMINlSTRAlRlX GATEWAY FUNDING DIVERSIFIED MORTGAGE KYLEN OF JAMES C. BU$tl ~ATE SERVlCE$.I..P, . 300 WELSH ROAD.. BUI1.D1NG 6. 1224 BelT CREEK BOUlEVARD HORSHMt" PA 19044 MECHANICSBURQ, PA 17000 ' PA G. PROPERTY LOCAl1OH 143 WEST VINE; STREET, SHIREMANSTOWN, FA 17011 COUNTY: CUMBERLAND PARCEL 10: 37-23-0657.1680 TOWNSHlP~ SHIREMANSTOWN BOROUGH ... httItmentAgent E LAND T~8FER8. Plactoflottlernent 381!! MARKET STREET CAMp HILL., PA I L IettlelMnt o.te I OIab.......lMnt 0.. 11311200612:00:00 PMl1131/2O(l5 J.IUMMARY 01' IORROWIIR" TMN8ACTION8 K. 8UMMARY 01' SELLER'S TRANSACTIONS 100. Gron Amount oa.1IrDm hmwer 400. Gn..* AmOunt bu. To Sell... 10'.~PtIO* $125,000,00 401. PUI'llh" Prlco $125,000,00 102. P.....ntII Prol*lY <Kl4, Ptdonal Ptopltl'ly 10S. SMtl.ment Ch.,... to Bono..,. $4.331,67 403. 104. 404. 105. 405. Adju--."b Fot 1Wd'l. paid By W...ln Advan~ AdJu.trMn.lIDr IIHuI PlIId By 8..... In Advanqe 1De.0IlyfT0Il'n1'btI1 .....0 lTownTaxes 107.Ca....ty'f~ 4Q7,CountyTaxn 1oe.~""1 408,AI..1IrT*'4a 1lX1,SohQQIT....,.3,0.11L\tr1/31J2005to7f112OOt1 $842.01 4011. School T-.,.310.1&'yt 113112005 to 111/2{)O6 IM2.01 110. 410, 111. 411. 112, 412. 113, MeI'24.OCl.Iqtl' for 1131/2OQ5 10 4J112001!1 $115.00 413, S.wer 24.00iqtJ' for 113112005 to o4i1/2005 116,00 120. GrbU AMOunt Du. Prom 801'l'OWel I 200. AmCKInW Paid By 01" In Behalf Of Bo~r 201. Earn.1ll: Money 202. Prlrdpal frotn Gateway Funding D1vtnllled Mortgage 8tfViCM.LP. 203.ExiItln .'-ken 10 '04. 205. 205. "". 200. 20.. MI..tmem. For It4tIlM Unpaid B)' s.u_r 210. CftyITown TIA$ 211. CountyT8llIlI400.17fyr 1111200510 113112005 21a."Mf,,".!f 213. 214, 21.5. 216, ' 211. 218. :U8. $128.88IU8 420. Gtod AmOuntDu. To hl"r 100. Roduotlon.ln AmQunt aue 'I'D Wor ".500,00 601, Exc.a (I~lI " 111.000.00 SOl. Settlement eM"1il" To '.ller lllne 1400) 503. ExIl11n; Lan(.) teken SUbject To !504. Payoft' of Fht Mortg(lgllllQ$n iSO!S.Payoft'dSecond ~e l.J;Ien .... SO,. .... .... Adjutmenb for It1tmlI Unpllkl By leII..., 610. Clly1Town TbU 611, County Taxes 400.77/yr 111/200s 10 1131/20Cl15 132,94612.Mnllll'fMln\:lil 513, 6'.,. !i1(i, 618, 517. 1518. 519. I $125,658.01 19,404.00 $32.94 22O.TwlPaldBy/FwllCM'l'OWlll' 300. CUb AtSetOement I'fomlT'o BolfOMr 301. GlOM Amol.m1 Due From BomJwer (line 120 302. ~"~" PaIcI Borrower (I1ne-UQ) 120. Total Reduotion Amo..nt uu. leU... , $11 5,5S2.94 600. Cash At s.tttement Ta/From Sell.r , $128,88U8 &01. G~. Amount DUll To SllIIlIr (l1oe 420) "16,$32~ fJ02, L.e.. Olldu(Jllon& Il'i Atnt Due To Seliei' (line 1520) "."30.8" . "25,558.01 $8,436.&4 '~.CUh[XJlfromr ITolo1'l'OWfl $13.356.74Iso,.CaShIX]To[ ]FromS'" $116.121.01 I I 1__- JAN/28/2005/FRI 02:4I PM SECURED LAND FAX No, 7I7 59l 8506 P,003/003 4Q040242S . TK L.8ettlement--- ' no. T...... 00f!lI9IIuI0n 121OllO.oo 0'" -1100.00 DIvIalCJn rI ConmuIon (line 700 AI FoIoW&: 701. 17S00.00 to ERA-NRT, ItlC. 702. $eIIng" CommInIon 703. C~ palcI at tlldement 106. TranaactiDn F.. to ERA-NRT,InD. 101. TrBntlatlon Fee to ERA-NRT. Ina- 800. Itwn. p~ In Conneatkm WIth LOM 801. LoIIn 0ttgnIIDn FIIl!I 502. loan CXacount 803.~ Pee ...."""'" ace:. ~.lnepedIan Fee 811. Flood Cart. f!..1O FlrstAmericlln F\oo(I 814. AppIoeIIon Fee to 13IlI8MYFunmg D1v1lf!lllled MortGIQI Serv\ceI, LP. (POC 37t\i,OO) 81i5,e Ma1IICourlerFeetoGatWayFund\tlgDIverItIIed ~I,LP. 81D,~VnderwrItIngSy8temlo~FundlngDlVllnllildMortg.BerVIoeI.L.P. 800. It",,,. ReqUhd II)' Lender To Is. htd In AdYan_ 901. IMMMffrQm 11311200510 2/1/2005 016.&3OO14aY' 902. Mortgavl!llnal~ Premium for 903. Hezerd NurllOOll Pmmm tot 1000. Rn.rvM snn WIth LIn., 1001. Hazard Ins RHerve S mo a 21.12/mo Gateway Fooding Dlwralf*! Mortgage ServIoe" LP, 1002. Mor1;age Ins ReseNo 2 mo a 7.ue / me Gateway Funding Dlvtl'lltlAd Mortgage ServlON. L.P, 10Q3. PrupertyYIIXM 1004. COvn TlIX R8IflMl12ma CD 33AOfrno Gatawayflundln; DIveleIfted t.torf08g8S1lrvlOO$, L..P. 1006. SohooI WX 8 n'lO 0 108.18/ mo Balewly Ful1dirta DI\ietIlned Mortgage ~ LP. 1009. Aggregate Aououn1InQ A4uttmDnt from Gsl8way Fundlnlf Dlvetsltled Mortgage Sef'oI\OM, LP. 1too.".~ 1101. SotdemenlorC~nG Fee 1102. AflWaCt or TItle Searoh 1103. n-. ec.mlnaUon . 1105. DocuIMl'1tPf1ll)atallOl'l to $eounld I.endTI'llf'ItMI'I- MechanlOlburg 1106. F...lo O.th 1107.~FOK 1108. Title InsullllllMl tl Secured land Tnlnllfera . MechlI'lIcabUtQ 1101. Lendor'I Coverage$116000.00 (ll 1110. Own'" COYef'8Qe 51m1OQ,00 ($i1l3.7~ 1111, Endottemenll 00I300I9D0JB20 to secutld Land TflMfn . MechBnlCllbl,lfll 111S.lnsured ~~ P\'OlIIctIon Letter 10 FImAmtrl~ 't1tIa ~rance Co~III"1Y 1200. QavemlMnt R.oordfn, And Transfer eMr 1201. RecordInQ F..: DeecI'3ll.00; ~ortgllge17UO 1202. CltylCauntyT~l260.00 1203. stile Deed TIII($125O.00 1205. lSOO. AddIUoul S.mam.ntclwvn 1S02,PestlnepecCionlOe5Ich*&TIIery 1:11)3. HarM WImK11y Ia AON Horne Wwmrty 1304. fteMIe Ce.f1o OI'OAl'08dl Ptoporty M8nogement 1308. Home InepQlan to BImnr & llllery 127$.00 1400. TotIIJ leatementChmpa (EmIr on Lln..101. hllticln oJ And SOz. ho1Ion K) $4,331.57 I~ My~ UtH8eUlemIInt tendtothebolit r(f/ IIdgeand. Mdeoouret91t1l19lTl8l'l1ofall on my account Otby me In th/I tramJaotlon. I further' cei1lfy ttlat I have ~ I copy of the HUD-1 5ett1erT1en1l!llltement. ...... PaId From 8omJwer's FundlN.8tttlemDnt PIid From SelIf1r'a PW1dI At SettII:ment rr.soo.oo $125..00 '125.00 ....00 "',00 117.50 $20.00 Sls.1iS $G15.70 $148.50 $400.80 S873." -$287.01 $10.00 $75,00 $10.00 $98S.75 ....,00 $38.00 '111.00 Sl,2GO.OO '1,eo.oo "'5,00 $409.00 ....00 h,404.oo .I U1Sel1ll!lnts IUVERO 0I!LLmlB o..tInK.f'otIIigef JM'l8I C. Bulh e.b1_ By; CBralA. !l8nck,AlrnInIlll1lIrtlc Et\CIlA.Kytlln . The HUD-l SetIIement staCernem wNd11 have~ taa ttue atl(l aCCUl'8leaCOCM11~thl. tranncl:lOn.1 nave OMJIMlOQI"wIIt Cl.uH h fundi to N dlf;tlUf$$tl1ll with thlIatlletnanl. SdMfMnl Aotn1 - 11311200612:00:00 PM SECURED LAND TRANtlfI:R8. MECHANICSBURe I. # Bonds Total Price Total Interest Total Valne 74 $7,400.00 $10,672.48 $18,072.48 Issue Interest Serial Number Issue Date Series Denom Price Iuterest Value Rate 08/1990 EE $200 $100.00 $120.08 $220.08 4.00% 12/1992 EE 200 100.00 97.36 197.36 6.00% 12/1992 EE 200 100.00 97.36 197.36 6.00% 11/1992 EE 200 100.00 97.36 197.36 6.00% 11/1992 EE 200 100.00 97.36 197.36 6.00% 10/1992 EE 200 100.00 97.36 197.36 6.00% 10/1992 EE 200 100.00 97.36 197.36 6.00% 10/1992 EE 200 100.00 97.36 197.36 6.00% 09/1992 EE 200 100.00 103.28 203.28 4.00% 09/1992 EE 200 100.00 103.28 203.28 4.00% 08/1992 EE 200 100.00 103.28 203.28 4.00% 08/1992 EE 200 100.00 103.28 203.28 4.00% 07/1992 EE 200 100.00 103.28 203.28 4.00% 07/1992 EE 200 100.00 103.28 203.28 4.00% 06/1992 EE 200 100.00 103.28 203.28 4.00% 06/1992 EE 200 100.00 103.28 203.28 4.00% 05/1992 EE 200 100.00 103.28 203.28 4.00% 05/1992 EE 200 100.00 103.28 203.28 4.00% 05/1992 EE 200 100.00 103.28 203.28 4.00% 12/1991 EE 200 100.00 107.36 207.36 4.00% 12/1991 EE 200 100.00 107.36 207.36 4.00% 11/1991 EE 200 100.00 107.36 207.36 4.00% 11/1991 EE 200 100.00 107.36 207.36 4.00% 11/1991 EE 200 100.00 107.36 207.36 4.00% 10/1991 EE 200 100.00 107.36 207.36 4.00% 10/1991 EE 200 100.00 107.36 207.36 4.00% 09/1991 EE 200 100.00 111.5 2 211.52 4.00% 09/1991 EE 200 100.00 111.52 211.52 4.00% 08/1991 EE 200 100.00 111.52 211.52 4.00% 'L......,~ . 1'-_ . .. . ~ Savings Bond Calculator VaIU" A~ Of -- 109/2004 Bond Info Series I EE Bonds ill Results Denomination $1200 II rr~~~;t7 \ "..~e") \~._- "'.\ J "....:.. /" "., ,", \,. Page 1 of3 - Serial Number Issue Date I_.~ YTD Interest $526.80 Next Final Accrual Maturity Note 0212005 08/2020 12/2004 12/2022 12/2004 1212022 11/2004 11/2022 11/2004 11/2022 10/2004 1012022 10/2004 10/2022 10/2004 10/2022 0312005 09/2022 03/2005 09/2022 02/2005 08/2022 02/2005 08/2022 01/2005 07/2022 01/2005 07/2022 12/2004 06/2022 12/2004 06/2022 11/2004 0512022 1112004 OS/2022 1112004 OS/2022 1212004 12/2021 1212004 12/2021 11/2004 11/2021 11/2004 11/2021 11/2004 11/2021 10/2004 10/2021 10/2004 10/2021 0312005 09/2021 03/2005 09/2021 02/2005 08/2021 ~ ill rn rn rn fi a rn ~ [j "1 L m ~ m m m ~ a m rn rn a m a a rn ~ ~ rn Savings Bond Calculator Page 2 of3 08/1991 EE 200 100.00 111.52 211.52 4.00% 02/2005 08/2021 ill 08/1991 EE 200 100.00 111.52 211.52 4.00% 02/2005 08/2021 ij 07/1991 EE 200 100.00 111.52 211.52 4.00% 01/2005 07/2021 ~ " 06/1991 EE 200 100.00 111.5 2 211.52 4.00% 12/2004 06/2021 ill 06/1991 EE 200 100.00 111.52 211.52 4.00% 12/2004 06/2021 ~ 05/1991 EE 200 100.00 111.52 211.52 4.00% 11/2004 OS/2021 ill 05/1991 EE 200 100.00 111.52 211.52 4.00% ]](2004 OS/2021 ill 05/1991 EE 200 100.00 111.52 211.52 4.00% 11/2004 OS/2021 ill 04/1991 EE 200 100.00 111.52 211.52 4.00% 10/2004 04/2021 ~ 04/1991 EE 200 100.00 111.52 211.52 4.00% 10/2004 04/2021 ill 03/1991 EE 200 100.00 115.76 215.76 4.00% 03/2005 03/2021 ill 03/1991 EE 200 100.00 115.76 215.76 4.00% 03/2005 03/2021 rn ~ 02/1991 EE 200 100.00 115.76 215.76 4.00% 02/2005 02/2021 9 ill 02/1991 EE 200 100.00 115.76 215.76 4.00% 02/2005 02/2021 m 01/1991 EE 200 100.00 115.76 215.76 4.00% 01/2005 01/2021 ill 01/1991 EE 200 100.00 115.76 215.76 4.00% 01/2005 01/2021 ill 12/1990 EE 200 100.00 115.76 215.76 4.00% 12/2004 12/2020 rn \, 12/1990 EE 200 100.00 115.76 215.76 4.00% 12/2004 12/2020 ill 11/1990 EE 200 100.00 115.76 215.76 4.00% 11/2004 11/2020 ill 11/1990 EE 200 100.00 115.76 215.76 4.00% 11/2004 11/2020 m 11/1990 EE 200 100.00 115.76 215.76 4.00% ]](2004 ]](2020 ill 10/1990 EE 200 100.00 115.76 215.76 4.00% 10/2004 10/2020 W 10/1990 EE 200 100.00 115.76 215.76 4.00% 10/2004 10/2020 ill 09/1990 EE 200 100.00 120.08 220.08 4.00% 03/2005 09/2020 ill 09/1990 EE 200 100.00 120.08 220.08 4.00% 03/2005 09/2020 ill 03/1988 EE 200 100.00 142.96 242.96 4.00% 03/2005 03/2018 ill 10/1987 EE 200 100.00 142.96 242.96 4.00% 10/2004 10/2017 ill 06/1987 EE 200 100.00 147.84 247.84 4.00% 12/2004 06/2017 ill 01/1987 EE 200 100.00 152.80 252.80 4.00% 01/2005 0112017 W 08/1986 EE 200 100.00 186.80 286.80 4.00% 02/2005 0812016 ill 04/1986 EE 200 100.00 186.80 286.80 4.00% 10/2004 04/2016 m 11/1985 EE 200 100.00 192.56 292.56 4.00% 11/2004 11/2015 ill 07/1985 EE 200 100.00 198.40 298.40 4.00% 01/2005 0712015 ill 02/1985 EE 200 100.00 204.32 304.32 4.00% 02/2005 02/2015 ill 09/1984 EE 200 100.00 214.40 314.40 2.56% 03/2005 09/2014 ill 05/1984 EE 200 100.00 214.40 314.40 2.56% 11/2004 OS/2014 ill 12/1983 EE 200 100.00 229.44 329.44 2.57% 12/2004 1212013 ill 08/1983 EE 200 100.00 243.28 343.28 2.97% 02/2005 0812013 ill 03/1983 EE 200 100.00 262.48 362.48 2.59% 03/2005 03/2013 ill httn://wwwli:. nl1hl;~.-1"",ht f...",....... ~__+rn""'/C"1"""''''''''''''' . Savings Bond Calculator Page 3 of3 10/1982 EE 200 100.00 319.60 419.60 4.00% 10/2004 10/2012 m 06/1982 EE 200 100.00 328.00 428.00 4.00% 12/2004 06/2012 c ill 01/1982 EE 200 100.00 336.56 436.56 4.00% 01/2005 01/2012 ill ,; 09/1981 EE 200 100.00 345.28 445.28 4.00% 03/2005 09/2011 m " 04/1981 EE 200 100.00 365.12 465,12 4.00% 10/2004 04/2011 m 11/1980 EE 200 100.00 374.48 474.48 4.00% 11/2004 11/20 I 0 m lIIiIII~ViewingBonds 1-74 Le"e"d Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty MA Matured and Not Earning Interest Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator o o c o .....- .~" ',-,.',. .v-~, ,~ '-,----'--~;.,;;'?~~'{:'i'"ii\r:';,_~-' '::.: '--\f:""\i-r::'-''"-~~~~-'b~~_:t''"-r'i.:..,_''"r''.t'''-<~t~''f:t~'*y:" ',*< " ,.' I Pi ~="'''"7!iiiii~i!ii'~' ~~'..;~. ~i~~".Qiiiiiiiiii~' . >""_~~'''''_-...:..'' n^':::.'.:I AT THE MA.TURlTY HEREOF WILL PA'" " < '!f\}J~lli~Ii)1t,~~nY~l@1.m~lill~ I SERIES EE SERIES EE _~1,,"'-'I .itilIW SERIES EE ~~m~l,"", hI ~ ~ Co!Jtoc r{!)Yl,-~t'n'__1_<t3_m I l"'ONT~>_____~~"'~1 )\f\t. ~ ,-' ", I ,14, N A V Y ~; f '..",.. !<I;.trl>!(\ I' ~ CEMTER ~~SH 0 0 ~1. , O...T1NG STAMP. FEflRIj~~'Y 07 19F1 ~ , '! ' ./ ; , JMJ[S C BUSIi l'J2 4610 f1".IAN ;{IJAO MF.CHA'JICSflUR.G PA 911 00192 ,OG142 30 61Zt2 17055 1 Pfll1 ErWIN '1 BIJS!! ",::~:::,:::g~::::fi.'~:~;::"~~ R 3 812 320 E E ......."'~'o. ') S"_'101'/h;,,,,''''f' ~._".""_'all.'''''.''''''~''.' ,.,.,.,...._. ".mt.' ,0,1. . "D' \I:", ,",~__,""""'.."" 1lI.m~1OO>~(w~ AT THE M....TURITY HEREOF WILL PAY "!\:\}J@I;[~~l!i!~'lml!))~I~\lf;S} "c ~t ~ OJ 0 I ~ ,0' ~\~3w51 t~ ~ , i , . ~o 614~ ,~pr-'11 19F1 -IMONTH~::: : _- _-~-vEA"'-I- - ~, 7 n S 5 pef' [n." r-.; 'J p,llSY \IAVY ".~'r r: """,,[..' I. ~ \s\5.u\N<j"bi<'>tt'g , CF\IT[C~WA5H n r l J!Ii'~[\?7"'Tlr~~~p ,/ , T"""""......m."""...ur.<,__:."...".."..OT..........., w^"'~(.~::::::,:.~:~\~"~ ::,'~ mC\O<<;:::"=k ....."."'." <, s,,_.,....-....,.....!v>y R3815755FE ~ ~'.r;.tl~ ~r 8 ~w:-tJ... ~ w:_-' _-~ ~wy.J!m)~(Wl~~ . ...T T\1E M....TURITY HEREOF WILL PAV ~\'J(f!>~tr~~)U~1i!.@.RJ&~ .To JAMES C BUSH 192 30 6142 4610 BRIAN ROAD MECHANICS BURG PA 17055 911 00192 306142 1 ISSUE DATE WHICH \51\-\E fIRST DA'Y OF f I COIffOO. i ~ \ k~~5.1 ~~ I SEP_t.E_~B.ER__15t8_L lMClNTHI~~_~_~ lYll'A"" " POD EDWIN M BUSH NAVY R If G ,sIW~~MN-6E'" CENTER:WASH 0 C : \ ClATINO STAMP , NOVEMBE?", 14 19~Y T.".....""""..""....UT"".'. ~"..TV"'"..<T,....I..(.. ......."".,.".... - '~"'."":""'''"\' .....",."..'.,'"'..."... \...oJL.:....~ ,...,,,""'." . .h<_'J''''-IA;i,"",~'Y !\/) 041379 EE .. . ~..........._" ....-..'" "-.' 'W III :'" _- ISSUE DATE WHICH IS YHE FIRST DAY OF To JAMES C BUSH 192 30,6142 4610 ;BRIAN ROAD MECHANICSBURG PA 17055 911 ;00192 306142 1 JAt;\\I,~~:J~.,-- e (fJ+ 100. IJL /r>1 33/P.5~ -43//).51.0 .~..; , NAVY REG,e'f'f'ftA'Nt12:; CENTER\ W~^~J;!....Q..C :' APRIL\03 198~/ , -' -, - POD EOWll-t H BUSH SERIES,EE .f1llUOl.O"......DU""VAllT.. ". .' "..~-~...'"... DV~_~:::~~IT.- '. '~~.~~i:~'- _ONGroII .\ R4 044 429 EE . , IW\I:.., _- . w=_ _-. . I To JAMES C BUSH .' 192-30~;b142 143 W. VINE STREET :;;~;.'.\ SHIREMANS W\lN\PAi70,uf\\\ ". ..... ........':,:..'.\ 91100192 ;106142f.i1,';.?i:! ',' ; ;,'. .', ...'.s/....,..'.... \ '. . . --. ~.,~:~'~"-, ! " ___i' f POD EOWI N M BUSH /, . .-'Mt,7~:}:~'~I/ NA VY:'R.~fJJ1l.J<i;lcE CENT\ER WASH.O':C A lJG'V STT"2 1'-1 9 ~2 ., , ' , , . ......... ,/.' ~... _ __J CDS/- 100,0, It'll. 3). 9.01 -:;'.?-8,DO , ~ ! ~ SERILS EE '...IOI<DlIlIOV.D"-.'UnI(l.e..; UO...'l'<..........,.....'''''.D. _"'""""'.0."....... ". ."'DelIIT."..."'.'''', lH!~"'TtoI'r<To"","''',,,,,y " ~~'......:-~ _,"" ')~"'w~ R4047638EE :... - . -- "-~~~~Q.tt~ AT THI!: MATURITYHEREOf'WIU.'AY ~~~~~ To JAMES C 'BUSH 19230 6142 143 W VINE' STREE T SHIREMANSTOWN PA . 11011. 91100192306142 1 . ISSUE DATE WHICH 15 THE FIRST 0",'1' Of t ObI- 100, IX jrrf. 319. b~ 11q,IJ,D OCT.~,:*?_~.-,-- POD' EOWIN '" BUSH , \ NAVY RIiG""""I~E~ C E N TE R :, WAj,ij. 'p_.C' ,: JANUAR"( oa- 19'83 '~ ~' ...,,_._u""".u.~,......__.___-... _M~..::=~1tI . ::::'.. .n~~..>oo,~_ _<<'" ........,,,...";;Z:;. R12 630 643 EE . ~----~ ISSUE DATE WHICH IS THE FIRST DAY OF POD EOWI N M BUSH MRCJ'L191l3_ _ __ \MONTI-l~ ~ _ _ _ _ ~ ~ Y'II;...rtl ,,' "', , ' , ' NA VY;' Rl!Gwoli<ll'h\ Nt E CENTER WASH D ,t MA-Y~28T98~ , " tDlJr /000 lof. :z b2.4! .3w2-'!S JAMES C BUS H 192 30 6142 143 Ii VINE STREET SHIREMANSTOWN PA 17011 911 00192 306142 1 ......_..................."..... . "".TY_...................... . ...,..........."",..." . .'. AT.."......""......'" ..M.....~:.~a.i.,....,.. :::' ~~...~........ R12 633 722 EE . w: _ _- ..Em ISSUE DATE /I L I Db DC WHICH 15 THE FIRST DAY OF f.., 061 . . 1M. 243. ~ AU""c.:r -1-9""---- 7.0' ,-"::.---."..-, 343. " , , , NAVY ~EG""I'1~C~ CENTER WA.~.lJ. C: OCTOB'ItR 15 1983 .... .-'/ JAMES CBUSH 192 30 6142 143 Ii VINE STREET SHIREMANSTOWN PA 17011 911_00192 306142 1 POD fDW IN M BUSH -.-.--... ----..- -.--........ '. .... ......-..-, _____' : ~.>.A._ _. ~~....~ R14 161 393 EE . . -- ~, ) ISSUE DATE WloilCtl IS THE FIRST DAY OF ~J!~Ul~D~.~ '-,'. - .' ATnu;M"TUR~TYHE:REop.wlL.\.'AY ~~I1-~~'8S} MJAMES C-BUSH 192306142' '143WWINE3,sTREET SHIREMANSTOWNPA , 17011., 911.00192 306142. 1. M'.BUSH DECEMBER '1983 . -IMONTH;::;: :~-r~...l-- . NAVY R!iG,.~.l.HAA<<:E'~ CENTER: WASH. O. C : MARCH, ~'";yl}'h,/ ~'" -. ,1 ~ SERIESEE : I '....-.-..-.................-..........-. _~TDTIIII" "..P......__...._. _",,,.,_,,' .:"... ~<.>. A._ ..- '.:.. ......".,...~ R1B 471997 EE . '. : I~. lJ "" :~ t _- ~ ~': _- ...- t 1 ... . .~.~, .:>iQ' 1lRJID~~(ID~ AT THE MATUAlfY HEREOF WILl.. 'AY ~~[D.iI1!Jj~~~~ , To JAMES C BUSH 19230 6142 143 W VINE STREET SHIREMANSTOWN PA 17011 911 00192 306142 1 ~ SERIES EE peD EDWIN M BUSH ."V. ...._b._.O""OO.AlIf~....... c....rv_............IOOOO. ....ouu.J.Gf'O...... '.' ",,0'"'''''__.''.01'. O"""""H'OI'_'.'-.V . '.' . ~'J >. 1-- ..""',..._ So-,.<I""r;:;z., MAY 1984 -(~~-::::-l~A~-- - , NAVY RfiG,~E" CENTER:WASH 0 C : JULY "21~T~W ,/ " 051 /001.. ;nf: 2-/4.4 3/4.-40 R16 945 621 EE . :....: \I. ...- .... ~~~.~A.'. ATTHI! MATURITY HEREOFWIU.'AY . ~~~~ .JAMES.CiBUSH ,'192' :SOi6142, . 14;3HhVIlNE ;STREET " SHlREMANSTOWN 'PA:~UO~t ~ . 9U:';09'-"Z:30~142',1 ; .,POD j EDWIN H. ;;BUSH ':.: - .....~.._OUH........n.o..... '.' '.. '.'........_ ""'...~_. '. .~- .........,ueT'or"".. .. .....""_........._..- ;....' . ..............."".............. .... .:.:. ~ '-t). A._ , .' -~,...' .. .'. -. - . ""<I"~ . :., I _- .... . , ,. ~~~.~ AT THE MATUIU1"'t f.\EREOF WILl. "AV ~~~1~!~~~ To JAMES C BUSH 192 30 6142 143 W VINE STREET SHIREMANSTOWN PA 11011 91100192 306142 1 POD' EDWIN M BUSH '..._.......0_............... a~""'_......_o _....."'1'0_... _ .....""..."""'..._.. __~.__~~ . ~~>. ..4- ---- '--~tA.";;;Z:, R21257 586 EE . ISSUE DATE WMICl-t IS THE FIRST D...., OF e tiJ+ /00, DD In!: 2-0432- 30432- FE.!~.a}'!.fi8:-CH85_ ~~_____~~~l , , NAVY R~G '.~~E\ CENTER: WASH 0 C : APRIl::" 27'-1'985/ , , . - R22 496 543 EE . ...- ~ , t t"I_- \It_-_ 1lB~~~Qlf~ ATTHl! "'''TUI'lITYHIEAEO'WIU-PAY ~~~'8~~ ISSUE DATE WHICH IS THE fiRST OAY OF JAMES C BUSH 192 30 6142 143 W VINE STREET SHIREMANSTCWN PA 17011 911 00192 306142 1 J,\L\X~:~~~_~-"",,.,-- N A V Y /R EO;...f.i-NA NeE CEN1l!R WASH 0 t . o.o.TIN<llaT_ SEPTE'~BER 14 1'98 " ~/' POD EDWIN M BUSH ~ SERiF..S EE TlOlI_...........".......... ....... u......._........_ ......II/LOIC'TTO..... ." ...."".................. _-....,......,.......,"" ': :;)-...c >. A._ - .......,....."r;Z; R23 521868 EE I W :.. ..- -- , mB.~~W~' "TTHl! "'Atv,.ITY HEl'IEQII'WILL PAY r~!mgti~ To JAMES C BUSH 192'30 ,;'6142 143 W VINE 'STREET SHIREMANSTOWN PA . HOn 911 00192 306142 1 !.Wl}~ ~ ~i~ ISSUE DATE WHICH IS nt(I'IRSTO,,-Yor ~9.x..~~~!!:-.:1.-~85 POD EDWIN M BUSH -- , , NAVY'~E~CE CENTER WASH 0' C: FE8RUA~~TOt~1r9~6 " " ~ SERIES EE '-_._._..~-_..- ...._~~"'.::'~' . ...... . '-i-:-:>.-A_ -- . '--'1",.."';;Z:; R23 930503 EE '. -....------------------- to!Jf JOD() 1m-. iQg.41 243,40 . C05+ IOO,Q Inf. iq25~ ZQ25/P . to~oo, 00 In!-: ;gt.,.g~ Zgt,.gD to:;/- I DOL III Jn8 - - Z&J.g8D t ofJf- 1000!. If"/-: 152XL 2-5 ZSD to!;! /00.00 In+: i47.t4 - - 247. g4- toi;l I DO DC !fJ+' 142% ;Z//2.91o ( CDs-!- IOD.Di /M /42Q;.; -24:2 q!; COJt IOO.DD 111+ \It.og 2 2 D . b8 . . . ~.~.~ . ~71;;~1~~ : 192.306142. . ;,.~ . 50C.5~C'EMP'D"O ~~"~-,.-l.~ II (' r:i!', T E, ',.r: ""; l ':,A:~ ;-,,- ,- -:----1 1_1990 "~.'>l. _ Co:r [00.00 Int. 110 D8 ~DD3 p' ,'.,. linn., I _- CD~ 00.00 (If (2.0,Dg I~ pO. eo!JtIOD.DD \(1f ~ '}.-/5./"" "11"':>1' _~~ :_- _-. '. __ .... '. < - '-' \ ., ~~'[f~~~~..mlMfl~ .~~~ .,::}i~9~;~'61U;" . ,.;1"" . ~< ';:" r' 1" ."'<c s~"ib<p '0 "0 f:__;-:'" ~J~J' ,...~,;,\: ..,,' ~S C' .B....H.. r,~~.. "'>:;JIJ--. ... _n... '.~ "l,.::lf, : <n.'143tlfESl'.'UINE $ir~:E; :;;;f"':;~"'"RE""'tfS!OWN' r . . "-,".< . t' " j .;".{'i'i llJ'ctu' ;. i,,, j,.,....'.\' ;,' -,'". , . ..-J~-_.!/,:':,.:~', , J. CO?~OOD _J. 115./! I r n ..:--:::; 2-15./1 Ctll 100.01 )()t. 1151k .---;:;; J1S.l~ Crjj 100.00 _.I- It Sib \r[l~ )16.1b r~ _-'~" i ~". mDl~ -~~.~'SERms'E'E~\ """""".,,"""'''.~~ 'jS~;\J,f.DA':TE:,~.'_:': ~~::;:; ~ '.'c';"'!-' 'S"'lF t"'rflS'r,nAY.)!'" 30 6~~i ^,,"'-';;r~'-"~"'" i I'if rl'~9ol '''' ......-..... i._ I ! ,~. ._...:........J "'om",.."" ~ . CAT"ERI.NE . .... .. .lAflES' C BUS" 'i;~1.. , BAKER--K80LL,(: 143 WE'ST VINE, $."R~ T I i TR.EASURER.';{" ,~, ~"~~E,flAJI~~~"JI~li i'(~~OU . ,rf~~:::~'=M;i~~ ~' ' : .. ~,,, ' ~ '.' '~,:f~'I';",~~USBUR"!.!"~. ; "~,""'''f::':: ' ;.... ~'i;;);t""i:'~ "",,,;:..,f .. .t~t;;';~;"'~~~O~~::~=.'.9.(j'<'.,..~ "....!~,. ".'. ~:::L.fu.,III,'~ ~11 ,II. ,I [................~.......~.,.~I.<I:;".....'tG~'~.. ~~,:'..7~~t~.,"\',f iliinulR' , Ic&af'~'"~lq"i't4i~i!'Ii.fi'rr\ ,\.i< :."",1':;:; ~!:f~~~..i!:.""":..:~~t~~~U~tlt-!~g,~2,lt~:~PH ';~( , .0:8(:)8.~ dO 0 7,1: 0 5, ,':lOD:i:;321, .:1'1 Gl,lI.\:\i.~i",~,'~f.:i::~?i;~ ~1!'i t DM 100,( lnt. \15,{ -lIS./1 tol;t I DO. 01 \nt~ J-l5tb CD!>t 100.DD 1y1~ J15'1o ~,j\._~-U'. ',';;",....,. .",>:~ i~, No ATlH~.~W"" >.', ~ e~tO.OD [~ Z.15,'10 co~tD,DO .J- 115.1~ lr~ 216.10 eD1DO.oo Int. \l5.1~ ~ I e00~DO.D[ J... IIS11 \(l~ J-I S1~ Ccd IDO.t( l(lt~ 7Y3.i!c CDf;t IDO.CD Int. 1151~ -t1571o CoM- lOO,[ tri, 1115 211. <:>2- CDbt 100,0: lrtf. lILS:; -lll.'5?: CiYJt 10D.00 Int. 111.52 2 II .'52. ", ."\1:..,....:.. ~ \I: _- _-; '. Co!Jt IOD[ Inf. (11.5: ~ tll.~i \I: _ _-. , . - . I . C rt>r 100 DO \ nt III. 52-_ ~tll,?2- t;.'~~,,: 'Qj;~~_ v"6..., ~ .'{~~-~Z~~:i"'7i'--'r . ~~~ " .' ....,', ,:. ..... .9a'L~_(!! B.a.: t~, i 1.~~~~o~.~~;(~t~H' r:~L'.' ,(. "'~'!~~llTi'''\ItNEi. '~!/f ,t'. 'T~suReR ~l~;;'.~~~.(i<.. .....C"~~".ii 'i\'{"~~~-;~i~.:f!~':~~~~Sd~ oWO'b'd!l':oS ". =,icio7;~l,a705 ~u~,'!-di~;1;:,j:.tiit.i cctt IOO.OD It'll-. 1\ \. 52 J. I I. s;z. !i'..;;]~t~~ .:.:: ~.. . ~ ~ _- t " ~. i" 06t Ic()' co Int. 111.52- ~ . W tel:.,. _- tel: _- ... _- II , ..~~t~. ~ ".<.';1":' ',1 \ ::.~:;~{~': i{',,~".' . '.If . .' . ':t',: j",! ,'\ IEt~I"; " . "IU~oU' r(i~t-:~/' 1. , f:"':':!./lff' .~:b~i' Co'Jf- 100:..00 Inf. II L ':)2- -J-11.52- ,", ,", ;,',,:,;. ' cost 100.00 In~ )..11 S2- · . lol W :.. I _- . W:... _. . .' _-'; f . . CCbt /00 D Irrr. III~ ~.211. 62 _,~fWI) "','WMl~lI~ :,;~, ,,~~~1~rn;m,"- 1.92 90 6142 ;ri~f \ ,'t ,,, "-.'~$OC"5f:C;;'E-"""O';'''Q ~:;"i:~~:~,~ ~,~JAIlE5~C !lUSH Ft~~l1 '," ',:; ;1113 lEST, VI BE ,a7.'.... }~lISB~~~~.~\~~n), , li:-r"','7i011 if'i',,', '>! ,,';", i' i f i "'[J~' i'! '1f' ",f,:!"'"':", H~.'C"'t,c,f",,:'. I~' i ~::::',".::e:::'.~, [!';i;t'l'lit',',J~~lI~i"W'~;l::11 'il'$.[,,' .- "'~7~'.;;".L.,.__ - "'::. .1. ~~ '~.:....:_~._, '."" .' " , 'f'~ 111'22<3 "~I(r! ~lilJiHi1; I "I] ,." 1ll:J,~ni,,""C::.JtijiJ,L.n'_';! ; , "i1H.'UH~ 9!1gtlb':;;';'~;(!,.;/tp'Q;t;."q,:IS ~ 511,,';7 . lol w:" J _- ". - - ., -- , ,.', " Q.V>~ml\ .~ -~"''''.,.!.: "-';"j ~ . to!J fOOD Inf. 111,5: 211.52- eOJt IDO.m I n.+. /1/52 -;2 11.52 Co'~ DO.o Int.lll.5 )11,9 :.tJ _ _ \t:_ . . _- . I ")m>~~q~ , ,,," 'l ' 'DfrITi1IlA.~ :",<~>..,. .f f " , . .,; Ccxt lOo.n Int 107.31 --.::;- J D1. 3h i> '~ o!J 100CD ,rrf: / Dl. 3~ .~ CI11 /00.0 I nt-. I D1.31 ~ Cost I CO.ti Int. iDl3/ -201.3( Coat- 100.L 1m. \Dl.3 - - ZOl. Jl:; Cb!Jt IOO.C In+' \D1.3 Z. D1 3i Crbt 100.0 1m. \D3.}8 l D3).B ofJ I DO.a tn-r. I03.L25 7-03.)~ to:t 100,0 In+. \D32~ 2 03.)~ tr>>t IOO.CO \I'*. long to?:2 S C{)6t loo.a \ nt. I03,)S 2 0 3. 2g Co~+ loo.a Inr. \ 03.2~ ---= 2D3.2g Co?t 1D0,a Inf. I DUS -2 03).8' Co~t 1001 Inf. i 03.11 2 D3. 22 CD~t lOOO Irrr. \ 03.] 2-D 3.2~ tD~t 100.0 1m. l 03. 2S 2D3.2~ CObt lOO.1 1r1+.1 D3. 2l -2.D3.28 Iwe tD~t 100.0: Int. Ql.3{; \ql?)6 " '," ...' ....., -.' ,,- :. ;,'\).) ,{'NDt~...O'~_u ~~~,.~ ), f . mWO.D?I:OS\ . . , . Co~t IC'O.t Ivt+. qlj \qT3b IDO.t lY.t tDO.a In+. ql3~ \ Ql:>1o ~""(,'\~~ '; \'\;N"t~'"~'N,a ~~",' ..0;10007<1:05 Co~ IOD.DI In+' Ql.)~ \Ql)t CD)/- IOO.CD 1m. ql.% \Ql% SMITH BARNEY..... cltlgroupJ October 14, 2004 Law Offices of Young & Young Attn: J. David Young, Jr. 44 South Main Street P.O. Box 126 Manheim, PA 17545 Dear Mr. Young: Enclosed is the date of death valuation for the account of Mr. James C. Bush as requested by his executor. There was no outstanding accrued interest as of Mr. Bush's date of death. Total interest and dividends paid in this account this year until date of death equals $504.65. The account was in individual name and Mr. Bush did not maintain any other accounts at this branch location. If you have any questions or require further information, please call me at (717) 780- 1726. Wade Registered Associate to: Douglas E. Smith Financial Consultant Wah enclosure THE iNFORMATION HEREIN HA$ BEEN OBTAINED FROM SOlJi(CES WE BEliP/E TO BE RELIABLE, BUT DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS. CitigroupGlobal Markets Inc. 11 Nonh 3rd Street, 2nd Floor Harrisburg, PA 17101 Tel?1? 7801700 Fax 717 233 2090 Toll~free 800 2371700 Account Valuation for James C. Bush Account #724-10734-1-5-410 As of 9-15-2004 Security Quantity Price Per Share Total Value Emerald Growth Fund, Class A 724.112 $ 11.53 $ 8,349.01 Evergreen Equity Index, Class C 369.159 $ 41.85 $15,449.30 Evergreen Global Opp., Class A 442.88 $ 20.67 $ 9,154.33 Evergreen Balanced, Class A 2,087.61 $ 8.05 $ 16,805.28 Putnam New Opp. Fd. Class B 357.673 $ 33.14 $ 11,853.28 TRAK Large Cap Value 1,207.73 $ 10.14 $12,246.35 TRAK Small Cap Value 358.034 $ 15.40 $ 5,513.72 TRAK IntI. Equity Investments 462.139 $ 9.13 $ 4,219.33 TRAK Large Cap Growth Inv. 339.989 $ 11.16 $ 3,794.2B TRAK Small Cap Growth Inv. 125.892 $ 12.54 $ 1,578.69 Cash & Equivalents $ 2,486.94 Total $ 91 ,450.51 THE INFORMATION HEREIN HAS BEEN OBTAINED FROM SOURCES WE !ltuEVE TO BE RELIABLE, BUT DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS. .: CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburgh, PA 15219 October 12, 2004 /':.--::;... I' ~^ -,\ LAW OFFICES YOUNG and YOUNG 44 SOUTH MAIN STREET POBOX 126 MANHEIM, PA 17545 c, Estate of JAMES C BUSH Date of Death: Sep 15, 2004 SSN: 192-30-6142 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death, For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884. Sincerely, ~ Ann Rhodes Operations Services +~ CITIZENS BANK Account Number 6100893006 Account Title JAMES C BUSH Date Opened 3/17/97 Account Type Checking Principal Balance as ofDOD $22481.56 Interest from Last Posting to DOD $.00 Account Balance as ofDOD $22481.56 YTD Interest to DOD $30.33 /***~ * ~ * * THRIFT SAVINGS PLAN Thrift Savings Plan National Finance Center P.O. Box 61500, New Orleans, LA 70161-1500 October 19, 2004 J. David Young, Jr. Attorney At Law 44 South Main Street Post Office Box 126 Manheim, PA 17545 Re: TSP account of James C. Bush, Deceased Dear Mr. Young: This answers your letter to this office dated October 5, 2004, requesting information regarding the Thrift Savings Plan (TSP) account of James C. Bush. The TSP is one part of the retirement system created for Federal employees in the Federal Employees' Retirement System Act of 1986. (See 5 U.S.C. ~ 8351, 8401-79.) The TSP is a tax-deferred retirement savings plan similar to those authorized under section 401(k) of the Internal Revenue Code for private sector employees. Mr. Bush's TSP account number is his Social Security number and the account is held solely in his name. As of the date of death, Mr. Bush's TSP account balance was $11,874.13. The disposition of a TSP account is a matter of Federal law. The account balance of a deceased participant is distributed according to the order of precedence found at 5 U.S.C. ~ 8424(d). First in the order of precedence is the beneficiary or beneficiaries designated by the participant in a properly executed and filed Form TSP-3, Designation of Beneficiary. If there is no designated beneficiary, the account is paid to the participant's surviving spouse. If there is no surviving spouse, the account is paid to the children of the participant, and descendants of deceased children by representation. If there is no child of the participant (or descendants of deceased children), the account is paid in equal shares to the parents of the participant, or entirely to the survivor of them. In the absence of these enumerated beneficiaries, the account is paid to the executor or administrator of the deceased participant's estate (including one authorized to dispose of the estate under small estate procedures). If no estate is administered, the account is paid to the participant's next of kin under the laws of the state of the participant's legal residence at death. We are providing replacement participant statements regarding Mr. Bush's TSP account for the time period specified. Participant statements are detailed statements, which contain a complete record of all the transactions in an account. To liquidate this account we must receive a completed Form TSP-17, Information Relating to Deceased Participant, along with a copy of the certified death certificate. We have enclosed a blank copy of the form for you to complete. In your letter, you ask for the names of the beneficiaries of Mr. Bush's TSP account. We are unable to provide this information; a final beneficiary determination cannot be made until a Form TSP-17 is received and reviewed. We hope this information has been helpful. Sincerely, ~tud ~EGINALD G. HARGETT, Chief ~ Thrift Savings Operations Branch Enclosure (s) REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned From 1/1/04 to Date of Death Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principai and Accrued Interest Interest Eamed From 1/1/04 to Date of Death Name of Joint Owner IRA SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Baiance at Date of Death Accrued Interest to Date of Death Totai Principai and Accrued Interest Interest Earned From 1/1/04 to Date of Death Name of Joint Owner LIFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principai and Accrued Interest Interest Earned From 1/1/04 to Date of Death Name of Joint Owner KEY LOAN ACCOUNT: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Name of Co-maker Collateral Estate of: JAMES C. BUSH Date of Death: 09/15/2004 Social Security Number: 192-30-6142 tvlR MEMBERS 1st FEDERAL CREDIT UNION 10989 -00 07/14/1969 $3,076.06 $1.18 $3,077.24 $19.34 None 10989 -11 05/09/1987 $2,042.35 $.00 $2,042.35 $.00 None 10989 -10 04/13/1983 $33,844.67 $16.10 $33,860.77 $267.40 None Beneficiary: Estate 5876 -04 02/01/2001' $2,000.00 $.77 $2,000.77 $14.14 None 5876 -04 05/17/1993 $218.89" None Property: 143 Vine Street Shiremanstown, PA 'Account opened with funds from 5876-00 "Loan will be paid by Credit Life Insurance rr;~DERAL CREDIT UNION ^lJnfseA. WOlfe~ Insurance Services Supervisor October 1, 2004 . ('" y.) f,'-.LIj .:'y M \iY 5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.memberslst.org ~ PACIFIC LIFE 10/05/2004 Attn: Donna Young & Young PO Box 126 Manheim, PA 17545 RE: Accumulated Cash Value Contract Number: V A97441450 Annuitant: James C Bush Contract Owner: James C Bush Dear Young & Young: We are writing in response to information requested on the above referenced contract. . Accumulated Cash Value as of the date of death September 15, 2004 is $14,040.25. If you have any questions, please call the Pacific Line at (800) 722-2333. Our Service Representatives are available to assist you Monday through Friday from 6 a.m. to 5 p.m. Pacific time. Neither Pacific Life nor its representatives give tax or legal advice. Sincerely, MacJ /l.aUkr~5 Mary Hawkins Director, Contract Administration PACIFIC LIFE INSURANCE COMPANY ANNUITIES & MUTUAL FUNDS Post Office Box 71B7, Pasadena, California 91109-7187 Tel (800) 722-2333, Fax(626) 403-9886 75-00100-20 ~ PACIFIC LIFE September 24, 2004 Mr. Blank 422 Orchard Ln Manheim, PA 17545-1140 RE: Contract: V A97441450 Annuitant: James C Bush Contract Owner: James C Bush Designated Recipient: Edwin Bush Dear Mr. Blank: Please accept our sympathy on your loss. We are replying to a request for a claimant package for the above referenced contract. A detailed description of the benefit options and instructions are provided in the enclosed claimant package. If the designated recipient, Edwin Bush, passed away before the owner, Pacific Life will recognize the Estate of James C Bush as the Designated Recipient. Please include a certified death certificate for Edwin Bush in addition to the requirements detailed in the Claimant S -I- m_ . . "-.-' d .on - rll""p.7<<E/1';. tatement. L- ~J..u.--j:'. _..,.~C'1 ~'.I..I~ TW.'i..) ~.s t?I1~.t.'(iiu.L t:-/,:>W,fU '':')o.I~fT ill"") IV':'>, ,-...- Upon receipt of the requested documents we will process the benefit. The benefit amount will be calculated as of the date all processing requirements are received in good order. If the contract is a variable product, unless new instructions are provided, any applicable death benefit step-up will be allocated according to the future allocation instructions that are currently on file for this contract. In a multiple designated recipient situation, the death benefit will be calculated when the first set of claim paperwork is received in good order. Consequently, the death benefit proceeds may fluctuate with the market for the remaining recipients yet to claim. In addition, please note that any of the following active programs such as Pre-Authorized Checking, Scheduled Withdrawal, Substantially Equal Payments, or Minimum Required Distributions have been terminated at this time. If you have any questions, please call the Pacific Line at (800) 722-2333. Our Service Representatives are available to assist you Monday through Friday from 6 a.m. to 5 p.m. Pacific time. Neither Pacific Life nor its representatives give tax or legal advice. Sincerely, //fa:?) /-t;uJkr~S Mary Hawkins Manager, Contract Administration cc: Douglas E Smith Citigroup Global Markets Inc PO Box 12057 Harrisburg, PA 17108- 2057 PACIFIC LIFE INSURANCE COMPANY ANNUITIES & MUTUAL FUNDS Post Office Box 71B7. Pasadena. California 91109.7187 Tel (800) 722.2333. Fax (626) 403-98B6 Sun "',:;-;/ ~....... Life FinancialSM October 12, 2004 Young and Young Attn: J. David Young, Jr. 44 South Main Street PO Box 126 Manheim, PA 17545 RE: Regatta Platinum Fixed/Variable Annuity Contract Number 79-7900-206694 James C. Bush Owner James C. Bush Annuitant Dear Mr. Young, Thank you for your recent request for the value on September 15, 2004 for the annuity contract referenced above. We welcome the opportunity to assist you. Our records indicate that the value of this contract on September 15, 2004 was $18,764.40. We hope this information has been helpful. If you have any questions, please contact our Customer Service Department at (800) 752-7215. ~/!L CHeryl Palmer Correspondence Representative 77700630100804 -.;i:; '_iii ,fq ~~ Witman Auctioneers Inc. ~ ,,~ J ~ AuctioNeers aNd Appraisers 'f. VV ~~. "~l\oviding J'l Complete Pto/essional J'luction Sewice ~~", Since '970" Telephone ~:,....~ 667 Frultvllle PIke (7' 7) 666-6736 .. Manheim, PA '7646 FAX (7' 7) 664-:1737 September 30, 2004 Page 1 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 u Executor: Carol Blanck 422 Orchard Lane Manheim, PA 17545 (717) 665-5618 Appraisal Done To Determine True Market Value for Inheritance Purposes Died September 15, 2004 - Community General Hospital, Harrisburg, PA Jay M. Witman, Auctioneer/Appraiser AU001127-L 657 Fruitville Pike Manheim, PA 17545 /Jay 5lt. Witman 657 ::Ftuitvil/e Pike, 5ltanheim, PJ'l '7545 ..Luke!R.. Witman II'q -~~ Witman Auctioneers Inc. ~ ,,~ J ~ Auctioneers and Appraisers 'f.1IV ~. ' 'P\oviding Jl Complete P\ofessional Jluction Selvice ~~" Since '970" Telephone ~,.,..~ 6117 Frultvllle Pike (717) 6611.11736 ~ Manheim, PA 1711411 FAX(717) 664.2737 September 30, 2004 Page 2 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes COMMONWEALTH OF PENNA. ) )SS: COUNTY OF LANCASTER, PA ) Before me, a Notary Public in andfor said County and State, personally appeared Jay M. Witman, who, being duly affirmed according to law, said that he has been engaged in the business as an auctioneer and appraiser for said types of personal property for more than 36 years, and that he is familiar with current market prices for said types of personal property in Lancaster County, Pennsylvania, and that Jay M. Witman has personally examined the personal property belonging to: James C. Bush Estate vllow{ng ,!ppra~resents his best judgment. ~ '- . '-..1J ..---... Jay an uctioneer/Appraiser 657 Fruitville Pike Manheim, PA 17545 Lie. #AU001127-L Affirmed and Subscribed to Before me this 30th Day of September 2004 !Jay 3ft, Witman 657 g\uitvil!e Pike, 3ftanheim. PJl'75t15 -Luke~" Witman ,f'C' -~~ Witman Auctioneers Inc. ~ ,,~ J ~ Auctiolleers alld Appraisers 'f ,IIV ~~.. "Ploviding Jl Compl,te Plo/essional Jluction Sewic, 'l~", Since '970" Telephone ~ "'.~ 667 Frultville Pike (7' 7) 666-6736 ... Manheim, PA '7545 FAX (7' 7) 664-2737 September 30, 2004 Page 3 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes STATEMENT OF LIMITING CONDITIONS To Whom It May Concern: I, the undersigned, do hereby certifY that to the best of my knowledge and belief, the statements are correct, subject to the limiting conditions herein setforth. I wish to certifY that I have no undisclosed monetary interest in the described property now or in the future. My employment and my compensation are not contingent upon the valuation found in this report. I have inspected the property and allfacts pertaining to the property and to the best of my knowledge the facts presented in this report are true. In the event that this appraisal has to be used in a court of law, a few will be establishedfor those purposes between owners and the auction corporation. This appraisal has been made in conformity with the rules of Professional Ethnics and the National Auctioneer's Board and Appraisers. Auctioneer/Appraiser !}ay:M. Witman 657 :Jluitvill, Pike. :Manheim, PJl17545 .Luke!R. Witman ,tV -~~ Witman Auctioneers Inc. ~ ,,~ J ~ Auctioneers and Appraisers 't . VV ~.. ' 'Ploviding ell Complete Plofessional elluction Sewice ~~" Since 1970" Telephone ~~'e' 667 Frultville PIke (7' 7) 666-6736 ManheIm, PA '7646 FAX (717) 664-2737 September 30, 2004 Page 4 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes In my opinion and best judgment after careful study and reviewing of per said documents, I have tried to give a fair and adequate value of what I think this item would bring at a well-advertised or promoted auction. I wish to inform you that prices at public auctions do fluctuate with high and low values depending upon many uncontrollable variables. It is in my opinion and best judgment that I appraise these items at the following price on this day. SUMMARYPAGE Total Appraised Value (Note: See detailed information on pages 5-9) - "" ~L -. ------:, ~ $18,240.00 gay.'M. Witman 657 :Jluitville Pike, .'Manheim, Pelll75Q5 Luke SR.. Witman If V ~~ Witman Auctioneers Inc. ~ ,,~ J ~ , , Auctioneers and Appraisers . 'f . VV fI" Plooiding ell Complete Plo!essLOnal elluctLOn Sew"e 'l~" Since 1970" Telephone ~:"'..~ 667 Frultv/lle Pike (717) 666.6736 ~ Manheim, PA 17646 FAX(717) 664.2737 September 30, 2004 Page 5 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Valuefor Inheritance Purposes Ext. Descriotion Value 2002 Ford Taurus SE Deluxe 4-Door Sedan (Purchased new 2/27/02) _ Six Cylinder, Six Passenger, Fully Loaded, Cloth Interior, 10,243 Miles, Auto Overdrive Transmission, 3 Year/36,000 Miles Warrantv 9500.00 - KITCHEN AREA Maole Dinette Set w/(4) Captain Chairs 50.00 Maple Hutch 110.00 Roval Worcester Enaland Set of China (Evesham Pattern) 125.00 (4) Kaiser West German v Fruit Plates 30.00 Cuckoo Clock 35.00 Milk Pitchers (11) @ 20.00 220.00 Canister Set 15.00 Miscellaneous Kitchen Items 10.00 10}; fje tiC 000 s()lJ> r:c t... I ,J.t-~ -C-,4,uL. I /IV /(.liYJ;l !lay 5lt. Witman 657 ::Jluitoille Pike, 5ltanheim, Pell'7545 .Luke!R. Witman ,fq -~~ Witman Auctioneers Inc. ~ ,,~ J ~ Auctioneers and Appraisers ~ . VV ~ t?" ' 'Plooiding JI Complete Plofessional Jluction SelOice ~~", Since '970" Telephone ~~'e' 657 Frultville Pike (7 I 7) 665-5735 Manheim, PA 17545 FAX (717) 664-2737 September 30, 2004 Page 6 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes DINING ROOM Cherry Dininq Room Table and (4) Chairs 350.00 Cherry Hutch wlGlass Break Front (Matches the above) 800.00 Set of Bamboo Stackable Tier Tables 40.00 Service for Eight - France Genuine Lead Crystal Parfaits, Goblets Wines, and Cordials 110.00 (5) Bush Coat of Arms Wine Glasses 20.00 Japan - Andrea Lunch Set 25.00 Franklin Mint Flowers of the Year Plate Collection Set - England Fine Bone China (12) @ 10.00 . 120.00 Wedqewood Chirstmas Muas (2) @ 15.00 30.00 Table Linens 20.00 Oneida Stainless Steel Silverware Set wlCase 25.00 Oreck SweeDer 25.00 SOlb _~(., ,AI /UN;' --CAML I tNI"AI~ !Jaya1. Witman 657 '3luitoi!!e Pike, a1anheim, PJI'7545 Luke SR.. Witman ,tV -~~ Witman Auctioneers Inc. ~ ,,~ J ~ Allctioneers and Appraisers " . VV ~.. ' '~~ovidin9 J/ Complete ~~olessional J/uction Sewice '-l~" Since 1970" Telephone ~.... ,e- 667 Fruitville Pike (717) 666-6735 .. Manheim, PA '7546 FAX (7' 7) 664-2737 September 30, 2004 Page 7 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes LIVING ROOM 35.00 120.00 55.00 40.00 70.00 35.00 40.00 50.00 85.00 _ (!AUI., 1/11"(1112 - (!A.,te I. I III' I<IIIIl .- C'A,toI., IN Kt.-r. 800.00 40.00 50.00 gay :Jrt. Witman 657 '3witville ~ike, :Jrtanheim, ~J/ 17545 Luke g{, Witman "q -~" Witman Auctioneers Inc.. ~ ,,~ J ~ "Auctionccrs and Appraiscrs . 't . VV ~. PlOviding .Jl Complete Pto/essronal .Jluctron SelO'ct 'l~" Since '970" Telephone ~"..~ 657 Frultvllle Pike (7/7) 665-6735 ~ Manhe/m,PA 17646 FAX (71 7) 664-2737 September 30, 2004 Page 8 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes HALLWAY/FOYER Framed Prints/Paintinas (25) @ 10.00 250.00 Narrow Hall Table 35.00 Jaoanese Horse w/Rider 45.00 Small Stiegel Type Hall Lamp 30.00 Multi-Flower Table Lamp 35.00 Modern Hamilton Tall Case Chime Clock. Moon & Dial, Open Glass, Brass Pendulum 1000.00 BASEMENT (2) Brass Table Lamos 20.00 Brovhill Uoholstered Love Seat 100.00 Pine End Tables (2) @ 20.00 40.00 Pine Chest/Table w/(2) Drawers 65.00 Upholstered Recliner 50.00 Upholstered Chair 35.00 Oak End Table w/Drop Leaf 35.00 RCA Colored TV 25.00 Sham VHS VCR 30.00 Decorated Entertainment Unit 65.00 Larae Louisville Kentuckv Stonware Bowl 35.00 Student Desk Lamo 40.00 Brass Hanaina Lantern 20.00 Modern Gone With The Wind Lamo 35.00 Black & Decker Workmate Table 20.00 Tool Box w/Miscellaneous Tools 5.00 /Jay 5l1. Witman 657 r:Ituitville Pike, 5l1anheim, P.Jl'7545 .Luke 9t. Witman ,fU -~" Witman Auctioneers Inc. ~ ,,~ J ~ Auctioneers and Appraisers 'f ,VV ~.. ' 'Pwviding JI Complete PlOlessional Jluction Sewice ~~" Since '970" Telephone ~.,.,..~ 657 Frultville Pike (717) 666.6736 ~ Manheim, PA 17646 FAX (71 7) 664.2737 September 30, 2004 Page 9 James C. Bush Estate 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done At: 143 W. Vine Street Shiremanstown, PA 17011 Appraisal Done To Determine True Market Value for Inheritance Purposes MASTER BEDROOM 5-Pc. Cherry Queen Ann Style Bedroom Suite - 4-Poster Bed, (2) Ni ht Stands, Butler Dresser, Hi h Chest-of-Drawers Dresser Lam Ni ht Stand Lam s 2 10.00 UPSTAIRS HALLWAY Butler Chest-of-Drawers w~ 4 Drawers Shi Pictures in Hallwa a rox. 10 $20.00 BACK BEDROOM #1 Bedroom Suite 2 35.00 BACK BEDROOM #2 2000.00 35.00 20.00 250.00 200.00 350.00 70.00 Ma Ie Kneehole Desk U holstered Recliner 3-Section Pine Bookcase German Beer Stein 55.00 - (l'AMJ L ,IN /C.".a 50.00 110.00 40.00 gay 5tt. Witman 657 'Jtuitville Pike, 5ttanheim, PJll75Q5 Luke lR.. Witman o Great-West RETIREMENT SERVICES~ Securities offered through GWFS Equities, Inc. A Great-West Company 8515 East Orchard Road Greenwood Village, CO 80111 (303) 737-3000 Address mail to: P.O. 173764 Denver, CO 80217-3764 October 12,2004 YOUNG AND YOUNG ATIN J DAVID YOUNG JR ESQ 44 S MAIN ST MANHEIMPA 17545 RE: Participant Name: James Chambers Bush (Deceased) Plan #: 98978-01 Dear Mr. Young: We are in receipt of your request for information regarding James Chambers Bush's Commonwealth of Pennsylvania Deferred Compensation Program. Great-West Retirement Servicesw became the record keeper for Mr. Bush's Commonwealth of Pennsylvania Deferred Compensation Plan August 1,2004. Information on this account prior to that date can be obtained from the Plan's prior record keeper, CitiStreet, at 1-800-422-1327. Mr. Bush was invested in the Stable Value Fund. This mutual fund did not pay simple interest; therefore none was paid to Mr. Bush from the date we became the record keeper. It's value changed on a daily basis based upon the performance of the underlying interest bearing securities and other investments within the Fund's portfolio. The value in this account as of September 15,2004, was $105,587.06. This was an individual account. Carol A. Blanck was named on this account as primary beneficiary. If you have questions, please submit them in writing to the address listed above. Sincerely, G Anne Thompson Group Retirement Correspondent Financial Services Division The Power of PartneringSM . BLUE BALL National Bank October 13, 2004 J. David Young, Jr. Young and Young 44 S. Main St., P.O. Box 126 Manheim PA 17545 Re: James Chambers Bush Estate Dear Mr. Young: As of the date of death, September 15, 2004, James Chambers Bush had the following account at the Blue Ball National Bank: Mortgage Account - #5030375, opened April 19, 1993. The balance due as of date of death was $41,806.61 plus $138.22 interest accrued. If we can be of further assistance, please contact us. Sincerely, YIt. ~~ Ma:;:: Leaman Community Office Manager MEL/lw po. Box 580, 1060 Main Street, Blue Ball, PA 17506, 717.354.4541. 800 . 346 . 3437, www.bbnb.com A Subsidiary of PennRockFinancial Seroices Carp. REGISTER OF WILLS OF iClMlER:AM) COUNTY, PENNSYLVANIA INVENTORY Estate of BUSH, JAMES CHAMBERS No.21 04 0865 , Deceased Date of Death 09/15/2004 Social Security No. 192-30-6142 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IlWe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: J. David YounQ. Jr. I.D. No.: 39136 Personal Representative: ~f;Y (f 6.-' · (4. \&~ .. J-; Administratrix Address: YounQ & YounQ, Attorneys-at-Law P. O. Box 126 Dated February 17, 2005 Manheim Telephone: (717) 665-2207 PA 17545 Description Real estate situate at 143 W. Vine Street, Shiremanstown Borough, Shiremanstown, Pennsylvania - sale price Value 125;00.0.00 $14,800 U.S. Savings Bonds, Series EE 18,,0.72.48 c,'; Smith Barney Account No. 724-10734-1-5-410 91;450.51 i..", ~"'J Citizens Bank Checking Account No. 6100893006 22,481.56 Miscellaneous receipt - Citizens Bank Checking Account 451.46 Members 1 st Federal Credit Union Checking Account No.1 0989-11 2,042.35 Total (Attach Additional Sheets if necessary) 361,826.77 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 v"" Continuation of Inventory BUSH, JAMES CHAMBERS 21 04 0865 PaQe 1 Description of Inventory Description Members 1st Federal Credit Union Savings Account No. 10989-00 Value 3,077.24 Members 1 st Federal Credit Union Life Savings Account No. 5876-04 2,000.77 Members 1st Account No. 104914 1,970.32 Members 1st IRA Savings Account No. 10989-10 33,860.77 Pacific Life Contract No. V A97 441450 14,040.25 Sun Life Financial Contract No. 79-7900-206694 18,764.40 Government Securities Investment (G) Fund - Thrift Savin9s Plan No. 192306142 11,874.13 U.S. Office of Personnel Management, final annuity payment 1,179.55 AT&T - refund from cancellation of service 4.13 Blue Ball National Bank - refund of mortgage escrow account 451.52 Central Penn Auto Club - refund from cancellation of membership 52.50 Com cast - refund from cancellation of service 2.83 Proceeds from sale of tangible personal property and automobile 14,550.00 Tangible personal property, taken in kind - appraised value 500.00 Grand Total $ 102,328.41 361,826.77 Subtotal $ STATUS REPORT UNDER RULE 6.12 Name of Decedent: James Chambers Bush Date of Death: September 15, 2004 will No. 2104-0865 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete. Yes x No 2. representative complete: If the answer is No, state when the personal reasonable believes that the administration will be 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. co Attorney Date: February 17, 2005 i=> c:> Capacity: Personal Representative X Counsel for personal representative v-- co c- c- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In the Estate of: ) ) ) ) ) No. 2104-0865 BUSH, JAMES CHAMBERS, Deceased. ACCOUNT and RELEASE Date of Death: Date of Administratrix's Appointment: First Complete Date of Advertisement: Accounting Stated for the Period: September 15, 2004 September 22, 2004 October 7, 2004 September 16, 2004 to February 17, 2005 \/ SUMMARY OF ACCOUNT Proposed Schedule of Distribution PRINCIPAL Receipts Net Gain on Sales or Dispositions Less Disbursements: General Disbursements Debts of Decedent Funeral Expenses Administrative Expenses Fees and Commissions Paoes 3 3 4 4-5 5-6 6 6-9 9-10 64,606.69 46,651. 74 4,224.04 13,193.28 7.800.00 Balance before Distributions Distributions to Beneficiaries 10 Principal Balance on Hand INCOME Receipts Disbursements Income Balance on Hand COMBINED BALANCES REMAINING 10-11 11 $387,383.03 + 1.033.30 388,416.33 -136.475.75 251,940.58 - 50.000.00 201,940.58 867.01 52.42 814.59 $202.755.17 . The Combined Balances Remaining consists of the following: Cash Tangible personal property, in kind, appraised value TOTAL -2- $ 500.00 202.255.17 $202.755.17 PROPOSED SCHEDULE OF DISTRIBUTION Distribution by assignment/agreement of the parties as follows: Carol Blanck, tangible personal property, in kind, appraised value Edwin M. Bush, III, 1/5 of residue consisting of cash Susan Conyac, 1/5 of residue consisting of cash John I. Blanck, Jr., 1/5 of residue consisting of cash Christine M. Hepler, 1/5 of residue consisting of cash Jennifer L. Blanck, 1/5 of residue consisting of cash GRAND TOTAL FOR DISTRIBUTION PRINCIPAL RECEIPTS 2005 Assets of Decedent per Inventory filed (See attached Exhibit "A") SUBSEOUENT RECEIPTS 2004 Oct. 27 Proceeds of Sun Life Financial Contract No. 79-7900-206694, minimum death benefit adjustment Nov. 4 Proceeds of MetLife Total Control Account, death benefits 2005 Jan. 31 Pro-rata share of real estate taxes due seller per real estate settlement TOTAL PRINCIPAL RECEIPTS -3- $ 500.00 40,451. 04 40,451.04 40,451.03 40,451. 03 40,451. 03 $202.755.17 $361,826.77 12,475.64 12,522.61 558.01 $387.383.03 CONVERSION SCHEDULE Gain Loss 2004 $ $ Oct. 5 $10,800 U.S. Savings Bonds, Series EE and 14 $4,000 U.S. Savings Bonds, Series EE Book value 18,072.48 Proceeds 18,072.48 -0- -0- 15 Citigroup Global Markets, Inc. Smith Barney Account No. 724-10734-1-5-410 Book value 91,450.51 Proceeds 92,777.85 1,327.34 Nov. 2 Pacific Life Contract No. VA97441450 Book value 14,040.25 Proceeds 13,746.21 294.04 2005 Jan. 31 Real estate located at 143 West Vine Street, Shiremanstown, PA Book value 125,000.00 Proceeds 125,000.00 -0- -0- TOTAL 1,327.34 294.04 Net Gain Transferred To Summary 1.033.30 $ 1.327.34 $ 1.327.34 PRINCIPAL DISBURSEMENTS GENERAL DISBURSEMENTS 2004 Oct. 8 Red Rose Veterans Honor Guard, donation for funeral services $ 150.00 -4- GENERAL DISBURSEMENTS, cont, 2004 Nov, 22 2005 Feb. 17 Register of Wills, Agent, payment on account of PA Inheritance Tax on $175,000.00 at 12% and on $175,000.00 at 15% less 5% discount 44,887.50 Register of Wills, Agent, balance of PA Inheritance Tax due 4,569.19 Carol A. Blanck, gift in lieu of administratrix fee 15,000,00 DEBTS OF DECEDENT 2004 Sept.30 Oct. 20 Members 1st Federal Credit Union, deduction of membership fee from proceeds of accounts 25.00 Blue Ball National Bank, mortgage payment 503.00 WSI - Mid Atlantic, trash service 31.65 Allstate, car insurance premium less refund of $44.08 28.45 PPL, electric service 33.26 8 Lower Allen Township, sewer service 24.00 Verizon, telephone service 14.09 American Water Company, water service 28.50 -5- $ 64,606.69 DEBTS OF DECEDENT. cont. 2004 Oct. 28 Nov. 4 2005 Feb. 17 Blue Ball National Bank, mortgage payment 503.00 30 Checks paid after date of death from Citizens Bank Checking Account No. 6100893006 111. 23 Blue Ball National Bank, mortgage pay-off 41,682.36 15 Holy Spirit Hospital, professional services 29.20 U.S. Treasury, 2004 individual income tax due 3,620.00 PA Dept. of Revenue, 2004 individual income tax due 18.00 FUNERAL EXPENSES 2004 Sept.30 Buch Funeral Home, Inc., funeral expenses ADMINISTRATIVE EXPENSES 2004 Sept.21 23 28 Register of Wills, Letters of Administration, short certificates, Letters fee 228.00 Recorder of Deeds, deed copy 10.00 Vital Records, death certificates for Edwin Bush 36.00 Bank of Lancaster County, estate checkbook charge 15.50 -6- $ 46,651.74 4,224.04 ADMINISTRATIVE EXPENSES. cont. 2004 Oct. 6 20 25 29 Nov. 4 11 19 Vital Records, death certificates for Edwin Bush Register of Wills, short certificates 8 Carol Blanck, reimbursement for payment to Central Penn Appraisers for real estate appraisal 14 Easy Siders Home Improvement Company, Inc., soffitt repairs 18 Register of Wills, short certificates Witman Auctioneers, Inc., tangible personal property appraisal Cumberland Law Journal, estate notice The Sentinel, estate notice PPL, electric service 7 Virginia Stauffer, cleaning house Ron Neufeld, painting/papering residence 8 Kreamer Bros. Glass, Inc., window repairs Virginia Stauffer, cleaning house UGI, gas service Virginia Stauffer, cleaning house -7- 27.00 15.00 300.00 303.30 12.00 583.00 75.00 64.49 25.83 80.00 200.00 108.24 80.00 140.88 80.00 $ ADMINISTRATIVE EXPENSES. cont. 2004 Dec. 1 2005 Jan. 2 10 18 24 30 PPL, electric service UGI, gas service 2 Virginia Stauffer, cleaning house 3 Virginia Stauffer, cleaning house UGI, gas service PPL, electric service PA American Water Company, water service Shireman Gardens HOA, homeowner's association fee George Dimoff, Realtor for Jack Gaughan, reimbursement for fireplace remote control Lower Allen Township, sewer service Virginia Stauffer, cleaning house PPL, electric service UGI, gas service less refund of $30.33 PA American Water Company, water service WSI - Mid Atlantic, trash service -8- 27.61 70.00 90.00 110.00 70.00 37.05 55.79 61.00 227.90 24.00 80.00 41.42 39.67 28.55 32.12 $ ADMINISTRATIVE EXPENSES, cont. 2005 Jan. 31 Feb. Expenses per real estate settlement: County taxes Realtor's commission Transaction fee Document preparation Notary fees Transfer tax Home warranty Resale certificate 3 John Blanck, reimbursement for UPS shipment to S. Conyac 8 TDB Enterprises, LLC, snow removal PPL, electric service PA American Water Company, water service 17 Reserve: 32.94 7,500.00 125.00 75.00 10.00 1,250.00 409.00 35.00 112 . 72 20.00 9.76 23.51 Register of Wills, additional cost of Letters of Administration 105.00 Register of Wills, filing Inventory 13.00 Register of Wills, filing PA Inheritance Tax Return 15.00 Young and Young, Attorneys-at-law, notary fees 3.00 Recording Account and Release FEES AND COMMISSIONS 2005 Feb. 17 Carol A. Blanck, administratrix fee (Calculated at $15,000.00) -9- 75.00 waived $ 13,193.28 FEES AND COMMISSIONS. cont. 2005 Feb. 17 Young and Young, Attorneys-at-Law, attorney fee 7.800.00 $ 7.800.00 TOTAL PRINCIPAL DISBURSEMENTS $136.475.75 PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES 2004 Dec. 17 John 1. Blanck. Jr. , advance distribution $ 10,000.00 Christine Hepler, advance distribution 10,000.00 Jennifer Blanck, advance distribution 10,000.00 Susan Conyac, advance distribution 10,000.00 2005 Jan. 3 Edwin M. Bush, III, advance distribution 10.000.00 TOTAL PRINCIPAL DISTRIBUTIONS $ 50.000.00 INCOME RECEIPTS 2004 Oct. 14 Interest earned after date of death on U. S. Savings Bonds, Series EE $ 71.60 Nov. 22 Interest on MetLife Total Control Account (death benefits) 3.57 Dec. 1 Interest earned after date of death on Members 1st IRA Savings Account No. 10989-10 86.33 23 Interest earned after date of death on Government Securities Investment (G) Fund Thrift Savings Plan No. 192306142 135.06 -10- INCOME RECEIPTS, cont. 2005 Interest on Bank of Lancaster County Accounts (estate): Checking No. 2204830801 Money Market No. 9020018049 $ 6.43 564.02 TOTAL INCOME RECEIPTS $ 867.01 INCOME DISBURSEMENTS 2004 Sept.30 Interest adj ustment on Members 1st Federal Credit Union Savings Account No. 10989-00 and Life Savings Account No. 5876-04, proceeds of account less than reported date of death balances $ .42 2005 Feb. 17 PA Dept. of Revenue, fiduciary income tax due for year ending 2/28/05 52.00 TOTAL INCOME DISBURSEMENTS $ 52.42 WE, the undersigned, being the heirs-at-Iaw of JAMES CHAMBERS BUSH, Late of the Borough of Shiremanstown, County of Cumberland and Commonwealth of Pennsylvania, deceased, do hereby acknowledge that we have received of and from the said Estate our full net distributive share thereof, to wit, in accordance with the preceding account. WE, hereby accept and approve said Account above stated with the same force and effect as if it had been duly filed in the -11- Office of the Register of wills and audited in the Orphans' Court and had been adjudicated and confirmed absolutely and the amount paid to us had been duly awarded to us. WE, further stipulate and agree to the taking, in kind of tangible personal property as a part or all of the distributive share as indicated under the Schedule of Distribution. WE, further agree that if any just and proper claim is hereinafter presented to the Administratrix, to be responsible for our our pro-rata share of the same, up to the amount of our inheritance. AND, WE hereby release the said CAROL A. BLANCK, Administratrix of the Estate of JAMES CHAMBERS BUSH, deceased, of and from any and all claims we have under the law against the said Estate and/or the said Administratrix. WITNESS our hand and seal this 17th day of February, 2005. WITNESS: (l~~! L 4. .~d" ~ ~/ ~. A. Blanck (See attached separate Release) Susan Bush Conyac (See attached separate Release) Edwin M. Bush, III -12- WITNESS: (See attached seoarate Release) John I. Blanck, Jr. {j{p~utv1n.~~ Christine M. Hepler (See attached seoarate Release) Jennifer L. Blanck COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF LANCASTER On this 17th day of February, 2005, before me a Notary Public, personally appeared CAROL A. BLANCK and CHRISTINE M. HEPLER, who acknowledged the foregoing Release to be their act and deed and desire the same to be recorded as such according to law. WITNESS my hand and Notarial Seal the day and year first above written. (~cw N{;AR~~ My commission expires: COMMONWEALTH OF peNNSYLVANIA NOTARIAL SEAL . SUSAN L. CONNELLY, Notary Public Manheim BolO., LancaSter County M Commission Expires January~, ~ -13 - PARTIAL RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Executrix of the Estate of James Chambers Bush, the following assets: PRINCIPAL Cash $ 10,000.00 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this day of , 2004. \- O'A] (} 7 ~ct.c ~n Conyac Affirmed and subs~bed before me this {~ day ~Pr' 2004. ,"'liWJ::::., '"":I" "~..,;., USA S u." ~. ."~ 'r11U.L i.~ .i:i MY COMMISSION # CC 991 "!.r.R".~' EXPIRES: Janua~ 2 "",f27 .j"fl\' 601ldedT~1U Nota p '1 ,'uvo ry UbIIcUlldsrwr/lers My UBLIC expires: RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Administratrix of the Estate of JAMES CHAMBERS BUSH, the following assets: PRINCIPAL Cash $ 40,451.04 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this ;2P day of RI:Y~, 2005. ~ ---Susan Conyac ~QC Affirmed and subscribed before me this <93 day o~~o~ , NOTARY PUBLIC My commission expires: ii";~\ --,.t-- - - - - -- .*: "., \"'-_ ,_;'i ...~:R!::~~ct~.' KAREN l. PENDARVIS MY COMMISSION # 00254568 EXPIRES: Oclober24.2007 Bonded Tf'rru CNA Surety PARTIAL RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Executrix of the Estate of James Chambers Bush, the following assets: PRINCIPAL Cash $ 10,000.00 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this /1-11t day of]lcz: ' 2004. Z{f)ji2- Edwin M. BuSh, III Affirmed and subscribed before me this i~/"" day of &<>-e..... ,2004. ,,~~'r""'" Janice P. Gray !.f~';' MY COMMISSION # DD140752 EX1'IRES \,,\ .' l August 11. 2006 "7,~0".;;';' BONDEDTHRUTROYFAININSURANCe, lNC. ",r,,'l'- RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Administratrix of the Estate of JAMES CHAMBERS BUSH, the following assets: PRINCIPAL Cash $ 40,451.04 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this ;25 day of Ho. , 2005. &fiz Edwin M. Bush, III , Affirmed and subscribed before me this ~~~ay ofciLG ,2005. ) &~~ :::'Lb ~- '..-t'-!:U2~ c) ( NOTARY PUBLIC .- My commissio~ ~xf\.r~s~~cr.~""-,,,-'-'----- ---.-.--- , "\' ....""."." K",',' ", ",',fE 8ROWN1NG t'. .....'\~'{ "u...:~~.. ,-" ,,' ' ,," ' . ~.R f";' No;- " "l'~"iC - State of Flonda ~. ~ .~ ~~r:.I~~ExpieSMay21,2005 r, ~m}~ ComOl',,'on' DD017627 " , I'J",.9i,;..""-' " ,",' -.....-,,~->"'~~~~-q,'......~. .,'-,,, ~, PARTIAL RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Executrix of the Estate of James Chambers Bush, the following assets: PRINCIPAL Cash $ 10,000.00 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this day of , 2004. 2O~~aC~ Affirmed and subscribed before me this day of , 2004. NOTARY PUBLIC My commission expires: RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Administratrix of the Estate of JAMES CHAMBERS BUSH, the following assets: PRINCIPAL Cash $ 40,451.03 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this d, S-.l+day of "tb~~, 2005. ;/uL- (}~~ John I. Blanck, Jr. Affirmed and subscribed ) before me this ~~~day ) Of~Q..<~, 2005. l ~~A~U~Cg'~<lVI~-1 My commission expires: '~L"-~ \ \ ""2..D\'=> C:=J L_ \-\.-o~ g~rtk of PA- CCcWl~ o{ kebc'"U/LOn PARTIAL RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Executrix of the Estate of James Chambers Bush, the following assets: PRINCIPAL Cash $ 10,000.00 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed Chi. Q&n;4e~ ) Affirmed and subscribed before me this '8~ day of t>ecemb4' , 2004. ~~~ My commission expires: C:.. IIi af N01'ARIAL lIEN. 1l/illAM. BOYER. N*Y NIle ,.....BaIo.I.IIlIIlDn CoII'IIy .., ~..J 1 '" ElqliII Nov. 5. 2007~.. PARTIAL RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Executrix of the Estate of James Chambers Bush, the following assets: PRINCIPAL Cash $ 10,000.00 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Executrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this Lf~day of ))e~, 2004. ~~G( Affirmed and subscribed before me this 9 day of~~d?6e,- , 2004. ~~ /t? ~ - NOTARY PUBLIC My commission expires: ~~~ RECEIPT AND RELEASE KNOW ALL MEN BY THESE PRESENTS, that the undersigned, individual or corporate, does hereby acknowledge receipt from CAROL A. BLANCK, Administratrix of the Estate of JAMES CHAMBERS BUSH, the following assets: PRINCIPAL Cash $ 40,451.03 IN CONSIDERATION of said payment and transfer, the undersigned does hereby release, remise, quitclaim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the JAMES CHAMBERS BUSH Estate. IN WITNESS WHEREOF, the undersigned has caused this Instrument to be executed this <<5' day Of~ 2005. ~c.G Jennife L. BHmck Affirmed and subscribed before me this ;ZS day Of~- ~Ri/&If:J ' 2005. _.'!'ndL/J <fJ ~ / NOTARY PUBLIC My commission expires: /~/'I/()~ COMMOE ARTMENT OF REVENUE N A D NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL.._T~1XES._ . ,., ._ ,~. ~_APPRAISEMENT, ALLOWANCE OR DISALLOWANCE ,. INHERITANCE tax olvlsloN - OF DEDUCTIONS AND ASSESSMENT OF TAX _-'-- REV-1547 EX AFP [03-05) PO BOX 280601 - - HARRISBURG PA 17128-0601 `' '; _ _ _. DATE 05-16-2005 ESTATE OF BUSH JAMES C ,~ .-. ~~'..~..-, i ~ `- ~~ ~ ~ ~ DATE OF DEATH 09-15-2004 FILE NUMBER 21 04-0865 - CUMBERLAND (~t._~~ - '", -v . COUNTY ,~_ J DAVID Y~1(!f# { J~ ESt~ "~ ~ ACN 101 YOUNG & ~G~~1+IG ATTYS Amount Remitted PO BOX 126 MANHEIM PA 17545 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~ „^~e^~~^~~^^ee^^ ~~O~Y~~Y~t~~~Yi~`3~'tf~5~~'I,Ta't"~t'~~'d~'~t1~A~~YY~lO~ejt~~A~RAslaf~'N ~F~A~ d~ DISALLOWANCE OF DEDUCTIO ESTATE OF BUSH JAMES C FILE N0. 21 04-0865 ACN 101 DATE 05-16-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN (1) 125,000.00 NOTE: To insure proper 1. Real Estate (Schedule A) 109 , 522.99 credit to your account, 2. Stocks and Bonds (Schedule B) (2) submit the upper portion .00 of this fora with your 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 tax payment. 4. Mortgages/Notes Receivable (Schedule D) (4) 127,303.78 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .0 0 6. Jointly Owned Property (Schedule F) (6) (7) 105,587.06 7. Transfers (Schedule G) (8) 467 , 413.83 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 25,184.38 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 4 6,6 5 1.7 4 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) (11) 71 .836 .12 11. Total Deductions (12) 395, 577.71 12. Net Value of Tax Return .0 0 13. Charitable/Governmental Bequests; Nonelected 9113 Trusts (Schedule J) (14) 3 9 5,57 7.7 1 14. Net Value of Estate Subject to Tax NOTE: if an assessment was issued previootal~ofsALL returnsaassessed~toTdate,and 19 will reflect figures that include the t ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due rwin~n~ •------ - DATE NUMBER INTEREST/PEN PAID (-) 11-22-2004 CD004661 2,362.50 02-22-2005 CD004981 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) . 00 X (16) .00 X (17) 250,582.39 X (is) 144,995.32 X 00 _ .00 045 . . 00 12 30,069.89 15 21,749.30 (19)= 51,819.19 AMOUNT PAID 44,887.50 4,569.19 TOTAL TAX CREDIT 51,819.19 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.? RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NDTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 20D0. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF WILLS, AGENT. Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county, or the issuance of an Orphan's Court citation. REFUND CCR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax° (REV-1313). Applications are available online at www.revenue.state.ua.us, any Register of Wills or Revenue District Office, or from the Department's 24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3D20 [TT only). OBJECTIONS: Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofaaaeals.state.aa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. ADMIN- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one [1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .D00164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~$'~ ~~T ~$$-1991 ~~ ~~f ~1 ~J'T l~r 1983 16% .ODD438 1992 9% .000247 2002 6% .000164 1984 11% .D00301 1993-1994 7% .000192 2003 5% .000137 1985 13% .000356 1995-1998 9% .000247 2004 4% .000110 1986 10% .000274 1999 7% .000192 2005 5% .000137 1987 10% .000274 2000 7% .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.