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05-30-12 (2)
J 1505610105 REV-1500 Extn2_ll>tF„ PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~F~.p ~E~*~FpINHERITANCE TAX RETURN PO BOX 280601. Harrisburg, PA >,~>28-o60i RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ' 239-44-7602 12/01 /2011 11 /28/1931 Decedent's Last Name Suffix Decedent's First Name MI Kimel Robert J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST. BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 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 C OMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED 70: Name Daytime Telephone N~ber -~: John R Steffee CPA CSEP ,- 717 975-8500 ~~ iv a~ -r , , REGISTER OF Vix L-S':4SE ONLY ' _ ~'_'i: ~ i i. First Line of Address -; { _, - . f C 342 N Front Street ~ `'-- ~ C- ~a ' -- ;-n Second Line of Address ~ n0 ~ ~~ C.J -~ - r.. Y o City or Post Office Wormleysburg State ZIP Code PA 17043 Correspondent's a-mail address: john@pfStaX.COm DATE FILED Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE SON RESPONSI FO FILI G RETURN _ Q -'~_` ~~ DATE ~ ~`~`~ CGS-. ~ \~~~~ 1--_ t{ 1i ~ ~-~~.>,.J~Z\ ~; B ~, •,1 1 'Z_. ADDRESS - - "" 861 Country Club ad Camp Hill, PA 17011 SIGN E OF PREPA ER THE T AN REPRESENTATIVE >, c P~ ADDRES 342 N ront Street Wormleysburg, PA 17043 1505610105 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 J ~~ 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Robert J Kimel 239-44-7602 RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 84,410.77 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 140,822.14 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .:.. _ .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 90,075.23 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 315,308.14 9. Funeral Expenses and Administrative Cosis (Schedule H) ................. .. 9. 24,562.65 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 5,652.04 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 30,214.69 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 285,093.45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 285,093.45 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 taxable `` at lineal rate x .0 45 285,093.45 16. 12,829.21 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18_ 19. TAX DuE ...... ................................................. 19 12,829.21 .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Robert J Kimel STREET ADDRESS 862 Country Club Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 497.98 - -- ___- B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 12,829.21 Total Credits (A + B) (2) 497.98 (3) (4) (5) 12,331.23 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)]. 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 rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (y-11) ~i~ pennsylvania f.~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Robert J Kimel 21-12-0019 All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size REV-i5o8 EX+ (u-io) Pennsylvania SCHEDULE E f..17 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert J Kimel 21-12-0019 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. If more space is needed, use additional sheets of paper of the same size. REV-1737-& EX + (6-08) ~ Pennsylvania ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & use schedule G, Part z, ONLY for MISC. NON-PROBATE PROPERTY proportionate method of tax computation. ESTATE OF Robert J Kimel FILE NUMBER 21-12-0019 Part 1 must include all transfers of real estate and tangible personal property located in Pennsylvania. Complete Part 2 ONLY when the proportionate method of tax computation is elected. Include in the description of property the date the transfer was made and the name and relationship of the transferee. This schedule must be completed and filed if the answer to questions 1 through 4 on the reverse side of the REV-1737 cover sheet is yes. DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, the relationship to Decedent and the date of transfer. DATE OF DEATH % OF DECD'S EXCLUSION NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1~ 2009 Lincoln Town Car 18,000.00 100 18,000.01 2 fidelity IRA A/C #X05-924350 8,299.64 100 8,299.6 3 Fidelity Rollover IRA A/C #219-298514 63,347.59 100 63,347.5! 4 Erie Ins #Q112105311 Auto Ins Refund 428.00 100 428.01 PART 1 TOTAL $ $ $ 90,075.2: DESCRIPTION OF PROPERTY ITEM Include the name of the Vansferee, the relationship to Decedent and the date of transfer. DATE OF DEATH % OF DECD'S EXCLUSION NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1. 0.0 PART 2 TOTAL $ $ $ TOTAL (Also enter on Line 7, Recapitulation.) $ 90,075.23 (If more space is needed, use additional sheets of paper of the same size) REV-1511 EX+ (10-09) j Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Robert J Kimel 21-12-0019 Decedent's debts must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Organist -Paid in Cash by John Kimel 2 Pastor -Paid in Cash by John Kimel 3 Commentorative Pamphlet;Life of Bob Kimel -Paid in Cash by John Kimel a Hayworth Miller Funeral Home 5 B. 1 2. 3. 4. 5. 6. 7. a 9 ~o ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Thomas J Richards Street Address 861 Countr~r Club Drive _ City Camp Hill -_--- - --_----- Year(s) Commission Paid: 2012 state PA ZIp 1.7011 Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City -- ---- --- -- -_ _ - -State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Postage $43.35 +$1.04 + 23.45 +5.75 Advertise legal notice -Harrisburg Patriot News Parking Letters Testamentary/Short Certificates $5.00 + $343.50 + 8.00 395.00 2,375.00 73.59 65.16 10.00 356.50 - TOTAL (Also enter on Line 9, Recapitulation) I $ 24,562.65 ZIP 100.00 100.00 95.00 2,992.40 18,000.00 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-OS) i Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert J Kimel 21-12-0019 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert J Kimel 21-12-0019 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~ John S Kimel 2150 Homestead Hills Drive Winston Salem, NC 27013 Brother 50.00 2 Carmell M Kimel Sister 453 Ledford Circle High Point, NC 27265 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. 50.00 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. District Nd./~~ / ' ` Local No. ~ /(~ DECEDENTS NAME (First, Middle, Last) SEX DATE OF DEATH (Month,Day,Year) ,. Robert James Kimel 2• Male 3. December 1, 2011 SOCIAL SECURITY NUMBER I AGE-Last Birthday UNDER 1 YEAR .UNDER 1 DAYti DATE OF BIRTH (Monfh,Day,Year) BIRTHPLACE (County and State a. 239-44-7602 (Years) Months Days Hours Minutes ' November 28,-1931 or Foreign Country) s. 80 sb. sc. s. 7. Fors th Co. NC WAS DECEDENT EVER IN U.S. 9a. PLACE OF DEATH (Check only one ) BARMED.FORCES7 (Yes or No) rJ0 .HOSPITAL: ®Inpatient ~-ER/Outpatient ~ DOA. OTHER: Q Nursing Home Residence Other (Specify) FACILITY NAME (If not institution, give street and number) CITY,TCWN, OR LOCATION OF DEATH INSIDE CITY OMITS? COUNTY OF DEATH ~ - (Yes or No) sb. Fors h Medical Center s=. Winston-Salem sd. Yes se. Fors th MARITAL STATUS -Married, Never SURVIVING SPOUSE (If wife, give maiden name) DECEDENT'S USUAL-0CCUPATION (Give kind of work KIND OF BUSINESS/INDUSTRY Maried, Widowed, Divorced (Specify) _ "tlone during most of working ~Ie. Da not. use retlred.J _ NeWSPa Per 10. Never Married 11. None tza T pe. Setter' 12b. RESIDENCE-STATE COUNTY CITY, TOWN, OR LOCATION STREET AND NUMBER. ,3a. PA 136. Cumberland ,3c. Cam Hill 13d. 862 Countr Club Road •' fNSIDE CITY LIMITS? ZIP•CODE Was Decedent of Hispanic Origin? lspeclty Yes or RACE-American Indian, . DECEDENTS EDUCATION (Specify only highest grade (Yes.orNo).' No-If YesspecilyCuban,Mexican,PuedoRican, Black,White,Etc: (Sper:i(y) domptefedl.Elementary/Secandary(0-12)'Col/ege(13-17+) etca 13e. Yes 13f.17011 1a. ^ Yes® No(speafy) ts. White 1s. 12 FATHER'S NAME (First, Midd/e,Last) MOTHER'S NAME (First, Middle, Maiden Surname) n- Carl C. Kimel 19. EIma,Sri;d.er INFORMANT'S NAME (Type/Print) MAILING ADDRESS (Street and Number orRUalf2buteidumber,CityorTown,Stab,ZiNCode) DATE AMENDED 1sa. John Kimel ~ 1sb 2150 Homestead Hills Drive Winston Salem NC 27103. 1so. Part I. Enter the diseases, injuries, or complications That caused the death. Do not enter the mode of dying, such &s cardiac or respiratory arrest,, Approximate Interval shack or heart failure. IF appropriate, nter tobacco, alcohol, or drug use. List only one cause on each line. - Between Onset and . IMMEDIATE CAUSE ~ ~ -'(PRwUTOrTYFE) Death (Final disease or e. Slii J O condition resulting In DUE TO (OR AS A CONSEQUENCE OF): ~ death) - Sequenliatlylist conditions if b. any, leading to immediate DUE TO (OR AS A CONSEQUENCE OF): . • cause.EnterUNQERLYING. _ .. ~ _ - CAUSE '(Disease dr injury that initiated events resulting c' in death) LAST DUE TO (OR AS A CONSEQUENCE OF): PARTIL' Oltler signiricanl conditions conlri-bruling to deal but not resulfing in the underlying use given(in_ Part 1, such s tobacco, al hot, or drug use; diabetes, etc. 20b. CG( - l F~fj w~G ! /`~ VJE ~~. ~ -L l~c~•~cr ~~ ~~~~ AUTOPSY? es or No) ff Yes, were findings considered in determining Was case referred to Medical Exa iner7 (Yes or No) TIME OF DEATH cause of'death2 - ~ :2O P M. ~: 21a. 21b, ~~. 21 c.) ~ ~ 22. NOTICE STATE LAW REQUIRES THAT A L DEATHS DUE TO TRAUMA, ACCIDENT,`HOMICIDE( SUICIDE, OR UNDER SUSPICIOUS, UNUSUAL. OR UNNATURAL CIRCUMSTANCES BE REPORTED TO, AND CERTIFIED BY A EDICAL EXAMINER ON A MEDICAL FY4MINER'S CERTIFICATE OF DEATH. ANY DEATH FAWNG INTO THESE CATEGORIES IS WITHIN THE MEDICAL EXAMINER'S JURISDIC O REGARDLESS OF THE LENGTH OF SURVIVAL FOLLOWING THE UNDERLYING INJURY. ~ •~ • Substitute for DHHS 1872 (Revised 3rD3 V.R. Review &D6) VITAL RECORDS TSI Form NC2 SIGNATURE AND TfTLE OF CERTI R DATE SIGN D (Monlh,Da ,Year 23a. 2 Z 23b. 24 AME A D~~~F~SS (y~P~RSO Wf C COMP~j~D CA~ E OF D G ~( ITE,~12~~ yp~r Pn~ ~ ~'~' ^' ~ ~~ ~ METHOD OF DISPOSITION PLACE OF DISPOSITION (Name of cemetery, crematory, or of r LOCATION -City orTown,State, Zlp Code Burial ®Cremation ^ Removal ( place) 2sa ^ Donation ^ Other zsb. Hayworth-Miller Crematory 2so. Winston-Salem NC 27103 NAME AND ADDRESS OF FUNERAL HOME Haywo -Miller Funeral Hom e, Inc. NAME OF FUNERAL DIRECTOR LICENSE NUMBER 2sa. 3315 as ek Park y 'n ton-Salem, NC 27103 zsb. Wesle Saunders zs~ FS2407 51 URE ~~ DATE FILED NAME OF EMBALMER LICENSE NUMBER _h-~.7 (Month.Dav. ar) z7. j zsd. Bod Not Embalmed 2se N/A North Carolina Dpp N.CeVital Recot dsnd Human Services I I (III III~E~~~~l~ I>4~I1II~~~I~I~I III. CERTIFICATE OF DEATH 1 zolllisllaz3s D 118 2924 - •--- - - COMMONWEALTH OF PENNSYLVA""" COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the Sth day of January, Two Thousand and Twelve Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of ROBERT JAMES K/MEL late of EAST PENNSBORO TOWNSH/P (First, Middle, LasU in said county, deceased, to TOM RICHARDS lFiisl, Middle, Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 5th day of January Two Thousand and Twelve . File No. 2012-00099 PA File No. 21- 12- 0019 Date of Death 12/01/201 1 S . S . # 239-44-7602 f' ? _ eglsTer Of Wills ` `/~ ti \ ~ ! // . ~ ~- NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL LAST WILL AND TESTAMENT of ROBERT J. gIMEL I, ROBERT J. KIMEL, of Harrisburg, Dauphin County, Pennsylvania, being of full age, sound mind and memory, and under no restraint, do make, publish and declare this to be my Last Will and Testament, and hereby revoke all Wills and Codicils ever before made by me. FIRST: I direct my Executor to pay all of the expenses of my last illness, of my funeral and burial and of the administration of my estate. SECOND: I direct my Executor to pay all inheritance, estate, transfer and similar taxes (including interest and penalties) assessed or payable by reason of my death on any property or interest in property which is included in my estate for the purpose of computing taxes. My Executor shall not require any beneficiary under this Will to reimburse my estate for taxes paid on property passing under the terms of this Will. THIltD: I give, devise and bequeath to such of the following named persons who shall survive me the following gifts: 1. To my friend, MICHAEL F. ZERBE of Dauphin County, Pennsylvania, my two (2) brass 17~' Century ~_ ..k ~,,,~ ~; :,~~_ ~ 4`~. .:e reproduction candle sticks. 2. To my friend, WILLIAM N. KRENZ, JR. of Dauphin County, Pennsylvania, my hunt scene picture over the entertainment center, the black-marble-top Maitland-Smith bachelor's chest, and the Empire marble-top credenza. i 3. To my friend, THOMAS A. RICHARDS of Cumberland County, Pennsylvania, my dutch cupboard. Initial ~~K PAGE ONE OF FIVE PAGES FOURTH: I give, devise and bequeath the entire residue of my estate, whether real, personal or mixed, of every kind, nature and description whatsoever, and wherever situated, which I may now own or hereafter acquire, or have the right to dispose of at the time of my death, by the power of appointment or otherwise, to my brother, JOHN S. KIMEL of rsyth County, North Carolina, and to my sisters, LOUISE KIMEL BURGESof Forsyth County, North Carolina and CARMELL M. KIMEL of High Point, North Cazolina absolutely and in fee simple, share and share alike. FIFTH: Should, however, any of the beneficiaries named in Paragraph THIRD above predecease me or fail to survive me by thirty (30) days, then the gifts, devises and bequests to the deceased beneficiary shall fail and be of no effect, and in that event, I give, devise and bequeath the entire residue of my estate, whether real, personal, or mixed, of every kind, nature and description whatsoever, and wherever situated, which I have the right to dispose of at the time of my death, by power of appointment or otherwise to the remaining beneficiary or beneficiaries, absolutely and in fee simple, share and share alike. SIXTH: I nominate, constitute and appoint my friend, THOMAS A. RICHARDS of Camp Hill, Cumberland County, Pennsylvania, as Executor of this, my Last Will and Testament, and I direct he shall not be required to enter security in this, or any jurisdiction in which he may act. In the event, for whatever reason, he shall be unable to serve, I appoint my brother, JOHN S. KIMEL of Forsyth County, North Carolina, to be my Executor and direct that he shall not be required to enter security in this, or any jurisdiction in which he may act. \J ~ ~.~.. X. ~l .N~'L~ ~v-a ~ LS S ~ l2 L`.L.LJ~ 1vlF (~L {\ o~ 1 c 1 `l vY.t~_ Initial ~ PAGE TWO OF FIVE PAGES SEVENTH: In addition to the powers conferred upon my Executor by law, he shall also have the authority, without Court Order or proceeding: (a) To sell, pursuant to option or otherwise, at public or private sate and upon such terms as such Executor shall deem best, any real or personal property belonging to my estate, without regard to the necessity of such sale for the purpose of paying debts, taxes, or legacies; (b) To adjust, compromise or settle any and all claims in favor of or against my estate; (c) To assign or transfer any certificates of stock, bonds or other securities; (d) To do any and all things necessary or proper to complete the administration of my estate, all as fully as I would do, if living. EIGHTH: No gifts hereunder shall be subject to anticipation, assignment, pledge, obligation of beneficiaries, executors or attachments. IN WITNESS WHEREOF, I have hereunto signed my name and aclalowledged this instrument, consisting of Five (5) typewritten pages, identified by my signature, as my Last Will and Testament, in the presence of the undersigned witnesses, on this ~ day of 2007. ~ <~~~~.~ Robert J Kimel, Testator PAGE THREE OF FIVE PAGES COMMONWEALTI3 OF PENNSYLVANIA COUNTY OF DAUPHIN ss I, ..ROBERT J. KIlv1EL, Testator, whose name is signed to the attached of foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Wili and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. r y!~..~- . Robert J. el, Testator SWORN OR AFFII2.MED to and acknowledged before me, ROBERT J. KIMEL, Testator, this _~ day of 2007. Notary Pu lic ~ CpMMONWCAL7H F PENNSYLVANIA Nobuial &~d AprN L Unn, Notary Public Ftopewe0 TNp., Cumberland County My Canrnissbn E~ires June 19, 2010 Member, Pennsylvania AssuGation of Notaries PAGE FOUR OF FIT'E PAGES COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS .~ -, We, ~~ M~-~Sw'1 ~Ed~ and ~' /Q(~~i~~ ~ ~c~/1/i~s the .witnesses whose names. are .signed to the attached or 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 signed it willingly and 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 time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Witness Witness SWORN OR AFFIRMED to and acknowledged before me 'by ~0 0.s ,r7'I, ~rn swt ~tJ~ and ~OvJ~ ~' . J o--~ , the witnesses, this g day of )'YJa,.~ 2007. _ COMMONWEALTH OF PENNSYLVANIA Notarial Seal April L Linn. Notary Pubik . Hopewell Twp., (,~berlarld County tart' -~YsionE~iresJune ~s, 20~o No Pub >c Member, Penn,sYivanla AssoGation of Notaries PAGE FIVE OF FIVE PAGES May 2, 2012 Shareowner Services Post Office Box 64874 St. Paul, MN 55164-0874 www.shareowneronline.com ROBERT J KIMEL Tom Richards 861 Country Club Rd Camp Hill PA 17011 Re: Financial Confirmation Dear Shareowner: Account Number: 3097126992 Registration: ROBERT J KIMEL 862 COUNTRY CLUB ROAD CAMP HILL PA 17011 Account Creation Date: 5/21/1993 Issue Name of Stock: PPL Corporation Total Share Balance on 12/1/2011: 392.663 Certificate Shares: 100.000 4~0_ o~ ~'l~~i~ QP3 L ~~4vL~z ~r, ~ DRS/Book-Entry Shares: 100.000 Dividend Reinvestment Plan Shares: 192.663 Dividend Amount Paid YTD: N/A Closing Price per Share on 12/1!2011: $29.78000 Ticker Symbol for the Company is: PPL Stock Exchange: NYSE K ~l. ~~ Imo. ~ ~-1-~~~~~.1~ ~ 11 ~ ~~-1-_ ~~ Please note that as a transfer agent, we are not directly connected to the stock market. The above price is given as an estimate and is not a guarantee of a specific price. If you have any questions, please call our office toll-free at 1-800-345-3085. Our Shareowner Relations Specialists are available to assist you Monday through Friday, from 7 AM to 7 PM Central Time_ You may also send an email to us by selecting "Contact Us" at any time while online at www.shareowneronline.com. Sincerely, Wells Fargo Shareowner Services PP01 1 'ZFNC0123~1 ~1 ~1 ~Y~Y~`r~Y' 'PL Corp., PPL Historical Quote - (NYSE) PPL, PPL Corp. Stock Price - BigCharts.com Page 1 of 1 Enter Symbols or Keywords r SEARCH E+#arSrm8nlr'xeyworrls: r^) ppl st~~ sit t~aknm '~, ' r ' Home Quotes News Industries Markets Historical Quotes BigReports This Historical Quotes tool allows you to look up a security's exact closing price. Simply type in the symbol and a historical date to view a quote and mini chart for that security. j Enter Symbol: ppl EnterDate: 12/01/11 , r PPL Corp. ~u. Dec rt. 2011 Closing Pace: Open High. o.v - A , 1 ; Volume. Sponsored Links Have a CD Maturing Soon? Click for today's top CD rates & avoid getting locked into a low rate! RateFinder. erg/T cp-S-:; G-Rates FHA Cuts Refi Requirement Rates Hit 3.01°/o APF2! Calculate New Mortgage Payment Now. www-MCagageRatesErpsns com President Barack Obama Pres. Obama Speech Video On C-SPAN. Watch Clips for Free Online Now. www. c-span. crg PPL to Blow Up in 2012? Don't trade PPL until you get our trusted free weekly trading advice! vrnw.TheBest F!ewsletters com Find a broker J1", ~,+r' ~ M~ri4rad. tAarketwaMha kercen~ CDrrtpv;r~ BrCk@fS Compare Brokers _ ..a:o:Jy~°' AApdert~.tisrm Brdcer Gefner MwkatWatdrBm+oacs~,roer Scottrade: $7 Trades, Tratle free for 60 tlays Fast Executions with TD Amentratle ~~~~~~~~ ~~~ ~~ Home About (Job Oppodunities I Contact Us Feedback I Helo Copyright 2012 MarketWatch, Inc. All rights reserved. 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All quotes are in local exchange time. http://bigcharts.marketwatch.com/historical/default.asp?symb=ppl&closeDate=12%2F01 %2F 11 &x=29&y... 5/25/2012 Estate of Robert J Kimel Value of Morgan Stanley Smith Barney Investment Account December 1, 2011 Account # Positions uantit Hieh Low Ave Value 785-668834 BLV 50.00 89.699 88.593 89.146 4,457.30 BSV 90.00 81.200 81.080 81.140 7,302.60 Mutual Funds SCHICX 1,864.29 5.710 10,645.10 Gov't Securities 383741_WCI 17,000.00 785-767657 BLV BSV 63.00 89.699 72.00 81.200 Gov't Securities 31394BP32 10,000.00 38374LWC1 10,000.00 Estate Value F:\\Clients\Kimel Estate\MorganStanleyAccount.xlsx 105.352 17,909.84 88.593 89.146 5,616.20 81.080 81.140 5,842.08 103.579 10,357.90 105.352 10.535.20 72,666.22 MorganStanley SmithBarney Client Advisory Center PO Box 951106 South Jordan, UT 84095 April 23, 2012 Tom Richards 861 Country Club Camp Hill, PA 17011 Dear Mr. Richards: Thank you for your continued business with Morgan Stanley Smith Barney. Enclosed is the document we discussed. If you have any questions, please do not hesitate to call us. The telephone number for the Client Advisory Center is (888) 454-0555. My direct line is (801) 617-7264. For your convenience, you may also access account information at morganstanleyclientserv.com. Sincerely, Jace Hansen Client Advisory Center Hours of Operation: 8:00 am - 7:30 pm, Eastern Time Monday through Friday Encl: Date of Death Values Morgan Stanley Smith Barney LLC. Member SIPC. MorganStanley SmithBarney Client Advisory Center April 17, 2012 PO Box 951 106 South Jordan, UT 84095 Account # Positions Quantity Date of Death Price Evaluation 785-668834 HIGH LOW CLOSE BLV 50.00 12/1/2011 89.699 88.593 89.35 BSV 90.00 12/1/2011 81.2 81.08 81.17 Mutual Funds PRC S H ICX 1864.29 12/1/2011 5.71 Government Securities PRC 38374LW C 1 17000.00 12/1 /2011 105.35151 785-767657 Positions Quantity Date of Death Price Evaluation HIGH LOW CLOSE BLV 63.00 12/1/2011 89.699 88.593 89.35 BSV 72.00 12/1/2011 81.2 81.08 81.17 Government Securities PRC 313948 P32 10000.00 12/1 /2011 103.57912 PRC 38374LW C 1 10000.00 12/1 /2011 105.35151 Encl: Date of the Deatli Values Morgan Sianley Smith Barney LLC. Member SIPC. Q MBTBarlk ACCOUNT NO. ACCOLJHIT TYPE - 51259877 POWER CHECKING ROBERT J KIMEL 862 COUNTRY' CLUB RD CAMP HILL F'A 17011 00 0 04306M NM 017 65146 STATEMENT'PERIOD' PAGE NOV.24-DEC.23,2011 1 OF 1 INTEREST EARNED FOR STATEMENT PER]~OD 0.57 CAPITAL-HARRISBURG INTEREST PAID YEAR TO DATE 3.12 AC"C"nTTNT ~TTMMARY BEGINNING BALANCE DEPOSITS'&: OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUI\fT N0. AMOUNT NO. AMOUNT 14,205.58 2 511.59 1 600.00 6 755.73 0.57 13,762.01 ACC(~TTNT ACTTVTTY POSTING DATE TRANSACTION DESCRiPTiON DEFOSITS,INTF;REST F~ OTHER i,DDITZONS CHECKS & OTHER SUBTRACTIONS DAILY BALAAFCE 11-24-11 BEGINNING BALANCE $14,205.58 11-28-11 M&T ATM CASH WITHDRAWAL ON 11/26 330.00 WEST SHORE PLAZA, LE~MOYNE, PA 11-28-11 AT&T PAYMENT 36.54 11-28-11 UGI UTILITIES UGI BILL 27.00 13,812.04 12-01-11 CHASE 400726P97 PENSION 778.05 12-01-11 CWA/ITU PENSION NPP 12/11. 133.54 12-01-11 CAPITALBLUECROSS INS. PRE;M 195.07 14,528.56 12-06-11 CHECK NUMBER 0963 600.00 12-06-11 HUMANA, INC. INS PYMT 44.00 13,884.56 12-07-11 COMCAST CENTRAL CENTRAL PA 123.12 13,761.44 12-23-11 INTEREST PAYMENT 0.57 13,762.01 ENDING BALANCE $13,762.01 CHECKS PAID SUMMARY. _.. 963 12-06-11 600.00 ANNUAL PERCENTAGE YIELD EARNED = 0.04 °s DID YOU KNOW THAT YOU CAN ACCESS UP TO 24 MONTHS OF ACCOUNT ACTIVITY, CLEARED CHECKS AND NOTICES FROM ANYWHERE YOU HAVE INTERNET ACCESS...AT THE OFFICE, ON VACATION...ANYWHERE? JUST LOG ON TO YOUR SECURE M&T WEB BANKING ACCOUNT AND GO TO THE "CUSTOMER SERVICE" TAB TO EDIT YOUR DELIVERY OPTIONS AND CHOOSE THE DOCUMENT TYPES YOLJ WANT TO RECEIVE ELECTRONICALLY. START ENJOYING THE CONVENIENCE OF ELECTRONIC DELIVERY TODAY! TO ENROLL IN WEB F3ANKING, VISIT MTB.COM/WEBSANKING. MEMBER FDIC. ©~ ACCOUNT NO. ACCOUNT TYPE" 15004222293893 POWER MONEY MARKET ROBERT J KIMEL 862 COUNTRY CLUB RD CAMP HILL PA 17011 00 0 06123M NM 017 74983 STATEMENT PERI OD PAGE OCT.14-JAN.13,2012 1 OF 1 INTEREST EARNED FOR STATEMENT PERIOD 375.49 WEST SHORE PLAZA INTEREST PAID YEAR TO DATE 120.69 ZT(''(''(1TTT~TT CTTMMZIAV BEGINNING BALAPdCE DEPOSITS ~ OTHER ADDIT;CONS WITHDRAWALS & OTHER SUBTRACTIONS CURRENT TNTEREST PATD ENDITJG BALANCE NO. AMOUNT N0. AMOUNT 0.00 1 12E~,173.13 1 126,548.25 375.12 0.00 AC''("(1TTT~TT Z1('TT~ITTV POSTING .DATE TRANSACTIQN iESCRIPTION: DEPOSITS,,INTEREST & OTHER ADDITLONS W/DFAW}jLS & OTHER SUBTRACTIONS DAILX BALANCE 10-14-11 BEGINNING BALANCE $0.00 10-17-11 DEPOSIT 126,173.13 126,173.13 11-14-11 INTEREST PAYMENT 120.45 126,293.58 12-14-11 INTEREST PAYMENT 133.98 126,427.56 01-ll-12 INTEREST PAYMENT 120.69 01-11-12 CLOSEOUT 126,548.25 0.00 ENDING BALANCE $0.00 ANNUAL PERCENTAGE YIELD EARNED = 1.29 $ ** GROW YOUR SAVINGS THE EASY WAY ** EASY SAVE IS A CONVENIENT SERVICE THAT ALLOWS YOU TO SET UP AUTOMATIC TRANSFERS FROM YOUR M&T CHECKING ACCOUNT TO YOUR M&T SAVINGS ACCOUNT. ** YOU CHOOSE THE AMOUNT AND FREQUENCY ** YOU CAN CHANGE OR STOP IT AT ANY TIME TO GET STARTED, LOG ON TO M&T WEB BANKING AND CLICK THE TRANSFERS TAB OR STOP BY YOUR LOCAL M&T BRANCH. LEARN MORE AT MTB.COM/EASYSAVE. MEMBER FDIC. FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL (800) 724-2440 Car ]111®f dale I, (name:)_:To/in/ ki~vre~ of (address:) ~/,~, a/SD lfo~~PSfeac~ /~i%/s ~3r, lc~i~sfon Sa/PrrJ, hereby certify that I am the lawful owner of this vehicle: Car, ruck, SUV, Van, Crossover SUV) Year ADD 2 Make ,~ %N~o,/N Model rc~.t~ Ca/` VIN# ~~-NHM,~j'2 V29X616637 and have the authority to sell it. I hereby acknowledge the receipt of $.1,$fD~D-oO in the form of elteck ,from (Buyer's name:} as full payment for the purchase of the said vehicle, which is sold "AS IS". I hereby state that the mileage of the vehicle at the time of sale is a9'7~S(~ I do hereby grant, sell and transfer fitll ownership of this vehicle to the buyer. I certify that this vehicle, at the time of sale, is flee from all encumbrances, taxes, fees and liens except as those specified on the Title or listed below; and that, I (Seller) will defend and be held fully responsible for such lawful claims and demands with respect to the vehicle, if any. Buyer accepts full liability for the vehicle, damages, and any third party liability incurred from the vehicle use fram the date of sale. If applicable, Seller agrees to make arrangements fo-- the reasonable delivery of vehicle title from lien holder to buyer immediately. ~ ~~%7. ~ ~ Set s S-anature i/s/ gnature Co~fraht!' Date Date Thomas A. Richards 861 Country Club Road Camp H i I I, PA 17011 717-761-6533 Fidelity Investments Account Re-registration Services Via Fax: 1-800-275-6033 May 9, 2012 Re: Robert J Kimel Estate IRA A/C #'s x05-92435C1; 219-298514 Hello: Robert J Kimel died December 1, 2011. As you can see from the attached short certificate, I have been named the Executor of his estate. Please send the values of his two IRA's with Fidelity as of the date of his death directly to me at 861 Country Club (toad, Camp Hill, PA 17011. Sincerely, Thomas A Richards Cc: John R Steffee, CPA va/ZL/LV1Z UtS:LY YHA May 14, 2012 'THOMAS A RICHARDS 861 COUNTRY CLUB RD CAMP Hll.L, PA 17011-1f 15 Dear Thomas A Richards' ~!JUUL We are resj~anding to your request for information regarding Robert Kitnel's Fidelity Investments account(s). All information in the enclosed valuation report(s) is (arc) based on assets in the Fidelity account(s) as of the date indicated on the report(s). Valuation information is provided through a third party valuation service provider'. Fidelity does not warranty the accuracy of [Iris information for any particular purpose, nor does Fidelity provide Ir_gal or tax advice. Consult with an attorney or tax professional regarding any specific legal or tax situation. We hope this information is helpful. If you have any questions about account holdings or need instructions on how to transfer the ~~unership of the accounts, please visit us at Fidelity.com and search under "Change Account Registration" or call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m. to G:30 p.m. Eastern time. 5 incerely, Carla Gvins Carla Goins Fidelity Investments AGCOunt Re-Registration Services Representative Our file; W 120205-09MA.Y 12 LGLTR2/uDODCtVFM 531298,1,E l3rakeragt Scrriccz pn'~ rlc~l by t' idellfl' t3rnkeragc SCf~'Ices LI,C Member NYS(:, SPIC Clenring. cu~iudy and ;culcmuii ~c[~7ces by Nntlonal Flnan~Iul 5cCVteeS LLC Member NYSC, SPIC ~>.ri. ~g,,._ 7?f1f1Ql, CancinnFlti.01~1 d5~77-t)Ojd N S Y- h m b O ~t ~~ E w N K O U W r-' G m n a m N p, rD f n r~ o n ~ ~ n w r~1 n cn R ~ U<7 f"r 'd G w cn r ''C (A n Pi m ~ b m ~, O w a rr G n --~ R m I -' ~ m rn ._ . ~ w N r•. 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F• ~ v: ~ ~ ~, O w o r {1. o ~ ~ ~ ,_ ~ o ° 0 o 0 ° .~ D ° O N ~.. 7 7 F-~ ~ - '> ~ ,A ~ ~i f-r Y• s ;~ a ~ ~ ~ -` ~ ~ R ~ N CIi ~ G ~ V ~ - G ~ v U1 R }--~ v: p L fl ~ U C~ a y U1 - o O O O Y~ O H O o O tT O .n rt 1^~ O a s ~ c ~ -• I N ~ ~7 rr ~ r~ n ;p .. ,., o rn a rn N ~ 2' O N [*] L, o ,~ ~• n ~ ~ _. K ~ - u, r'r K r7 ~ R ~ ~ n ~ a o r- N ~ N fT N cn ~ ~ ~ J rn [p tr O ~p `~ `~ ~ H < O 1 Y O ,tom .. C7 ~ C7 n Y • r9 N ;~ ~ ~< ~nnr~oo N ~c m ~tT w v,~ ~~ ~ .. ~ ~ H Y• O O M i ~a .I. ~T 1,~ •r ~_ . Ul G r~ (D ~ t rr i -i i1, ~ '~ n 7C . ] r-~ Ut fD r' o ~ r .. w H ; N fT ,t1 N t ~ Nw;S ~- o m u, w G N c sv r- 0 a NOTICE OF PREMIUM REFUND Erie ~~ Insurance' 100 Erie Ins. PI. Erie, PA 16530 'e 000 0001790 00000000 001 001 01790 INS: 0 0 AA7221 ESTATE OF ROBERT J KiMEL CIO THOMAS RICHARDS EXECUTOR 861 COUNTRY CLUB RD CAMP HILL PA 17011 $ 428.00 Q112105311 AA7221 MURDOCHINSURANCE 2000169105 PRO RATE CANCELLATION NON-NEGOTIABLE THIS REFUND CHECK HAS BEEN ISSUED TO YOU AS A RESULT OF A PREMIUM CREDIT BALANCE REMAINING ON THE CANCELLED POLICY/ACCOUNT INDICATED ON THE BELOW CHECK. IF YOUR RECORDS DO NOT AGREE, PLEASE NOTIFY YOUR AGENT. DATE MO. DAY YR. 02 26 2012 REFUND AMOUNT POLICY/ACCOUNT NO AGENT NO. AGENT NAME CHECK NO. REFUND REASON CH27S1 v.08 5 4.201 ~~( ~~~ ~~ .. . ~~,~--- _ ~ od ~~v= ~~,~ ~•tic~.~~l._~~~~~~~r_4~ ~~~:~e_ cam' ,_.t , c-r ~~ C~La ~ L~-~y. ~'u ~.~ ~G~.r~ ~~ t4~1~_ ~~A L~'~~.~ v~ ~~' i; V .P'i- ~~C_.'~r~.-ice' ~~l ~ 1 Hayworth-Miller Funeral Home, Inc. 3315 Silas Creek Parl_~ :~a} Winston-Salem, NC 27103 Phone: (336) 765-8181 Statement John Kimel 2150 Homestead Hills Drive Winston Salem NC 27103 Payment-In-Full Due ilpon Receipt Of This Statement Please contact ou-• Billing Department at 336-765-8181 for any questions regarding this account. Contract Date Statement Date Account Number Regarding Date of lleath Dec 01, 2011 01/06/2012 II-0786-SCR Kimel,RobertJames 12/01/2011 'Transaction Date Transaction Description Amount Balance Balance Itemized List Of Goods and Services $2,658.35 $2,658.35 ~Uec U /, ZU I I 10 Additional Death Certificates ',Dec 13, 201 1 '.Obituary -Winston-Salem Journal $100.00 .. __ ___ $2,758.35 $134.05 $2,892.40 Balance Due: X2,892.40 8 v \ 1~1~~ HAYWORTH-MILLER FUNERAL HOME, INC. 3315 Silas Creek Parkway Winston-Salem, North Carolina 27103 Phone: 336-765-8181 RECEIVED FR V V ~u ~..1 L~. i. / DATE ~ ~ l ~ti£ . ~~ , 20 ~-Z DOLLARS $ /O OIJ A ~ /I ~ -- - FOR L' - -(o,a7~,L Amount of Ac Amount Paid .. Balance Due .. Cash j count ..........$ ___. THANK YOU! .................. $ ~~ ~ D~ Check':.---'. "^.0---_ C C ~ ~ By ~ iUi ...'[~~ Thomas Richards 861 Country Club Drive Camp Hill, PA 17011 May 20, 2012 Services Provided in connection with duties as Executor of Robert J Kimel's Estate. $18,000.00 Payable upon.. receipt. of acceptance of PA Inheritance Tax Return PFISTER & ROMPALO, P.C. 342 NORTH FRONT STREET WORMLEYSBURG, PA 17043 Phone:717-975-8500 BILL TO ROBERT J. KIMEL ESTATE C/O TOM RICHARDS 1424 NORTH SECOND STREET HARRISBURG, PA 17102 INVOICE INVOICE NO. DATE 40692 4/11/12 CUST ID KIM602 PROJECT PAG E 1 of 1 2011 INDIVIDUAL TAX RETURNS 395.00 i '~ ~ ~~ ~~'~ [3 ~~ A FINANCE CHARGE OF 1.5o PER MONTH WILL BE APPLIED TO ALL OUTSTANDING BALANCES THAT EXCEED 30 DAYS. TOtal'Due 3 95.0 0 PFISTER & ROMPALO, P.C. 342 NORTH FRONT STREET WORMLEYSBURG, PA 17043 Phone:717-975-8500 BILL TO ROBERT KIMEL ESTATE C/0 TOM RICHARDS, EXECUTOR 861 COUNTRY CLUB ROAD CAMP HILL, PA 17011 INVOICE INVOICE NO. DATE 41338 5/29/12 CUST ID KIM676 PROJECT PAGE 1 of 1 2011 FIDUCIARY TAX RETURNS & PA INHERITANCE TAX RETURN 2,375.00 A FINANCE CHARGE OF 1.5o PER MONTH WILL BE APPLIED TO ALL OUTSTANDING BALANCES THAT EXCEED 30 DAYS. Tota i Due` 2, 3 7 5 .0 0 ~ ~ ~~ MARIETTA POST OFFICE MARIETTA, Pennsylvania 175479998 4144060547 -0097 05/09/2012 (717)426-1106 10:33:55 AM Sales Receipt Product Sale Unit Final Description Oty Price Price SAINT PAUL MN 55164 $0.45 Zone-5 First-Class Letter 0.90 oz. Expected Delivery: Sat 05/12/12 Return Rcpt (Green Card) $2.35 Certified $2.95 Label #: 70091680000062759110 Issue PVI: $5.75 Total Paid by:- Personal Check $5.75 Order stamps at usps.corn/shop or call 1-800-Stamp24. ~o to usps.com/clickriship to print shipping .labels with postage. For other informaticr~ call 1-800-ASK-LISPS. kk~Yr Y(:C:tX~X:CIt]t;CY(Y(YCYCItY(7(Y(Y(k Yr :t *Ylk7F :tk kk~YC Y(Yrkk k]t~Y(IC YC%Y(1r;r:CX]txY(XYCYC1tY(Y[k XYC Y(XXYf Yr k'IrXkkk:tX k'Xk Get your mail when _and where you want it with a sea,re Post Office Box. Sign up for a box online at usps.com/poboxes. :tYtY(7C7t:t:t:tYfY(Y(~YCk:CY(YCY(Y(1tY(~~~rtY()t ~1t :C 7(Yf ]C YCX Y(YCkk* XY(YCX Jtk:tYCkkY(YC1cxk]tXYC YC It Yr Y[Y(Y(:t X:C >r :tk%XkkkkkYCkk MARIETTA POST OFFICE MARIETTA, Pennsylvania 175479998 4144060547 -0097 01/17/2012 (717)426-1106 04:13:31 PM Sales Receipt Product Sale Unit Final Description Oty Price -Price WINSTON SALEM NC 27103 $10.25 Zone-4 Priority Mail 4 lb. 9.60 oz. Expected Delivery: Thu 01/19/12 -- Insurance $33.10 Insurance Amount $3,000.00 Label #: VH6878504151iS Issue PVI: $43 35 Total: $43.35 Paid by: MasterCard $43.35 Accoun, #: XXXXXXXXXXXX5785 Approval #: 097912 Transaction #: 149 2:i 903162493 /I I ~~ © ~ rr ~ ~ • $5.75 Postage $ Insurance Fee B i 1 1 # : 1000302495386 rioted Delivery Fee C 1 erk : 02 ~rsement regwred) ecial Handling Fee • ~ Rece;~t Fee ~ . ~ ~ ~ ~ment required) ~ ~ , - • ~ ~ - - - stage & Fees ~j r~ r~ fS' , ~T P(-Ul 11M 5AY r` nJ Postage $ ~D Certified Fee f~ ~ Return Receipt Fee ~ itndcrsement Required) Restricted Delivery Fee 0 li=ndorsement Required) m --Q Total Postage & Fees I $ l pt. No., or PO Box No. ~/ ZS ~ UUUi!(U Postmafk~ ~Q,1)Il ~ Here )~2 te, ZIP+4® ..k Postmark r r Here Go to: ho ps://postalexperience.ccm/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE ~~5/C)9/2012 '~ YOUP, OPINION CGUNTS ~, Sent TO xkk;rr;~rkxkkrc~rkkkkx~cxvckrr~rxxkx~ex~crrk~r~cx:ekrr ...................... Xkkkkk:rkkkkkkkkkkkkkkXkkkkkYf :C Y(YCk Y(Y(Y(Y(Y(Y[ p C Srree!, Apt. No.; ~ ~orFOBaxNo. ______________ City. State, ZIP+4 ~ Customer Copy :.. ... - MARIETTA POST OFFICE MARIETTA, Pennsylvania 175479998 4144060547 -0097 03/23/2012 (717)426-1106 12:07:45 PM Sales Receipt Product Sale Unit Final Description Qty Price Price WINSTON SALEM NC 27103 $18.95 Zone-4 Express Mail PO-Add Flat Rate Env 1.80 oz. Label #: EI120668692US Sat 03/24/12 12:00 PM - Expected Delivery. Money Back Guarahtee Signature Requested Issue PVI: (Forever> 10 $0.45 \ Mercury ~ Project/MESSENG Mission Total: $18-95~ $4.50 $23.45 Paid by: Personal Check $23.45 Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. Fnr other information cal _1-80Q-ASK-USPS. III'~fNlll'~~II~IhV~III1IVI~VIP~'AI~I~VIIIIIP~'~I'lllll'~Illilll PO ZIP Cotle Day of Delivery Postage _ y 4 ' T ~ Nezt ^ 2ntl ^ 2nd Del. Day { , 1 i ~ j ~ 1 / I ~' Sched uled Date o7 Dellvery Return Rec eipt Fee i __. , I Date Accepte r ~~ ~ ~~l~ I ~ J ,_' ~ .7 ( 1 Month Day $ ~ t I Mo ~ Day Vear Scheduled T me of Delivery COD Fee I Insurance Fee I r _ --- iin~e Accepted ~ ~ ~ ^ 3 PM $ Q ~ J ' i ^ AM Noon ,, ~ PM ' Military Total Po St age 8 fees .. ! I ~ ~ L_ ^ 3rd DaY ^ 2ntl Da ~ I ~ ~ Flat Rat e~Q or Weight Y Id tl l ~,' Int'I Alpha Country Code i a s I Accepte s; ~p_ lbs. ozs. ~~"Y MARIETTA POST OFFICE MARIETTA, Pennsylvania 175479998 4144060547 -0097 01/10/2012 (717)426-1106 12:24:25 PM Sales Receipt Product Sale Unit Final Description Qty Price Price WINSTON SALEM NC 27103 $0.84 Zone-4 First-Class _ Letter 2.50 oz. Nonmach First-Class $0.20 Issue PVI: $1.04 Total: $1.04 Paid by: Cash $1.05 Change Due: -$0.01 Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. :f~r>r:~Y~~~~~f~rxY~~*:~:~~~TfYfYf~Y~Y~Yr~t>rT~~r~>r:~:~:~~x>rTf~ **~x>t~**x>t***~~~fT~~fY~Tr~f~rT~~r~~**~Tr:~~rTrT~~~~T~:~~ Get your mail when and where you want it with a secure Post Office Box. Sign up for a bcx online at usps.com/poboxes. **~*xY;:f*~fx***~*:f~f~Y~:f*~~~~~~~_*~f*~~~~t~;~~T~T~--- - i, EXPRESS Customer Copy Label 11-B, March 2004 M/~IL UNITED ST4TES POSTALSERVICE® Post OfficeTo Addressee Det~very Attempt Time ~ AM Employee Signature Day __. Ma ^ PM _ _ Gehvery Attempt i Time ~ AM Employee Signature I Mo. Day ^ PM _ _ rDelivery Daie ~ I,me ~ AM Employee Signature Mo. PAYMENT BY ACCOUNT ~ WAIVER OF SIGNATURE (Damestlc Mail Onfy) Express Mail Corporate ACCt. NO. Additional merchandise insurance isvoidH customer requests waiver of sfgrrature.: I wish dellvery to be""made without obtaining'sighatdre of addressee or addressee's agent (rf delivery employee F ea - Ag nc~ Acct No or judges that article can be left in secure location) and I Poval Se•vice ACCt No authorize that tlel very employee's signature constitutes valid proof of dellvery. NO DELIVERY - C~ Weekentl Holiday ^ Mailer Signature , 7t ~~~' _ Fv4W FROM: (PLEASE PRINT) PHONE I 1• ) `, .-~i ~1 1 ~~.\i tic 1 Cvu~_. ~~., I ~ ` -s~L~ \.. L. ~ ~. ~ , L ~.. I TO:IPLEASE PRINT) PHONE ( `'~ ~, " ~ ~ ~. ~' .ti . 4 ` __ ~ I ICI ~ f>~ -- ,~ X11 ~_~ h1- 1,4, ZIF . 4 IU S- ADDRESSES ONLY. DO NOT USE FOR FOR EI11GN POSTAL CODES.) Jt !z~ l• .J T ~ ~~ ~ ~ FOR INTERNATIONAL DESTINATIONS, WRITE COUNTRY NAME BELOW. • ~ I II f ~ ~i The Patriot-News Co. 2020 Technology Pk~~y Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 RICHARDS 861 COUNTRY CLUB RD- CAMP HILL PA 17011 (7.h~ ~1dfCI0l-NfUtc Now you know THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Holly Blain, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently du-y recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0002191783 ran on the dates shown below: February 03, 2012 NOTICE I,S HEREBY GIVEN that - February 10, 2012 ~ February 17, 2012 - ~~ ~ Letters of Test Iner~torv have been - ~r ~f."1gth'E 5'~.4T,EOF`ROBERT - ) I J ~ JA~~S~FCfM L~ Jafeof CAMP HILL,._ G 'ERfJ~Np;P"A:whodled ~E~ (126ER1 2011._toTOM .' C ARb~ 861 COUNTRY CLUB RD _ _ . . / --, ' ~ ~ / , CA/yISPH+~L PAVOII -- - A~1l~persons Indebted io the sold estate Sworn to and~~ubscri ed be '~e me~thls,~0`1 day of March, 2012 A. D. J ~ are required to make payment, and ~ ~ "--~ those ii~ving claims or demahds To pre~senf the same without delay to the _ : . ~ ~~ _ j `,l ~ s ~ % t ,~ ` '' ~ ` Executor ar his attorney name tielow: ,_~~ y ~ / ~,~ i ~ ~- ~ ;~- _ TOM RICHARDS 861 COUNTRY CLUB RD Notary Public CAMP: HILL, PA 17011 " 71T-767-6533 ~Oh1MbNWEAf,I-H OF PENNSYLVANIA i Noterlel Sea! Sherrie 1. Owens, Notary Public Lower Paxton Twp., Dauphin County MY Commission Expires Nov, 26, 2015 MEMBER, PENNSYIVANip ASSOCIATION OF NOTARIES The Patriot-News Co. 2020 Technology Pkv~y Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 RICHARDS 861 COUNTRY CLUB RD. CAMP HILL ACCT # NAME 233237 RICHARDS 233237 RICHARDS 233237 RICHARDS c~he~latriot News Now you know PA 17011 IN~1/OICE AD ORDER # DATE EDITION ADDTL. INFO. 0002191783 02/03/12 METRO WEST 0002191783 02/10/12 METRO WEST 0002191783 02/17/12 METRO WEST ALL CHARGES ARE NE T TYPE OF CHARGE AMOUNT BASIC AD CHARGE $41.77 BASIC AD CHARGE $41.77 BASIC AD CHARGE $41.77 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 $65.16 ~v Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication ___ THE PATRIOT-NEWS SATURDAY, DECEMBER 3, 2011 • A7 Mr. Robert James Kimel WINSTON-SALEM - Mr. Robert James Kimel, 80, passed away December 1, 2011 at Forsyth Medical Center. He was born November 28, 1931 in Forsyth County to the late Carl C. Kimel and Elma Snyder Kimel. He was preceded in death by his two sisters, Louise Burgess and Aileen Kimel. Mr. Kimel was a member of Mount Carmel United Methodist Church.. He was raised at the Methodist Children's Home and graduated from Reynolds High School in 1950. After graduation he moved to Miami, Fl and worked for the Miami Herald and subsequently moved to Harrisburg, PA and retired from the Harrisburg Patriot News. Mr. Kimel is survived by his brother, John S. Kimel and wife Violet of Winston- Salem and a sister, Carmel M. Kimel of High Point. He is also survived by several nieces and nephews. A private memorial service will beheld at a later date. Online condolences may be made at www.hayworth- miller.com. L www.pennlive.com/obits ~';. _ .. ESTATE NOTICES Run 3 times (preferably in the PA Community on Friday dependent on the address of the deceased). NOTICE IS HEREBY GIVEN that Letters of Testamentary have been granted in the ESTATE OF ROBERT JAMES KIMEL, late of CAMP HILL, CUMBERLAND PA who died DECEMBER 1, 2011, to TOM RICHARDS, 861 COUNTRY CLUB RD CAMP HILL, PA 17011. All persons indebted to the said estate are required to make payment, and those having claims or demands to present the same without delay to the Executor or his attorney name below: TOM RICHARDS 861 COUNTRY CLUB RD CAMP HILL, PA 17011 717-761-6533 ,state ivotlce Page I of l Estate Notice aleeds@patriot-news.com (aleeds@patriot-news.com] SenC Wednesday, January 25, 2012 12:06 PNI To: Tom Richards Atfnchments: ESTATE NOTICES.doc (24 KB) Please Indicate which shore you want the legal notice to run on, your name, address & phone # to complete order form. Also mention that Robert Kimmel was a past employee and that Yupha Matos ok'd a 50% discount on the cost. When you complete the attached form, please email to When we receive tt, we'll call you for prepayment - we accept all major credtt cards. Hopefully I haven't forgotten anything. Call me ff you have ANY questions! Thanks! Anna 255-8131 x:x:+:zxxxx:: Anna Leeds (717) 255-8131 Reader services Represen[atlve The Patriot-News 2020 Technology Parkway, suite 300 Mechanicsburg PA 17050 Fax: (717) 257-4726 aleeds@pnco.com ww w. pen nli ve. com/pairiotne ws "'~>PJFi GENT IRLI TI' NOTICE: This may contain information that is privileged, confidential or otherwise protected from disclosure. If you ., ~,- ..r_~t the intended recipient, please notify the sender immediately, purge it and do not dissemi Hate c. cnpv it. https://webmail.hmcl comcast.net/owa/?ae=Item&t=IPM.Note&id=RgAAAABaIIwPgIy3... 1/25/2012 L+C~~UST ~TF~F=~T F:E~EYF°T ~~= Et41T~`~ T ~ ~'9~ m CTT TYC'1E a j! ~ ~t0~ ~ ib~ fi p.$~yp y~y - - u W J c ~ t'75 tl~P LPG'~~ a -~ r ~ ~-~ 3~ ~Fl~ OF F'~ e ~E~T m iG~- e~~ T!-Et~9~l~` ~`~3~a ~ ~~`~ YUUE~`3' '~~ ~I~ a ,~~,°~ u ~i U `~ 5 u G ~~ ~~ ~O~ D ~ ~~ °GU G ti f.rt r.rs ~-~°a ~(v Yr, i,u~~vlvltr+J VHULR NO. PHONE DATE ~ , l __ NAME i' ( ~T7" ADDRESS SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT QTY. DESCRIPTION PRICE AMOUNT 5;~~ 7U.. TIC!r .~_,f., ~' ~'F t~ I `~1 TAX RECEIVED BV ^ TOTAL rr+uuuu a,o Hu claims and returned goods must be accompanied by this bill. /~ .. _. f r,. _V~ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sgware Carlisle, PA 17613 KIMEL ROBERT JAMES Estate File No.. 2012-00019 Paid By Remarks: THOMAS A RICHARDS HMW Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE Check# 928 Total Received......... Receipt Date: 1./05/2012 Receipt Time: 15:51:59 Receipt No.: 1068282 Receipt Distributicn ----- Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 40.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN 343.50 343.50 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 KIMEL ROBERT JAMES Estate File No. 2012-00019 Paid By Remarks: THOMAS A RICHARDS HMW Receipt Distribution Receipt Date: 4/26/2012 Receipt Time: 13:27:31 Receipt No.: 1.069670 Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN Check# 1011 $8.00 Total Received......... $8.00 THOMAS A RICHARDS 861 COUNTRY CLUB RD CAMP HILL, PA 17011 717-761-6533 Register of Wills PAY TO THE ORDER OF - t C`~ ETRO BANK `OR ~:03L30L846~: 5i 3L0726 928 s f ~ ~ 60-184/313 ~ l,G~ ~ Ot DATE ~~ _ ~ $ ~ u>7 ~-^°s~ ~ -_~~DOLLARS LJ ~~y a~ ~: r. 811' 09 28 ~a,~a~a ~~a,~e ~ ~.J Q ~ ~ ~ ~ R! ~ ~ N f \J U ~ > f C ~~~~--~~ 3 1 ~ ~ ~ o 0 ~ o 0 ~ U ~ ~ ~ o 0 o 0 ~ o 0 ~ o ~n 0 o ~ vi v-, v-, v v-~ ri N vi ~Ti ..... _ . ~ _ O (~ ` N .~ U ~ c~ ~ -,~ ' ~ ~ ~ ~J ~ O ~ > N cv ~ ~ "~ ~ ~ ~ ~ ~ V3 ~ ~ ~ ~ ~ a 3 ~. p A ~ ~ R ~ U x ~~+ G b U O 7J ~ ;~ .~ ¢ w w 3 0 ~ ~ ~ ~ ~ ~~ > ~ o ~ ~ ~ ~ ~ ~ ° ~ o ~ ~ a U ~'- i ~ a >> ~ W . 3Q o V o ~v UQ a~ o~ > ^ O a~ a~ v o c U a o o ~q ... P. ~a cn Z c>; ~ 0.1 w ¢ ~, ¢ O U ~ ~ ~ ~ W ~ ~ ~ ~' 3 ~ ~ U a a s ~ , , , ~ ~ y ~' ~ , ¢ z ~ CLIENT KIM602 PFISTER & ROMPALO, P.C. 342 NORTH FRONT STREET WORMLEYSBURG, PA 17043 717-975-8500 April 11, 2012 Estate of ROBERT J KIMEL C/O TOM RICHARDS 1424 NORTH SECOND STREET HARRISBURG, PA 17102 DCN: 00-234728-38233-2 Filing Status: Single To whom it may concern: Your 2011 Federal Income Tax Return was electronically filed by us and acknowledged as accepted by the Internal Revenue Service on April 9, 2012. There is a balance due of $4,558. Make your check payable to the "United States Treasury" and mail the enclosed Form 1040-V payment voucher on or before April 17, ?_012 to: INTERNAL REVENUE SERVICE P.O. BOX 37008 HARTFORD, CT 06176-0008 If you have questions about the return, wait four weeks from the acceptance date before calling the IRS Tele-Tax number, 1-800-829-4477. Your 2011 Pennsylvania Individual Income Tax Return was electronically filed by us and acknowledged as accepted by the State of Pennsylvania on April 10, 2012. There is a balance due of $876. Make your check payable to the "Pennsylvania Department of Revenue" and mail both your payment and payment voucher on or before April 17, 2012 to: PA DEPARTMENT OF REVENUE PAYMENT ENCLOSED 1 REVENUE PLACE HARRISBURG, PA ] 7129-0001 Please be sure to call if you have any questions. Sincerely, RICHARD F ROMPALO CPA Pfister and Romyalo, P. C _ Certified Public Accountants Richard F. Rompalo, C.P.A. 342 North Front Street John R. Steffee, C.P.A., C.S.E.P. Wormleysburg, PA 17043 Frederick W. Pfister, C.P.A. 717-975-8500 Office 717-975-9952 Fax INSTRUCTIONS FOR FILING PAYMENT VOUCHERS (BALANCE DUE FOR THE 2011 TAX YEAR) ATTACHED HERETO IS YOUR ~ Form 1040-V -Federal Payment Voucher Form PA-V -Individual PA Payment Voucher Form - THE FORM SHOULD BE MAILED IN THE ENCLOSED ENVELOPE ON OR BEFORE: APRIL 17, 2012 THE BOXES CHECKED BELOW APPLY TO THIS RETURN: g~ Include your remittance in the amount of $ .~~ v Z~ C~~~ ~@q~ ~ payable to ~ UNITED STATES TREASURY ^ PA DEPARTMENT OF REVENUE Put your Social Security number, tax year ending 2011 Form ~ ~ ~ ~ -- u on your check. SPECIAL INSTRUCTIONS: F:iFormsiTax Season DocumentslInstructions for Filing Payment Vouchers -Balance Due.doc update 12-14-i1 j PAY 70 TH F. I ORDER OF c~ M&T Banlc u West Shore Plata O/fim ~ ~=~-S~g'_ a~(j~ ~~1,"DOLLARS u icial Solutions MFM() ~..5~~ - ~ by ~:0 3 L 30 29 5 5~: 984 3040 198ii' L009 EST. OF ROBERT J KIMEL THOMAS A RICHARDS,EXEC 861 COUNTRY CLUB RD. CAMP HILL, PA 17011 - - - - - - - - ~ vriaui Heir anu man nnn ~ uu~ ra incin anu r~c~ui n Department of the Treasury Internal Revenue Service (99) 2011 ~ Use this voucher when making a payment wdr Form 1040. ~ Do not staple this voucher of your payment to Form 1040. ~ Make your check o~ money ceder payable to the 'United States Treasury ~ Wrde your social seta"rity number (SSN) on your check or money order. ROBERT J KIf1EL 1,424 NORTH SECOND STREET HARRISBURG PA ],7],02 Form 1040-V Payment Voucher Enter the amount of our a ment .. ..... - 4 , 5 5 8 FDIA8601 L 05!19/i l 1 Q3Q INTERNAL REVENUE SERVICE P.O. BOX 37D08 HARTFORD CT 06],76-OODB B3 56123 1009 DATF 239447602 AW KI~1E 30 0 2D1,11,2 67,0 Pfister and Romnalo, P. C Certified Pubbc Accountants `"-" Richard F. Rompalo, C.P.A.. John R. Steffee, C.P.A., C.S.E.P. Frederick W. Pfister, C.P.A. 342 North Front Street Wormleysburg, PA 17043 717-975-8500 Office 717-975-9952 Fax INSTRUCTIONS FOR FILING PAYMENT VOUCHERS (BALANCE DUE FOR THE 2011 TAX YEAR) ATTACHED HERETO IS YOUR ^ Form 1040-V -Federal Payment Voucher Form PA-V -Individual PA Payment Voucher ^ Form - THE FORM SHOULD BE MAILED IN THE ENCLOSED ENVELOPE ON OR BEFORE: APRIL 17, 2012 THE BOXES CHECKED BELOW APPLY TO THIS RETURN: Include your remittance in the amount of $ V 7 ~ ~/~~~~'L ~1~~b payable to ^ UNITED STATES TREASURY PA DEPARTMENT OF REVENUE (~QS~- ~~~~C~ l ~7 Put your Social Security number, tax year ending 2011 Form ~l-t-- ~ on your check. SPECIAL INSTRUCTIONS: F:/Forms/Tax Season liocuments/Instructions for Filing Payment Vouchers -Balance Due.doc update 12-14-11 239-44-7602 KI 1100916087 PAYMENT AMOUNT KIMEL ROBERT J 717-232-7370 $ 876.00 1424 NORTH SECOND STREET HARRISBURG pA DEPARTMENT USE ONLY 17102 PAIZ3401L 1U21111 Make check or money order payable to the Pennsylvania Department of Revenue EST. OF ROBERT J KIMEL s3135s1zs _ .101. 0 THOMAS A RICHARDS,EXEC 861;000NTRY CLUB RD. ~, _ CAMP HILL, PA .17011 DATE - PAY TO THE I ~. ~~~ ~~~ , ORDER OF ~ r S DOLLARS 8 `~'°"".,~.°m""' ~M~ BaIll~ Power Financial Solutions ~ ~ Wert Stwre Plae Difin ~ ~ - - - . - ~ - - MEMO ~- 5~~ - ~G~ t- _ ~~:03 L 3029.55: 9843040 L9B11' LO LO (~omcastQ Service Details Contact us: ~ www.comcast.com ~ 1-800-XFINIT1( N l~,~~,, ~ s a. Ys~'u ~ f, ..., h, _ 1_ ., . . ,..... __ .. , . For Telephone(s): (717)232-7370 Universal 02/29 - 03/27 -1.30 Connectivity Charge Regulatory Recovery Fee 02/29 - 03/27 -1.81 The Regulatory Recovery Fee is not a tax or government-mandated charge. It defrays regulatory costs such as state universal services, relay services, and. certain state/local utility fees. View Voice Detail at www.comcast.com/viewbi l l Total XFINITY Voice $3.11 Effective 02/29/12, you removed Digital Economy at $9.25 per month and Digital Economy at $29.95 per month and Economy Intemet Service at $26.95 per month and Modem Lease -Voice at $7.00 per month and Comcast Unlimited at $39.95 per month. Adjustments for previously billed services removed 02129/ 12 Digital Economy 02!29 - 03127 ,8.05 27 days @ $0.2981/day based on a monthly rate of $9.25 X ~~~' "~ ~i Account Number 09547 185282-04-7 Billing Date 03/07/12 Total Amount Due $41.80 Payment Due by 04/01/12 Page 2 o f 2 Digital Economy 02/29 - 03/27 -26.08 27 days @ $0.9659/day based on a monthly rate of $29.95 Economy Intemet Service 02/29 - 03/27 -23.47 27 days @ $0.8693/day based on a monthly rate of $26.95 Modem Lease -Voice 02/29 - 03/27 .-6.10 27 days @ $0.22591day based on a monthly rate. of $7.00 Comcast Unlimited 02/29 - 03/27 34.80 27 days @ $1.2889/day based on a monthly rate of $39.95 Total Partial Month Charges & Credits -$98.50 TV FCC Regulatory Fee 02/29 - 03/27 -0.08 Sales Tax 02/29 - 03/27 127 Franchise Fee 02/29 - 03/27 -1.99 Voice Sales Tax 02/29 - 03/27 -1.50 Total Taxes, Surcharges & Fees -$4.8d Comcast, Service Details Account Number 09547 185282-04-7 Billing Date Total Amount Due Auto Pay 01/14/12 $128.26 02/07/12 Page2of2 Contact us: C~ www.comcast.com _ 1-800-XFINITY ~••,__.._..___ __________ _ _~ 0 P ' R ~,.~._~) Digital Economy 01/28 - 02/27 29.95 ............................................................................................................................. Add'I Outlet 01/28 - 02/27 0.00 ...... Digital Economy 01/28 - 02!27 9.25 Additional Outlet The Regulatory Recovery Fee is not a tax or government-mandated charge. It defrays regulatory costs such as state universal services, relay services, and certain state/local utility fees- View Voice Detail at www. co m cast. co m/v i ew b i l l `~-,~ ~~~~ ~ For Telephone(s): (717)232-7370 Comcast Unlimited 01/28 - 02/27 39.95 Voice Services Include All The Popular Calling Features and Comcast Enhanced Voice Mail with Web Access Modem Lease -Voice 01/28 - 02/27 7.00 Operator Services 4.50 & Directory Assistance ..................................................................... ....................................... ................. Universal 01/28 - 02/27 1.49 Connectivity Charge Regulatory Recovery Fee 01/28 - 02127 2.15 Regulatory Recovery Fee 0.23 Total XFINITY Voice $55.32 kt, t ~ `d$ IP f ~r~ t y, 1 ~ t pP~~~i°°y~~~~l~il~<~t11~1r~ u . - ~'~ t ~ '~'~ ~}Xll~~ y ~'tya}~i~an~','li+~ 1 7a~ ale ~c~N~}}1 Ilik . ~;~~il~~ ~'~'~~,1. ~ o4e ~~4 IullCl It l~ ,~lai~'S ~I~p 14~~"~ ~b~p 1~ fv~,~.~~~>~R ~ " i~wla ti~ , ~ H{ c1 ~ a+r ~~~~~~r~>>f~I~~~~5~/~ { ~~1~~~~~ fq~~~~/~~ ~., ~~.5,a:.iQ4~1l ~dL'li ~.(rr~a~`~s~~~'^a~. ~~~.I~Ra` ~ a~17"~ ~ ~ id J~',~Sa? ~ ,~,1.1~'k.. rf~ k..:1RI~da d!!„5Yf3 _ TV Franchise Fee 01/28 - 02/27 2.26 Sales Tax . 01!28 - 02/27 1.46 FCC Regulatory Fee 01/28 - 02/27 0.08 voice Sales Tax 0.28 Sales Tax 01/28 - 02/27 1.71 ....................................................................... 911 Fees .................................... 01 /28 - 02/27 .................. 1.00 Total Taxes, Surcharges 8~ Fees $6.79 ~A~OC~ ~ -_ -° -----'-Page ~__,..__ .~~_: ~3 of 3 , Billing Cycle Date. 02/06/12 - 03/05!12 - Account Number: 464008957588 Prior Activity 464008957588 Previous Balance 13.98 TTOTAL PAST DUEBALAiVCE $1'3.98 A simpler bill -made possible! Coming soon! Your AT&T Wireless bill will have a new look, with: - Easy-to-scan overviews of your services and charges -Convenient breakdown of charges for each wireless user - Big, bold current charges and due date amounts .r- . ~} O _} Page: l of 3 ~~Y, _, `O(` Billing Cycle Date. 02/06/12 - 03/05!12 '`'~'°` Account Number: 464008957588 How To Contact Us: . 1-800-331-0500 or 611 from your cell phone . For DeaflNard of Hearing Customers (TTY/TDD) 1-866-241-6567 Wireless Number 717-329-]633 Previous Balance 13.98 Payment Posted 0.00 PAST"DU ~ BALANCE 13:96 Payable Immediately Monthly Service Charges 0.00 Usage Charges 0.00 Credits/Adjustments/Other Charges 0.00 Government Fees & Taxes 0.00 TO'I:AC CUF2RENT CHARGES 0.00 Aue Ik1ar 28, 2012 .Late fees assessed' after Apr ~ .. ~.; :,: ..,. Totat`Amaun~ Du,ex ~13.9~ i ~ ~ ~, ~; _. This bill reflects charges that do not appear on the previous statement. N Add a Line with Famiiy Talk from AT&T n ~j„ ~\ FamilyTalk(R) plaps start at just $69.99/month including ~J ~ (~' 700 Rollover Minutes. Add up to three additional lines for only $9.99 each. Sign up now by calling 800-449-1672 or visit ATT.COM/ADDALINE Return the portion below with payment only to AT&T Mobility. Erie° Insurance ~\ Exchange Member Erie Insurance Group 100 Erie Ins. PI. Erie, PA 16530 Named Insured ROBERT J KIMEL 862 COUNTRY CLUB RD CAMP HILL PA 17011-1615 ERIE Agent Agent Number AA7221 MURDOCHINSURANCE 4614 DERRY ST HARRISBURG, PA 17111-2695 (717)564-7071 Premium Invoice n/ See Summary Page for important policy messages. 1,'Vant to pay this bill onlir:e? Go to vr:vrd.erieins::rar;ce.ecm, Pcy "~^y 8i!! and make a ce^venient, secure online payment. Other bill paying options are also available on our Web site. Contact your Agent with questions or coverage changes. Fees will be added for any returned payments and included on future invoices. Keep top portion for your records /Return bottom portion with your payment Detach here P00004 ROBERT J KIMEL 862 COUNTRY CLUB RD CAMP HILL. PA 17011 - 1615 Address Change: L_ 1 PERMANENT U TEMPORARY Agent Number: AA7221 Agency Name: MURDOCH INSURANCE Agency Phone: (717) 564-7071 Policy Number: 0112105311 Policy Type: Private Passenger Auto Please Write Your Policy Number On Your Check and Make Payable to: PHONE (_) r ~ Thank you for choosing Erie Insurance for your ~1' ~ / o ~jnsurance needs! ~ ~ ~ ~ ~~_ ~9 v` ~,~ U ~ Insured Copy Mail Date: 11/30/2011 Policyholder: ROBERT J KIMEL sit, Policy Number: Q112105311 '`~"~~' Policy Type: Private Passenger Auto Policy Period: 11 /21 /2011 - 11 /21 /2012 2357119 AA7221 Previous Minimum Due Payment: Thank You! Net Adjustments: Past Due Amount: Current Installment: Billing Fees Due: To pay in full: ~ /Minimum Due: ~. C~ Due Date: ~ ..~ ~ Mail Date Due Date $519.00 $519.00 CR $0.00 $0.00 $34.00 $0.00 $34.00 $.34.00 12/21.12011 Detach here 11 /30/2011 12/21 /2011 MINIMUM DUE $34.00 TO PAY IN FULL: ERIE INSURANCE GROUP ~ Amount You Are Paying: $ 100 Erie Insurance Place I Payment Plan: A Erie, PA 16530 'Change pay plan to ', (See Reverse side for pay plan options) PLEASE DO NOT WRITE BELOW THIS LINE $34.00 07,01722],112105311996110000000?000340000003400 Summary for policy 0112105311 Messages Please refer to the Payment Plan Options section for important information concerning payment plan discount options. Policy Overview Policy Number: 0112105311 Past Due: $0.00 Policy Type: Private Passenger Auto Current Installment: $34.00 Policy Period: 11/21/2011 - 11/21/2012 Billing Fees Due: $0.00 Pay Plan: A To pay in full: $34.00 Premium: $553.00 Minimum Due: $34.00 Policy Balance Summary Since Last Invoice Previous Balance: $519.00 Payments Date Amount Payment 11 /07/2011 $519.00 CR Net Payments: $519.00 CR Adjustments Date Amount Net Adjustments: $0.00 Premium Changes Date Amount Endorsement Effective 11/2112011 11/02/2011 $34.00 Net Premium Changes: $34.00 Billing Fee(s) Date Amount Billing Fee(s) Charged: $0.00 Current Balance: $34.00 As of this time you have no future installments due for policy Q112105311 during this policy period. P00004 Page 3 of 3 958CAR 11/01 Erie° Insurance Group 700 Erie Ins. PI ~ Erie, PA 76530 717-564-7071 AA7221 MURDOCH INSURANCE NAMED INSURED ESTATE OF ROBERT J KIMEL C/O THOMAS RICHARDS EXECUTOR 861 COUNTRY CLUB RD CAMP HILL PA 17011-1616 AUTO POLICY NUMBER Q11 2105311 IF ID CARDS ARE ENCLOSED, THEY FOLLOW THIS PAGE L AGTRFMVDD 12/12/11 AGENT AA7221 MURDOCH INSURANCE I~ POLICY NUMBER DATE DUE PAYMENT DUE PAYMENT PLAN Q11 2105311 H THIS IS NOT A BILL. A A SEPARATE BILL WILL FOLLOW. ERIE INSURANCE GROUP P.O. BOX 1699 PLEASE DO NOT WRITE BELOW THIS LINE ~ ERIE, PA. 16530 BLGRPA ~I ERIE INSURANCE EXCHANGE Erie FAMILY AUTO POLICY Insurance ~~~ Group AMENDED DECLARATIONS 02 * * EFFECTIVE 12/02/11 ATTACH THIS TO YOUR POLICY. 100 Erie Ins. PI. i *** Erie. PA 16530 REASON FOR AMENDMENT - AMENDED I LABORED - ALSO SEE _~ AGENT ITEM 2. POLICY PERIOD'> POLICY NUMBER AA7221 MURDOCH INSURANCE 11/21/11 TO 11/21/12 Q11 2105311 H 'I ITEM 1. NAMED INSURED AND ADDRESS ITEM 3.OTHER INTEREST i ESTATE OF ROBERT J KIMEL C/O THOMAS RICHARDS EXECUTOR 861 COUNTRY CLUB RD CAMP HILL PA 17011-1616 AGENT - MURDOCH INSURANCE 4614 DERRY ST AGENT PHONE - (717) 564-7071 HARRISBURG PA 17111 26.59 ***##*************#***********s***s*s***~#*********#************************** * YOUR COLLISION COVERAGE AND DEDUCTIBLE APPLY TO PRIVATE PASSENGER * AUTOS YOU OR A RESIDENT RELATIVE RENT FUR 45 DAYS OR LESS. THIS IS * SUBJECT TO LIMITS, TERMS AND CONDITIONS IN THE POLICY. **********##**#****************s****#*************#*~:s************#*********** ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER PHY LIOTCMCL RATINGCLASS DDP, 1 09 LILAC TOWN CAR S 2LNHM82V29X636637 PA 4D H 0613 ALAS MS79 ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM OR INCL, IS SHOWN FOR THE %OVERAGE . COVERAGE] , LIMITS Ai.D AN.ITJ~L PP.EMI UMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #1 *****GOOD DRIVER RATES APPLY***** --- THE LIMITED TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. --- LIABILITY PROTECTION- BODILY INJURY 100M/P RSON $300M/ACC E 67 /ACC PROPERTY DAMAG~ $100M 105 FIRST PARTY BENEFI S- MEDICAL EXPENSE ~5M 21 UNINSURED MOTORIST COVERAGE- BOD INJ $100M/PERSON $300M/ACC-UNSTACKED STS COVER GE- 7 UNDERINSURED MOTORI % 6 ACC-UNSTACKED BOD INJ $100M/PERSON $$300M 3 PHYSICAL DAMAGE COVERAGES- COMPREHENSIVE - $250 DED 60 COLLISION - 500 DED 253 OPTIONAL COVER GES- ROAD SERVICE 4 TOTAL ANNUAL PREMIUM FOR EACH AUTO 553 TOTAL ANNUAL POLICY PREMIUM $ 553 NO CHANGE IN PREMIUM DUE TO THE CHANGE $ 0 ITEM 6. APPLICABLE POLICY ENDORSEMENTS EXCEPTIONS TO DECLARATIONS ITEMS AUTOAITOSAFPU01 ~1~~1; AF)SFO1 03/07, AF)SA03 06/11. ***FORMERLY - KIMEL, ROBERT J ANTI-THEFT DISCOUNT APPLIES-PASSIVE DISAB AUTO 1 AUTO/LIFE MULTI POLICY DISCOUNT APPLIES PASSIVE RESTRAINT DISCOUNT APPLIES - MULTIPLE AIRBAGS AUTO 1 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 1 PAY PLAN DISCOUNT APPLIES ~ L AGTRFMVDD 12/12/11 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT of REVENUE INFORMATION NOTICE FILE N0. 21 12-0019 BUREAU OF INDIVIDUAL TAXES A N D Po Box zao6ol TAXPAYER RESPONSE ACN 12502054 HARRISBURG PA 17128-0601 DATE 05-01-2012 REV-1543A AFP (l-OD) TYPE OF ACCOUNT EST. OF ROBERT J KIMEL ^ SECURITY S.S. N0. 239-44-7602 X^ sEC AccT DATE OF DEATH 12-01-2011 ^ STOCK COUNTY CUMBERLAND ^ soNDs REMIT PAYMENT AND FORMS T0: JOHN S KIMEL REGISTER OF WILLS 2150 HOMESTEAD HILLS DR 1 COURTHOUSE SQUARE WINSTON SALEM NC 27103-6444 CARLISLE PA 17013 FIDELITY INVESTMENTS has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that-at the death of the above decedent, youwere a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 239447602 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check DOD Valuation 8 , 299.64 payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax Payments are made within three Amount Subject to Tax 4, 149.82 (3) months of the decedent's date of death, ^ 12 you may deduct a 5% discount of the taz due. Tax Rate X . // Any inheritance tax due will become delinquent 497.98 ~ GV~/[. ine (9) months after the date of death. Q~ Potential Tax D ue ~ J/ TAXPAYER RESPONSE PART FAILURE TO. RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT-BASED ON,iTHLS„NOTICE; ~ The above information and tax due is correct. A . You may choose to remit Dayment to the Register of Wills with two copies of this notice to obtain 1 . a discount or avoid interest, or you may check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART ~ below. PART If you indicate a different tax rate, Please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 1 2. Percent Taxable 2 X 3. Amount Subject to Tax 3 4. Debts and Deductions 4 - 5. Amount Taxable 5 6. Tax Rate 6 X 7. Tax Due ~ C1F~ICIAL U~ E, ~QNI Y,r,,U AAF t PA` DFPnRTMFNT OF 'FEVENUE =. "~ _ •~~ s '; 6 - , ~* f 8 -.h ~k ..~. ~~ 'ctn DEBTS AND DEDUCTIONS CLAIMED PART ...rte .,. r., anvGG DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and comp te~ th~b~ t~of my knowledge and belief. HOME C ~ /