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HomeMy WebLinkAbout08-03-12 1505610140 1500 ex (°'-'°' REV - OffiCIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 2 1 1 2 0 5 2 7 Harristwrfl, PA t7t28-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Binh MMDDYYYY 1 2 5 1 4 8 4 1 2 0 4 2 8 2 0 1 2 0 4 2 1 1 9 2 4 Decedent's Last Name Suffix Decedents First Name MI O R L O U S K Y M A D L Y N G (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 © 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prbrto 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ® 8. 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. 9113(A) between 12-31-91 and t-1-95j (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DH2ECTED T0: Name Daytime Telephone Number S U S A N J H A R T M A N 7 1 7 2 4 9 7 7.8 0 First line of address 1 I R V I N E Second line of address City or Post Office C A R L I S L E R 0 W State ZIP Code P A 1 7 0 1 3 REGISTER ~ LS USE ANt.Y ,,..,, ~ L"` ~ t f Cx~ 1 ~~`' ~ a' ~~ W Q/ITE FILED w. comspondsnCs a-mail address: s u s a n a d u n c a n h a r t In a n 1 a w• c o m Under perisl°es of perjury, I declare that I nave examined Nie return, indutlirg accompanying ectiaduos and statements, and to die best d my knowledge and bebM, it is true, correct and compote. Dedaradon of preperer osier eiali the personal representative ie based On all information of w111G1 preparar has arty knotNsdge. 435 BOILING SPGS PA 17D07 DATE , 406 GLENN AVENUE BOILING SGPS PA 17007 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J ~, ' ~ 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Hama: M A D L Y N G• O R L O U S K Y 1 2 5 1 4 8 4 1 2 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .. 1 2. Stocks and Bonds (Schedub B) .................................... .. 2• 3. Closely Held Corporation, Partnership or Sob-Proprietorship (Schedub C) ... .. 3. 4. Mortgages and Notes Receivable (Schedub D) ........................ .. 4. 2 0 7 5 2 0 • 5 6 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Probate Property Inter-Vivos Transfers & Miscellaneous N ~ (Schedule G) Separate Billing Requested ..... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 2 0' ~ 5 2 0. 5 6 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9• 4 8 5 2 . 2 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 9 8 4 0 . 2 6 11. Total Deductions (total lines 9 and 10) ............................. .. 11. 1 4 6 9 2 . 5 2 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 1 9 2 8 2 B . 0 4 13. Charitabb and Governmental 8equests/Sec 9113 Trusts for which an ebction to tax has not been made (Schedule J) .................... .. 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) .................... .. 14. 1 9 2 8 2 8. 0 4 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxabb at lineal rate X •045 1 9 2 8 2 8. 0 4 ts. 8 6 7 7. 2 6 17. Amount of line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 1 B. . 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610240 Side 2 8 6 7 7. 2 6 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0527 DECEDENTS NAME MADLYN G• ORLOUSKY STREET ADDRESS 168 E• POMFRET STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: t• Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 8 , 0 0 0.0 D g. Discount 4 21.0 4 3. Interest 4. K 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. (1) 8,677.26 Total Credits (A + g) (2) 8 , 4 21.0 4 (3) (4) 0.00 5. ff Line 1 +Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 56.2 2 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 Np a. retain the use or income of the property transferred : .............................................:....................... . ^ b. retain the right to designate who shall use the property transferred or its income : .............................. . ^ c. retain a reversionary interest or ............................................................................................... . ^ d. receive the promise for life of either payments, benefits or care7 ...................................................... . ^ 2. If death occuned after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................................................... . ^ 3. Did decedent own an 'in Vust foI' or payable-upon~ieath 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 benefxiary designationl ................................................................................................. . ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of Vansfers to or for the use of the surviving. spouse is 0 percent [72 P.S. §9116 (a) (1.1} (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net v~ue of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptlve 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 Vansfers to or for the use of the decedent's lineal beneficlaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) p2 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 p2 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•150a EX + (5-9e) scHEOV~E E COMMOMwEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. IN RES DENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER MADLYN G• ORLOUSKY 21 12 0527 Indude a~ proceeds of Ikigaaon arW ale oats ale proceeds wale reosived by the estate. AN propeAy jointltrowMd wltlr ripM of surrtionbip must M dtsebsed on ScheduN F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t. M8T BANK CHECKING ACCT• M 26 71036768 ?,752.75 [SEE DOD LETTER ATTACHED] 2. MEMBERS FIRST SAVINGS ACCT• M 49822-00 317.19 [SEE DOD LETTER ATTACHED] 3• MEMBERS FIRST CHECKING ACCT• ~ 49822-11 200.00 [TEE DOD LETTER ATTACHED] 4• MEMBERS FIRST CERTIFICATE OF DEPOSIT ~ 49822-40 24,225.76 [SEE DOD LETTER ATTACHED] 5• MEMBERS FIRST CERTIFICATE OF DEPOSIT ft 49822-42 39,387.45 [SEE DOD LETTER ATTACHED] 6• MEMBERS FIRST CERTIFICATE OF DEPOSIT ~ 49822-43 13,123.61 [SEE DOD LETTER ATTACHED] 7• MEMBERS FIRST CERTIFICATE OF DEPOSIT # 49822-45 12,155.64 [SEE DOD LETTER ATTACHED] 8• MEMBERS FIRST CERTIFICATE OF DEPOSIT * 49822-48 86,987.58 [SEE DOD LETTER ATTACHED] 9• MEMBERS FIRST CERTIFICATE OF DEPOSIT # 49822-51 23,306.51 CSEE DOD LETTER ATTACHED? 10• MAGAZINE REFUND 36.66 11• DEPARTMENT OF REVENUE REFUND 27.41 TOTAL (Also enter on line 5, Recapitulation) I ; 2 0 7 , 5 2 0. 5 6 (If more space is needed, insert addiQonal sheets of the same size) REV-1511 EX+ (10-09) , Pennsylvania DEPMTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS MADLYN G• ORLOUSKY 21 12 0527 DecedsM't debts mutt be reported on ScMduk 1. ITEM NUMBER DESCRIPTION AMOUNT q, FUNERAL EXPENSES: t. EWING BROTHERS FUNERAL HOME, INC• 1,D73.26 2• FUNERAL LUNCHEON 400.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Clty State ZIP Year(s) Commission Paid: 2, AtmmeyFe«: DUNCAN & HARTMAN, PC 2,000.00 3, Faintly Exempilon: (It deoedenfs address is Imt the same as daimanfs, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 315.50 5 Aosountant Fees: 8. Tax Retain Preparer Fees: 7. MARTSON LAW OFFICES 548.50 8• FILING FEE 15.00 9• HELD IN RESERVE 500.00 TOTAL peso enter on Lines, Recapitulation) I S 4, 8 5 2. 2 6 II nwre space is nfleded, use additlonal sheets of paper of the same size. REV-1512 EX+ (12-0a) • pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MADLYN G• ORLOUSKY 21 12 0527 RapoR debts incurred by the decedent prior to death that remained unpaW a< the date of death, indudMq unreimbuned medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t, CENTURYLINK 25.33 2• AT&T 15.08 3• THORNWALD HOME 2,179.59 4• MAY RENT 415.00 5• PPL 58.26 6• THORNWALD HOME 6,647.00 7• REIMBURSE MILEAGE, POSTAGE, TELEPHONE, 500.00 MISC• EXPENSES - THOMAS ORLOUSKY TOTAL (Also enter on Line t 0, Recapitulation) I i 9, 8 4 0 n mae space is needed, insen edditloRal sheds of the same size. -i 513 EX• (Ot-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES SATE OF ,y~YN G• ORLOUTKY Cy yc uscr RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ., 3ER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustw(s) OF ESTATE • TAXABLE DISTRIBUTIONS [Include autrigh(spousai[d'siribu6ons and Iranslers under Sec. 91 6 a 1.2. 1. THOMAS ORLOUSKY Lineal 435 CRISWELL DRIVE 1/8 SHARE BOILING SPRINGS, PA 17007 2• JOHN ORLOUSKY Lineal 710 GINGRICH LANE 1/8 SHARE DAUPHIN, PA 17018 3• MARGARET (HILL) RAMER Lineal 43 HILL DALE DRIVE 1/8 SHARE EPHRATA, PA 17522 4• PATRICK ORLOUSKY Lineal 79 OLD TOWN ROAD 1/8 SHARE GARDNERS, PA 17324 5• MATTHEW ORLOUSKY Lineal 3904 YELLOWSTONE LANE 1/8 SHARE EL DORADO HILLS, CA 95762 6• ELAINE ORLOUSKY LEINHEISER Lineal 4 FENWICK DRIVE 1/8 SHARE CARLISLE, PA 17013 7. THERESA RISKIS Lineal 406 GLENN AVENUE 1/8 SHARE BOILING SPRINGS, PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: t. TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S Ir mae space Is neeaea, use aamuonat sr~eets a paper a me same size. BENEFICIARIES - Page 2 NAME & ADDRESS RELATIONSHIP SHARE Mark Orlousky Lineal 1/8 P.O. Box 222 share Aspers, PA 17304 REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 8, 000.00 Discount: 4 21.0 4 Interest Table ~ Year Days Delinquent this time period Balance Due this year interest this period Before 1881 1982 1983 1984 1985 1986 1987 1988 throw h 1991 1992 1883 throw h 1994 1995 throw h 1998 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 I TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: J~ F ~FILFS~DATAFILEIWILL5~6'7d6~W WIL :, I, MADLYN G. ORLOUSKY, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable aRer my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. If he shall survive me by thirty (30) days, I give, devise and bequeath all of my estate, both real and personal property, unto my husband, JOHN F. ORLOUSKY, absolutely. 3. In the event my said husband, JOHN F. ORLOUSKY, shall predecease me or fail to survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, in equal shares, unto my children, JOHN ORLOUSKY, MARY ORLOUSKY, MARGARET HILL, THOMAS ORLOUSKY, MARK ORLOUSKY, PATRICK ORLOUSKY, MATTHEW ORLOUSKY, ELAINE LEIlVIIEISER, and THERESA RISKIS. 4. I nominate, constitute and. appoint my said husband, JOHN F. ORLOUSKY, as Executor of my estate. In the event he is unwilling or unable to so act, then I appoint THOMAS H. ORLOUSKY and THERESA R[SKIS, as Executors of my estate. 5. I direct that my Executor(s) shall not be required to file a bond to secure the faithful Page 1 of 3 Pages !~~ M.G.O. /~ . , performance of their duties in any jurisdiction. 6. I authorize and empower my Executor(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any nil or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any. other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. 1N WITNESS WHEREOF I have hereunto set my hand and seal this a3 r 4' day of `.~v~ c , 199 7 EAL) Madlyn .Orlousky SIGNED, SEALED, PUBLISHED AND DECLARED bytheabove-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS. I, Madlyn G. Orlousky, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Madlyn G. ousky . S rn or affi ed to and acknowledged before me by Madlyn G. Orlousky, the Testatrix, thisv~-ir°~day of , 1997. Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial seat Corrine L. Myers, Notary PubNc Carlsle Bono, Cumberland CounlY My Commission Expires May 27, 1999 $S. COUNTY OF CUMBERLAND We, JCae Lf i.~G ~ • 1~CC.~~ a.,td P~y ~ ~ is ~. ~ e~.f{Gnc~ the witnesses whos~names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Marilyn G. Orlousky, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. d s 0 N d oC.. ar is /1 v~~ Address ' 7i y-Ec 7'Ir~c .g / 7v~ ~ Sworn or affirmed to and subscribed before me this o~3 day of ~L~-r~ , 1997! /1 i .. Q~ Notary Public Notarial Seal Corrine L. Myers, Notary Public Carlisle Boro, Cumberland County Page 3 of 3 Pages ~ ~,ly Commission Expires May 27, t Ss9 Q ~B~ 499 Mitchell Road, Millahoro, DE 19966 Adjustment Services Duncan & Hartman, P.C. One Irvine RoW Carlisle, PA 17013 Re: Estate of Madlyn G Orlousk~ Social Security 125-14-8412 Date of Death: April 28.2012 Phone 888-502.4349 Fax (302) 934-2955 1 lone 4, 2012 I( Dear Sir or Madam: Per your inquiry on May 23, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names t~ Opening Date Balance on Date of Death Accrued Interest Total Checking Aernunt 2tS7103t57t58 Theresa M. Riskin (POA) Madlyn G. Orlousky Thomas H. Odousky (POA) 0801/1976 ~S7,752.75 a .oo 37,752.75 For aq addiMoanl iataratatloo oa t®e above saoaob, lndudteP owaershlp and a~ chaoPa, donors and/or rdmbnraemmt of funds, please d the iDPit 3/eeet Carlisle d 711-7AOrLSl6. We were uaabk to !assts aW sle depodt Dos ror the aboveaoentlonad deecdeaL !bit Mtter does oat bidude aq aeaataY b whin the daanRd me7 Gave been ![sled s Power d At6ornel. Cu~lan of thibrae 1lradkre, Repraeabttlve Afae. err 1tveAee under a Writlm Apeemeot. Sincerely. Valerie Mercer Adjustment Services MAY-09-2012 11:48 From:M1ST LEND~INS SLPRT 7177955178 ~~qq,, 20:82497860 P,1~1 074 a MEMBERS i'* fnlrlF.aAT. C7lRA1T [1MON SAYIN4S ACCOUNT: Account Number/Su11ix Date Account EetaDNahed Princ~al balance at Dnb of Death Accrued Inroroat to Date of Death Total PdnrJpal and Accrued Interest Name of Joint Owrtar CMECKtNO ACCOUNT: Account Numberl3uMx Data Aocawk Established Principal BaklnCe tlt Dab 01 Death Accrued Irtterest to Date of Death Total Prncipel ane Accrued In[orest Neme d,-oint Owner S:Ef3TiFICATES OF DEPO8IT- Account NtmbeOSufdx Dete Accaurd Established Principal 8alanu at Date of Osath Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Ovmer <9d22-00 06/03(1986 5317. t 3 S.OB $317.19 None 49822-17 03/0212012 5200.00 $AD $200.00 None 49S22J0 4882244 4982213 11/03/20t0• 07/08J2008-' 1 013 112 0 08"' $24,214.12 S39.385.61 $13,114.39 $i1.&t $21.84 $9.22 324,225.76 S39.387,45 $13.123.61 Non! None Nane 'Rollover from certificate 4982241, oripinsly eaublisMd 10/2912007. "C>pwnod by tnnahr of shares from 49822-00. "'Opened by transfer of shams hom 49822-00. CERT~ICATES OF DEPOSIT: Account NumbedSuffix 49824-48 48d22~8 481t22di1 Date Atcourk EetabNtrhed 06/1612005' 10/T9H 998" DBIOd/2003 Principal Batana at Date of Death (12.148.65 588,738.83 $23,246.32 Accrued Interest to Date of Death 58.99 5248.95 $BD.19 Total Principal and Accrued Interest 312,155.04 X88.987.50 $23.306.51 Nams of Joint Owner None None None 'Rollover hom certificate 498?x.43, originplly eaMhliahad t2H611987. •*Qpened by Vanster of shares from 49822-00. R^5~1~°T P~~E~( REAL REDIT Danielle A. Kllne Lsndinp hqurance SYDpOrt Specialist AAay 9, 2012 EstaL oi: MADIYN ORLOUSKY Date of Dsath: W12812d12 Soda) Socurky Number: 128-148411 5000 L,uaise Dtivc P.U. Bux 30 ' Mcchanicxburg, Petu>tsylvenia 17033 (8(Ky) 283-2328 www.tzie~laexsist.urp,