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HomeMy WebLinkAbout03-30-12 (3)i _ r. __ 1505610140 RED-1500 EX ~°'-'°' PA Depart~rnent of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 30601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 8 5 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYWY Date of Birth MMDDYYYY 0 2 0 1 1 0 9 1 8 1 9 1 8 Decedent's Last Name Suffix Decedent's Firs t Name MI B A W N M A R G A R E T E (If Applicable) Enter Survi~ing Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security N;.mber FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) OX 6. Decedent Died Testae ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds ~teceived ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TWIS SE TION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number G E R A L D J S H E K L E T S K I E S Q 7 1 7 7 7 4 7 4 3 5 First line of address 4 1 4 B R I D G E S T• Second line of address P 0 B G X E City or Post Office State ZIP Code ~ r`., REGISTER S U SE Or1L,Y -, t7iS~ L~ ~- ' "+ t - Z> r- ~..G`~x7 `~ :: ,~ ~~, :. ~ ~ . ~ ,, X C'a C: C: =~.7 ~ , r A _y f';O _ r DATE FILED _- ~'~ ~'' C --r N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's a-mail address: g S h e k 1 e t S k i a~ S t O n 21 a W• n e t Under penalties of perjury, I dec. and 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 complete. D ration of pr~arer other than the personal representative is based on all information of which preparer has any knowledge. I NATURE OF P SON RE O SIB F F ING RETURN DATE ADDRESS ~ t JENNIFER R• LONE, 9520 BALLAGAN COURTBRISTOW VA 20136 SIGNATU EPARER OTHER A R TIVE DATE DRESS '- GERALD J• SHEKLETSKI ESQ• 414 BRIDGE ST•, NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY 15056:',8140 Side 1 1505610140 `-z7 ~~ =jJ ,;_~ ~.~ ~, r J 7 J Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARGARET E. BAWN 21 11 0854 Decedent's Name Page 2 File Number Correspondents Name First line of address Second line of address City or Post Office State ZIP Code Daytime Telephone Number Correspondent's a-mail address: Under penalties of perjury, I declare that I have ex mined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of aver other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE SPONSIB ING R URN DATE. ~ ADDRESS LISA R• HEAD 119 REVjELATION RD NORTH EAST MD 21901 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: MARGARET E• B A W N 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ..................... ...... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9• 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has npt been made (Schedule J) ................ ...... 13. 1 4 5 0 0 0. 0 0 6 8 6 8 3. 2 0 2 6 8 3 4. 1 9 2 0 8 2 4. 1 2 2 6 1 3 4 1. 5 1 4 7 3 5 2. 2 4 4 7 3 5 2. 2 4 2 1 3 9 8 9. 2 7 14. Net Value Subject to Tax (Line 12 minus Line 13) .. ........... .. ..... .. 14. 2 1 3 9 8 9 . 2 7 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 .o _ 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate x .15 2 1 3 9 8 9. 2 7 1 s. 3 2 0 9 8. 3 9 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3 2 0 9 8. 3 9 Side 2 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 0854 DECEDENT'S NAME MARGARET E• BAWN ____ _ STREET ADDRESS 1814 WILLOW _ R O A D _____ _ __ _ _,_ ____ CITY --_-_- --_--- STATE ;ZIP CAMP HILL PA '17011 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2 Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 32,098.39 Total Credits (A + B) (2) 0 • 0 0 (3) (4) (5) 0.00 32,098.39 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................... ... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................ ... ^ Q ~ry interest; or ............................................................................................. e ... ^ X^ p d. rece ve the romif;e for life of either payments, benefits or care? .................................................... ... ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................... ... ^ X^ 3. Did decedent own arh "intrust for" orpayable-upon-death bank account or security at his or her death? ...... ... ^ 4. Did decedent own arr individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................... ... ^X ^ IF THE ANSWER TO ANY OF THE AIBOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 19'94, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: MARGARET E• BAWN 21 11 0854 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wiling buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• ALL. THAT CEIRTAIN TRACT OR PARCEL OF LAND AND PREMISES 145,000.00 SITUATE, LY',ING AND BEING IN THE TOWNSHIP OF LOWER ALLEN, IN T~iE COUNTY OF CUMBERLAND AND COMMONWEALTH OF PENNSYLVANI!A•••KNOWN AS 1814 WILLOW ROAD, CAMP HILL, PENNSYLVANIIA 17011• SOLD TO BRIAN PHILLIPS AND AMANDA HUNT ON MARKH 23, 2012• COPIES OF DEED AND SETTLEMENT SHEET ATTACHED HERETO. _ TOTAL (Also enter on Line t, Recapitulation.) I S 14 5 , 0 0 0 0 0 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX ~ (6-98) scHEOV~F s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET E. SAWN 21 11 0854 Ali property jointty•owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. h5h SHARES !CHEVRON CORPORATION COMMON STOCK h8,h83.20 TOTAL (Also enter on line 2, Recapitulation) I a 6 8, h 8 3 2 0 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY r:aiAi t ur: FILE NUMBER: MARGARET E• BAWN 21 11 0854 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ~. 1992 DODGE!SPIRIT SEDAN 800.00 TITLE 4499$155102IS, VIN 1B3Xa563xnf223615 BLUE BOOK VALUE - $2,800.00 2• PNC BANK CERTIFICATE OF DEPOSIT ACCOUNT #31800148478 6,001.20 3• PNC BANK CERTIFICATE OF DEPOSIT ACCOUNT #31000271889 1,001.34 4• PNC BANK CERTIFICATE OF DEPOSIT ACCOUNT #31200355992 2,OD9.61 5• PNC BANK CERTIFICATE OF DEPOSIT ACCOUNT #31500236295 10,347.15 6• PNC BANK CHECKING ACCOUNT #5005032143 2,217.44 7• PNC BANK SAVINGS ACCOUNT #5130190191 4,009.82 8• PATRIOT-NEWS NEWSPAPER REFUND 100.50 9• CAPITOL BLUl= CROSS REFUND 291.83 10• ALLSTATE AU1f0 INSURANCE REFUND 55.30 TOTAL (Also enter on Line 5, Recapitulation) I E 2 6, 8 3 4 If more space is needed, insert additional sheets of paper of the same size __ __ _ i REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER•VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY - __ - ESTATE OF FILE NUMBER MARGARET E• SAWN 21 11 0854 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV•1500 is yes. ITEM NUMBER DESC IRTION OF PROPERTY. INCLUDE THE NAME DF1HE FEREE, THEIti ReunoNSHI? To oECEDENTAND THE DATE of Ea. TTACH A eoPY or: THE DEED FoR REAL EsTATe DATE OF DEATH VALUE OF ASSET °~ OF DECD'S INTEREST EXCLUSION pv naPUCa~Fy TAXABLE VALUE t NEW YORK LIFE SINGLE: LIFE ANNUITY 20,824.12 100.00 20,824.12 POLICY 75617723 TRANSFEREE- JENNIFER R• LOWE RELATIONSHIP TO~DECEDENT -.NIECE TOTAL (Also enter on Line 7 Recapitulation) I$ 2 0, 8 2 4. b 2 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE= TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARGARET E• BAWN 21 11 0854 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. PARTHEMORE'FUNERAL HOME AND CREMATION SERVICES, INC• 11,566.87 B. ADMINISTRATIVE COf?TS: Personal Representi~tive Commissions: Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: ZIP 2, AltomeyFees: STONE LAFAVER & SHEKLETSKI 8,400.00 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship pf Claimant to Decedent 4. Probate Fees: LETTERS TESTAMENTARY 323.50 5 Accountant Fees: 6. Tax Return Prepares Fdes: 7. 1'HE SENTINEL - LEGAL ADVERTISING 242.64 8• CUMBERLAND LAW JOURNAL 75.00 9• VERIZON 75.15 10 • LIGI 15.94 11• FEENNSYLVANIA AMERICAN WATER 34.93 12• DIRECT TV 32.12 13• LOWER ALLEN TOWNSHIP - TRASH AND SEWER 103.55 14• EAST PENNSBORO AMBULANCE SERVICE, INC• 92.00 15• PPL 188.06 16• LOWER ALLEN TOWNSHIP - TRASH AND SEWER 98.55 17• WERIZON 38.66 18• UGI 13.33 TOTAL (Also enter on Line 9, Recapitulation) 3 4 7 , 3 5 2.2 4 If more space is needed, use additional sheets of paper of the same size Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARGARET E. BAV'JN 21 11 0854 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8 Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19• PE:NNSYLVANrA AMERICAN WATER 73.83 20 • PF'L 14.70 21• SETTLEMENT CHARGES ON SALE OF 1814 WILLOW ROAD, 18,259.79 CAMP HILL, PA ($ 10,750.63/LINE 502 + $ 8,346.43 SELLER WELD/LINE 513 MINUS $837.27 ($ 498.13/LINE 406 + $339.14/LINE 408) REAL ESTATE TAX PRORATIONS _ $18,259.79 22• UGI 12.15 23• PE:NNSYLWANTA AMERICAN WATER 28.58 24 • PF'L 12 •00 25• UGI 59.31 26- PE:NNSYLVANTA AMERICAN WATER 28.43 27 • PF'L 19.13 28• UGI 219.10 29• PE:NNSYLVANYA AMERICAN WATER 27.75 30 • PF'L 26.26 31• PENNSYLVANIA AMERICAN WATER 28.66 32• UGI 106.99 33 • PP'L 127.00 34• UGI 13.50 35 • PP'L 24.28 36• KINGDOM PANTING 2,100.00 27• 217111-2012 SCHOOL TAX 1,251.26 28 • WINDOW REPI4IR 268.80 29• BATHROOM FLOOR REPAIR 258.42 30 • CHIIMNEY REM'AIR 450 • DO 3],- GLASS REPAIR - KITCHEN WINDOW 54.00 32• HOME INSPECTION 325.00 33- ELECTRIC REPAIR 709.00 34• HARRISBURG PHARMACY 27.00 35• LAWN MAINTENANCE AND SNOW REMOVAL 221.00 36• BATHROOM REPAIR 66D•00 37• FILING FEES-INHERITANCE TAX RETURN AND INVENTORY 30.OD 38- ADDITIONAL PROBATE FEE 50.00 39- PA-40 - 20]L], PENNSYLVANIA INCOME TAX 66•DD 40- RESERVE FOf$ CLOSING EXPENSES 500.00 SUBTOTAL SCHEDULE H-67 26,051.94 REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITAN(:E TAX RETURN RESIDENT CIECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: MARGARET E• SAWN 21 11 0854 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ltst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS ' [Include outsght spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1. JENN]:FER R • LOWE Collateral SCHED.G,ITEM 1 AND 9520 BALLAGAN COURT 1/2 OF RESIDUE BRISTOW, VA ~D136 2 • LISA R • HEAD Collateral 1/2 OF RESIDUE 119 REVELATION ROAD NORThI EAST, MD 21901 ENTER DOLLAR AMOUNTS OR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTI NS: A. SPOUSAL DISTRIBUTIONIS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITf16LE AND GOVEf~NMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTERR TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S If more space Is needed, use additional sheets of paper of the same size. STONE, LAFAVER & SIIEHLETSHI _ ATTORNEYS AT LAW 414 BRIDGE STREET NBW CUMHBRLAND, PA 17070 LAST WILL AND TESTAMENT OF MARGARET E. BAWN I, MARGARET E. BAWN, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Co-Executrices hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I devise and bequeath all of my estate, of every nature and wherever situate, in equal shares to my nieces, LISA R. HEAD and JENNIFER R. LOWE. ITEM III: In the event any of the two individuals named in Item II above o:E this will are not living at the time of my decease, I then direct ghat the share of such deceased individual shall lapse and that such deceased individual's share shall be divided equally among the individuals named in Item II above of this will who survive me. ITEM IV: I appoint JENNIFER R. LOWE and LISA R. HEAD, Co-Executrices of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his or her duties in any jurisdiction. Page 1 of 4 IN WITNESS WHEREOF, I, MARGARET E. BAWN, have hereunto set my hand and seal this ~.. `~ day of ~,~, 2008 . ~ ~ ~~ MARGARET E. BAWN SIGNED, SEaALED, PUBLISHED and DECLARED by MARGARET E . BAWN, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence each other, have subscribed our names as witnesses. Witness' Address i t n e s y~ y ~~ S~'f~ i 1J~~, ~ Guy-~~ ~ Address Page 2 of 4 ~_ COMMON6n1EALTH OF PENNSYLVANIA: . SS: COUNTY OF CUMBERLAND , I, MARGARET E. BAWN, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. .. '~i cc~, MARGAR T E. BAWN Sworn to or affirmed to and acknowledged before me by MARGARET E. t~ ~ BAWN, the Testatrix, this ~~ day of °u'~~.---~ ~ .2008 . COMMONWEALTH OF PEN SYLVANIA ~ ~ ' `" Notary Public BROOaxnbe~d Kara. P ~ ~ ~ 6,2012 Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND . We . _~~j~-~i~ _ ~ and ~ r1Y1i ~ ~k. ~~2(l~~ the witnesses whose names are signed to the attached or foregoing instrurent, being duly qualified according to law, depose and say that we were .present and. sari Testatrix sign and execute the instrument as her last will; that, Testatrix signed' willingly and tha1''she executed it~~' as~ her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. Witnes ness Sworn to or affirmed t sand acknowledged before me by !~~~ / ~'~ ~ and ~ ~ ~, G , witnesses, this-~~~ day of e~V }~f~YV~~.{,~/ 2008 . COMMONW lT I OF PE~'NNSYLVANIA gRpp PA-a~P ~o N ConuM ' Icer Junr 2012 Page 4 of 4 Notary Public STONE L.AFAVER & SHEKLETSKI ATTORNEYS AT LAW ti 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E 6ERALDJ. SHEKLETSKI NEW CUMHB$LAND, PA 17070 www.stonelaw net September 23, 2011 Pennsylvania Departrnlent of Revenue Harrisburg District Office Lobby, Strawberry Square Harrisburg, PA 171280101 Re: Estate of Margaret E. Bawn Date of Death: Juty 30, 2011 Social Security No. 188-07-3211 Estate No. 21-11-0854 Greetings: OF COUNSEL CHARLES H. STONE JON F. LAFAVER TELEPHONE (717) 774-7493 FACSIMILE (717) 774-9869 Please find enclosed an original Safe Deposit Box Inventory for Box No. 40114196. Thank you for your attention in this matter. Should you have any questions, please feel free to contact me. Very truly yours, GJS/jam Enclosures cc: Jennifer R. Lowe, Co-Executrix Lisa R. Head, Co-Executrix STONE LaFAVER & Gerald J. ekletski, Esquire REV-465 EX + (J•01) 9- SAFE DEPOSIT BOX COMMONWEALTH OF PENNSYLVANIA I DEPARTMENT OF REVENUE INVENTORY INHERITANCE TAX DIVISION DEPT. 280801 HARR158UR0 PA 17128-0801 Plsase Print or T e MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE ~~ ~ R i i UMBEg ~~ ` SOCIAL SECURITY (Requbed) OR DEATH CERTIFlCATE NUMBER (only if SSN K unknoMm) DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH ADDRESS•OF DE DENT STRE ,- (CITY) (STATE) (ZIP CODE1 -f ~ ! ~ . 1,/~ It a w ~ ~'i~10 ~~,'ll ~~/~- ! 70 lr NAME AND ADDRESS OF PER80N R OUESTINO THE OPENING OF THE SAFE DEPOSIT BOX (NAME) -~ IiV J e ham,'-F~ ~ Lo e (STREET ADDRE'.iS) Z O Qa ~l ~ v ~' (CITY) (STAT) ~ (ZIP CODE) cy t . I S U'~ 1J ZOI NAME ,ADDRESS AND RELATIO HIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING s. (NAME) ..~ ~ LOwG 1,~ unH,-~' ~' R (RELATIONSHIP) ~' - ~ ~ ~ , . xr~ ~~ rr k (STREET NAME, A ~ { , ,r ~ ~ , (CITY) ~ ~ (ST~/ATE) (ZIP CODE) L ~ ~ ` (RELATIONSHIP) ~ , l~,~ •P Gt ~ x ~ l~~r'/X ' - (STREET NAME) ( (CITY) ~„ ' , (TATE) (ZIP CODE. CL !~I :l~ I (~ ZI ~~! a (NAME) .. _ _ _ir _ (RELATIONSHIP) `. ~ '~. • ; I IsrHEET NAME) ~ (CITY) (STATE) i {ZIP CODE) • NAME AND ADDRESS OF FINANCU~L INSTITtfT10N WHERE THE SAFE DEPOSIT BOX IS LOCATED ~ =~• . ~ t (NAMIr) Pic` //-~~i~ i ~/ , ' , I - „'. ~ ~ • t .. ~. (STREET NAME) ~ ~ ~.. r ~`~~' ' l ~ ~ ~ (CITY)• Y (STATE) ~ ~// ~ (ZIP COO ~ 0 " ` '7 ~1 1 NAME OF PERSON MAKING LAST E Y , , DATE AN TIME OF LAST ENTRY ~ ~ ~~ ` ... • Nov. ~ •Zo~~ ~ . . DATE CONT CT TO RENT eOX NUMBER OF BOX 07 ` . YITLE UNDER WIi1CH BO IS REQUESTED ~ , ~ zo ~t f -~f95P.~foi~~r9/o. Ccf a•~~~ ~ ~ wtil. ~ ~ , NAME ANO ADDRESS OF PERSON( (HAVING A CESS TO$OX a. (NAME) , b. (NAME-. (S~TjREEcT ADDRE(SS) - (CITY) (S/T1REET ADDRESS) I _ ~,D (STATE) (ZIP CODE) ~ ~ l ' ('~'~ ~/'F'' ZDl ~!o ICIT17 (STATE) ~ C (ZIP CODE) NAME AND TITLE OF EMPLOYEE TAKRIIO THE INVENTORY a 5 2 90 a.vl~f~ I~Jac~ - I~t~tGt K ~ a ~ ~ ~~ ~ t ~ WAS A WILL IN THE BOXY l /EYES ~ NO 1 as, s. Data of wil: ~ ~ ~ Q ; Z ~ Z QQ R c.`r b. Name and address of personal represMtadve, H named in the w61 (NAME) ,. (STREET ADDRESS) ' LY ! ti Z ~ ~ Q ~ ~ ~ ~ (CIT,) [' ~TE) •' . f 121P CODE) ~ / . I 4 j pw (~f~s V Z0~3~i e. Name and addrsss of attorney, d any (NAME) L~ Is c~ { -I u (STREET ADDRESS) , D 1 ~ ~'i t~j ~o v~ ~a ~~ a k ~ ~C n }CITY) ~ (STATE) IVD(~-~l ,~r 5~- I`~~ (ZIP CODE) 'Z19o~ SAFE DEPOSIT BOX INVENTORY Page of .• The Department is authorized under federal law, 42 U.S.C. $ 40b(c), to use the decedent's Social Security number in ~ administering this state tax law. The department uses Social Security numbers to establish a decedent's identity and ensure proper credit for tax payments. (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of cpmpany, certificate number, date of certificate, name in which stock is registered, and number of shares and clalas of stock. (3) Obggation~s of U.S. GovstnmeM: Number of items, date of issue, face value, names in which registered and type of ownership, i.a., jointly hdid, payable on death, etc. (4) Bonds: Designate by Harris, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Lt~lan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps,',Manuacripts, etc: List and describe as fully as possible. (7) Deeds Martgages, Currsrht Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) Aq other contents. ITEM ITEM DESCRIPTION NO. ' C 3 .~ ,, ,/...,n.•,r. _ i . ,.~ .~ ., ~ /~S'a S'D 6 3X5 9 / ~./~ ~//o /2.00 ~ I d 1 CERTIFY UNDER PENAL OF PffRJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT ANgCOMPLQ CIE RESIT OF 1~11Y K WLED AND 8 EF. SAFE DEPOSIT BOX INVENTORY: ~'~C ~ Cv ` ~~~~r ~ S q ~ I y /~1> ^ Exscutorltrix) Administrator(trix) I ^ Estate Representative ^ Joint owner of safe deposit tax NOTE: Attach additional 8'/:" :c 11 " sheens) if necessary or use duplicates of this page of form. Tp~MiNrG„'y OMB Approval No. 2502-0266 o~ ~ r ~ ~+ =e4~ ~ ~ ~,~= A. Settlement Statement (HUD-1) ~N pQJe~ B. Typs of Loan 1.®FHA 2.0 RHS 3. QConv. Unins. 4. ~ VA 5. ~ Conv. Ins. 6. Fib Number: PHILLIPSHUNT 7. Loan Number: 1540078324 8. Mortgage Insurance Case Number: 446-1129357-703 C. Nate: 7hls loan Is /umished to give you astatement o/actual settlement costs. Amounts paid to and by the settlement agent aro shown. toms marked (p.o.e.)' were paid outside fhs dosing; they aro shown here for inlormatlonal purposes and aro not included in the tote/s. D. Name and Address of Borrower: Brian S. Phillips and Amanda L. Hunt 2150 W. Susquehanna Trail York, PA 17404 E. Name and Address of Seller. Jennifer R. Lowe, Co-Executrtx and Lisa R. Head, Co-Executrix F. Name and Addross of Lender: EVERBANK 8100 NATIONS WAY JACKSONVILLE, FL 32256 G. Prtpperty Location: 1814 UVillow Road Camp Hill, PA 17011 Cumberland County, Pennsylvania H. Settlement Agent: 23-2402318 PURITY ABSTRACT COMPANY 3329 MARKET STREET CAMP HILL PA 17011 Ph. (717)737.8359 I. Settlement Date: March 23, 2012 Place of Settlement: Century 21 Really Services 3315 Market SL Cam HIII, PA J. ummary of Borrower's trsmsactlon K. Summ of Sslbr's transaction 100. roes Amount Due from Bortower: 400. Gross Amount Due to Seller. 101. C ntrad Saba rice 145 000.00 401. Controd sabs rice 145,000.00 102. P roonel ro 402. Personal ro 103. S ttbment Cha es to Borrower Line 1400 8448.16 403. 104. H ME WARRANTY to AHS 460.00 404. 105. 405. Ad oats fa ibms k! Ssibr In advanu ustmaMs for Ibm W SNbr In advance 106. UNTYJTOWNSHIP 03/23/12 to 01/01/13 4 408. COUNTY/TOWN HIP 0383/12 to 01/01/13 498.13 107. ITY TAX to 407. CITY TAX to 108. S HOOL TAX 0383/72 to 07/01!12 339.14 408. SCHOOL TAX 03/23/12 to 07/01/12 339.14 109. 409. 110. 4 0. 111. 411, 112. 412. 120. roes AmourK Dw from Borrower 154,745.43 420. Gross Amount DW to Sstbr 145,837.27 200. ouMs Paid or In BshaH of Borrower 600. Rsduetlons In ourrt Dw SNbr: 201. sit or earnest mon 1 000.00 501. Excess de sit inatrudions 202. rind al amount of new ban a 141,324.00 502. Sel0emsM cha s to Seler Line 1400 10,750.63 203. xistin loan a taken sub ed to 503. Existin bans ken sub'ed to 204. 504. Pa fr First Mort 8 s 205. a econ ort a 206. 506. 207. 507. De sit dbb. as rotxeda 208. 508. 209. 509. Ad w snb for Items un b 8sibr Ad wtmsrrb for un id SNbr 210. OUNTY/1'OWNSHIP to 510. COUNTY/TOWN HIP to 211. ITY TAX to 511. CITY TAX to 212. CHOOL TAX to 512. SCHOOL TAX to 213. slier Assistance 8,346.43 513. Seler Assistance 8,346.43 214. 514. 215. 515. 216. 518. 217. 517. 218. 518. PA INHERITANC TAXES to REGISTER OF WILLS, A 32,142.56 219. 519. 220. otal Pald Mor Borrowwr 150,670.43 620. Total Rsductlon cunt Dw Ssibr 51,239.62 300. ash at Ssttbmsnt tromlto Borrorwr 600. Cash at ssEWm to/Irom Sslbr 301, roes amount due from Borrower Ifne 120 154 745.43 601. Groan amount du to Seibr line 420 145 837.27 302. sa amount aid b Ror Borrower line 220 ( 150,670.43 602. Leas rodudiona due Seller line S20 ( 51,239.6 307. Gash a From ~ To Borrower 4,075.00 607. Cash ~X To ~ From Sslbr 94,597.65 The Undersigned hereby acknowledge receipt of a completed copy of this statement d any attachments refsrrred to he ~ (/~~, Bortowar / ~~~/~,`___ Seller "C/ ~,~~_ l ~ ~~ Brian S. Phillips f/ ~~~ J nn er R. LoweC, C~o(-Executrix r ,~~ L~ Amanda L. Hunt Lisa R. Head, Co-Executrtx the PubNe Repptltq Btednt ter rYe NleCtlnlt of MYnrtitellert b eetlmetad ~ JSIIIMMMe Der feepOtlM (er , nNMwMq• en0 npalMa the dale. TMe eperwy IIMy not ea1sU rds kxonnaeon, ene you an not roquied to pmpeb, flee lolm, unbu K t/tpbys a oulenry veMd OMB cancel umber. No taMMMtleRy b aeeun4 tlee dlacbawe b rteabably. litb b deegnW to pmvge the Dartbe b a RESPA mvmsd traneaceon wNh ~nlonnatton fuhp bMl aettlVnMll txxeee. Page 1 of 3 HUD-1 (P H I L L I PS H U NT. P F D1P H I LL I P S H U NTl4 5) L_ Sattlament Charoes I00. Total Real Eatata Broker Fps $ 8,340.00 Paie From P°IC From ' stun o Comm ssion Gne 700 as lows: 9orm~ara sever. r01. $ 4 365.00 to Jack Gau hen ERA FunCa at FunOa er Note: Line 701 Includes Ad ustment of 195.00 For sememenr sertlertbrN '02. 4 170.00 to CENTURY 21 REALTY SERVICES r03. C mmia ion aid at settlement 535.00 r04. ADD'L Commission to Centu 21 Rea Services 695.00 r05. DEED PREP r06. ADD'L COMMISSION to CENTURY 21 REALTY SERVICES 295.00 r07. r08. 709. 710. 711. 712. 300. ms P abb In Connaetton with Loan 301. O r on inatlon cha e $ 8447.98 302. Y6ur credit or charge (points) for the specific Interest rate chosen $ -5,546.97 303. Your adjusted o mat on charges from GFE #1 (from GFE Oft) from GFE #A ~+ ' 900.98 s ;' -; `-'-=' ,~~"~ 304. A ralsal fee to CORELOGIC from GFE 003 POBC 5425 305. C edfl Re rt to from GFE 003 306. 8x aernce to LERE A from ) L 7 307. F od certi nation to from ) 308. rom #) ~;,;.-;, _~,. ~ , ' ` 309. (rom ) . ,,,. a; ~~ 1r, 310. (rom ) 311. rom 3 •a~ur m~',:,r~ i00. s R uirad Lander to Ba Pald In Advance 301. Dpiy Interest cha ea from 03/23H2 to 04/01/12 9 514.519600/day (from GFE #10) 130.88 4`l ~+'"'~-~~a"~' `'' 302. Mort a e Insurance romium for months to EVERBANK 303. H meowne s naurence ar .0 ors to 304. from GFE #3 rom 1 from GFE #11 1,399.25 " 305. (from GFE #11) 1000. Ibd with Lender 1001, nAlal deposit for your eaaow account (from GFE #9) 966.37 ;; omeowne a nsurenco mon a per mon 100. ort a e nsurance 1.000 moots 132.97 r moot 13.7 -~ > 1004. ropertytaxes $ U months per month -,>,;f; ° ~ r., v=s;+l' I months per month ~ ti~ +~~~~->~:~ " CH months per rnoMh ` ^~ ~,r°. V ` . ~- =,.; ~ 1005. $ .:.w•Y; '.bz.ek~<i~::~k~. Assessments months per month 1006. months ~ S per month S 1007. COUNTYITOWNSHIPTRXES 2.000 months (~ 5 53.50 per month 5 107.00 1008. 'SCHOOL TAXES 10.000 months ~ S 103.44 per monlA S 1,034.40 1009. AGGREGATE ADJUSTMENT 5 -399.00 `'• .«+~.=~ 1100. Cha 110E ftle services and lender's title inauronee rom p,12.04p 1,410.75 1102. (Settlement or Goain fee $ 1103. eat le nsurence to RS R A N from GFE #5 ENH.t3ASl 123.38 1104. ode a lkle nsurance to I A .7 BA I T`'t" 1105. Lender's title oli IimR $ 141 324.00 1106.. ere title II Ilmft $ 145 000.00 1107. cot's ortion of the total title insurance remlum to PURITY ABSTRACT COMPANY S 1,225.81 ' ' 1108. Underwriter's ortlon of the total title insurance romium to FIRST AMERICAN TITLE INS. CO. S 216.32 ' 1109. ota Fee to Note Clerk 10.00 1110. ayo out oin wire 1111. ax ert ca on ee to U B TRA 10.00 1112. 1113. 1200. owmmart Raeordinp and Tranafar Cha-pp 120E ovemment rocordin cha ea to RECORDER OF DEEDS from GFE #7 ESTIMATE!! 162.00 <' ~ ° , :~~ ~ ` 1202. S 82.00 Mort a e S 100.00 Releases S Other E ` 1203. ramfer taxes to RECORDER OF DEEDS (from GFE 008) 1,450.00 " 1204. Ci /COUn tax/stampa $ 1,450.00 S 7,450.00 1205. fate taxlstam s S 1 450.00 S 12os. I zo7. 1300. Additlonal SatWmard Cha p 1301, ufred services that u can oho for from GFE #8 440.50 ~' 1302. LOOD CERTIFICATION to ELITE LENDER SERVICES $ 15.50 1303. 1ST pUARTER SEWER/REFUSE to LOWER ALLEN TOWNSHIP 10.24 103.67 1304. 2012 COUNTYII'OWNSHIPTRXES to BONNIE K. MILLER TAX COLLECTOR 641.98 1305. HOME/PEST INSPECTIONS to THE VIRTUS GROUP $ 425.00 1400. otal Satttemark Cha p snbr on Ilnp 103 Seetlon J and !30 Sactlon 8448.16 10 750.83 ey aiprarq P°0° + a fhb aretvrMrr4 me agnstona arJrnorAsaps receipt a e r;«nWer.a mPy a peps 2 a a a mia wee P.q.. PURITY en Agent Certiried to be a true wpy. Page 2 of 3 HUp-1 (PH I LLI PS HU NT. PF D1PH I LLIPS HUNT/45) Comparbon of Good Faith Eatimab (GFE) and HU0.1 Charge Good Faith EsUmab HUD-1 Cha p That Cannot Ineroap HU0.1 Lins Number Our origination charge # 801 6,447.96 6,447.96 Your credit or cha a (points) for the specKic interest rate chosen # 802 -5,546.97 -5,546.97 Your adjusted origination charges # 803 900.99 900.99 Transfer taxes #1203 1,450.00 1,450.00 Cha p Thst In Tabl Cannot Increase More than 10% Good Fahh Estlmab HUD-1 Government recording charges #1201 175.00 162.00 Appraisal fee # 804 450.00 425.00 Mort age Insurance Premium # 902 1,399.25 1,399.25 FLOOD CERTIFICATION #1302 15.50 15.50 Tobl 2,039.75 2,001.75 Increase between GFE and HUD-1 Charges S -38.00 or -1.86 Charge That Can Change Good Faith Fsdmab HU0.1 Inkial deposit for your escrow aeceunt #1001 1,811.69 988.37 Daly Interest charges # 901 $ 14.519800/day 130.68 130.68 Homeowner's insurance # 903 540.00 444.00 Titles rvicea and lenders title insurance #1101 1,589.12 1,410.75 Owners title insurenee to FIRST AMERICAN TITLE INS. CO. #1103 30.00 123.38 HOMEVPEST INSPECTIONS #1305 475.00 425.00 .Dare Tanns Your initial Ian amount k $ 141,324.00 You- loan bmt le 30 years Your Initial Inbrest reb b 3.7500 °h Your Iltitlal monthly amount owed for principal, Inbrpt and $ 787.48 inGudp arty mortgage insurance b ~ Principal © Interest ® Mortgage Insurance Can your Inbrpt reb rtes? © No ^ Yes, ft wn rise to a maximum of %. The tint change will be on and can change again every _ months after . Every change date, your interosl rate can increase w decrease by ! %. Over the Iffe of the loan, your Interest rate is guaranteed to never be bwer than % or higher than %. Ewn if you males paymsnb on time, can your loan balanu rbs? ^X Na ^ Yea, h can rise to a maximum of $ Ewn M you make paymsnb on tlms, can your mouthy © No ^ Yes, the tint increase can be on and the monthy amount awed for principal, Irrterpt, and mortgage Irrsurencs rip? amount owed can rise to S The maximum it can ever rtae to is S Doss your loan haw a prepayment penally? © No ^ Yee, your maximum prepayment penalty is $ Dop your loan haw a balloon payment? ® No ^ Yea, you haw a balloon payment of $ due in _ yeah on Total monthy amourk owed Including perow account paymsnb ^ You do not haw a monthy escrow payment for items, such as property taxes and homeowner's insurance. You must pay these Items directy yourseK. X^ You have an additional monthy escrow payment of $193.94 that resuNs In a total initial monthy amount owed of $981.40. This inGudes principal, interest, any mortgage Insurance and any items checked below: ^X Properly taxes ^X Homeowners Insurance ^ Flood Insurance ^ ^ ^ vote: a you have any questions about the Seftlement Charge and Loan Terms hated on Shia forth, please contact your tinder. Page 3 of 3 HUD-1 (PH I LLIPS HUNT. PFD/PH I LLI PSHU NT/45) HUD-1 Attachment Borrowor~e): Brian S. Phillips and Amanda L. Hunt Sallel(s): Jennifer R. Lowe, Co-Executrix and Lisa R. Head, Co-Executrix 2150 N. Susquehanna Trail York, PA 17404 Lender. EVERBANK Settlement Agern: PURITY ABSTRACT COMPANY (717)737-8359 Piece of SetdemeM: Century 21 Realty Services 3315 Market St, Camp Hill, PA Settlement Dab: March 23, 2012 Property Location: 1814 Willow Road Camp Hill, PA 17011 Cumberland County, Pennsylvania Borrower Loan Payoff Details HOME WARRANTY to AHS Loan Payoff As of Total Additional Interest days Cd1 Per Diem Total Loan Payoff 460.00 A~ijustsd Origination Charge Details O~iginatlon Charge ORIGINATION CHARGE 795.00 to EVERBANK BROKER COMPENSATION 5,652.96 to EVERBANK Total S 6,447.96 Origination CredWCharge (points) for the specific Interest rats chosen Cnedit/Charge -5,546.97 to EVERBANK Total S -5,546.97 Adjusted Originatbn Charges S 900.99 Rlaserves Deposited with Lender Hbmeownel's Insurance 111.00 3.000 at 37.00 per month Mortgage Insurance 132.97 1.000 at132.97 per month COUNTY/TOWNSHIPTRXES 107.00 2.000 at 53.50 per month SCHOOL TAXES 1,034.40 10.000 at103.44 per month AGGREGATE ADJUSTMENT -399.00 at per month Total S 986.37 Title Services and Lender's Title Insurance Details BORROWER SELLER WARNING: h kt a crime b knowlnyly make false statemsnb b tM Unibd States on this or aryr simllsr form. Penaltles upon conviction un Include a floe and Imprbonmerd. For deblb see: TNIe to U.S. Code 8ectlon 1001 and 8eetlon 1010. (P H I LLI P S H U NT. P F D!P H I LL I P S H U NT/45 ) HUD-1 Attachment - Continued Email Document Retrieval to PURITY ABSTRACT COMPANY Notary Fee to Notary Clerk Overnight Fee/Package to PURITY ABSTRACT COMPANY Lender's title insurance to FIRST AMERICAN TITLE INS. CO. 50.00 30.00 12.00 BASIC 1,318.75 Total S 1,410.75 S 0.00 __ Owner's Title Insurance BORROWER SELLER Owner's Policy Premium 123.38 to FIRST AMERICAN TITLE INS. CO. Total S 123.38 S 0.00 Lenders Title Insurance BORROWER SELLER 'teas abo shown above In TIW Servlcss and Lenders Tltb Irgurang Detaib Lender's Policy Premium 1,068.75 to FIRST AMERICAN TITLE INS. CO. Lender's Endorsement Charges 250.00 Endorsement Endorsement Charge SHORT FORM 100.00 END 1100 100.00 END 900 50.00 Total S 1,318.78 S 0.00 WARNING: his ^ erlme to knowlnpy make false statsmerKs to. the Unlbd State on fhb or soy sknlbr form. Penalties upon eomrlctlon an Include a floe and Imprbonment For detalb see: TIW 1B U.8. Coda Sectlon 1001 and Sectlon 1010. (PHILLIPSHUNT.PFD/PHILLIPSHUNT/45) Z:UtE\DED1Bawn.Margaret - 1814 Willow Road.wpd Tax Parcel 11: 13-23-0547-381. Address:1814 Willow Road Camp HIII, PA 17011 DEED THIS INDI~NTURE made the l9~ day of /n6L/~i.- , in the year 2012, between JENNIFER R. LO WE and LISA R. HEAD, Co-Executrices of the Last Will and Testament of MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN, late of Lower Allen Township, County of Cumberland, and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantors, -AND- BRIAN S. PHILLIPS and AMANDA L. HUNT, joint tenants with rights of survivorship, of the second part, hereinafter called the Grantees; WHEREAS, the said MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN became in her llifetime seised, as of fee, of and in a certain tract of land, together with the improvements thereon erected,, situate in then Lower Allen Township, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on July 30, 2011, having first made her Last Will and Testament in writing dated September 24, 2008, duly probated and registered in the Office of the Register of Wills of Cumberland County on August 5, 2011, wherein and whereby she appointed as Co-Executrices, the said JENNIFER R. LOWE and LISA R. HEAD, to whom Letters Testamentary were duly issued by said Register of Wills on August 5, 2011, wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register of Wills, recourse thereunto beingtthad, appears: ... . NOW THIS' INDENTURE WITNESSETH, that the said Grantors, for and in consideration of the sum of ONE HUNDRED FORTY-FIVE THOUSAND and NO/100 -------------($145,000.00)----------- Dollars, which has been paid to they by the said Grantees at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THAT' CERTAIN tract or parcel of land and premises, situate, lying and being in the Township of Lower Allen, in the County of Cumberland, and Commonwealth of Pennsylvania, more particularly described as follows: BEGINNING at a point on the North side of Willow Road, as shown on the hereinafter mentioned Plan of Lots, at the southwestern corner of Lot No. 7, Block A, which point is five hundred sixty (560) feet West o:f the northwest comer of the intersection of Willow Road with State Highway Route No. 21019; thence along the northern side of Willow Road South seventy eight (78) degrees fifty four (54) minutes West, eighty (80) feet to a point at the southeast corner of Lot No. 9, Block A; thence along the eastern side of Lot No. 9, Bock A, North eleven (11) degrees six (06) minutes West, one hundred twenty (120) feet to a point at lands of Rolling Green Cemetery; thence along said last mentioned lands, North seventy eight (78) degrees fifty four (54) minutes East, eighty (80) feet to a point at the corner of Lot No. 7, Block A; thence along the western side of Lot No. 7, Block A, South eleven (11) degrees six (06) minutes East, one hundred twenty (I20) feet to a point, the PLACE OF BEGINNING. -1- BEING Lot No. 8, Block A, on the Plan of Lots of Cedar Village, as recorded in the Cumberland County Recorder's Office on June 9, 1955 in Plan Book 7, Page 26. BEING the same premises which J. Ross Parson and Evelyn J. Parson, husband and wife, by Deed dated April 11, 1991D, and recorded April 26, 199Q, in the Office of the Recorder of Deeds of Cumberland Counter in Deed Book "N", Volume 34, Page 412, granted and conveyed unto Margaret E. Bawn. TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters„ water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in anywise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, the said MARGARET E. BA`JVN, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. AND the said Grantors, for themselves and their respective heirs, executors and administrators, does covenant, promise grid agree to and with the said Grantees, their heirs and assigns, that they, the said Grantors, have not 1leretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge., estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals the day and year first above written. Witness Witn ss --~~ (SEAL) JENNIFER R. LOWE, Executrix of the Last Will and Testament of MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN Q~~ LISA R. HEAD, Executrix of the Last Will and Testament of MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN -2- STATE/COMMONWEALTH OF COUI`1TY OF . SS: On this, the day of , 2012, before me a Notary Public, the undersigned officer, personally appeared JENNIFER R. LOWE, Executrix of the. Last Will and Testament of MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. COUNTY OF ~ ~~ . On this, the /~ ~~ day of ~C,rY~1 , 2012, before me a Notary Public, the undersigned officer, personally appeared LISA R. HEAD, Executrix of the Last Will and Testament of MARGARET E. BAWN a/k/a MARGARET ELIZABETH BAWN, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. Notary Public STATE/COMMON'WEALTH OF ~~ ~ / ~ • SS' IN WITNESS WHEREOF, I have hereto set my hand and ota 'al se ; /' , //~ - ~- t/ ~; ~~ ~ Notary Public State at Fb~ida Notary Public Robett J Roan y My Commlasion EEaf 1399 '>o.,~~ Expiresornsrsof• I hereby certify that the precise address of the Grantees is f ~ _ - DATE: Attorney for -3- THE CREDIT ADVICE BELOW REPRESENTS A DIVIDEND PAYMENT ~ Chevron To Inquire about your account, contact BNY Mellon Shareowner Services Toll Free Number 800-368-8357 Outside the U. S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 RETAIN FOR YOUR RECORDS i _~ c': SHAREHOLDER OF TRANSACTION DESCRIPTION DIVIDEN D CHEVRON CORPORATION _ __ - _ ____ _ _ _ _ INVESTOR ID CUSIP __ _ ACCOUNT KEY ISSUElCLASS OF STOCK RECORD DATE ~ PAYABLE DATE ~ t252606.?8691 ~ 001 76016876410 - - _- - BAWN--MARGE0000 COMMON x.75 P V --_ - -_ --- --~-- - - - -- ----- ~ 08/1912011 --- -- - -- - 09!12/2011 - --- -- --- - - -- RATE PER SHARE __ _ _ - CERTIFICATED SHARES BOOK•ENTRY SHARES GROSS AMOUNT 68 TAX WR}IHELD $0 00 CURRENT DIVIDEND 68 $511 $0.7800000 ~ 0 656.0000 _ 5511. . . DIVIDEND PAID YEAR TO DATE -j TAX WITHHELD YEAR TO DATE TAX IDENTIFICATION NUMBER Please detach and retain this form for your records. e~ wec ea SO 0(1 I ON FILE ___ 001 750 16576410' ' $AVVN-MARGEOt)OQ 0004Btt39:Ot A4 Q.388 0t TFC OtYs11 5000f3A02000000. RI N GTIONS R ' PAY TO 7'F~ ST , I J ~OU iN AGCO#tCi~IVC£ WlTh4 ORDER OF; '` ~ - THIS ['11Vit~~Nt) HAS BEEN CftE1JiTED TO THE .,, ,, ,. ACCOU1xtTDESCRIBEQ:BEi.OW: ~~,: • ~ MARl3ARE'F E BAWN 1814 WILLOW RD CHECKINQ~ ACCT. NO.""""'2143: t~ CAMP HILL PA 17011-7451 CREDIT AMOUNT li~~~l~~~l~illll~~illill"ilili~11~t11~~1~111~iliiJ.'i!'lil~'lli 5511.68 ~ PLEASE REFER ABOVE FOR ADDITIONAL INFORMATION CONCERNING THIS DIVIDEND. __BNY Mell n Shareowner Services is dedicated to providing you with the besl~ shareowner experience) id you know that you could manage your portfolio online 24 hours a day, seven days a week? Simply log lIt to Investor ServiceDirect® (ISD) at www.bnymellon.com/shareowner/isd iii, jorry Sign 1:1u( Heip Preview Maii w! YI Toolbar Mail t My Y' Yahoo! .............. -.... _- ..... ~_. _...._ I .._. ...... ... . ... ........... Search Web 1 Search _ .. i...__ ,.~_~..~ DOW t' 0.40°/a Nasdaq O.OOYo NEWT HOME INVESTIIVG NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES ~- ] GET QUOTES Finance Search Chevron Corp. (CVX) CVX Wed, Sep 14, 2011, 9:17AM F_DT - US Markets open in 12 mins On Sep t3: 95.93 0.00 (0.00%) Historical Prices Get Mlstorlcal Prices tor. GO Set Date Range ~:i Daily Start Date: Jul '` 29 2011 Eg. Jan t, 2010 r_}Weekly End Dats: Aug - 1 2011 ;,i Monthly .i Dividends ONy Get Prices First ~ Previous ~ Next ~ Last __..._ __ Prices ' Date Open High Low Close Volume Close Aug 1, 2011 106.08 106.13 103.92 105.38 9,309,400 104.54 Jul 29, 2011 103.72 105.23 103.p7 104.02 9,697,600 103.19 .~-~ C'.lose price adjusted far dividends and splits. Z U~+~~ (first i Previous ~ Next (Last ~~ Download to Spreadsheet .~ ~~,/ Currency in USD. ~ U~Y~ ~ ~ 65~ v ~ ~ ~c~ ~~ ~~~ Copyngnl 1 2011 Yahoo! Inc. All rights reserved. Privacy Policy -About Our Ada -Terms of Service - CopyrighUlP Poliq -Send Feedbade - Yah001 NeWS Network Quotes are real-lima for NASDAQ, NYSE, and Amox.See also dolay times for other exchanges. All information provided "as is"for informational purposes only, not intantled for trading purposes or advice. Neither Yahoo! nor any of mtlependertt providers is liable for any informational errors, incompleteness. or delays, or for any actions taken in reliance on information contained herein By accessing the Yetrool sde, you agree not to redistribute the information found therein. Real-Time continuous s6saming quotes are available Through our premium service. You may tum streaming quotes on or oH. f undamental company tlata provided by Capital IQ, Historical chart data and daily updates provEdetl by Commodity Systems, Inr.. (CSI). Intamatronal historical chart data. dairy updates, fund summary, fund performance, dividend data end Morningstar Indox data provided by Morningstar, Inc. New CumberlandAuto Sales Sept. 13, 2011 To whom it may concern: Auto appraisal 1992 Dodge Spirit 4 door sedan VIN # 1B3XA563XNF223615 Owner: Mazgazet E. Bawn 1814 Willow Road Camp Hill, PA 17011 In my opinion, the above mentioned vehicle in it's current condition, has an appraised value of Eight hundred dollars ($800.00) KDY Enterprises INC T/A New Cumberland Auto Sales 173 Old York Road New Cumberland, PA 17070 er) Dealer # 08617801 KD License # MV032792L Aug. 18. 2011 1:32PM PNC BANK ~. ~~ ~urs~m~w~Y August 18, 2011 Gerald J Shelcletski Encl. Stone Lafaver 8c Shekletski 414 Bridge St POBoxE Near Cumberland, PA 17070 RE: Margaret E Bawn SSN: 188-07-3211 DOD: 07-30-201 l No. 1930 P. 1 Dear Mr. Shekletsld: In response to your request for Date of Death {DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31800'148478 MARGARET E BAWN DOD balance: $ 6,000.00 + 1.20 accrued interest Interest paid 01-01-2011 thru 07-30-2011$ 36.42 Y1'D Account # 31000271889 MARGARET E BAWN DOD balance: $ 1,000.00 + 0.34 accrued interest Interest paid 01-01-2011 thru 07-30-2011$ 7.23 YTD Account # 31200355992 MARGARET E BAWN DOD balance: $ 2,009.46 + 0.15 accrued interest Interest paid O1-O1-2011 thru 07-30-2011$ 9.46 Y1'D Account # 3150023b295 MARGARET E BAWN BURIAiL RESERVE ACCT DOD balance: $10,340.93 + 6.22 accxued interest Interest paid O 1-01-2011 thru 07-30-2011 $ 62.54 YTD Established: 02-24-1999 Established: 09-21-2005 Established: 0l -28-2011 Established: 09-10-2003 . Page 1 of 2 r AuS.18. 2411 1:32PM PNC BANK Checking Account Account # 5005032143 MARGARET E BAWN DOD balance: $ 2,217.44 non interest bearing Savings Account Account # S 130190191 MARGARET E BAWN DOD balance: $ 4,009.75 + 0.07 accrued interest Interest paid 01-01-2011 thru 07-3 0-2011 $1.15 YTD Safe Deposit Baz Thr, decedent maintained safe deposit box # 196 MARGARET E BAUN JENNIFER R LOWS Located at: Cedar Cliff Mall Branch 1104 Carlisle Camp Grill, P.A 17011 {71'7) 761-3180 No. 1930 P. 2 Established: 0l -29-2007 Established: 11-09-1988 Please note that this office provides date of death balances for deposit accounts (IltAs, CDs, Checking and Savings). We do aot process any Sastncial transactions or provide statements. if you need assistance with any ofthese items, ploase call 1-888-PNC-BANK {1-88&762-2265) or stop by Your local PNC Bank branch office. Sxncezely, National Financial Services Cenier PNC Bank, N.A. M~mbcr FDIC This message is intended for the use of the individual or entity to which ft is addressed and may contain information that is privileged, cor~dential and exemptfront disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent resporuible for delivering this message to the intended recipient, you are hereby notified that arty dissemination, distribution ar copying of this communications is strictly prohibited If you have received this communication in error, please notify me immediately by reply or by telephone at 800-761-1775 and immediately destroy this faxed document. Page 2 of 2 Sev. 19. 2011 11:47AM .r.cm..•+wr~~•. Septeac~bex 16, zaii Ma~~. sly prrc Bank 2 last qua St Mechanitcebat~, PrA. 17055 Rc; Pokey 75iG17723 Dcceden~ Margaret ~~. Bain Dear Mr. Shama: ~~ arr>,~ Aslbse't~nriea ArraiM hoar ~000,~@l8 r We htuQe rcc~roed your toquest for iAfomoati~oa. Please fmd the iaformativn tequ.sted beloar. late of Death vas (7130/10 ~ 2o,s24:12 ~~ ~~~ abao~ rn~ ~ a~~atx~ ~~ ~ of thr dart of dcatb. 'Thu~c ~,., au adckitioaal ptiyxm~at pmcoseed after the c11e10~t'e death ox< 8/23 /11 ~ 245.64. The cult val~u is thereEoxe $210,578.48. Tha policy is a Single Life Az<nuitp with cash refund. If you bavm tup qucetioma ox aonrexas, our Giiaxt Se:tvieea l~icp~entativess are apai)nble Monday thzough ~~adap from 8:30 a.zla. to 5:30 p.m. Eas~ta'Y"tme at 1-800-762~S,2f.Z. ~Y~ Michele C. G~sat Anauity Sexvice Aasaciatc Frew Yolk ufi Mnuigl BerVioe Center • F+,O. t30it 88~ • ProviQenoe, {il 0941? • 7«800-'f6?r8212 Annuitioe fir. iaued by New York t~ls Msur'nos and Neatly Corporation (NYL]AC~ (A D~wae Corporatlon) VeAAbk annuiNea ere dietrbuttd by: NYLI~'1: DleMbutors tJ.C, tiAamber iFINI~+eId~C NYLIAC and NYt.iFE Distributors LI.C em wholy owned tWbefeAOMN of New YOr1t t.He Inovrsnes Cernpeey F.~ RMAI•M A.M IJ~w.e YA~Ir Nr ~M~r1 No. 3460 P. 2 Aug. 18. 2011 1:32PM PNC BANK r Checking Account Account # 5005032143 MARGARET E BAWN DOD balance: $ 2,217.44 non interest bearing Savings Account Account # 5130190191 MARGARET E BAWN DOD balance: $ 4,009.75 + 0.07 accnud interest Interest paid O 1-01-2011 thru 07-30-2011$1.1 S YTD Safe Deposit Boz The decedent maintained safe deposit box # 196 MARGARET E BAUN JENNIFER R LOVVE Located at: Cedar Cliff Mall Branch 1104 Carlisle Camp mill, PA- 17011 {717)761-3180 No. 1930 P. 2 Established: Ol -29-2007 Established: 1 i-09-1988 Please note that this office provides date of death balances for deposit accounts (IitAs, CDs, Checking and Savi~ags). We do not process any linancistl transaetio~ or provide statements. if you need assistance with anY of these items, please cai11-888-PNC-BANK {1-888-762-2265) or stop by Your local PNC Bank branch office. Sincerely, National Financial Services Gcnter PNC Bank, N.A. Member FDIC Thr's message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt fro~-s disclosure under applicable law_ I,f'the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 sip. ~9. 2a>> >>.4~AM memwe+~a~~rw" Septen~bex 16,2011 M~uk j. sly Pivc sank 2F~M~sL Mechaaitcebutg, P.A 17055 R.e: Policy 75617723 D Marga><et Fem. Bawa Des Mr. Sbasrax: wiener oe rbe ~~ tYow x004,~Qi8 W e b~t+Qe xtcciQed yaut toquest for iufot~os-ti~oa. Please fend the iafomaation toqussted balaar. date of Deatb Value ~1/30/11) ~ 20,824:12 The amount above its ~e etcumuhtion valnc as of tile' date of deeds. 1"hc~ce ~ an additios>Al psp~eiat processed after the cdiemt'o death ova 8/23/11 £ox 245.64 ~'ba euax~nt value is therefo>~e ~20,5y&48. The policy is a Sink Y.ilie Aunuitp with cash tefimd. If p~ou rzva in]r qucsurnas ax concexas. oux C,lierit Se:tvice~a ~tcpx:es~ddtativ~ axc aou]able Monday through Ftadsy from 8:30 a.zi~a. to 5:30 p.m. Eastern Time at 1,800-762~S,2f.2. Si~scenl'y,~- I~ ,p ~L~ l' , i~ 1Vli~chele C. Gent Anauity Sexvice Assdciatc ~ York LNe grrnuily tsMoe Center ~ p,0. Box 9859 • ProYidMOe~ W Oi940 • Delowore 1Corpora8on) AnnniS~ ans iaued ~ Now York 1Jh Insursnea snd Annuity Corporation (NYW1G`~ (A VortAble ennuEties ere dleoibuted ity: NYLIt~ D1eMbutors ~C, FAember FII~RMSIPC NYLW~ and NYLIFE D~tribulars t,1.C ere wholly owMtl subaldMriM o(New York t3ht Irwwena ~++Pm+Y ~.~ AMrIbM AIM Aliw.r Vnr4 MrI ~M~n No, 34b0 P. 2