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HomeMy WebLinkAbout08-01-12,~ ~~-~~~ .4 FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN THE ESTATE OF DORIS J. EPPLEY KNOW ALL MEN BY THESE PRESENTS, that, WHEREAS, Doris J. Eppley, late of Cumberland County, Pennsylvania, died testate on ,having first made her last will and testament duly executed on March 18, 2004; WHEREAS, the said Doris J. Eppley, by the aforesaid last will and testament, named John A. Eppley, Executor of said last will; WHEREAS, letters testamentary on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor, John A. Eppley hereafter collectively called the personal representative. WHEREAS, the personal representative has gathered the assets of the estate of the said decedent and the assets consist of personal and real property, to a total value as set forth in Exhibit "A", a copy of the Pennsylvania Inheritance Tax Return filed by said personal representatives, and which has been provided to each heir; WHEREAS, the debts and deductions, including the payment of inheritance tax in the ~.~ t..~ q..~--~ said estate are further referenced in Exhibit "A"; ~© ''`' ,-,-~ .~ ; a" WHEREAS, a balance for distribution of $9,020.00 exists; ~..~. ~. -: ~ .~ CI3 ,: O~-, ,__. '.'- WHEREAS, the balance for distribution has been reduced to cash and ~ai~ab leor ` ~1 distribution in accordance with the terms of the last will and testament of the said ~cedent. -- r1~, NOW, THEREFORE, KNOW YE, that we, being all of the named beneficiaries of the will and the said decedent, do hereby each of us, acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sum or sums of money, legacies, bequests, and devised as are given, devised and bequeathed to each of c. ~ f~ , !.!'> :E 7 _,~ r- ;rEi c~~,.-~ _;., LL - -n l= c~ a us respectively by the said will of Doris J. Eppley in the amounts due us under said will, which amounts we have received this day, in the amounts as set forth on Exhibit "B" hereto. AND, each of us does hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Cumberland County. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, heirs, executors, and administrators and assigns of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the estate of the said decedent, and each of us do further hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata, our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, and intending to be legally bound hereby, we have hereunto set our hands and seals on the dates below indicated. WITNESS: ohn A. Epp ey COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND AND NOW, this ~~'~day of ~~l' J SS. 2012, before me, the undersigned officer, personally appeared John A. Eppley, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL ALMAYVETTE GONZALEZ, Notary Public S. Middleton Twp., Cumberland County My Commission Expires March 18, 2013 IN WITNESS WHERE , an mten g to be legally bound hereby, we have hereunto set our hands and seals on the dates below indicated. TNESS: /~ ~` /J Donna K. Bameycastle STATE OF FLORIDA SS. COUNTY OF1"~Fi~ . AND NOW, this ~ ~ day of ~~t ~ , 2012, before me, the undersigned officer, personally appeared Donna K. Barneycastle, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. 1N WITNESS WHEREOF, I hereunto set my hand and official seal. CINZIA DiBERNARDO ~/ ~ / J I / ~~ Notary Public, State of Florida f/ ~/ MY Comm. Expires Jan. 8, 2014 No. OD949976 Notary Public 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 11 0273 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 209-12-9670 02/09/2011 07/29/1926 Decedent's Last Name Suffix Decedent's First Name MI Eppley Doris J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return _ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) c 1 ` 6. Decedent Died Testate _ . 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ._ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. g113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number David A. Baric, Esquire (717) 249-6873 Firm Name (If Applicable) i ~ REGISTER OF WILLS USE ONLY Baric Scherer I i First line of address 19 West South Street Second line of address City or Post Office Carlisle Correspondent's a-mail address: dbarlC@barlCSCherer.COrTI 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 has any knowledge. TUR ~F PER ON ESPONSIBLE FOR FILING RETURN TE -G~ ~cvror~- --- - ----- -- -- -- _- -- ----'~ 8~~~---- - X509 York Road, Carlisle, Pennsylvania 015 SIGNATURE O R RER~OTHE N PRES TIVE DA / / ADDRESS Y 19 West outh Street, Carlisle, Pennsylva la 7013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 I State ZIP Code ~ DATE FILED PA 17013 J 15056052059 REV-1500 EX DOn$ J Eppley ' s Name: Decedent __ RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Property (Schedule F) _; Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Totat Gross Assets (total Lines 1-7) .................................. .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 11. Total Deductions (total Lines 9 8 10) .............. .................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 621,373.40 16. 17. Amount of Line 14 taxable at sibling rate X .11 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .... .. ... ........................................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 Decedent's Social Security Number 209-12-9670 179, 000.00 149, 092.50 320, 834.40 648,926.90 27,553.50 27,553.50 621, 373.40 621,373.40 27,961.80 15056052059 REV-•1500 EX Page 3 rlacarilpnt's Cemnlete Address: File Number 21 11 0273 DECEDENT'S NAME _ Doris __ J Eppley STREET ADDRESS 610 Somerset Drive CITY Mechanicsburg DECEDENT'S SOCIAL SECURITY NUMBER 209-12-9670 STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 27,961.80 2. CreditslPayments A. Spousal Poverty Credit _-_ 920 00 25 . , B. Prior Payments __ C. Discount 1,296.00 --- _- Total Credits (A + B + C) (2) 27,216.00 3. InterestlPenalty if applicable D. Interest E. Penalty - ---- --" -" - _ Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 745.80 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 745.80 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. ....... ^ ^z b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary 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 receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation? ................................................................................................................. ....... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER Doris J. Eppley 21-11-0273 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. _. ...._,_ __._. ~_ ~ __I---~ -- c-L. J..1. G (If more space is needed, insert additional sheets of the same size) Nrevio~s edmm~s are ocso~~ErE - ,'A SettlerTlent StateTTleIlt U_S Department of Housing and Urban Development OMB Aooroval No 2502-0265 1 ^FHA 2 ~FmHA 3 ^Conu Unins. 6. File Number 7 Loan Number 8 Mortgage Insurance Case Number 4 ^vA 5 L1Conv Ins. 20111EPPLEY _ __ __-____-_ ----7Fi-7o m ~TsTie3lo give you a sTaremen o ac ua se emen cos s. moon s pay o an y e se e n agen are s own , C. NOIe Items marked "(p.d c )" were pals outside the closing; they are shown here rot mformadon purposes and are not mcwdeo in In¢ meals TdfeExpress Settemenf System WFRNING If is a crone to knowingly make raise statements to the United Slates on 1MS or any other similar Iwm. Pendllies upon fnnwcllon can rnciutlE d fine and Im hsonmenl For details See Trtle 18 U. S code Sectrdn 1001 and SeGwn 1014 D NAME OF BORROWER. John A. Eppley and Debra A. Eppley - - ADDRESS _ E NAME OF SELLER Estate of Doris J. Eppley ADDRESS - -- ------ --- ---- _ - - -- 1 F NAME OF LENDER. ADDRESS i G PROPERTY ADDRESS. 610 Somserset Drive, Mechanicsburg, PA 17055 Mechanicsburg Borough __ _ H. SETTLEMENT AGENT. Baric Scherer, Telephone: 717-249.6873 Fax: 717.249-5755 PLACE OF SETTLEMENT'. 19 West South Street Carlisle PA 17013 _ ___ I SETTLEMENT DATE. 0612912011 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 179 000.00 401. Contract sales rice 179 000.00 __ 102. Personal Property 402 Personal Pro ert _ _ _ _ 103 Settlement char es [o borrower line 1400 1 211.38 403. __ 104. 404. ___ 105 - -- 405. -- - Adjustments for items aid b seller in advance Adjustments for items paid by seller I n advance _ 106. Cit /town taxes 406. Cit (town taxes - 06I29111to12131111 107 Count taxes 470.19 407. Count taxes 06129111 to 12131111 470.19 __ 108 School Tax 06129111 to 06130111 11.11 408. School Tax _ 06129111 to 06130111 _ _- 11.11 109 409 - -- t 10 -- 410. -.- - -- -- 111. 411. _ 112. --- 412. ___ 120. GROSS AMOUNT DUE FROM BORROWER 180 692.68 420. GROSS AMOUNT DUE TO SELLER 179 481.30 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER __ 201. De osit or earnest mone __ 501. Excess Deposit (see instructions/- ___.___ 202. Princi al amount of new loans 502 Settlement charges to seller (line 1400) _ __ _ -_-_~ 203. Exlstin loans taken suti ect to _ 503 Exlsting loan(s) taken subject to ___ __ 204 ~ 504. Payoff of First Mortgage Loan __-____ _ 205. 206 207 Credit a ainst Est. interest 179 000.00 5D5 506. ~ 507. Credit a ainst Est. Interest ----- I - _ I~ _179 000.00 208. -- 508. - }- -- --~ _- 209. 509. I Ad ustments for items un aid b seller Adjustments for items un aid b seller 210. Cit (town taxes 510. Cdyltown taxes ___ 211. Count taxes 511. Countvtaxes _ 212. School Tax _ ~ 512. School Tax _ ~f ___ 213. -------- 214. ------ 215 216. _ 217. 218. _ 513 -__,_ 514. T 515 516. --- --- - 517. 518. ___ _ _ _ - _ 219. 519. _ 220. TOTAL PAID BYIFOR BORROWER 179 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER _ 179 000.00 300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R _ 301. Gross amount due from borrower line 120 180 692.68 601. Gross amount due to seller (line 4201 ___ 179 481.30 302. Less amounts paid by/for borrower line 220 179 000.00 602. Less reduction amount due seller line 520 __ 179 000.00 303. CASH FROM BORROWER 1 692.66 ~ 603. CASH TO SELLER ______ -_ ____ 481.30 U S..DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT IGIIn nU~~"~ I:11bG) let HantlUOOk <3C~ File Number. 20111EPPLEY SAGE TitleExoress Settlement System --_ -_ - L. SETTLEMENT CHARGES - PAID FRO PAID FROM I _ 700. TOTAL SALES/BROKER'S COMMISSION based on price $179 000.00 = _ __ M BORROWER'S SELLERS ~ Division of commission (line 700) as follows FUNDS AT FUNDS AT __ _ X701 $ to SETTLEMENT SETTLEMENT __ 702. $ to - 703. Commission aid al Settlement _ ~ __ __ _ _ _ 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee _ ____ % _ _ % Loan Discount 802 __ ~ -~ ___ __ . 803. A ralsal Fee --- 804. Credit Re on _ _ _ i ~--- - 805. Lender'slns ecbon Fee _ ~ 806. Mort a e A lication Fee __ ____ __ __ ~' 807. Assum lion Fee _ __ ~ ~' 808 I I . 809. _ --- - - 810. -- --- - 811 -~-- -- - -- ------ 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE to (a $ rday 901 Interest From -~ - _ _ 902. Mort a e Insurance Premium for to - 903. Hazard Insurance Premium for to 904. -_~ _ _ 905. _ _ 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance ___ mo. Co $ - rmo __ _ -_ - 1002. Mort a e Inswance __ mo Cagy $ Imo 1003. Cit Pro en Tax ____ mo to $ _____ Imo _ _1004. County Property Tax __ mo. (a) $ imo __ 1005. School Tax _ mo to $ imo _ __ 1009. A re ate Anal sls Adiusfinent 0.00 _ _ __ -_-~' __~ ~_--_-~ ___ _ _ _ _ _ _ _ 0.00 1100. TITLE CHARGES ~ _ 1101 Settlement or closet fee ___ __ ___ __ ~- 1102. Abstract or title search ____ __ 1103. Title examinatlon __ - ______ __ 1104. Title insurance binder ~ _ ___ _ 1105. Document Pre araGon ___ _ _ to Cash _ ____ 1106. Nola Fees 10.00 ______ _ _ to Boric Scherer 1107. Attorne 's fees 1 128.38 _ _ __ includes above items No Attorney Certification I _ ____ 1108. Title Insurance __ _ I _ _ includes above items No __ _ ___ 1109. Lender's Coverage $ ___ _ 1110. Owner's Covera e $ _ 179,000.00 - ______ _ 1111. -~ _ __ ----- 1112. _ 1113. _ ~ ___ 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES __ 1201. Recordin Fees Deed $ 63.00 Mort a e $ Release $ ~ 63.00 I 1202. Cit /Count tax/slams Deed $ Mortgaqe $ _ }-__ 1203. State Tax/stam s Deed $ ;Mortgaqe $ I 1204. _- i -_~- 1205. - - -- - ---~ I ------ 1300. ADDITIONAL SETTLEMENT CHARGES 1301 Tax Certification _ to Barry L. Heckard Tax Collector _____ 1302. Pest Ins ection 10.00 _ 1400. TOTAL SETTLEMENT CHARGES tenter on hoes 103, Section J ono 502, Section KI __ i ~ 1,211.381_ HUO CERTIFICATION OF BUYER ANU SELLER I have carefully levlewetl the HUD-1 Settlement Statement an0 to the Dest of my knowletlge antl Dellel, IL Is a flue antl accurate statement of all receipts ono ais DUrsemems matle on my account ur Dy me in t transaction I /uRhe~ certify that 1 have receivetl a copy of the HUD-1 Settlement Slalernenl Jopn A/tppley • - J/ // ueora ntpPley y /// ~~~W7~N"_ V e ores pp ey WFRNING IT IS F CRIME TO KNO WINGLV MAKE FALSE STATEMENTS TO THE The HUD-t Settlement SI a whl<n 131a prepay tl Is ntl ccurate account of iNs ue UNITED STATES ON THIS OR ANV SIMILAR FORM PENALTIES UPON CONVICTION iransacllon I nave taus se Ih tuntls to a r tl I coraanc e won Ines statement CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE 18 U 5. CODE SECTION 1001 AND SECTION 1010 ~ 1/ ~ ~ SETTLEMENT AGE /~7/ pATE ]~-~~/~/ J - G7L / REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Doris J. Eppley 21-11-0273 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ 768 shares; Verizon @ $36.68 28,170.24 2. 184 shares; Fontier Comm. @ $9.42 1,733.28 3. 1,978 shares; AT & T @ $27.97 55,324.66 4. 21 shares; LSI Corp. @ $6.44 135.24 5. 792 shares; PNC Bank @$64.21 50,854.32 6. 37 shares; NCR @ $18.89 698.93 7. 75 shares; Alcatal-Lucent @ $3.56 267.00 8. 200 shares; PPL @ $25.01 5,002.00 9. 217 shares; Comcast @ $23.53 5,106.01 10. 38 shares; MetLife @ $47.39 1,800.82 TOTAL (Also enter on line 2, Recapitulation) I $ 149,092.50 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Doris J. Eppley 21-11-0273 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. checking account, Sovereign Bank 3,994.00 2. money market savings, Sovereign Bank 17,347.00 3. CD # 1685551358; Sovereign Bank 37,276.00 4. CD # 1685552539, Sovereign Bank 10,018.00 5. regular savings, Members First Federal Credit Union 4,618.00 6. life savings, Members First Federal Credit Union 4,000.00 7. CD # 7223-40, Members First Federal Credit Union 5,677.00 8. CD # 7223-42, Members First Federal Credit Union 46,559.00 9. CD # 7223-49, Members First Federal Credit Union 9,920.00 10. CD # 7223-50, Members First Federal Credit Union 4,047.00 11. CD # 7223-51, Members First Federal Credit Union 45,305.00 12. CD # 7223-56, Members First Federal Credit Union 15,337.00 13. CD # 7223-57, Members First Federal Credit Union 5,511.00 14. CD # 7223-58, Members First Federal Credit Union 1,696.00 15. CD # 7223-59, Members First Federal Credit Union 12,655.00 16. CD # 7223-60, Members First Federal Credit Union 30,685.00 17. personalty 3,694.00 18. Chevy Cavalier 4,100.00 19. refund Verizon 209.00 20. refund Patriot News 288.00 21. federal income tax refund 1,102.00 22. Forest Park refund 5,160.00 23. Granulawn refund 273.00 24. CD # 334312-42, Members First Federal Credit Union 51,363.40 TOTAL (Also enter on line 5, Recapitulation) $ I 320,834.40 (If more space is needed, insert additional sheets of the same size) .,~ REV-1511 EX+ (12-99) SCI~IEDI~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT -- _____ ESTATE OF FILE NUMBER Doris J. Eppley 21-11-0273 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Musselman Funeral Home 1,882.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) None Social Security Number(s)/EIN Number of Personal Representative(s) _ Street Address City ,State Zip Year(s) Commission Paid: 2. Attorney Fees 21,440.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant None Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 573.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 250.00 ~. West Shore EMS 240.00 s. Guardian LT Care 268.00 s. appraisal fee 350.00 ~o. United Water 53.00 ~~. Comcast 251.00 *****************SEE ATTACHED SHEET*********************** TOTAL (Also enter on line 9, Recapitulation) $ 2 ~ ~ 5 5 3 . 5 0 (If more space is needed, insert additional sheets of the same size) Estate of Doris J. Eppley No. 21-11-0273 Schedule H Continued: 12. PP L $457.00 13. lawn care $280.00 14. Verizon $ 26.00 15. Mechanicsburg Borough $118.00 16. Nationwide Insurance $501.00 17. Patriot News (advertising) $ 60.00 18. Cumberland Law Journal (legal adv ertising) $ 75.00 19. Sentinel (legal advertising) $155.00 20. auction expenses $112.00 21. personal tax $ 10.00 22. county real estate taxes $452.00 E REV-1513 EX+ (g-00) ~. . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Doris J. Eppley 21-11-0273 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] 1 • John Eppley son 1 / 2 2• Donna Barneycastle daughter 1 / 2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ($ 0.00 (If more space is needed, insert additional sheets of the same size) Partial Distributions: John A. Eppley Donna K. Barneycastle Payments: $106,000.00 06/29/11 $179,000.00 (in kind real property) $ 20,000.00 05/07/12 $305,000.00 $285,000.00 06/29/11 $ 5,000.00 09/28/11 $ _15,000.00 05/07/12 $305,000.00 Checking account interest $ 1.54 Attorney fees to Baric Scherer LLC $1,355.00 2011 PA individual tax payment $ 59.00 Stott & Stott Financial Services (tax preparation) $ 250.00 Cemetery Plot advertising $ 25.25 2011 PA estate tax payment 101.00 $1,791.79 Deposits: IRS refund Balance of Account $10,225.66 $ 810.00 Proposed Distribution $ 9,020.00 balance for final income tax returns for estate John A. Eppley Donna K. Barneycastle $1,205.66 $4,510.00 $4,510.00 EXHIBIT "B"