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HomeMy WebLinkAbout05-14-12ti 1505610105 J REV-1500 EX (oz-ii)(FI) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~`~ ` T County Code Year File Number ~FPINHERITANCE TAX RETURN PO BOX 28o6ot i y `.~1 ~ <<-~ Harrisburg PA 17128-0601. RESIDENT DECEDENT >~ ~ ~ i -y _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Binh MMDDYYW 197-34-02 11 08/04/1942 Decedent's Last Name Suffix Decedent's First Name MI Keith Jr. Robert L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A S e's 5ocial Securit Number pons y THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return 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. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust •~- 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Atty. Michael J. Wilson (717) 795-6217 First Line of Address 113 Iron Furnace Court Second Line of Address City or Post Office Lewisberry State ZIP Code PA 17339 REGISTER OF V1pL~S USE ONLY ~'-y - _ . ~ - j_.... i ~T - :;~- " ~ ~- B. - r Iw _ ~. DAT~fJLEIS f' -~ C>} Correspondent's a-mail address: attorneymichaeljwilson@michaeljwilsonlaw.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belies, it is true, correct a mplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU F RSON RESPONSIBLE Fpf3iFILING RETURN _ / DfyTE Matthew Sco Keith 1100 S. York Road, Dillsburg PA 17019 SIGNAT OF PAR R OTHER TF REPRESENTATIVE M~ ~ `~ ~'~iT ~ /~ A / i ~ ADDr1ESS "- ~ Attorney Michael J. Wilson, 113 Iron Furnace Court, Lewisberry PA 17339-9339 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 '17 r- '-~ _.~ l.' - ~ _ ....,J ~~..•.: l ~-, , - ~ F - ; ~=± ~.~~ ~~ --: t 15056102D5 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: Robert L. Keith, Jr. 197-34-0282 RECAPITULATION 1. Real Estate (Schedule A) ............................................ . 1. 0.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 9,154.21 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C} .... . 3. 0.00 4. 9 9 ( ) .......................... Mort a es and Notes Receivable Schedule D 4. . 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 32,517.16 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 88,333.34 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 451 14 158 (Schedule G) O Separate Billing Requested...... .. 7. . , 8. ( 9 ) ........................... Total Gross Assets total Lines 1 throw h 7 8. . 288,455.85 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 19,295.70 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I} ............. .. 10. 117,609.91 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 136,905.61 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 151,550.24 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 00 0 an election to tax has not been made (Schedule J) ...................... .. 13. . 14. Net Value Subject to Tax (Line 12 minus line 13) ...................... .. 14. 151,550.24 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 00 . (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 151,550.24 1B. 6,819.76 17. Amount of Line 14 taxable 0 00 . at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 00 . at collateral rate X .15 18 19. TAX DUE ....................................................... ..19. 6,819.76 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561D205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Robert L. Keith, Jr. __ _ _ __ ___ _ STREET ADDRESS 46 Trudy Circle _ CITY -~ - ~ STATE ZIP i Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments __ - __ _ B. Discount 3. Interest (1) Total Credits (A + B) (2) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6, 819.76 0.00 0.00 0.00 6,819.76 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income ..................................... ...... ^ c. retain a reversionary interest ....................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ~ ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ....... ....... ^ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................................................................. ....... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 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)J. • 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(a)(1)]. • The tax rale 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. T~-: ~ -s co et 1 r ~` ~- t~aj _ cis is a true copy of t;ze record. which) is on file in the Pennsylvania Department of Health, in accordance with t=.° V~tai Sratrstics E-a~.'<~ ~l~ 1953, as amended. a VI/ARNING: It is illegal to duplicate this copy by photostat or photograph. ~~:~~5~~ -»~. ~a~ ar~~ Marina O'Reilly Matthew State F:e~istrar Cate HtDS-Ida Rev nr2oo6 COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORDS TYPE /PRIM IN PERMgNeNr CERT{FICATE OF DEATH BLACK INK (See Instructions and examples on reverse) ~~ )I 1. Name t1 Decetlenl(First, mitldk, lass, sulfis) 2. Sex 3. Social Securiy Number d. Dale of Deem (Month, tlay, year) Robert L. Keith Male 197 - 34 - 0282 8/14/2011 5. Age (Las) Birthday) lkrtlm t a Under 1 tla 6. Date M e&rm Mmth, da , ea 7. Bill lace G' and stale or )oral count 6a. Piece of Deem Check onl on MorAS Oays Hours MlnNes H o spital: Other , y 69 vra. 8/4 (1942 Huntingdon, PA L9'InpaueN ^ ER / Oulpatienl ^ DOA ^ Nursing Home ^ Resrlence ^ Othcv - Speciy' ar. Couny of Deals & Cly, Boro, Twp. d Deem g' ~ 6d. Facdiy Name Qf not insatulion, give sheet antl number) 9. Was Decetlent d Hispanic Orym? S§' ND ^ Yes 1D. Race: American Intlian, Sled, While, etc. Cumberland East Pennsboro Holy Spirit Hospital otYe%%petiyDpban, tspaaM Mexican, Puedo Rican, etc.) 11. Decedent's Usual Oct abort Kindof work d e dodo most el works kte. Do not state retired 12. Was Decedent ever'm Cie i3. Decedent's Etlucalion (Specify Dory Itighesl gratle mmpated) 1d. Marital Status: Mameq Neves Married 16. Surviving Spouse gl wile, give maiden name) Kind of WwK KiM of Business/Industry U.S. Amred Forces? Elementary /Secondary IP12) College (1-4 or ba) Witlowed, Divorcetl (SpeciyJ Ca fain Prison [fives ^ N¢ 2 Wado 18. DecedenYS Meiling Atltlress (Street, city! 1bxn, s21e, zip code) Decatlenl's Ditl Decetlent 46 Trudy C7.rC1e gofual Residence na scats UA ToVmsn 17t. C$vea, Decedem n~ad in _ uarmv3an crop. Mechanicsbur PA 17050 ? t7b c°pny c'-tnnbPrland ° nd O No Dapadentnverwarnn gi Atiual Lknaa tt ciyl Bart 18. Feme(s Name (First, middle, last, suffix) 19. Homers Noma (First mitltlle, maiden surname) 20s. Informant's Name (TYpe 1 Print) 20b. Informant's Mating Adtlmss tetras), cgy I town, state, zip cotle) 1100 S. York Rd. Dillsb PA 17019 21 a. M ethod of D"spoeilion ^ cremation ^ Doratipn • 216. Data of DisposNOn (Monet, day, yeap 21c. Plate pl Disposi4on (Name of nmetery, crertrarorY or Omar pace) 21 d. Locafwn (Ciy /town, scare, zip coda) n S'r' Buda) ^ Removatrom to ~ W CremetbnraDOnalbnqutNONzstl 8/19/2011 Rolling Green Memorial Park Camp Hill PA 17 11 ^ Omar-S Esaminer/COmnM ^Ves^ No 0 s 22a. Sgnaluraol Sarv' cerM g az such) 22b. License Number 22c. Name and Atltlress of Feciliry Neill Funeral Home F Inc CA a 23e.c arty when nrtiyng 23a Cre bell d my knowledge. deem attuned at the time, date antl place staled. (Signature antl We) 230. License Number 23c. Date Signed (Month, day, year) physician not avalalsk a{ time of tleah to ~ ~ [~ ,~ _ Q, _ \ 7 T u~ - ~ use of seam. ~. r, V:~(a7. -:l.) 3 Q i 6 OL i- iu t Items 2426 must be completed by person 24. Tsne of DealGeS 26. Dale Prorouncetl Dead (Monet, tlay, year) 26. Wes Casa Referred to Metlical Exarrurer I Comner tar a Boson Other Than Cremation or Donation? who pronounces death J ~ M. 4 C(S ~ i ~ O t ^Ves ~~ CAUSE OF DEATH (See Inatruttlona all e:emplea) , Approximate imerval: Pad II: Enter other s vri front mntlKms mntrbufino tc ggaLh_ 2B. Did Tobacco Vse Cntrldsle to Deam? hem 27. Pad I: Eller the amain of events -tlise9sas, njuriea, or mmplicefims -mat daectty caused me deem. DO NOT enter Terminal events wch as cardiac acres), Onset to Death but not restating in me untledying cause given ~^ Par! I. ^ y ^ Probabl respiratory arrest, or ventnaWr fibrii'etion wMwut showing me eliobgy. List only ore cause on each line. y 8• ^ po Unknown INNEGUsiE CAUSE (Final tlkease or wndilbn restating in deem) C / ~ 29. C Female: _~_ J a Q~r Due b ( s a consequ~ent ~ r¢gnanl vermin past year 5•au¢ntiepy list nntlNOna, it arty, b_ ~~~ // / /~ /y/ ~ Metlxtpp t o the rouse Ilsled on kn a ^ Pre t al lure M tleath lan ^ o pusT Enl•r Cr UNDERLYING CAUSE (°f agce°t e 4' No pregnant, but pregnant wim.n 42 tleYs L (tliseese a'njury that inkkled fie t ~~~/~ ~ vents resuabg in deals) LAST. ! - of tleam ^ sue e ~ ^' 1"~ % a t 'rarrca Nd pregnant, but pre t 43 da year goon ys to t before tlealh ~] UnM°Wn it pregnant wimin the pas) year 30a. Was an Autopsy 300. Were AMapsy Fillings 31 Mannl d Death 32a. Date of Injury (Monet, coy, year) 320. Describe How Irryury Ocarred 32c. Place of Injury. Home Farm Sheet factory Pedormed? gvaYabk Prior to Corn lesion ° ~~~~~~ ^ , , , , O(hce BuiMing, arc. (Sp¢eM1 of Cause of Deatn? ILNarural Homicide ^ V ~ ^ Y ^ N ^ Acc'tlent Pestling Investigation 32d. Time of Injury 32e. Injury a1 Work? 32f If 7ransporlalim Injury (SpecMJ 32 . Location of in a ISlreel, i /town, stale g I ry cry ) es es o itl ^ B ^ C b N I b O t i tl ^Ves ^ No ^ Dover/Dperator ^ Passenger ^ Pedestrian uc e ou ¢ e erm ne e M ^ Omsr. Speuy 33a. CeNfier (abed oNy one? 33b. SignaWre and Tithe d Cediaer • CedAyirg physician (Pnysicrzn tertiyng rouse of tleath wFren another physician has pronounced tleam antl competed Item 23) ~ J~ To tM heel of my knprkdge, dnth occurred due to tM cause(s) end manna ea skied _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ V • PmnounGnq and earrMyMg pNyskkn (PMadan bNh Wonouncing tleaM antl ceNtying to rouse of tleam) r 33tl. Signed (Month, d~ er T° fns heel 01 my Nnosbdge, death acurred al tM time, dlde, and plan, and do t° me muse(s) end manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medkel EaamlrMr/Coroner f /"~ ~~ ~O// T Onllse basic of esxnlralfon and)orinvestigellon, in my opinion, death ottWmd at the time,date, and place, end tl w t°the cause(s)ell manMr as stated., ^ 3q. en~~Person Who CwrpleN~ Deem ()lam 21)iypa/Print ~~j l1 js~ / s j' j•~, 7" R s - fete D'bC t robe ^ ~ ] ~ a DaN Fkd (MO m, daY. Year) ~ ~ ~j a~ ~J ~ /j v / / I I .' I I L I /1 I lcJJ ~:tF -ttS'~' ~rl / G~N~I~ , . r ~ DisposNOn Permit No. ©./ ~ ~7 FJ ! 7 LAST WILL AND TESTAMENT OF ROBERT L. KEITH, JR. I, ROBERT L. KEITH, JR., currently residing in 5233 Windsor Boulevard, Lower Allen Township, Cumberland County, Pennsylvania, do make, publish, and <> l d b me i di il C ~~ ~ ~• ous y ma y . s prev e c o ~ ~ ; ~ _ _ ;~: ; _~ ' l~ -~, ARTICLE ONE f -~ ~ , ~: " IDENTITY OF TESTATOR'S FAMILY --- declare this to be my Last Will and Testament, hereby revoking all Wile and I declare that I am married to REBECCA ANN KEITH, and that all references in This Will to "my wife" are references to her. I have one natural child now living, MATTHEW SCOTT KEITH, and any reference in this Will to "my child" is intended to refer to him. My child has attained the age of 21 years. ARTICLE TWO PAYMENT OF DEBTS AND TAXES I hereby instruct my Executor(s) or Executrix(ces) to account for and pay all debts and taxes of my Estate from the gross assets of my Estate prior to any distribution provided for herein. Debts shall include, but not be limited to, funeral expenses, attorneys fees, ~ :~~ Page 1 of 10 r; ~ '~f ~~•f `.,v 1, ,~ other professional fees and executor/executrix fees or commissions. Taxes shall include, but not be limited to, federal estate taxes, inheritance taxes, property taxes and income taxes, regardless of whether such tax liability was incurred before or after my death. The purpose for my inclusion of this instruction is to insure that no class of beneficiary hereunder is treated differently than another with respect to distributions provided for herein because of my Estate failing to have sufficient funds to satisfy the liabilities set forth herein. Nothing herein should be construed to prohibit partial distributions of my Estate pending a final distribution provided that my Executor or Executrix is absolutely certain that sufficient assets remain to satisfy all such debts and taxes which are known to or reasonably anticipated by him or her. ARTICLE THREE DISPOSITION OF ESTATE I give, devise, and bequeath all my personal and real property or mixed property, tangible or intangible, to my wife, provided that she survives me by thirty (30) days. I give, devise, and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed, to my wife, provided that she survives me by thirty (30) days. Page 2 of 10 i .~ f :~ `i" ~~ _~ ~ ~ . ~ ~~ ti In the event that my wife predeceases me or fails to survive me by thirty (30) days, then and in that event only, I direct that all my personal and real property or mixed property, tangible or intangible, be liquidated and the proceeds distributed to my child. In the event that my child, should predecease me or fail to survive me by thirty (30) days, then and in that event, I direct that the predeceased child's share of my Estate shall pass to his issue, per stirpes. In the event that any of my child should predecease me or fail to survive me by thirty (30) days leaving no issue, then and in that event only, I direct that such share or shares of my Estate shall be distributed to my surviving heirs by law. In the e~Tent that any sum is to be distributed to a predeceased child's issue who has not yet attained the age of 21 years, then and in that event onl;~, I direct that said issue's share shall be distributed to the issue's biological mother to be held and administered together as custodial funds in a custodial account established and maintained pursuant to the Pennsylvania Uniform Transfers to Minors Act (PUTMA) or its successor or equivalent statute. In the event of the death, resignation, renunciation, or inability to act as custodian by the aforesaid biological mothers, then and in that event only, I appoint my attorney at law MICHAEL J. WILSON, of Camp Hill, Pennsylvania, to act as custodian of such funds. Page 3 of 10 E i,,~i ;i ,~ r' ~ °~ ' ~a~ ~~ ARTICLE FOUR EXECUTOR Appointment I appoint my wife as the Executrix of this Will. In the event of her death, resignation, renunciation, or inability to act in that capacity, then I appoint MATTHEW SCOTT KEITH, as Executor of this Will in her stead and place. My Executor or Executrix, whether original, substitute or successor, is referred to herein as my "Executor". No Bond Required No bond or other security shall be required of any Executor appointed in this Will. Compensation of Executor M,y Executor shall receive no compensation for services rendered to my estate. Powers My Executor shall have, in extension and not in limitation of the powers given by law or by other provisions of this Will, the following powers with respect to the settlement and administration of my estate: (1) To employ any attorney, investment advisor, accountant, broker, tax specialist, or any other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all services performed by any of them. Page 4 of 10 ~/ ;/ 1p ~; (l (r i ~L ~ s (2) To conduct alone or with others any business in which I am engaged or in which I have an interest at my death, with all the powers of any owner with respect thereto, including the power to delegate discretionary duties to others, to invest other property held hereunder in such business and to organize a partnership or corporation to carry on such business. (3) When paying legacies or dividing or distributing my estate, to make such payments, division, or distribution wholly or partly in kind by allotting the transferring specific securities or other personal or real properties of undivided interests therein as a part of the whole of any one or more payments or shares at current values in the manner deemed advisable by my Executor. (4) To hold and retain all or any part of my estate in the form in which the same may be at the time of my demise, as long as my Executcr may deem advisable, without diversification, and whether or not the same be of the character permissible for investments by fiduciaries. (5) To invest and reinvest any funds of my estate in such securities and other property, real or personal, as he shall deem advisable, whether or not such securities or other property be of the character permissible for investments by fiduciaries. (6) To borrow money for any purpose in connection with the administration of my estate or the trust created hereunder; to execute promissory notes or other obligations for amounts so borrowed; and to secure the payment of / 1; PageSof 10 :~~ r r ~, 4-: ~~~..~ ~ ;. ~ any amounts so borrowed by mortgage or pledge of any real or personal property of which I may die seized or possessed, or which may at any time form part of my estate in such amounts and upon such terms and conditions as my Executor may deem advisablf~. (7) To adjust, settle, compromise, and arbitrate claims or demands in favor of or against my estate, upon such terms as my Executor may deem advisable. (8) To exercise, at such times and in such manner as my Executor shall deem appropriate, any rights of election or other rights which may from time to time be available to them under the provisions of the Internal Revenue Code or any other tax laws, including, without being limited to, the power to make such decisions as my Executor may deem appropriate in all the circumstances (regardless of whether the decision in a particular case may be the most advantageous ane from the point of view of my estate as an entity). (9) To execute and deliver any and all instruments in writing which my Executor shall deem advisable in the exercise of any of his powers, authority or discretion. No party to any such instrument signed by my Executor shall be obliged to inquire into its validity or be bound to see to the application of any money or other property paid or delivered to my Executor pursuant to the terms of any such instrument. Any of the above powers may be exercised, except as otherwise ,, Page 6 of 10 `~ ~~~ a provided by law, from time to time in the discretion of my Executor without further court order or license. ARTICLE FNE WILL CONTESTS If any beneficiary or remainder man under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any share or interest in my estate established by this Will given to that contesting beneficiary or remainder man under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary or remainder man had predeceased me without issue. ARTICLE SIX GENERAL Effect of Inoperative Invalid, or Illegal Provision If any of the provisions of this Will or of any Codicils thereto are held to be inoperative, invalid, or illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully operative and effective so far as is possible and reasonable. The headings above the various provisions of this Will have been included only in order to make it easier to locate the subject covered by each provision and are not to be used in construing this Will or in ascertaining my intentions. Page 7 of 10 4 P. ~ i ~~ "~ fi IN WITNESS WHEREOF, I, ROBERT L. KEITH, JR., hereby set my hand to this my last Will and its accompanying Acknowledgment and Affidavit, consisting of ten (10) typewritten pages, on this f' r'~ _"rr day of '~ _-' ~`" ~-F ~: y 199$. (SEAL) ,'" `~ ROBERT L. KEITH, JR. Attestation Clause Signed, sealed, published and declared by ROBERT L. KEITH, JR., the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, all being present at the same time have subscribed our names as witnesses. ~~c~ ~a ,~``~ :1~'yt,- residing at ~ .~j'S~ ~~lsvk~(~y~/ p'~~% ~v/t %t.-~,~~~~ ?c<(z __.,-____~~ ,,r. .f I ~.1 .1 ~~ ~ b ~' residing at ^ _a `_. _ ~ .s _ _ ~ ,~~ ; _~ Page 8 of 10 ACKNOWLEDGMENT Commonwealth of Pennsylvania ) ss: County of is',,.rr~„~~~~tt,u.~ ) I, ROBERT L. KEITH, JR., whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ~ ;. ROB ~ T L. KEITH, JR. Sworn to or affirmed to and acknowledged before me by ROBERT L. KEITH, JR., the Testator, this F"~°~ day of -=-= ~t° ~°'~'-~ ~-%" ~ , 1998 ,~ ~j , Notary Public ttIOTARtAL SEAL fiIIICfiAEL J. WILSON, Notary Public Fairview Township York County Nly Commission Expires Jan. 28, 2042 Page 9 of 10 AFFIDAVIT Commonwealth of Pennsylvania ) ss: County of ~`u; •!~ ~ ~c ~..= f~~~~ ) .; ; J We, ~.~~~ ~ Ff>'.~ .'J ~%~fi%G ~~ y and -_ ~ ~-, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that he executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator, signed the Will as witnesses; and that, to the best of our knowledge, the Testator was at that timel8 or more years of age, of sound mind and under no constraint or undue influence. --_ .~ < < Witness Witness Sworn or affirmed to and subscribed to before me by ~~ ~t ~. {=,~ j ~~~' f5~:~~~~.t ~~ I and ~~t~i<{ ~.~ r'- l~ ~.~'~t ~.-f Witnesses, this r '7rn day of _~~-~L;;G.?,''-.`~ , 1998. G, ~. ~~T Notary Public NOTARIAL SEAL ~ M{CHAFE J. W1LSf?N, Notary Public Fairview t'ownshi~ York County My Cammfssion Exp(res Jan. 28, 20U2 Page 10 of 10 AFFIDAVIT Commonwealth of Pennsylvania ) ss: County of l.~Gl /~Ir ~F.:, 6~C.'1 lv~.e~ ) r~ rJ C7 We, ~~~,i ~~~~ ;'` ',~i~2 ~~ y and , _ , ~ , . ,, the (J witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that he executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator, signed the Will as witnesses; and that, to the best of our knowledge, the Testator was at that timel8 or more years of age, of sound mind and under no constraint or undue influence. _. ~, -~ _ - -~ . ~.~ 4 ~, ~ "~ ~ t - ~\ h~ Witness Witness Sworn or affirmed to and subscribed to before me by ~%~-~ ~~ ~- L`s ~ _~ ' ~5 ,.~ ~ ~ -F-~ 4 ~! and ~ r~i :<{ ,.: r'~• /3 : ~~ . ~'~ ~. c.= ii , Witnesses, this M ('7<~ day of r~~~ ~~'~~ ~~- ` , 1998. i' a . r: ~,: I. `L Notary Public ~. - a NOTARIAL SEAL ~ M{GHAEt_ J. t~1-N.SQN, Notary Public Fairview Tawnship York County My Commission Exp(res Jan. 28, 2002 Page 10 of 10 REV-1503 EX+ (~-11) pennsylvania SCHEDULE B DERAR7MENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert L. Keith, Jr. 2011-925 All properly jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size GD(i8f:: ~ PRUCO SECURITIES, LLC One North Jefferson St. Louis, MO 63103 The following are included in this check V N ~' Date Description m A g 10/11/11 CHECK ISSUED A N N m A O i+ ~D N_ N - Z - Z Z Z ~~ Z ~ Z ~ Z Z Z Z Z Z Z Z Z Z Z Z O O O O O October 11, 2011 Account No. YC2C-4676-5905 Check No. 9377207 CUSIP Type Payment Type Amount 1 CHK $7,204.50 Accounts carried by First Clearing, LLC, Member New York Stock Exchange and SIPC. PLEASE DETACH BEFORE DEPOSITING ~r Prudential SH-96-PRU1 P-1 ESTATE OF ROBERT L KEITH JR MATTHEUI' SCOTT KEITH EXECUTOR 1100 S YORK RD DILLSBURG PA 17019-9594 PRiJDl:N17h1, JIaNISON 20/2o FOCUS CL n L'CHECti STATEb1ENT 1 ~ ~ Daie of distribution: ~ September 28- 201 1 Reason for distribution: Redemption ~ ~ Account Number i 0031000084 i Check Number. 000950702 i i ~, Total Distribution: $L9-1~1.?1 Page I of i I Class ~~ / ~ I ~ Date llistribution ~l~~pe Share Price Shares Value Shares Redeemed -- 09/28/l i Gros; llisuibution 14.f40 13 ~J 77 51949.71 Net fund Distribution $1.949.71 I'.ndin~ Value 0.000 $0.00 Detach before cashing or depositing check N /. REV-i5o8 EX+ (ii-io) Pennsylvania SCHEDULE E DEPARTMENT Dr REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert L. Keith, Jr. 2011-925 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1988 Redman Mobile Home 18,000.00 2, Refund -United Healthcare Insurance Company -Health Insurance Benefit (see attached) 2,286.00 3. Refund -Office of the Controller Cumberland County -Burial Expense Refund (see attached) 100.00 4. Refund - Verizon Wireless (see attached) 79.04 5, Refund - DS Waters (see attached) 9.16 6. Refund -Sgt Grit, Inc. -Burial Expense Refund (see attached) 42.96 7. John Deere Model 2305 Compact Utility Tractor 12,000.00 TOTAL (Also enter on Line 5, Recapitulation) $ I 32,517.16 If more space is needed, use additional sheets of paper of the same size. Unite~1H27itnCar~, Insurance Company PO Box ?40819 Atlanta. GA 3i)3 4-~D819 THE ESTATE OF MR ROBERT L KEITH JR* 46 TRUDY CIF: MECHANICSBURG PA 17050-3638 If you have questions please contact us at: UnitedHeaithcare Insurance Company PO Box 740819 Atlanta, GA 30374-0819 TDLL FREE : 1 -80C-523--588;' TTY#,~ 711 ESPANO!_: ?-80C-822-026 PAGE 1 DF 3 SUMMARY OF BENEFITS MEMBERSH~~' ~ 031469429 DCTDBER 20, 2011 Paid to Paid to Provider(s) You Totals ~o . oo ~2 , 286 . o0 !f you suspect fraud. caN the Fraud Hotline at 1-800-242-0453 Please remember to submit your claims on a timely basis The certificate of insurance includes a time limit far submitting proof of loss ~~' Supplemental and Personal Health Plans ~ I;z~itedHealthcare InSUrance Compan~- C. Please detach check belovr and cash promptly -~3bb~? •C I~cc,c~ ca NNN~ ''cnana nz a:~sbn~r•. ?~°z'~z~ -+nbtn~-+ iFizn"a !s;~ b a~c~ IcnaCxtanz xbozr~c~ cn-a-3rt~a~ ~a"~OcnaOvai CC`~'L7~'=:~ 'C~~=r\~C=72x I O c1) !- a rn ~: x NU'! 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'C -' +C cls ~ '3 ' C U ~ fl :' ':= p '~ ~ •-, ~ < 3 Z C 1p " ME~z ax ~ c `~ ~' ~.~ d" b -~ ~ ~ ~' .~~ ~ ~ ~., H ~ ~ ~ ~ ~ r ~ C cn x ~~ :r o ~~ M . z ~ o~-- ~~ ccn .~ _ ~; ~ ~ ~ ~, A' - ~' ~ O "`'~ O r ~ ` co;~ z ~~o~; ~n ' ~- ~ '~ ~a ~ a ~; b ~ ~ ; i.' ~' G ~3 ~S C C' o ~ o ~' ~-, ' ;r Z ~ ~ ~ -' ~ ~ :n ' O ' O d Us ~ " CA ,Z" Q7 ~ ~ ~ C ti ~ I M ~- C!1 ~ -a _ C ~ x d < ~ = .~ 9 ~ ~ x ~ ~ ~ ` r~ ;, ~ n U. ~ ~ r .-~ CZ 7 Z ~" Z ~~~ y ~z;~T.N^ .. ,,., r. -- O ~-? cJ ~ ~ n < ;' ;~ N G ~ ..: C ''~y ~ w a v~ :~ :^ ~ p ~ z ,~ ~ ~+ ~ 1 7 ~z ~ .~ ~ > x N Y ~ - ~ .1 . T ~ ~ ~ x ~ ~ ~ ~ Z O c; ~ ~' Y .,. O ~ -s; "~„~ ~ ~ ~ C ~ CY G ~ ~ ~ z ~ ~- _ c ~ ~, ~ ~ r w {" !D :.J C `~ .. ' n 1 J .., ~, N ~ ~. O '~ N ~ O rJ C7 ~~ ~ ~r'," y ~. _ ~ ~- ~ _ ~ ~ o ~~ m : , ~ .< o ~- ~ , ~ ,, ~ ~ ;-. N G , '* ' ? d c', `-' p ~~ O 999017827 MATTHEW KEITH CHECK NUMBER 824330 DATE p9/O9/11 INVOICE NUMBER DATE DESCRIPTION GROSS AMT. DISCOUNT NET AMOUNT 82311VA 08/23/11 R Keith Jr-Buri 100.00 0.00 100.00 County of Cumberland TOTALS 100.00 0.00 100.00 PLEASE ADDRESS A\'Y CORR[SPOti DF: ~'CE REGA RUI\'G THIS ~'O UCHER OR TRAM1'SACTIOti TO THE OFFICE OF THE CO\TRO LLER, CUNBERLA h'D COI::S'TY COURT HOUSE. CARLISLE, PA. 17013. lerizon Wireless INVOICE NUMBER D0001A000001050383550722550277 INVOICE DATE DESK"',IPTION I GROSS I DISCOUNT ~ NET AMOUNT 1010412011 CREDIT REF ~D 79.04 79.04 Check No. Check Date Vendor No. Handling Code 11655354 10/06/2011 0011709014 VE Total 57s.oa $7s.oa Questions? Call 800/922-0204 g~ APCRF OR8978 DS WATERS OF AMERICA, INC ATTN: ACCOUNTS PAYABLE 5660 NEW NORTHSIDE OR. SUITE 500 ATLANTA, GA 30328 Address Service Requested 000315 RKDKSTIA DS Waters 1~ 1u CUSTOMER. REFUNDS 2011 R KEITH 46 TRUDY CIR ~_ MECHANICSBURG PA 17050 ~ (n~~~~n~~~~un~~~~~~~n~~~~n~~nn~~~~n~n~~r~~~~n~ur~~ 20317409 Page 1 of 1 Check Date: 09/14/2011 Vendor Number: 158739 62 Invoice Number Invoice Date P.O. Number Reference Gross Amount Discount Net Amount 12009183548063 09/03/11 QUESTIONS CALL 8004447873 $9.16 $9.16 $9.16 $0.00 $9.16 irk GRf1''., :'f~G. 224589 ROBERT L. KEITH JR 8/10/2011 77891 Refund Date Credit Memo Refund Amount Discount Net Amount Description 8/1!2011 18766 42.96 0.00 42.96 Order Number: 1257315 Check Total $42.96 Check Number 77891 ' REV-1Sog EX+ (01-10) j~i Pennsylvania DEPARTMENT OE REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Robert L. Keith, Jr. 2011-925 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Matthew Scott Keith 1100 S. York Road, Dillsburg PA 17019 Son Jamie L. Keith Daughter-in-Law B C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORJOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A . . 08105108 House and Acreage (see detailed appraisal attached with Deed) 265,000.00 1!3 88,333.34 2. TOTAL (Also enter on Line 6, Recapitulation) $ 88,333.34 If more space is needed, use additional sheets of paper of the same size. Mark Heckman Real Estate Appraisers 1309 Bridge Street, New Cumberland, PA 17070 r ne .........INVOICE ....,.... File Number: 1100SYork2011 Michael Wilson, Esq. 113 Iron Furnace Court Lewisberry, PA 17339 oaim2ol z Invoice # : 1100SYork2011 Order Date : Lewisberry, PA 17339 Reference/Case # PO Number Your Clients: Matthew and Jamie Keith 1100 S York Road Dillsburg, PA 17019-9594 Single Family Appraisal Report Invoice Total State Sales Tax @ Deposit Deposit Amoun[ Due Terms: PAID IN FULL Please Make Check Payable To Mark Heckman Real Estate Appraisers 1309 Bridge Street New Cumberland, PA 17070 Fed. I.D. #: Available upon request. This firm is a sole proprietorship. Thank you for using our services- $ 300.00 -------------- $ 300.00 $ 0.00 ($ 300.00 ) ($ ) -------------- $ 0.00 PH (717) 774-7202 FAX (717} 774-0383 EMAIL heckmanappraisers(d3comcast.net Mark Heckman Real Estate Appraisers 1309 Bridge Street, New Cumberland, PA 17070 no. APPRAISAL OF Single Family Residential Appraisal LOCATED AT: 1100 S York Road Dillsburg, PA 17019-9594 CLIENT: Michael Wilson, Esq. 113 Iron Furnace Court Lewisberry, PA 17339 AS OF: August 14, 2011 BY: Mark W. Heckman, Certified General Appraiser Commonwealth of Pennsylvania Certification No. GA000666L PH (7171 77d-77n7 FAX /7171 77d_n3A3 FMAII hero mnnnnnraicure(rTrnmr~ef nut Mark Heckman Real Estate Appraisers Residential Appraisal Report File No 1100SYork2011 The purpose of this appraisal report is to prowde the client with a credible opinion of the defined valise d the subject progeny, given the irnended use of the appraisal. diem Namenrnended User Michael Wilson Es E-mail attorne michael'wilson michael' ilsonlaw.com cliern Address 113 Iron Furnace CouR ci Lewisber State PA zi 17339 Additional Intended Users Matthew and Jamie Keith Intended use Estimate market value as of effective date for ossible rte otiations with moR a e lender Pro Address 1100 S York Road Ci DiIlSbur State PA zi 17019-9594 owner of Public Record RobeR L Keith Jr. and Matthew S Keith coon York L al Descri ion Deed Book: 1981 Pa e: 0213 " Assess« s Parcel a 67-49-000-OD-0087-00-00000 Tax Year 2011 R.E. Taxes S 1 074.00 Nei hbahood Name Waffln ton Townshi Ma Reference See Assessors Parcel # Census Tract 0203.20 Pro Ri hts A aised Fee Sim d Leasehold Other describe research did did not reveal a irx sales a translers d the sub t la the three ears for to the effective date d this a sisal. Prior SalesTransfer Date None within the ast 3 Price ears. sources Deed Analysis of prig sale a vansfer history of the subject property (and comparable sales, if applicable) Aeeordin to information rovided b the multi-list services in this re ion the sub'ect roe has not been listed for sale within the ast three ears. Accordin to the Deed the sub ect roe has • not transferred within the past three years None of the com arable sales transferred within the prior year of their recent sale date. Offerings, options anA contracts as of the efledive date of the appraisal N/A Nei hlxrxhrwd Charactarlsdcs Ona-Unit NousingTrends Ona•Unit Housi Present Land Uss% Location Urban Suburban Rural Pro ert Values Increasi Stable Declinin PRICE AGE One-Unit 75 % Built-U Over 15% 2575% Under ZS% Demand$u ShrMa a In Balance Over Su I E 000 s 2~4 Unit 5 % Growth Ra id Stable Slow Markets Time Under 3 mths 3-6 mths Over 6 m(hs 81 Low New Multi-Famil 2 % ~ Neighbahood Boundaries See Attached Addendum 485 Hi h 100+ Commercial 5 % 220 Pred. 25 Omer Vacant 13 % ~ Neighborhood Description The sub'eCt roe is in a rural Rion of this re ion. A substantial ortion of the surroundin land in the area is " a ricultural and woodlands. Market activi indicates avers a or better acre tance in the market lace. No unfavorable factors were observed which would adversely effect marketability Market Conditions (including support fa the above conclusions) See Attached Addendum Dimensions See le al descri lion. area 33.42 Ac Sna Irre ular view Avers e S cif¢ Zoni Classification Conservation zoom Dexri lion Sin le-tams! detached dwellin s are ermitted. Zonin Com liance X Le al Le I Nonconlormi Grandfathered Use No Zoni III al describe Is the highest and best use d the subject property as improved (or as proposed per plans and specifications) the present use? Ves No If No, describe. See Attached Addendum Utllltles Public Other describe Public Other describe O//~sitelm rovements-T a Public Private Electrici 100 AMP water Well street Stone Gas None Sanita sewer Se tic one None Site Comments The sub'ect is located on a rivate maintained road that is shared b three roe owners. As er Warrin ton Townshi the creation of an additional tots is rohibited alon a rivate street. Site has avers a site im rovements avers e landsca in and seal maintenance. The site im rovements and services to the site are ade uate and acre table in this market. There are no a arent adverse easements encroachments or other adverse conditions on this site. Private wells and se tics stems are common in this area. GENERAL DESCRIPTION FOUNDATION E%TERIORDESCRIPTION materials INTERIOR materials Unds One (k,e wiacc. unit Concrete Slab Crawl S ce Foundation Walls Cone 810Ck Floors HW C t Y of Stories 1 Full Basement Partial Basemem Exterior Walls Stone vn I Walls DW Panel T Dec Att. S-Del/End Unit Basement Area 240 tt. Roof Surface Shln le Rubber TrimlFinish WOOd Existin Pro vd Under Const. Basement Finish 0 % Gutters & Downs uts Aluminum Bath Floc Ceramic Tile Desi S le Ranch Outside En /Exit Sum Pum WirdowT Dbl. Hun DI Bash Wainscot DW Fiber 1855 Vear Built 1900 Storm Sash/Insulated NO/$OITIe Car Slaa e None Effective a rs 15 Screens Some Urivewa R o1 Cars 2 Anic None Fleatin FWA HW Radiant amenities WoodStove s M Drivewa Surface Stone Dr Stair Staus Other Fuel Oil r-Ire ace s ~ fence Gara e A of Cais 2 Flnnr Scuttle Codin Cernral Ax Conditionin PatidDeck Porch Iar rt l of Cais Finished Healed IMividual Other Paxl Other Att. [kt. Builcin a Dances Rmn erata Ran !Oven Dishwasher Des sal Microwave Washer! er Other dex:nbe ~ Finished area above c rade corrtains. 5 Rooms 2 Bedrooms 1 Bath(s) 1 152 Square Fmt of Gross Living Area above Grade addnpnal Feauaes The sub'ect consists of two bedrooms one full bath and livin room and dinin area combination kitchen and enclosed heated orch/den which is current bein used as a bedroom. Oversized two-car detached ara e' covered rch' den has hardwood fluorin and crown rnoldin remodeled bath has a tub and se arate shower new roof over ara a and new car etin in the house. Commerns on one Improvements These im rovements are of averse uali frame desi nand reNect avers a maintenance. The followin items of deferred maintenance are noted: double hung windows are in poor condition and need to be replaced, the leanin chimne needs to be re soled and the exterior stone pointing was poorly done and needs to tx: repointed _ The ceilin hei ht in the main house is 7 5' and considered functional obsolescence. __ ;lnnrr,f nq A(i •.~rtwne iU.1D 111 N])] wy,v,rU~rm I!,n .rm r „y,ye ° }IYItl010 ~ : r,ll ~.- M _~ N r1 ~~~~~' n„qe i X11 Il AC. ) fei~rral N ry _ P~,uvl N 75!2011; ~~ .~'Ak M4 Iln,2k0i.1 Mark HeGcman Real Estate Appraisers Residential Appraisal Report Flle No 1loosvorkzoll FEATURE SUBJECT COMPARABLE SALE N0. 1 COMPARABLE SALE N0. 2 COMPARABLE SALE N0. 3 1100 S York Road Address Dillsbur 411 Mumper Lane Dillsbur 480 Cabin Hollow Road Dillsbur 265 Beaver Creek Road Dillsbur Proximi tosub~ n 3.97 miles WNW 3.83 miles WSW 1.27 miles SE Sale Price S S 265 000 S 330 000 E 300 000 Sale PricdGross Liv. Area s 0.00 . n. S 163.68 . n. S 199.28 . tt. S 204.78 . n. Data Sources Assessment Records &MLS Assessment Records &MLS Assessment Records &MLS verification sources Assessment Records &MLS Assessment Records &MLS Assessment Records &MLS VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION .~ saa vrM+x DESCRIPTION .~ saervm•n DESCRIPTION .(~ sae v m Sale or Financing concessions Conventional None Known Conventional None Known Conventional None Known Date or Sale/Time 8/05/2011 10/22/2009 7/2512011 Laauon Rural/Avera a RuraUGoOd -5 000 Rural/Good -5 000 RurallAvera e LeasetalNFee Sim le Fee Sim le Fee Sim le Fee Sim le Fee Sim le site 33.42 Acres 12.87 Acres +62 000 11.04 Acres +67 000 20.70 Acres +38 000 View Avera a Avera a Avera a Avera e Desi s le Ranch/Avera a Ranch/Good -15 000 Ranch/Good -15 000 Ranch/Avera e • Quali of Constrtlcbon Avera a Good -15 000 Good -15 000 Avera e ~ Actual A e 111 Years 33 Years 26 Years 43 Years condition Avera a Avera a Good -15 000 Good -15 000 Above Grade • rn,d se,ms earns ro,d cams ean~ Tad aAm,. earns rad aomn e:rcns RaamCount 5 2 1 6 3 2 -4 000 7 3 1.5 -2 000 5 2 2 -4 000 Gross Area 20.00 1 152 . n. 1 619 . n. -9 300 1 656 . n. -10 100 t 465 a -6 300 • Basemerrt&Finished • Rooms Below Grade Part. Basement Unfinished Full, Exp.lMkout Unfinished -12,000 Full Basement Recreation Rm -10,000 -8 000 Full Basement BR F-Bth -10,000 -6 000 Frmctlonal uua Avera a Avera a Avera a Avera e • Heatin Coolin Oil HW NO CA Oil HW NO CA EBB EHP CA -3 000 EBB No CA Ener Efticiern Items T ical for A e T ical for A e T ical for A e T ical for A e tiara e/car ort 2 Car Det tiara e 2 Car Att tiara a -2 000 1 Att tiara a +2 000 3 Car Det Gar -3 000 Porch/PatidDeck Porch Patio Encl. Por Deck -4 000 Stn Patio Fire lace None None None 2 Fire laces -4 000 Other None None 2 L Pole Barns -30 000 Sm t S Home -25 000 Other None None L Gazebo -5 000 None Net Adustrnent Tmal S 300 S 53100 E 35300 Adjusted Sale Price orCom rabies Net Adj. -0.1 % Gross Ad 46.9% f 264 700 Net Mj. -16.1 % GrossAd. 57.9% E 276 900 Net Adj. -11.8% GmssAd. 37.1% E 264 700 Summar d Sales Com arson Approach See Attached Addendum COSTAPPROACH TO VALUE Site Value Comrnnnts ESTIMATED R[PRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE .... .... ...... - S Sorace of cost data Dwellin 1 152 S . Ft c? S - S 0 Quali rati from cost service EBective date of cost data BSmt: 240 S . Ft. S . Ft. r~ E S 0 • Comments on Cosl A r>ach oss livin area calculations, de eciation, etc. In view of the a e of these im rovements the Cost A roach Cara elcar 0 5 . Ft. ~ s - f 0 • cannot be considered an accurate indicator of value. Total Estimate wcosaNew - s 0 Less Ph ical Functional External De eciation _ = f I 0 De eciated Cos[ of Im ovements S 0 'A5-i5' Value of Site tin rovements - S INDICATED VALUE BY COST APPROACH......... - S 0 INCOME APPROACH TO VALUE Estimated Momh MarkM Rent f X f.,rrxs Rent Muniplier = S Indicated Value by hxome Approach • Summary of Income Appoach (incltxting support for market rent and GRM) _ Indicated Valueb ~. Sales Comparison AODroaChS 265 OOO C tAppr h('/d 1 p Att 0 I me Approach (i/AevelorxA)3 -- See Attached Addendum This aplxaisal is made 'as ~s,' wblc¢I to rompletion per plans and speuhcatiws on the basis or a hypolhencal cmxliUnn that the improvements have been unnplr•IeA, ^ su0~ect to the lollowmg mparts or alterations on the basis of a hypdhetical cnndrtgn Ihat the repairs ~x atir+ations have Ixaen canpleted ^ suhiect Io the !nlhrwinq • See Attached Addendum Based on the scope or wrrrk, assumptions, limillrrg coral pions and appraiser's certificatlorl, my (our) opinion or the defined value of [he real property that is the suhlcr:t o(this report Is S 265,DDD as or AUgUSt 14 2011 , which is the effective date ot[his appraisal. r,r. m , ->.~ ,.,pTm, rv.W7 1r. .. r..m o +rIPAU 1 .,n>:v N p M>' nurk,M ]S oia Mark Heckman Real Estate Appraisers Mark Heckman Real Estate Appraisers Residential Appraisal Report file No 1100SYork2011 Scope of Work, Assumptions and Limiting Conditions Scope of work is defined in the Uniform Standards of Professional Appraisal Practice as "the type and extent of research and analyses in an assignment." In short, scope of work is simply what the appraiser did and did not do during the course of the assignment. It includes, but is na limited to: the extent to which the property Is identified and inspected, the type and extent of data researched, the type and extent of analyses applied to arrive at opinions or conclusions. The scope of [his appraisal and ensuing discussion in this report are specific to the needs of the client. other identified intended users and to the Intended use of the report. This report was prepared for the sole and exclusive use of the client and other identified intended users fcx the identified Intended use and its use by any other parties Is prohibited. The appraiser is not responsible for unauthorized use of the report. The appraiser's certi0cation appearing in this appraisal report Is subject to the following conditions end to such other specific conditions as are set forth by the appraiser in the report. All extraortlinary assumptions and hypothetical conditions are stated in the report and might have affected the assignment results. 1. The appraisa assumes no responsibility for matters of a legal nattre aBectxg the property appraised a title thereto. nor does [he appraiser render any opinion as to the title, which is assumed to 6e good and marketable. The property is appraised as though under responsible ownership. 2. Any sketch in this report may show approximate dimensions and is included only to assist the reader in visualizing the property. The appraiser has made no survey of the property. 3. The appraiser ~s not required to give Testimony a appear in Court because d having made the appraisal with reference to the property in question, unless arrangemerns have Deen previousty made thereto. 4. Neither all, nor any part d the content d this report, copy a other media thaed (including conclusions as to the property value, the ideaity oRhe appraise, professional designations, a the hrm with which the appraise is connected), shall be used fa any purposes by anyone Dut the client antl other intended users as identified in tMS report. nor shall rt be amveyed by anyone to the public through advertising, public relations, news, sales, a other media, without [he written consent of the appraiser. 5. The appraiser will na disclose the conteas of this appraisal report unless required Dy applicable law or as specified in the Uniform Standards d Professional Appraisal Practice. 6. Information, estimates, and opinions furnished to the appraiser, and contained in the report. were obtained from sources considered reliable and believed to be true and correct. however, no responsibility for accuracy d such items furnished to the appraiser is assumed by the appraiser. 7. The appraise assumes that there are rw hidden a unapparenl condtions d [he property, subsoil, or structures, which would render it more a less valuable. The appraisa assumes no responsibility fa such conditions, or for engineering a testing, which might De required to discover such factors. This appraisal is na an environmental assessment d the property and should not De considered as such, B. The appraiser specializes in the valuation of real property and is not a home inspecta, bolding contracta, structural engineer, a similar expert, unless otherwise noted. The appraiser did not conduct the intensive type d fieltl observations d the kind irnended to seek and discover property ~fects. The viewing of the property and any improverttents is fa purposes of developing an opiNOn of the defined value d the properly, given the intended use of this assignment. Statements regarding condition are based on surface observations only. The appraisa rlaims no special expertise regarding issues including, Dut na limited to'. foundation settlement basement moistt+e problems, wood destroying (a other) insects, pest inteslation, radon gas, lead based paint mdd a environmental issues. Unless otferwise indicated, mechanical systems were not aaivated a tested. This appraisal report should na be used Io disclose the condroon d the property as M1 relates to the presence/absence d detects. The client is invited and encouraged to employ qualified experts to inspect and address areas of concern. If negative conditions are dixovaed, the opinion of value may he affected. Unless otherwise noted, the appraiser assumes the components that constitute the suDJect property improvement(s) are fundamentally sound and in working order. Any viewing of the property by the appraiser was limited to readily observable areas. Unless otherwise noted, attics aril crawl space areas was nd accessed. The appraiser did na move furnitwe, floa roveings or other items that may restrict the viewing d the property. 9. Appraisals involving hypothetical contlilions related to completion of new consVUCtion, repairs a alaation are based on the assumption [hat such completion, alaation a repairs will be competently performed. 10 Unless the iaended use d this appraisal specifically includes issues of property insurance covaage, this appraisal should na 6e used fie such purposes. Reproduction ur Replacement cost figures used in the cost approach are fa valuation purposes only, given the intended use of tfte assignment. The Dehninon of Value used In this assignment is unlikely to 6e consistent with the definition of Instxable Value la property insurance covaage/use. t 1. The ACI General Purpose Appraisal Report (GPAR'"') Is not intended for use in transactions that require a Fannie Mae 1004/freddie Mac 70 form, also known as the Uniform Residential Appraisal Report (URAR). Additional Comments Related To Scope Of Work, Assumptions and Limiting Conditions t Fqe t W r ianna~.,l r..,..,i n„ rmP n~w,x:nm~r mrzma .. rnseunn Mark Heckman Reat Estate Appraisers Kesidenual Nppra)sat Keport Filo No 11 UUJYOrKZV11 Appraiser's Certification The appraiser(s) certifies tha4 to the best of the appraiser's knowledge and belieL 1. The statements of fact contained in this report are tore and cortect. 2. The reported analyses, opinions, and conclusions are limited only by the reported assumptans and limning conditions and are the appraiser's personal, impartial. and unbiased professional analyses, opinions, and conclusions. 3. Unless otherwise stated, the appraiser has no present a prospective interest in the property that is the subject of [his report and has no personal interest with respect to the parties involved. 4. The appraiser has no hies with respect to the property that is the subject oRhis repel a to the parties involved with this assigrnnerrc. 5. The appraiser's engagement in this assignment was not con6ngem upon developing or reporting pedetermined results. 6. The appraiser's compensation la completing this assignment is rat comingem upon the development or reporting of a predetermined value or direction in value that favrxs the cause of the diem, the amoum of the value opinion, the attainment of a stipulated result. a the occurterce of a subsequent event directly related to the Intended use of This appraisal. 7 The appraiser's analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity wnh the Unrform Standards of Professional Appraisal FYactice. 8. Unless otherwise rated., the appraiser has made a personal inspection of the property that is the subject of this report. 9. Unless need below, ne~ one provided significant real property appraisal assistance to the appraiser signing this certification. Signiricam real property appraisal assistance provided by: Additional Certifications: Definition of Value: ®Market Value ^Other Value: Source ur Definition: USPAP 2010 The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller each acting prudently and knowledgeably, and assuming the price is not affected by undue stimulus. ADDRESS Of THE PROPERTY APPRAISED: 1100 S York Road _ Dillsburg, PA 17019-9594 _ EFFECTIVE DATE OF TI1E APPRAISAL: AUpUSt 14 2011 _ APPRAISED VALUE OF THE SUBJECT PROPERTY S 265,000 APPRAISER 1. `~ Signature •~ ~ ~1A~''~J Name: Raetta outlets, PA Cert. Resid. R.E. Appr. _ stare Cernfcationt RL138741 ,x License f a Other fdescnhel: Slate F. State: PA Expmanra Date M Cendn.anon a License. 6/30/2013 Date nl Signanre and Repnn 04/17/2012 Data of Property W.*wmg March 28, 2012 Degree n( property viuwinq ®Intenw and Exteror ^ Ext~ninr Onty ^ Dx1 iat personally view ~~r~ar~~ SUPERVISORY APPRAISER Signawfe~ ~9a~~d-.,--`. Name. Ma; W. Heckman PA Cert. General R.E. Appr Store Certiecatian t GA000886L _ ur Licem,e r stale PA _ Expiration Date of Certification a License: 8/30/2013 Datu d Sgnaure. 04117!2012 Date of Property Viewing: March 28 2012 __ Degree eA property viewing. ®Imerrtx and Exterior ^ Exterux Only ^Db rot pnva:dly ;iew ~YMurM wgAri viR~,e. Wx114 Ar11 rww viw.n~nn I.n M1Vm'iYMVYY YM IIIIII nCi':1vn.n,r'.VI ~',ima 4r+r~-aw er vv~n Pyy A,t / fyV0.R^') rw„,.,nl Riww A~ru.r..i rnY~itY„ ,~-_. Mark Heckman Real Estate Appraisers ADDENDUM Client Michael Vvtlson Esg __ File No.: 1100SYork2011 _Property Address 1100 S York Road Case No ~ - City: pillsburg State: PA Zip: 17019-9594 Neighborhood Boundaries The subject property is located in Warrington Township. Neighborhood boundaries inGude E Lisburn Road to the north, Rosstown Road to the east, Carlisle Road to the south, and Route 1 S to the west. Insufficient sales in close proximity to the subject property require the appraiser to extend search parameters. Neighborhood Market Conditions Market conditions in the subject's neighborhood has been favorable in recent years due to consistently low mortgage interest rates. Housing values have appreciated at a moderate rate as well. However, the market in this area has slowed and residential dwellings are being marketed for longer periods; typically 120 days or less. Appraisers have also encountered more seller concessions/assistance than in recent years. If interest rates stay at a moderate level and the local economy remains the same, home prices should continue to remain stable. Highest and Best Use The subject property is located among properties of similar appeal and the improvements have adequate economic life remaining to warrant their continued use as a residence. Comments on Sales Comparison The range of values for this report is outside of normal guidelines. This was unavoidable due to the lack of comparable sales. The appraiser did extend search parameters to a 15 mile radius to find similar homes. The appraiser has selected the best comparables available currently. After a thorough search of all available market data, the three sales used are considered to be the best indicators of value. All three sales are considered to be reliable indicators of value, and are weighted similarly in the final reconciliation. In order to find comparable sales, it was necessary to use less recent sales. Appropriate adjustments have been made for all differences. Comparable sales used are all closed sales. Differences in site area are adjusted at a rate of $3,000 an acre. A small site adjustment is warranted due to the fact that the land surrounding the subject is not subdividable and the ground around the subject improvements is wet and marshy. A Design and Appeal Adjustment is warranted For Comparable Sale Nos. 1 and 2. It is noted that Comparable Sale Nos. 1 and 2 have three bedrooms while the subject has two. Other sales with two bedrooms were significantly different in location, size, age, special conditions and design, and were not used for that reason. Those chosen are the best available. Comparable Sale No. 3 includes a one-story detached home on the property. An adjustment is warranted. Final Reconciliation THE APPRAISER HEREBY CERTIFIES THAT THIS REPORT HAS BEEN PREPARED IN COMPLIANCE WITHIN THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE(USPAP), THAT THE APPRAISER IS A DISINTERESTED PARTY AND THAT THE VALUE STATED IN THIS REPORT IS ACCURATE TO BEST OF THE APPRAISER'S ABILITY, AND THIS VALUE HAS NOT BEEN PREDETERMINED. See attached appraiser's certification and Statement of Limiting Conditions. The appraiser considered only those items that were permanently attached to the property as realty. Any items not so affixed such as refrigerators, washers, dryers, above ground swimming pools, etc., were not included in the estimate of market value. The opinion of value stated in this appraisal is based upon market conditions present as of the effective date. This appraisal assumes a reasonable marketing period for the subject property of four months. The Sales Comparison Analysis reflects recent activity in the market place and is given the most weight. In view of the age of these improvements, the Cost Approach cannot be considered an accurate indicator of value. The Income Approach is inappropriate because few single family houses are rented in this market. This appraisal is based on readily observable conditions and is not to be considered as a thorough home inspection to analyze or warrant the subject property andfor its mechanical systems. Conditions of Appraisal This appraisal report has been prepared with the property In "as is" condition. The appraiser considered only those items that were permanently attached to the property as realty. Any items not so affixed, such as refrigerators, washers, dryers, above ground swimming pools, etc., were not included in the estimate of the market value. No personal property has been incuded in this valuation. THE APPRAISER MAKES THE HYPOTHETICAL ASSUMPTION THAT THE CONDITION OF THE SUBJECT PROPERTY AS OF AUGUST 14, 2011 WAS IN AVERAGE CONDITION. ACTUAL DATE FOR THE PROPERTY INSPEC'f1ON IS MARCH 2$, 2012. !~dderc-xn Page 1 d 1 Mark Heckman Real Estate Appraisers USPAP ADDENDUM file No 1100SYork2011 Borrower: PRIVATE Property Address: 1100 S York Road City: Dillsburg County. York State: PA Zip Code: 17019-9594 Lender: Michael V/tlson Esg ur~r~i+nr~nw~ nr r nr•wr+~ n This Appraisal Report is pig of the following types: ^ Self Contained (A written report prepared under Standards Rule 2 2(a), pursuant to the Scope of Work, as disclosed elsewhere in this report.) ® Summary (A written report prepared under Standards Rule 2 2(b), pursuant to the Scope of Work, as disclosed elsewhere in this report.) ^ Restricted Use (A written report prepared under Standards Rule 2 2(c), pursuant [o the Scope of Work, as disclosed elsewhere ~n this report, restricted to the stated intended use by the specified ciient or intended user.} Reasonable Exposure Time My opinion of a reasonable exposure time for [he subject property at the market value staled in this report is: 120 daVS. The market appears to be stabilizing and while housing prices on a national basis are said to be declining, the Central PA market, in genera{, has not seen this type of depreciation. However, the market in this area has slowed and residential dwellings are being marketed for longer periods; typically 120 days or less. Additional Certifications Q I have performed NO services, as an appraiser or in any other capacity, regarding the property that is the subject of this report within the three year period immediately preceding acceptance of this assignment. ^ I HAVE performed services, as an appraiser or in another capacity, regarding the property that is the subject of this report within the three-year period immediately preceding acceptance of [his assignment. Those services are described in the comments below. Additional Comments Clarification of Intended Use and Intended User: The Intended User of this appraisal report is the lenderlClient. The Intended Use is to evaluate the property that is the subject of this appraisal for fair market value, subject to the stated Scope of Work, purpose of the appraisal, reporting requirements of this appraisal report form, and Definition of Market Value. No additional Intended Users are identified by the appraiser. APPRAISER: SUPERVISORYY AP~PR~AIS~ER (only it required): Signature -x~~~`L"~'~ Signature: -1 Name: Raetta Souders, PA Cert. Resid. R.E. Appr. Name: M W. Heckman, PA Cert. General R.E. Appr. V Date Signed: 04/1712012 Date Signed: 04/1 712 0 1 2 __! State Certification F: RL139741 State Certification K: GA000666L or State License p: _ or State Lkense -: __- or Other (describe): -_ State ~ State: PA _~- State: PA Expiration Date of CerGfica6on or License. 6/30/2013 _~ Expiration Date of Certilicauon or License: 6/30!2013 ~S~~u ervisory Appraiser inspection of Subject Property: Effective Date of Appraisal: Au ust 14 2011 LJ Did Not ^ Extenoronly from strr>et ®Interior and Exterior FLOORPLAN SKETCH Client: Michael Wilson Es File No.: 1100SYork2011 Pro ert Addre55:1100 S York Road Case No.: City t)illsburg State PA Zlp: 17019-9594 Sketch by Apex IV WindowsTM AREA CALCULATIONS SUMMARY Goda Description Siza Totals GLA1 First Floor 960.00 First Floar 192.00 1152.00 P/F covered Porch 266.00 269.00 TOTAL LIVABLE (rounded) 1152 LIVING AREA BREAKDOVNV Broakdown Subtotals Fi rat Floor 24.0 x 40,0 960.00 9.0 x 24.0 192.00 2 Areas Total (rounded) 1152 PH (717) 774-7202 FAX (717) 774-0383 EMAIL heckmanappraisers~comcast net DIMENSION LIST ADDENDUM Client Michael Wilson Esg File No.: 1100SYork2011 Property Address 1100 S York Road Case No.: Cit : Dillsbur State: PA Zi :17019-9594 i1~.x„M u.vq ai ~ v~n.~xe. IN/1 ]11 fl): I wn.v~w,4, mn ~, 4,1tt:~~1f0] Area Measurements Area Type Measurements Factor Total Levelt Level2 Level3 Other Bsmt. Garage 40.00 x za oo x 1.00 = sso.oo OO D O O O O v24.00 x 8 00 x 1.00 = 192.00 x x _ ^ ^ ^ ^ ^ ^ x x _ _ X % _ X x ^ ^ ^ ^ ^ ^ _._ x z z _ ^ ^ ^ ^ ^ ^ _ x x x _ _, x x _ _, x x _ _ x x _ _ x x _ _~ x x _ _ x x _ _- z x _ O O O x X= D D D x x _ x x _ O O D x x= O O O _ x x __ x x _ _, _ X x_ ^ O O O O O _ -- x x _ % X __ _- x x _ x x _ D O O __ X X= D O O _, x x _ ___ X X _ X x = D ^ ^ D ^ ^ x x ~,_ X X _ ^ ^ ^ ^ ^ ^ _-- x x _ __ x x _ O ___ x x _ ^ ^ ^ ^ ^ __ x x _ X X _ _ __ x x_ ^ D ^ ^ D D _~ x x ~ _ __^ X X _ D O __ x x= O O O _~ x x ~ _ ° ° ° ° ° _x X= ^ ^ a o __ x X_= o D ^ D ^ o __ x x _ -- x x __ X x _ ^ D ^ ^ ^ (~ .__ a X D D ^ ^ ^ ^ GROSS BUILDING AREA (GBA) 1,152 GROSS LIVING AREA (GLA) 1,152 Area(s) Area %ofGLA %ofGBA Living 1,152 100.00 Leve11 1,152 100.00 100.00 Level2 0 0.00 0.00 Leve13 0 0.00 0.00 01her 288 25.00 25.00 GBA Basement ^ 0 Garage ^ 0 ^ SUBJECTPROPERTY PHOTO ADDENDUM Client: Michael Wilson, Esq. file No.: 1100SYork2011 Property Address: 1100 S York Road Case No.: Cit : Dillsbur State: PA Zi :17019-9594 FRONT VIEW OF SUBJECTPROPERTY Appraised Date: August 14, 2011 Appraised Value: E 265,000 REAR VIEW OF SUBJECT PROPERTY STREET SCENE Client Michael Wilson Esg File No.: 1100SYork201 t Property Address 1100 S York Road Case No.: Cit : Dillsbur State: PA Zi :17019-9594 Two-Car Detached Garage Rear and Side Vew of Subject Double hung windows need to he replaced. '+"`9 ~f I -mwwe. Y(YI.!l~ fl11]..w.u r«p r.in 1 =~'~~ '"':' h ~s ._ , ~ `, ;, ~~~ ^xt ~ f - .. .~ ,f t .~~. - ..'~r~ ~. Doub4e hung windows need to be replaced. Stonework needs to be repointed. Chimney is leaning and needs to be repointed. IYrM[eU VSng MlvMlwne fif1p 1118111 .ww.~r,+:M tam Client: Michael Wilson Esq. File No 1100SYork2011 Property Address. 1100 S York Road Case No.: Cit : Dillsbur State: PA Zi :17019-959a Living Room and Dining Area Bath .yw wn n~ nrv «...x~.,a ~~ n. ~ i , irzmn Kitchen Kitchen Cabinets Water infiltration in basement. ~, .,gym ~.,.y.c~ .am,.,.. mn v. xm-.....,~,.,., ~ ~m COMPARABLE PROPERTY PHOTO ADDENDUM Client: Michael Wilson, Esq. File No 1100SYork2011 Property Address:1100 S York Road Case No.: Cit : Dillsbur State: PA Zi :17019-9594 -- --tip ,r ~ __. Vii.- r~ l ~~~.~ ~~ i ~, .ti, 1~ ~ y .. ,.,,.1 ~. ~ -. ~. .r e r ~~~ k ~~ ,~'' w i:, t ~ .. . . ',r ~ r ,~ I j 4 .~ ,, ;~ a y. ,,,~,~,,„ ..,., ., ,.~ ~. ; .m, _ _ -.~ _,. ,.....,. ~. w. _-_ _. _ _. •' /~yY',t ~ -!V <~ . ~ I I i ~ ~- w.r ~ ~ *~;. ~ `~ , ,~' ~ `` ~ ti ~ ,k*s~ • l: ii :~, M ~s+.1 Y ~~~ ' ft~w T~ufi ~^'~1,y~,~ I .. , ~ ~ ~ sr'~`'N :. COMPARABLE SALE #1 411 Mumper Lane Dillsburg Sale Date: 8!05/2011 Sale Price; $ 265,000 COMPARABLE SALE#2 480 Cabin Hollow Road Dillsburg Sale Date: 10!22!2009 Sale Price: $ 330,000 COMPARABLE SALE#3 265 Beaver Creek Road DiNSburg Sale Date: 7125!2011 Sale Price: $ 300,000 PLAT MAP ~ ~ ~•h: .f ,A ~',, ~. 49000 0 D008.B B0 , ~ ~'~ r J' , ~' .Q'., r jI 40000 01 ~'~y `+ ` 4®OOOOD~O880O ', ~~ 4900QOD008400 ~,.^'f - '•~ ti -__ ' - _ _ - ' __ ____;I~ _= _ ~~ ~~" Q o ~ ----tea-:. ~. ~.~ - ~~. M .~..L_~ --...._.~._ __...._ r' 1518.x' 4~ .... b _ r'+ ~ ~', ~ ~~ 4®QOOND0057F0 49000OE0O23~ It ,', R13 480000 EOQar--il OOm' ~-~- Oft Gam' ' ~ 4900 Sub'ec# 1 PH (717) 774 7202 FAX (717) 774-0383 EMAIL he E0O22fO ~~l S ~~ I~ I r~ ~ ~i !~ I OenJet Ernapping_ ~nraicprclrilmmract naf LOCATION MAP Client Michael Wilson Es4 File No.: _ 110oSYork2011 Property Address: 1100 S York Road Case No.: Cit : Diflsbur S[a[e: PA Zi :17019-9594 _---- ---__--_ c.un~n~,un~ty °4"?0~ ~ Iil~ o ~A•~iq Park ~'p ' t5J 8owmansdale ~ ra~r n (/ 4lnsiaA - -yo i ~~~ ~ {otlegt .~9Q• `J;i7~a.*.s d3 i o:e sham. ; - . - - v .,n•~:,> ~~`a j Andersantown a'~ ¢a X Siddonsburg a i 1 rS. s i ^ a ~~ r~ ° °' s yr p` Monaghan Twp 0 `,' M di Carro{{'Twp Comparable Sale 1 s,w~n~ll Ra Subject ~ 411 Mumper Ln 1100 S York Rd Dillsburg, PA 17019 Dillsburg, PA 17019 '' is (3.97 miles WNW} $ Perk ~ ~1~~ ~,C ~o ~+4'tls» arc ~ ,~ 9 0 d^ OIy Y 3° nr~ Ra U no 3 ~r 3 Comparable Sale 2 480 Cabin Hollow Rd Dillsburg, PA 17019 (3.83 miles WSW) 1f'?'r:~~111t;~4;~i1 T4 ~ _ _, o-a S e-~ 19• ~'~ s, ~ I va Y,' ~ ' 9 ~` ~ , • ay ~ Ar PH (717) 774-7202 FAX (717) ~tm~~ dy Qua Y~ f Ra o;' .~ cs ~~ Comparable Sala 3 265 beaver Creek Rd Dillsburg, PA 17019 (1.27 miles SE) !r. ~Mn Re a°*ra ee Vray~~ Qa d~ A P4 _ _i ~arjple Rd i_~~. D~ W eVfsviile S'` a~ ~ ``',, ~ a`? ~' I 4~~ 2.7 miles ~~ EMAIL heckmanappraisers@comcast.net "lient~ Michael Wilson Esg File No.: 11005York2011 pro ert Address:1100 S York Road Case No.: ~itY' Diifsburg State: PA Zip: 17019-9594 F1oodMap Legend Fbod Tones Areas anndelad try SOOyear Ooodlny Men oetstdla r# tM 100- eM S00•yer Madpuura ~ ~ Ana ^wndatad tay toayau aoodtnq _~.~ Mesa rrwrdMtd try t00yaar eooWnq wiM rntetAy nlLard Faeo«try uaae ~~ Ftdod4yaY Iraea w+fh vllptfy hazard d4ess N taNNarrMMO UW pessiMe at»r harNdf Areal nd rnapyN Ort a^Y ptprfha0 FIRM PH (7171 774-7202 FAX f717) Flood lnformetion Community: 422232 -TOWNSHIP OF WARRINGTON Property is not in a f EMA spacial flood hazard araa Map Number 42133C0155E Map Dale: 09125!2(109 Pane{. 0155E F1PS, 42133 Zona X NenhAr hansamen<:a Fl[wtd Ma2arq Gertd4ratlem iTFNGt ner AGt make nny repreaenrotlooa a wuranttaa to any parry Gw~temMg the con!enl. accuracy ur rpmp!erBna;a Or this /lppd lepon, inclU ding any WaRanty Jr maf4ttinla7r~lfy Jr fllnwaa vn a pa rtNvlar pxupn!ut. vetthwr TF HC nor AU ~wr IM ywil.!r or ;he flood repwf aha11 haw any IIaDtlNy 'o any ihlyd parry t<H any use ~x miauae or this Aa>d report 774-0363 EMAIL heckmanappraisers( Client: Michael Wilson Es File No.: 1100SYork2011 Pro ert Address: 1100 S York Road Case No.: Cit : Diflsbur State: PA Zi :17019-9594 r `tQ ~( ~`~ ~ ~ ~~~ E~ ', ~a~6 ~, This Deed TAX PARCEL k 67ai9-000-0U-008T \rtADE THIS 5--i~' day of ~~ 'the year two thousand right (2008). -r'/ BETWEEN ELIZABETII A. THOMPSON> asingicpcrsoa~of f)irlsburg, Yaic County, Patnsylvania Grnntor(s~ AND ROIIFRT L. KEITI-I, JR, a singleprrson, and MATTHEW S. KEITH and JAMIE L. KEITH t a husr~and ana wiFc, or Di{Isburg, Ycxlc County, Petutsylvartia Grantee(s}, as.joirtt tcrtattls with the right nF vurvivor~hip and not as tenants in common. WITNFSSBtIf, that in wnsidcraticxt of TflRE1; HUNDRF,D "CIIOUSAiVD DOLLARS (5300,000.00) in hand paid, ttte ret~eipt whereof is hereby acknowledged, the said grantor(s) do(es) hereby Q grant and convey to cite said grantee(s~, their heirs, and a~.signs: ~, ~ +,nk l 9 rt t Pelt L t 3 i ~ i PH (7171 774-7202 FAX 1717) 774-0383 EMAIL heckmanappraisers~comcast.net ALL 771A? CEft?A1N trace o[ land, together witty Smproraanrr+ts therrart erected, sll situatr Ln the Tawns!+1p oL Narrington, County oC York, s^.d -:ccasonwerlth of Pennaylvrnie, being moc• particulorly 7wundad and dea~rtbed as tollowa, to witr E7EGSNN [tKf at a steel pin on the nottho rn aide 4f • right-oC-ray to the aiorementionad prepises aed lands ror or formerly of Ra7.pn H. Shaffer worth sixty-one Ibl) drgrrrs six (61 minutes [iftean liS} seconds vast cnrre hundred aeronty-nine and sixty-arvan hundredths IJ?9.51 feet to a aC.eal pin at lands nor or CoraMCly oC the John fi. Harvick [:stater ±henee along lands nor or formerly of Ski Nnreica, Inc. the Loilo++inq caureca end GSetancea; soutA fifty (501 dogrees five CS) airwtss ten r10) :+ecands East three hundred [valve and alevrn hundredths 1312.117 Cett to a flat rocks thence Sovth nine (91 .lwgrwcs twenty-two 1227 r.lnutrs Len (10} seconds Laat one thousand six hundred elgnty-Live and seventy-aaren hundrMtES 11,691.1'17 lee[ to a stone st :snds now or formerly of the c. ooaonwealth of Yennsytvania7 them along laai c+entioned iarda South elghty-three 1837 drgrsos twenty 1207 nlnutea tiro 197 aercnds Nrat ono thousand three hundred Lwrnty-Chree end ,tXty-ncnr hundredtns (1,313.691 teck to stones of lands now or fa rme rly of Jartn N. Kunzlerr thrnee slonq the lase mentlansd lands nor ar formerly of Petrr S. Sonne Paal N. Gshrse and Iasugler C. Nickry War±h kwenty-six (2b} depress {1H) minutes raro 107 seconds East one thou send two hundred khirt.y-three and ninety-eight hundredths (1.2J3.9H7 feet to a stoner thwn*:e along lands nor or rornerly of Cwuglaa ¢. Mickey and Pa~a1 S. Kochez North six Ibi degrees wfght lBl mlrnara trency (201 seconds Meat +rrrn hundred thirty-o+ne and riay-ale Lur,Gredtna IT31.56} [eat to s steel pin end the plaar at OLCIpN[NG. !'nNTA1YING 33.10 acres in accordance with a survey prepacrd by Racfnoy I,ne nectar and Associaf,aa, dated Nsrrh b, 19119, and lnclu2od as part of uriur Qeed of record. Satd prrmlasa bring known an4 avnaipelly nuttier .,.s 1100 So uch Xork Road, Dill sburq, FA 17019. CE,+:::G the nape preciaea rhlch t'lronre R. Hudson snd Karen fi. 4udson, huatLand and xtfs, by their dead dated 17Rrem)+wr tF, 1996 and recorded on UecooArr :r3, 1996, In f4ccord Oaok 1190, PacJr 2151, granted and convoyed •.n to =1iaaDeih A. Shompaon, etngle person, Grantor herein. "f1DER AND SI7(1JF.C'f, nere rt hrl raa, to ras.aaent e, cutrictlona, r4a~rvetlars, conditions and rlghra aL .ay a[ record or viatbl• cpon tnrpccti,.n of prrmiaca. [<XiET[IER wide all and siagulsr die buifdinga, improvcrtleells, ways, ++iwd, waters, w°aterccxitsta. eights, Iihellies pririicges, beroditamet-ts and apQiQteLrarieeo to the same }lcionging or in snywise appertaifsiag: thence the teversian al-d revtnions, mnaifxler and rcxnsindtrs, (erns, itisua and profits thereof, and of every pert ar-d parcel thettiaf, FAX (717) net Client Michael Wilson Esq File No.:1100SYork2011 Pro ett Address:1100 S York Road Case No.: City' Dillsburo State' PA ZID: 17019-9594 _ I 1 I A`lI) the acid grsntor does hereby WamM SpveidlY ~-+ l~f~Y ~bY ~VeY~- TN WI'iT3FS3 WHERYAF, said glnatror(s) has/hrve htxcueto set hialhultheir pand(a) and xal(s) the day aad yerr first above wrietrn. C.~+ Wien (lira cth A. "Tlwmpaott _ SrAtf>QFPI:N:TSYLVANiA ('t)tJt~lTY OF t)rt this, thr,~'day of .1QC~~e~Gd~"" 2008. before me, s Notary RtWic, the undersigttod of r, pcrsondly apptared Etitabcth A. ii-ompson. known w me (a satiaSActotrily proven) to ha the pcnon(:) whoa naaae(s) is/ate ti~ubscribod to the within instrumem, and acknowledged that helslrcnltey execntod .acne fnr the purposes tlxrein crnrlairred. IN Wr1NE.S3 WHERCOF. T hereunto act my hand and official seal. raww tw ~ -C~t.7"''H~AL) c~t+w.s a Ntru aoen neao tneaa eanr..oa+t eou+r- hheoarur,ne~r..>t•v>a. zoos C~r:R nl~ 1cA~lls of ttr-.s1pT:2HCC ~ ! do hcrcby certify chat the ptrxise residenoo and complete patl ofl'ioe address of the within grantees ia: S'~ 33 lStardtt~g~kr~•~ PH (717) 774-7202 FAX (717) 774-0383 EMAIL heckmanappraisers@comcast.net ~~~~ ~~ __ PH (717) 774-7202 FAX (717) 774-0383 EMAIL heckmanappraisers~comcast.net YORX COUNTY RECORDER OFDEF_D.S ?d EISTMAR1Ci¢I'STREET YOR~4 P.t 11.101 Randi L RruinRsr -Recorder Glovia A. Fletxttg - ~Dv=Y Inurwprnt IYntntxr- 2001i05I4I7 Retotded On 11/14/2000! At t1:10:2b AS1 • tartnrert'Typt-bEED in~oicr Kambar- 7dS323 'Grantor - T1iQStP50`I, LLI2AITLTH A • Grarta - KP.TTIl, ROBERT L JR User - II)D ('wtolrer - ASSUitED LA.1'D Book -1951 Startlr~ Pap • 213 'Total Pglea - • ReteMrd Br: COUNTER • ret:s PARCEL IDBNTIVICATION OVUMB[R ST74'1'R 'TW11tSRA SJ1X a,,ooo.oo a9o.oo~ooarrooooo00 sT;+as MRIT 2]-X so. so 'ratat v.t~P[w: 1 .res/kcass zo .msrlts 330. o0 itECOR~TNO 1rRts ;33.00 At1'ORWIBLR HO[7fIZt0 531. SO PIM t((3ldLR Pt6S a2.00 cotr~m >tACxrns tics s2.ao 1100 ARCHIVE! trss 3.00 NQR'tIRRN TOtbf COVt74S 31, 500.00 9CNOOL RiA7.TS SX% t1ARRIfiCSCnt T4MN'JxID a1,S00.00 SO?11L PAZD x6,062.00 I Cesti~ T6$ DoCUtntmt'ILt $~ Reoordsd [n York Cau»lX PIL t q ~ r ,: tw1a. w oe.r 7'NiS 1.5.E CERTIF!('ATIUN PAGE PLEASE DO 1V(3T DET.~CII THIS PAGE 1S NpW PART ~)F THIS LEGAL Dl?C11.tIF-NT • - inrenreHee deW[d yt !e lphlltl ®!~' [beep dur/s~ Me Ttnlt[etlM N['1'+ee [ell e+y e.t M NIII[[t1I N ItIt1 PlR~ e~k:1981 r.se:217 PH (717) 774-7202 FAX (717) REV-1510 EX+ (08-09) pennsylvania 1.~7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Robert L, Keith, Jr. 2011-925 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 DESCRIPTION OF PROPERTY INCLUDE1tiENAMEOFTHETRP,4JSFEREE,THEIRRELATiDNSHIPTODECEDEMAND THE DATE OF TRANSFER. A7TAOH A COPY OF 7HE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °lo OF DECD'S INTEREST EXCLUSION (IF APPL]CASLE) TAXABLE VALUE 1• Annuity -Prudential -Contract E0324201 14,952.88 100 14,952.88 2 Annuity -Prudential -Contract E0217120 64,025.19 100 64,025.19 3 Annuity -American Equity Life Insurance Company -Contract No. 593163 8,333.48 100 9,333.48 4 State Employee Retirement System -Death Benefit 62,072.38 100 62,072.38 5 CheckinglSavings Account No. 9019308 3,672.03 100 3,672.03 6 CheckinglSavings Account No. 209003688 1,756.24 100 1,756.24 7 Checking/Savings Account No. 209003510 2,638.94 100 2,638.94 TOTAL (Also enter on Line 7, Recapitulation) $ I 158,451.14 If more space is needed, use additional sheets of paper of the same size. ooooao2 ~ o ~ I ~ ~ ~ ~ I (~ ~ ' ~~ Prudential Pruc:o Lite insurance Company Check Statement A Prudential company Prudential Annuity Services, P.O. Box 13666 Pnaadelpnia. PA 79176 Date: AUGUST 2~ 201 1 3730937474 MATTHEW S KEITH Owner: Robert: L Keith 1100 SOUTH YORK RD DILLSBURG PA 17019 Annuitant: Robert. L Keith Contract #: E0324201 Product: SP II! Basic Market Type: Non Qualified Page 1 of 1 1f you have any ques#ons, please Contact your Registered Representative, RANDAIt D KAVFA4ANN 8t 7-717:303-7933 or the<,4f~nuitles Service Ce»ter of 1-888-778-2888. Thank you for your patience while we completed your request for death benefits from the contract listed above. The table below provides a breakdown of how we determined the net check amount. Taxab{e amounts are reported to you and the Internal Revenue Service. The federal taxable amount of your payment is $ 552.88. The state taxable amount is $ 552.88. We have presented this information based on our understanding of tax law. You may wish to consult your tax adviser if you have any tax questions. Because each situation is unique, neither the Company nor its representatives can provide tax advice. Financial Breakdown Information GROSS FUND WITHDRAWL AMT 14952.88 FEDERAL TAX WITHHOLDING 110.58 NET AMOUNT OF CHECK 14842.30 (VPAS d0897701 PLEASE DETACH CHECK -KEEP STATEMENT FOR RECQRDS ooaooozo9 l I I I I I I I I Prudential Pruco Lite Insurance Company Check Statement A Prudential company Prudential Annuity Services, P 0. Box 13686 Philadelphia, PA 79176 Date: AUGUST 25 2011 3730937473 MATTHEW S KETTH Owner: Robert L Keith Jr 1100 SOUTH YORK RD DILLSBURG PA 17019 Annuitant: Robert L Keith Jr Contract #: E0217120 Product: Discovery Select Annuity Market Type: IRA Page 1 of 1 !f you have ar;Fy questions, pfease con#act your Registered Rg~rege»tative, ftANDALt D KAUFA@,4NN at 1-77T-3173-1833 vt ihe:Mnultles Service ~e»ter at 7-888.778-2888. Thank you for your patience while we completed your request for death benefits from the contract listed above. The table below provides a breakdown of how we determined the net check amount. All or part of the gross payment may be taxable. We have presented this information based on our understanding of tax law. You may wish to consult with your tax adviser if you have any tax questions. Because each situation is unique, neither the Company nor its representatives can provide tax advice. Financial Breakdown Information GROSS FUND WITHDRAWL AMT FEDERAL TAX WITHHOLDING NET AMDUNT OF CHECK 64025.19 12805.04 51220.15 (VPAS d089209) PLEASE QETAGH CHECt~ i '"^FNT FQR RECQERIOS ;~l~t~„Iber I2, 2r,11 ;vT1~~1~T>-~lw L KrITH 1 100 S YORK RD D[LLSSliRG, P.~~ 17019 Re: Robert LKeith -Deceased An.~iiit;r Conh•act \b. 5:31 <„ Dear Matthew L Keith: Please find enclosed our check in the amount of 59,355.43 representing the total claim payable for the above named contract. The claim check amount was calculated as follows: Gross Claim Amount 59,333.45 Interest From Date of Death 521.95 Less Federal Tax Withholding 50.00 Less State Tax Withholding 50.00 Total Check Amount $9,355.43 As a result of this payment of proceeds, $21.95 will be reported as income to the Intei-~~al Reienue Service (IRS). You will receive a 1099R tax foi7n reflecting the distribution amounts. We hope this claim has been handled as desired. If you have any questions, please contact our oflice at I-888-221-1234. Sincerely, Nicki Skellenger Claims Service Administrator ce: URL INC - 0053459 Enclosure P.O. Box 71216 • Des Moines, IA 50325 • 1-888-221-1234 • 515-221-0002 • 515-2?1-9947(FaYI - ~~~~~»~~ .~.~,or,,..,., ~~• ~~}~- ~~--~ AMERICAN EQUITY INVESTMENT LIFE INS. CO. VENDOR 000000593163 CHECK NO. 5600721654 DESCRIPTION NET AMOUNT DB: Death Clear 2193$ CR: Death Claim Pay 21703 9,355.43 . DEATH CLAIM TAXABLE INCOME $21.95 FED WITHHLDNG $0.00 STATE WITHHLDNG $0.00 SUNDRY: 01-593163 09-12'-11 NSKA CHECK TOTAL 9,355.43 COMMONWEALTH OF PENNSYLYANlA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIRD ST STE 150 HARRISBURG, PA 17101-1716 1-800-633-5461 www.sers.state. pa. us November 1, 2011 MATTHEW S KEITH 1100 S YORK RD DILLSBURG PA 17019 Re: ROBERT L KEITH SSN: 197-34-0282 Dear Beneficiary: We are writing to you regarding the above named account. The enclosed forms must be completed by you, according to the printed instructions, before we can proceed with the processing of this account for payment. Please note: The Retirement Code does not provide for the payment of interest on the principal sum of a death benefit. Please read the enclosed information pertaining to the recent change in the Federal tax law. Also, please complete and return all applicable forms to our office as soon as possible. To aid you in making selection decisions, the following information is provided: Death Benefit Payable to you: Taxable Portion: Non Taxable Portion: $62,072.38 $57,936.62 $4,135.76 If you have any questions or need assistance, please contact the field office nearest you at 1-800-633-5461. Sincerely, &~ Debra G. Murphy, Director Benefits Determination Division Enclosures BEN65 ESTATE OF FILE NUMBER Robert L. Keith, Jr. 2011-925 Decedent's debts must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: I" Neill Funeral Home, Inc. z. Veterans Administration -Casket with Shipping 3. 4. 5. 6. REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ___, Street Address City __ _ __ _ _ State __ ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address ___ ___ ____ City ___ _ __ _.__ State _ ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~• Estate Advertsiement -Cumberland Law Journal s. Estate Advertisement -Patriot News, ~~ s. Copying and Postage Expenses - Mailings to Court i o. Mark Heckman Real Estate Appraisers TOTAL (Also enter on Line 9, Recapitulation} I $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 8,394.32 4,995.00 0.00 5, 000.00 0.00 373.00 0.00 0.00 75.00 123.38 35.00 300.00 19,295.70 Neill Funeral Home, Inc. 3401 Market Sveet Ce ill, PA 1 701 1 4428 17)737-8726 Supervisor :Kevin J. Shillabeer The folbwtrtp is a detaMsd d1 for the professional services and/or mernhendise ananped for Robert L. Keith Jr: Date of Servloe :August 19, 2011 Matthew Scott Keith Statement Date September 08, 2011 1100 S York Rd Contract Number 741101000280 Dilisburg, PA 17019-9594 Art'erlper Name Kevin J Shiliabeer Initial Selactlon Flnel Selectlon Differerxe Fttrteral Diroetor and Stall Serv{cea Basic Services Funeral Director and Staff $2,680.00 $2,680.00 --- Total Funeral DireUar and Staff Senrloris $2,680.00 $2,680.00 - Care and Preperetlon of Remains Embalming $795.00 $795.00 -- Dressing and Casketing of Deceased $395.00 $395.00 -- Total Care and Properatlon of Remains =1,190.00 51,190.00 - Use of Fadlities and Related Services Chape! Funeral Ceremony $395.00 $395.00 -- Use of Faalities and Staff for Viewing $395.00 $395.00 -- Total Uae of Fedlitlea and Rotated Services $790.00 $790.00 - 7ranapor~tlon Transfer of Remains to Funeral Home $495.00 $495.00 --- Service Vehide $395.00 $395.00 --- Funeral Vehicle/Hearse $395.00 $395.00 -- Total TrartspoAatlort $1,285.00 61,285.00 - Outer Goods end SeMaes Memorial Package $195.00 $195.00 --- VFW Flag Case $175.00 $175.00 --- US Aftercare Planner $245.00 $245.00 --- Flowers $79.50 $79.50 --- 24-Hour Compassion Helpline $95.00 $95.00 --- Total Other Goods and Services 6789.50 S789.50 - Irtitlal Selection Flnal Selection Dlfferertce Mercltertdlse Std Graveliner Concrete $995.00 $995.00 --- Total Merchandise 1995.00 5995.00 - Cash Advance Cemetery $1,395.00 $1,395.00 --- Clergy !Religious Facility $150.00 $150.00 --- Certified Copies of the Death Certificate $30.00 $30.00 --- Nevuspaper Notice $318.82 $318.82 --- Tatel CashAdvartoa 61,893.82 11.893.82 - Total SeMoes, MerGhendlse and Cash Advenoe $9,623.32 19,623.32 - Allowances Affinity VFW {$1,228.50) ($1,228.50) --- Total AlioM-ertces ($1,728.50) (61,228.50) - Total Charges (Total Services +/- ANorvertces + Tawas) 68,394.82 68,394.82 - Lees Cash Received 60.00 lJnpeid Bala-toe Due 68,394.82 _ t~ v 3 ~~ ~/S Page 2 of 2 Ima9eS fn ~~~: invoice~receipt'~ ..jP9 .~ f - ~, g'~. e ~ F ~ ~"~" ~ „~ ~ r a~ ~ ~ a . ~s ~ h ~, '.' ~ .WACHdv1A BANK ~ ~ U „:. L~A~ NfEipJ.1. HOME 3401 MARKET STREET CAMP N1Lt-. PP. 17011 n• ? 4 i i~~' ~:540 L"'9~' 2~~~ 200002 29??986"' I~ zsu+tw W ){ U TOIfEMR~ aj ~u. D` r~,~ 83q~1.~~ 0128 ~~~p313 ~ ~ ~ 3 Zp l1 Ma11n~+ s ~~ °°"' ~, ~~ ~ a ~ ~7atis ~ ~1~n9~ ;nc. mn» ; Its Jn@tA r ~~IAIS P^y C1; r- ae~o+ ~ ~ ~ ~ndM~ ~ van „,,,,,f~ e ; ~~~. 1t7~ PA 11db6 r 717~''~7~ ,..,... ~ t,,. ~2 AuUdroq rtta~lo~inlpa fog ~-~ u+0 L 28 ?~: Lt,? ? 290 i L6 ~:23138226 7411 ~io.0000651 ti~ME RECEIPT NEILL FUNER~- INDIVIDUAL CASH 3401 MARI4ET 5TRE~T ~ ~~(~,._ CAMP HILL, PA 1701'1 S 717-7 726 ACCOUN'i No. s ____ --`-'- AccTlcor+TR• ~~. DATE ----~- J l,/ ,C. APPROVA4 N ACCT/CONTR. NAME K M 1 ^~_ __ _ RECE1 V BD FROM C.C. TY'~ _ TRUST NO• DFSCRIPTION $ - ~- .___.-__ ['C. ~ CASH ~ i~ ~u/CNECK TOTAL. (] DFarr THANK YOU CREDT CARD Pink • Cnntn>I c-•.c+y Yef1gW - CtMinKl fik .... RY wnuc Cu•nome[ COY ..... _._ ..- _... __ _ . ...., ~nunme.htm[5j11~2012 1 „r i /...Filesp20ALL' REV-1512 EX { (12-OS) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert L. Keith, Jr. 2011-3229 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I • Mortgage - Mid-Penn Bank 96,679.81 1100 S. York Rd, Dillsburg PA 17019 Property held in joint tenancy with son and daugher-in-law. Decedent's interest in loan reported at 1/3. Loan Statement dated August 22, 2011 with Principal balance is attached to this Schedule. 2. John Deere -Outstanding balance on loan financing of John Deere tractor 8,377.24 3. Home Depot -Credit Card Balance Payoff 7,314.61 4. Lowe's -Credit Card Balance Payoff 151.17 5. Phone Bills - Lantl Lines and Cell -Contract Balances Payoffs 8/16, 8/22, and 10/26/2011 594.73 6. Stonemill Property Managment -Lot Rental Payments until Sale of Mobile Home 2,684.00 7. Stonemill Property Managment -Water Bills for Lot until Sale of Mobile Home 300.09 8. PPL -Electric Bills -until Sale of Mobile Home 689.11 9. Taxes -Hampden Township 64.32 10. Home Paramount 81.09 11. American Insurance 80.00 12. Michael J. Wilson, Attorney at Law - reimbursement of costs 75.00 13. West Shore Ambulance 118.74 14. Repairs to Mobile Home 400.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 117,609.91 If more space is needed, insert additional sheets of the same size. ' MID PENN BANK E394 NORTH RIVER ~~30A;3 • HA'.4FAX. f'Ft 17C32 7":?-fi„2-2133 www.midpennbank. Northern Region - 1-86E~-6HAP Cagital Region - 1-87 rr"-9NAP 24-hour Telebanker -Toll Frae: 1-888-MID-PENN (1-88E3-643-7 or iocaf dial (71 ;'} 896-~ Robert L Keith Jr Matthew S Keith Jamie L Keith 46 Trudy Circle Mechanicsburg PA 17050 LOAN: 980520.1 AS OF: 08/22/1.1 ~ i * L O A N P A Y M E N T* PAGE :I. _- ~---------------LOAN TYPE :... --- -- __ _ - -- -- ------MORTGAGE - - _ -MATURITY DATE.. - - ----~~7~~7S-R PRINCIPAL BALANCE: 290,039.44 ORIGINAL LOAN DATE: 08/05/08 CURRENT RATE: 6.7500 ORIGINAL LOAN AMOUNT: 300,000.00 INTEREST THRU 08/22/11 : 1,157.81 INTEREST PAID 2011: 11,468.9E3 DATE OF LAST PAYMENT: 07/28/1:_ ESCROW BALANCE: 61.91 LAST PAYMENT AMOUNT: 2,083.00 DATE PAYMENT DUE: 09/01/11 PRINCIPAL DUE: 314.32 INTEREST DUE: 1,631.47 ESCROW DUE: 137.21 ********************* TOTAL AMOUNT DUE: * 2,083.00 ********************* ADD ADDITIONAL LATE CHARGE OF 97.28 I F NO PAYMENT IS RECEIVED BY 09/16/11 * PLEASE RETURN THIS PORTION WITH YOUR PAYMENT a~~.:~ .<ss>: Prepared By: MID PENN BANK 349 UNION ST MILLERSBURG, PA 17061 (717) 692-2133 Return To: MID PENN BANK 349 UNION ST MILLERSBURG, PA 17061 1717) 692-2133 Parcel Number: 67-49-00-OD-0087-00-00000 Premises: 1100 S. YORK ROAD, DILLSBURG, PA 17019 [Space Above Th'ss Line For Recording Data] MORTGAGE DEFINITIONS Words used in multiple sections of this document are defined below and other words are defined in Sections 3, 11, 13, 18, 20 and 21. Certain rules regarding the usage of words used in this document are also provided in Section 16. (A) "Security Instrument" means this document, which is dated 08.05.2008 , together with all Riders to this document. (B) "Borrower" is ROBERT L. KEITH JR.; MATTHEW S. KEITH; JAMIE L. KEITH Borrower is the mortgagor under this Security Instrument. (C) "Lender" is MID PENN BANK PENNSYLVANIA -Single Family -Fannie Mae/Freddie Mac UNIFORM INSTRUMENT -61PA) lo5us~ m Page 1 of i6 Initials VMP Mortgage Solutions, Inc. 180015 2 1-7 29 1 Form 3039 1101 #`_ Lender is a CORPORATION organized and existing under the laws of THE STATE OF PENNSYLVANIA Lender's address is 349 UNION ST, MILLERSBURG, PA 17061 Lender is the mortgagee under this Security Instrument. (D) "Note" means the promissory note signed by Borrower and dated 08-05-2008 The Note states that Borrower owes Lender THREE HUNDRED THOUSAND AND NOI100 Dollars (U.S. $ 300,000.00 )plus interest. Borrower has promised to pay this debt in regular Periodic Payments and to pay the debt in full not later than 09-01-2013 (E) "Property" means the property that is described below under the heading "Transfer of Rights in the Property. " (F) "Loan" means the debt evidenced by the Note, plus interest, any prepayment charges and late charges due under the Note, and all sums due under this Security Instrument, plus interest. (G) "Riders" means all Riders to this Security Instrument that are executed by Borrower- The following Riders are to be executed by Borrower [check box as applicable]: 0 Adjustable Rate Rider 0 Condominium Rider ~ Second Home Rider ~X Balloon Rider 0 Planned Unit Development Rider ~ 1-4 Family Rider VA Rider 0 Biweekly Payment Rider C] Other(s) [specify] (H) "Applicable Law" means all controlling applicable federal, state and local statutes, regulations, ordinances and administrative rules and orders (that have the effect of law) as well as all applicable final, non-appealable judicial opinions. (I) "Community Association Dues, Fees, and Assessments" means all dues, fees, assessments and other charges that are imposed on Borrower or the Property by a condominium association, homeowners association or similar organization. (J) "Electronic Funds Transfer" means any transfer of funds, other than a transaction originated by check, draft, or similar paper instrument, which is initiated through an electronic terminal, telephonic instrument, computer, or magnetic tape so as to order, instruct, or authorize a financial institution to debit or credit an account. Such term includes, but is not limited to, point-of-sale transfers, automated teller machine transactions, transfers initiated by telephone, wire transfers, and automated clearinghouse transfers. (K) "Escrow Items" means those items that are described in Section 3. (L) "Miscellaneous Proceeds" means any compensation, settlement, award of damages, or proceeds paid by any third party (other than insurance proceeds paid under the coverages described in Section 5) for: (i) damage to, or destruction of, the Property; (ii) condemnation or other taking of all or any part of the Property; (iii) conveyance in lieu of condemnation; or (iv) misrepresentations of, or omissions as to, the value and/or condition of the Property. (M) "Mortgage Insurance" means insurance protecting Lender against the nonpayment of, or default on, the Loan. Initials: -6lPA) losoal Page 2 of is Form 3039 1101 m (N) "Periodic Payment" means the regularly scheduled amount due for (i) principal and interest under the Note, plus (ii) any amounts under Section 3 of this Security Instrument. (O) "ItESPA" means the Real Estate Settlement Procedures Act (12 U.S.C. Section 2601 et seq.) and its implementing regulation, Regulation X (24 C.F.R. Part 3500), as they might be amended from time to time, or any additional or successor legislation or regulation that governs the same subject matter. As used in this Security Instrument, "RESPA" refers to all requirements and restrictions that are imposed in regard to a "federally related mortgage loan" even if the Loan does not qualify as a "federally related mortgage loan" under RESPA. (P) "Successor in Interest of Borrower" means any party that has taken title to the Property, whether or not that party has assumed Borrower's obligations under the Note and/or this Security Instrument. TRANSFER OF RIGHTS IN THE PROPERTY This Security Instrument secures to Lender: (i) the repayment of the Loan, and all renewals, extensions and modifications of the Note; and (ii) the performance of Borrower's covenants and agreements under this Security Instrument and the Note. For this purpose, Borrower does hereby mortgage, grant and convey to Lender the following described property located in the YORK COUNTY [Type of Recording Jurisdiction] of RECORDER OF DEEDS [Name of Recording Jurisdiction]: which currently has the address of 1100 S. YORK ROAD [Street] DILLSBURG [city], Pennsylvania 17019 [zip code] ("Property Address"): TOGETHER WITH all the improvements now or hereafter erected on the property, and all easements, appurtenances, and fixtures now or hereafter a part of the property. All replacements and additions shall also be covered by this Security Instrument. All of the foregoing is referred to in this Security Instrument as the "Property. " Initials: -6(FA) 105081 Page3 of is Form 3039 1/01 B BORROWER COVENANTS that Borrower is lawfully seised of the estate hereby conveyed and has the right to mortgage, grant and convey the Property and that the Property is unencumbered, except for encumbrances of record. Borrower warrants and will defend generally the title to the Property against all claims and demands, subject to any encumbrances of record. THIS SECURITY INSTRUMENT combines uniform covenants for national use and non-uniform covenants with limited variations by jurisdiction to constitute a uniform security instrument covering real property. UNIFORM COVENANTS. Borrower and Lender covenant and agree as follows: 1. Payment of Principal, Interest, Escrow Items, Prepayment Charges, and Late Charges. Borrower shall pay when due the principal of, and interest on, the debt evidenced by the Note and any prepayment charges and late charges due under the Note. Borrower shall also pay funds for Escrow Items pursuant to Section 3. Payments due under the Note and this Security Instrument shall be made in U.S. currency. However, if any check or other instrument received by Lender as payment under the Note or this Security Instrument is returned to Lender unpaid, Lender may require that any or all subsequent payments due under the Note and this Security Instrument be made in one or more of the following forms, as selected by Lender: (a) cash; (b) money order; (c) certified check, bank check, treasurer's check or cashier's check, provided any such check is drawn upon an institution whose deposits are insured by a federal agency, instrumentality, or entity; or (d) Electronic Funds Transfer. Payments are deemed received by Lender when received at the location designated in the Note or at such other location as may be designated by Lender in accordance with the notice provisions in Section 15. Lender may return any payment or partial payment if the payment or partial payments are insufficient to bring the Loan current. Lender may accept any payment or partial payment insufficient to bring the Loan current, without waiver of any rights hereunder or prejudice to its rights to refuse such payment or partial payments in the future, but Lender is not obligated to apply such payments at the time such payments are accepted. If each Periodic Payment is applied as of its scheduled due date, then Lender need not pay interest on unapplied funds. Lender may hold such unapplied funds until Borrower makes payment to bring the Loan current. If Borrower does not do so within a reasonable period of time, Lender shall either apply such funds or return them to Borrower. If not applied earlier, such funds will be applied to the outstanding principal balance under the Note immediately prior to foreclosure. No offset or claim which Borrower might have now or in the future against Lender shall relieve Borrower from making payments due under the Note and this Security Instrument or performing the covenants and agreements secured by this Security Instrument. 2. Application of Payments or Proceeds. Except as otherwise described in this Section 2, al( payments accepted and applied by Lender shall be applied in the following order of priority: (a) interest due under the Note; (b) principal due under the Note; (c) amounts due under Section 3. Such payments shall be applied to each Periodic Payment in the order in which it became due. Any remaining amounts shall be applied first to late charges, second to any other amounts due under this Security Instrument, and then to reduce the principal balance of the Note. If Lender receives a payment from Borrower for a delinquent Periodic Payment which includes a sufficient amount to pay any late charge due, the payment may be applied to the delinquent payment and the late charge. If more than one Periodic Payment is outstanding, Lender may apply any payment received from Borrower to the repayment of the Periodic Payments if, and to the extent that, each payment can be Initials: -61PA) 1o5oe1 Pagea of is Form 3039 1/01 B paid in full. To the extent that any excess exists after the payment is applied to the full payment of one or more Periodic Payments, such excess may be applied to any late charges due. Voluntary prepayments shall be applied first to any prepayment charges and then as described in the Note. Any application of payments, insurance proceeds, or Miscellaneous Proceeds to principal due under the Note shall not extend or postpone the due date, or change the amount, of the Periodic Payments. 3. Funds for Escrow Items. Borrower shall pay to Lender on the day Periodic Payments are due under the Note, until the Note is paid in full, a sum (the "Funds") to provide for payment of amounts due for: (a) taxes and assessments and other items which can attain priority over this Security Instrument as a lien or encumbrance on the Property; (b) leasehold payments or ground rents on the Property, if any; (c) premiums for any and all insurance required by Lender under Section 5; and (d) Mortgage Insurance premiums, if any, or any sums payable by Borrower to Lender in lieu of the payment of Mortgage Insurance premiums in accordance with the provisions of Section 10. These items are called "Escrow Items." At origination or at any time during the term of the Loan, Lender may require that Community Association Dues, Fees, and Assessments, if any, be escrowed by Borrower, and such dues, fees and assessments shall be an Escrow Item. Borrower shall promptly furnish to Lender all notices of amounts to be paid under this Section. Borrower shall pay Lender the Funds for Escrow Items unless Lender waives Borrower's obligation to pay the Funds for any or all Escrow Items. Lender may waive Borrower's obligation to pay to Lender Funds for any or all Escrow Items at any time. Any such waiver may only be in writing. In the event of such waiver, Borrower shall pay directly, when and where payable, the amounts due for any Escrow Items for which payment of Funds has been waived by Lender and, if Lender requires, shall furnish to Lender receipts evidencing such payment within such time period as Lender may require. Borrower's obligation to make such payments and to provide receipts shall for all purposes be deemed to be a covenant and agreement contained in this Security Instrument, as the phrase "covenant and agreement" is used in Section 9. If Borrower is obligated to pay Escrow Items directly, pursuant to a waiver, and Borrower fails to pay the amount due for an Escrow Item, Lender may exercise its rights under Section 9 and pay such amount and Borrower shall then be obligated under Section 9 to repay to Lender any such amount. Lender may revoke the waiver as to any or all Escrow Items at any time by a notice given in accordance with Section 15 and, upon such revocation, Borrower shall pay to Lender all Funds, and in such amounts, that are then required under this Section 3. Lender may, at any time, collect and hold Funds in an amount (a) sufficient to permit Lender to apply the Funds at the time specified under RESPA, and (b) not to exceed the maximum amount a lender can require under RESPA. Lender shall estimate the amount of Funds due on the basis of current data and reasonable estimates of expenditures of future Escrow Items or otherwise in accordance with Applicable Law. The Funds shall be held in an institution whose deposits are insured by a federal agency, instrumentality, or entity (including Lender, if Lender is an institution whose deposits are so insured) or in any Federal Home Loan Bank. Lender shall apply the Funds to pay the Escrow Items no later than the time specified under RESPA. Lender shall not charge Borrower for holding and applying the Funds, annually analyzing the escrow account, or verifying the Escrow Items, unless Lender pays Borrower interest on the Funds and Applicable Law permits Lender to make such a charge. Unless an agreement is made in writing or Applicable Law requires interest to be paid on the Funds, Lender shall not be required to pay Borrower any interest or earnings on the Funds. Borrower and Lender can agree in writing, however, that interest Initials: -61PA) loeosl Page 5 or is Form 3039 1/01 m shall be paid on the Funds. Lender shall give to Borrower, without charge, an annual accounting of the Funds as required by 1ZESPA. If there is a surplus of Funds held in escrow, as defined under RESPA, Lender shall account to Borrower for the excess funds in accordance with RESPA. If there is a shortage of Funds held in escrow, as defined under 1tESPA, Lender shall notify Borrower as required by RESPA, and Borrower shall pay to Lender the amount necessary to make up the shortage in accordance with RESPA, but in no more than 12 monthly payments. If there is a deficiency of Funds held in escrow, as defined under RESPA, Lender shall notify Borrower as required by RESPA, and Borrower shall pay to Lender the amount necessary to make up the deficiency in accordance with 12ESPA, but in no more than 12 monthly payments. Upon payment in full of all sums secured by this Security Instrument, Lender shall promptly refund to Borrower any Funds held by Lender. 4. Charges; Liens. Borrower shall pay all taxes, assessments, charges, fines, and impositions attributable to the Property which can attain priority over this Security Instrument, leasehold payments or ground rents on the Property, if any, and Community Association Dues, Fees, and Assessments, if any. To the extent that these items are Escrow Items, Borrower shall pay them in the manner provided in Section 3. Borrower shall promptly discharge any lien which has priority over this Security Instrument unless Borrower: (a) agrees in writing to the payment of the obligation secured by the lien in a manner acceptable to Lender, but only so long as Borrower is performing such agreement; (b) contests the lien in good faith by, or defends against enforcement of the lien in, legal proceedings which in Lender's opinion operate to prevent the enforcement of the lien while those proceedings are pending, but only until such proceedings are concluded; or (c) secures from the holder of the lien an agreement satisfactory to Lender subordinating the lien to this Security Instrument. If Lender determines that any part of the Property is subject to a lien which can attain priority over this Security Instrument, Lender may give Borrower a notice identifying the lien. Within 10 days of the date on which that notice is given, Borrower shall satisfy the lien or take one or more of the actions set forth above in this Section 4. Lender may require Borrower to pay cone-time charge for a real estate tax verification and/or reporting service used by Lender in connection with this Loan. 5. Property Insurance. Borrower shall keep the improvements now existing or hereafter erected on the Property insured against loss by fire, hazards included within the term "extended coverage," and any other hazards including, but not limited to, earthquakes and floods, for which Lender requires insurance. This insurance shall be maintained in the amounts (including deductible levels) and for the periods that Lender requires. What Lender requires pursuant to the preceding sentences can change during the term of the Loan. The insurance carrier providing the insurance shall be chosen by Borrower subject to Lender's right to disapprove Borrower's choice, which right shall not be exercised unreasonably. Lender may require Borrower to pay, in connection with this Loan, either: (a) a one-time charge for flood zone determination, certification and tracking services; or (b) a one-time charge for flood zone determination and certification services and subsequent charges each time remappings or similar changes occur which reasonably might affect such determination or certification. Borrower shall also be responsible for the payment of any fees imposed by the Federal Emergency Management Agency in connection with the review of any flood zone determination resulting from an objection by Borrower. Initials: -6IPA) (05081 Page6 of is Form 3039 1/O1 If Borrower fails to maintain any of the coverages described above, Lender may obtain insurance coverage, at Lender's option and Borrower's expense. Lender is under no obligation to purchase any particular type or amount of coverage. Therefore, such coverage shall cover Lender, but might or might not protect Borrower, Borrower's equity in the Property, or the contents of the Property, against any risk, hazard or liability and might provide greater or lesser coverage than was previously in effect. Borrower acknowledges that the cost of the insurance coverage so obtained might significantly exceed the cost of insurance that Borrower could have obtained. Any amounts disbursed by Lender under this Section 5 shall become additional debt of Borrower secured by this Security Instrument. These amounts shall bear interest at the Note rate from the date of disbursement and shall be payable, with such interest, upon notice from Lender to Borrower requesting payment. All insurance policies required by Lender and renewals of such policies shall be subject to Lender's right to disapprove such policies, shall include a standard mortgage clause, and shall name Lender as mortgagee and/or as an additional loss payee. Lender shall have the right to hold the policies and renewal certificates. If Lender requires, Borrower shall promptly give to Lender all receipts o1' paid premiums and renewal notices. If Borrower obtains any form of insurance coverage, not otherwise required by Lender, for damage to, or destruction of, the Property, such policy shall include a standard mortgage clause and shall name Lender as mortgagee and/or as an additional loss payee. In the event of loss, Borrower shall give prompt notice to the insurance carrier and Lender. Lender may make proof of loss if not made promptly by Borrower. Unless Lender and Borrower otherwise agree in writing, any insurance proceeds, whether or not the underlying insurance was required by Lender, shall be applied to restoration or repair of the Property, if the restoration or repair is economically feasible and Lender's security is not lessened. During such repair and restoration period, Lender shall have the right to hold such insurance proceeds until Lender has had an opportunity to inspect such Property to ensure the work has been completed to Lender's satisfaction, provided that such inspection shall be undertaken promptly. Lender may disburse proceeds for the repairs and restoration in a single payment or in a series of progress payments as the work is completed. Unless an agreement is made in writing or Applicable Law requires interest to be paid on such insurance proceeds, Lender shall not be required to pay Borrower any interest or earnings on such proceeds. Fees for public adjusters, or other third parties, retained by Borrower shall not be paid out of the insurance proceeds and shall be the sole obligation of Borrower. If the restoration or repair is not economically feasible or Lender's security would be lessened, the insurance proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due, with the excess, if any, paid to Borrower. Such insurance proceeds shall be applied in the order provided for in Section 2. If Borrower abandons the Property, Lender may file, negotiate and settle any available insurance claim and related matters. If Borrower does not respond within 30 days to a notice from Lender that the insurance carrier has offered to settle a claim, then Lender may negotiate and settle the claim. The 30-day period will begin when the notice is given. In either event, or if Lender acquires the Property under Section 22 or otherwise, Borrower hereby assigns to Lender (a) Borrower's rights to any insurance proceeds in an amount not to exceed the amounts unpaid under the Note or this Security Instrument, and (b) any other of Borrower's rights (other than the right to any refund of unearned premiums paid by Borrower) under all insurance policies covering the Property, insofar as such rights are applicable to the coverage of the Property. Lender may use the insurance proceeds either to repair or restore the Property or to pay amounts unpaid under the Note or this Security Instrument, whether or not then due. Initials: -61PA) 105081 Page 7 of 16 Form 3039 li0l m 6. Occupancy. Borrower shall occupy, establish, and use the Property as Borrower's principal residence within 60 days after the execution of this Security Instrument and shall continue to occupy the Property as Borrower's principal residence for at least one year after the date of occupancy, unless Lender otherwise agrees in writing, which consent shall not be unreasonably withheld, or unless extenuating circumstances exist which are beyond Borrower's control. 7. Preservation, Maintenance and Protection of the Property; Inspections. Borrower shall not destroy, damage or impair the Property, allow the Property to deteriorate or commit waste on the Property. Whether or not Borrower is residing in the Property, Borrower shall maintain the Property in order to prevent the Property from deteriorating or decreasing in value due to its condition. Unless it is determined pursuant to Section 5 that repair or restoration is not economically feasible, Borrower shall promptly repair the Property if damaged to avoid further deterioration or damage. If insurance or condemnation proceeds are paid in connection with damage to, or the taking of, the Property, Borrower shall be responsible for repairing or restoring the Property only if Lender has released proceeds for such purposes. Lender may disburse proceeds for the repairs and restoration in a single payment or in a series of progress payments as the work is completed. If the insurance or condemnation proceeds are not sufficient to repair or restore the Property, Borrower is not relieved of Borrower's obligation for the completion of such repair or restoration. Lender or its agent may make reasonable entries upon and inspections of the Property. If it has reasonable cause, Lender may inspect the interior of the improvements on the Property. Lender shall give Borrower notice at the time of or prior to such an interior inspection specifying such reasonable cause. 8. Borrower's Loan Application. Borrower shall be in default if, during the Loan application process, Borrower or any persons or entities acting at the direction of Borrower or with Borrower's knowledge or consent gave materially false, misleading, or inaccurate information or statements to Lender (or failed to provide Lender with material information) in connection with the Loan. Material representations include, but are not limited to, representations concerning Borrower's occupancy of the Property as Borrower's principal residence. 9. Protection of Lender's Interest in the Property and Rights Under this Security Instrument. If (a) Borrower fails to perform the covenants and agreements contained in this Security Instrument, (b) there is a legal proceeding that might significantly affect Lender's interest in the Property and/or rights under this Security Instrument (such as a proceeding in bankruptcy, probate, for condemnation or forfeiture, for enforcement of a lien which may attain priority over this Security Instrument or to enforce laws or regulations), or (c) Borrower has abandoned the Property, then Lender may do and pay for whatever is reasonable or appropriate to protect Lender's interest in the Property and rights under this Security Instrument, including protecting and/or assessing the value of the Property, and securing and/or repairing the Property. Lender's actions can include, but are not limited to: (a) paying any sums secured by a lien which has priority over this Security Instrument; (b) appearing in court; and (c) paying reasonable attorneys' fees to protect its interest in the Property and/or rights under this Security Instrument, including its secured position in a bankruptcy proceeding. Securing the Property includes, but is not limited to, entering the Property to make repairs, change locks, replace or board up doors and windows, drain water from pipes, eliminate building or other code violations or dangerous conditions, and have utilities turned on or off. Although Lender may take action under this Section 9, Lender does not have to do so and is not under any duty or obligation to do so. It is agreed that Lender incurs no liability for not taking any or all actions authorized under this Section 9. Initials: -61PA) 105091 Page 8 of is Form 3039 1101 m Any amounts disbursed by Lender under this Section 9 shall become additional debt ol~ Borrower secured by this Security Instrument. These amounts shall bear interest at the Note rate from the date of disbursement and shall be payable, with such interest, upon notice from Lender to Borrower requesting payment. If this Security Instrument is on a leasehold, Borrower shall comply with all the provisions of the lease. If Borrower acquires fee title to the Property, the leasehold and the fee title shall not merge unless Lender agrees to the merger in writing. 10. Mortgage Insurance. If Lender required Mortgage Insurance as a condition of making the Loan, Borrower shall pay the premiums required to maintain the Mortgage Insurance in effect. If, for any reason, the Mortgage Insurance coverage required by Lender ceases to be available from the mortgage insurer that previously provided such insurance and Borrower was required to make separately designated payments toward the premiums for Mortgage Insurance, Borrower shall pay the premiums required to obtain coverage substantially equivalent to the Mortgage Insurance previously in effect, at a cost substantially equivalent to the cost to Borrower of the Mortgage Insurance previously in effect, from an alternate mortgage insurer selected by Lender. If substantially equivalent Mortgage Insurance coverage is not available, Borrower shall continue to pay to Lender the amount of the separately designated payments that were due when the insurance coverage ceased to be in effect. Lender will accept, use and retain these payments as anon-refundable lass reserve in lieu of Mortgage Insurance. Such loss reserve shall be non-refundable, notwithstanding the fact that the Loan is ultimately paid in full, and Lender shall not be required to pay Borrower any interest or earnings on such loss reserve. Lender can no longer require loss reserve payments if Mortgage Insurance coverage (in the amount and for the period that Lender requires) provided by an insurer selected by Lender again becomes available, is obtained, and Lender requires separately designated payments toward the premiums for Mortgage Insurance. If Lender required Mortgage Insurance as a condition of making the Loan and Borrower was required to make separately designated payments toward the premiums for Mortgage Insurance, Borrower shall pay the premiums required to maintain Mortgage Insurance in effect, or to provide anon-refundable loss reserve, until Lender's requirement for Mortgage Insurance ends in accordance with any written agreement between Borrower and Lender providing for such termination or until termination is required by Applicable I,aw. Nothing in this Section 10 affects Borrower's obligation to pay interest at the rate provided in the Note. Mortgage Insurance reimburses Lender (or any entity that purchases the Note) for certain losses it may incur if Borrower does not repay the Loan as agreed. Borrower is not a party to the Mortgage Insurance. Mortgage insurers evaluate their total risk on all such insurance in force from time to time, and may enter into agreements with other parties that share or modify their risk, or reduce losses. These agreements are on terms and conditions that are satisfactory to the mortgage insurer and the other party (or parties) to these agreements. These agreements may require the mortgage insurer to make payments using any source of funds that the mortgage insurer may have available (which may include funds obtained from Mortgage Insurance premiums). As a result of these agreements, Lender, any purchaser of the Note, another insurer, any reinsurer, any other entity, or any affiliate of any of the foregoing, may receive (directly or indirectly) amounts that derive from (or might be characterized as) a portion of Borrower's payments for Mortgage Insurance, in exchange for sharing or modifying the mortgage insurer's risk, or reducing losses. If such agreement provides that an affiliate of Lender takes a share of the insurer's risk in exchange for a share of the premiums paid to the insurer, the arrangement is often termed "captive reinsurance." Further: (a) Any such agreements will not affect the amounts that Borrower has agreed to pay for Mortgage Insurance, or any other terms of the Loan. Such agreements will not increase the amount Borrower will owe for Mortgage Insurance, and they will not entitle Borrower to any refund. Initials: -61PA) weoel Page 9 of is Form 3039 1/01 m (b) Any such agreements will not affect the rights Borrower has - if any -with respect to the Mortgage Insurance under the Homeowners Protection Act of 1998 or any other law. These rights may include the right to receive certain disclosures, to request and obtain cancellation of the Mortgage Insurance, to have the Mortgage Insurance terminated automatically, and/or to receive a refund of any Mortgage Insurance premiums that were unearned at the time of such cancellation or termination. 11. Assignment of Miscellaneous Proceeds; Forfeiture. All Miscellaneous Proceeds are hereby assigned to and shall be paid to Lender. If the Property is damaged, such Miscellaneous Proceeds shall be applied to restoration or repair of the Property, if the restoration or repair is economically feasible and Lender's security is not lessened. During such repair and restoration period, Lender shall have the right to hold such Miscellaneous Proceeds until Lender has had an opportunity to inspect such Property to ensure the work has been completed to Lender's satisfaction, provided that such inspection shall be undertaken promptly. Lender may pay for the repairs and restoration in a single disbursement or in a series of progress payments as the work is completed. Unless an agreement is made in writing or Applicable Law requires interest to be paid on such Miscellaneous Proceeds, Lender shall not be required to pay Borrower any interest or earnings on such Miscellaneous Proceeds. If the restoration or repair is not economically feasible or Lender's security would be lessened, the Miscellaneous Proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due, with the excess, if any, paid to Borrower. Such Miscellaneous Proceeds shall be applied in the order provided for in Section 2. In the event of a total taking, destruction, or loss in value of the Property, the Miscellaneous Proceeds shall be applied to the sums secured by this Security Instrument, whether or not then due, with the excess, if any, paid to Borrower. In the event of a partial taking, destruction, or loss in value of the Property in which the fair market value of the Property immediately before the partial taking, destruction, or loss in value is equal to or greater than the amount of the sums secured by this Security Instrument immediately before the partial taking, destruction, or loss in value, unless Borrower and Lender otherwise agree in writing, the sums secured by this Security Instrument shall be reduced by the amount of the Miscellaneous Proceeds multiplied by the following fraction: (a) the total amount of the sums secured immediately before the partial taking, destruction, or loss in value divided by (b) the fair market value of the Property immediately before the partial taking, destruction, or loss in value. Any balance shall be paid to Borrower. In the event of a partial taking, destruction, or loss in value of the Property in which the fair market value of the Property immediately before the partial taking, destruction, or loss in value is less than the amount of the sums secured immediately before the partial taking, destruction, or loss in value, unless Borrower and Lender otherwise agree in writing, the Miscellaneous Proceeds shall be applied to the sums secured by this Security Instrument whether or not the sums are then due. If the Property is abandoned by Borrower, or if, after notice by Lender to Borrower that the Opposing Party (as defined in the next sentence) offers to make an award to settle a claim for damages, Borrower fails to respond to Lender within 30 days after the date the notice is given, Lender is authorized to collect and apply the Miscellaneous Proceeds either to restoration or repair of the Property or to the sums secured by this Security Instrument, whether or not then due. "Opposing Party" means the third party that owes Borrower Miscellaneous Proceeds or the party against whom Borrower has a right of action in regard to Miscellaneous Proceeds. Borrower shall be in default if any action or proceeding, whether civil or criminal, is begun that, in Lender's judgment, could result in forfeiture of the Property or other material impairment of Lender's interest in the Property or rights under this Security Instrument. Borrower can cure such a default and, if acceleration has occurred, reinstate as provided in Section 19, by causing the action or proceeding to be Initials: -61PA) ~oeosl Page io or is Form 3039 1101 m dismissed with a ruling that, in Lender's judgment, precludes forfeiture of the Property or other material impairment of Lender's interest in the Property or rights under this Security Instrument. The proceeds of any award or claim for damages that are attributable to the impairment of Lender's interest in the Property are hereby assigned and shall be paid to Lender. All Miscellaneous Proceeds that are not applied to restoration or repair of the Property shall be applied in the order provided fot in Section 2. 12. Borrower Not Released; Forbearance By Lender Not a Waiver. Extension of the time for payment or modification of amortization of the sums secured by this Security Instrument granted by Lender to Borrower or any Successor in Interest of Borrower shall not operate to release the liability of Borrower or any Successors in Interest of Borrower. Lender shall not be required to commence proceedings against any Successor in Interest of Borrower or to refuse to extend time for payment or otherwise modify amortization of the sums secured by this Security Instrument by reason of any demand made by the original Borrower or any Successors in Interest of Borrower. Any forbearance by Lender in exercising any right or remedy including, without limitation, Lender's acceptance of payments from third persons, entities or Successors in Interest of Borrower or in amounts less than the amount then due, shall not be a waiver of or preclude the exercise of any right or remedy. 13. Joint and Several Liability; Co-signers; Successors and Assigns Bound. Borrower covenants and agrees that Borrower's obligations and liability shall be joint and several. However, any Borrower who co-signs this Security Instrument but does not execute the Note (a "co-signer"): (a) is co-signing this Security Instrument only to mortgage, grant and convey [he co-signer's interest in the Property under the terms of this Security Instrument; (b) is not personally obligated to pay the sums secured by this Security Instrument; and (c) agrees that Lender and any other Borrower can agree to extend, modify, forbear or make any accommodations with regard to the terms of this Security Instrument or the Note without the co-signer's consent. Subject to the provisions of Section 18, any Successor in Interest of Borrower who assumes Borrower's obligations under this Security Instrument in writing, and is approved by Lender, shall obtain all of Borrower's rights and benefits under this Security Instrument. Borrower shall not be released from Borrower's obligations and liability under this Security Instrument unless Lender agrees to such release in writing. The covenants and agreements of this Security Instrument shall bind (except as provided in Section 20) and benefit the successors and assigns of Lender. 14. Loan Charges. Lender may charge Borrower fees for services performed in connection with Borrower's default, for the purpose of protecting Lender's interest in the Property and rights under this Security Instrument, including, but not limited to, attorneys' fees, property inspection and valuation fees. In regard to any other fees, the absence of express authority in this Security Instrument to charge a specific fee to Borrower shall not be construed as a prohibition on the charging of such fee. Lender may not charge fees that are expressly prohibited by this Security Instrument or by Applicable Law. If the Loan is subject to a law which sets maximum loan charges, and that law is finally interpreted so that the interest or other loan charges collected or to be collected in connection with the Loan exceed the permitted limits, then: (a) any such loan charge shall be reduced by the amount necessary to reduce the charge to the permitted limit; and (b) any sums already collected from Borrower which exceeded permitted limits will be refunded to Borrower. Lender may choose to make this refund by reducing the principal owed under the Note or by making a direct payment to Borrower. If a refund reduces principal, the reduction will. be treated as a partial prepayment without any prepayment charge (whether or not a prepayment charge is provided for under the Note). Borrower's acceptance of any such refund made by direct payment: to Borrower will constitute a waiver of any right of action Borrower might have arising out of such overcharge. 15. Notices. All notices given by Borrower or Lender in connection with this Security Instrument must be in writing. Any notice to Borrower in connection with this Security Instrument shall be deemed to Initials: -61PA) weo$I Page ii of is Form 3039 1l01 c9 have been given to Borrower when mailed by first class mail or when actually delivered to Borrower's notice address if sent by other means. Notice to any one Borrower shall constitute notice to all Borrowers unless Applicable Law expressly requires otherwise. The notice address shall be the Property Address unless Borrower has designated a substitute notice address by notice to Lender. Borrower shall promptly notify Lender of Borrower's change of address. If Lender specifies a procedure for reporting Borrower's change of address, then Borrower shall only report a change of address through that specified procedure. There may be only one designated notice address under this Security Instrument at any one time. Any notice to Lender shall be given by delivering it or by mailing it by first class mail to Lender's address stated herein unless Lender has designated another address by notice to Borrower. Any notice in connection with this Security Instrument shall not be deemed to have been given to Lender until actually received by Lender. If any notice required by this Security Instrument is also required under Applicable Law, the Applicable Law requirement will satisfy the corresponding requirement under this Security Instrument. 16. Governing Law; Severability; Rules of Construction. This Security Instrument shall be governed by federal law and the law of the jurisdiction in which the Property is located. All rights and obligations contained in this Security Instrument are subject to any requirements and limitations of Applicable Law. Applicable Law might explicitly or implicitly allow the parties to agree by contract or it might be silent, but such silence shall not be construed as a prohibition against agreement by contract. In the event that any provision or clause of this Security Instrument or the Note conflicts with Applicable Law, such conflict shall not affect other provisions of this Security Instrument or the Note which can be given effect without the conflicting provision. As used in this Security Instrument: (a) words of the masculine gender shall mean and include corresponding neuter words or words of the feminine gender; (b) words in the singular shall mean and include the plural and vice versa; and (c) the word "may" gives sole discretion without any obligation to take any action. 17. Borrower's Copy. Borrower shall be given one copy of the Note and of this Security Instrument. 18. Transfer of the Property or a Beneficial Interest in Borrower. As used in this Section 18, "Interest in the Property" means any legal or beneficial interest in the Property, including, but not limited to, those beneficial interests transferred in a bond for deed, contract for deed, installment sales contract or escrow agreement, the intent of which is the transfer of title by Borrower at a future date to a purchaser. If all or any part of the Property or any Interest in the Property is sold or transferred (or if Borrower is not a natural person and a beneficial interest in Borrower is sold or transferred) without Lender's prior written consent, Lender may require immediate payment in full of all sums secured by this Security Instrument. However, this option shall not be exercised by Lender if such exercise is prohibited by Applicable Law. If Lender exercises this option, Lender shall give Borrower notice of acceleration. The notice shall provide a period of not less than 30 days from the date the notice is given in accordance with Section 15 within which Borrower must pay all sums secured by this Security Instrument. If Borrower fails to pay these sums prior to the expiration of this period, Lender may invoke any remedies permitted by this Security Instrument without further notice or demand on Borrower. 19. Borrower's Right to Reinstate After Acceleration. If Borrower meets certain conditions, Borrower shall have the right to have enforcement of this Security Instrument discontinued at any time prior to the earliest of: (a) five days before sale of the Property pursuant to any power of sale contained in this Security Instrument; (b) such other period as Applicable Law might specify for the termination of Borrower's right to reinstate; or (c) entry of a judgment enforcing this Security Instrument. Those conditions are that Borrower: (a) pays Lender all sums which then would be due under this Security Instrument and the Note as if no acceleration had occurred; (b) cures any default of any other covenants or Initials: -61PA) Iososi Page iz of is Form 3039 1/01 B agreements; (c) pays all expenses incurred in enforcing this Security Instrument, including, but not limited to, reasonable attorneys' fees, property inspection and valuation fees, and other fees incurred for the purpose of protecting Lender's interest in the Property and rights under this Security Instrument; and (d) takes such action as Lender may reasonably require to assure that Lender's interest in the Property and rights under this Security Instrument, and Borrower's obligation to pay the sums secured by this Security Instrument, shall continue unchanged. Lender may require that Borrower pay such reinstatement sums and expenses in one or more of the following forms, as selected by Lender: (a) cash; (b) money order; (c) certified check, bank check, treasurer's check or cashier's check, provided any such check is drawn upon an institution whose deposits are insured by a federal agency, instrumentality or entity; or (d) Electronic Funds Transfer. Upon reinstatement by Borrower, this Security Instrument and obligations secured hereby shall remain fully effective as if no acceleration had occurred. However, this right to reinstate shall not apply in the case of acceleration under Section 18. 20. Sale of Note; Change of Loan Servicer; Notice of Grievance. The Note or a partial interest in the Note (together with this Security Instrument) can be sold one or more times without prior notice to Borrower. A sale might result in a change in the entity (known as the "Loan Servicer") that collects Periodic Payments due under the Note and this Security Instrument and performs other mortgage loan servicing obligations under the Note, this Security Instrument, and Applicable Law. There also might be one or more changes of the Loan Servicer unrelated to a sale of the Note. If there is a change of the Loan Servicer, Borrower will be given written notice of the change which will state the name and address of the new Loan Servicer, the address to which payments should be made and any other information RESPA requires in connection with a notice of transfer of servicing. If the Note is sold and thereafter the Loan is serviced by a Loan Servicer other than the purchaser of the Note, the mortgage loan servicing obligations to Borrower will remain with the Loan Servicer or be transferred to a successor Loan Servicer and are not assumed by the Note purchaser unless otherwise provided by the Note purchaser. Neither Borrower nor Lender may continence, join, or be joined to any judicial action (as either an individual litigant or the member of a class) that arises from the other party's actions pursuant to this Security Instrument or that alleges that the other party has breached any provision of, or any duty owed by reason of, this Security Instrument, until such Borrower or Lender has notified the other party (with such notice given in compliance with the requirements of Section 15) of such alleged breach and afforded the other party hereto a reasonable period after the giving of such notice to take corrective action. If Applicable Law provides a time period which must elapse before certain action can be taken, that time period will be deemed to be reasonable for purposes of this paragraph. The notice of acceleration and opportunity to cure given to Borrower pursuant to Section 22 and the notice of acceleration given to Borrower pursuant to Section 18 shall be deemed to satisfy the notice and opportunity to take corrective action provisions of this Section 20. 21. Hazardous Substances. As used in this Section 21: (a) "Hazardous Substances" are those substances defined as toxic or hazardous substances, pollutants, or wastes by Environmental Law and the following substances: gasoline, kerosene, other flammable or toxic petroleum products, toxic pesticides and herbicides, volatile solvents, materials containing asbestos or formaldehyde, and radioactive materials; (b) "Environmental Law" means federal laws and laws of the jurisdiction where the Property is located that relate to health, safety or environmental protection; (c) "Environmental Cleanup" includes any response action, remedial action, or removal action, as defined in Environmental Law; and (d) an "Environmental Condition" means a condition that can cause, contribute to, or otherwise trigger an Environmental Cleanup. Initials: -6lPAl 105081 Page t3 of 76 Form 3039 1101 B Borrower shall not cause or permit the presence, use, disposal, storage, or release of any Hazardous Substances, or threaten to release any Hazardous Substances, on or in the Property. Borrower shall not do, nor allow anyone else to do, anything affecting the Property (a) that is in violation of any Environmental Law, (b) which creates an Environmental Condition, or (c) which, due to the presence, use, or release of a Hazardous Substance, creates a condition that adversely affects the value of the Property. The preceding two sentences shall not apply to the presence, use, or storage on the Property of small quantities of Hazardous Substances that are generally recognized to be appropriate to normal residential uses and to maintenance of the Property (including, but not limited to, hazardous substances in consumer products). Borrower shall promptly give Lender written notice of (a) any investigation, claim, demand, lawsuit or other action by any governmental or regulatory agency or private party involving the Property and any Hazardous Substance or Environmental Law of which Borrower has actual knowledge, (b) any Environmental Condition, including but not limited to, any spilling, leaking, discharge, release or threat of release of any Hazardous Substance, and (c) any condition caused by the presence, use or release of a Hazardous Substance which adversely affects the value of the Property. If Borrower learns, or is notified by any governmental or regulatory authority, or any private party, that any removal or other remediation of any Hazardous Substance affecting the Property is necessary, Borrower shall promptly take all necessary remedial actions in accordance with Environmental Law. Nothing herein shall create any obligation on Lender for an Environmental Cleanup. NON-UNIFORM COVENANTS. Borrower and Lender further covenant and agree as follows: 22. Acceleration; Remedies. Lender shall give notice to Borrower prior to acceleration following Borrower's breach of any covenant or agreement in this Security Instrument (but not prior to acceleration under Section 18 unless Applicable Law provides otherwise). Lender shall notify Borrower of, among other things: (a) the default; (b) the action required to cure the default; (c) when the default must be cured; and (d) that failure to cure the default as specified may result in acceleration of the sums secured by this Security Instrument, foreclosure by judicial proceeding and sale of the Property. Lender shall further inform Borrower of the right to reinstate after acceleration and the right to assert in the foreclosure proceeding the non-existence of a default or any other defense of Borrower to acceleration and foreclosure. If the default is not cured as specified, Lender at its option may require immediate payment in full of all sums secured by this Security Instrument without further demand and may foreclose this Security Instrument by judicial proceeding. Lender shall be entitled to collect all expenses incurred in pursuing the remedies provided in this Section 22, including, but not limited to, attorneys' fees and costs of title evidence to the extent permitted by Applicable Law. 23. Release. Upon payment of all sums secured by this Security Instrument, this Security Instrument and the estate conveyed shall terminate and become void. After such occurrence, Lender shall discharge and satisfy this Security Instrument. Borrower shall pay any recordation costs. Lender may charge Borrower a fee for releasing this Security Instrument, but only if the fee is paid to a third party for services rendered and the charging of the fee is permitted under Applicable Law. 24. Waivers. Borrower, to the extent permitted by Applicable Law, waives and releases any error or defects in proceedings to enforce this Security Instrument, and hereby waives the benefit of any present or future laws providing for stay of execution, extension of time, exemption from attachment, levy and sale, and homestead exemption. 25. Reinstatement Period. Borrower's time to reinstate provided in Section 19 shall extend to one hour prior to the commencement of bidding at a sheriff's sale or other sale pursuant to this Security Instrument. 26. Purchase Money Mortgage. If any of the debt secured by this Security Instrument is lent to Borrower to acquire title to the Property, this Security Instrument shall be a purchase money mortgage. 27. Interest Rate After Judgment. Borrower agrees that the interest rate payable after a judgment is entered on the Note or in an action of mortgage foreclosure shall be the rate payable from time to time under the Note. Initials: -61PA) losoal Page is or is Form 3039 1101 e r .. ~:; •' `Fr;:,,;:;: BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any Rider executed by Borrower and recorded with it. Witnesses: JAMIE L. KEITH _ (Seal) -Borrower _ (Seal) -Borrower ROBERT L. KEITH JR. MATTHEW S. KEITH -61PA1 io5os~ Page 15 of 16 _ (Seal) Borrower _ (Seal) -Borrower _ (Seal) $orrower _ (Seal) -Borrower Form 3039 1(01 COMMONWEALTH OF PENNSYLVANIA, County ss: On this, the 5TH day of AUGUST, 2008 ,before me, the undersigned officer, personally appeared ROBERT L. KEITH JR.; MATTHEW S. KEITH; JAMIE L. KEITH known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged that he/she/they executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission Expires: Title of Officer Certificate of Residence I, CINDY A DOYLE , do hereby certify that the correct address of the within-named Mortgagee is 349 UNION ST, MILLERSBURG, PA 17061 Witness my hand this 5TH day of AUGUST, 2008 CINDY A DOYLE, MORTGAGE LOAN UNDERWRITERpgeat of Mortgagee Initials: -6(PA) 105081 Page 16 of is Form 3039 1/01 v r PAYMENT RIDER THIS PAYMENT RIDER is made this .5TH,,,,,,,,,,,,, day of ,AUGUST,,2008 ., and is ............... incorporated into and shall be deemed to amend and supplement the Mortgage, Deed of Trust, or Security Deed (the "Security Instrument") of the same date given by the undersigned ("the Borrower") to secure Borrower's Note to ...MID PENN BANK 349 UNION ST,.••,•„ MILLERSBURG, PA 17061 .... ,. . .. .......................................................... . .. ......................................... ......................................................... .......................................... of .••...•. t e ender") the same date and coveringg the property described in the Security Instrument and located at: 1100 S. YORK ROAD, DILLSBURG, PA 17019 ............................................................................................................................. (Property Address) ADDITIONAL COVENANTS. In addition to the covenants and agreements made in the Security Instrument, Borrower and Lender further covenant and agree as follows: A. PERIODIC PAYMENTS OF PRINCIPAL AND INTEREST The Note provides for periodic payments of principal and interest as follows: 3. PAYMENTS (A) Periodic Payments I will pay principal and interest by making periodic payments when scheduled: ^ I will make .......................... payments of 5 ........................................................ each on the .................... ..• . ........................................... ......................................... of each ......... ......................................................................................................... .......................................... beginning on ............................................................. . ® I will make payments as follows: 59 MONTHLY PAYMENTS OF 51,945.79 BEGINNING 10-01.2008. ~ In addition to the payments described above, I will pay a "Balloon Payment" of $ 283;573.28,•••.•..•...••..•, on •09;01:2013 .• •• ............................. .......... The Note Holder will deliver or mail to me notice prior to maturity that the Balloon Payment is due. This notice will state the Balloon Payment amount and the date chat it is due. (B) Maturity Date and Place of Payments I will make these payments as scheduled until I have paid all of the principal and interest and any other charges described below that I may owe under this Note. My periodic payments will be applied to interest before Principal. If, on ,09:01.-2013 I still owe amounts under this Note, I will pay those amounts in full on that date, which is called the "Maturity Date." will make my periodic payments at ..349 UNION STREET,.MILLERSBURG, PA 17061 • .................................................................................................................................. .................................................................................................................................. ••••••••••••••••••••••••.••...•.......• ................. or at a different place if required by the Note Holder. MULTIPURPOSE FIXED RATE PAYMENT RIDER (MULTISTATE) Bankers Systems, Inc., St. Cloud, MN Form MPFR-PR 6/15(2004 ref: MPFR-MN (page 7 of 2 pages) O B. FUNDS FOR TAXES AND INSURANCE Uniform Covenant 3 of the Security Instrument is waived by Lender. BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Payment Rider. ............ {Seal) ............................................. ROBERT L. KEITH JR.; JAMIE L. KEITH -Borrower ................................. (Seal) ......................... MATTHEW S. KEITH -Borrower Bankers Systems, Inc., St. Cloud, MN Form MPFR-PR 6/15/2004 (page 2 of 2 pagesl r PAYMENT RID~ERof '.. .....,.... THIS PAYMENT RIDER is made this .5TH,,,,,,,,,,,, AUGUST, 2008 ,,,,,,,,,,,,,,,, and is incorporated into and shall be deemed to amend and supplement the Mortgage, Deed of Trust, or Security Deed (the "Security Instrument") of the same date given by the undersigned ("the Borrower") to secure Borrower's Note to ...MID PENN BANK: 349 UNIt1N ST,,,,,,,, ,MILLERSBURG, PA ,17061... ........................................................ .......................................................................................................... of t e en er - the same date and coveringg the property described in the Security Instrument and located at: 1100 S. YORK ROAD, DILLSBURG, PA 17019 (Property Address} ADDITIONAL COVENANTS. In addition to the covenants and agreements made in the Security Instrument, Borrower and Lender further covenant and agree as follows: A. PERIODIC PAYMENTS OF PRINCIPAL AND INTEREST The Note provides for periodic payments of principal and interest as follows: 3. PAYMENTS (A- Periodic Payments t will pay principal and interest by making periodic payments when scheduled: ^ I will make .......................... payments of S ........................................................ each on the ............................................................................................................ of each .................................................. ................................,................... .......................................... beginning on ......... ............................................ . ........ ® I will make payments as follows: 59 MONTHLY PAYMENTS OF 51,945.79 BEGINNING 10-01-2008. ~ In addition to the payments described above, I will pay a "Balloon Payment" of $ 283:573.28 ., on ,09 01.201,3, , .................. ........................................ The Note Holder will deliver or mail to me notice prior to maturity that the Balloon Payment is due. This notice will state the Balloon Payment amount and the date that it is due. (B) Maturity Date and Place of Payments I will make these payments as scheduled until I have paid all of the principal and interest and any other charges described below that I may owe under this Note. My periodic payments will be applied to interest before Principal. If, on .09;01.2013 I still owe amounts under this Note, I will pay those amounts in full on that date, which is called the "Maturity Date." will make my periodic payments at ,.349 UNIQN STREET,,MILLERSBURG: PA 17061 .................................................................................................................................. .................................................................................................................................. ....................................................... or at a different place if required by the Note Holder. MULTIPURPOSE FIXED RATE PAYMENT RIDER (MULTISTATE) Bankers Systems, Inc., St. Cloud, MN Form MPFR-PR 6/15/2004 ref: MPFR-MN (page 7 of 2 pages) ^ B. FUNDS FOR TAXES AND INSURANCE Uniform Covenant 3 of the Security Instrument is waived by Lender. BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Payment Rider. ............................................. ............ (Seal) R08ERT L. KEITH JR.; JAMIE L. KEITH -Borrower ....................... ................................. (Seal) MATTHEW S. KEITH -Borrower Bankers Systems, Inc., St. Cloud, MN Form MPFR-PR 6/15/2004 (page 2 of 2 pagesl c REV-1513 EX+ (01-10) j`~ Pennsylvania SCHEDULE J ~ ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert L. Keith, Jr. 2011-925 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Matthew Scott Keith, 1100 S. York Road, Dillsburg PA 17019 Son 100°10 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET~$ If more space is needed, use additional sheets of paper of the same size. - -