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J 1505610101 IX (oa-ao) REV-1500 PA Department of Revenue Pen^rnvania "~ GFFlDIAL USE ONLY County Code Year File Number Bureau of Individual Taxes PO eoX zso6ot INHERITANCE TAX RETURN r-) ~ °~ Hardsburg, PA 171z8-06ot RESIDENT DECEDENT O( ~ ( t7~ ENTER DECEDENT INFORMATION BELOW Social Secudly Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06/23/2010 05/31/1934 Decedent's Last Name Suffix Decedent's First Name MI Miller John ,~ (H Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Narne MI Miller Esther K Spouse's Social SecudTy Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE z3z-6o-151s REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW t7~ t. Odginal Retum O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federel Estate Tax Return Required death after 12-12-32) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wili) (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 12-37-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD 8E DIRECTED TO: Name Daytime Telephone Number r.._, Louis Fazekas (717) 645-1 O~Cj First line of address 6043Edward Drive Second line of address REGISTER r~ Z' `~ IV ~~ ,-„ , ;, - . G` ~ n,i ~ ~ C ., City or Post Office State ZIP Code ~ DATE FILED Mechanicsburg PA 17050 Correspondent's a-mall address: IOUIS.taZBkaB(f~US.anny.Inll x+ ~' '-i <` > ,~ `i ~__~.~ i -`~ ;,: iTi ~~~ T7 Under penames or perjury, I declare that I have examined this return, including accompanying schedules end sretemeMS, and to the best of my knowledge and belief, it is true, cared and complete. Dedaretion of preparer other than the personal representable is based on all information of whidi preparer has any knowledge. SIGNATURE OF PERSON SPONSIBLE F ~ FlLlhl a RETURN // DAT ~~ ~ ~x.c~i7ar S~fT ADDRESS 6043 Edward Drive, Mechanicsburg, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056101D1 1505610101 _...j Lsoselolos REV-1500 EX Decedent's Social Secudty Number _ Decedents Nama: John R. Miller RECAPITULATION 5. Real Estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Heid 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. Jointty Owned Roperty (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 0.00 0.00 0.00 0.00 50, 508.00 69,500.00 0.00 120,008.00 9. Funeral ExpensBS and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabifitfes, and Liens (Schedule 1) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Yalue of Estate (Line 8 minus Line 11) .............................. 12. 13. Chadtable and Qovemmental Bequests/Sec 9113 Trusts for which an election to lax has not been made (Schedule J) ........................ 13. 14. Nat Value SubJeet to Tax (Line 12 minus Line 13) .............. ........ .. 14. 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_ 0.00 15. 16. Amount of Line 14 taxable 0 00 at lineal rate X .0 _ . 16. 17. Amount of Line 14 taxable 0 00 at sibling rate X .12 . 17. 1 B. Amount of Line 14 taxable 00 0 at collateral rate X .15 . 1 B. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 150561x105 1505610105 4,300.00 0.00 4,300.00 115,708.00 0.00 115,708.00 0.00 O J REV-1500 EX Pane 3 Decedent's Complete Address: Flle Numbar DECEDENTS NAIME John R. Miller STREET ADDRESS 10 Kevin Road cITY Mechanicsburg srATE PA zIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. CrediWPayments A. Pdor Payments 0.00 B. Discount Total Credits (P,+B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Rage 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line Z, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, ,AGENT. a.~,, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 'I. Did decedent make a transfer and: Yes No a. retain the use or income of the property transfemed :...................................................................................... .... ^ x^ b. retain fhe right to designate who shall use the property transferred or its income :........................................ .... ^ Q c. retain a reversionary interest; or ..................................................................................................................... .... ^ ><^ d. receive the promise for life of either payments, benefits or care? .................................................................. .... ^ Q :!. If death occuned after Dec. 12, 1982, did decedent transfer property within one year of death wiMout receiving adequate considera0on? .......................................................................................................... .... ^ FI. Did decedent own an "intrust fact' or payable-upon-death bank account or security at his or her death? .......... .... ^ ><^ al. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefGary designation? .................................................................................................................... .... ^ 0 IF THE ANSWER TO ANY OF 1~HE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .`I: ;~ .+~4 ~,.. '!" a'~i'?R~,~k„".~":':s`,'":n"".,.r: fit.<;.rg":c °~s~'°.,,r:: w.~'vTe. a. ,.„ .r, ~`'-r*.,,',t~"u~c`5~~:~, ^a;,•CC4?'r~-.,.. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the faz 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;l (1.1) (ii)]. The stNlute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even'rf the surviving spouse is the only beneficiary. For dates of death on w 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 oT 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 t~enefidaries 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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (11.-08) "' ~~ ° ' pennsytvania DEPARTMENT OF flEVENUE INHERITANCE TAX RETURN RESIDEM DECEDENT ESTATE Of John R. Miller SCHEDULE A REAL ESTATE 'ILE NUMBER 2011-00229 All ral property owned solety or as a tenant in common moat be reported at fair market wlue. Fair market value is defined as the puce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of Me relevant fags. Real propert/ that is Jointly-owned with M9~ oT survivorship moat be diKlosed on Schedule F, Attach a copy of the settlement sheet if the property has been sold. ITf:M I{ Include a copy of the deed showing decedent's interest if owned as tenant in cnmmon. VALUE AT DATE NUMBER OF DEATH OESCR[PT10N 1 I None TOTAL (Also enter on Line 1, Recapitulation.) ~ # If more spare is needed, insert additional sheets of the same size. o.oo o.oo REV-1509 E%~ (6-98) scNEOU~E s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John R. Miller 2011-00229 REV-7504 EX+ (g-9e) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpNLE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER John R. Miller 2011-00229 (If more space is needed, insert additional sheets of the same size) REV-759! EXt (e-9e) SCHEDULE D GOMMON~NEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER John Ft. Miller 2011-00229 All pmparly Jolnttyawned rdth right of survivorship must M dieclosad on gehMula F. (If rtare space is needed, insed eddAional sheets of the same size) REV-1508 E%+ (31-10) Pennsylvania SCNEpYLE E DECaarm[rvT DE aEVeN~E CASHr BANK DEPOSITS & MISC. RIHEHITANCE TqX RETUNN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: John R. luliller 2011-00229 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorohip must be disclosed on Schedule F. 1. M&T Checking & Savings Account 2. 2003 Toyota Camry 3. MET Live Savings 4, New Cumberland Federal Credit Union (NCFCU), 345 Lewistown Rd, New Cumberland, PA, Acct. 040681 5. New Cumberland Federal Credit Union (NCFCU), 345 Lewistown Rd, New Cumberland, PA 17070, Life (NCFCU) Insurance based on balance in account. 8,818.00 7,000.00 14,332.00 17,562.00 2,796.00 TOTAL (Also enter on Line 5, Reopitulation) S ` 50,508.00 If more space is needed, use additional sheets of paper of the same size. REVa5o9 EX+ (oi-io) ~ ' pennsylvania SC11EpULE F DEPARTMENT OF REVENUE INMERRANCE TAX RETURN 70INTLY-OWNED PROPERTY 0.f5[DEM DKEDENT ELATE OF: FILE NUMBER: John R. Miller 2011-00229 if an assts became ~olMly owned within one year of the decedent's date of death, R must be reported on Schedule G. SURWNING JOINT TENANT(S) NAME(S) ADDRESS RElATIONSNIP TO DECEDENT A• Esther N;. Miller 110 Kevin Road, Mechanicsburg, PA, 17050 I Spouse e. C. IOINTLY OWNED PROPENTY: I1EM NUMBER IFTiER FOR:N)IM TENAM DATE MADE ]0[NT DESCRIPTION OF PROPERTY INCWDE NAME OF FINANCUL WBRRIfION AND BANK ACCOUM NUMBER 00. SIMILAR IDENRFI7NG NUMBER. ATTAOI DEED FOR ]DINKY NEUJ RFAL EBTATE. DATE dF DFATH VALUE OF ASSET %oF DEDEDENTS INiERESr DATE DF OEniM VAWE OF DECEDENTS INn:RESr 1' p` 01/07/69 Single Family Residence 139,000.00 50°k 69,500.00 TOTAL (Also enter on Line 6, Recapitulation) I; 69,500.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (OB-09) ,1 ~~ pennsytvania SCHEDULE G ` pEPARTMENT OF REVENDE INTER-VIVOS TRANSFERS AND INHERITANCE TA%RENRN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBE0. John R'.. Miller 2011-00229 This schedule must be completed and Nled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPITON OF PROPERTY iNQIDE THE xaxE OF TNe TacxsFeu£, 1NEat aEUTmxsxm TO pEC~a+r ANp rHE wTEOr Tanxsrs. aTlaaacpPr of TREO®Fac ar:,u aTaTE DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION nF ~PUC~aie TAXABLE VALUE 1. None 0.0( TOTAL (Also enter on Line 7, Recapitulation) ; f 0.00 If more space is needed, use additional sheets of paper of the same siie. REV-157.11 EX+ (SO-09) °~ pennsylvania DEPARTMENT OF REVENllE INHERRANQ: TA% RETURN RESmENr oECfoEwr SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John Ft. Miller 2011-00229 Decedent'c debts mutt be reported an Schedule I. A. FUNERAL EXPENSES: t' Myers Funeral Home 0. ADMINISTRATIVE COSTS: 1. Personal RpDresentative Commissions: Name(s) of Personal Representative(s) Street Address City Yearts) Commission Paid: State __ ZIP 2. Attorney Fees: 3. family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Ci[y State _ ZIP Relationship of Claimant to Decedent _ 4. ~ Probate Fees: 5. I Accountant Fees: 6. ~ Tax Return Preparer Fees: 7, 4,300.00 TOTAL (Also enter on Line 9, Recapitulation) I ¢ 4,300.00 If more space is needed, use additional sheets of paper of the same size. aev-islz Ex+ iIZ-Dai ~ ~ pennsylvania SCHEDULE I DEPARTMENT OF 0.EVENUE DEBTS OF DECEDENT, INHERRANCE TA%RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER John R.. Miller 2011-00229 Rleport debts incurred 6y the decedent prior to death that remained unpaid at the date of death, indudinp unreimbaned medical expenaea. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (O1-10) `~` pennsylvania SCHEDULE J DERARTMENT OF REVENUE BENEFICIARIES INHERITANCE Tql( RETURN QES1-ENT DECEDENT ESTATE OF: FILE NUMBER: John Ft. Miller 2011-00229 RELATIONSNiP TD DECEDENT AMOUNT OR SHARE NUMBEFI NAME AND ADDRESS Of PERSON(S) RECEMNG PROPERTY Do Nat LIK TruKee(c) OF ESTATE I TAXABLE DISTRIBUTIONS pncfude outngfit spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Esther K. Miller Spouse 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES IS THROUGH 16 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DI$TRIBUT10N5 UNDER SECRON 9113 FOR WHILH AN ELECRON TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTR18UfI0NS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 0 If more space is needed, use additional sheets of paper of the same size. REV-1514 EXt (4.09) ~~ Pennsylvania SCMEp11LE K °ennnmerv* or nevexue LIFE ESTATE, ANNUITY Bureau aflydiMdual TazeS & TERM CERTAIN ~~~r Hertisbury PA 17>za-o6o1 (CHECK BOX 40N REV-1500 COYER SifEEn ESTATE OF FILE NUMBER John R. Miller 2011-00229 This schedule ~wuld be used for all single-Rfe, joint or suaessive life estate and tens-certain calculatbns. fvr dates of death pdor to 5-1-89, actuarial factors for single-life calculations can be obta(ned from the ()epartrnent of Revenue. Actuarial factors can be found in IRS Publiption 1457, Actuarlal Values, Alpha Volume for dates of death from 5-1-89 [0 4-3D-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of insWmeM that cmated the future interest and attach a wpy of R to the tax return. ^ Will ^ Irltervitros Deed Df Trust ~ Other NA '~'OYiFE'tl:NYtliT" 6Ag1t,QF,Oj~+ , .• ,~ None ^ Life or ^ Term of years ^ Life or ^ Tenn of Years ^ Life or ^ Tenn of Years ^ Life or ^ Tenn of Years ^ Life or ^ Term of Years 1. Value of fund from which iffe estate is payable .........................................$ 2. Actuarial factor per appropriate table ............................................... . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate % 3. Value of Iffe estate (Line 1 muRlplied by Line 2) ....................................$ NAME OF LIFE ANNUITANT DATE OF BIRTH DATE bF ii'¢AYN ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Tenn of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekty (52) ^ 13i-weeky (26} ^ Nbnihly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Olher ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment Line 2 multiplied by Line 3 .................................. . 5. Annui~ry Factor (see instructions) Interest table rate - ^ 3.5°k ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (See instructions.) ................................................ . 7. Value of annuity - If using 3.5, 6, or 10°h, or if variable rate and period payout is at end of period, wlalation is Line 4 x Line 5 x Une 6 ...........................$ if using variable rate and period payout is at beginning of period, calculatlon is (Line 4 x Line 5 z Line 6) + Line 3 ...............................................$ 0.00 NOTE: fie values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and IS through 18 of the return. If more space is needed, use additional sheets of the same size REV-1645 EX+ (11-09) `~ ~izllnsylvania INHERITANCE TAX SCHEDULE L-1 bEPARTMENT OF gEVENIIE >HREaRnnceraxREruRN REMAINDER PREPAYMENT ELECTION FIE6IDEM DECEDENT -ASSETS- I. ESTATE OF FILE NUMBER Jro h In ~• E M ~ 1 l ~.r a,o 11 - o o ~,a~1 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) Total Value of Real Estate $ (Include on Section II, Line C-1 on Schedule L.) B. Stocks and Bonds (Please )ist.) Total Value of Stocks and Bonds $ (Include on Section Il, Line C-2 on Schedule L.) C. Closely Held Stock/Partnership -Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please fist.) Total Value of Cash/Miscellaneous Personal Property $ (Include on Section II, Line C-5 on Schedule L.) [II. TOTAI. (Also enter on Section II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. REV-1646 Ex+ (11-09j k~' Pennsylvania INHERITANCE TAX SCHEDULE L-Z DEGpgTMENT [IF gEVENOE livHEUranceraxaEruaw REMAINDER PREPAYMENT ELECTION AE9DEM ~ECEDEM -CREDITS I. ESTATE OF FILE NUMBER Tohn R~ ~~ll~-r aotl-oozz~ II. ITEM N0. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Liabilities $ (include on Section II, Line D-1 on Schedule L) 8. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are Not Included for Tax Purposes or that Do Not form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include an Section It, Line D-3 on Schedule L) [II. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ Cf more space is needed, attach additional sheets of paper of the same size. REV-1647 EX+ (02-30) pennsylvania SCHEDULE M oEPAaTME»r ar pE~E,,,,E FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN (Check Box qa on REV-x500) RESIDENT DECEDENT ESTATEI OF FILE NUMBER John R. Miller 2011-00229 This schedule is appropriate only for estates of decedents who died after Dec. 12, 1962. This schedule is to be used for all future interests where the rate of tax that will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. None 2. 3. a. s. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document In which the surviving spouse exercises such withdrawal right. [] Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer; IV. Summary of Compromise Offer: 1. Amount of future interest $ 0'~ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as past of total shown on line 13 of REV-1500.) ........ $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ^ 6%, ^ 3%, ^ 0% ....................$ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ^ 6°fo, ^ 4.5°h .......................... $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (32ND) (Also include as part of total shown on Line 17 of REV-1500.) ........ $ 6. Value of Line 1 taxable at collateral rate (15°k) (Also include as part of total shown on Line 18 of REV-1500.) ........ $ 7. Total value of future interest (sum of Lines 2 [hru 6 must equal Line 1) $ 0.00 If more space is needed, use additional sheets of paper of the same size. .,~,,,~ t X GFZANTEO TEMPLATE SubJec:t Extension letter for John R Miller From "Heimbach,Amber"<aheimbach@pa.gov> Date Monday, October 24, 2011 11:03 am To "'louis.faaekas@us.armymil"'<louis.fazekas@us.army.mil> pen~sylva~nia DEPARTMENT 4F REVENUE ,,,,,,,,,,,,,,,,,y ,.,.,.,..may,. ,.,..aing sent from an unmonitored account. Please do not reply. Re: fatale of John R Miller file Number2111-0229 Dear Sir or Madam: This is in response to your letter of Esther K Miller concerning the inheritance tax return due in the above referenced estate. Since it qs apparent that you will be unable to file a tax return in the near future, the estate record will be placed in an infom~al hold status for an additional period of six (6) months so that the department will initiate no enforcement activity until April 24, 2012. At the end of that period we would ask that you contact us to provide an updated status for our file. The return may be filed at any time during the informal hold period. IGndly Hoke that this action will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date, Thank you for your cooperation and if I may be of any further assistance please feel free to contact my office. Sincerely, Laurel Fulmer Supervisor Inheritance Tax Division IfulmerCa state. oa. us Aease do not reply to this erred. This mailbox is not rrbnitored and you will not receive a response. For assistance, visft us on the web at www.revenuestate.pa.us or call us at 717-787-8327 The infometlon transmitted is intended only for the person or entity to whom ft is addressed and may contain confidential and/or privileged material. Any use of this inforrrletion other than by the intended recipient is prohibfted. y you receive this message in error, please send a repty e-rreY to the sender and delete the rreterial f rom any and all conputers. Ble:///J:/Esther Miller -Completed Fonns/PA State Tax Extension - Esther Miller.htm 111 riunz The following message is being sent from an unmonitored account F}~ "Blattenberger, Linda" <Iblattenbe@pa.gov> Date Friday, October 2l, 2011 2:30 pm To "'LOUIS.FAZEKAS@US.ARMY.MIL" <louis.fazekas@us.army.mil> en+ c~ rc~n+e+n~+ tn+nc n+ cn r_o nn+TCn rn THE ESTHER MILLER ESTATE TILL Od/24/12 t~. pennsylvania~ DEPARTMENT OF REVEriIUE The following message is being sent from an unmonitored account. Please do not reply. Re: Estate of JOHN MILLER Social Security No.: WA Date of Death: 06/215/11 Dear Siir or Madam: This e-mail is to verify that you have been granted an extension of 6 months which will terminate on 09/25/12. This is an extension of time to file, not an extension of time to pay. Interest will begin to accrue on any unpaid Pennsylvania inheritance tax as of 03125112. As no county file number has been issued, this extension cannot be entered into the Department's computer. A copy of this e-mail should be attached to both copies of the Pennsylvania inheritance tax return when it is filed with the Register of Wills in CUMBERLAND County. ff you have any questions concerning this a-mail, please contact me at 717-787-8327. Sincerely, Laurel Fulmer, Supervisor Inheritance Tax Division Please do not reply to this email. This mailbox is not monitored and you will not receive a response. For assistance, visit us on the web at www.revenue.state.pa.us or call us at 717-787-8327 The hrforrration transmitted is intended only for the person or entity to whom it is addressed and may contain confidential and/orpriv+7eged material. Any use ofthis infom~ation other than by the intended recipient is prohibited. Ifyou receive this message in error, please send a reply a-mad to the sender and delete the material from any and all computers. file:///J:IEsther Miller- Completed FonnslPA State Tax Extension.htm N aD /s n ~u o c g ~ ~ E ~ 0 J i O ~ T m Z C p~ __ ~_ u Q A~ W 0 L r d 0 r ~ N ~ ~ O ~ N r' Z Q C1 C 6 O, LL H Z O ~ m r, O c p Z07~O ~~ °rx~ ammo ~'Op~ ~Uo:~i 0 M N Q J d J_ ~ ~~ xr w~ xV ~w wWxO ° LL~p7 a OYpm Q W W ~ N QQau r~oa ~ wmwx W~vw r OJ Po ~ ®~ ~- ~~~~ Hampden Office If you have any questions, please i call our Telephone Banking Center at 1-800-724-2440 Today's Date: Business Date: 04/02)2011 04/04/2011 Tiine: 10:39 AB Checking Deposit $14,332.21 ****7239 6109 /O6 33 r ~~~~~ Hampden Office If you have any questions, please call our Telephone Banking Center at 1-B00-i24-2440 Today's Date: Business Date: 04/02/2011 04/04/2011 Time: 10:39 AM Checking ****7239 Total Balance: $31,889.25 Available Balance: $17,557.04 Thanks for visiting us today. We are happy to assist you! ~r~~ ~~-a ~ ~~~/rcnc-~ Thanks for visiting us today• We are happy to assist you! P/C.E ~I NEW CUM$ERLAND FEDERAL CREDIT UNION }''our Community Credit /Zlnion CO. Bos 658 ~, N<w Cumberland, IA 17070 • www.ncfcunnlinc.org (717) 77A-7706 • (BRB) 716-2328 . Fax: (717) 774-7996 STATEMENT OF ACCOUNT 1 SHRED-IT TRUCK 4-30 YORKEXPO SCHOLARSHIP ENTRY DUE 5-13 COLLEGE FUNDING SEMINAR 5-26 2.75% NEW-USED CAR 60 MO 4.74% HOME EQUITY TO 120 MO 351 1 AV 0.335 1111111111111111111111111111111111111111111111111111111111111 JOHN R MILLER 10 KEVIN ROAD MECHANICSBURG PA 17050-6802 Joint Owners 040681 EBTHER MILLER FROM To 0301 1103311 TMNSACTON DATE EFFECTIVE DATE DESCRIPTION AMOUNT FINAN CHARG CE E FEES FINE ! S BALANCE 0301 PREVIOUS BALANCE S1-PRIMARY SHARES 17561 0303 WITHDRAWAL CHECK -1'7556 2 5 P-ESTATE OF ESTNER K. MILLER 0331 DIVIDEND 4 5 THE ANNUAL PERCENTAGE YIELD EARNED IS 0.2 . 0331 NEW BALANCE DIVIDEND IS CALCULATE 5 USING A DAILY BALANCE METHOD. OVERDRAFT AND RETURNED ITEM FE S SUMM R I TOTAL FOR I TO AL I THIS PERIOD -- ---------------- -I - ~ --I--- - YEA --- -T -- -DA --- E - -° --- ------ TOTAL ---° OVF_R -----------^-- - - - RAFT FEES I S 0.00 I S 0.0 TOTAL RETU NED ITEM FEES I S 0.00 1 S 0.0 TAX YE R <'01 0: REPORTED DIVIDENDS 67:72 TOTA FINAN E CHAR GE 0.0 TOTAL DIVIDEND YEAR-TO-DATE TOTAL FINANCE CHARGE YEAR-TO-DATE for atl mvir:yn ecept IM avmOc. Oivitbnde Hawn, il' over 510, wltl be reported ~ ~ beta a Ne Inrenul R•vnnue SeMU for mb 7 . 3 D . D D wemn year. • MDICATES EFFEiCTNE DATE NOTICE: See reverse silts far important information 0800351 PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDIML TAXES AND PD BOX 280601 TAXPAYER RESPONSE HARRISBURG P~A 1]128-0601 xEV-~sas eK err tae-oei I~~I ~~ FILE N0. 21 11-0264 ACN 11126207 DATE 04-19-2011 ROSE E FOZEKAS 6043 EDWARD DRIVE MECHANICSBURG PA 17050 EST. OF ESTHER K MILLER SSN 232-60-1516 DATE OF DEATH 01-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. M & T BANK provitletl the Oepartnenk with the inforn ation below, which has been usetl in calculating the potential kax tlue. Recortls indicate that at the tleath of the above-nametl decedents You were a joint owner/benef icia rY of this account. If you feel the inf ornation is ineo tract, please obtain written co rrettion frgn the financial in stitutionr attach a coot to this fora and return iY to the above atldress. This account is taxable in acco rtlance with khe Inhe sit ante Tax laws of the Conmgmra alth of Pennsylvania. Please call (]17) 781-8327 with puastions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS A«ount No. 1500421 9415062 Date 01-24-2009 To ensure proper cretlit to the account, two EstablSshed copies of this notice nust aeeonpanv Account Balance $ 13 194 23 pavnenY to the Register of Wills. Make check " . x payable to Register of Wills, Avant". Percent Taxable X 50.000 Amount Subject tp Tax y` 6,597 12 NOTE: It tax payments are na tle wikhin three . non the of the tlecetlent's date of tleath. Tax Rate X . 0 45 tleduct a 5 percent discount on the tax tlue. Potential Tdx DUe ~ 296 8 7 Anv Inheritance Tax due will becone delinquent . nine months after the tlake of death. u TAX RETURN - COMPUTATION LINE 1. Da Te Establishatl 2. Account Balance 3. Percent Taxable 4. Amount Subject tp Tax 5. Debts and Detluetions 6. Amount Taxable 7. Tax Rate 8. Tax Dua PART 3^ DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS 2 S 3 X A $ 5 6 S 7 X 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TaTAL (Enter on Line 5 of Tax ComputatloN 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowletlge and belief. i,..„~ WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance Tax becomes delinquent nine months attar the decedent's date of death. 3. A joint account is taxable even when the decedent's nave was added as a natter of convenience. 4. Accounts (including those held between husband antl wife) the detetlent Dut in joint naves within one year prior to death are fully taxable. 5. Accounts est abli shed iointlY between husband and wife wore than ova Year prior to tle ath are not taxable. 6. Accounts held by a decedent "in trust for" another or okhe rs are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "%" in Block A of Part 1 of the "Taxpayer Re sponse'• section. Sian two copies antl submit then with a check for the amount of tax ko khe rapist er of wills of the tounky indicated. The PA Depa rtnent of Revenue will issue an official assessment (FO rn REV-1548 EX) upon receipt of the return iron the register of wills. 2. BLOCK B - If the asset specified on Yhis notice has been or will be reported antl kax paitl with the Pennsv lvania Inheritance Tax Return filed by the estate's rep resen tativa, place an "X" in Block B of Part 1 of the "Taxpav er Response" section. Sign one coot and return to khe register of wills of the county intli toted. 3. BLOCK L - If the notice information is into tract and/or tletluc lions are being claimed, check Block L and eompl ate Parts 2 and 3 acco rtlinB to the instructions below. Sign two copies antl submit them with your cheek for the amount of taz payable to the register of wills of the county indicated. The PA Deo artwent of Revenue will issue an official assessment (FO rn REV-1548 FX) upon receipt of the return from the repi stet of wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account oripinallY was established or titled in the manner existing at tlake of death. NOTES For a decedent who died after 12/12/82, acco unks the decadent put in joint names within one veer of death are fully taxable. However, there is an exclusion not to exceed 03,000 par transferee, re6a rdless of the value of the account or khe number of accounts held. If a double asterisk (s.) appears before Your fi rs4 nawe in the address portion of this notice, the 13,000 exclusion was deducted frow the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percentage of the account that is taxable to each survivor is tle ke mined as follows: A. The pa rcentape taxable of ioint assets established oars than one veer prior to khe tle cedent•s death: 1 OIVI DED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BV 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joink asset ropistered in the nawe of the decedent antl 4wo other persons: 1 DIV SOED BY 3 (JOINT OWNERS) DIVI DEO BY 2 (SURVIVORS) _ .167 X 100 = 16.7 oe rcent (TAXABLE TO EACN SURVIVOR) B. Tha oe rcentage taxable for assets created within one year of the decetlent•s death or accoun ks owned by the decedent buk held in trust for another individual(s) (trust benaf iciaries): 1 OIY IDED BY TOTAL NUMBER OF BURYIYING JDI NT MULTIPLIED BY 100 = PERCENT TAXABLE OWNERB OR TRUST BENEFICIARIES Example: Joint account registered in the nave of the decedent and 4wo other De rsons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 pa rcent (TAXABLE FOR EACH SURVIVOR) 4. The ono unt subject 4o tax Qine 4) is date rninetl by wultiplYinp the account balance (Line 2) by khe percent taxable (Line 3). 5. Enter 4he total of 4ha debts and deductions lisked in Part 3. 6. The ewount taxable (Line 6) is deke twin ed by subt ratting the debts and deductions (Line 5) from the awount subject 4o tax (Line 4). 7. Enter the ago ropriate tax rate (Line 7) as tletern inad below. sThe tax rata imposed on the net value of transfers frow a deceased child 21 Years of ape or younger at death to or For the use of a natural parent, an adoptive pa rant or a steppe rent of the child is 0 percen4. The lineal class of heirs includes grandparents, oa rents, children and other lineal tlescentlents. "Child re n•' includes natural children w ha that or not they have De vn adopted by others, adopted children and step children. "Lineal descendents" includes all ch iltl ten of the natural parents antl 4heir tlescentlents, whether or not they have been adopted by others; adopted tlescentlents and their descendants; end step-tlescentlents. "Siblings" arv defined as individuals who have at least one parent in cowwon with the detetlent, whether by blood or adoption. Tha Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts antl deductions are detern inad as follows: Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 Percent 6 pare ant 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 Percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent f 12 percent 15 percent A. You are legally responsible for pavwentr or the estate subject to adwiniskration by a personal representative is insufficient ko pay the deductible ilea s. B. You actually paitl the debts after the death of the detetlent antl can furnish proof of vaywent. C. Debts being claiwatl must be itewizetl fully in Part 3. If additional space is needed, use B 1/2" x 11'• sheek of paper. Proof pf payment way be requested by the PA Depa rtnent of Revenue. BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 PENNSYLVANIA INNERITANC:E TAX INFORMATION NOTICE AND FILE N0. 21 11-0264 TAXPAYER RESPONSE ACN 11126206 DATE 04-19-2011 rsv-:sae eM err ,oe-ee~ ROSE FOZEKAS 6043 EDWARD DR MECHANICSBURG PA 17050 £ST. OF ESTHER K MILLER SSN 232-60-1516 DATE OF DEATH 01-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. M & T BANK provided the Depa rtnent with the information below, which has been used in calculating the potential tax due. Recortls intlicake that at the tleath of khe above named dacetlentr you were a Joint ownor/benef icia rv of this account. If You feel the inf ormatf on is into rrect, please obtain written correction from the financial institution, attach a copy to tM1is fore and return ik to the above address. This account is taxable in acco rtlance with the Inheritance Tax laws of the Connornrealkh Of Pennsylvania. Please call (717) 787-8327 with coast ions. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILIN6 AND PAYMENT INSTRUCTIONS Account No. 60574097 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due u TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxab la 4. Amount Subject to Tax 5. Debts and Detlu<tions 6. Amount Taxable 7. Tax Rate 8. TaX Due Oate 03-29-2006 Established $ 4,441.98 X 50.008 g 2,220.94 X .045 fi 99.94 OF TAX ON JOINT/TRUST ACCOUNTS 2 S a X 4 +t 5 6 .y` 7 XX A a. 4 To ensure proper cretlit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills. Ageni'•. NOTE: If tax paynents are matle within three months of the decedent's date of tleath. deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become tlelinouenk nine months afker the tlate of death. PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE Under patio lties of perjury, I declare that the facts I have reported above are true, correct antl complete to the bast of my knowledge and belief. H(1MF ( ) GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforeation subeitted by the fin aneial institution. 2. Inhe ri tanee Tax becomes tlelinouenk nine eonths after the tlecedent's data of tleath. 3. q joint account is taxable even when the tletetlent's nave was addetl as a natter of convenience. 4. gccounts (including those held between husbantl and wife) the decetlent put in joint man es within one year prior to death are fully taxable. 5. Accounts askablishetl jointly between husband and wife wore than one veer Drior to deatA are not Taxable. 6. Accounts heltl by a decetlent •'in trust for" ano iher or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the info rma flan and cowputation in the notice are correct antl tletlucti ons are not being claiwed, place an "X" in Block A of Part 1 of the "Tax gay er Response" section. Sign twa copies and subnik then with a check for the awount of tax to the reBi star of wills of the county intlicated. The PA Departwent of Revenue will issue an official assessment (Form REV-1548 IX) upon receipt of The return frow the register of wills. 1. BLOCK B - If the asset so etif ietl an this notice has been or will be reported antl tax paid wikh the Penn rylvania Inheritance Tax Ratu rn filed by the estate's representative, place an "X" in Block B of Park 1 of the "Taxpav ar Response" section. Sign one coot/ and return to She register of wills of the county indicatetl. 3. BLOCK C - If the notice inf orwation is incorrect and/or deductions are being chine tl, cheek Block C antl conpl ate Parks 2 and 3 accortling to the instructions below. Sign two cosies and submit thaw wish your check for the awount of tax payable So Lha re gi star of wills of the county intlicated. Tha PA Department of Revenue will issue an official assessment (FOrw REV-1548 IX) upon receipt of the return from the register of wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the aeeounk aripinally was establj shetl or titled in the wanner existing at date of death. NOTE: For a decetlent who dietl after 12/12/82, accounts the decedent pu4 in joint manes within one year of tleath are fu11Y taxable. Hwever, there is an exclusion not ko exceed f3,000 per transferee, reBartlle ss of the value of The account or the nuwber of accounts held. If a double asterisk (s~) appears before your first nawe in the address portion of Shis notice, the (3.000 exclusion vas deduetetl frow the accounk balance as reported by the financial 3nztituti on. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percentage of the account that is taxable 4o each su rviror is Bete rwinetl as follows: A. The parcanta9e taxable of joint assets established wore than one year Drior to the decetlent's death: I OIVI DED BY TOTAL NUMBER OF OIVI DEO BY TOTAL NUMBER OF MUITIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the nawe of the tlecedent antl two other parsons. 1 DIV IOEO BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .16] X 100 = 16.] percent (TAXABLE TO EACH SURVIVOR) B. The percentage taxable for assets created within one Year of the decetlent's death or accounts owned by the decedent but held in trust for another indivi tlual (s) (trust beneficiaries): 1 OIV IDEO BY TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Ex anvle: Joint account repiste red in the nawe of the decetlent antl two other persons and establishetl within one year of tleath by the tlecedent. 1 OIVI[N[O BY 2 (SURVIVORS) _ .50 X ]00 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax CLine 4) is deterpined by wultiDly ine the account balance CLine 2) by the percent taxable CLine 3). 5. Enter the total of the debts end deductions listed in Part 3. 6. The awount taxable (Line 6) is dote rwined by su bt ratting the debts and deductions (Line 5) frow the awount subiect to tax (Line 4). ]. Enter the appropriate tax rate (Line 7) as det•rn fined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 35 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent . 12 percent 15 percent •:ne wax race lwpaseg on the net value of transte rs ttaw a deceesetl Chiltl 21 years of ape or younger at tleath t0 or for the use of a natural Dare nk, an adoptive parent or a stepparent of The chiltl is 0 percent. The lineal class of hairs includes Drnntlparen ks, parent s, child ran and other lineal descentlents. •'Chiltlren" includes natural children w he Thar or no4 they have bean adopted by othersr atloptetl children and stet/ children. "Lineal descendents" inclugez all children of the natural parents and their descentlents, whether or not they have been atloptetl by others; atloptetl tlescendenis and Their tlescendants; and step-descentlants, "Siblings" are tlef road as individuals who have at least one parent in cowwon wikh the tlecedent, whether by blood or atlopkion. The Collateral class of heirs inelutles ell other benef ieiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and tletluctions are deterwinetl as follows: A. You are legally responsible for Daywent, or the estate subiect fo administration by a perspnal representati re is insufficient to vat/ the tletluctible items. 8. You attUally Daitl the tlebts df ter the tleath of the tlecedent and can furnish proof of paywent. C. Debts being Claiwetl must be ltewized fully in Part 3. If adtlitional space is needed, use 8 1/2'• x 11" shee4 of Dapar. Proof of payment may be reauestetl by the PA Oepa rtwent of Revenue. Faur Generations... Celeb;~ating Gibe, Honoring 7Yadition.e l~ZYERS `.~un~ral0'~6me, c~7na BOYD L. MI'ERS, JR., Supervisor 37 E. MAIN STREET MECHAN[CSBURG, PENNSYLVANIA 17055 (717)766-3421 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for chose items that you selected or that are required. If we are required by law or by a cemc~.tery' or crematory ro use any items, we will explain in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for mbalming you did not approve if lected arr ngeme such as ~re^et Cremation or i mediate burial. If we charged for embalming, we i e la' h below. For the Service oiF~-f~_, ~ ~ ~ ~- 1 ~ L ~-~ ~-~ Date ~f "Death ~ ~ ~ Charge to:~~J I~~~~L, I~~l,l, e.rt- I o ~Le~~r~ I(j- ~ d~~ '~cS ..~~ A. CHARGE FOR !iERVICES SELECTED: 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff .... m a ming ...................... E City Other clothing 3 8 E Other preparation of body SUB-TOTAL OP PROFESSIONAL SERVICES......... Alf~r~ FACILITIES AND SERVICES Use of fac'' ' ervtces for t ~T+~' ~ viewin V.isitatio ake)...... ... i++~ ' Use of facilities and services for funeral ceremony .. , ...... ... i Use of facilities and services for Memorial Service . . Use of equipment and services for graveside service .......... f ~ . ... i Other use of facilities ............................... i ~ r SUB-TOTAL OF FACILITIES/EQUIPMENT ........... A2 '~ 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Puneral H n Local ........................... sE (L` Hearse (Casket Coach) ,,,,~~ ~~ /I ' Local ....................... .... SY~ Limousine Local ....................... .... E Family car Local ....................... .... f '"' Flower car or floral disposition Local AcGL f ..................... . Lead carlclt[gy, car . _\. .- , , - .. c Cremation urn .................. . (Description) 1 Z ~[ rj'6 OTHER t'12 c7w ''(-~~~ s~-„=° f U.7 TOTAL MERCHANDISE SELECTED .................. B E2Lcs~~ C. SPECIAL CHARGES: Forwarding of remains tc~ f (Funeral Home) Receiving of remains from f (Funeral Home) Immediate Burial ................. f Direct Cremation.yfa. x}r E SUB-TOTAL OF SPECIAL CHARGES ................ C f J D. CASH ADVANCED Opening Grave .................. Cemetery Equipment ... ......... . Lo[and Deed .................... Newspaper Notices-Local ... . Newspaper Notices-Out-of-town.... Telephone & Telegrams ......... . Airfare ....................... . Clergy/Mass Offering ......... ... . Pallbearers ..................... . Certified Copies of the Deaatth~ /' ~ Certificate ........./ 0 C°..~; Police Escort ......... Flowers ... ................... . Vault Service Charge ............. . f f E E~ C2~ fLUp.. ire' f S~ S ~ 3 S ~r~ i~-c, ~~ E7~f`~.---J b i f Roland Johnson Appraisal Services 0007053 APPRAISAL OF LOCATED AT: 10 Kevin Rd. Mechanicsburg, PA 17050 FOR: Louis Fazakas BORROWER: NA AS OF: August 29, 2011 BY: Roland D. Johnson, SRA RL-001737-L A SINGLE FAMILY RESIDENCE Roland Johnson Appraisal Services 0007053 09/02/2011 Louis Fazekas File Numher: tOkevin Dear Mr. Louts Fezekas: In accordance with your request, I have appraised the real properly al: 10 Kevin Rtl. Mechanicsburg, PA 17050 The purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the market value of the property as of August 2s, 2011 is: $139,000 One Hundred Thirty-Nine Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. Respecdully, Rolantl D. On, SRA RL-001737-L State Certi0ed Appraiser APPRAISER'S LICENSE Faril]leMae SINGLE FAMILY 0007053 Msk{Op Und~rwrltsr QuantltaUv~A lltt NMI ft FNeNO.: 10kevin THIS SUMMARY APPRAISAL REPORT IS INTENDED FOR USE BVTHE LENDER/CLIENT FOR A MORTGAGE FINANCE TRANSACTION ONLY. Pro en Adaess 10 Kevin Rd. C9 Mechanicsbur Stale PA 2i Code 17050 L ai Desai ion DEED BOOK 23C PAGE 266 Cam Cumberland Assesses Parcel NO. 10-19-1804083 Tax Vea 2011 RETaxes81608.41 5 bl ASSeswzrzsf N/A Borrower NA Curenl Oe*ar Esther Miller Ocw m: Owner Tenam X Vacant Nei hbahoatl a Pro'ea Name Ham en Tw Pro ed T e PUD Contlominium HOAS N/A IMO. Sales Prke 8 NA Date of Sale NA Desai ionlE amoum of ban char esrconcessians to be aid b serer NA Pro n d terse aisetl X Fee Sim Leaseholtl Ma Reference 2847-2B Cenws Traa 113.05 Note: Race and the racial coin sitionof the nei hborhood ere note sisal factors. Lotalbn Urban SuWban Real Properly values Increasing Stable Declining Sirplefamily housing PRICE AGE PRICE A p ®Oua 75% 2575% Untler 25% DemanNSU I Shona a In baMme Buillu ^ ^ DPY ^ 9 ® ^Om supply $1000) (ya) EI000) (Vrsl GmwN rate RaM SWGe Slow Maaeun ame UMa3 mos. 3L mos. Ova6mos. 110 tow 0 NAA LOw NA Neighborhood boundaries The sublecl's neighbolfiood is bound to the North by Conodoguinet Creek to 375 H' n 70 NA H' h NA the Worst by Lambs Gap Rd. to the SouM by Cadise Pike and to the East by Route 581. H'~ Predominam "~ " - : ' Pretlominam `-': 140 45 Nq NA Dimensbns 70 z 125 She area 8750 Sa.Ft. Shape Reetannular Sped6c zoning dessi(calion antl tlescnplion ResidentWl Suburban -Stn le-Pamir Dwellin 5 Permaled Zoning compliance ^X Legal ^ Legal norzomaming (GmnMethaed use); Illegal, aaach tlescnplion No zonirp Hi hest eM best use d wb'ecl as im ved a as o setl er Mns and 5 cifirations : X Presem use Other use, aaach descri ion. Utilities Public Other Publk Olha t7lfsilelrtlprovarrenls Type Publk PrNale Ebcuichy ^X 200 AMP Water ^X Suea Asphalt ^X ^ Gas Santee sewn X AI PreNae atlwrse siecadeons %Selllaas alu ' I sFde seas ac.7 Ves X No If Ves atlaN desm ion. Soace(s) used fa physical charaderistics al propety: X Imerxr and exlena inspeaice Enerkr inspection kom Suem Prevbus appraisal files ML5 XASSes6menl arm lax retails Pnmins dion Pro owner XONer Describe: Real Ouest Professional Famll Member. No.mSlaiesi T DeLlatl. Detached Eaaia Walls Vin I Bfick RoolSWace Shin le ManulacWred Hausin Ves X No Dces Ne as ccelorm to Ne nei hbahood in terms a n , contlilion, and conswaion malenaN? X Ves No H No, aaach tlesai ion. Are there any a rem physical deficiencies a wntldions Nat wouN aaed the sountlness a swctural integrity d Ne improvemems a ale livabilhy of Iva property? Ves X No II Ves attach tlescri lion. Are (here any apparem aMase ernironmemal contlhions (hazardous wastes, toxk wbslances, etc) present in Ne improvements, on the sfe, a in Ne immetliale vkinity d Ne o en 7 Yes X No II Ves, attach tle bn. I rewathed the wbjed markm area la comparable listings antl sales Ihal are the most similar and proximate to the subjea properly. Myreseach reseabdataala 5 sales ranging in sales price homf 125.OOOmf 165.000. Myreseach reseNetlataalU 6 I6lirlgs rangingklisl prke aomf 135.OOOIOE 165.000. The anal s of the can reble sales below relbas maraN reaclbn l0 5 ni5cant variation between Ne sales antl thew ' FEATURE SUBJECT SALE 1 SALE 2 SALE 3 10 Kevin Rd. 6015 William Dr. 432 Lintlen St. 11 Donald St. Atltlress Mechanicsbur Mechanicsbur Mechanicsbur Mechanicsbur x:, ProximA to SUb'a '(i'emt-'-~ri~ 0.23 milesE 1.08 miles SSW 0.32 miles SE Sales Prke S NA .' f 149 900 r,r: .M ,. . .• k..'xf 149 900 . °'t^r"3s+8 137 000 Prital"xoss lH. area S 0.00 f 180.01 0'""' ` ` S 92.13 m k" d- 8 137.00 m I' `= r ' 'r w~rY Dora a vein. Souces <`r - i. MLS & Taz Records MLS & Tax Records MLS & Tax Records VPLUE ADl11S11AE DESCRIPTN)N DESCRIPTION .HS DESCRIPTION .lis DESCRIPTION .DS Salesa Flnandng ~, a tin 4~t ,.=y: Conventional FHA FHA concessions r ltl . ~_. Yes DOM 313 -2 500 Ves DOM 31 -5 843 Ves DOM 83 E 000 Date of Salelfime '~'?~~`-`§ 0415-2011 04-29-2011 OB-30-2011 Location Suburban Suburban Suburban Suburban Ste .20 Acre .20 Acre .49 Acre -1 500 .20 Acre View Averse Averse Averse Avere e Desi S le Ranch Ranch Ranch Ranch Aaual A e vrs. 43 Veers 53 Years 46 Veers 43 Years Contlabn Avere a Avero a Avere a Avere e " ' Above Gretle zoo ' ear, • awn: Tmu ' aeaa: e.ur inlet • aamrs • earn 's ~ ~t Taus ' aarur • enn ,!>;'' Room COUnI 8 ~ 3 ~ 1.50 6 ~ 3 ~ 1.00 ~ 2,000 7 ~ 3 ~ 1.50 ~ 5 ~ 3 ~ 1.00 ~ 2,000 G~ " P>ce 1 400 S . Ft 1 153 S . FC 3 700 1 627 . FL' -3 400 1 000 S . FU 6,000 Baserlafartl Fil611aJ Full Basement Full Basement Full Basement Full Basement Rooms Bebw Graee L-She eFR t7an Unfinished 6000 Unfinished 6000 FR 3000 Gera car None 1-Car Car ort -3000 None None HeaeCoolin Elec BBMO CA Gas FA/CA -3 000 Elec RadICA -3 000 Gas FAICA -3 000 Re irs Ves No -3 000 No -3 000 No -3 000 Nel Ad'. al X . - ' 8 200 X - ' f 10 743 X - ' f 1 000 t ~ %t ~ ~~ 4' ~ i. ~ ' ~ ~y~ M a n a0ks , n n '- ` E 150100 ~ E 139,157 % l f 138,000 Date of Prim Sales None 05-05-2008 07-05-2007 11-09-2006 Price of Pdor Sales 0 E 153 000 f 1 8 1 Analysis of arty current agreement of sale, aplion, or listing of ale wbjed properly and enalysb of the prig sales of wbjed and comparabks: Aecordin t0 information rovided b [he mule-list services In this ion the sub act ro has not been listed for sale within the st 3 ors. Summary of sales comparison and value conclusion. See Addendum This appraisal is made X 'as~is', or subjedb complaacn per plain antl specNCalimsonthe basis ofahypoNelical tontlabn lhallhe impouemams have beentmlpleleda sub'ecl to the lollawin re airs, alleralions a conditions: BASEOON AN EXTERIORINSPECTION FROM THE STREETOR AN X INTERIORANDEXTERIORINSPECTgN.IEBDMATETHEMARKEFVALUE,ABOEFINED. OFTHE REAL PROPERTYTHATIBTHESUBJECTOFTHISREPORTTO BE8139.000 AS OF OB-29-2011 terry, PAGE 1 OF 3 YdflOie Md¢ Yawl LYYd YYO rms. <~~~q xl mm..~. eoo zunn.,,,,..,aoe SINGLE FAMILY 0007053 Desktop tlnderarrlter Ouantitatlys Analysis Appralpl Report FaP UO 10kevin Project Information for PUDS (if applicable)-IS the Oeveloperlbuiltler in control of the Home Owners' Association (HOA)? Ves No Provide the lolloxing infamalion for PU05 only H the tleveloperNUitla is in conuol of the HOA and the subject properly is an soothed tlwellilg unit: Trial mrNter dphasea Total number of unas Total number of units sold Tdalrunibadurils retie] Telal atmber of unks for sak Dala Source(s) Was the project treated by the conversion of exislirg Witlings into a PUD? ^ Yes No P y25, smt¢ d8te Of COIIVeISIOn: Dceslhe project <onUin any mulWdwelling oohs? ^Ves ^NO Data SOUrce~ Are the common ¢lemems completed? ^ Yes ^ No If No, Eescribe sUlus of compktpn: Are any common ekrrenls leased to or by the Home Owners Association? Ves No If yes, anach addendum describing renal terms and options. Describe common a@menls and recreational facilaies~. Project Information for Condominiums (if applicable)-IS the developerlbuiltler in conuol of the Home Owners' Association (HOA)? Ves No Provide the 1011owirg infamalion fa all Contlominum Projects Trial number of phases Total number of units Total number of units solo Taal number d albs rased Total numbs of units for sa@ Oala Sourcels) Was the project created by the conversion of existing buildings into a condominium? Ves No H , dale dcorwasion: Prged Type: ^ Primary Resgence ^ SecorM Home or Recreational ^ Row or Townhouse ~ Garden ^ Mitlrise Hgkrse Condition of me project, qualay of conslrudion, unit mix, ea.. Are the common elements completed? Yes No II No, describe status of compklbn. Are any common elemema kasetl toa by the Home Owrmrs'gssaialien? Ves No Il yes, atlach addendum describing resat tams and options. Describe common ekmems and recreabonal facilbies: PURPOSE OF APPRAISAL: The purpose of This appraisal is to estimate the market value of the real property that is the subject of This report hosed on a quantitative sales comparison analysis for use in the mortgage finance Transaction. DEFT NITION OF MARKET VALUE: The most probable price whicha property should bring ins 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 aflecte0 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) both parties are well informed or well advised, and each acting in what he considers his awn best interest; (3) a reasonable time is allowed for exposure in the open marker; (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 tar the property sold unaffected by special or creative financing or sales concessions' granted by anyone associated with the sale. ' Adjustments to the comparables must he 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 marker 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 properly by comparisons to financing terms offered by a Third party institutional lender that is not already involved in the property or Ira nsaclion. 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 LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION CONTINGENT AND LIMITING CONDITIONS: The appraises s certification that appears in the appraisal report i5 Subject to the following conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the properly being appraised or the title to il. The appraiser assumes that the lisle is good and marketable and. Therefore, will not render any opinions about the title. The property is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided any required sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's delerminalion of its size. 3. 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 helorehand. 4. The appraiser has noted in the appraisal report any adverse conditions (such as, but not limited lo, needed repairs, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject properly or That he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise slated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the presence of hazardous wastes, toxic substances, etc.) that would make the properly more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, expressed or implied, regarding the condition of the property. 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 [he field of environmental hazards, the appraisal report must not be considered as an environmental assessment of the property. 5. The appraiser eDtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnished by other parties. 6. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice. 7. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can distribute the appraisal report (including conclusions shout the property value, the appraiser's identity and professional designations, and references to any professional appraisal organizations or the firm with which the appraiser is associated) to anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage insurer; consultants; professional appraisal organizations; any state or federally approved financial inslilution; or any department, agency, or inslrumen[alily of the United Stales or any state or the District of Columbia; except that the lenderlclient may distribute the report to data collection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media. 8. The appraiser has based his or her appraisal report and valuation conclusion (or an appraisal That is subject to completion per plans and specifications on the basis of a hypothetical condition that the improvements have been camplete0. 9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal That is. subject to completion, repairs, or alterations on the assumption that completion al the improvements will be Derlormed in a workmanlike manner. 1a;H. PAGE 20F 3 Fannie Mae Fam 2055 996 RpltM iyrg PCI sNnue, BV.tH B~EI wit' nort~L.mm 0007053 agrees 1. I performed this appraisal by (i) personally inspecting from the street the subject property and neighborhood and each of the comparable sales (unless I have otherwise indicated in this report that I also inspected the interior of the subject properly); (2) collecting, confirming, and analyzing Bala from reliable public andlor private sources; and (3) reporting the results of my inspection and analysis in this summary appraisal report. I further certify that I have adequate information about the physical characteristics of the subject properly and the comparable sales to develop this appraisal. 2. I have researched and analyzed the comparable sales and ofleringsllistings in the subject market area and have reported the comparable sales in This report that are the best available for the subject property. I further certify That adequate comparable market data exists in the general market area to develop a reliable sales comparison analysis for the subject property. 3. I have taken into consideration the factors that have an impact on value in my development of the estimate of market value in the appraisal report. I further certify Thal I have noted any apparent or known adverse conditions in the subject improvements, on the subject site, or on any site within the immediate vicinity of the sublecl property of which I am aware, have considered these adverse conditions in my analysis of the property value to the extent that I had market evidence to support them, and have commented about the effect of the adverse conditions on the marketability of the subject properly. I have not knowingly withheld any significant information from the appraisal report and I believe, to the best of my knowledge, Thal all statements and information in the appraisal report are True and correct. 4. I slated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the contingent and limiting conditions specified in this form. 5. I have no Present or prospective inleresl in the property That is the subject of this report, and I have no present or prospective personal interest or bras with respect to the participants in the transaction. I did not base, either partially or completely, my analysis andlor the estimate of market value in the 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 properly or on any other basis prohibited by law. 6. I have no present or contemplated future inleresl in the subject property, and neither my current or future employment nor my compensation for performing Ibis appraisal is contingent on the appraise value gf the property. 7. I was not required to report a predetermined value or direction in value Thal favors the cause of the client or any related party, the amount of the value estimate, the attainment of a specific result, or the occurrence of a subsequent event in order to receive my compensation andlor employment for performing the appraisal. I did not base the appraisal report on a requested minimum valuation, a specific valuation, or the need to approve a specific mortgage loan. e. I estimated the market value of the real property Iha1 is the subject of this report based on the sales comparison approach to value. I further certify that I considered the cos[ and income approaches to value, but, through mutual agreement with the client, did not develop them, unless I have noted otherwise in This report. 9. I performed This appraisal as a limited appraisal, subject to the Departure Provision 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 the place as of the effective dale of the appraisal (unless I have otherwise indicated in this report that the appraisal is a complete appraisal, in which case, the Departure Provision does not apply). 10. I acknowledge that an estimate of a reasonable lime for exposure in the open market is a condition in the definition of market value. The exposure lime associated with the estimate of market value for the subject Properly is consistent with the marketing lime noted in the Neighborhood section of this report. The marketing period conclutle0 for the sub)ect property al the estimated market value is also consistent with the marketing time noted in the Neighborhood section. 11. I personally prepared all conclusions and opinions about the real estate that were set forth in the appsisal report. I further certify that no one provided significant professional assistance to me in the development of This appraisal. SUPERVISORY APPRAISER'S CERTIFICATION: II asupervisory appraiser Signed the appraisal report, he or She certified and agrees that; I directly supervise the appraiser who prepared the appraisal report, have examined the appraisal report for compliance with the Uniform Standards of Professional Appraisal Practice, agree with the statements and conclusions of the appraiser, agree to be bound by the appraiser's certifications numbered 5 through 7 above, and am taking full responsibility for the appraisal and the appraisal report. APPRAISE SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signaure: Name: Rol d D ,bh Company Name: Rda boson Aporaisal Services Company Address: 6820 Somerset Street Harrisburg PA 17111 Date of RepoNSignature:09/0212011 Stale Certification N: RL-001737-L or Stale License N: State: PA Expiration Dare of Certification or License: 06/30/2013 Signature: Name: Company Name: Company Address: Dale of RepoNSignalure: Slate Cerifcation A: or Slate License k: State: Expiration Date of Cen~calan or License: ADDRESS OF PROPERTVAPPRAISED: SUPERVISORY APPRAISER. 10 Kevin Rd. SUBJECT PROPERTY Mechan'csburg PA 17050 ^ Did not inspect suDjecr property ^ Ditl inspect exterior of subjea progeny from street APPRAISEDVALUEOFTHE SUBJECTPROPERTV$139.000 ^Did inspect inleria and exteria of subject property EFFECTIVE DATE OF APPRAISAL/INSPECTION 08-29-2011 COMPARABLE SALES ^ Did not inspect exteror of comparable sales from street LENDER/CLIENT: ^ Did inspect exterior of comparable Sales from Street Name: Company Name: N/A Company Address: 1eGR, PAGE 30F 3 Fannie Mae Fam Io55 9-96 urt«ue.emzaeni.....~..ervm Roland ~~ohnson Appraisal Services ADDENDUM Borrower. NA File NO.: 10kevin ProoeM Adtlress: 10 Kevin Rtl. Case No 0001053 Ckv: tlechanicsbura State' PA Zio: 11050 Lentler WA Summary of Market Data After a thorough search of all available market data, the three sales used are the bas[ indicators of value. Appropriate adjustments have been made for all differences. An adjustment was made to the "SITE" of Comparable Sale No. 2. Its significantly larger lot size is considered superior to that of the subject. The subject does have deferred maintenance. The boors, plumbing, and amenities of the bathroom and powder room are in the process of being replaced. Intertor painting of rooms is needed to make subject marketable. Cos[ to cure is estimated at $3,000. A deduction of $3.000 will be made to the Comparable Sales for "Repairs" in the Sales Comparison Analysis. This appraisal report has been prepared with the property in'as is" condition. No personal property' has bean included in this valualion. This appraisal assumes a reasonable marketing period for the subject property of four months. The Market Approach re6ects recant activity in the market place and is given the most weight. THIS IS A SUMMARY APPRAISAL REPORT. THIS SUMMARY APPRAISAL REPORT IS INTENDED FOR USE BY THE CLIENT TO ESTIMATE MARKET VALUE FOR ESTATE TAXES ONLY. THIS REPORT IS NOT INTENDED FOR ANY OTHER USE. Flood Info: 42036000100 ZoneX 01-05-1996 PLEASE NOTE THAT THIS APPRAISAL CONTAINS A DIGITAL SIGNATURE THAT IS PASSWORD PROTECTED. USE OF THIS DIGITAL SIGNATURE REPRESENTS THE'ORIGINAL"APPRAISAL. THIS APPRAISAL REPORT CONTAINS 15 PAGES. xmd.~ Pepe 1 a t Baaowa NA File No. 10kevin Pro Address 10 KBWn Rd. cn Mechanicsbur coum Cumberland sure PA zi code 17050 Lender N/A APPRAISAL AND REPORT IDENTI FICATION This Appra isal Report is gngof the fol lowi ng types: ^ Self Contained (A wtinen report prepared under Standards Rule 2-21a), pursuant to the Scope of Work, as disclosed elsewhere in this repaLl ® Summary (A wnnen repar prepared antler Standards Rule t-2(b), pursuant to the Scope of Work, as dixlosed elsewhere in this report.) ^ Restricted Use (A written repot prepared under Standards Rule 2-2(c), pursuam to the Scope of Wak, as disclosed elsewhere in this report, resakted to Ne staled inleMed use by the specified ckent a mended user.) Comments on Standards Rule 2-3 I certify that, to the best of my knowledge and belief: The statements of fact contained in this repay are We and correct. The reported analyses, opinions, and conclusions are limited only by the reposed assumptions and limiting contliNOns, and are my personal, impartial, and unbiased professional analyses, opinions and conclusions. I have no (or the specified) present or prospective interest in the properly that is Ne subject of Nis repah and no (or the specified) personal imeresl with respect to the parties involved. I have no bias with respect to the properly Thal is Ne subject of this report a Ne ponies involved wiN this assignment. My engagemem in Nis assignment was not contingent upon developing a repaving predetermined results. My compensation for completing this assignment is not contingent upon Ne development a reposing of a predetermined value a direction in value Nat (avers Ne coax of the client the amount of Ne value opinion, the asainment of a stipulated resuk, a the occurrence of a subsequem 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 wdh the Uniform Standards of Professional Appraisal Practice. I have (or have not) made a personal inspection of Ne propey Nat is Ne subject of this report. No one provided significant real property appraisal assistance to the person sgning this cevihcation. pf Ihere are exceptions, the name of each individual providing significant real property appraisal assistance is stated elsewhere in This repo(.) Comments on Appraisal and Report Identification Note any USPAP related issues requiring disclosure and any S[a[e mandated requirements: Signature: Name, Rola d D Jon Date Signed: 09/02/20 State Cenifcation s: RL-001737-L or State Lkense M'. Stale: PA __ Expiration Date of CesRcatron or License: 06/30/2011 EHedive Date of Appraisal: AuAUSt 29 2011 SOPERVISORV APPRAISER (only if required) Signature: Name, Date Signed'. Sate Certfication N: or SIa[e Lkense F: Sate: Expiration Date of CenRCation or License, Supervisory Apprarser inspection of Subject Property: ^ Ditl NOt ^ Exteria~anty from sVeet ^ Intena and Exterior nmm was no ~. ®.zw srer m..a~~..a~ nIMENCI(1N 1 IST ADDENDUM GROSS BUILDING AREA (GBA) 2.492 GROSS LIVING AREA (GLA) 1400 Areals) Area %o(GLA %of GBA Liuirg 1.400 56.18 Leven 1.400 100.00 56.18 - Level2 Level3 Olher GBA Basemen) ® 1 092 43.82 Garage ® - ^ Area Measurements Area Type Measurame`us Factor Total Level) LeveV2 level3 Other Bsmt. Garage 2600 x 42.00 „ ~ _ ,.092.66 ^X ^ ^ ^ © ^ 1400 „ 22.00 x ~ 308.00 © ^ ^ ^ ^ _ ~ x „ _ x „ „ _ ~ X ~ _ ^ ^ ^ ^ ^ ^ ~_ x x x x _ . . _ „- = ~_ x x __ O ^ ^ ^ ^ ^ x x x „ __ _ X ~ X % „ _ x X ~ O __ x x __ _ D D O D D x x x x ,_ ~ x - x __ _ x x ° ° ° ° ° ° ~~ x ~~ „ xx ^ ^ ^ ^ ^ ^ _ . x x ~ _ x „ x . D O O O Q ~ x __ x x x u tJ - „ ' __ x „ _- : ~_ x x x „ x x __ x x ~ x ~ x % x ~ x „ ~ „ ~ „ __ x x __ x - x __ ^ ^ „ x ^ ^ ^ ^ x x „ • x g U __ „ ° X ~ ~~ x x ~~ x x __ x x „ - x __ x - x ^ ^ ^ ^ ^ ^ __ x x - x x „ x - ~ ° ° ° ° ° xx= ^ o ^ ^ ^ LOCATION MAP SUBJECT PROPERTY PHOTO ADDENDUM Borrower: NA File No.: 10kevin PrOpefN Address: l0 Kevin Rtl. Case No.: 0007053 CdV: Mechanicsbum Stale: PA Zip: 17050 Lender: NlA FRONT' VIEW OF SUBJECT PROPERTY Appfaised Date: August 29, 2011 AppraisE~d Valpe: 8139,000 REAR VIEW OF SUBJECT PROPERTY STREET SCENE SUBJECT PROPERTY ADDITIONAL PHOTO ADDENDUM Borrower: NA File No.: 10kevln Property Addfe55: 10 Kevin Rd. Case NO.: 0007053 CAy: Mechanicsbum Slate: PA Zip: 17050 LendeC N/A FRONT VIEW SIDE VIEW SIDE VIEW PWgL~ug M'I mArae. BYI.SLB1E1w.w.xlwOmm FNiItOlAA10 SUBJECT PROPERTY ADDITIONAL PHOTO ADDENDUM Borrower: NA File No.: 10kevin Property Address:l0 Kevin Rd. Case No.: 0007053 I:Ity: Mechanicsburg Slate: PA Zip: 17050 Lender: WA REAR VIEW STREET VIEW noe..m~~ynn ~..aoozu nnow„wae~ vwzioicm,n SUBJECT PROPERTY DEFERRED MAINTENANCE PHOTO ADDENDUM Borrowef: NA File No.: tOkevin Property Addre55:10 Kevin Rd. Case No.: 0007053 CdV: Mechanicsbum Slale: PA Zip: 17050 L¢nd¢r. N/A BATHROOM FLOOR BATHROOM FLOOR BATHROOM FLOOR nmrm,dgw.~om~.¢eoozuem....~~.~ axnimemio SUBJECT PROPERTY INTERIOR PNOTO ADDENDUM Bcxrower: NA File No.: 10kevin Property Addfe55: 10 Kevin Rd. Case No.: 0007053 Cily: Mechanicsburv Slale: PA ZID: 17050 Lender. N/A POWDER ROOM LIVING ROOM I DINING ROOM KITCHEN RtW'Nieuq.lCl Wwvc ~i'NBit~xxralw~.mn M1110~BA10