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03-16-12 (2)
1505610105 REV-1500 EX (oz-u) (FI) ` s OFFICIAL USE ONLY PA Department of Revenue P~~Ylvarda Coun Code Year File Number MMIITNEIRM IIM~UE Bureau of IndtvidualTaxes INHERITANCE TAX RETURN PO BOX z8o6oi IV ~ I Harrisburg, PA i'7iz8-o6oi RESIDENT DECEDENT ' `~ ~ ' ~ I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _... 165-58-6748 :06/17/2011 ' 08/08/1961 Decedent's Last Name Suffix Decedent's First Name MI _ _ _ __ Ireland ' Scot _ _ _ _ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number. ___ _ __ FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Retum O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax'. Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule U) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name __ Daytime Telephone Number _ _ :Barbara Sumple-Sullivan ___ _ _. __. (717) 774-1445 __ __ First Line of Address 549 Bridge Street Second Line of Address City or Post Office State ZIP Code New Cumberland PA !. 17070 REGISTER OF WI~.LS USE ON ... +~a i1' , ~,. ;A( m ~ a' cn _ ~~~C ~ 7 DAT GED ~. Correspondent's e-mail address: barbara-bSSeSgl~VeriZOn.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and ~mplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S NATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS v 803 Linwood Sleet, New Cumberland, PA 17070 3 ~ SIGNATURF,r0F~f2EP?~RER~OTF~(2 THAN REPRESENTATIVE ne Bridge Street, New Cumberland, PA 17070 PLEA8E U8E ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 ";>C.:~ ~-/~ ~- T^ ~mj ~.~'S ,. 1505610205 REV-1500 EX (FI) Decedent's Name: Scot Ireland Decedent's Social Security Number 165-58-6748 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2.' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ' 95.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ! 82,205.60 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 126,671.55 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ! 208,972.15 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9.; 17,178.30 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 40,027.14 168,945.01 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. I 168,945.01 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 __... _._.... __. _..._._......... (a)(1.2) X .0_ ..._ 16. Amount of Line 14 taxable at lineal rate X .0 _ 17. Amount of Line 14 taxable at sibling rate X .12 .:. 18. Amount of Line 14 taxable 168,945.01 at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19.! 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 22,848.84 25,341.75 O 1505610205 1505610205 J REV-1;08 EX+ (u-io) ` i~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Sco Ireland 2011-00916 If more space is needed, use additional sheets of paper of the same size 342s" ~Yl~i'1~5~1'~ ~'~~~' ~®AD C'P ~II.~,, ~A, 17011 717-763-1644 ~'~ 717-763-1646 ~i~IlIlflb ~gIlS~t'fldC~Il®tIlS ~®~-gn ~A-40 - PA 1~ndIl~ndr~al lnc®~e 'Tam ~e~~n~-n T'a~ab~e Year ~~ded Deee~be~- 31, 2011 Name: SCOT H IRELAND Date Due: April 17, 2012 Remittance: None is required. There is a total overpayment of $95, which is to be refunded in its entirety. Signature: You have signed your electronically filed return with a Personal Identification Number (PIN). Sign and date Form PA 8879, Pennsylvania e-file Signature Authorization. Return it as soon as possible to: PADDEN, GUERR><1VI & ASSOCIATES,P.C. 3425 SIl1Il'SON FERRY ROAD CAMP FIILL, PA 17011 We will not file your return until we receive your PA e-file signature authorization form. Other: Your return is being filed electronically. Do not mail Form PA-40. Initial ,and date the copy of the return and retain it for your records. 28540 03i -'> -12 6:00 PM _ _n~~ aylvania DE R%- ~-MENT OF REVENUE Form Pfi-379 f ~'~~~s~9~~~~~ ~-~a~~~ ~a~r~~~~ar~ ~~~~~n~~~~~~.~;~ 00.23 X984006342 Ta~nnv~r' ni~,~,o - ~ ,1 - , SCOT 3 I~~~ espouse s ame Social Security Number 165-58-6748 spouse's Social Security Number ~~~ ~ t pax rcaiurn Insormation -Tax Year Ending Dec, 31, 2011 (bYhole dollars only) 1 Adjusted PA Taxable Income (Form PA-40, Line 11) .. .... 2 PA Tax Liability (Form PA-40, Line 12) .. _ ... . ..................... ~. Total PA Tax Withheld (Form PA-40, Line 13) ... , . , .. _ _ . ... ..................... 4. Refund (Form PA-40, Line 30) . , . _ . , . ................... 5. Total Payment (Tax Due) (Form PA-40, Line 28) ... , .. , . , , PART II Declaration and Signature Authorization of Taxpayer Under penalties :f perjury, I declare I have examined a copy of my electronic individual income tax retum and accompanying schedules and statements or m} 2011 PA Tax Return (Form PA-40), and to the best of my knowledge and belief, it is true, correct and complete. I further declare that t~e =Mounts in Part I above are the amounts shown on fhe copy of my electronic income fax return. If applicable, I authorize the PA Departme:lt c Revenue and its designated financial agents to initiate an electronic funds withdrawal (direct debit) entry to my designated account for Pennsylvania taxes owed. I also authorize my financial institution to debit the entry to my account and the financial institutions involved in the pr;cessing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to layment. I certify the funds for this withdraw are originating from an account within the United States or one of its territories. I have selected a :ersonal identification number as my signature for my electronic income tax return and, if applicable, my electronic funds withdrawal consert, Taxpayer's Personal Identification Number (PIN): (check one box only). 0 I authoriz= P_ADD E N C-t7ERRIt~TI '' ASSO - 1 4,600 2. 141 3. 9 5 a. 9 5 5. ___ - c C1P_TES,P.C. 28540 to enter my PIN as my :signature on my tax year 201 electronically filed income tax return. ^ I will enter ry PIN as my signature on my tax year 2011 electronically filed income tax return. Your signature Spouse's PIN: .(check one box only) ^ I authorize tax year 201' electronically filed income tax return. ^ I will enter my PIN as my signature on my tax year 2011 electronically filed income tax return Spouse's signature Practitioner PIN Prograrn Participants Only- Continue Below 'ART III Certification and Authentication Date ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN 2 3 0 9 8 ~ 718 6I As a participanf in the Practitioner PIN Program, I certiry the above numeric entry is my PIN, which is my signature on the tax year 2011 electronically filed income ta„ return for the ta„payer(s) indicated above. I confirm I am participating in fhe Practitioner PIN Program in accordance with the requirements established for this program. RO's signature Date 03/09/12 to enter my PIN as my signature on my Date 03/09/12 ERO mush reta9n this foam an~1 the supporting docaa~°ien;rs forth,ee years.. DO NO i Sl~3~j~T Tl~1S EOR~a'I TO ~"HE' PEP1f~SYLWAN~A D=PAR~~'EP,! T Off' REVEP~@!E. REV-i5og EX+ (oi-lo) t s ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F I ' 70YNTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Scot Ireland 2011-00916 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING )DINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Therese J Fisher 803 Linwood Street Fiancee New Cumberland, PA 17070 B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE T MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ]DIMLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET / of DECEDENT'S INTEREST DATE of DEATH VALUE OF DECEDENT'S INTEREST 1, A. 05/10/03 Metro Bank Savin s Acct. No. 626164644 g 5,407.98 50 2,703.99 2. A. 05/12/03 Metro Bank Checking Acct. No. 536257595 8,003.21 50 4,001.61 3. A. 04/22/96 House on 803 Linwood Street, New Cumberland, PA 17070 151,000.00 50 75,500.00 (See attached deed and appraisal of Michael R. Ent dated 6/17111) TOTAL (Also enter on Line 6, Recapitulation) $ 82,205.60 If more space is needed, use additional sheets of paper of the same size. SCHEDULE F EXHIBITS ~ PENNSYLVANIA INHERITANCE TAX ~7 INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~.F FILE: N0. 21 ~ PO Bl7X 280601 Pennsylvania AND ACN 11159392 HARRISBURG PA 17128-0601 DEPARTMENT OFREVENUE TAX P AY E R R E S P O N S E DATE 09-01-2011 REV'1543 EX AFP f05 -11) THERESE J FISHER 803 LINWOOD ST NEW CUMBERLAND PA 17070 EST. OF SCOT H IRELAND SSN 165-58-6748 DATE OF DEATH 06-17-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. METRO BANK provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yDU art the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it tq the. above address. Please call 717.787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 626164644 Date 05-10-2003 To ensure prover credit to the account, two Established copies of this notice must: accompany Account Balance $ 5,407.98 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX ~` 2, 703.99 NOTE: If tax payments are made within three months of the decedent's date of death, TaX Rate X ~ 15 deduct a 5 percent discount on the tax due. Potential TaX Due $ 405.60 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND,WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and O N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: OFFICIAL USE ONLY a AAF 2 PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD`` LINE 1. Date Established 1 .~T ;.. . 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5"- 6. Amount Taxable !, $ g '6 7. Tax Rate 7 X '7 - 8. Tax Due g 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION eMniiuT porn ~~~ amine n or fax computation) g Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOM E C ~ woRK c ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ~, PENNSYLVANIA INHERITANCE TAX ~ BUREAU OF INDIVIDUAL TAXES '~~ INFORMATION NOTICE FILE, NO. 21 PD Bax 280601 Pennsylvania HARRISBURG PA 171za-o6o1 TAXPAYERNRESPONSE ACN 11159391 DEPARTMENT 6FREVENUE DA T E REV-1543 E% RfP ( 05-11) 0 9 - 01 - 2 011 THERESE J FISHER 803 LINWOOD ST NEW CUMBERLAND PA 17070 EST. OF SCOT H IRELAND SSN 165-58-6748 DATE OF DEATH 06-17-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ^ SAVINGS CHECKING ^ TRUST ^ CERTIF. M ETRD BANK provided the department with the infiormation below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the SpOUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 536257595 Date 05-12-2003 7o ensure proper credit to the account, two Established copies of this notice must: accompany Account Balance $ $ ~ ~ 03.21 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to TaX 4 ~ ~ 01.61 months of the decedent's date of death, TaX Rate X 15 deduct a 5 percent discount on the tax due. 6 ~ ~ . 2 4 AnY inheritance tax due will become delinquent Potential TaX Due nine months after the date of death. PART TAXPAYER RESPONSE 1^ FAILURE TO RESPOND. WILL RESULT~`IN AN OFFIDTAL TAX ASSESSMENT' A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. BLOC K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ^ The above information is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY a relationship to decedent- ^ A AF PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 I 1 2. Account Balance 2 $ ~ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 +fi ~ 5. Debts and Deductions 5 5 6. Amount Taxable 6 ,fi 6 7. Tax Rate 7 X 7 8. Tax Due B $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION nMniinlr pern Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HD ME C ~ WORK C ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ~~~~~~ ~~~ pure ~ yr iax computation) 5 APPRAISAL OF 1105 OAK LANE NEW CUMBERLAND, PA <_ , Borrower/Client S OT IRELAND & THERESE FISHER File #lo. 80317070-L Pro a Address 803 Linwood St Ci NEW CUMBERLAND Coun CUMBERLAND State PA Zi Code 17070-1443 Lender N/A URAR ................................................................................................................. . . . . ..................... Subject Photos ............................................................................................................................ .................................................................................... 1 .............................................................................. . 7 Interior Photos .......... . ..... ......................................_....................................................................... Comparable Photos 1-3 ............... ..........,................._....................................................... 8 ............................................................................................... USPAP Compliance - Altemate ......... . ...................................................................................... 9 .. ......................................................................................... Multi-purpose Supplemental Addendum ...................................................................................... .................................................................................... 10 ............... 11 Building Sketch ................................... ....................................................................... ........................................................................................ Location Map ................._.................... ..................................................................................... 13 __,............................................._.................................. Appraiser's Certificate ............ .............................................._...................................... 14 ..................................................................................................... Invoice .............. ..........................................................................._........ 15 ......................................................................................................................... ...................................................................................... 16 Form TOCP- "WinTOTAL" appraisal software by a la mode, inc.-1-800-ALAMODE TABLE OF CONTENTS MICHAEL R ENT (717) 730-3010 (Main File No 80317070-L Paoe #t Uniform Residential A raisal Re ort 80317070-L The nurnnse of thic cumin°~, ~ ~~,i .,, ~~ P File# 80317070-L - ~- - ~- r °••-~ ~~•~ ~~~~~~~,~~~~~~, rv~o~ °~~ °ccmare, ono aeequatei su ported, opinion of the market value of the subject property. Pro a Address 803 LINWOOD ST. Ci NEW CUMBERLAND State PA Zip Code 17070-1443 Borrower SCOT IRELAND &THERESE FISHER Owner of Public Record S. RELAND & T.FISHER County CUMBERLAND Le al Descri lion DEED BOOK 137; PAGE 535 Assessor's Parcel # 26-23-0543-422 Tax Year 2010 Nei hborhood Name NEW CUMBERLAND BOROUGH R.E. Taxes $ 1,933.00 Ma Reference 2602300543-422 Census Tract 0107.00/3240 Occu ant Owner Tenant Vacant S ecial Assessments $ 0 PUD HOA $ " Pro a Ri hts A raised ^ er ear ^ er month ® Fee Sim le ^ Leasehold ^ Other describe Assi nment T e Purchase Transaction Refinance Transaction Other describe SCOT IRELAND ESTATE APPRAISAL Lender/Client THERESE FISHER Address 803 LINWOOD ST., NEW CUMBERLAND PA 17070 Is the subject roe current) offered for sale or has it been offered for sale in the twelve months rior to the effective date of this a raisal? Re ort data sources used, offerin rice s ,and dates . CENTRAL PENN MLS. ^ Yes ~ No I ^ did ^ did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not erformed. Contract Price $ Date of Contract Is the roe seller the owner of ublic record? Yes No Data Source s Is there any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the borrower? ^ Yes ^ No M Yes, re ort the total dollar amount and describe the items to be aid. Note: Race and the racial composition of the neighborhood are not appraisal factors. Nei hborhood Characteristics One-Unlt Housing Trends One-Unit Housing Present Land Use °k Location Urban Suburban Rural Pro a Values ^ Increasin ®Stable Declinin PRICE AGE One-Unit 65 Built-U Over 75% 25-75% Under 25% Demand/Su I ^ Shorta a In Balance ^ Over Su I $ 000 rs 2-4 Unit 10 % Growth Ra id ®Stable Slow Marketin Time Under 3 mths 3-6 mths ^ Over 6 mths 60 Law NEW Multi•Famil 5 % Nei hborhood Boundaries LEMOYNE BOROUGH TO THE NORTH THE SUSQUEHANNA RIVER TO 350 Hi h 150 Commercial 10 % THE EAST FAIRVIEW TOWNSHIP TO THE SOUTH & LOWER ALLEN TOWNSHIP TO THE WEST. 150 Pred. 40-70 Other VC 10 °/ Nei hborhood Descri lion SUBURBAN AREA WITH AVERAGE ACCESS TO SCHOOLS, SHOPPING, RECREATION AND EMPLOYMENT. SUBJECT NEIGHBORHOOD IS WITHIN 25 MINS. DRIVING TIME OF THE MAJOR JOB MARKET OF THE STATE CAPITAL COMPLEX 1N HARRISBURG. LAND USE ABOVE: OTHER 10% =VACANT LAND 10% Market Conditions includin su ort for the above conclusions THE SOUTH CENTRAL PENNSYLVANIA HOUSING MARKET REMAINS RELATIVELY HEALTHY DUE IN PART TO THE STATE CAPITAL COMPLEX AND SUPPORTING AGENCIES & BUSINESSES PROVIDING AMPLE EMPLOYMENT. VALUES ARE STABLE. AVERAGE MARKETING TIME CURRENTLY 60-150 DAYS. SEE ADD'L.COMTS. PG. 3 Dimensions 0.15 ACRE Area 0.15 ACRE Sha e RECTANGLE View AVERAGE S ec'rfic Zonin Classification R-1 Zonin Descri lion RESIDENTIAL SINGLE FAMILY Zonin Com liance Le al Le al Nonconformin Grandfathered Use No Zonin Ille al describe Is the hi hest and best use of subject ro ert as im roved or as ro osed er Ions and s ecificatiens the resent use? ~ Yes ! No If No, describe Utilities Public Other(deseribe) Public Other (describe) Off-site Improvements-Ty a Public Private Electric' ^ Water Street MACADAM Gas Sanita Sewer ® ^ Alle N/A FEMA S ecial Flood Hazard Area Yes ®No FEMA Flood Zone X FEMA Ma # 42041 C0282E FEMA Ma Date 3!16/2009 Are the utilities and off-site im rovements ical for the market area? Yes ^ No n No, describe Are there an adverse site conditions or external factors easements, encroachments, environmental conditions, land uses, etc. ? Yes ®No If Yes, describe NONE NOTED DURING INSPECTION. APPRAISER IS NOT EXPERT IN ENVIRONMENTAL MATTERS. General Descri lion Units One One with Accesse Unft # of Stories 1.5 T e Det. Att. S-Del./End Unit Existin Pro osed Under Const. Desi n S le 1.5 STORY Year Built 1957 Effective A e rs 25 Attic None D St i Foundation ^ Concrete Slab ®Crawl S ace Full Basement Partial Basement BasemeniArea 912 s .ft. Basement Finish 50 % ~ Outside Ent /Exit Sum Pum Evidence of Infestation ^ Dampness ^ Settlement Heatin FWA HWBB Radiant Exterior Description materials/condition Foundation Walls BLOCK/AVG Exterior Walls BRICK/VIN/AVG Root Surface FIB.GL.SHIN./AVG Gutters & Downs outs ALUMINUM/AVG Window T e VINYL DBL.HNG/AV Storm Sash/Insulated DBL.PANEIAVG Screens YES Amenities Woodstove s # Interior materials/condhion Floors CPTJHWlCT/AVG Walls PLASTR/DW/AVG Trim/Finish WD/PAINTED/AVG Bath Floor CERAMIC TILE/AV Bath Wainscot FIB.GLS/C.T./AVG Car Stora a None Drivewa # of Cars 2 Drivewa Surface ASPHALT/AVG ro a r Stairs Floor Scuttle ^ Finished ^ Heated Appliances ^ Refrigerator ®Range/Oven Other Fuel GAS Coolin Central Air Conditionin ^ Individual ^ Other ^ Dishwasher ® Disposal ^ Microw Fire laces # 1 Fence ^ ®Patie/Deck DECK Porch COVERD ^ Pool ~j Other SHED ave ^ Washer/Dryer ^ Other describe Gara e # of Cars ^ Ca ort # of Cars ^ Att. ^ Det. ^ Built-in Finished area above rode contains: 6 Rooms 3 Bedrooms 2 Baths 1 612 S ware Feet of Gross Livin Area Above Grade . Additional features s ecial ener efficient items, etc.. BASEMENT CONTAINS A FINISHED FAMILY ROOM & REC.RM. Describe the condition of the roe includin needed re airs, deterioration, renovations, remodelin ,etc.. PROPERTY CONDITION AND CONDITION OF IMPROVEMENTS ARE TYPICAL OF THE NEIGHBORHOOD, PRICE RANGE AND AGE OF IMPROVEMENTS. PROPERTY WOULD BE READILY ACCEPTED IN THE MARKETPLACE. Are there an h sical deficiencies or adverse conditions that affect the livabili ,soundness, or structural inte r' of the ro ert ? ^ Yes No If Yes, describe Does the roe enerall conform to the nei hborhood functional udlit , st le, condition, use, construction, etc. ? ~! Yes ^ No h No, describe Freddie Mac Form 70 March 2005 Page 1 of 6 Fannie Mae Form 1004 March 2005 r Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Ilnifnrm Racirianti~l er.r.r~ic~f Qo.,,,.+ (Main File No 80317070-L Pace #7 80317070-L There,are 4 ,com arable ro erties current) There are 7 comparable sales in the subject FEATURE SUBJECT Address 803 LINWOOD ST. NEW CUMBERLAND, PA 17070- Prazim' to Subect Sale Price $ Sale Price/Gross Liv. Area $ s .ft. Data Sources Verification Sources VALUE ADJUSTMENTS DESCRIPTION Sales or Financing Concessions Date of Sale/Time Location SUBURB/AVG Leasehold/Fee Sim le FEE SIMPLE Site 0.15 ACRE View AVERAGE Desi n S le 1.5 STORY Quali of ConsVuction AVERAGE Actual A e 54 25 Condition AVERAGE Above Grade Total Bdrms. Baths - ----------.. - offered for sale in the subject nei hborh neighborhood within the past twelve mon COMPARABLE SALE # 1 945 16TH ST. NEW CUMBERLAND PA 17070 0.20 miles SW $ 157,900 $ 118.01 s .ft. MLS/ CO.TAX RECORDS LISTING OFFC. 10194763 DESCRIPTION + - $ Ad'ustment TOM:95 DAYS VA -4,950 10-07-10 SUBJCT.BORO FEE SIMPLE 0.34 ACRE AVERAGE 1.5 STORY AVERAGE 61 25 AVERAGE Total Bdrms. Baths r r. ~.~-~-• • ...Yv. • ood ran in in rice from $ 140 000 ths ranging in sale price from $ 140,00 COMPARABLE SALE # 2 1330 BRANDY AVE. NEW CUMBERLAND, PA 17070 0.44 miles SE $ 150,000 $ 105.04 s .ft. MLS! CO.TAX RECORDS LISTING OFFC. 10202452 DESCRIPTION + - $ Ad'ustment TOM:31 DAYS CONY. -6,000 01-25-11 SUBJCT.BORO FEE SIMPLE 0.25 ACRE AVERAGE 2 STORY AVERAGE 80 25 AVERAGE Total Bdnns. Baths melt tSU317070-L to $ 170,000 0 to $ 170,000 COMPARABLE SALE # 3 613 BROOKHAVEN RD. NEW CUMBERLAND, PA 17070 0.43 miles SE $ 153,000 $ 94.91 sq.ft. MLS/ CO. TAX RECORDS LISTING OFFC. 10196918 DESCRIPTION + - $ Atl ustment TOM:88 DAYS FHA -4,890 10-26-10 SUBJCT.BORO FEE SIMPLE 0.22 ACRE AVERAGE SPLIT-LEVEL AVERAGE 55 25 AVERAGE Total Bdrms. Baths RoamCaunt G Li i A 6 3 2 5 3 1 +1,500 7 3 1 +1,500 6 3 1.5 +750 ross v n rea Basement&Finished Rooms Below Grade Functional Utili Heatin Conlin • Ener Efficient Items Gara a/Car ort - Porch/Patio/Deck • SHED 1,612 s .ft. 912Sq.Ft. FR/REC.RM. TYPICAL MKT GAS FA/CAC STANDARD NONE CV.POR/DECK SHED 1,338 s .ft. FULL FR/DEN TYPICAL MKT OIL HW/NO CA STANDARD NONE SUN RMlPATIO SHED +2,740 -1,OOO +1 500 -1 500 1,428 s .ft. FULL UNFINISHED TYPICAL MKT GAS FA/CAC STANDARD 1 C.DET.GAR. CV.B,SCR.POR NONE +1 840 -1,OOO +2,000 1,500 -1 000 +500 1 612 s .ft. PARTIAL FAM.RM. TYPICAL MKT GAS FA/CAC STANDARD NONE SCRND.POR. NONE +1,000 SDO +500 • Net Ad'ustment otal + - $ -1 710 ^ + ®- $ -3 660 ^ + ~I - $ -2,140 Adjusted Sale Price Net Adj. 1.1 % Net Adj. 2.4 % Net Adj. 1.4 % of Comparables Gross Adj. 8.4 % $ 156,190 Gross Adj. 10.2 % $ 146,340 Gross Adj. 5.0 % $ 150,860 I did did not research the sale or transfer histo of the subject roe and com arable sales. If not, ex lain M research did did not reveal an riot sales or transfers of the sub ect roe for the three ears riot to the effective date of this a sisal . Data Sources CUMBERLAND COUNTY TAX RECORDS. M research ^ did did not reveal an riot sales or Vansfers of the com arable sales for the ear riot to the date of sale of the cam arable sale. Data Sources CUMBERLAND AND YORK COUNTY TAX RECORDS. Re ort the results of the research and anal sis of the riot sale or transfer histo of the sub ect roe and com arable sales re ort addflional riot sales on a e 3 . ITEM SUBJECT COMPARABLE SALE #1 COMPARABLE SALE #2 COMPARABLE SALE #3 Date of Prior Sale/Transfer NONE W ITHIN PREVIOUS NONE OTHER THAN NONE OTHER THAN NONE OTHER THAN Price of Prior SalelTransfer THREE YEARS ABOVE ABOVE ABOVE Data Sources COURT HS. RECORDS COURT HS. RECORDS COURT HS. RECORDS COURT HS. RECORDS Effective Date of Data Sources 07-20-11 07-20-11 07-20-11 07-20-11 Anal sis of riot sale or transfer histo of the sub ect pro a and com arable sales NO PRIOR TRANSFER OF SUBJECT W ITHIN PREVIOUS THREE YEARS. Summa of Sales Com orison A roach DUE TO THE LIMITED NUMBER OF RECENT COMPARABLE SALES W ITHIN THE SUBJECT'S IMMEDIATE MARKETPLACE THIS APPRAISER BELIEVES IT APPROPRIATE TO EXPAND SEARCH PARAMETERS TO INCLUDE THE PREVIOUS 9 MONTHS AND TO ACCEPT AGE RANGES GREATER THAN 20% DIFFERENT THAN THE SUBJECT AND TO INCLUDE DIFFERING STYLE DWELLINGS WITH UTILITY SIMILAR TO THE SUBJECT FOR COMPARISON. SIMILAR MARKET CONDITIONS HAVE EXISTED DURING THIS PERIOD. ALL COMPARABLES SELECTED WOULD BE CONSIDERED BY THE SAME PROSPECTIVE PURCHASERES IF THEY WERE ON THE MARKET AT THE SAME TIME AS THE SUBJECT. ALL COMARABLES SELECTED ARE LOCATED WITHIN ONE-HALF MILE OF THE SUBJECT WITHIN THE SUBJECTS MUNICIPALITY. CONTINUED ON PAGE 3 ADDITIONAL COMMENTS Indicated Value b Sales Comparison Ap roach $ 151,000 Indicated Value by: Sales Comparison Approach 5 151 000 Cost Approach (if developed) S Income Approach (if developed) $ ADEQUATE MARKET DATA IS AVAILABLE WITH SEVERAL SALES IN THE SUBJECTS PRICE RANGE AND MARKET AREA. THEREFORE THE SALES COMPARISON APPROACH TO VALUE IS THE BEST METHOD FOR THIS APPRAISAL. THE INSPECTION DATE FOR THIS APPRAISAL WAS 0 7/1 812 0 1 1 NOT 06/17/2011. THIS IS A RETROSPECTIVE APPRAISAL. This appraisal is made ~i "as is", ^ subject to completion per plans and specifications on the basis of a hypothetical condition that the improvements have been completed, ^ subject to the following repairs or alterations on the basis of a hypothetical condition that the repairs or alterations have been completed, or ^ subject to the • followin re uiretl ins ection based on the extraordinar assum tion that the condition or deficienc does not re uire alteration or re air: Based on a complete visual inspection of the interior and exterior areas of the subject property, defined scope of work, statement of assumptions and limiting conditions, and appraiser's certification, my (our) opinion of the market value, as defined, of the real property that is the subject of this report is S 151,000 as of 0 6/1 712 0 1 1 ,which is the date of ins ction and the effective date of this a sisal. ---._ .-._ .. ....... . .. .......... ~.,.,., rage [ or b Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-80D-ALAMODE Fannie Mae Form 1004 March 2005 ' Main File No 80317070-L Paae #3 Uniform Residential A raisal Re ort 80317070-L PP P FileJf 80317070-L rCnNT KRf1~~ Dr ~ r,enovrT n FAVOR OF SUPPLY, DUE IN PART TO A NATIONW IDE SLOW-DOWN IN HOUSING MARKETS, HOWEVERENOT TO THE EOXTENT THAT E IN WOULD BE CONSIDERED AN "OVER SUPPLY". HOUSING PRICES SHOWED LITTLE APPRECIATION AND DECLINES IN SOME CASES, WITHIN THE SUBJECT MARKETPLACE FROM THE LAST HALF OF 2007 THROUGH MOST OF 2008. VALUES SHOWED SOME INCREASE TOWARD THE END OF 2008 TO THE PRESENT DUE IN PART TO LOWER MORTGAGE RATES. CONT. FROM PG. 2 SUMMARY OF SALES COMPARISON APPROACH SALE PRICE/ GROSS LIV. AREA MAY VARY WIDELY FROM SALE TO SALE FOR THESE STYLE DWELLINGS IN THIS PRICE RANGE DEPENDING UPON MARKET APPEAL OF THEIR FEATURES, AMENITIES & DECOR. THE COMPARABLES AVAILABLE DID NOT ALLOW THE SUBJECTS SITE SIZE TO BE "BRACKETED". SINCE EACH SITE OF THE COMPARABLES AND THAT OF THE SUBJECT HAVE DIFFERING ADVANTAGES WHICH PROVIDE SIMILAR MARKET APPEAL NO SITE ADJUSTMENTS WERE NECESSARY. THE SUBJECT'S GLA IS CONSIDERED "BRACKETED" SINCE COMPARABLE # 3 HAS SIMILAR GLA. '*" THIS APPRAISAL WAS COMPLETED FOR THE ESTATE OF SCOT IRELAND THERESE FISHER IS THE EXECUTRIX "'" • BOTH OF THESE PARTIES ARE LISTED AS OWNER OF RECORD. THE DATE-OF-DEATH WAS 06/17/2011. THE APPRAISED VALUE OPINION OF THE SUBJECT PROPERTY OF $151 000. IS AS OF 06!17/2011 AND IS ALSO THE CURRENT MARKET VALUE IN THIS APPRAISER'S OPINION. THE CONDITION OF THE SUBJECT PROPERTY IS BELIEVED TO BE SIMILAR DURING SAID PERIOD. COST APPROACH TO VALUE (not required b Fannie Mae) Provide ode uate information for the lender/client to re licate the below cost fi ures and calculations. Su ort for the o inion of site value summa of com arable land sales or other methods for estimatin site value THE SITE VALUE WAS OBTAINED FROM THE COUNTY TAX ASSESSMENT RECORDS. ESTIMATED REPRODUCTION OR ^ REPLACEMENT COST NEW .Source of cost data Ouali ratio from cost service Effective date of cast data Comments on Cost A roach toss livin area calculations, de reciation, etc. THE COST APPROACH WAS CONSIDERED BUT NOT USED IN THIS APPRAISAL SINCE IT IS LESS RELIABLE THAN THE SALES OMPARISON APPROACH WHICH TAKES INTO ACCOUNT OPINION OF SITE VALUE ..____.._.......__...__- - - -.......- ._ -$ 31,100 DWELLING S .Ft. @ $ _____-_ _$ S .Ft. @ $ _$ _$ Gara a/Ca ort S .Ft. @ $ _$ Total Estimate of Cost-New =$ -- -- Less Ph sical Functional External CURRENT MARKET CONDITIONS BY USING RECENT COMPARABLE SALES WHICH THE COST APPROACH DOES NOT, THEREBY LEADING TO POSSIBLE IMPROPER CONCLUSIONS. De reciation =$ De reciated Cost of Im rovements .___-....___----.___..._,____-___ - _$ "As-is" Value of Site Im rovements __ - - _ -$ Estimated Remaining Economic Life HUD and VA only 40 Years INDICATED VALUE BY COSTAPPROACH _.--...__._--_--___..--____--__ =g 31,100 INCOME APPROACH TO VALUE (not required b Fannie Mae) Estimated Month! Market Rent $ X Gross Rent Multi tier = $ Indicated Value b Income A roach Summa of Income A roach includin su ort for market rent and GRM PROJECT INFORMATION FOR PUDs (If applicable) Is the develo er/builder in control of the Homeowners' Association HOA ? Yes No Unit e s Detached Attached Provide the followin information for PUDs ONLY'rf the develo er/builder is in control of the HOA and the sub'ect ro ort is an attached dwellin unit. Le al Name of Pro'ect Total number of hoses Total number of units Total number of units sold Total number of units rented Total number of units for sale Data source s Was the re'ect created b the conversion of existin buildin s into a PUD? Yes ^ No If Yes, date of conversion . Does the ro ect contain an multi-dwellin units? Yes No Data Source Are the units, common elements, and recreation facilities com tote? ,Yes ^ No B No, describe the status of com lotion. Are the common elements leased to orb the Homeowners' Association? ^ Yes No If Yes, describe the rental terms and o lions. Describe common elements and recreational facilities. Freddie Mac Form 70 March 2005 Page 3 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE (Main File No 80317070-L Pace #4 uiniurlin rseslaentlal H raisal Re ort °U"`~`~-` PP P File# 80317070-L This report form is designed to report an appraisal of a one-unit property or a one-unit property with an accessory unit; including a unit in a planned unit development (PUD). This report form is not designed to report an appraisal of a manufactured home or a unit in a condominium or cooperative project. This appraisal report is subject to the following scope of work, intended use, intended user, definition of market value, statement of assumptions and limiting conditions, and certifications. Modifications, additions, or deletions to the intended use, intended user, definition of market value, or assumptions and limiting conditions are not permitted. The appraiser may expand the scope of work to include any additional research or analysis necessary based on the complexity of this appraisal assignment. Modifications or deletions to the certifications are also not permitted. However, additional certifications that do not constitute material aterations to this appraisal report, such as those required by law or those related to the appraiser's continuing education or membership in an appraisal organization, are permitted. SCOPE OF WORK: The scope of work for this appraisal is defined by the complexity of this appraisal assignment and the reporting requirements of this appraisal report form, including the following definition of market value, statement of assumptions and limiting conditions, and certifications. The appraiser must, at a minimum: (1) perform a complete visual inspection of the interior and exterior areas of the subject property, (2) inspect the neighborhood, (3) inspect each of the comparable sales from at least the street, (4) research, verify, and analyze data from reliable public and/or private sources, and (5) report his or her analysis, opinions, and conclusions in this appraisal report. INTENDED USE: The intended use of this appraisal report is for the lender/client to evaluate the property that is the subject of this appraisal for a mortgage finance transaction. INTENDED USER: The intended user of this appraisal report is the lender/client. DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) bath parties are well informed or well advised, and each acting in what he or she considers his or her own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated with the sale. *Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. STATEMENT OF ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser's certification in this report is subject to the following assumptions and limiting conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it, except for information that he or she became aware of during the research involved in pertorming this appraisal. The appraiser assumes that the title is good and marketable and will not render any opinions about the title. 2. The appraiser has provided a sketch in this appraisal report to show the approximate dimensions of the improvements. The sketch is included only to assist the reader in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in this appraisal report whether any portion of the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, or as otherwise required by law. 5. The appraiser has noted in this appraisal report any adverse conditions (such as needed repairs, deterioration, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during the research involved in pertorming the appraisal. Unless otherwise stated in this appraisal report, the appraiser has no knowledge of any hidden or unapparent physical deficiencies or adverse conditions of the property (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) that would make the property less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, this appraisal report must not be considered as an environmental assessment of the property. 6. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or aterations on the assumption that the completion, repairs, or alterations of the subject property will be pertormed in a professional manner. °~ ~ ~'^' • ~ ~~~°~~° ~~~~ rage 4 or ti Fannie Mae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Mann File No 80317070-L~ Paae #5 unrtorm Residential Appraisal Report File# 80317070-L APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have, at a minimum, developed and reported this appraisal in accordance with the scope of work requirements stated in this appraisal report. 2. I perarmed a complete visual inspection of the interior and exterior areas of the subject property. I reported the condition of the improvements in factual, specific terms. I identified and reported the physical deficiencies that could affect the livability, soundness, or structural integrity of the property. 3. I performed this appraisal in accordance with the requirements of the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 4. I developed my opinion of the market value of the real property that is the subject of this report based on the sales comparison approach to value. I have adequate comparable market data to develop a reliable sales comparison approach for this appraisal assignment. I further certify that I considered the cost and income approaches to value but did not develop them, unless otherwise indicated in this report. 5. I researched, verified, analyzed, and reported on any current agreement for sale for the subject property, any offering for sale of the subject property in the twelve months prior to the effective date of this appraisal, and the prior sales of the subject property for a minimum of three years prior to the effective date of this appraisal, unless otherwise indicated in this report. 6. I researched, verified, analyzed, and reported on the prior sales of the comparable sales for a minimum of one year prior to the date of sale of the comparable sale, unless otherwise indicated in this report. 7. I selected and used comparable sales that are locationally, physically, and functionally the most similar to the subject property. 8. I have not used comparable sales that were the result of combining a land sale with the contract purchase price of a home that has been built or will be built on the land. 9. I have reported adjustments to the comparable sales that reflect the market's reaction to the differences between the subject property and the comparable sales. 10. I verified, from a disinterested source, all information in this report that was provided by parties who have a financial interest in the sale or financing of the subject property. 11. I have knowledge and experience in appraising this type of property in this market area. 12. I am aware of, and have access to, the necessary and appropriate public and private data sources, such as multiple listing services, tax assessment records, public land records and other such data sources for the area in which the property is located. 13. I obtained the information, estimates, and opinions furnished by other parties and expressed in this appraisal report from reliable sources that I believe to be true and correct. 14. I have taken into consideration the factors that have an impact on value with respect to the subject neighborhood, subject property, and the proximity of the subject property to adverse influences in the development of my opinion of market value. I have noted in this appraisal report any adverse conditions (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) observed during the inspection of the subject property or that I became aware of during the research involved in pertorming this appraisal. I have considered these adverse conditions in my analysis of the property value, and have reported on the effect of the conditions on the value and marketability of the subject property. 15. I have not knowingly withheld any significant information from this appraisal report and, to the best of my knowledge, all statements and information in this appraisal report are true and correct. 16. I stated in this appraisal report my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the assumptions and limiting conditions in this appraisal report. 17. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or opinion of market value in this appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the vicinity of the subject property or on any other basis prohibited by law. 18. My employment and/or compensation for pertorming this appraisal or any future or anticipated appraisals was not conditioned on any agreement or understanding, written or otherwise, that I would report (or present analysis supporting) a predetermined specific value, a predetermined minimum value, a range or direction in value, a value that favors the cause of any party, or the attainment of a specific result or occurrence of a specific subsequent event (such as approval of a pending mortgage loan application). 19. I personally prepared all conclusions and opinions about the real estate that were set forth in this appraisal report. If I relied on significant real property appraisal assistance from any individual or individuals in the performance of this appraisal or the preparation of this appraisal report, I have named such individual(s) and disclosed the specific tasks perormed in this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in this appraisal report; therefore, any change made to this appraisal is unauthorized and I will take no responsibility for it. 20. I identified the lender/client in this appraisal report who is the individual, organization, or agent for the organization that ordered and will receive this appraisal report. ' ' """"' '"'°"' """ ' " ""°' ~" ~""~ Page 5 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No. 80317070-L' Pa e #6 Uniform Residential A raisal Re ort 80317070-L PP P FileN 80317070-L 21. The lender/client may disclose or distribute this appraisal report to: the borrower; another lender at the request of the borrower; the mortgagee or its successors and assigns; mortgage insurers; government sponsored enterprises; other secondary market participants; data collection or reporting services; professional appraisal organizations; any department, agency, or instrumentality of the United States; and any state, the District of Columbia, or other jurisdictions; without having to obtain the appraiser's or supervisory appraiser's (if applicable) consent. Such consent must be obtained before this appraisal report may be disclosed or distributed to any other party (including, but not limited to, the public through advertising, public relations, news, sales, or other media). 22. I am aware that any disclosure or distribution of this appraisal report by me or the lender/client may be subject to certain laws and regulations. Further, I am also subject to the provisions of the Uniform Standards of Professional Appraisal Practice that pertain to disclosure or distribution by me. 23. The borrower, another lender at the request of the borrower, the mortgagee or its successors and assigns, mortgage insurers, government sponsored enterprises, and other secondary market participants may rely on this appraisal report as part of any mortgage finance transaction that involves any one or more of these parties. 24. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. 25. Any intentional or negligent misrepresentation(s) contained in this appraisal report may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., or similar state laws. SUPERVISORY APPRAISER'S CERTIFICATION: The Supervisory Appraiser certifies and agrees that: 1. I directly supervised the appraiser for this appraisal assignment, have read the appraisal report, and agree with the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 2. I accept full responsibility for the contents of this appraisal report including, but not limited to, the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 3. The appraiser identified in this appraisal report is either asub-contractor or an employee of the supervisory appraiser (or the appraisal firm), is qualified to perform this appraisal, and is acceptable to pertorm this appraisal under the applicable state law. 4. This appraisal report complies with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 5. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. APPRAISER Signature -~' Name MICR Company Name RE/MAX REALTY ASSOCIATES, INC Company Address 3425 MARKET ST. CAMP HILL PA 17011 Telephone Number (717) 761-6300 Email Address ment(o~capitalareahomes com Date of Signature and Report 07/20/2011 Effective Date of Appraisal 0 6/1 712 01 1 State Certification # RL001676L or State License # or Other (describe) _ State # State PA Expiration Date of Certification or License 6 /3 012 0 1 3 ADDRESS OF PROPERTY APPRAISED 803 Linwood St NEW CUMBERLAND, PA 17070-1443 APPRAISED VALUE OF SUBJECT PROPERTY $ 151,000 LENDER/CLIENT Name THERESE FISHER Company Name THE ESTATE OF SCOT IRELAND Company Address 803 LINWOOD ST. NEW CUMBERLAND PA 17070 Email Address NIA Freddie Mac Form 70 March 2005 SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signature Name Company Name Company Address Telephone Number Email Address Date of Signature State Certification # or State License # State Expiration Date of Certification or License SUBJECT PROPERTY ^ Did not inspect subject property ^ Did inspect exterior of subject property from street Date of Inspection ^ Did inspect interior and exterior of subject property Date of Inspection COMPARABLE SALES ^ Did not inspect exterior of comparable sales from street ^ Did inspect exterior of comparable sales from street Date of Inspection __ Page 6 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-B00-ALAMODE Main File No. 80317070-L Pa e #7 $ubieCt Phntn Pana Borrower/Client SCOT IRELAND & THERESE FISHER Wa a Address 803 Linwood St C NEW CUMBERLAND Coun CUMBERLAND State PA Zi Code 17070-1443 Lender N!A Subject Front 803 Linwood St Sales Price Gross Living Area 1,612 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 2 Location SUBURBlAVG View AVERAGE Site 0.15 ACRE Quality AVERAGE Age 54(25) Subject Rear Subject Street Form PIC3x5.SR - "WinTOTAL" appraisal software by a la made, inc. -1-800-ALAMODE Main File No. 8031707D-L Pa e #8 Interior Phntnc Borrower/Client SC T IRELAND 8 THERESE FISHER Pro a Address 803 Linwood St Ci NEW CUMBERLAND Coun CUMBERLAND State Pq Zi Code 17070-1443 Lender N!A '~ z ~. ~ ~., ,{ ~tY ` 5i ~ y~, 'war ~ wh ~ +w. c f .I LIVING ROOM F .ate.,.. i BATHROOM 2ND BATHROOM KITCHEN -;-~ ,~,,, ~ i ~ t -. 7t f r ' ~~ jT " ~ ~ Y~ .~~y.,- ~~~ . a 1 ~i I i . s F, edi~ wc~r - f ~. .I ADDITIONAL VIEW OF SAME BATHROOM Form PICSIX - "WinTOTAL" appraisal software by a la mode, inc. - i-800-ALAMODE Comparable Photo Paae (Main File No 80317070-L Paoe #9 Borrower/Client SCOT IRELAND & THERESE FISHER v Pm a Address 803 Linwood St Ci NEW CUMBERLAND Count CUMBERLAND State PA Zi Code 17070-1443 Lender N/A Comparable 1 945 16TH ST. Prox, to Subject 0.20 miles SW Sale Price 157,900 Gross Living Area 1,338 Total Rooms 5 Total Bedrooms 3 Total Bathrooms 1 Location SUBJCT.BORO View AVERAGE Site 0.34 ACRE Qualty AVERAGE Age 61(25) Comparable 2 1330 BRANDY AVE. Prox. to Subject 0.44 miles SE Sale Price 150,000 Gross Living Area 1,428 Total Rooms 7 Total Bedrooms 3 Total Bathrooms 1 Location SUBJCT.BORO View AVERAGE Site 0.25 ACRE Quality AVERAGE Age 80(25) Comparable 3 613 BROOKHAVEN RD. Prox. to Subject 0.43 miles SE Sale Price 153,000 Gross Living Area 1,612 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 1.5 Location SUBJCT.BORO View AVERAGE Site 0.22 ACRE Quality AVERAGE Age 55(25) Form PICPIX.CR - "WinTOTAL" appraisal software by a la mode, inc. -1-80D-ALAMODE USPAP C_f1MP1 IeAI('G ennr=~rnr one ~Maln File No 80317070-L Pace #10' ----- ~ ----•~•~~ rueNO.:80317070-L Borrower SCOT IRELAND &THERESE FI HER Order # Pro a Address 803 LINWOOD ST. Ci NEW CUMBERLAND Coun CUMBERLAND State PA Zi Code 17070-1443 Lender/Client THERESE FISHER Client Reference # (Jnly those items checked X apy2/y to this repoR PURPOSE, FUNCTION AND INTENDED USE OF THE APPRAISAL ® The purpose of the appraisal is to provide an opinion of market value of the subject property as defined in this report, on behalf of the appraisal company facilitating the assignment for the referenced client as the intended user of the report. The oar ly function of the appraisal is to assist the client mentioned in this report in evaluating the subject property for lending purposes. The use of this appraisal by anyone other than the stated intended user, or for any other use than the stated intended use, is prohibited. ^ The purpose of the appraisal is to provide an opinion of market value of the subject property as defined in this report, on behalf of the appraisal company facilitating the assignment for the referenced client as the intended user of the report. The o~ function of the appraisal is to assist the client mentioned in this report in evaluating the subject property for Real Estate Owned (REO) purposes. The use of this appraisal by anyone other than the stated intended user, or for any other use than the stated intended use, is prohibited. ^ The purpose of the appraisal is to , on behalf of the appraisal company facilitating the assignment for the referenced client as the intended user of this report. The only function of the appraisal is to assist the client mentioned in this report in evaluating the subject property for .The use of this appraisal by anyone other than the stated intended user, or for any other use than the stated intended use is prohibited. ~ TYPE OF APPRAISAL AND APPRAISAL REPORT -~ ® This is a SUMMARY Appraisal written in a U.R.A.R. Report format and the USPAP Departure Rule has not been invoked. ^ This is a Limited Appraisal written in a Report format and the USPAP Departure Rule as been invoked as disclosed in the body or addenda of the report. The client has agreed that a Limited Appraisal is sufficient for its purposes. SCOPE (EXTENT) OF REPORT ® the appraisal is based on the information gathered by the appraiser from public records, other identified sources, inspection of the subject property and neighborhood, and selection of comparable sales, listings, and/or rentals within the subject market area. The original source of the comparables is shown in the Data Source section of the market grid along with the source of confirmation, if available. The original source is presented first. The sources and data are considered reliable. When conflicting information was provided, the source deemed most reliable has been used. Data believed to be unreliable was not included in the report nor used as a basis for the value conclusion. The extent of analysis applied to this assignment may be further imparted within the report, the Appraiser's Certification below and/or any other Statement of Limiting Conditions and Appraiser's Certification such as may be utilized within the Freddie Mac form 439 or Fannie Mae form 1004b (dated 6/93), when annlirahla MARKETING TIME AND IXPOSURE TIME FOR THE SUBJECT PROPERTY ® A reasonable marketing time for the subject property is 120 day(s) utilizing market conditions pertinent to the appraisal assignment ^ A reasonable exposure time for the subject property is day(s) utilizing market condtions pertinent to the appraisal assignment APPRAISER'S CERTIFICATION I cert'rfy that, to the best of my knowledge and belief: The statements of fact contained in this report are true and correct. The report analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions. I have no present or prospective interest in the property that is the subject of this report, and nor personal interest with respect to the parties involved, unless otherwise stated within the report. I have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment My engagement in this assignment was not contingent upon developing or reporting predetermined results. My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. I have ~ or have not ^ made a personal inspection of the property that is the subject of this report. (If more than one person signs this report, this certification must clearly specify which individuals did and which individuals did not make a personal inspection of the appraisal property.) No one provided significant professional assistance to the person signing this report. (If there are exceptions, the name of each individual providing significant professional assistance must be stated.) NOrE In the case of any conflict with a client provided certification (i. e., fannie Mae or Freddie MacJ, this revised certification shall take precedence APPRAISER'S AND SUPERVISORY APPRAISER'S SIGNATURE APPRAISER ~///f Signature: a / ~ , ~~ Name: MICHAEL R. ENT Date of Report (Inspection): 06/17/2011 State License/Certification #: RL001676L State of License/Certification: PA Expiration Date of License/Certification: 6/30/2013 USPAP Compliance Addendum - 4/99 SUPERVISORY-APPRAISER (only if required) Signature: Name: _ Date of Report (Inspection): State License/Certification #: State of License/Certification: Expiration Date of License/Certification: ^ Did inspect subject property ^ Inspected Comparables ^ Interior & Exterior ^ Interior & Exterior ^ Exterior only ^ Exterior only MICHAEL R ENT (717) 730-3010 Form FAUCA - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No. 80317070-L Pa e #11 MULTI-PURPOSE SUPPLEMENTAL ADDENDUM FOR FEDERALLY RELATED TRANSACTIONS 80317070-L MICHAEL R ENT !7171 73n 4n1 n _ _ -- -- ~" rue No.: riUJ1 /U70-L 3orrower/Client SCOT IRELAND &THERESE FISHER 'roperty Address 803 LINWOOD ST. amity NEW CUMBERLAND County CUMBERLAND State PA Zip Code 17070-1443 _ender THERESE FISHER This Multi-Purpose Supplemental Addendum for Federally Related Transactions was designed to provide the appraiser with acon- venient way to comply with the current appraisal standards and requirements of the Federal Deposit Insurance Corporation (FDIC), the Office of the Comptroller of Currency (OCC), The Office of Thrift Supervision (OTS), the Resolution Trust Corporation (RTC), and the Federal Reserve. This Multi-Purpose Supplemental Addendum is for use with any appraisal. Only those statements which have been checked by the appraiser apply to the property being appraised. PURPOSE & FUNCTION OF APPRAISAL The purpose of the appraisal is to estimate the market value of the subject property as defined herein. The function of the appraisal is to assist the above-named Lender in evaluating the subject property for lending purposes. This is a federally related transaction. ® EXTENT OF APPRAISAL PROCESS ;~ The appraisal is based on the information gathered by the appraiser from public records, other identified sources, inspection of the subject property and neighborhood, and selection of comparable sales within the subject market area. The original source of the com- parables isshown in the Data Source section of the market grid along with the source of confirmation, if available. The original source is presented first. The sources and data are considered reliable. When conflicting information was provided, the source deemed most reliable has been used. Data believed to be unreliable was not included in the report nor used as a basis forthe value conclusion. ^ The Reproduction Cost is based on supplemented by the appraiser's knowledge of the local market. ^ Physical depreciation is based on the estimated effective age of the subject property. Functional and/or eMernal depreciation, if present, is specifically addressed in the appraisal report or other addenda. In estimating the site value, the appraiser has relied on personal knowledge of the local market. This knowledge is based on prior and/or current analysis of site sales and/or abstraction of site values from sales of improved properties. ® The subject property is located in an area of primarily owner-occupied single family residences and th I A e ncome pproach is not consi- dered to be meaningful. For this reason, the Income Approach was not used. ^ The Estimated Market Rent and Gross Rent Multiplier utilized in the Income Approach are based on the appraiser's knowledge of the subject market area. The rental knowledge is based on prior and/or current rental rate surveys of residential properties. The Gross Rent Multiplier is based on prior and/or current analysis of prices and market rates for residential properties. ^ For income producing properties, actual rents, vacancies and expenses have been reported and analyzed. They have been used to pro- jectfuture rents, vacancies and expenses. ~ ® SUBJECT PROPERTY OFFERING INFORMATION According to CENTRAL PENN MLS, the subj t ec property: ® has not been offered for sale in the ast h p mont s or 3 years. ^ is currently offered for sale for $ I ^ was offered for sale within the past months or years. ^ Offering information was considered in the final reconciliation of value. ^ Offering information was not considered in the final reconciliation of value. ^ Offering information was not available. The reasons for unavailability and the steps taken by the a rais l i d l pp er are exp ne a ater in this addendum. ® SALES HISTORY OF SUBJECT PROPERTY According to CUMBERLAND COUNTY TAX RECORDS, the subject ro rt p pe y: ® Has not transferred in the past months or 5 years. ^ Has transferred in the past months or years. ^ All prior sales which have occurred in the past months or years are listed below and reconciled to the ap- praised value, either in the body of the report or in the addenda. Date Sales Price Document # Seller Buyer ® FEMA FLDOD HAZARD DATA Subject property is not located in a FEMA Special Flood Hazard Area. ^ Subject is located in a FEMA Special Flood Hazard Area. Zone FEMA Map/Panel # Map Date Name of Community X 42041C0282E 3/16/2009 NEW CUMBERLAND BOROUGH ^ The community does not participate in the National Flood Insurance Program. ® The community does participate in the National Flood Insurance Program. ® It is covered by a regular program. ^ It is covered by an emergency program. Page 1 of 2 Form FNCMPA - "WinTOTAL" appraisal sofhvare by a la mode, inc. -1-800-ALAMODE Main File No. 80317070-LI Pa e #12 80317070-L File Nn ~ Rn Q'17n7n_I ® The subject property is currently not under contract. ^ The contract and/or escrow instructions were not available for review Th il bil . e unava a ity of the contract is explained later in the addenda section. ^ The contract and/or escrow instructions i d were rev ewe . The following summarizes the contract: Contract Date Amendment Date Contract Price Seller ^ The contract indicated that personal property was not included in the sale . ^ The contract indicated that personal property was included. It consisted of Estimated contributory value is $ ^ Personal property was not included in the final value estimate. Personal property was included in the final value estimate. ^ The contract indicated no financing concessions or other incentives . ^ The contract indicated the following concessions or incentives: ^ If concessions or incentives exist, the comparables were checked for simil i ar concess ons and appropriate adjustments were made, if applicable, so that the final value conclusion is in compliance with the Market Value defined herein. ® MARKET OVERVIEW Include an explanation of current market conditions and trends. 4 months is considered a reasonable marketing period for the subject property based on CURRENT MARKET CONDITIONS & COMPARABLE SALES, PROVIDED SUBJECT PROPERTY IS COMPETITIVELY PRICED. ® ADDITIONAL CERTIFICATION The Appraiser certifies and agrees that: (1) The analyses, opinions and conclusions were developed, and this report was prepared, in conformity with the Uniform Standards of Professional Appraisal Practice ("USPAP"), and in accordance witht he regulations developed by the Lender's Federal Regulatory Agency as required by FIRREA, except that the Departure Provisions of the USPAP do not apply. (2) Their compensation is not contingent upon the reporting of predetermined value or direction in value that favors the cause of the client , the amount of the value estimate, the attainment of a stipulated result, orthe occurrence of a subsequent event. (3) This appraisal assignment was not based on a requested minimum valuation, a specific valuation, or the approval of a loan. ® ADDITIONAL (ENVIRONMENTAL) LIMITING CONDITIONS The value estimated is based on the assumption that the property is not negatively affected by the existence of hazardous substances or detrimental environmental conditions unless otherwise stated in this report. The appraiser is not an expert in the identification of hazardous substances or detrimental conditions. The appraiser's routine inspection of and inquiries about the subject property did not develop any information that indicated any apparent significant hazardous substances or detrimental environmental conditions which would affectthe property negatively unless otherwise stated in this report. It is possible that tests and inspections made by a qualified hazardous substance and environmental expert would reveal the existence of hazardous substances or detrimental environmental conditions on or around the property that would negatively affect its value. ^ ADDITIONAL COMMENTS ® APPRAISER'S SIGNATURE & LICENSE/CERTIFICATION Appraiser's Signat • 66117/2011 Date Prepared 07/20!2011 Appraiser's Name (print) MICHAEL R. ENT Phone # {717) 761-6300 State PA License # Certification # RL001676L Tax ID # ^ CO-SIGNING APPRAISER'S CERTIFICATION ^ The co-signing appraiser has personally inspected the subject property, both inside and out, and has made an exterior inspection of all comparable sales listed in the report. The report was prepared by the appraiser under direct supervision of the co-signing appraiser. The co-signing appraiser accepts responsibility for the contents of the report including the value conclusions and the limiting condi- tions and , confirms that the certifications apply fully to the co-signing appraiser. ^ The co-signing appraiser has not personally inspected the interior of the subject property and; has not inspected the exterior of the subject property and all comparable sales listed in The report. ^ has inspected the exterior of the subject property and all comparable sales listed in th e report. I ^ The report was prepared by the appraiser under direct supervision of the co-si nin a i Th ~ g g ppra ser. e co-signing appraiser accepts responsibility for the contents of the report, including the value conclusions and the limiting conditions, and confirms thatthe certifications apply fully to the co-signing appraiser with the exception of the certification regarding physical inspections. The above describes the level of inspection performed by the co-signing appraiser. ^ The co-signing appraiser's level of inspection, involvement in the appraisal process and certification are covered elsewhere in the addenda section of this appraisal. ^ CO-SIGNING APPRAISER'S SIGNATURE & LICENSE/CERTIFICATION Appraiser's Signature ^ Trainee ^ Review ~^ Other ' Appraiser s Name (print) SS # I, State License # Certified # Page 2 of 2 Form FNCMPA - ^WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Buildinn Clrafrh Main File No. 80317070-L Pa e #13 Borrower/Client SCOT IRELAND & THERESE FISHER Pto ert ~Addresy 803 Linwood St ' Ci NEW CUMBERLAND County CUMBERLAND State Pq Zi Code 17070-1443 Lender N/A i2.o' ~ DECK 25.0' BED BATH ROOM ROOM 5.0' BATH ROOM BED b DEN 0 "' ROOM BED ai o N ~ LIVING ROOM KITCHEN ROOM 30.0' DINING SECOND FLOOR nnea COVERED i b fO PORCH ' 'd 12.0' -._.-------18.0' -----.-___. FIRST FLOOR sk.~~ Draa.l~~ Comments: LIVING Brea AREA BREAKDOWN kdown Subtotals First Floor 28.0 x 30.0 890.0 16.0 x 25.0 400.0 6.0 x 12.0 72,p Second Floor 10.0 x 30-0 300.0 4ltems (Rounded) 1612 Form SKT.BIdSkI - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Wain File No. 80317070-L Pa e #14 LOC9tlOn Man Borrower/Client SCOT IRELAND & THERESE FISHER Pro a dtlresq 803 Linwood St Ci NEW CUMBERLAND Coun CUMBERLAND State pq Zi Code 17070-1443 Lender N/A a la mode, inc: `~~ s' _ a,,P ~ ~~ a-ay- ~~ m: ev,+:. ~an,~arv -_ ICJ s ~r~Y h`~C` dr~r./ iAs 5ti 9P o t - - SP 0 iJd` 8~i ~ a9e 'st 5[ ~t F>3 ^ aa,~.^y 1~,C~ 5~ ~~y ct a\z~ r `a~r~ ASH ~ 9~ ~a ~i ''~ Pst J f ,~ ~Q[? ... - .. CP C\~~ cCC ,a ~ `0 @~ ~ ev !.2 :1 111 ~~ A. C Sti C/di~ p4, ~o~ ~~P m ~Ls V~C~ 5~ Cc~t.-F,O~-. oQ, ^ ~ 1~.~~2` ta~e2 , p~.,~ Dr ~~ 408 ~0, ~ ~~ 1 r 1 ~ r r ~ r~ Ci - O~ ~ oa ,~ ~`~~°° 1h~~5 ~a`~2`~cc Brandt A VP - -- - ' _ - - ="Simpson-F~Lry ~d - _ Q~ •11 ~r I 'CZ~y 9r i 0 ~'dxel_ 8tv 'c,, x`~ 40B v Hri~S e, ~`e~!cl;aven Rd rya Q 7~ ~~ti ~~ ~~ aTDre C~ oa Park Aye P~ s~ d o sf m „ h~. ~'r~i N s0 S \~`1 G~ , ~~cap Dr p -i -~'/ltfiop Dr ~~~~~ ~ Q;e~errt ~~tn ~z _ ~ - o ~2 ~~ S. ~`' ~;1 btn~ _ o ~~dz r~-~= - =- ar:: - .- Form MAP.LOC - "WinTOTAL" appraisal software by a la made, inc. -1-800-ALAMODE Nlain File Nc. 80317070-L Pa e #15 ,~ Appraiser's Certificate ~C`atrtrt}nin-~eaith ttf Peiitrsrl,•ania - -, ~ ! ~~ ~: ~ _ "': ~ ~':, :~ ~~I _ , i3cpartmen# eif•itatc -- Bt re:tu ~l' f'roi '-sitt~a~.tnci tts S3tcti • tivn. pa t1 ~ltta>rs l ~.' t'[7 Einar ~G~IQ Fiat•rishurl; I' 1 7-7It1±-?fi~9 cal ~ Ccrtifie:tie Type Certificate tittttuF ~I Certified Residential Appraiser ~ Active ~~ - '~ _ _ initi:~l C'ertificatiou I)att ~I ,'~.'~ ~~ -,. ~ ~ U6CHkEL Rc€'J cNT t'ertife::6t 11117?993 ' ~~ 5278 QEERFtEL6 AVE Lumber MECHAt:ICSBURG PA 11055 ;~I RL0016i6L Fxfriratinn i)atc , 05F30J20t3 `~ ~i .. ~, ~ ti ~ ' ~I 1~.1'i L' I. ~rtl~:-1•!~~. 'IfCI 1.1 ~'":'I :'ss".II-'. i:iliv: f~'i.'.?:~I: ;•I..1 ~~":•I':. '.-_-.......... ~._~~~. ~>r': J(l[4"L}' µ `~ i.. ~~ I -4Ite J:a-T~.-:ttlF'iT"f1 ~~ ~ti Form SCNLGL - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE ~ Nlain File Nu. 80317070-L Pa e #16 MICHAEL R. ENT RE/MAX REALTY ASSOCIATES, INC. 3425 MARKET ST. CAMP HILL, PA 17011 Telephone Number: (717) 761-6300 Fax Number: T0: THERESE 803 LINDWOOD ST. NEW CUMBERLAND, PA 17070 Telephone Number: N/A FazNumber: Attemate Number: E-Mail: INVOICE INVOICE NUMBER 80317070-L DATE 07/20!2011 REFERENCE Internal Order #: 80317070-L Lender Case #: 80317070-L Client File #: 80317070-L Main Flle # on form: 80317070-L Other File # on form: 80317070-L FederalTazlD: Employer ID: 25-1651204 DESCRIPTION Lender: N/A Client: THE ESTATE OF SCOT FISHER PurchaserBorrower: THERESE FISHER Property Address: 803 LINWOOD ST. Clty: NEW CUMBERLAND County: CUMBERLAND State: PA Zip: 17070-1443 Legal Description: DEED BOOK 137; PAGE 535 FEES AMOUNT FULL URAR -FORM 1004 325.00 SUBTOTAL i 32s.oo PAYMENTS ~ AMOUNT Check#: 629 Date: 07!1812011 Description: METRO BANK 325.00 Check #: Date: Description: Check #: Date: Description: SUBTOTAL '. 32s.oo TOTAL DUE $ D Form NIV5 - "WinTOTAL" appraisal software by a la made, inc. -1-800-ALAMODE MICHAEL R ENT (717) 730-3010 DEED FOR 803 LINWOOD AVE. ~~ ~ C ~`1/~~ ~ V N.. 990. Fw SIaN. Dud . T».a.i1n i7 _ ~}3 ~f ~C y3 ~~ !Lukens Co., P]tlladelDhLL . Ol u~ ~~~ abe "'''~ ~~~ ~-i t~je ~ day o/ April in the year o/ oar Lord one thousand nine hundred and Ninety-Six ( 96 ) ~etmeett ~ JOHN W. SUDDUTH, Single- Man; By Thomas A. Hamilton, Esq., his Attorney-in-Fact, Specially Constituted by Thomas A. Hamilton, Esq., By Power of Attorney dated December 22, 1995, and recorded immediatly prior hereto (hereinafter called the Grantor ), of the one part, and SCOT H. IRELAND and THERESE J. FISHER joint tenants with right of survivorship and NOT as tenants-in-common, (hereinafter called the Grantees ), of the other part; ~ittteggetf~, That the said Grantor for and in coaeideration of the eum of Eighty-three Thousand Seven Hundred Forty Dollars ($83,740.) Iswful money of the United States of America, nnto him well end truly paid by the said Grantee s at and before the eealing and delivery of these presents, the receipt whereof is hereby acknowledged, ha ve granted, bargained, sold, aliened, enfeoffed, released and confirmed, and by these presents do es grant, bargain, sell, alien, enfeoff, release and confirm unto the said Grantees, their heirs and Aeeigne, forever, ALL THAT CERTAIN tract of land situate in the borough of New Cumberland; County of Cumberland, State of Pennsylvania, more particularly bounded and described as follows to wit: BEGINNING at a point on the northerly line of Linwood Street at the dividing line between lots Nos. 3 and 4, Block "A" of the hereinafter mentioned Plan of Lots; thence in a northerly direction along said dividing line one hundred thirty-one (131) feet to a point; thence north fifty-eight degrees, twenty-four minutes east (N 58' 24' E) along land now or formerly of Suburban Realty Company fifty (50) feet to Lot No. 5 on said plan; thence in a southeasterly direction along lots Nos. 5 and 6 one hundred thirty and sixty-seven hundredths (230.67) feet to the northerly line of Linwood Street; Thence in a westerly direction along Linwood Street fifty (50) feet to the place of BEGINNING. iiooK 137 PacE 535 V ~ ~ • BEING Lot no. 4, Block ^A" in the Plan of Lots of Amos A. Mailey HAVING thereon erected a single dwelling house No. 803 Linwood Street. BEING the same premises which JOHN W. SUDDUTH, widower, and, WILLIAM H. SUDDUTH, JOHN E. SUDDUTH, his children by their indenture dated April 1, 1996 and recorded in the office of the Recorder of Deeds in and for the County of Cumberland on April 1; 1996 in Deed Book 136, Page 989, did grant and convey unto JOHN W. SUDDUTH, single-man. :~. is i~i. iii .. .. .'.: i~l_-i~. .cCOiiU~i~ Oi DEtU5 '96 HPit :iZ H(~ 10 25 P_ h Op. pp pp Gp Gp Op IA Ii"l .C~~0dS00 • y ~ 6 N Q .-. 3~ z W fO M ~ m.C ~C~+~i~G~C m.~O ~ C o ~O a~ ~ r s~.~ m T -~ a ~ ~ s d .r x o ¢ C C -J' [WD K ~ C L~ y OC J 6 ~ p v~ ¢ ro r.~. Q T 4 .L N } 5n p4 p P U .. ep p~~ ~ 47 I!~ pW~ ~ SOC~ F'~ a.Y V G ~ r7 ti l.-. S~~l~ Fu $Oblt 1~7 PRGE ~' 5~ v r t r « ~ogettjer wtih all and sinbvler tenements, hereditiments;mprovemente, Weye, streets, alleys, passages, waters, water - courses, 'righEs, liberties, privileges, hereditamenta and appurtenances wbatsoever tlwreunto belonging, or in any wise appertaining, and the reversions and remainders, rents, 19anC8 and profits dtereof, and all the estate, right,- title, interest, property, claim and demand whatsoever of the said Grantor in law, equity, or otherwise howsoever, of, in, and to the same and every part thereof. ~o ~jabe atYb to ~joYb the said ]ot or piece of ground above described tenements, hereditamenta and premises hereby granted, or mentioned and intended eo to be, with the appurtenances, unto the said Grantee s , their heirs and Aesigna, io and for the only proper tree and behoof of the said Grantee s, their heirs and Aesigne forever. REGISTEf.ED ii'! I'i~'_' ~~ ]s. Secretar,~ ~nb the said Heirs, Executors, and Administrators DO by these presents covenant, grant and agree, to and with the said Gratttee s, their heirs and Assigns, that the said Grantor, his Heirs, all and singular dte hereditamente and premises herein described and granted, or mentioned and intended so to be, with the appurtenances, unto the said Grantee s, their heirs and Assigns, against them the avid Grantor, his Beira, and against all end every other Person and Persona whomsoever lawfully claiming or to claim the same or any part thereof, hy, from or under him, his heirs and assigns or any of them, Shell and Will WARRANT and forever DEI'I/ND. ,3Cn ~itnegg ~~jereof the said part of the fire[ part to these presents hereunto set hand and seal Dated the day and year first above written. ~tQneR. SealeD attb ~eti6ereD 1 Q~_ s /~~ ~ ~ ~~ ..~. _. '~ ~, ..»..»...........'...~~~Q..... ~.. ~.. .....~ S L ~~,~ /<~G ~~"' JOHN W. SUDDUTH by his Attor e~ in-Fact, Thomas A. Hamilton, Est ....» .........................._......___.._ _ . aye` .........................................................._. _._.. ..... nest. Bboii 137 encE ~ S3'7 Y + ~, RF,CF_!!~L•D a+lbr dny aJ !lu dafr aj flte above fadafurr o/ fhr abmz-nmard GrmMrr R'f'I ;~IISSS AT SiGNiNG: State of Pennsylvania County of Cumberland ON TXE 2nd doy a) April Anxo Domini 19 96 brfarr nre, rbr snbrrribrr, Thomas A. Hamilton, Esq, attorney-in-fact for John W. Sudduth -errmmfly n--eared fbr obmrr-nasued hidn,Porr fa br h1s sad in due /orrn a( Inm orknowlcdgrd !hr above nrarded nr n,rb, nrf m,d drrd, sad drrirrd tlm romr miybJ br IJ'1TNESS my band and rra! the da 7••n T. r,... d 18 ~~ '~ y m+ yror a/orrraid• '~' rb, StlA '~ , ~ ~ . NOTARyy, SEAL L[NDA L. 11C1lEiM. Notary Pub11C alfq Ht11 Cu~berland Count M ~rei. ~T~~- ~~ ~ ::~~.il^~ ~e~a • ~ r y Caam1Sf10N /lres July 2Q 1996 ~ •, drl pY1~~~ ~ ~` , 7r ....y Tberrridnuro/fbrwtbix-namrdGronteeir803 Linwood St., New Cumberl~~Py On brhal/ v/ raid G.aulra ~~ C ro E I ., I ~ ~ Cr' ~ U rn borow W y O y, v ~ ~ "~ ~ G C 0. ¢ai •.,1 O d ~ w' F ~ G ~ ~ ti F 0. I ~ Q'' Q L X V 1 ~. ~ / ~ a H ' i~ o OAF °z H ' cnE6 '~ a ° = a ~ orDe in the Oifice for Recording of Deeds, in and for ~~«~'~%Q/IC/t_ (___,_~~~Q, in Deed Book ~..~7 No. page ~~J~~ &c. ~~. ~:~~ a~~_ .Mr~l. ~~ C! • ~,J,. ~..• r~FG ~f1tIP$9 my hand and eeal of Office this ~'~j~~~sd. C~~~ °f Anno Domini 19 w °~ 'k~- : ' . / ~ ~ , 1 ~ f ~"~~a f ly •'t.~ ~+ ' `,h4• . r' Y V b40K ~.a3~1 PAGE rJ3S I p~'~~ REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Scot Ireland 2011-00916 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the RFV-i snn is vac Ir more space is neegeg, use additional sheets of paper of the same size. SCHEDULE G EXHIBITS - _ - SUPERVALUSTAR401(k) ~p7~~t-y~Ap y, Sr~A~ ~®~ ~ ~lan c Plan Administration C/ E! l~~J 1 ( ) ~ dy~,tr. ~,® PO Bor. 5166 ~~~ ~ L~ ~~ iE' ~ Boston, MA 02206-5166 ~~ Statement Period April 1, `` EARTH 2011- June 30, 2011 Turn of(your paper statement Through the STAR Web i s te. Questio~zs? +~.~, ,Automated 24-hour Help Line 1-888-STAR-088 ~ ~ DoM 4 2 3 ~;, Participant Service Representatives are available Monday through Friday, 8 a.m. to 9 p.m. ET TDD Access Number. 866-620-45302 SCOT H IRELAND ~lnternetAccessat: 803 LINWOOD STREET - wwwsupervalustar401k.com NEW CIIMSERLAND, PA 17070 Pa~•ticipa~zt Prole Plan Entry Date/Status 03/27/2000!1-erminated IRS Plan Number 4106'17000 YourTotalAccount Value Account Balance Fl~istor y Opening Value On April 1, 2011 +EmployeeContributions $129 983 68 ($)In Thousands $4365 s~z~ $~~ >tst +EmployerContributions $4365 stns $~°g stm + Other Credits/Payments(a) $0.00 sins + Investment Gain (Loss) $757.96 - Distributions/Debits(b) $1125 S70 sas Closing Value On June 30, 201.1 X130,$17.69 Total change in value during this period ~834.D1 $0 zom zoos zoos zoto Current Period Personal Investment Performance c ( ) oaoirzon osraorzmt O CJ$o/O Comparison of yourpreviousyear-entltotat Opening value vs. values at ING Year-To-Date Personal Investrnent Performance(c) c closing value 2.~6 ~o Values as of June 30, 2011 Your current asset allocation basetl on your total closing balances within each asset type: YouYAssetAllocation & Balance by Fund Investment Type/Fund Name Measure Units/Shares x Price Market Value 62%, L' Short Term Investments Stable Value Fund Units 7,355.2340 $11.082182 $81 51204 0% Bond Funds 38%, Balanced Funds 2025 Retirement Portfolio Units 4,683.7751 $10!i26905 $4g,305_~ 0°! ,~ Stock F;.~nds 0% Other Funds 0%® Self-Managed Account 0%~ Employer Stock Total Fund Balances $~ 30,817 69 To better understand what asset allocation means and which asset allocation maybe appropriatf=for your circumstances, visit your plan's Web site at www.supervalustar401k.com or call 1-888-STAR-088 (1-888-782-7088). Page 1 of 3 I.,A~' ®FI~'ICES BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070-1931 PHONE: (717} 774-1445 FAX: (717) 774-7059 Supervalu Star Plan Administrator P.O. Box 5466 Boston, MA 02206-5166 March 12, 2012 Via fax only: 888-228-6823 Re: Scot Ireland, Social Secaarity No. 165-58-6748 Dear Sir/Madam: This office represents the estate of your former employee, Scot Ireland. Attached is a copy of the Mr. Ireland's death certificate indicating that Mr. Ireland died on June 17, 2011. I am also enclosing documentation of the appointment o:f Therese J. Fisher as his Executrix. I am additionally including an Authorization executed by Ms. Fisher authorizing release of information to my office. I am requesting written confirmation of the following information: 1) Written confirmation that the date of death value for Mr. Ireland's 401 (k) account was .$129,671.55. 2) Written confirmation that the account was subject to a loan in the amount of $19,755.35 as of Mr. Ireland's date of death on June 17, 2011. Please fax your confirmation as soon as possible. I understand this inforrriation will be provided in three business days. I would like to attach your verification to an inheritance tax return due to be filed on March 17, 2012. Your-cooperation is appreciated. Please contact the undersigned with any questions: i /_ Sincerel~vonrs_ i '-- Barbara Sumple-Sullivan BSS/as Enclosure cc: Ms. Therese J. Fisher REV-151? EX+ (1U-09) r....... ~~F~, SCHEDULE H ~ Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Scot Ireland 2011-00916 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' Stone & Murray Funeral Home __ _ .: 6, 972.00 2. Rolling Green Cemetery Company, Cemefary Plot 400.00 3. Rolling Green Cemetery Company, Transfer Fee for Cemetary Plot 120.00 4. Royer's Flowers 349.80 5. Rolling Green Cemetery Company, Grave Stone 4,297.00 _ _ _ __ _ e. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Z• Attorney Fees: 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4, 5. 6. 7. 8. i 9. 10. I TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. 4,000.00 ........................ 96.50 280.00 75.00 263.00 325.00 17,178.30 SCHEDULE H EXHIBITS -~ O D O T m n 2 D Z m m r m C7 m 0 D r ~~ D m ~~ n ~~ . o ~ ~`~ m ~.\ ~ ~~' I ~~ ~~ ~~ C~ C7 ~ ~ D ~ O m m~ z C phi o ~' o j ~ o ~ ~ ~ ~ ° o ~ n I C o ~ ~ ~ a ~ ~ ~ ~ m m o ~~ m •c m .N j' ~ ~~~: • ~1. a ~ ~ ~ ' 1 { C '` ~ V : ~~: ~ ;~; .. . :~ . , . , ~~ \ \ ~~ ~ h U~~ ~~~ ~' 1 ~ • ~t~~ c ~ ~'1 ~, o :'Jl :~ 2 ~ ~ ~ ~ y ~ ~ ~ y o m m ~ o m c c~ m c m m ~ 3 y r0 ~ ~ y ~ ~ O O O. O O ~ _~ 25 ~ " C m ~ o ~ .om nTi m m m ~ ~ ~ ~ ~ ~' $ n < ~ m m y y y ~ ~ j D T ? ~ ~ Re Go Qe ~ ° ~ 37 ~ n• y Oo Ila (n CA Cn O ~l ~ n~ ~ 1 1 ~ ~ ` 0 m ~ D ; : : : = C ID ~ m F : ~j N ~. -. m ~ ~ ~ ~ ~ ~ m H ~~ ~ ~• ~~ : ; :: ~ ``~ ~ ~ ,,. m r ~ ° s ~ m ~' ~• ~ ~ C7 D ~~ m ~ ~ n m y y c~ m w O m ~ w. `~ m D r° a <' w .~ m y ~ m ~ x m D ~' ~ m .Z ~ ° a °. 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ARE -1'fli: O1~V~~fER(S) OF OR H:11~'~ ;1 i`JF_T EQL;I'fY fr\TF~Rf:S'r f)1= ', ~ ------- ----------_- ----~------------------._..._-- IN_THE FOf_LO1VIiVC; DESCRIBCD C:E~\~ETERI' rNTLRiV[EN"f R.IGr-rrS An~D/oR i~4ERC'F[;\ND1SE~~ Q~~~- --- FOR .51.00 :'AND OTHER 'vALU,\BL[3 CONSIDERAT[Oi~i. RECGIPT pF WHIG{ [5 HEREBY .4Ck^ 1cD, I~VE DO HERF_B} QUI"CC'i.A(~1, RELEASE AND TR;1NSrER ALL RIGHT, INTERIiST, TITLE, USE, CLAD' 1AND, AND [=QU1T'r`, rF ANY, WHAT- SOEVER, IN TI-[E ABOVE-DC.SCR[BED CEN[E"r'L'•R}' (NTERViENT RIGI~~" .~/nR ~4ERCHANDISE .4ND [F APPL[C~-1BLE, qr iTHpRr7T' IS3C!ANCE OF OWNFRS111.°~D-O~CUMENT;~.TI(7N TC~: P ~ 0 C ~ ~~ ialcphma ~umnei :~ ------ ..I.Ir •~.. ..r.-i -__ ?, ::\'D L''r' "I'1-I!S A(-'l', [/\VE Tj0 HGKEB}` RF~r_!= -Il lE I3E1_ll\','-iv.\~\•(L-I~ C'L-`,1.E~I E:11" FI:CjrV[ ;\[y'( \f~ID .-\I.I. I_.I:\BILITY OF ,1~!1. r:=;-ri ~ru-> wfl:\~sr-,r~, rr: 1,~ c.~~.,,,,1_~..r(, ,-rrr-1 ~nus• ~rl~~.=,,~:snc -nn •; 1Vitne;,eci L~. } Si-_n~_rl ihi, (~c- - ~lu~, „I --~ ~~'` ~---------- --- c`~Q_1 ~ --- _.. ---- -------------- ------- Ir,NA7! IRF-:: ---- N.~A71 OF CEMETF_R Y: ->~- r-- -`~~--cam --- - ~ _ ~ -. aC'CFF'TFD Y'r' ~ ~~lif<;\II'};F~Si!)P I'I-R ;r`~~lr"i 1~'IiC!'`rl RI(:~Hf f`:'11= :E~! I["(L~ \,;r,.rJl•'. F(11 ,_.. ,I ~ i ';RF ~(:[i'J("-; rR \'~:SFFRRIiD -\(r'~jrill~l I fir I_r~ ~\.D r.,ItFL-f! rr~. , ~; ~ ~ ', ~ --' - " ~~ - _ _ _ ; -- { ~._ _.,. ;..~~,~ ~~ :s,st9i~ttti siaai~3~~~~a~~{~~l9litl`Ilfiltlt-i~~11li1~ (I~t~ii~l~l~i{~~~i1a~11~~Ii~~l~~~~~{~j~ 0 a .. s CERTIFICATE OF INTERMENT RIGHTS RECEIPT Grantee Fisher, Therese J CERTIFICATE ~~~ 403302 Date of Sale 6 7 6 2 01 1Sales Agreement No, trap G f er Interment Rights Sale Amount $ Endowment Care Amount $ ---__ Transfer F'ee $ ~ 2_ ~ , ~ ~ Certificate of Interment Rights Delivered on ^ At Cemetery Office ^ By Sales Counselor p B (Date) as indicated below; y Mail Received By: •~d ~ _~ PLEASE RET RN TO CEMETERY OFFICE IMMEDIATELY ~.~ ~ _. ~i i~• ,~r~ i ,.. LlE'I I<.tr: ~~SU NAidCY ~-iL~i ?&,~2U11 Transaction: 9B9?S REu #2 3;10I:,m Ln# Pn Descr Qty Arncunt Ex~t Arrit 1 2'% CASk:E I S 1 1 5:00 175.00 U~ i mated order: 45201 t 19 CORSAGE i 35.i)O X5.00 Validated order: 45202 3 82 RIE;BOrd A 1 S,OO 5,00 Validated order: 45202 4 21 SPF,'A'~` 1 ? 10 . CO 110.00 Validated order: 45203 5 82 RIBB01~ A 1 5. CiU 5, 00 !%alidai:ed order: 45203 Tax: 1y.8i) Total: 340.Qri Check Tender: _i49.80 Thank:-You For .'our' Patronage www.royer~•com Order Number: 45201 Delivery date; i)6,~21/2011 Reciuient; IRELAt; Address: O STOfdE & t•1uKRAY ; / City/State: I'•JEW CL'hIFiERLAPID PA Order I~ai.imber: 45202 Delivery Date; Ob'21/~~011 Recipi;:nt; IRELAND Address: U S70Ni: ~ FIIJRRAY /! Cit~%/State: ~IEIFJ Cllh'iBEP,LAr!U PA Ordei P1uoiLer: 45203 Del i•,~Cr;~ Dote: 06/21/%Ol l Recipient: IRELAND Address : STOiJE ~ , ° ~; i r ~iuRRN ~ , City,~Statc: NEw~J LiJPS[3EF2LAPiCi F'A Contract File Folder Name/Number CEIVIETERY INTERMENT RIGHTS, MERCHANDISE, AND SERVICES PURCHASE/SECURITY AGREEMENT THIS AGREEMENT PROVIDES FOR PERPETUAL/ENDOWMENT CARE. 'nc~ undersigned, referred to as 'Purchaser', hereby agrees to purchase the Interment Rights, Merchandise and Services described herein, subject to acceptance and approval of the above named cemetery, hereafter referred to as 'Seller'. Purchascc Lust Nan'e: I- `F i -1 I I I First: _.I t I .I I I I I I I Middlr I'I I I I I I Telephone: .._ ...__ - SSN`. DOB: _ (-J_ '_ / / Email: Adores: I I I I I I I L I I l f l 1. I- I- 11 I I I I I I I q'ty' I 1- L. I I I I 'I =1= I I 1 1 State' I I- I Z'p Co-Purchaser: tazl Name: I I I I l l l l Fi rsr. 1 1 1 1 1 1 1 Middle: I I I I I I I Telephone: SSN: DOB: -) -- - - / / Email: ~.. Address: I I I I I I I I I I I I I I I I I I I I I I I I I I O't}` I I I I I I I I I I I I I Slate: I I I Z'p Deceased: Last Nar»e: -)- ; I- -F _I' I- I"' I I I I I I I I I I I I First: I- I_ I. f' I I I I I I I I I I Middle: I-- I I I I I I DOB: / ~- / DOD: - Burml Dme: - / - / - / _ / _' Veteran: Description of Intermeln Rights to be used: "' _ _ - _ " : Nlemorializalion Rights: Issue Certificate of In:u~ment RI_hts m: Address: City: State: Zip: INTERMENT - _ • Interment Rights $ -~- (Includcs Perpetual/Endowment Care of $ ) • Interment and Recording Fees - • Outer 13urial Container Supplier Model/Design Material/Color • Oufer Burial Container ]nstallation _ NIEMORIALIZATION • Memorial - ~ _ Supplier Type/Color Design/Size ~~ • Memorial Base - Supplier - Type/Color - Design/Size -- • N(emorial Perpetual/Endowment Care --- • Memorial Installation Fee ` _ • Memorial Inspection Fee <- • Nameplatt:/Scroll -.- • Lettering -- - - _ • FlUrrer Vase Supplier Type/Color Design/Size • Vase Base ~. Size/Material Notes & Payment Terms (where applicable): w1P;HCHANDISE & SERVICES -- • Urn _ Supplier Type/Color Design/Size • Admin/Processing Fee _ -~ • Other - • Other - • Other _ • Other • Other - • Other TOTALS, ALLOWANCES & TAPES • Interment Rights ..............._..............._............................. ( _. ) Reason • Merchandise/Service ........................................................ ( - ) Reason Apply to ' Merchandise/Service ......................................................_ ( -- ) Reason Apply to Sub Total Total Taxable -° Sales Tax (if applicable) ................................................... TOTAL CASH PRICE $ ~- Less: Down Payment _ _ Other Total Down Payment ( - '- _- ) Unpaid Balance of Total Cash Price $ TERMS The Total Cash Price is due and payable as of the date of this Agreement. A delinquency charge of percent will be assessed monthly on any balance no[ paid within 30 days of the date of this Agreement If less than full payment is received, Seller shall deduct the accrued delinquency charge from the amount received and credit the remainder of the payment to the Unpaid Balance. Security Interest: Seller (or its assigns) will have a security inierest in the Interment Rights and Merchandise being purchased as described above. Seller will retain title to said Interment Rights and Merchandise until the Total Cash Price, together with any delinquency charges thereon, have been paid by Purchaser to Seller. NOTICE: By signing this Agreunent, Purchaser is agreeing that any claim Purchaser may have against the Seller shall be resolved by arbitration and Purchaser is giving up his/her right to a court orjury trial as well as his/her right of appeal Signed this day of ~p_ --~ __~_~, Purchaser _i -- "~ '---- .- - Relationship: Accepted ' I:ine.~l iliac I bare rcviiwcJ Ibis Jiicunien~ liir aecumcy :inJ cumnliicnc~.. Co-Purchaser: Relationship: . Date: / / Counselor: # ~mi ` / / Date NOTICE: See Otlter Side for Additional Terms and Conditions which are Part of This Agreement =onn: 220-PA (05/071 Distribution Schedule: While = Cemetery Gmv Yrllow = r,,.,nn..r rn.,,, RECEIPT FOR PAYMENT GLENDA EARNER STRASBAUGH Receipt Date: 8/30/2011 Cumberland County - Register Of Wills Receipt Time: 08:29:24 OnP Courthouse Square Receipt No.: 1066806 Ca~lisle, PA 17613 IRELAND SCOT Estate File No.: 2011-00916 Paid By Remarks: BARBARA SUMPLE SULLIVAN DB ----------~-------- ----- Receipt Distribution ----- ------__________ ____ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 30.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE JCS F 15.00 8.00 CUMBERLAND CUMBERLAND COUNTY GENERAL COUNTY GENERAL FUN F EE AUTOMATION FEE 23.50 5.00 BUREAU OF RECEIPTS & CNTR CUMBERLAND COUNTY UN M.D ----------- GENERAL FUN Check# 4735 Total Received...... ----- g ... 81.50 _ ~~ '~ ~ f S, o o i n hevi'~'~h cL~ ~t~ l i~.P '~2 e ~ 3' ~ (o ~ 1'Z~ ~?l~ • s"9 Pc~dd~n, ~~rerrE~i ~ ~.ssacF~~es, P.C. 3425 ~'~~pson Ferry Rd. Camp Hill, PA 17011- Tel: 71 7-763-1644 Fax: 717-763-1646 pga@~~acpas.com www.pgacpas.com Invoice Submitted To: ~nvO~ce c/o Therese Fisher Invoice Date: Mar 12, 2012 Scot H. Ireland 803 Linwood St. Invoice Num: 34362 New Cumberland, PA 17070 Billing Through: Mar 12, 2012 Payment Terms: Net 30 In Reference To: Scot H. Ireland (28540:) Return top portion with your remittance Preparation of 201 1 personal tax returns Amount Paid: $ Total Amount Of This Bill: Previous Balance: Balance Due: This Statement Contains Charges Through March 12, 2012 5280.00 $0.00 S280.00 A FINANCE CHARGE OF 1.00 PER MONTH IS ADDED TO ALL INVOICE BALANCES OVER 30 DAYS PAST DUE THANK YOIJ FOR KEEPING YOUR ACCOUN7CURRENT. Page 1 of 1 CUMSERLAND LA~V JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 September 23, 2011 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Barbara Sumple-Sullivan, Esquire RE: Scot Ireland Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: September 9, September 16, and September 23, 2011 Advertising Cost Proof of Publication Second Proof Request Payment received To#al Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director in File No. 80317070-L Page X16 ~ FROM: MICHAEL R. ENT RE/MAX REALTY ASSOCIATES, INC 3425 MARKET ST. CAMP HILL, PA 17011 Telephone Number: (717) 761-6300 T0: THERESE 803 LINDWOOD ST. NEW CUMBERLAND, PA 17070 Telephone Number: N/A Alternate Number: Fax Number: Fax Number: E-Mail: DESCRIPTION Lender: N/A Purchaser/Borrower: THERESE FISHER Property Address: 803 LINWOOD ST. City: NEW CUMBERLAND County: CUMBERLAND Legal Description: DEED BOOK 137; PAGE 535 FEES FULL URAR -FORM 1004 ~t~~~[~E INVOICE NUMBER 80317070-L DATE 07/20/2011 REFERENCE Internal Order #: 80317070-L Lender Case #: 80317070-L Client File #: 80317070-L Main File # on form: 80317070-L Other File # on form: 80317070-L Federal Tax ID: Employer ID: 25-1651204 Client: THE ESTATE OF SCOT FISHER State: PA Zip: 17070-1443 AMOUNT 325.00 SUBTOTAL 32s.oo PAYMENTS AMOUNT Check #: 829 Date: 07/18/2011 Description: METRO BANK Check #: Date: Description: 325.00 Check #: Date: Description: SUBTOTAL 3zs.oo TOTAL DUE ~ o Form NIV5 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAAdODE MICHAEL R ENT (717) 730-3010 r RE1~'-1512 EX+ (12-OS) ~: ~ Pennsylvania '~ DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Scot Ireland 2011-00916 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. East Pennsboro Ambulance Service, Inc. 88.80 2.; Chase Credit Card Account No. 5184450003662602 758.74 3.' 'Federal Income Tax Liability (2011) 2,232.00 4.' ';Cumberland County Tax Liability (2011) 13.95 5. Supervalu Star Loan 19,755.35 TOTAL (Also enter on Line 10, Recapitulation) $ If more space is needed, insert additional sheets of the same size. 22.848.84 SCHEDULE I EXHIBITS East Pennsboro Ambulance Service, Inc. Post Office Box 47 Enola, PA 17025 (717) 732-5552 F14X (717) 728-9501 Federal Tax Number 23-2464545 BILL TO PATIENT NAME: Scot Ireland Ireland,SCOt ADDRESS: 803 Linwood Street 803 Linwood Street New Cumberland, PA 17070 ADDRESS: New Cumberland, PA 17070 PICK UP. Holy Spirit TAKEN TO: Residence DESCRIPTION: Stretcher TRIP NUMBER - - - -- --_ __-_ ]1-25706 DATE OF SERV... DESCRIPTION UNIT RATE AMOUNT 6/10/2011 Stretcher Transport -One Way (non-member) - 84.00 84.00 A0130 ~' 6/10/2011 Str Van Mileage -Loaded Miles 3 1.60 4.80 ~ SCOT H. IRELAND a3-os THERESE J. FISHER 803 LINDWOOD ST NEW CUMBERLAND, PA 17070 - 1717) no-1102 , ~ PAY TO THE ~~ ~L ~~~~ ORDER Of _ C yy~ " ETRO ~~BANK For your c Card TypF Credit Cai Invoice DATE INVOICE # 6/13/20].1 11-1158 627 11 f0-164~i3 12 ~~ / "~C.P Se ~ y I DATE d~ ~ ..p `C~~~ . O v ~~~~ ~ ~D LXRS IJ - C ~ . C _ FOR SIP ~:03L30L846~: 53 625759 511' 0627 Ha~aM gage Expiration:--/ _ Amount to be charged: $ I agree to pay the above total amount according to card issuer agreement. Signature: Comments: Your payment is due upon receipt. Medicare and most insurances do not cover this service. >f you need to check with your insurance company, please ask if your plan covers transportation code A0130. Please Note: Unpaid accounts may be sent to a collection agency after 90 days. TOTAL DUE ~POO.O~ '~ SCOT H. IRELAND 03-06 626 THERESE J. FISHER ~ 803 LINDWOOD ST NEW CUMBERLAND, PA 17070 ~ _ ~`~~-- ~, t~ 68-184/313 ~ t2 :3 (717) 770-1102 DATE j PAY TO THE °` ~... ~ ~`k e-c.'" ~d ~:°. ="~w-'~.~ r'~'~~ ~. ~ `"'I ~: ~ ~ m~ ~; 7 ORDER OF . .._ "'~w: a 4 .t. ~. C"4-- - • Y. ~, ~~'O~°a ,~1~.~.OD~" 8 B e~kuz on ~"~~ ET6tQ ~ ~ ;` ''~ c t ' a p/~(~~ ltr ~~ p/`11 V K , ~" _ ' ~`~ ~:03i3OL846~: 53 625759 5n 0626 alantl CIaMe _.....__.._I.. Payment Due Date New Balance Past Due Amount Minimum Payment U71~0111 :~5a.74 ~n~ ~ ~~ - CHASE : _ Account number: 5184 4500 0366 2602 Make your check payable to: +r--- Chase Card Services. ~ ~ i`~" Please write amount enclosed. New address or a-mail? Print on back. 5184450DD3662602DD00250000075874DDODD0000000000 43231 BEXZ,64,1 D lurlllrlulnlrlrrlrrliurlrlurrllrlrirnliuf~lu~lllrilnl SCOT H IRELAND 803 LINWOOD ST CARDMEMBER SERVICE NEW CUMBERLAND PA 1707D-1443 PO BOX 15153 WILMINGTON DE 19886-5153 Irrrlll~~rllirrrlrrrllir,r.rritrirririrrlrrllrll~rrrrllrllrrrl j ~: 5000 i 60 2B~: 408000 3 6 6 2 60 2 Ln• 's I afiea from CHASE ~ / Manage your account online: Customer Service Additional contact www.chase.com/creditcards 1-800-945-2000 information on bark ~l ACCOUNT SUMMARY Account Number: 5184 4500 0366 2602 Previous Balance $222.05 Payment, Credits -$329.04 Purchases +$865.73 Cash Advances $0.00 Balance Transfers $0.00 Fees Charged $0.00 Interest Charged $0.00 New Balance $758.74 Opening/Closing Date 05/14/11 - 06/13/11 Total Credit Line $16,500 Available Credit $15,741 Cash Access Line $16,500 Available for Cash $15,741 PAYMENT INFORMATION New Balance $758.74 Payment Due Date 07/10/11 Minimum Payment Due $25.00 Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to $35.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99%. Minimum Payment Warning: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: If you make no You will pay off the And you will end up additional charges balance shown on paying an estimated using this card and this statement in total of... each month you about... PaY•-• Onl the minimum 3 ears $897 payment If you would like information about credit counseling services, call 1-866-797-2885. ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description ~ $ Amount ,..~~_ - . _.._._ _.. _... _. _;x,..~, . _ 06/02 CVS PHARMACY #1630 003 CAMP HILL PA -106.99 06/05 Payment Thank You Electronic Chk - -222.05 - -, ~ .__. ~~a ~ ~ ~~j 05/24 LZC'LEGALZOOMCOM 800-7730888 CA ~~ ~ 81.95 05/24 EDGEPARK SURGICAL 330-963-6998 OH 54.80 05/28 CVS PHARMACY #1630 003 CAMP HILL PA 106.99 06/04 THE HOME DEPOT 4120 MECHANICSBURG PA 612.00 06/11 SUPPORT SQUAD 868-2258566 FL g.gg Total fees charged in 2011 $30.30 Total interest charged in 2011 $218.21 Year-to-date totals reflect all charges minus any refunds applied to your account INTEREST CHARGES Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Balance Balance Percentage Subject To Interest TYPe Rate (APR) Interest Rate Charges _ Purchases t 1.24`>~, (v) _a _._ -0- _. ~"f1NCES x,a ~.7:Sa,...:. .. .: :. _ Cash advances 19.24% (v) -0- -a -- _ ~ _ ,..,:.~ - OOOOODt FIS33338 D 13 X INS14923 000 N Z 13 11/06/13 Page 1 of 2 06598 MA MA 43231 16410000730474323101 28540 03/05'2D12 6:D0 F" •' E i Department of the Treasury-Internal Revenue Service 99 ~, !_ ~%•~%. Pc~c~¢v~~t~~~ 6caEO~e Tah ~Eft:FGC9 OMB No. 1545-0074 •IRSUseOrifJ='bonotwdteorstapleinthisspace. For the yi.~r .:an. 1-Dac 31, 2011, or other tax year beginning , 2011, ending , 20 ~ .~iE?e SP.parate instfuCtlon S. Yourfrst Wane and initial Last name Deceased Your social securitynumber SCOT H IRELA1vD 06/17/11 165-58-6748 If a joint recur`:, spouse's first name and initial Last name Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. 803 LINC~OOD ST City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). I3E~u+T CUE~EF?.LP~D PP_ 17 0 7 0 Foreign country name Foreign province/county Filictg Stetus 1 2 Check only cne 3 6a Exetllptions b c If more than four dependents, see instructions and check here - Apt. no. Foreign postal code Make sure the SSN(s) above and on line 6c are correct. Check here if you, or your spouse if filing jointly, want 53 to go to this fund. Checking a box below will not change your tax or refund. I ~ You ~ Soouse Single 4 I I Head of household (with qualrfymg person). (See instuctions.) If L-J the qualrfying person is a child but not your dependent, enter this Married filing jointly (even iF only one had income) child's name here. P Married filing separately. Enter spouse's SSN above 5 ~ Qualifying widow(er) with dependent child and full name here. Yours If If -- a someone can claim you as a dependent, do not check box 6a Bozes checked S ouse .............. ..... y on 6a and 6b ...... ................. Dependents: J ~n 1d e No. of children on sc who: (2) Dependent's ~ und r (3) Dependent's age 17 qual. • Ilved with you social security number '1) First name Last name relationship to you tic credit • did not five with (see instr.) you due to divorce i or separation (see instructions) . Dependents on 6c not entered above d Total number of exemptions claimed ............................. ............... 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ...................... nCOme 8a Taxable interest. Attach Schedule B if required ... Attach Form(s) b Tax-exempt interest. Do not include on line 8a ......................... 8b W-2 here. Also 9a Ordinary dividends. Attach Schedule B if required attach Forms W-2G and b Qualified dividends ................................................ ~ 9b .. 1099-R if tax 10 Taxable refunds, credits; or offsets of state and local income taxes was wtt eld. 11 Alimony received If you did not .... 12 Business income or loss .Attach Schedule C or C-EZ ( ) get a W-2, 13 Capital gain or (loss). Attach Schedule Drf required. If not required, check here ~ ... see instructions . 14 Other gains or (losses). Attach Form 4797 ........... 15a IRA distributions .............. 15a .............. b Taxable amount 6a Pensions and annuities 16a ............. b Taxable amount Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E not attach, any payment. Also, 18 Farm income or (loss). Attach Schedule F .......................... ... please use 9 Unemployment compensation ................ Form 1040-V. 20a Social security benefits 20a ~ 9 , 7 0 01 .......... ............................... b Taxable amount Other income. List type and amount Gambling income . . ...... 22 Combine the amounts in the far ri ht column for lines 7 throw h 21. This is our total income 23 Educator expenses 23 Adjusted .. .. 24 Certain business expenses of reservists, performing artists, and GLOSS fee-basis government officials. Attach Form 2106 or 2106-EZ 24 income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903 26 _... 27 Deductible part of self-employment tax. Attach Schedule SE 27 28 Self-employed SEP, SIMPLE, and qualified plans Y8 _.... .... 29 Self-employed health insurance deduction 29 30 Penalty on early withdrawal of savings ................. . 30 . 31a Allmon y paid b Recipient's SSN 6 31a 32 IRA deduction _......... 32 33 Student loan interest deduction 33 34 Tuition and fees. Attach Form 8917 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 35 ............ . . ....................... 37 Subtract line 36 from line 22. This is our ad'usted ross income . _ . 6. ,r isclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. ..................... Add numbers on lines above 7;76 1 f 9a 10 11 12 13 14 15b 16b 20, 094 17 18 19 lob 4 677 21 _ 1, 500 22 34,035 36 _ 34,035 Form ~040(2D11) 28540 03/05'2012 6:00 PM =armlo4or2_t1) SCOT H IRELP?3D ~i; edutS Standard Deduction for- •People whc check any box on line 39a or 39b or who can be claimed as a dependent, see instructions. • All others: Single or Married filing separately, $S,BOD Married filing jointly or Qualifying widow(er), $11,600 Head of i 'wusehold, b8,500 ®~~'ie6' yaxes 38 Amount from line 37 (adjusted gross income) .................. 39a Check ~ You were born before January 2, 1947, Blind. Total boxes r if: Spouse was born before January 2, 1947, BBlind. } checked - 33a L b If your spouse itemizes on a separate return or you were adual-status alien, check here - 39b 40 Itemized deductions (from Schedule A) or your standard deduction {see left margin) 41 Subtract line 40 from line 38 , ....__ .................................. 42 Exemptions. Multiply $3,700 by the number on line 6d Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- Forms 44 Tax (see instr.). Check if any from: a () b Form c 962 8814 4972 elec ... ......................... ternative minimum tax (see instructions). Attach Form 6251 4 Add lines 44 and 45 ............ oreign tax credit. Attach Form 1116 if required 47 48 Credit for child and dependent care expenses. Attach Form 2441 48 49 Education credits from Form 8863, line 23 49 50 Retirement savings contributions credit. Attach Form 8880 50 51 Child tax credit (see instructions) 51 52 Residential energy credits. Attach Form 5695 52 53 Other credits from Form: a 3800 b 8801 c ~ 53 54 Add lines 47 through 53. These are your total credits ................................................. 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- , .. , .:. ............... 56 Self-employment tax. Attach Schedule SE 57 Unreported social security andaMedicare tax from Form: a ~ 4137 b ~ 8919 ............ Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59a Household employment taxes from Schedule H ........................................................ b First-time homebuyer credit repayment. Attach Form 5405 if required ................................. Other taxes. Enter code(s) from instructions ..:..................................... 61 Add lines 55 through 60. This is your total tax 62 Federal income tax withheld from Forms W-2 and 1099 62 1 0 63 P~ Pl'lei1~S 63 2011 estimated tax payments and amount applied from 2D10 return 63 If you have a 64a Earned income credit (EIC) 64a qua ing child, attach b Nontaxable combat pay election 64b , , . . Schedule EIC. 65 Additional child tax credit. Attach Form 8812 .............. 5 66 _......... American opportunity credit from Form 8863, line 14 66 67 First-time homebuyer credit from Form 5405, line 10 67 68 Amount paid with request for extension to file B8 69 Excess social security and tier 1 RRTA tax withheld 69 70 Credit for federal tax on fuels. Attach Form 4136 70 71 ~... Credits from Form: a ~ 2439 b ~ 6839 c 8801 d 8885 71 72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments F?estat~d Direct deposit? See instructions. - ............ line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid . 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here - ........... b Routing number - c Type: ~ Checking ~ Savings - d Account number 75 Amount of line 73 you want applied to our 2012 estimated tax - 7.g 165-58-6748 pane: ~_3s 34,03 ao 5,800 41 28 235 a2 3 700 a3 24,535 44 3 , 254 72 1, 0 63 73 74a AiT10Uilt 76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions - 76 2 232 You Ov-~e 77 Estimated tax penalty (see instructions) . .. , , 77 d -~'-~- Do you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. No Third Party 1 Designee Designee's Personal identification number(PIN) - 71861 name - H . DAVID PP~DEN Phone no. - 717 - 7 6 3 -16 4 4 Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, '~" ~~ ~ they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. ~E're Your signature Date Your occupation oint return? ~ Daytime phone number ~eeinstr. T/1P_INTE23P.I~CE SUPERVISOR .eep a copy Spouse's signature. If a joint return, both must si n. u your 9 Date Spouse's occupation If the IRS sent you an Identity Protection PIN, ;cords. _ Printlrype preparer's name ~ald A. DAVSD PADDEN reF~rer Firm's name - PP~D SE Only Firm's address - 3425 CAMP ,A I Preparefs signature N, GUERRII~I & ASSOCIATES,P C S II~P S ON FERRY ROAD HILL PA 17011 Date Check LJ rf PTIN 03/09/12 self-employed P01204634' Firm'sEIN~ 23-2Z 90841 Phone no. 717-763-1644 Form ~{ 04® (2011) 28540 03/09/2012 6:00 PM -- __-. CUP~~ERLAND COUNTY TAX BUREAU , Local Earned Income Tax Raturn Taxpayer's name and address Your social security number SCOT H IRELAI~TD (DECEASED) 165-58-6748 803 LINWOOD ST NEW CUNISERLAIv'D ~ PA 17 0'] 0 Resident PSD Code Daytime phone number Extension Filing status: Township Single X MFJ NEW CUMBERLAND BORO Complete this section if you moved during the year Time Period Address To To Income 211 Spouse's social security number Amended Return MFS Final Return X i az a~~err~omt S Ouse Resident If you had NO EARNED INCOME enter the reason why: 1. Gross earnings reported on W-2's ..................................... 1. 3 10 0 .......... 2. Allowable honreimbursed employee business expense 2. 3. Other income/loss 3 4. Taxable W-2 earnings (Total of lines 1 thru 3) 4. 3 100 5. Net income from a business, profession, farm, etc .......... 5. .................. 6. Losses from a business, profession, farm, etc 6 7. Total net income/loss from a business, profession, farm, etc 7. 8. Informational Purposes Only: S Corp Profits/(Loss) as reported on PA-40 g, 9. TOTAL TAXABLE EARNED INCOME ................................. . 9. 3 l OO ......... ax Computation 10. Tax rate .............. 10. 1. 4 5 0 0 0 ......... 11. Tax Liability ....................... ....................... 11. 4 4 . 9 5 12. Flat Tax/Occupational Tax 12. 13. TOTAL TAX LIABILITY 13. 44.95 Payments and Credits 14. Tax withheld ........................................................... 14. 31.00 ...... 15. Estimated tax payments .................................... 15 .. . Credit for prior year overpayment ............................. 16. . .............. redit for tax paid to Philadelphia ............................. 17 . redit for taxes paid to other states 18. 19. Other Credits: ' 19. 20. TOTAL PAYMENTS AND CREDITS 20. 31 , OO Refund or Amount Due 21. Tax due 21. 13.95 . Interest ......................... .. . Late Penalty 22. ............................ 24 Amount D 23. . ue ............. .. ........................ ................. 24. 1 3 . 9 5 5. verpayment ............... ......... 26. Amount applied to next year's estimated tax 25. 27 Amount f f d ' 26 . o re un to be transferred to spouse s current year return 27. ............... 28 Amount d ith . ue w return AMOUNT YOU OWE 28. 13.95 29. Amount to be refunded REFUND 29, MAIL THIS RETURN TO: PAYA~NT DUE/CUMBERLAND COUNTY TAX BUREAU P.O. BOX 899 CAMP HILL, PA 17001-0899 _._~ Under penalty of perjury, I declare that I have examined this return and that to the best of my knowledge and belief, it is true, correct., and complete. - .._< Taxpayer's signature Date Spouse's signature I Date MAINTENANCE SUPERVISOR Occupation Occupation r H. DAVID PADDEN ~ 03/09/12 717-763-1644 Prepared by other than taxpayer Date Paid preparers, telephone number SCOT H IRELAND ~~~~At-~~~CJ ~~~[~. ~d~~(Alr,) ~LLE~~ ~'~~ °~'" ,SCi3 LINWOOD STREET , NEW CUMBERLPIQD, PA 17070 Statement Period April 1, 2011- June 30, 2011 Total Amount Loan Payment Payoff Loan Balance - Prindipal.Paid Interest Paid !' TotaLPaitl Loan Balance Accrued Interest Borrowed Status Amount Date on 04/01/2011 7his:Period + This.Period -, :This Periotl on 06/302011 This Period $28,634.99 Active $119.36 05/22/2014 $19,755.35 '' $D.00 $0:00 °- $0.00; $19,755.35 $0.00 Total $19,755.35 $0.00 $0.00 $0.00'. .$19,753.35 For loans issued after December3l, 2001, interest will continue to accrue on the outstanding amount of your loan if scheduled repayme=,nts are not received in a timely manner. In the event that you default on your loan, the outstanding amount of your loan will be reported as a taxable distribution. After the loan is reported as a taxable event, it will continue as an outstanding loan against your Plan account, will continue to accrue interest, and will count as an outstanding loan for purposes of determining the amount and number of future loans you maytake. Accrued interest is in addition to your remaining loan balance and must be paid to satisfy the loan. (a) Credits include forfeitures antl Trust to Trust transfers, if applicable. _(b) Debits incude recordkeeping expenses, antl if applicable new loans, expedited delivery charges, intemafional redemption fees, and fodeitures. (c Personal Investment Performance (PIP) is a measurement of the performance of YOUR entire account forthe time you were invested in the plan during the statement period. PIP is calculated based on the performance of yourinvestments during that pedod, taking into account your activity among investments. This method of calculating performance is usetl by the financial services industry. Other methods of calculating your PIP may yield different results. YTD PIP is based on the performance of yourinvestments from the first of the calendar year to the end of the statement period. If the period coveretl by this statement spans over to the prior year, the YTD PIP displayed will be forthe 12 months preceding the ending tlate of the statement period. Call 1-888-STAR-088(1-868-782-7088) formore information on your Personal Investment Performance. (d) Equivalent shares are calculated by dividing your closing balance in the Stock Fund by the closing price of that Fund's Common Stock as reported b;~ the New York Stock. Exchange on the last trading data cf the statement period. Equivalent shares are approximate, since to this Fund participants own units of a Funtl that primarily invest in stock and a very small portion of cash. e Please read this statement carefully. Any error must be reported within 60 days. Page 3 of 3 LAW OFFICES BARBARA SUlVIPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070-1931 PHONE: (717) 774-1445 FAX: (717) 774-7059 Supervalu Star Plan Administrator P.O. Box 5466 Boston, MA 02206-5166 March 12, 2012 Via fay only: 888-228-6823 Re: Scot Ireland, Social Security No. 165-58-6748 Dear Sir/Madam: This office represents. the estate of your former employee, Scot Ireland. Attached is a copy of the Mr. Ireland's death certificate indicating that Mr. Ireland died on June 17, 2011. I am also enclosing documentation of the appointment of Therese J. Fisher as his Executrix. I am additionally including an Authorization executed by Ms. Fisher authorizing release of information to my office. I am requesting written confirmation of the following information: 1) Written confirmation that the date of death value for Mr. Ireland's 401(k;l account was $129,671.55. 2) Written confirmation that the account was subject to a loan in the amount: of $19,755.35 as of Mr. Ireland's date of death on June 17, 2011. Please fax your confirmation as soon as possible. I understand this information will be provided in three business days. I would like to attach your verification to an inheritance tax return due to be filed on March 17, 2012. Your-cooperation is appreciated. Please contact the undersigned with any questions: ~_ ~~' Sincerer yours %~ i '- Barbara Sumple-Sullivan BSS/as Enclosure cc: Ms. Therese J. Fisher 1 REV' 1513 EX+ (01-10) Pennsylvania 4.~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Scot Ireland 2011-00916 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 (a) (1.2).] 1~ I Therese J Fisher II Fiancee ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 100% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF SCOT IRELAND Q~ ,scot IreC~a~d' DECLARATION I, Scot Ireland, a resident of the commonwealth of Pennsylvania and county of Cumberland; and being of sound mind and memory, do hereby make, publish, and declare this to be my last will and testament, thereby revoking and making null and void any and all other last will and testaments and/or codicils to last will and testaments heretofore made by me. All references herein to "this Will" refer only to this last will and testament. FAMILY At the time of executing this Will, I am unmarried. The names of my children are listed below. Unless otherwise specifically indicated in this Will, any provision for my children includes the below-named children, as well as any child of mine hereafter born or adopted. Michael Ireland Megan Fisher Tiffany Fisher Cory Fisher DEBT I direct that as soon as is practical after my death, the executor named pursuant to this Will review all of my just debts and obligations, including last illness and funeral expenses, except for those secured long-term debts that may be assumed by the beneficiary of such property, unless such assumption is prohibited by la~v or on agreement by the beneficiary. The executor is further directed to pay any attorneys' fees and any other estate adn-unistration expenses. The executor shall pay these just debts only after a creditor provides timely and Page 1 of my Last Will and Testament ~ ~~ (initial) DOC~500~7~9Rs sufficient evidence to support its claim and in accordance with applicable state law. I direct that any estate, inheritance, and succession taxes, including any interest and penalties thereon, imposed by the federal government or any state, district, or territory, attributable to assets includible in my estate, passing either under or outside of this WiII, be apportioned among the persons interested in my estate in accordance with applicable state and federal law. My executor is authorized and directed to seek reimbursement from the beneficiaries of my estate of any taxes paid by my executor to the extent allowed by law. If my executor cannot collect from any person interested in the estate the amount of tax apportioned to that person, the amount not recoverable will be equitably apportioned among the other persons interested in the estate who are subject to apportionment. If a person is charged with or required to pay tax in an amount greater than his or her prorated amount because another person does not pay his or her prorated amount, the person charged with or required to pay the greater amount has a right of reimbursement against the other person. I further direct that if any beneficiary named in this Will is indebted to me at the time of my death, and evidence of such indebtedness is provided or made available to my executor, that share of my estate that I give to any and each such beneficiary be reduced in value by an amount equal to the proven indebtedness of such beneficiary unless: (i) I have specifically provided in this Will for the forbearance of such debt, or (ii) such beneficiary is the sole principal beneficiary. SPECIAL DIRECTIVES Notwithstanding any other provision of this Will, I furthermore direct that: Therese J. Fisher is my sole beneficiary and should receive everything including our home and contents, vehicles, 401K, Any and All Life Insurance, current savings and checking accounts. Page 2 of my Last Will and Testament <J ~a ~ (initial) PRIMARY REMAINDER BENEFICIARIES I give, devise, and bequeath all of the rest, residue, and remainder o.f my estate, real and personal, wherever situated, after payment of all my just debts, expenses, taxes, and specific bequests, if any, in the percentages set forth below. Unless otherwise indicated in this Will, these shares will be distributed outright and free of trust. Name: Therese J. Fisher Relation: Fiancee Percentage: 100 DISTRIBUTION IF NO LIVING BENEFICIARIES If at any time before full distribution of my estate all of my beneficiaries are deceased and this instrument directs no other disposition of the property, the remaining portion of my estate will then be distributed to my heirs determined according to the laws of intestate succession, unless specifically disinherited elsewhere in this Will. E7CECUTOR NOMINATION I nominate my fiancee, Therese J. Fisher, to be the executor of this Will. If, for any reason, my first nominee executor is unable or unwilling to serve or to continue to serve as executor of this Will, I nominate my fiancee's daughter, Megan Fisher, to be the executor of this Will. If, for any reason, all of the nominees designated above are unable or unwilling to serve or to continue to serve as executor of this Will, I nominate my son, Michael Ireland, to be the executor of this Will. If none of the nominated executors are able and willing to serve or continue to serve, and the vacancy is not filled as set forth above, the majority of estate beneficiaries shall nominate a successor executor. If the majority of estate beneficiaries are unable to nominate a successor executor, the vacancy will be filled pursuant to a petition filed in a court of competent jurisdiction by the resigning executor or any person interested in the estate. Page 3 of my Last Wi11 and Testament ~ ~~ -~- (initial) MISCELLANEOUS E~ECUTOI2 PROVISIONS The term "executor" includes any executrix, personal representative, or administrator, if those terms are used in the statutes of any state that has jurisdiction over all or any portion of my estate. My executor will have broad and reasonable discretion in the administration of my estate to exercise all of the powers permitted to be exercised by an executor under state law, including the power to sell estate assets with or without notice, at either public or private sale, and to do everything he or she deems advisable and in the best interest of my estate and the beneficiaries thereof, all without the necessity of court approval or supervision. I direct that my executor perform all acts and exercise all such rights and privileges, although not specifically mentioned in this Will, with relation to any such property, as if the absolute owner thereof and, in connection therewith, to make, execute, and deliver any instruments, and to enter into any covenants or agreements bindiing my estate or any portion thereof. If there are two co-executors serving, they shall act by unanimous agreement. If there are more than two co-executors serving, they shall actin accordance with the decision made by the majority of co-executors. Subject to specific provisions to the contrary, I authorize my executor to distribute a share of my estate given to a minor beneficiary, up to the whole thereof, to a custodian under the applicable Transfers to Minors Act or Gifts to Minors Act, if in the executor's discretion, it is in the best interests of the beneficiary. The executor may also make distributions to a minor by making distributions to the trustee of a trust created under this Will for a minor beneficiary, the guardian of the minor's person, or the guardian of the minor's estate. No person named as an executor is required to post any bond. I authorize my executor to make the following choices or elections in m_y executor's absolute discretion, regardless of the resulting effect on any other provisions of this Will or on any person interested in my estate or in the amount of any of the taxes referred to: (a) choose a valuation date for estate or inheritance tax purposes or choose the methods to pay estate or inheritance taxes; (b) elect to treat or use an item, for either federal or state tax purposes, as either an income tax deduction or as a deduction for estate or inheritance tax purposes; (c) determine when a particular item is to be treated as taken into income or used as a tax deduction, to the extent the law provides that choice; and (d) disclaim aII or Page 4 of my Last Will and Testament ~ h~ ~ (initial) any portion of any interest in property passing to my estate at or after my death, even though any of these actions may subject my estate to additional tax liabilities. No person adversely affected by my executor's exercise of discretion under this clause is entitled to any reimbursement or adjustment, and my executor is not required to make any adjustment between income and principal or in the amount of any property passing under this Will as a result of any election under this provision. I authorize my executor, without obtaining court approval, to employ professional investment counsel on such terms as my executor considers proper, and to pay the fees of investment counsel as an expense of administration of my estate. However, my executor is under no obligation to employ any investment counsel. I authorize my executor either to continue the operation of any business belonging to my estate for such time and in such manner as my executor may consider advisable and in the best interest of my estate, or to sell or liquidate the business at such time and on such terms as my executor may consider advisable and in the best interest of my estate. Any such good faith operation, sale, or liquidation by my executor will be at the risk of my estate and without liability on the part of my executor for any losses that may result. SIIVIULTANE®US DEATI~ If it cannot be established if a beneficiary of my estate survived me, the provisions of the applicable Uniform Simultaneous Death Act, as amended, or any substantially similar successor act effective on the date of my death, will apply. NONLIABILITY OF FIDUCIARIES Any fiduciary, including my executor and any trustee, who in good faith endeavors to carry out the provisions of this VVilI, will not be liable to me, my estate, my heirs, or my beneficiaries for any damages or claims arising because of their actions or inaction, or the actions of any predecessor fiduciary acting pursuant to this Will. My estate will inderiulify and hold them harmless. Page 5 of my Last Will and Testament ,~ fib ~, (initial) ATTESTATIOI`.T This Iast will and testament, which has been separately sib ed by Scot Ireland, the testator, was on the date indicated below sib ed and declared by the above named testator as his or her Iast will and testament in the presence of each of us. We, in the presence of the testator and each other, at the testator's request, under penalty of perjury, hereby subscribe our names as witnesses to the declaration and execution of the Iasi will and testament by the testator, and we declare that, to the best of our knowledge, said testator is eighteen years of age or older, of sound mind and memory and under no constraint or undue influence. 1. QA ° ~~C '(~'10..~' (Sib afore o witness) (Print Name) Data ©~~ (Address) L l D S i~~rQ~ ~~'~ Ue, ~~~~.~ ~5 bvr~ ~~~ 170 ~J5' (City, State, ZII') ~~ ~ ~ l ~~~. ~3 . S -~-~-, (may (Sibature of witness) (Print Name) (Address) ~Q.~ ~"~ ~'1 n~10.~ 1a (7O`i~ (City, State, ZII') Page 8 of my Last Will and Testament =-~ ~-~ (initial) IN WITNESS WHEREOF, I, the undersigned testator, declare that I sign and execute this instrument on the date written below as my last will and testament and further declare that I sign it willingly, that I execute it as my free and voluntary act for the purposes expressed in this document, and that I am eighteen years of age or older, of sound mind and memory, and under no constraint or undue influence. (Sib afore of Scot Ireland) _~~ Date: ~ ' l 'll Page 7 of my Last Will and Testament S ~ `r` (~ tial) SAVINGS CLAUSE If a court of competent jurisdiction at any time invalidates or finds unenforceable any provision of this Will, such invalidation will not invalidate the whole of this Will. All of the remaining provisions will be undisturbed as to their legal force and effect. If a court finds that an invalidated or unenforceable provision would become valid if it were limited, then such provision will be deemed to be written, deemed, construed, and enforced as ~so limited. Page 6 of my Last Will and Testament ,- ~ ~ (initial) SELF-PROVING AFFIDAVIT Acknowledgment Commonwe th of Pennsylvania County of ~GL~N b~,~~2ot I, Scot Ireland, the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to Iaw, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sw`orn to or affirmed and acknowledged before me by Scot Ireland, the testator, this 2~ day of `~`%~t11~ , 20~. Signature of Scwot Ireland .~(- Si~-nat:u~e of Not' Public ~ ~ CCMMONWEALTH_OF F'ENhSYLVANl~4 Tamalene C, himmelbergcr- i;otary Public Seal) City of Harrisburg, Dauphin County k41' COMMISSION EY,PiF2ES DEC. 16, 2013 Affidavit Commonwe th of Pennsylvania County of [.1~n.t,/~~~/,.p~ C' We ~-'~ -~ and ~~ ~~tP~ ~ • ~~ the witnesses whose names are signed o the attached or foregoing instrument, being duly qualified ccording to Iaw, do depose and say that we were present and saw the testator sign and execute the instrument as the testator's Last Will; that the testator signed willingly and executed it as the testator's free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn. to or affirmed and subscribed to before me by ~ C~1. ~ ~ ~~~0. ~ and ~ ~.e.Y1 ~~ Qf1 ~.~ witnesses), this ~~ day of i'1 20 / / ~ '~ ~- Sib afore of Witness (Signature of Notary Public ~~~ ~~~ O! / (Seal) Signature of Witness COMMONWEALTH OF PENNSYLVANIA !~^ TARl~~L SE,4L Tamalene C. Himmelberger- ~'o~ry Public City of Harrisburg, ~~auphin County MY COMMISSION EXPIRES GEC. lo, 2013