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Home My WebLink About07-30-12J 15D561D143 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Pennsylvania County Code Year File Number Bureau of Individual Taxes UEVNRTMENT OF REVENUE PO 60x.280601 INHERITANCE TAX RETURN 21 11 1214 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 10 25 2011 03 25 1919 Decedent's Last Name Suffix Decedent's First Name MI NAVAGATO FRANK H (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 X^ 1. Original Return ^ 2. Supplemental Return ^ g. Remainder Return (date of death Limited Estate 4 prior to 12-13-82) F . ~ uture Interest Compromise 4a (date of death aver 1z-12-az) ~ 5. Federal Estate Tax Return Required 6 Decedent Died Testate (Attach Copy of will) ^ ~ Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ g, Litigation Proceeds Received ^ 10. between l2 3i ~i a d't~(datges~f death ^ 11 Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARIELLE F HAZEN ESQ 717 540 4332 REGISTER OF WILLS USE ONLY First line of address C'1 '~' 2000 LINGLESTOWN ROAD ~Q ~'' ~ Second line of address ~-? -. ~~ it ~, SUITE 202 ~U%`-' ~ o s. _ , ~ ' ~. City or Post Office LED '~ '- State ZIP Code _ _- HARRISBURG PA 17110 ~ ~7 ~ "~ -- ~ ~`=` ~~ T r- + N b ~~ Correspondent's a-mail address: mhazen@hazenelderlaw.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 belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of whi h SIGNA F PER 0 RESPONSIB E FOR FILIN RETURN c preparer has an y knowled ge. DATE Patrick V. Navagato annaccc 7 - Z 3 ~ ~ ~ 6118 Forrestal Circle Harrisbur PA 17112 SIGNATURE OF PRE RER OTHER THAN REPRESENTATIV ~ TE Marielle F Hazen, Esq. ~ Z `A DRES '--- 2000 Linglestown Road, Harrisburg, PA 17110 Side 1 15D561D143 15D561D143 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Navagato, Frank H 21-11-1214 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer~as any knowledge. ~~ Signature #2 Name Address1 Address2 City, State, Zip Date Signature #3 Name Address1 Address2 City, State, Zip Date 1905 Cooper Circle camp nm, PA 17011 ~~~ a©/~. 136 Briarwood Ct. Camp Hill, PA 17011 150561D243 REV-1500 EX °ecede"''S "ame: Navagato, Frank H RECAPITULATION Decedent's Social Security Number 1 2. 3. . Real Estate (Schedule A) ................................................................................... Stocks and Bonds (Schedule B) ........................................................................ Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)..... .... 1. ..... 2. .... 3. 167 , 0 0 0 . 0 0 29,090.55 4. Mortgages & Notes Receivable (Schedule D) .................................................... .... 4. 5• 6. 7. 8. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............ Jointly Owned Property (Schedule F) ^ Separate Billing Requested.......... Inter-Vivos Transfers & Miscellaneous I~oq Probate Property (Schedule G) ~J Separate Billing Requested.......... Total Gross Assets (total Lines 1-7) ... 5. .. g. .. 7' 18,849.75 $ ~ 52 7 ' 95 53,048.96 9. 10. 11. .................................................................. Funeral Expenses & Administrative Costs (Schedule H) ............... ..................... Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ Total Deductions (total Lines 9 & 10) .......................... ... 8. .. s. .. 1 p. 276,517.21 30,398.82 2,511.94 12. ....................................... Net Value of Estate (Line 8 minus Line 11) ...... .. 11. 32, 910.76 13. ........................... . ...................... Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. . 12. . 13, 243, 606.45 14. Net Value Subject to Tax (Line 12 minus Line 13) ......... ...... .............................. .. 1a. 243, 606.45 TAX COMPUTATION -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 .00 15 16. Amount of Line 14 taxable . 0.00 17 at linealrateX .045 243, 606.45 1s. 10 962 29 . Amount of Line 14 taxable , . at sibling rate X .12 0 . 0 0 17 18. Amount of Line 14 taxable . 0 ' 00 at collateral rate X .15 0 . 0 0 18 . 0.00 1 s. Tax Due ............... ................................................................................................... 1 g. 10 , 9 6 2 .2 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15D561D243 15D561D243 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Navagato, Frank H STREET ADDRESS 112 Linden Drive CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (3) (4) (5) {y :fi - Make Check Payable to: REGISTER OF WILLS, AGENT. 10,526.32 ---.-- 0.18 ~_ ----_ 436.15 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL 1. Did decedent make a transfer and: OCK$ a. retain the use or income of the property transferred :.......................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^ c. retain a reversions ~ x ry interest; or ............................ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ x receiving adequate consideration? ............... ..................................................................................................... x 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? ............... x ........ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF T^ .~^ ~' ~ ~~ ~ -, - _ ---- ---- -- - - - HE 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 tran spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)] ,---- For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for sfers to or for the use of the surviving [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 discl assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. the use of the surviving spouse is 0 percent For dates of death on or after July 1, 2000: osure of • 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 ar 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 p ent, an 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)], q sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or ado tion. P 10,000.00 5 362 32 File Number 21-11-1214 STATE ZIP PA 17011 (1) 10,962.29 Total Credits (A + g) (2) Rev-1502 EX+ (11 A8) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Navagato, Frank H 21-11-1214 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate -112 Linden Dr., Camp Hill, PA - as per appraisal value attached; sale of 167,000.00 property to decedent's granddaughter for $149,265.00 on 7/26/2012, see attached HUD-1 Settlement statement Line 401 TOTAL (Also enter on Line 1, Recapitulation) I 167,000.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS & BONDS ESTATE OF Nava ato, Frank H All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP DESCRIPTION NUMBER NUMBER ~ Heritage Investment Services Fund 2 43 shares of Met Life stock UNIT VALUE 33.4151163 VALUE AT DATE OF DEATH 27,653.70 1,436.85 I ~ I 29,090.55 TOTAL (Also enter on Line 2, Recapitulation) (If more space is needed, additional pages of the same size) Form PA-1500 Schedule B (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-11-1214 Rav-7508 EX+ (6-98) COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Navagato, Frank H 21-11-1214 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 DFAS retirement payment received after death 1,700.67 2 Highmark Retirement payment received after death 152.12 3 Refund- County RE taxes 7/24/12-12/31/12 - - as per attached HUD1 Settlement statement 302.65 Line 407 4 Refund -School RE taxes 7/24/12-7/1/13 - as per attached HUD1 Settlement statement Line 1,379.39 408 5 Refund -Sewer/refuse 7/24/12-9/30/12 - as per attached HUD1 Settlement statement Line 409 79.34 6 Unclaimed property from PA 19 78 7 PNC Bank - CD Acct.#31900313457 3,215.80 8 Auto - 2008 Mercury Mariner -private party value, Kelly BB 12,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 18,849.75 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Navagato, Frank H 21-11-1214 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Patrick V. Navagato B. C. ~niriT~ v nwuGn DRf1DFRTV• ADDRESS 6118 Forrestal Circle Harrisburg, PA 17112 RELATIONSHIP TO DECEDENT Child ITEM NUMBER LETTER FOR JOINT TENANT DATE I MADE JOINT DESCRIPTION OF PROPERTY NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH DECEDENT'S NTEREST 1 A 08/01/1975 PNC Bank -Checking Acct. #51 4004 6126 - 781.99 50.000% 391.00 account held joint with decedent's son, Patrick Navagato 2 A 02/28/2011 PNC Bank -Savings Acct. #50 0573 1649 - 16,273.90 50.000% 8,136.95 account held joint with decedent's son, Patrick Navagato TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 8,527.95 Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+(6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COM NHERITANCEOTAX RETURN ANIA ..«,r,cur nFCEDENT ESTATE OF N Frank H FILE NUMBER 21-11-1214 prp Mw..~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DATE OF DEATH % OF DECD'S INTEREST VALUE OF ASSET 29,864.14 100.000% ITEM UtpVRlr r ~..,..,. .. -- INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Met Life IRA Contract # 071040047A6 -Beneficiaries are decedent's 3 children -Carole Bongiorno, Patrick Navagato and Frederick Navagato 2 Met Life IRA Contract # 073347660AB - Beneficiaries are decedent's 3 children -Carole Bongiorno, Patrick Navagato and Frederick Navagato 23,184.82 1100.000% TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. TAXABLE VALUE 29,864.14 23,184.82 53,048.96 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+(10-06) COMMQN~~IDENT DECEDEN~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Navagato, Frank H 21-11-1214 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N R A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 9,428.11 Street Address City State Zio Year(sl Commission paid 2, Attorney's Fees Hazen Elder Law 4,800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent a. ~ Probate Fees Register of Wills I 365.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15,805.21 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 30,398.82 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF ato, Frank H ITEM DESCRIPTION NUMBER AMOUNT F~me_ r_ a~ enses 9,428.11 1 Cocklin Funeral Home H-A 9,428.11 Other Adn~rative Costs 31.11 Ace Hardware -paint, hardware for house updates 2 370.00 raisals -fee to appraise house 3 Clauser Real Estate App d at 112 Linden Dr. Camp Hill - as per attached t 5.234.78 e Ga 4 Closing costs on sale of en{I e 502 Lin HUD1 Settlement statem 75.00 5 Cumberland Law Journal -estate notice 1,170.00 g Enviroquest-home inspection and radon check homeowners Ins. -maintaining while real estate is being sold (Nov - 694.00 7 Foremost Insurance - May) 414.44 g Geico Insurance -car ins. premium 11.52 g Hazen Elder Law -disbursements g lies, paint, hases -repairs to house for sale (new carpet, cleanin supp 2,109.57 10 Home Depot purc primer, ceiling texture, cabinet refinishing and cabinet hardware) nd maintenance of lawn and landscaping while sale of 1,067.00 11 Judy Nittinger - -cleaning house a ending and moving furniture from house. i s p house turpzing paint mpg) sts to Pa k t l N 2,006.00 ca' ex ng 12 Labor co cei e removal) eplacement, c eaning paintinglprimmg, P Form PA-1500 Schedule H (Rev. 6-98) FILE NUMBER 21-11-1214 Copyright (c) 2002 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued (FILE NUMBER ESTATE OF 21-11-1214 Nava ato, Frank H AMOUNT ITEM DESCRIPTION NUMBER 204.90 13 LB Smith Ford - -oil change on auto, replace battery 162.90 14 Lower Allen Township -refuse -utility being maintained while real estate is being sold 163.95 15 Lower Allen Township -sewer -utility being maintained while real estate is being sold (Jan - June) 20.00 16 M&T Bank -fee for returned check 164.83 17 PA American Water Co. - -utility being maintained while real estate is being sold (Jan - June) 17.60 18 Postmaster -stamps 808.08 19 PPL Electric -utility -maintained while real property is for sale 30.00 20 Register of Wills -filing fees for Inheritance tax return and inventory 750.00 21 Roger E. Lauck - -repair of roof on house for sale of real property 291.17 22 Sentinel -estate notice 8.36 23 Weis Markets -trash bags for cleaning house H_B~ 15,805.21 Form PA-1500 Schedule H (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX nF~TRN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ato, Frank H Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses• VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 37.79 1 Birch -telephone final payment 774.01 2 Bonnie Miller -real estate taxes for 2011 66.14 3 Comcast -1112111 675.88 Ford Credit loan #43447519 -pay-off of auto loan 4 64.36 Heritage Investment Fund -backup withholding tax payment 5 50.00 6 Lower Allen Township -sewer -utility 53.95 7 Lower Allen Twsp -refuse utility 14.35 g MetLife Ins. premium 52.95 g PA American Water Company 288.00 10 Patrick Navagato -caregiver fee for October #51 4004 6126 (Jt. wl Patrick) -service charge 1114111 t 15.00 11 . PNC Bank -Checking Acc #50 0573 1649 (Jt. wl Patrick) -tax withholding from Interest t 1.26 12 . PNC Bank -Savings Acc 168.30 13 PPL Electric 25.00 14 RS & GI Michaliga - 2011 tax preparation fees 78.00 15 Senior Helpers -caregiver fee 54.99 16 Verizon -final bill lectrical work done at house before decedent's death 91.96 17 Wrightstone Electric -e I 2,511.94 TOTAL (Also enter on Line 10, Recapitulation) FILL Numa~r< 21-11-1214 (If more space is needed, additional pages of the same size) Form PA-1500 Schedule I (Rev. 12-08) Copyright (c) 2009 form software only The Lackner Group, Inc. REV-1513 EX+ (11-08) COM INHERITA~TCE T~ R~TURN ANIA RE IDEN DE ED NT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Nava ato, Frank H 21-11-1214 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER DECEDENT PERSON(S) RECEIVING PROPERTY of I 1 s (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal I• distributions, and transfers under Sec. 9116(al(1.211 Carole Bongiorno Child One-third of the 136 Briarwood Ct. Residue of the Camp Hill, PA 17011 Estate Frederick L. Navagato Child One-Third of the 1905 Cooper Circle Residue of the Camp Hill, PA 17011 Estate Patrick V. Navagato Child One-third of the 6118 Forrestal Circle Residue of the Harrisburg, PA 17112 Estate Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART It -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ~, COMMONWEALTH OF PENNSYLVA""^ COUNTY OF CUMBERLAND Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 10th day of November, Two Thousand and Eleven, I, SHORT CERTIFICATE GL ENDA EARNER S TRA SBA UGH Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of FRANK H NAVAGATO late of LOWER ALLEN TOWNSH/P (First, Middle, Lastl in said county, deceased, to PATRICK V NAVAGATO and (First, Midd/e, Cast/ FREDERICK L NAVAGATO and CAROLS BONGIORNO (First, Midd/e, LasU /First, Middle, Lastl 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 10th day of November Two Thousand and Eleven. File No. PA File No. Date of Death S.S. # 2011- 01214 21- 11- 1214 10/25/201 1 222-05-9929 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL LAST WILL AND TESTAMENT I, FRANK H. NAVAGATO, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath my tangible personal property to my wife, SUSIE NAVAGATO. In the event SUSIE NAVAGATO predeceases me or fails to survive me by thirty (30) days, then I give, devise and bequeath my tangible personal property in accordance with any memorandum I have handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Article IV hereof. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my wife, SUSIE NAVAGATO, of Camp Hill, Pennsylvania. In the event that SUSIE NAVAGATO predeceases me or fails to survive me by thirty (30) days, I give, devise, and bequeath the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate IN EQUAL SHARES to my children, CAROLE BONGIORNO, of Camp Hill, Pennsylvania, PATRICK V. NAVAGATO, of Harrisburg, Pennsylvania, and FREDERICK L. NAVAGATO, of Camp Hill, Pennsylvania, per stirpes. If a beneficiary fails to survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, per stirpes, the share the beneficiary would have received had he or she survived me by thirty (30) days. The share of any deceased child who does not have living issue shall be divided and distributed to my remaining children, per stirpes. Arti_ I nominate, constitute and appoint my children, CAROLE BONGIORNO, PATRICK V. NAVAGATO, and FREDERICK L. NAVAGATO, as Co-Executors of my Last Will and 2 Testament. I direct that my Co-Executors be permitted to serve without bond. In addi ' tion to those powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Co-Executo rs shall receive reasonable compensation for services rendered to my estate. Arti- cle VI In addition to the powers conferred by law, I authorize my Co-Executors, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, an real estate or personal property except that which I specifically bequeath herein y (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to le al investments, and without regard to the principal of diversification, g (d) to exercise any option or right arising from the ownership of investments, ' (e) to compromise claims without court approval and without consent of an beneficiary, y (fl to file any federal income tax return for any year for which I have not filed such return pnor to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessar b my Co-Executors; and to pay from my estate reasonable compensation for y y all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and 3 G) fees in effect while their services are performed. IN WITNESS WHEREOF, I, FRANK H. NAVAGATO, hereby set my hand to this my Last Will and Testament, on ~ ~ 2009, at Harrisburg, Pennsylvania. FRANK H. NAV ATO In our presence, the above-named FRANK H. NAVAGATO signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name Address 2000 Lin lestown Rd. Suite 202 Harrisburg P_ 10 2000 Lin lestown Rd. Suite 202 Harrisbur PA 17110 4 to receive reasonable compensation in accordance with their standard schedule of I, FRANK H. NAVAGATO, Testator, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and Acknowledged before me by FRANK H. NAVAGATO, the Testator on ~ «S'T ~ 7 2009. ~~~ C.~~2~1~ ~!~l, Notary Public ~}! FRANK H. NAV ATO .E a;~ ~, m.z , ., ~>;,~ S~k) t 3i - .. { ~Vt:~9tl'ifyµn..iid_~._.._hLi., i_)~t'ip_;:.4= ~t;.d76?~jt We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and Subscri ed to before me by ~' and~vcr.. ~ Q r..-~,.- -- - witnesses, on ~ J ~ ~ ~ ~ ~ 2009. mil' ' Notary Public r-- ~, ,n ~-- ~' ~ , 4. j ~ ::~ J!; 5 itn s Witn ~~ ` i ~~.; ..,~<.. r i E;:' /' ~, {S APPRAISAL OF REAL PROPERTY LOCATED AT: 112 Linden Dr Deed Book 22Y Page 879 Camp Hill, PA 17011 FOR: Hazen Elder Law 2000 Linglestown Rd. Harcisburg, PA 17110 AS OF: 1 oi2si2o11 BY: Dennis L. Stover PA Certfied Residential Real Estate Appraiser Certification Number Rl 138906 Clauser Real Estate Appraisals PO Box 777 Camp Hill, PA 17001-0777 Form GAt -'WinTOTAL' appraisal software by a b mode, inc. -1-800-ALAMODE Hazen Elder Law 2000 Linglestown Rd. Harrisburg, PA 17110 Re: Property: 112 Linden Dr Camp Hill, PA 17011 Client Hazen Elder Law File No.: 12-0123 R-2 In accordance wdh your request, we have appraised the above referenced property. The report of that appreisal is attached. The purpose of this appraisal is to estimate the market value of the property described in this appraisal report, as improved, in unencumbered fee simple title of ownership. This report is based on a physkal analysis of the site and improvements, a logtional analysis of the neighborhood and city, and an economic analysis of the market for properties such as the subject. The appraisal was devebped and the report was prepared in accordance with the Un'rform Standards of Professanal Appraisal Practice. The value conclusions reported are as of the effective date stated in the body of the report and contingent upon the certification and limiting condRions attached. It has been a pleasure to assist you. Please do not hesitate to contact me or any of my staff if we can be of additional service to you. Sincerely, Dennis L. Stover PA State Certified Residential Real Estate Appraiser Certficetion Number RL 138906 File No. 12-0123 R-2 Client Hazen Elder Law Pro Address 112 Linden Dr rland State PA 7a Code 17011 nt b C C Ci y um e oo Cam Hill Owner Estate of Frank H. Nava ato TABLE OF CONTENTS Cover Page ....................................................................................................................................................................................................................... 1 1 nMnr rrt Trancmittal ........................................................................................... 2 ........................................................................................................ 3 ....................................................................................................... 4 ......................................................................................................... 5 Form TOCNP -'WinTOTAL' appraisal software by a la made, inc. -1-800-AIAMODE SUMMARY OF SALIENT FEATURES Subject Address 112 Linden Dr Legal Description Deed Book 22Y Page 879 Djty Camp Hill County Cumberland State PA LpCode 17011 Census Tract 42041-0110.00 Map Reference 25420 Sale Price $ NA Date of Sale NA C6enl Hazen Elder Law Owner Estate of Frank H. Navagato Size (Square Feet) 1,902 Price per Square Foot $ Location Suburban Age 53 Condition A`~9 To~IRooms 7 Bedrooms 3 Baths 2.1 Appraiser Dennis L. Stover Date of Appraised Value 01!24/2012 Flnal Estimate of Value $ 167,000 form SSD -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE GEORGECLAUSER R-2 roar Estate of Frank H. Navagato APPRAISAL AND REPORT IDENTIFICATION Code 17011 This Appraisal Report is ~ of the following types: ^ Self Contairxxl (A written report prepared under Standards Rule 2-2(a) , pursuant to the Scope of Work, as disclosed elsewhere in this report.) ®Surtxrtary (A written report prepared under Standards Rule 2-2(b) , pursuant to the Scope of Work, as disclosed elsewhere in ttds report.) ^ Restricted Use (A written report prepared under Standards Rule 2-2(c) , pursuant to the Scope of Work, as disclosed elsewhere in this report, restricted to the stated intended use by the spec'rfied c8ent or intended user.) Comments on Standards Rule 2-3 I certify that, to the best of my knowledge and belief: • The statements of tact contained in this report are true and conect. • The reported anayses, opinions, and conclusions are limited ony by the reported assumptions and limiting conditions and are my personal, irtpartial, and unbiased professional analyses, opinions, and conclusions. • I have ra (or the specified) preserd or prospectlve interest in the property that is the subject of tlas report and rw (or ttre specified) personal interest with respect to the parties involved. • I have rw bias with respect to the property that is the subject of this report or the parties irnoNed with this assignment. • My ~gagemerd in this assignmerd was not contingent upon developing or reporting predetermined results. • My compensation for compledng this assignment is not contingent upon the devebpmerd or reporting of a predetermined value or direction in value that favors the cause of the cltent, the amamt of the value opinion, the attainmerd of a sgpulated result, or the occunence of a subsequent event directy related to the intended use of this appraisal. • My anayses, opinions and conclusions were developed orb this report has been prepared, in contormity with the Unrform Standards of Rofessional Appraisal Radice. • I have made a personal inspection of the propety that is the subject of this report. • No one provided sign'rficaM real property appraisal assistance to the person signing this certification. (g there are exceptions, the name of each individual providing significant real property appraisal assistance is stated elsewhere in this report.) Comments on Appraisal and Report Identification Note any USPAP related issues requiring disclosure and any State mandated requirements: SCOPE OF WORK The sco of work for this a sisal is defined b the com le of this a sisal ass' nment and the re orti re uin;ments of this a sisal form includ' the definition of market value a statement of assum tons and limiti conditions and certifications. The a raiser has at a minimum: 1 rformed a com late visual ins d'ron of the interior and erderior areas of the sub'ect ro 2 ins eel the net hborhood 3 ins fed each of the com arable sales from at least the street 4 researched verified and ana eel data from reliable ublic and/or rivate sources and 5 has re rted his anal is o lobos and contusions in this a sisal re ort The a sisal is based on the information athered b the a raiser from ublic records other identified sources ins coon of the sub'ect roe and ne hborhood and selection of com cable sales within the sub'ect market area. Theo ' tool source of the com rabies is shown in the Data source sectbn of the market rid ab with the source of confirmation ff available. Theo ' tool source is resented first. The sources and data are considered reliable. When conflicU information was rovided the source deemed most reliable has been used. Data believed to be unreliable was not included in the re ort nor used as a basis for the valuation conclusbn. "THERE WERE NO SERVICES REGARDING THE SUBJECT PROPERTY PERFORMED BY THE APPRAISER WITHIN THE PRIOR THREE YEARS AS AN APPRAISER OR IN ANY OTHER CAPACITY" APPRAISER: Signature: 1,~--- Name: Dennis L. Stover Date Signed: January 31 2012 State Certification #: RL 138906 or State License #: State: PA Expiration Date of Cert'rfication a License: O6/30/2013 Effective Date of Appraisal: SUPERVISORII APPRAISER (only If requiredl: Signatre: Name: Date Signed: State Certification #: or Stale License #: State: Expiration Date of Certification or License: Supervisory Appraiser inspection of SrAject Roperty: ^ Did Not ^ Exterior-anty from street ^ Interior orb Extedor form IDO6 -'YYnTOTAI' appraisal software by a b nwde, inc. -1-800-ALAMODE GEORGE CLAUSER Summary Report RESIDENTIAL APPRAISAL SUMMARY REPORT state~PA• ,2ifcodR,7o1, Ci :Cam Hill Pro Address: 112 Linden Dr r- Cou :Cumberland Legal Descri lion: Deed Book 22Y Pa a 879 Assessor's Parcel #: 13-23-0551-107 ~ Bonower 'd a licable : NA ~ rar vPar ~m ~ R.E. Tales: $ 1,988 S ecial Assessments: $ NA ~ -, n rw.~. r I rananf ~ Vacard I~ Ma~acturd and Scope of Ri Ms raised: Fee Si k Leasetwlc ueaseu nz ~w~ - Use: The intended use of this a sisal re ort is for the client to evaluate the ro that is the sub'ect of this a sisal to establis a irket value. Ilser(sl (bv name Or tVDe): The intended user of this a sisal re _ rt is the client ao ne~a~~meHarrisbura PA 17110 wiser: Dennis L. Stover naaress: r. ~. o R ral P ~ vx , , ~ ., Unit Hou rr O n~ Land m Land se g t L u Location: Urban Suburban Built up: ^ Over 75% ®25-75% ^ Under 25% cupancy Oc C ~I AGE ~ (yrs) 85 % One U 2-4 Unit 5 % y i ^ No ^ Likety * ®In Process Growth rate: ^ Rapid ®Stable ^ Slow i ii ®Owner Tenant ^ $( ) 70 Low 0 Mufti-Urit 5 % * To: vacant land to rr Dec Property values: ^ Increasing ®Stable ^ n9 ®kl BaWnce ^ Over SuppN ®Varanl (0-5%) 850 Hir h 150 Comm'I 5 % residential development Demand/suppty: ^ Slrorta9e Mark~i time: ®Urlder 3 Mos. ^ 3-6 Mos. ^ Over 6 Mos. ^ V fo ~ above rt charact sgcseand trends): The subject neighborhood is the Lower Market Area Boundaries, Descdpgon, and Market Conditions (including suppo hools and churches are located within 10-15 minutes of the ro .Full i sc Allen T .area of the West Shore School District. Sho d Ca ital Ci malls a roximate 10-15 minutes. Public school students attend the West Hill b' d an e service sho i is available at the Cam Shore School District. Em to ent centers are located in Harrisbur Cam Hill York and Meclranicsbur .Market conditions in the su Sales in recent weeks have been catal t i . ma ne hbortlood are considered moderetel active with bw mort a e interest rates bet the r inGudes 80% to 90% loan 1-3 ints 5.5-6.5% mort a e interest rates for u to rti es moderate active. T ical financi for residential ro - -. ~----on __a nn a~~ No Are CC6Rs a lcaule! res u ~w "'"""' • •-•- - - -- lam Highest & Best Use as improved: ®Present use, or ^ Oilier use (exp ~ ) Use as appraised in this report Residen~al _ Actual Use as of Effective Date: Residential Summary of Highest & Best Use: The h' hest and best use of the sub ect is the resent use. Utilities Pubkc Other ProviderlDescrip6an Off-site Improvements TYPe Pubkc Private ® ^ lopograf Size Bectriciry ® ^ 200 AMP Street Macadam ^ Shape Gas ^ ^ Nq Curb/Gutter Concrete ® ^ Drainage Water ® ^ Public Sidewalk Concrete ^ ^ Yew SarMtary Sewer ® ^ Public Stred Lights NA ^ ^ Storm Sewer ® _.. ..- -,---,_. ^ Yes ~ ~.,.,~o r „f n Cnrror I M None n Cul de Sac ^ Underground U81ipeS ^ Otlter (describe) FEMA S 'I Flood Hazard Area ^ Yes 129 no rrmN rRrou cw o ~ - _~ - - Site Cortvrretds: There are ra a rent easements encroachments s cial assessments slide areas or ilia al or le al nortconformr uses General Descdptlon ucenur v~.~r.~„ Unit Fou~~ Concrete Bock Slab 100% ^ Acc O f U n Area Sq. Ft. d . ne r s # o Exterior WaNs Aluminum/Stone Crawl Space 0 % Rrastle # of Stories Two Type ®Det ^ Att. ^ Roof Surface Rubber Basemerd NA Sump Pump ^ Ceiling Walls Design (Style) Bi-Level Gutters & Dwnspis• Aluminum ^ proposed ^ Und.Cons. Window Type DbIH /Casemt Dampness ^ No Evide ® E>asfin Fbor ide Ertb t O g Actual Age (Yrs.) 53 StorMSueens Screens Seitlerrrerd No Evidence y s u Infestation No Evidence Effective A e rs. 20 Appgatrces Attic ^ None Amenkies krteriorDescripdon Refrigerator Woodstove(s) #_ ^ Stairs ^ Rreplace(s) # 1 FP Fbors Ca et Walls D IVPanel RangeJOven ®Drop Stair ^ Portia Rear TrirrVRrlish Wood Disposal ^ Scuttle ®Deck Bath Fkar Ca Win f)ishwashw ^ Doorway ^ Porch Enclosed Rear Bath Wainscot CeremicNin FaNHood ®Fba ^ Fence Link Doors Wood Microwave ^ Heated ^ Pool ~_ Washer er R Bristled ^ 3 Bedrooms 2.1 Bath(s) 1,902 RNshed area above grade cadalns ooms 7 Type wd Cerdral Other ~~ dye ^ None Garage # of cars ( 3 Attach. Detach. BR-in 1 Carport i Driveway 2 corditlon of the property (inckding physical, func8onal and exlemal obsolescence)_ Subject is a Bi-Level style dwellirw in average condition with a ..,, c.we*..~r Nn adverse locatronal features noted. This - retied u n to disclose conditons and/or defects in the ro ~ R.ES[ DENTIA~ Capyrght® 2007 by a u mode, nc. This ram maY tie reproduced umnodified wiMa,t written permission, however, a b mode. inc. must be acYnowled9ed ~d X2007 ® Form GPRES2 -'WinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE RESIDENTIAL APPRAISAL SUMMARY REPORT My research did did not reveal any prior sales or transfers of the subject property for the three years prior to Vte ~ Data Sources : Cumberland Coun Tax Assessment Office p 1st Prior Sub ect SaleJTransfer Anatysis of sakJtransfer history aril/or any current agreement of saklGSting: ~ Date: Not in the last Summary Report :ATURE SUBJECT cumrNrv~o~c ~w~ .~ ~ 326 Somerset Dr 6 Grinnel Dr 12 Grinnel Dr 112 Linden Dr Cam Hill PA 17011 Shiremanstown, PA 17011 Cam Hill PA 17011 Cam Hill PA 17011 2 01 miles SW 1 47 miles E 1.47 miles E $ 195 00 to subject $ 1 Ba 9oa is NA $ 157noo c oa~~~sOtt Data Sources lns eccan ~~ ~•,~ m ~ ~-_°--- Tax Assessment Records Tax I Verrfication Sources VALUE ADJUSTMENTS NA DESCR~TION DESCRIPTION + - $ Ad'ust. Saks or Rnancing NA FHA -5 210 FHA Selle Concessions NA Sellers Hel 5117 Date of Same NA 5/6/11 MT 3 Fee Ri s raised Fee Sim le Fee Sim le Subi Locatbn Suburban Suburban 21~ Site .18 Acres .21 Acres ~^, Above Grade Taal norms cams ~~ °"~~ °°"° +2 500 9 3 Room Count 7 3 2.1 7 3 1.2 Gross Livi Area 1 902 S .ft. 1 820 S .ft. +1,230 Slab Basement & Rrpshed Slab Slab Rooms Bebw Grade NA NA NA ~,,,. Net Ad'ustment otal Adjusted Sak Pnce y v ~ ~. ,Y ~ _. , olComparabks ;~yr Surtrnary of Saks Comparison Approach Sales- used -were au 1 r' .u~%r ,~o~oa $ ~f IndlCatedValueD eareswm farm ~.,aM~. ,~, ~~~ 3/2007 CapyrigM® 2007 by a to mode, nc. This faro may ba reproduced unnad'died wimaut written pemWSSran, owever, a m REStD~NT1AL Forrn GPRES2 -'vrnTOTAL' appraisal software by a la made, inc. -1-800~ALAMODE RESIDENTIAL APPRAISAL SUMMARY REPORT for the opinion of site value (summary of land sales ar other methods for estimating site value): ommerds on Cost Approach (gross living area calculations, depreciation, etc.): JA Estimated Remain Economic L'rfe 'rf ~ifed ~ ~ Income Approac INf~IrIE APPROACH TO VALUE (if devebped) Estimated MordHy Market Bart S NA X Gross Rent Multlp Summary of Income Approach (including support for market rent and GF ne of Project: cannon elements and reaeational Summary Report MarkeUCCTAO of i Site External Indicated-Vakre-b ~ ; ~ ~+ """~'---°- -- ~ • -- Real Reconciliation Insufficient market data was available to rocess the Income roach. The Sales Com orison roach is deemed nos reliable and iven realest wet M. This appraisal is made ®"as is", ^ subject fD completion per pons and specifications on the basis of a Hypotlletical Condition that tlw improvements b been compbted, ^ subject to the folbwing repairs or alterations on the basis of a Hypotlretical Condition that the repairs or atteretbns have been compbted, ^ 1 the folowing required inspection based on the 6draadinary Assumption that the coMition or deficiency does rrot require alteration or repair. ff property is sold __ ... _ .__ ___...:..,,.~ ..~i, a hncatl nn dear test feSUN:S._ This r ort is also sub to other H ttxxiral l;onamgra aiwv, ru,w,~„q, ^°°°~~ '_..- -- - of Wok, Statement of Assumptions and Limiting Con Based on the degree of inspecfiorr of the subject Property, as indicated below, defkr ~ ~), as defined herein, of the real Property that is the and Appraiser's Certiflcallons, my (our) Opinon of the Uarket Value (a others 1p~ X011 ,which is the effective date of thrs ap of this repoR rs: S 167,000 ~ of: See attached a fl indicated above, this Opinion of Value is subject to Hypothetical Conditions and/or Extraordinary Assumptions included in this report. n~lrlaraA an integral Dart Of the report. This appraisal report may A true and complex copy of tins repot contain; 22 pages, including exlriblts which ,ro properly undersbod wittwut reference to the information contained in the complete report Attached Exhitrits: ® Scope of Work ®Limitirg CordJCertifications ® Map Addenda ^ Additional Sales ® photograph Addenda ®Sketch Addendum ^ Fbod Addendum ^ Mamri. House Addendum Hazen Elder Law APPRAISER Appraiser Name: Dennis L. Stover Compamr: Clouser Real Estate Appraisals Phorw: (7171737-7300 Fax: (7171730-0922 E-MaN: dstoverma comcast.net Date of Report (Signature): Janus 31 2012 Sate: PA Liceree or Certification #: RL 138906 Designation: Expiration Date of License or Certification: 06/30/2013 inspection of Subject: ®Interiar & Exterior ^ Exteda Orry ^ None Date of Inspection: 01/24/2012 SUPERVISORY APPRAISER (if required) or CO-APPRAISER ('rf applicable) Supervisory err Co-Appraiser Name: Comparry. Fax: E-Mail: Date of Report (Signature): State: Licernse or Certification #: Designation: F~riration Date of License or Certification: Inspection of Subject ^ Intwia 6 Exterior ^ Exlerta Ony ^ None Date of Inspection- „_ __, _.,,~p„ „,,,,,~;,, CapyiiOM® 20111 by a u made. nc. This ram may 6e i..y,,.,.,,.~.....-_.-- ------ Form GPRES2 -'WinTOTAL• appraisal software by a b mode, inc. -1-600-ALAMODE 3/2007 ^ Nanative Addendum ® Cast Addendum CNent Name: C..6:nn+ Phntn Pane Subject Front 112 Linden Dr Sales Price NA Gross Living Area 1,902 Total Rooms 7 Total Bedrooms 3 Total Baffirooms 2.1 Location Suburban Vew Avg Site .18 Acres Oualily Avg Age 53 Subject Rear Subject Street Form PICPD(.SR - ^yVinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE Interior Photos Clie~ri Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Cau Cumberland State PA Zi Code 17011 Owner Estate of Frank H. Nava ato LIVING ROOM BEDROOM BATH BEDROOM BATH BEDROOM FAMILY ROOM DINING ROOM KITCHEN HVAC Fonn PtCINT15 -'WinTOTAL" appraisal software by a la mode, inc. -1-80o-ALAM00E Building Sketch Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Coun Cumberland State PA Z Code 17011 Owner Estate of Frank H. Nava ato 112 LINDEN DR. FIRST FLOOR SECOND FLOOR ASTER S NClO5E0 PORC 8 BEDROOM BATH MASTER BEDROOM _ 8 BATH g p R. .~' LMNG BOOM $ KROIEN ,I ~' $ BEDROOM SBATR g 3 $ ]3.W R m' R NOT EWGT ANO MOT TOSCILE Bxnm q pa rv^~ CommeMS: AREA CALCULATIONS SUMMARY CoM Nst Sim. Net Toffs GLr11 Fizst Flooz 1485.00 BQILT-IN G1U111GE -260.00 ENCLOSED FOFCB -300.00 945.00 GLA2 Second Floor 957.00 957.00 Net ENABLE Area (Rounded) 1902 LNING AREA BREAKDOWN Erpkdown. Suhlotds First Floor 33.00 z 45.00 1485.00 BDILT-IN G71611GE 12.00 z 20.00 -240.00 ENCLOSHD FOFGN 16.00 z 18.75 -300.00 Second Floor 29.00 z 33.00 957.00 4 ttems (Rounded) 1902 Form SKT.BIdSkI -'WinTOTAL' appraisal software by a la mode, inc. -1-80QALAMODE Plat Map Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Coun Cumberland State PA Zi Code 17011 Owner Estate of Frank H. Nava ato 103 ~~.I ,~t.s=~ ~~ Ac. n .2xr~c. ' ~ g 141 '; 104 r~ ~ 1 I •~ ' . r~ ~. r . '~ . , C~+7 140 y S ' .~sef 195 ~ ~ ~'~ ~ i Ac j ... m ~ - ~ ~ ap 6.21 Ac. ~ ~ ~~ _. . 138 ,, 138 'i mss (~ . ~ tsar R ~ o p .2t ozrr>c. t ~ osoac. • r ~~ ~ € ,~ •~b ,z ~f - , F 70 IIe 57 r55 z ~ - ,.<_ ,. 1 ~p° I S.rsAQ -.; 8341 'sd ~, :108 125 1 26 tB) ~ . ~ 0.17Ac. rn ' ~~m ~~->2) ~ ~ taY ~t3 t, ~ j , ~ 27 ~ cor 109 t9) Ac. - < . t - O.37Ac - it ~Fp 1lAm '3 ~~ G1. 8q 11:0 [ ,,/c ~ 4 >80 ' y'~ i ~ ~i01 E ~ O , 0 42 Ac. i i p~ ~ ~ _ i tQ5 QO ~$,(~ 6,~~j o.ooa©o4so ao 9 le Form MAP.PLAT -'WinTOTAL' appraisal software by a la mode, inc. - i-8Oo-ALAM00E Comparable Photo Page Client Hazen Elder Law Pro Address 112 Linden Dr C Cam Hill County Cumberland State PA Zi Code 17011 Owner Estate of Frank H. Nava ato Comparable 6 Grinnel Dr Prox to Subject 1.47 miles E Sale Pdce 157,000 Gross Living Area 1,820 Total Rooms 7 Total Bedrooms 3 Total Bathrooms 1.2 Location Suburban Vew Equal Site .21 Acres Quality Avg Age 54 Comparable 2 12 Grinnel Dr Prox to Subject 1.47 miles E Sale Price 184,900 Gross Living Area 2,054 Total Roams 9 Total Bedrooms 3 Total Bathrooms 1.2 Location Suburban Ylew Equal Site .21 Acres Duality Avg Age 53 Comparable 3 326 Somerset Dr Prox to Subject 2.01 miffs SW Sale Price 195,000 Gross Living Area 2,016 Total Rooms 9 Total Bedrooms 3 Total Bathrooms 2.1 Location Suburban Yew Equal Site .19 Acres Duality Avg Age 45 Form PICPIX.CR - "WinTOTAI" appraisal software by a la mode, inc. -1-80(1~ALAMODE Suecial Conditions File Nn 12-0123 R-2 Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill COU Cumbedand State PA Zi Cade 17011 r Estate of Frank H. Nava ato SPECIAL CONDITIONS ADDENDUM The following checked 'gems are spec special conditions that were ident~ed by the appraiser during the inspection of the subject property, the incomparable sales, and their neighborhoods and locations. 1. The subject is located in a rural area and is less than 25% built-up. The condition is typical and common for the area and DOES NOT affect the market value. _X_ 2. Commercial uses are located within the subject's neighborhood. These uses are typical of similar neighborhoods and DO NOT affect the market value. _X_ 3. Industrial uses are located within the subject's neighborhood. The presence of industrial uses, is typical for the neighborhood and DOES NOT affect the market value. _X_ 4. Vacant and underdevebped Land uses are located within the subject's neghborhood. These uses are typical for the area and DO NOT affect the market value. _X_ 5. The predominant value in the neighborhood is about the same as that of the market value of the subject property. This condition DOES NOT have an adverse affect the market value. 6. The subject property is boated in a F. 1. A. Identified Fbod Zone. 7. Dampness is noted in the basement of the subject. Standing or running water was not present on basement tbor. _X_ 8. The subject is older than five(5) years old. All mechanical systems including the heating, electrical and plumbing system appears upon a visual exterior inspection to be in working order. No warranties are implied in this statement. _ 9. The electrical system was not connected during inspection. 10. The water service was not connected during inspection. 11. The heating system was shut down during inspection. 12. Well and septic are common to the area. 13. Repair items were noted in the comments section of the report. These comments on repair ttems are for descriptive purposes only aril are not required repairs. The repair items are cosmetic in nature and DO NOT affect the market value. 14. Subject is new constnx:tion and was 90% completed on date of inspection. Compliance and completion inspections suggested prior to settlement. 15. Should properly be sold, termite and radon certifications are suggested, wRh appraised value based on Gear results. 16. The land value exceeds 30% of total value due to the high demand for vacant land in this neighborhood. This condition is considered common and typical for the neighbortaod and DOES NOT affect the market value. 17. The land value exceeds 30°!0 of total value. This is due t0 tFte -large. size of the. site. this condition is considered to be typical and common and DOES NOT affect there market value. _ 18. Individual adjustments were required that exceed 10%. These adjustments were required due to the lack of more similar comparables on that individual rating. All three comparables are the BEST AVAILABLE. _ 19. Total adjustments exceed 159'°. This is due to the lack of comparables on that individual rating. All three comparebles are the BEST AVAILABLE. _ 20. One or more comparable sales are older than six(6) months old. Although there are compareble properties in the subject area, none have sold recently, therefore, sales in excess of six (6) months okl had to be used. _X_ 21. One or more of the comparables used were in excess of one(t) mile from the subject property. Although there are comparables in the immediate area, none have sold recently. Therefore, tt was necessary to use comparable sales outside of the immediate area. All comparables used are kxated in similar neighborhoods and within the same marketing area. All three comparables used were the BEST AVAILABLE. 22. Roofing certification is suggested. _ 23. Plumbing certification is suggested. 24. Electrical certification is suggested. 25. Heating certification i5 suggested. 26. Flood Hazard Insurance is suggested. 27. Seller is paying part or all of cbsing cost. This DOES NOT affect the market value. X 28. All comparable sales are Gosed sales. _X 29. The subject property has not transferred in the past three years.. _X 30. This appraisal is a Summary Report wRh complete data retained in appraisal file. form SUP -'WinTOTAI' appraisal software by a la mode, inc. -1-800-ALAMODE Location Maa Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Cou Cumberland State PA Zi Code 17011 Owner Estate of Frank H. Nava ato a la mode, int' y ` .~, ., w~ m ~ a ~ ~ '~ ~ ~ r '""`" a ~ . ~~}}~~. ~ ~ ~ ~]t~ .+, .~ ~ _ .,~. Ski.` a ~ '. <. ~, t . - F ~ ~~ a .r~ ~ ~' ~~•,~ ~ "`s 4 = x - ~y:'s ~z.:= '^ ~ ~~ ~~~, ~ `. car v~y~' 1 Yt 3 ~ ,'~F ea~a P 'zi .t ~+-~ ww. ~+,~, r~ ~. ,~ . ~ ~~ ~ s„~ . ~5~.~~ ~ M L C SMA. Y., .f,~: ~ ~"" KsiM `. ~ ~ ~~ ~t~ ~ x,~~ ., - ~x ~ i. ~ ~~ ~ _ _ ~, '~ ~ -~, -, - --.ter .. ~ y~ _; ,. ~ ,-. _. w.. ~ Skw~a.d s .~, ~ ...<.:wm a,, S ~` sa~`"'~' nrc~r~s ,- t ~ -' ~ ~.~ ., a r.4,n.' ~ =' ~,e,~,-,~ y ''~.e+F .' .5 ra,~sniv ?ct ,p °~ S ~ ,~ ~ G V ~ r ~, +~~~ ~; ,,~ ~+• ~ r . ~_ _ +~ ~ ~ ~ ~ ¢S,~e~' 'B -. ._. *. s, ~~~ .. iTM g - Wiz-+H..,._a~ ,t . ~ ` C.ox tiry~+.~ T. ~- t x _rpty, Form MAP10C -'WinTOTAL• appraisal software by a la mode, inc. -1-800-ALAMODE DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a compeg6ve and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, krawledgeabty and assuming the price is not affected by undue stimulus. Implicit in this definition is the consunxnafion of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typicatly motivated; (2) both parties are well informed or well advised, and each actirx~ in what he considers his own best interest; (3) a reasonable time is albwed far exposure in the open market; (4) paymerd is made in terms of cash in U.S. dollars or in terms of financial arrangements comparable thereto; and (5) ga price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessioru' granted by arryone associated vdth ttre sale. ' Adjustments to the comparabks must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are rannatly paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustmeds can be made to the cormarable property by comparisons to firencirg terms offered by a third party instibdiorel lender that is not already involved in the property or ttansacgar. Arty adjustment should not be cabulated on a mechanical dotlar far dollar cost of the financing or concession but the dollar amount of any adjustmerd should approximate the market's reaction to the financing or concessions based on the appraiser's judgerrcerd. STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION CONTINGENT AND LIMITING CONDITIONS: The appraiser's certrficagon that appears in the appraisal report is subject b the following conditions: 1. The appraiser wil not be responsible for mattes of a legal nature that affect either the property being appraised or the title to g. The appraise assumes that tta title is good and marketable and, therefore, will not render any opinons about the title. The property is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and urderstardirg the appraiser's determination of its size. 3. The appraise has examined the available good maps that are provided by the Federal Emergency Maregemed Agency (or other data sources) and has noted in the appraisal report whetlrer the subject site is boated in an ident'rfied Special Food Hazard Area. Because the appraiser is rrot a surveyor, fre or she makes no guarantees, express or impli~, regarding this detenrdregon. 4. The appraiser wiN rat give testimorry a appear in court because he or she made an appraisal of the property in quesfion, unless specgic arrangements to do so have been rtiatle belbiehand. 5. The appraise has esgmated the value of the land in the cost approach at its highest and best use and the improvements at their contributory value. These separate valuagora of the land and irr~rovements must not be used in conjuncgon with any otter appraisal and are invalid if they are so used. 6. The appraiser has noted in the appraisal report arty adverse condigons (such as, needed repairs, depreciafion, the presece of hazardous wastes, todc substances, etc.) observed dudng the inspecgon of the subject property or that he or she became aware of during ttre ramral research involved in pertomarg the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any fidder a urepparent conditions of the property or adverse environmental conditions (including the presence of hazardous wastes, toxic substances, etc.) that would make the property more or less valuabb, and has assumed that there are no such conditions and makes ra grerantees or wamanges, express or implied, regarding the condifion of the property. The appraiser wiN not be responsible for arty such conditions that do exist or for any engiraerirg or testirg that might be required to discover wtxther such conditions exist. Because the appraise is not an expert in the field of erniravnental hazards, the appraisal report must not be considered as an emirorvrrerdal assessmed of the property. 7. The appraiser obtairred the intarmafion, estimates, and opinions that were expressed in the appraisal report from sources that he a she considers !o be regable and beYeves them to be true and correct. The appraise does rat assume responsibigty fa the accuracy at such items that were furnished by other parties. 8. The appraiser wiq rat discbse ttre contents of the appraisal report except as provided fa in gre Uriform Standards of Professional Appraisal Pracgce. 9. The appraiser has based his a her appraisal report and vabagon conclusion for an appraisal that is subject to sagsfactory complefion, repairs, a atterafions on tla assumptbn ttiat completion of the improvenents witl be perfomx;d in a workmankke manner. 70. The appraiser must provide tws or her prior wrttten consent before the lender/dient specified in the appraisal report can distribute the appraisal report (including cencbsions about the property value, the appraiser's iderrgty and professiorel desigregoes, and references to arty prafessiorel appraisal organtzagons a the firm with wfrch the appraise is associated) to arryone ogre than the borrower, the mortgagee or its successors and assigns; the mortgage insurer, r;onsrltants; professiorel appraisal orgadzagons; arty state or federatly approved financial insfitugon; a arty deparbrx;rd, agency, a instrurnerdagty of the United States a arty state or the Distdct of Colunbia; except that the lerda/ckeM may distribute the property descriptbn section of the repot only to data colectbn or reportlng service(s) witlaul having to obtain the appraiser's prior wrttten consent. The appraiser's wrttten consent and approval must also be obiairred before the appraisal can be caweyed by anyone b the public Through adverdsirg, public relafions, news, sales, or othe media. Freddie Mac Form 439 6-93 Page 1 of 2 Fannie Mae Form 10046 E93 GEORGE CLAUSER Form ACR -'WinTOTAL' appraisal software by a la mode, inc. - t-800~ALAMODE APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have researched the subject market area and have selected a minimum of three recent sales of properties oast similar and proximate to the subject property for consideration in the sales comparison anaysis and have made a dotter adjustment what appropriate to reflect the market reaction to those items of significant variation. tt a sign'rficant item in a comparable property is superior to, or more favaabk than, the subject property, I have made a negative adjustment to reduce the adjusted sales price of the corr~arabk and, C a significant ttern in a comparable property is inferior to, or less favorable than the subject property, I have made a posttive adjustment to increase the adjusted sales price of the comparable. 2. I have taken into consideration Cre factors that have an impact on value in my developmerd of the estimate of market value in the appraisal report. I have not krawingry withheld any signrficarrt information from the appraisal report and I believe, to the best of my knowledge, that alt statemerds and information in the appraisal report are true and correct. 3. I stated in the appraisal report Dory my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject Doty to the contingent and limiting conditions specgied in this form. 4. I have no present or prospective interest in the property that is the subject to this report, and I have ra preserd or prospective personal interest or bias with respect to the partlcipants in the transaction. I did not base, either partialty or completety, my anaysis and/or the estimate of market value in the appraisal report on the race, cobr, religion, sex, handicap, familial status, or national origin of eitfrer the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the vicinity of the subject property. 5. I have ra presed or contemplated fuWre irderest in the subject property, and neither my current a future empbyment rar my compensation far performing this appraisal is contingent on the appraised value of the property. 6. I was rat required to report a predetermined vaWe a direction in value that favors the cause of Cre cttent or arty related party, Cie amount of the value estimate, Cre attainment of a specgc result, or Cte occurrence of a subsequerrt event in ado to receive my compensation and/or empbymerd for performirg ttre appraisal. I did rat base Cre appraisal report on a requested minimum valuatlon, a specific vapation, a the need to approve a specific mortgage ban. 7. I perfomred this appraisal in cordomity with C>e Urdam Standards of Professional Appraisal Practice that wee adopted and prandgated by the Appraisal Standards Board of Tire Appraisal Foundation and Crat wee in place as of the e(tective date of tHs appraisal, wtth the exception of Cre departure provisbn of those Standards, wMch does not apply. I ackraw4edge that an estimate of a reasonable time fa exposure in Ca: open market is a condiUan in the defirition of market value and Cre estimate 1 devebped is consistent with tla marketing time noted in Cre raighbarhood setion of this report, unless I have otherwise stated in Cxt reconciliation section. 8. I have personaly inspected the interior and exterior areas of Cce subject property and the exerior of alt properties fisted as camparables in the appraisal report. I furCrer cabiy Crat I have noted arty apparerd a known adverse conditions in Cre subject improvements, on the subject site, a on any site wiCrin the immediate vitnity of the subject property of which I am aware and have made adjustments for These adverse conditioner in my anaysis of the property value to the edent that T~rad market evii(ehce to support them. I have also oomrx~ded about the effect of the adverse oooditbns on Cre marketability of the subject prdperty. 9. I personalty prepared al conclusions and opinions about the real estate that were set forth in the appraisal report. C I retied on significant professional assistance from arty individual or kdividuals in the performance of Cre appraisal or Cre preparation of the appraisal report, I have named such individual(s) and discbsed the specrfc tasks pertomred by them in Cre reconciNation section of this appraisal report I cerfify that arty individual so named is qual'rfied to perform the tasks. I have not audarfzed arnyone b make a change to arty item in the report C>erefae, 'rf an unautlarized change is made to the appraisal report, I will take ra responsibility for tt. SUPERVISORY APPRAISER'S CERTIFICATION: C a supervisory appraiser signred the appraisal report, he or she certifies and agrees that: I directly supervise the appraise who prepared the appraisal report, have reviewed the appraisal report, agree with the statements and contusions of Cre appraiser, agree to be board by the appraiser's certifications numbered 4 Crough 7 above, and am taking ful responsibility for Cre appraisal and the appraisal report. ADDRESS OF PROPERTY APPRAISED: 112 Linden Dr, Camp Hill, PA 17011 APPRAISER: SUPERVISORY APPRAISER (only ii required: Signative: ~ ,~ .- ~ ~ Signatae Name: Dennis L. Stover Name: Dad Signed: January 31, 2012 pate Signed: State Certification #: RL 138906 State Certification #: a State License #: a State License #: State: PA State: E~iration Date of Certification a Licerue: 06/30/2013 E~iration Date of Certification or Ucense: ^ Did ^ Did Not Inspect Property Freddie Mac Fam 439 8-93 Page 2 of 2 Fannie Mae Form 111048 &93 Forrrr ACH -'1NinTOTAL' appraisal software by a la mode, inc. -1-800-ALAMODE Signature Compliance FileNo.12-0123R-2 li Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill CoUn Cumberland State PA Zi Code 17011 w r Estate of Frank H. Nava ato ELECTRONIC SIGNATURE COMPLIANCE W intotal and Project 2000 are fuly ASB (Appraisal Standards Board) compliant in their security. The signatures on this report have not been altered in any way and the digital signatures are to be considered as original. Fonn SUP -'WinTOTAL' appraisal software by a la mode, inc. -1->~0•ALAMODE Certificate Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Cou Cumberland State PA Ia Code 17011 Owner Estate of Frank H. Nava ato 'ice ~, ~ ~~ ~ ~`~~ ~""~~ CommonKeal[h of elgt `~ ; ,~ ~ ~ De a'f; ~ 4~ '~~~ '"~'~''' Butt~au of Prp F~~.O~ P ~<~c'dti~ate Type L~er'lHyaid 1269identlal AQpr~iser ~~~ ,~. y ~, A't~r:T;nr t3or '~iarrti~8ur~ E i ~ . ~ : "'~' 3 ~ '~~ F. , W / ~ , i ~~'`t` °~ ~ [~ `- ~' Certiticate ~i uct~bcr Rf.13~19@F . ~r ~ p'l ,'~q.x ' f ~' i _. .yc..",. 4 i -.i Fb- ~- ~ U :. ~~i. nta :. -nal .~'t~rs '~-26~i9 ~ ~`~ - ~` ~ Gerttfkyttc Status 4 ~~ ~ < <r Acttvo ~~F~~~' tcat~~bftt '< ~rr~srzooa t Ezp+rst~a 1?r:tC e< tldI30~2Di3' Form MAP.PLAT - •WinTOTAI' appraisal software by a la mode, inc. -1-80o-ALAMODE Qualifications Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Coun Cumberland State PA b Code 17011 Owner Estate of Frank H. Nava ato Dennis L. Stover, GRI, CSI' PA Certif ed Residential Real F`state Appraiser Certfiea#on NumberRL I3$9f16 CLAUSER REAL ESTATE APPRAISALS, LLC PO t3ox 777 Camp Hill, PA 17001-ff777 Phone {717) 737-73Q0 Fax (71'Ij 730-0922 E-.mail address: dstover4taac(c~comeast www.clauseravzlrais$I~~ct}an AL ICATIOI~+ SH>u~' ~DCICATICN' Harrisburg Area community College Associate in Business Adtnnsttatian Graduate Realtor Insritute GRI Designation New fitame Sales Pmfrssionat Coarse --- - CSPDes ____ __ __ tgnation ln~itttte of Real Estate Studies E78PAP- March L998 USPAP- Ianuary 2002 Basics of R~ideatiat Valuation & Sates Cotnparisort Approaeh-Apri12U02 Basic Income Propeaty Vaht~ppn-3aauaay 2Q02 advanced Income Frop~rty Valuation-January 2002 Residential Constmction-Septemtxx2002 National. USPAP-September 2003 All eolrrses to complete Pennsylvania State Residerttal Certification- All c~intu education courses to maintain current licetase t'ROFt?SSlO~ Ml=r~rupu Sr~IP/DES[GNATIt)N Pennsylvania State Certified Residential Real P~state Appraiser #tL 138906 Pettnsytvania Reel Estate Salespecsort- Lieertse #tS I50605A National Association of Reattors`~1 Peitnsylvatta AssaGiatian of Realtors~k Gmster llanrisburg Association of Reattors~ Fomt MAP.PLAT - •WinTOTAL• appraisal software by a la mode, inc. -1-801}ALAMODE Qualifications Client Hazen Elder Law Pro Address 112 Linden Dr Ci Cam Hill Cou Cumberland State PA Z Code 17011 Owner Estate of Frank H. Nava ato RFAL ESTATE E~PERT_ _ENCE 2003-Present PA State CerFified Resideartal Real Estate Appraiser, George C. Clausen heal Estate Appraisals 21104-Present Realtor, Uti'ron Realty, Inc., Middletown, PA 1997-ZOp3 Asaaistatrt to-the Appraiser, Ceatge C. Clausen Beat Estate Appraisals 1991-2044 Reap©r~ RE/MAX Realty Professionals, Harrisburg, PA 198ti-1+~9i Realtor, The Homestead Group Rc~ltor, Middlettswtt/Harrisbitrg DES OP APFRAISA> 5 COMPLETEI?• RESIDEi~TIAAT~ SingteFamiyResidenees, Multi-family l-~l tutits, and land. Appraisal samples upon request. AT'PRAISALS HAVE BEEN COMPLETED FC3R: Adams t.ountY NiEttiottai 8artk Allied Ffonte MwiAage Capital Gtirp, Am~twQbe Federal Cn~iit Urson Centric Bank Community First Fund First National Bank. First National Bank of MaFysvpte Fulton Bank Graystone Bank Harbortaxn lnicgrity Bank~~ .lcH~estovm Bar~C Legacy 80aNt hil & T Bank Madbn Bank Mesmbers Ftrttt Federat`Credit Un1on Mid Pam t3ank Meanbers ~'a'siFederal. Credit Union Meti+o t3ank Nadorrtti City Mortgage National Penn Bank Northwest Savings Bank Omega Bank Ortstown Bank Pennsylvania Staff Bank PNC Provkxs Bank Prudential Reiocatlar P5P Financial Sovereign Bank Starting Finance Gurjr; Wactwvia Waits Fargo Fonn MAP.PLAT -'WinTOTAL' appraisal software by a la mode, inc. - t-80QALAMODE GEORGE CLAUSER PROM: _. Clouser Real Estate Appraisals, LLC George C. Clouser, SRA P.O. Box 777 Camp Hill, PA 17001 Tekplane Number: 717-737-7300 Fax Number: 717-730-0922 T0: Marielle Hazen Hazen Elder Law 2000 Linglestown Rd. Suite 202 Harrisburg, PA 17110 E-IAai: info@hazenelderlaw.com Telephone Number: (717) 540-4332 Fax Number. (717) 540-4313 Alkmak Number. INVOICE i7-ui23 R-? DAiE Invoice Date: 01 /31 /2012 Due Dak: IMemalOrderX: 12-0123 R-2 Lender Case X: CIieM Fae q: FNA/VA Case X: IAab File # on form: 12-0123 R-2 OtherFtleryonform: Summary Report Federal Tax ID: 26-1647066 Empbyer ID: Lender: NA Client: Hazen Elder Law Purchaser/Borrower. NA Property Address: 112 Linden Dr City: Camp Hill County: Cumberland State: PA Zip: 17011 Legal Desaiption: Deed Book 22Y Page 879 SUBTOTAL Thank You, Your Business 'd Appreciated! TOTAL DUE $ 375.00 Form NN5D -'WinTOTAL' appraisal software by a la nwde, inc. -1-B00-ALAMODE •~'~°j~•~ A. Settlement Statement (HUD-1) OMB Approval No. 2502-0265 1. [X~ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number; 7. Loan Number. 8. Mortgage Insurance Case Numbe 12226 ~ocooooc2212 446-1311942.703 4. ^ VA 5. ^Conv. Ins. C. Note: This form is famished to give you a statement of actual setnement costs. Amounts paid to and by the settlement agents are shown Items marked "(p.o.c)"were paid outside the closing; they are shown here for informational purposes and are not inGuded in the totals. D. Name & Address of Borrower: Mid Bongiomo, David Bucher E. Name & Address of Seller: F. Nam ss of Lender: Frank H. Navagato Estate Wells Fargo Bank NA. 112 Unden Drive, Camp Hill, PA 17011 P.O. Box 5708, Springfield, OH 45501-5708 G. Property Location: H. Settlement Agent t 12 Linden Drive 1st Advantage Settlement Services Inc. I. Settlement Date: 07/26J2012 Camp Hilf, PA 17011 6375 Mercury Drive, Sulte 102, Mechanicsburg, PA 17050 Disbursement Date: 0 7/2 62 01 2 LowerAilen Toumship Telephone:717-591-7755 Fax: 717-591-7756 Place of Settlement: TitieExpress 6375 Mercury Ddve, Suite 102, Mechanicsburg, PA 17050 Printed 07/26/2012 at Safi pm by VW 100. Gross Amount Due from torrower 101, Contrail sales rNirn 400. Gross Amounf Due to Seller " aemernent charges to borrower (fine ', tments for items paid by seller in ad City/town taxes to County taxes 07/26!2012 to ~~ Taxes 07/26/2012 to Sewer/Refuse mr~nnlP ~ 110. cross Amounn Due from 200. Amounts Paid by or in B 201. Deposd or earnest money 202. Prinapal amount ~ new b 203• Existing ban(s) taken subk 204. Over Tolerance Refund 205. 206. Y71. t+ollnty taxes 212. SchoW Taxes 3,992.96 403. 404. 405. m taxes tares """"'<~'< 79.34 409. Sewer/Refuse 07/2 410. 411. __ - 412.. n:r 155,019.34 420. Gross amount Due to Selfe BOmO~ 500. Reductions In Amount Due ,_ 1 p00.00 501. Excess deposit (see insbut2ic 130,748.00 502. Set0ement charges to seller 503. ExisGn to s taken sub'ect 1,492.65 504. Payoff of first mortgage ban 505. Pavoff of carnnri mnAnonn i... seller ro t0 to c~u. Total Paid byJfor Borrower 300. Cash at Bafflement fromfto Borrower 3D7. Gross amount due from borrower pine 120' 302. Lass amounts paid bylFor bonower (Ilse 22 303. Cash ^X From ^ To Borrower 512. 513. 514. 517. 518. 519. 133,240.65 520. Totalf 600. Cash r 155,019.34 601. Gross ; 133,240.65 602. Less re 21,778.69 ~ ~ 603. Cash by seller to to 12131!2012 to 07/01/2013 to 09/30/2012 vn raxes to taxes t0 Taxes ~ eduction Amount Due Seder 5,234.78 ~.,cn..vm um teener ice to seller Qine 420} In amount due seller Qine ; To ^ From Setter 145,791.60 Previous editions are obsolete Page 1 of 4 HUD-1 700. Total Reat Estate Broker Fees $ 1,492.65 Division of commission Iine700 asfol(ows: Paid From Paid From 701• $1492.65 to ReMlax 1stAdvant a ~ Borrower's Seller's 702 $0.00 to Funds at Funds at 703. Commission paid atsetUement Settlement Settlement 704. to 1,492.65. 800. ftems P ble in Connection with Loan 801. Our origination charge (Indudes Origination Point 0.000 0 or $0.00} $630 00 802. . Your aedit or ch a arg (points) for the spedfic interest rate chosen ~:~ ins 0~ (from GFE #1) ,~.__ ,.~~ ..,,. 805. Credit report to Rels to Reis 806. Tax sanrirn to GFE 763.01 'Paid outside of dosin 3,992.96 5,234.78 g by (B)orrower, (S~ler, (L)ender, (I)nvestor, Bro(tC)er. "Credit by lender shown on page 1. "'Cred'it by seller shown on page 1. Previous edlttons are obsolete Page 2 of 4 HUD-1 Char es That in Total Cannot Increase More Than 10% _ Government recording charges # 1201 Good Faith Estimate HUD-1 Apprafsai fee 164.00 142.00 Credit repat #804 ~ ~ # 805 ~•~ Mortgage Ins. Premium 23.32 ~ ~ Flood {Life of Loan) # 902 2,248.75 # 1302 2,248.75 19.00 19.00 2,910.07 2,886.75 ' $ -23.32 -0.8014% Cha a That Can Chan e Initial deposit for your escrow account Good Faith Estimate HU0.1 Dairy interest Charges from # 1001 455.16 # 901 $13.4300/da 451.57 Homeowners insurance 214.88 ~~ Title senices and lender's title insurance # 903 0.00 # 1101 555,00 Owner's title insurance t,i 13.81 1,385 00 # 1103 0 ~ # 95.00 Loan Terms I Your initial loan amount is $130,748.00 Your ban term is 30. years Your initial interest rate is 3.7500% Your initial monthly amount owed for principal, interest, and any mortgage i $732 94 includes nsurance is , ^X Pdnclpai Interest ^X Mortgage Insurance Can your interest rate dsel X No. ^ ^ Yes, it can rise to a maximum f o %. The first change will be on / f and can change again every years ~ / / . Ems, c hange date, your interest rate can increase a decrease by °~, Overihe Irfe of the loan, your interest rate is guaranteed to never be lower than than °,y, % or higher Even 'rf you make payments on time, can your ban balance dse? X No. ^ ^ Yes, it can dse to a maximum of $ ,Even if you make payments on time, can your monthly amount owed for pnrxlpal, interest, and mwfgage insurance dse? X No, ^ ^ Yes the first increase can be on ! / and the monthly amount owed can dse to $ , The maximum it can ever dse to is $ Does your loan have a prepayment penalty? © No. ^ Yes, your maximum prepa ment lt i Does your loan have a balloon payment? y pena y s $ X^ No. ^ Yes, you have a balloon payment of $ due in years on / / Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow pa ment f It y or ems, such as ro and homeowner's insurance. You must pay these items directly youprselt~f ~ taxes ^X You have an additional monthly escrow a f p yment o $225.81 that results in a total inl8al monthly amount owed of $958.75. This includes pdrtdpal interest , , mortgage insurance and any items checked below: Q Property taxes Q Homeowner's Insurance ^ Flood insurance ^ t1 Note: if you have any questions about the Settlement Charges and Loan Terms listed on this form, please coma y ur lender, Corn arison of Good Faith Estimate GF and HUD•1 Char es Cha es That Cannot Increase Our origination charge HUD-1 Line Number Your credit or cha e ) p # 801 rg (points for the s edfle interest rate chosen # 802 Your adjusted odg nation charges 7ransfertaxes # 803 # 1203 Good Faith E--.stlmate ~ HUD•1 ~~~ 630,00 3,105.27 3,10527 -2,475.27 -2,475.27 0•~ 1,492.65 Previous editions are obsolete Page 3 0 4 HUD-1 .,,_ HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUQ1 Settlement Statement and [o the best of my knowledge and belief, tt is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that 1 have received a copy of the HUD-1 Settlement Statement. Mia Bongiomo C%2~w'.( Frank H. Navagato Estate The HUD-1 Settlement Statement which I have prepared (s a true and accurate account of this transaction I have caused or v1n11 cause the funds to be disbursed in accordance with this statement SETTLEMENT AGE ~ ~ ~j ' `~ DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 - .tau~nerui i~rrrrrr~~®n .~.: Name of Borrower. ,~_-- ~ „_„_ Mia Bongiomo David Bucher Frank H. Navagato Estate 12226 TttleExpress Prepared 07/26/2012 at 3:19 •~. ~ 1100. Title Cha s with P ee 1101. TNe services and lender's title insurance T0~ Cha a Borrower POC or Credit Borrower Line 1101 Seller Paid $ a Wire In Fee to 1st Advanta a Settlement Servi I ces na b. EmaillDoc Copy Fee to 1 st Advanta e Settle t S 1000 10'00 g men ervices Inc. a Ovemi t Delive Fee~ackage to 1st Adva t S tl 35.00 ~ ~ n age et ement Services Inc. d. Note Fee to Vckie Welker e. Closing Service Letterto Rrst American Title Ins C 25,00 35.OD ~•~ 35.00 urance ompany 1104. Lenders tl0e Insurance to 1 st Advantage Settlement Servi I 75.00 75.00 ces nc. 1280 ~ 1,280.00 $ 1,460.00 1,460.00 r ' M Date 7/26/12 Frank H. Navagato Estate ~~.~ ,- r _~ Date 7/26/12 Mia Bongiomo avid Bu Date 12 Note: This page is furnished to give you an itemization of the amounts shown on Paid From Paid From Lines 1101, 1103 and 1104 of the Settlement Statement (HUD-1 ). This page Borrower's SelleCs accompanies but is not a part of the settlement statement. If a discrepancy Funds at Funds at exists, the information shown on the Settlement Statement (HUD-1) aonlies. Cot+ro.,,o.,+ ~,...~_.___. Dec, 14. 2011 10:21AM PNC BANK ~~~ ~DtNi~ ~`Iif:1~lAY December 14, 2011 Corinne Eggers Woodhouse Hazen Elder Law 2000 Lighthouse Rd Ste 202 Harrisburg, PA 17110 RE: Name: Frank H Navagato SSN: 222-OS-9929 DOA: 10-25-2011 Dear Ms. Woodhouse: No, 8371 P, 1/2 In response to your request for Date of Death (DOD} balances for the customer noted above, our records show the followi~ag: Certificate of Deposit Account # 31900313457 FRANK H NAVAGATO SUSIE I NAVAGATQ DOD balance: $ 3,215.49 + 0,31 accrued interest Interest paid OI-O1-2011 thru 10-25-2011 $ 5.38 XTD Checking Account Account# 514004b12b FRANK H NAVAGATQ SUSIE I NAVAGATQ PATRICK NAVAGATQ DOD balance: $ 781.98 + 0.01 accrued interest Interest paid 01-01-2011 thru 10-25-2011 $ 0.91 YTD Savings Account Account # 5005731649 FRANK H NAVAGATQ PATRICK NAVAGATQ DOD balance: $ 16,271.32 + 2.58 accrued interest Interest paid 01-01-2011 thru 10-25-2011 $ 3730 YTD Established: O S -07-2007 Established: 08-01-1975 Established: 02-28-2011 Page 1 of 2 Dec. 14. 2011 10:2$AM PNC BANK No. $371 P. 2/2 Please note that this office provides date of death balances far deposit accounts (IRAs, CDs, Checkiag a~ad Savings). We do not process any financial transactions ar provide statements. I.f you need assistance with any of these items, please call 1-888-PNC-BAN1G (1-888-7b2-2265} ar stop by your local PNC Bank branch office. Sincerely, National Financial Services Center FNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged confrdential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error, please notify me immediately by reply ar by telephone at 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 Metropolitan Life Insurance Company P.O. Box 10342 Des Moines IA 50306-0342 MetLife November 9, 2011 PATRICK V NAVAGATO 6118 FORRESTAL CIR HARRISBURG PA 17112 RE: METROPOLITAN LIFE INSURANCE COMPANY CONTRACTS 071042047AB 073347660AB DECEASED FRANK NAVAGATO- Dear Mr. Navagato: We have processed your claim for the death benefit under the above contracts. The payment details for your share of the proceeds are as follows: These contracts are qualified and all proceeds are considered taxable in the year received. Your settlement will arrive under separate cover. The Internal Revenue Service requires we furnish the date of death value for Individual Retirement Annuities (IRA) on which a death claim has been filed in case this value is needed for income tax purposes. In most cases, the executor/administrator of the decedent's estate will not need the date of death fair market value for income tax purposes. The date of death valuation will only be necessary for income tax purposes if one or more of the decedent's IRAs contain nondeductible contributions and, in addition, the decedent received an IRA distribution in the year of death. This is to inform you that the value of the IRA contract 071040047A6 as of the date of death, October 25, 2011, was $29,864.14. This is to inform you that the value of the IRA contract 073347660AB as of the date of death, October 25, 2011, was $23,184.82. If you have any questions, please contact your representative or call our Customer Service Center at 1-800-638-7732 Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, ~~ Patty Clune Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services Metropolitan Life Insurance Company P.O. Box 10342 Des Moines IA 50306-0342 MetLife December 6, 2011 CORINNE EGGERS WOODHOUSE 2000 LINGLESTOWN RD STE 202 HARRISBURG PA 17110 Copy to: Agent: SARAH CLARK 101 ERFORD ROAD SUITE 200 CAMP HILL, PA 17011 RE: METROPOtITAN LIFE INSURANCE COMPANY CONTRACT 071042047 DECEASED FRANK NAVAGATO Dear Ms. Eggers Woodhouse: We are writing to provide you with important information regarding the above contract. The Internal Revenue Service requires we furnish the date of death value for Individual Retirement Annuities (IRA) on which a death claim has been filed in case this value is needed for income tax purposes. In most cases, the executor/administrator of the decedent's estate will not need the date of death fair market value for income tax purposes. The date of death valuation will only be necessary for income tax purposes if one or more of the decedent's IRAs contain nondeductible contributions and, in addition, the decedent received an TRA di§~ribution in the year of death. This is to inform you that the value of the IRA contract as of the date of death, October 25, 2011, was $29, 864.14 . Our records reflect the beneficiary designation as follows: Primary Beneficiary: PATRICK NAVAGATO, FREDERICK NAVAGATO & CAROLE BUNGIORNO Relationship: Children Percentages received: EQUAL If you have any questions, please contact your representative or call our Customer Service Center at 1-800-638-7732 (Client Line) Monday through Friday between 9:00 a.m. and 6:00 p.m., ET. Sincerely, ~.~ . J e Krieg ~~ Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services ~~~ ~, ~ DES 1 ~ 2~1i I. ,~ ~~ ~L.~.JL~bI ^ 3 Kacey Ct Ste 101 Mechanicsburg PA 17055-9221 (717) 796-9784 ^ ~~ HERITAGE INVESTMENT SERVICES FUND An investment that works Mr Frank H Navagato 112 Linden Dr Camp Hill PA 17011-7219 Quarter Ending Oct 25, 2011 Account Rate Matures Deaosits Interest withdraws Penalties Balance 1005633 5.00% 5/17/2014 $0.00 $65.59 $0.00 $0.00 $1,793.12 1005688 5.00% 6/19/2014 $0.00 $65.27 $0.00 $0.00 $1,784.95 1005750 5.00% 7/23/2014 $0.00 $35.14 $0.00 $0.00 $888.31 1005842 5.00% 8/13/2014 $0.00 $63.53 $0.00 $0.00 $1,737.26 1005891 5.00% 9/19/2014 $0.00 $63.19 $0.00 $0.00 $1,728.33 1005946 5.00% 10/15/2014 $0.00 $66.26 $0.00 $0.00 $1,722.24 1006072 5.00% 12/6/2014 $0.00 $61.33 $0.00 $0.00 $1,676.99 1006131 5.00% 1/15/2015. $0.00 $64.78 $0.00 $0.00 $1,684.04 1006208 5.00% 2/19/2015 $0.00 $61.30 $0.00 $0.00 $1,676.18 1006265 5.00% 3/15/2015 $0.00 $61.10 $0.00 $0.00 $1,670.80 1006319 5.00% 4/12/2015 $0.00 $63.34 $0.00 $0.00 $1,664.40 1006829 5.00% 12/12/2015 $0.00 $58.87 $0.00 $0.00 $1,609.47 1007281 5.75% Redeemed $0.00 $45.91 $1,514.83 $0.00 $0.00 1007281 5.00% 7/16/2016 $1,514.83 $19.06 $0.00 $0.00 $1,530.29 1009283 5.00% 11/28/2015 $0.00 $237.26 $0.00 $0.00 $6,487.32 Page 1 TOTAL PERIOD INTEREST $1,031~3TAL ON DEPOSIT (includes unposted interest) $27,653.70 ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-1214 BUREAU OF INDIVIDUAL TAXES PO BOX 2B0601 Pennsylvania AND ACN 11184084 HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 12-26-2011 REV-1543 EX AFP (A5 -11) EST. OF FRANK H NAVAGATO SSN DATE OF DEATH 10-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: SUSIE I NAVAGATO REGISTER OF WILLS 6118 FORRESTAL CIR 1 COURTHOUSE SQUARE HARRISBURG PA 17112-8524 CARLISLE PA 17013 boo a-q-~d~c TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PN C BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU are the Spouse Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased Dy checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140046126 Date 08-01-1975 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $` 782.00 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 130.34 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE AI PON L L .Ill. OF I SE E A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOC K B.~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 2 $ 3 X 4 5 6 7 X 8 +~ 1 2 '~ ' - 5 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID OFFICIAL USE ONLY (~ AAF~ PA DEPART#ENT pF REVENUE TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true, correct and c plete to the be of my kn wled9e and belief. HOME C ~ "` WORK ( ) 2 TA PAYER SIGNATURE TELEPHONE NUMBER DATE ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES F I L E PD BOX 280601 Pennsylvania AND ACN HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE TAX P AY E R RESPONSE DAT E REV-1543 EX RFP (OS-il) N0. 21 11-1214 11184255 12-27-2011 EST. OF FRANK H NAVAGATO SSN DATE OF DEATH 10-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: ** PATRICK NAVAGATO REGISTER OF WILLS 6118 FORRESTAL CIR 1 COURTHOUSE SQUARE HARRISBURG PA 17112-8524 CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. PN C BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If you are the SpOUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5005731649 Date 02-28-2011 To ensure proper credit to the account, two Established copies of this notice must accowpany payment to the Register of Wills. Make check Account Balance $ 13 ~ 271.00 payable to "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are made within three Amount Subject to Tax $ 13 ~ 271.00 months of the decedent's date of death, Tax Rate X . 0 4 5 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due ~ 597.20 nine months after the date of death. PART TAXPAYER RESPONSE I AILiiR TO ES WILL IN Alit FCC ASSES HT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and 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 D N L Y filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ 3 X 4 $ 5 6 7 X 8 +~ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK C ) TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true, correct and c~lets to the best p~ my kn~ edge and belief. HOME C ) /11//l .~. ~ ~ / e / ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-1214 BUREAU OF INDIVIDUAL TAXES PD BDx 2BB601 Pennsylvania ACN HARRISBURG PA 17128-0601 AND 11184085 DEPARTMENT OF REVENUE TAXPAY E R RESPONSE DAT E REV-1543 EX AFP (05-11) 12 - 26 - 2011 EST. OF FRANK H NAVAGATO SSN DATE OF DEATH 10-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: PATRICK NAVAGATO REGISTER OF WILLS 6118 FORRESTAL CIR 1 COURTHOUSE SgUARE HARRISBURG PA 17112-8524 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * $EE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 514004612b Date 08-01-1975 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 782, 00 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax $ 130 , 34 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ ~r,87 nine months after the date of death. PART TAXPAYER RESPONSE F IL IL Ut O AL T A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ g, The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrrect, and/or debts and deductions were paid. Complete PART ~2 and/or PART 3LJ below. PART If indicating a different tax rate, please state 0~ 1CI L USE 'ONLY' relationship to decedent: AAF.. PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 ~ ~.... 2 3. Percent Taxable 3 X _3-..y,, ,-,iw .w,,.w_ 4. Amount Subject to Tax 4 $ ~~ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ ~ b 7. Tax Rate 7 X 7 8. Tax Due 8 ~ 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and comy~llo the be~ o¢-my kno~dge and belief. HOME C ) /'/~ (/// ///,~a,_._ WORK C ) DATE IYIAL itnter on Lanes of Tax Computation) $