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08-15-12
1505611180 REV-1500 ex (°2_,,, (FI) Pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21-f 1-0637 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05222011 07301926 Decedent's Last Name Suffix Decedent's First Name MI STOUT EVELYN E (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 BOXES BELOW Qx 1. Original Return Q 4. Limited Estate Ox 6. Decedent Died Testate (Attach Copy of Will) Q 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 2. Supplemental Return 0 4a. Future Interest Compromise (date of death after 12-12-82) Q 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) 0 3. Remainder Return (Date of Death Prior to 12-13-82) 0 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes Q 11. Election to Tax under Sec. 9113(A) (Attach Schedule 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number STEPHEN D. TILEY 717-243-5~8 ''`' REGISTER ~ LS USE ~1LY i.J ~."~~ First Line of Address ~. ~ ;~ ~ , r_, _ 5 SOUTH HANOVER ST. ~ ` "' > ;~_, ~ ",a Second Line of Address „ ~' :, 4~ -n.i c.,~ --- City or Post Office DATE FILED State ZIP Code U ~ CARLISLE PA 17013 Correspondent's a-mail address: ~ ~~ ;~ <~ -~ ~J ~ 4~ ? r-) - , --s-T .~ -.~-, Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIG ATURE OF PERS N RESPyO~gNSIBLE FOR FILING RETURN DATE 544 `N HANOVER ST., CARLISLE- PA 17013 8 2750 SPRING HILL LANE ENOLA PA 170 SIGNATURE OF BREPARER OTHER THAN REP ENTATIVE DATE ADDRESS 7 STEPHEN D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 1505611180 J ~~k J 1505611280 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: EVELYN E STOUT 152-14-0346 RECAPITULATION 1. Real Estate (Schedule A) ........................................ . 1. 13 8 5 O O . O O 2. Stocks and Bonds (Schedule B) ................................... . 2. 12 7 9 5 6 . 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. N 0 N E 4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 4 4 7 8 21.0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 111983.67 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ..... .. 7. 13 8 7 31.0 O 8. Total Gross Assets (total Lines 1 through 7) ........................ .. 8. 9 6 4 9 91.6 7 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 5 2 9 2 8 . O O 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 2 8 O O . O 0 11. Total Deductions (total Lines 9 and 10) ............................ . 11. 5 5 7 2 8 . 0 D 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 9 0 9 2 6 3 . 6 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. 0 . O O 14. Net Value Subiect to Tax (Line 12 minus Line 13) .................... .. 14. 9 O 9 2 6 3 . 6 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 15. O.O O 16. Amount of Line 14 taxable at linealratex.o 45 909263.67 1s. 40916.87 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0 . O O 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE ...................................................... . 19. 40916.87 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505611280 1505611280 J REV-1500 EX (FI) Page 3 File Number 152-14-0346 Decedent's Complete Address: 21-11-0637 DECEDENTS NAME EVELYN E STOUT STREET ADDRESS 613 NORTH EAST STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 50000.00 B. Discount 2045.84 3. Interest Total Credits (A + B ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (1) 40916.87 (2) 52045.84 (3) (4) 1128.97 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ....................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income .......................................... ^ c. retain a reversionary interest ......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? .................................................................. ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................:..................................................... ® ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ............ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................................... ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in (72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT is I A I t vF: FILE NUMBER: Evelyn E. Stout 21 11 0637 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 that is jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM 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. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. Personal Residence 613 North East Street, Carlisle, PA 17013 Current Assessment: $147,700 times CLR 1.00 = $147,700 Acquisition Deed Recorded at Book "D," Volume 20, Page 810 Sold May 4, 2012. See copy of Deed attached as Exhibit "H" I 138,500 See Copy of Settlement Sheet attached as Exhibit "I" TOTAL (Also enter on Line 1 Recapitulation) I $ 138 500 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn E. Stout 21 11 0637 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Brokerage Account at MorganStanly SmithBarney See Exhibit "E" Account No.: 410-055417-003 a. 3,964.97 Bank Deposit Program Money Market 3 965 b. 1,038.177 American Bond Fund of America A , 12 842 c. 2,142.545 American Income Fund of America A , 37 602 d. 2,105.570 ING International Value A , 25 498 e. 2,280.329 INVECO Equity and Income A , 20 546 f. 132.710 MSIF Opportunity PTF H , 2,135 g. 398.000 Morgan Stanley 9,528 2. Series EE US Savings Bonds -See Statement Attached as Exhibit "F" (FACE VALUE EST.) 15,840 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+(11-10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Evelyn E. Stout 21 11 0637 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 M&T Bank -See Exhibit "A" Money Market Savings Account No: 15004221311224 219,755 Accrued Interest to DOD 30 2 Household Personal Property See valuation by Roy D. Gottshall -Exhibit "B" 1,746 3 1994 Chrysler New Yorker VIN #2C3ED46F2RH113281 See valuation by Gray's Auto Sales & Service -Exhibit "C" 1,462 4 Citizen's Bank -See Exhibit "D" Money Market #61064391100 223,224 Accrued Interest to DOD 39 5 Citizens Bank Interest Check dated May 16, 2011 23 6 Citizens Bank Interest Check dated May 19, 2011 26 7 Refund -Heritage Medical Group 57 8 Refund - Comcast 16 9 Refund -Capital Blue Cross 145 10 Refund -United States Treasury (2011 Personal Income Tax Refund) 1,113 11 Refund -Penna. Dept. of Revenue (2011 Personal Income Tax Refund) 185 TOTAL (Also enter on line 5 Recapitulation) $ I 447 821 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Evelyn E. Stout 21 11 0637 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Barbara Dale Leitzel 2750 Spring Hill Lane, Enola, PA 17025 Daughter B. Eugenia Gale Miller 544 North Hanover Street, Carlisle, PA 17013 Daughter C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET 96 OF DECEDENT INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A 6/6/66 Citizen's Bank -See Exhibit "D" -Checking #6107311944 . 41,443.04 ° 33.33 /0 13,812.97 B Accurued Interest to DOD 0.99 33.33% 0.33 2 A 1120/06 Citizen's Bank -See Exhibit "D" - 12 Mo. CD #6247706052 . . 106,290.60 33.33% 35,426.66 B Accurued Interest to DOD 3.50 33.33% 1.17 3 A 4/4!207 Citizen's Bank -See Exhibit "D" - 12 Mo. CD #6250435868 . . 57,763.69 33.33% 19,252.64 B Accurued Interest to DOD ' 10.45 33.33% 3.48 4 A 9/6/05 Citizen's Bank -See Exhibit "D" - 15 Mo. CD #6247704688 . . 104,259.69 33.33% 34,749.75 B Accurued Interest to DOD 71.61 33.33% 23.87 5 A 1!22!07 Citizen's Bank -See Exhibit "D" - 15 Mo. CD #6250436104 . . 26,135.55 33.33% 8,710.98 B Accurued Interest to DOD 5.46 33.33% 1.82 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) I S 111 983 67 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE G Pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & RESIDENATDECEDENTTURN MISC. NON-PROBATE PROPERTY t~Lnltc~r FILE NUMBER Evelyn E. Stout 21 11 0637 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is ves. DESCRIPTION OF PROPERTY ITEM NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND TI'IE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE 1. Cash gift to daughter, Susan Mac a'Bhaird, October 26 2010 VALUE OF ASSET 100 000 INTEREST 100 00% )IF APPLICABLE) VALUE , 72 Vista Road, Berwick, PA 18603 -See Exhibit "J" , . 3,500 96,500 0 2. IRA Account No. 410-047058-003 0 MorganStanley SmithBarney -See Exhibit "G" 0 0 a. 377.44 Bank Deposit Program Money Market 377 100.00% 0 377 b. 198.068 American Capital Income Builder C 10,379 100.00% 10 379 c. 681.803 INVESCO Global Core Equity 9,211 100.00% , 9 211 d. 168.000 Cisco Systems, Inc. 2,768 10.00% , 277 e. 440.000 Danone Sponsored ADR 6,283 100.00% 6 283 f. 20.000 Merck & Co., Inc. New Com 740 100.00% , 740 g. 88.000 Microsoft Corp 2,147 100.00% 2 147 h. 48.000 Morgan Stanley 1,149 100.00% , 1 149 i. 148.000 Oracle Corp. 5,008 100.00% , 5 008 j. 54.000 Pfizer Inc. 1,117 100.00% , 1 117 k. 72.000 Total Fina Elf SA 4,056 100.00% , 4 056 I. 36.000 Walt Disney Co. Holdg. Co. 1,487 100.00% , 1,487 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7 Recapitulation) $I 138 731 If more space Is needed, use addltlonal sheets of paper of the same size. REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Evelyn E. Stout 21-11-0637 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 2,640 2. Funeral Luncheon 202 3. Cumberland Valley Memorial Gardens 1,230 4. Funeral Flowers 374 5. Rev. J. McKenna -Funeral Services 150 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. 3. 4. 5. 6. 7. Attorney Fees: Frey & Tiley Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Frey & Tiley Tax Return Preparer Fees: Frey & Tiley Advertlsing -Cumberland Law Journal 8. Advertising -The Sentinel 9. Register of Wills -Short Certificate 10. Register of Wills -Filing Fee for Inheritance Tax Return 11. Additional Administrative Costs from Schedule H-1 12. Suburban Propane post-settlement oil bill for 613 N East Street TOTAL (Also enter on Line 9. Re If more space is needed, use additional sheets of paper of the same size. ZIP 23,500 725 0 0 75 190 4 15 23,427 396 $ 52 ESTATE OF: EVELYN E. STOUT SCHEDULE H-1 ADDITIONAL ADMINISTRATIVE COSTS 30-Jun 14Ju1 14Ju1 20-Jul 29-Jul 5-Aug 4Sep 8-Sep 8-Sep 9-Sep 19-Sep 27-Sep 20-Oct 20-Oct 7-Nov 7-Nov 30-Nov Roy D. Gottshall, Auctioneer -Personal Property Valuation UGI Carlisle Borough Tax Account -School Real Estate Tax 613 North East Street, Carliile, PA Barbara S. Leitzel -Reimbursement Advances to Sollenbrergers for Replacement Auto Title PP&L UGI Barbara S. Leitzel -Reimbursement House inspection $275.00; House cleaning, and repairs $1,131.18; and Chrysler title $19.50 PP&L -Reimburse Frey & Tiley Hazard Insurse on 613 North East Street, Carlisle, PA Reimburse Frey & Tiley UGI -Reimburse Frey & Tiley Borough of Carlisle PP&L UGI Barbara S. Leitzel -Reimburse for Repairs to House Mountain View Electric PP&L UGI Randy Pajovich (Yard and attic work at 613 N. East Street.) FILE NO.: 21-11-0637 75.00 13.28 1,648.60 3950 15.13 12.15 1,425.68 47.42 3,019.30 13.33 72.90 2454 13.50 650.00 11.88 12.15 300.00 Schedule H-1 Page 1 of 3 30-Nov UGI 13.34 30-Nov PP&L 13.06 30-Nov Suburban Propane 0 2113 363.21 1-Dec Suburban Propane -Service Contract 269.95 2012 19-Jan UGI (Check written for $13.07. Cleared for $13.00) 13.00 19-Jan Borough of Carlisle -Water & Sewer 72.90 19-Jan PP&L 14.99 19-Jan PP&L 18.23 3-Feb Suburban Propane - 2113 493.71 3-Feb UGI 13.78 24-Feb PP&L 18.39 24-Feb Raymond Christopher -Services to 613 North East Street 130.00 27-Mar Borough of Carlisle -Water & Sewer 72.90 27-Mar UGI 12 82 27-Mar PP&L 17.43 5-Apr George T. Hicks, Jr., Tax Collector 2012 County & Borough - 613 North East Street 738.65 5-Apr UGI 25.32 4-May Expenses of Sale: 613 North East Street: Realtor's Commission to Hooke, Hooke & Eckman 6,56755 1 % Transfer Tax 1,3 80.00 Final Water & Sewer to Carlisle Borough 55.89 Pro-ration of 2012 Cty. & Bor. Real Estate Taxes (486.38) Pro-ration of 2012/13 School Real Estate Taxes (256.75) Seller Credit to Purchaser Expenses 6 648.99 4-May Raymond Christopher -Mowing at 613 North East Street 1.00.00 4-May PP&L 10.78 Schedule H-1 Page 2 of 3 4-May Eugenia Gale Miller -Reimbursement Dirty Dog - 613 North East Street, Carlisle, PA 120.00 4-May Barbara Dale Leitzel -Reimbursement -Misc. Mowing 400.00 18-May UGI 3 78 18-May PP&L 16.95 11-Jun Refund - PP&L (10.78) 11-Jun Refund - Fickel Insurance Agency -House Insurance (909.54) 30-Jul Barbara S. Leitzel -Reimbursement -Clean out House New Family Enterprises, LTD re 613 N. East Street 90.10 TOTAL: 23,426.63 Schedule H-1 Page 3 of 3 REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES ~ LIENS ESTATE OF FILE NUMBER Evelyn E. Stout 21 11 0637 Report debts Incurred by the decedent prior to death that remained unpaid a~ thn daen ~t do~-ti inr[~ulin.. uwrni...{..,.wwJ w._JI__~ _--____ __ •• •••~•~ ~r~^w ~+ ~~~~~, niacn auuiuvnai 5neei5 OT [fle S8iT12 S12e. ESTATE OF: FILE NO.: EVELYN E. STOUT 21-11-0637 SCHEDULE I-1 ADDITIONAL DEBTS OF DECEDENT 30-Jun PP&L 37.45 30-Jun UGI :12.14 30-Jun CenturyLink 25.20 30-Jun Church of God Home, Inc. 1,866.50 30-Jun Roy D. Gottshall,Auctioneer -Personal Property Valuation 75,00 14-Jul Executive Bond Services, LLC -Additional Premimum Fidelity Bond for Estate of Ralph Baird 471.00 (Evelyn E. Stout was Executrix of the Estate of Ralph Baird) 14-Jul Eugenia G. Miller -Reimburse for advance to Lifeline Systems 81.74 14-Jul Dillsburg Foot & Ankle Center 26 28 14-Jul Quantum Imaging and Therapeutic Associates 2.16 14-Jul Borough of Carlisle -Water & Sewer 72.90 14-Jul CenturyLink -Telephone 3.89 19-Sep Ohio casualty (Final Payment on Cancelled Policy) 179.00 20-Oct Refund -CenturyLink (21.31) 20-Oct Refund -CenturyLink (3.89) 2012 19-Jan Refund -Quantum Imaging and Therapeutic Associates (5.14) 11-Jun Refund -Keystone Podiatric Medical Associates (26.28) TOTAL: 2,796.64 Schedule I-1 Page 1 of 1 REV-1737-7 EX + (8-08) REVERSE pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn E. Stout 21 11 0637 When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. RELATIONSHIP TO ITEM NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE Do Not Llst Trustees OF ESTATE I. TAXABLE DISTRIBUTIONS [inGude outright spousal distributions and transfers under Sec. 2118 (a)(1.2)] 1. Eugenia Gale Miller Daughter One Third Residuary 544 Norh Hanover Street, Carlisle, PA 17013 2 Barbara Dale Leitzel - a/k/a Barbara S. Leitzel Daughter One Third Residuary 2750 Spring Hill Lane, Enola, PA 17025 3 Susan Maureen Alley -Now Susan Mac a' Bhaird Daughter One Third Residuary 8 Walden Court, Hazelton, PA 18202 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART III (Enter total non-taxable distributions on Line 13 of REV 1737 cover sheet) $ 0 (If more space Is needed, use additional sheets of paper of the same size) MBTBaIlk 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Stephen D Tiley 5 South Hanover Street Carlisle, PA 17013 Re: Estate of Evelyn E Stout Social Security: 152-14-0346 Date of Death: May 22, 2011 Phone 888-502-4349 F ax (302) 934-2955 July 6, 2011 Dear Sir or Madam: Per your inquiry on June 30, 2011, 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 Savings Account Account Number 15004221311224 Ownership (Names ofl Evelyn E Stout Barbara Stout Leitzel (POA) Opening Date 08/12/09 Balance on Date of Dearh $219, 755.10 Accrued Interest $ 29.80 Total $219,784.90._--_-____-__ __-______-__. For any additional information on the above acrnunts, including ownership aad any changes, closures and/or reimbursement of funds, please call the HIgh Street Carlisle Office of #717-2404536. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services nr °a° /~ ~~~ ~~ ~~~ ~~~~i ~. ~~~ ,~ ~- .:~_ ~~ ,. r' ~..~.C~" / '~ v~~ ~~ .~ ,~.. __~ ~ ,> __ ~~ ~~ ~~ ~~ ~~~ ~~ %~ ~~ /~ ~~ /90 90 l'~ /~ ~~ ~~ ~~ ~~~- ~ ~ ~~~ ~~~ ~~ ~/ r -~~ / / ~~ ~-~~~ ~ ~~_. / ~~~ ~ a ~ ~ ~-~' ~- -~ ~~ /~ 1 ~ ~` ,~- r/~ ~~~~ ~ ~~ ~~~~ ~ ~~ ~~~~~ ~y~~~2., gal ~. ~ ~~ ~, ;~~~~~~` ~~~~v~ j~~ ~~ . ~'~ _ _.~ ~~ ~~~~ ~~~~/'~ ;~ ~-~~~ ~~~ L~c~ c%~. '~ ' L~~~ ~2~~~-~ ~~~ ~~~ .r~~ Gam. ~~G~~~~T!'i~. ;~ ~r ~~ ~~ _'~~~~ l ~~%~ r ` 1~ ~`- .fie ~ ~ - ~r 1!~- ~ ~{~ a~i ~~ ~~ r ~~= ~-- ~~~ , ~~ ~~ ~~~ ROY DE- 4sOTT :~ ~ s •. ~ ' /' 17 ,Q ~ S ~~ ~~ %~~ . ~' ~ /~.Z ~~ ~~ ~~. ~~ ~~J /~. ~ ~~ /~ /~ i~ ~` ~ ~~ ~ ~~ ~? JSPI~.kPi ~~~ ~.3~// GRAY'S AUTO SALES 8s SERVICE 825 Newville Road Carlisle, PA 17013 Phone: (717) 240 - 0708 Fax: (717) 240 - 0881 7~/-ri ~iliY~ O~'~ir~'J~3 ~ '~'~'v~ ~~.~ ~ ~~ a~, ~ .L /L' ~g,J,s`~ / V ~ 0 ~7~/9• y ~-- ~~ ~~~ i~~ ~ ~~ ~ N September 26, 2011 Frey & Tiley Attn Stephen D Tiley 5 South Hanover St Carlisle PA 170;13 Estate of EVELYN E STOUT Date of Death: ]~7ay 22, 2011 SSN: 152-14-0 X46 Dear Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance ~~~ith your request, the attached information sheet has been provided in the above decedent's name as of his/l,er date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiri~_s, please call 1-877-579-2667 S{ince:~y, 1 6_ Decedent Account REF#: 501245 Account Number 6 1 0073 1 944 Account Title EVELYN E STOUT/BARBARA STOUT LEITZEL/EUGENIA GALE MILLER Date Opened 6/6/1966 Account Type Checking Principal Balance as of DOD $41443.04 Interest from Last Posting to DOD $ .99 Account Balance as of DOD $41444.03 YTD Interest to DOD $10.29 ~tI1~I1C "D" ~i: 4 L r,~~ ~ ~ a ~T'i~ Account Number 6106439110 Account Title EVELYN E STOUT Date Opened 6/12/2002 Account Type Principal Balance as of DOD Checking $223223.71 Interest from Last Posting to DOD $38.53 Account Balance as of DOD $223262.24 YTD Interest to DOD $375.44 -, ~'r~1~IT " r~ .F~ .~ ;~ Account Number 6247706052 Account Title EVELYN E STOUT/BARBARA STOUT LEITZEL/EUGENIA GALE MILLER Date Opened 1/20/2006 Account Type Principal Balance as of DOD Time Deposits $106290.60 Interest from Last Posting to DOD $3.50 Account Balance as of DOD $106294.10 YTD Interest to DOD _ $410.28 F~FIi~I'6' "ID" Account Number 6250435868 Account Title EVELI'N E STOUT/BARBARA STOUT LEITZEL/EUGENIA GALE MILLER Date Opened 4/4/2007 Account Type Principal Balance as of DOD Time Deposits $57763.69 Interest from Last Posting to DOD $10.45 Account Balance as of DOD $57774.14 YTD Interest to DOD $260.47 1E~1~11~IT "fit'`' ~~ i = ~ Account Number 6247704688 Account Title EVELYN E STOUT/BARBARA STOUT LEITZEL/EUGENIA GALE MILLER Date Opened 9/6/2005 Account Type Time Deposits Principal Balance as of DOD $104259.69 Interest from Last Posting to DOD $71.61 Account Balance as of DOD $104331.30 YTD Interest to DOD $376.73 1e"'~i1~17' ~'H~"" Account Number 6250436104 Account Title EVELYN E STOUT/BARBARA STOUT _ LEITZEL/EUGENIA GALE MILLER Date Opened _ 1 /22/2007 Account Type Time Deposits Principal Balance as of DOD $26135.55 Interest from Last Posting to DOD $5.46 Account Balance as of DOD $26141.01 YTD Interest to DOD $115.86 OBIT ply" 4507 North Front Street Suite 201 Harrisburg, PA 17110 tel 717 255 6666 fax 717 255 6651 toll free 800 676 0673 August 10, 2011 Frey & Tiley Attorneys-At-Law Attn: Stephen D. Tiley 5 South Hanover Street Carlisle, PA 17013 RE: Estate of Evelyn E. Stout Date of Death: 05/22/2011 SSN: 152-14-0346 Dear Atty. Tiley: MorganStanley SmithBarney Please be advised that Evelyn E. Stout held two accounts with Morgan Stanley Smith Barney (acct #410-055417-003 and #410-047058-003) at the time of her death. Account #410-055417-003 was an individually-owned brokerage account titled Evelyn E. Stout. The account was opened on June 6, 2007. Account #410-047058-003 was a traditional IRA account for Evelyn Stout. The following information represents the date of death values for all securities held in acct #410-055417 on her date of death (May 22, 2011): Share Security Name/ Symbol No. of Shares rice Total Value on 5/22/2011 BANK DEPOSIT PROGRAM - 3,964.97 shs $1.00 $3,964.97 MONEY MARKET (BDPS) AMERICAN BOND Fi.?ND OF 1,038.177 shs $12.37 $12,842.25 AMERICA A (ABNDXI AlviEk]CAN INCOME FD OF 2,142.545 shs $17.55 $37,601.67 D~fG 1"JTERNATIONAL `~ A.L~IE .A ~ 2,iC5.570 shs ; $12.1.1 $25,498.45 Investments and s~:r4tc:~s of red throegh Morgan Stanley Smith Barney LLC, and accounts carried by Morgan Stanley & Co. Incorporated; members SIPC. q~~, et2~rv a;.W Morgan Stanley Smith Barney LLC. Member SIPC. INVESCO VK EQUITY AND 2,280.329 shs $9.01 $20,545.78 INCOME A (ACEIX) MSIF OPPORTUNITY PTF H 132.710 shs $16.09 $2,135.30 (MEGHX) MORGAN STANLEY (MS) 398.000 shs $23.94 $9,528.12 Please feel free to contact our office at 717-255-6690 with any questions. Sin rely, f. ~j~ , /''vv /' ~---` Emily L. iden Reg'd Client Service Associate The Beshore/Owen/Thomas Group This report has been generated from information that Morgan Stanley Smith Barney LLC and its Financial Advisors and Investment Representatives (collectively "we" or "us') believe to be reliable and accurate. We do not, however, represent or warrant the accuracy or completeness of the information contained in this report. You, the client, have provided us the data from which this report has been generated. The report has been calculated from software and formulas that were not developed by us. As such, all calculations, estimates and opinions included in this report constitute our best judgment as of this date and upon the information you have provided us and may be subject to change. It is your responsibility to do your own evaluation, and check calculations to determine the accuracy of the information contained in this report. 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Tiley 5 South Hanover Street Carlisle, PA 17013 RE: Estate of Evelyn E. Stout Date of Death: 05/22/2011 SSN: 152-14-0346 Dear Atty. Tiley: The following information represents the date of death values for all securities held in acct #410-047058 (IRA) on Evelyn's date of death (May 22, 2011): Share Securitv Name/ Svmbol No. of Shares price Total Value on 5/22/2011 BANK DEPOSIT PROGRAM - 377.44 shs $1.00 $377.44 MONEY MARKET (BDPS) AMERICAN CAPITAL INCOME 198.068 shs $52.40 $10,378.76 BUILDER C (ABNDX) INVESCO GLOBAL CORE EQUITY 681.803 shs $13.51 $9,211.15 A (AWSAX) CISCO SYS INC (CSCO) 168.000 shs $16.48 $2,767.80 DANONE SPONSORED ADR ~ 440.000 shs $14.28 $6,283.20 (DANDY) MERCK & CO INC NFW COM (MRK) 20.000 shs $37.00 $740.00 MICROSOFT CORP (M:SFi') - - 88.000 shs $24.40 $2,147.20 ~ ~ MORGAN STANLEY (MS) 48.000 shs $23.94 $1 149 12 - ~OR ACLE ~'OR P fORC1 l I 148 000 shs I $33 84 , . . . , -- - ' . . ~ . i $5,007.58 Investments and services offered through Morgan Stanley Smith Barney LLC, and accounts carried by Morgan Stanley & Co. Incorporated; members SIPC. ~~ Morgan Stanley Srnith Barney LLC. Member SIPC. PFIZER INC (PFEJ 54.000 shs $20.69 $1,117.26 TOTAL FINA ELF SA (TOT) 72.000 shs $56.34 $4,056.48 WALT DISNEY CO HLDG CO (DIS) 36.000 shs $41.31 $1,487.16 Please feel free to contact our office at 717-255-6690 with any questions. Sinc ely, ~~~ Emily L. Biden Keg'd Client Service Associate The Beshore/Owen/Thomas Group This report has been generated from information that Morgan Stanley Smith Barney LLC and its Financial Advisors and Investment Representatives (collectively "we" or "us") believe to be reliable and accurate. We do not, however, represent or warrant the accuracy or completeness of the information contained in this report. You, the client, have provided us the data from which this report has been generated. The report has been calculated from software and formulas that were not developed by us. As such, all calculations, estimates and opinions included in this report constitute our best judgment as of this date and upon the information you have provided us and may be subject to change. It is your responsibility to do your own evaluation, and check calculations to deterrnine the accuracy of the information contained in this report. Neither we nor our affiliates will be responsible for the consequences of your reliance upon any opinion, calculation or other information contained herein or for any omission. Investments and services offered through Morgan Stanley Smith Barney LLC, and accounts carried by Morgan Stanley & Co. Incorporated; members SIPC. ~~~ ~ '.i`~~~D TG BE A TRUE __- ' ~-~'~~FCT COPY OF '~ ~'.7s4lti#,~~ , Parcel No. 02-20-1800-131 EXECUTOR'S DEED, MADE THE S~'~~y o fMay, in the year of our Lord Two Thousand Twelve (2012). BETWEEN EUGENIA GALE MILLER (of 544 North Hanover Street, Cazlisle, PA, 17013), and BARBARA DALE LETI'ZEL (of 2750 Springhill Lane, Enola, PA, 17025), Co-Executrices of the Estate of EVELYN E. STOUT, Deceased, late of 613 North East Street, in the Borough of Carlisle, Cumberland County, Pennslvania 17013, party of the first pazt, GRANTOR, and RANDOLPH L. KINCADE, of 710 West South Street, Apartrnent 5, Carlisle, Pennsylvania 17013, party of the second part, GRANTEE, WHEREAS, Evelyn E. Stout died on May 22, 2011, seized in fee of the hereinafter described real estate, and by her Last Will and Testament dated Apri18, 1998, since her death duly proved and remaining of record in the Register of Wills, in and for Cumberland County, Carlisle, Pennsylvania, and filed to Estate file No. 21-11-0637, provided, inter alia as follows: 5. I hereby nominate, constitute and appoint my said husband, EUGENE E. STOUT, as Executor of this my Last Will and Testament but should he predecease me or fail to qualify, then in such event I nominate, constitute and appoint my three (3) daughters, or any of them, they being Eugenia Gale Miller, Bazbaza Dale Leitzel, and Susan Maureen Alley, as co-Executrices of this my Last Will and Testament, and I flusher direct that none of them shall be required to post any bond to secure the faithfW Performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. WHEREAS, Evelyn E. Stout died the unremarried widow of Eugene E. Stout, who died on May 2, 2007, and; WHEREAS, Susan Maureen Alley, now Susan M. Mac a'Bhaird, renounced her right to serve as a Co-Executrix of the said Last Will and Testament, and; WHEREAS, Letters Testamentary in the Estate of Eveln E. Stout, Deceased, were issued by the Cumberland County Register of Wills to Eugenia Gale Miller and Barbara Dale Leitzel on June 10, 2011, without the requirement that any bond be posted by them, which Letters Testamentary remain in full force and effect, and; included~n tRheAresiduary set forth ineparagraph three o the saidot~spe~fcally devised but is and; ill and Testament, WHEREAS, Section 3351 of the Probate, Estate and Fduciaries Code (20 P.S. § 3351) gives a persona! representative the power to sell at public or private sale any real property not specifically devised, NOW THIS INDENTURE H'ITNESSETH, that the said Grantors, for and in consideration of the sum of One Hundred Thirty-eight Thousand ($138,000,00 hundredths Dollars lawful money of the United States, to them in ~~ no Grantee, at and before the sealing and delivery herof, the receipt w f i hereby said acknowledged, have granted, bargained, sold, aliened, released and confirmed, and by these presents, do grant, bargain, sell, alien, release and confirm unto the said Grantee, his heirs and assigns, RNs. ALL THAT CERTAIN lot of ground with the improvements thereon erected, situate in the Borough of Carlisle, County of Cumberland and Commonwealth of Pennsylvania as follows: BEGINNING at a a point on the East side of North East Street at line now or late of N.L. Sheaffer; thence East along the lot now or late of said N. L. Sheaffer one hundred twenty (120) feet to a point on an alley; thence South along said alley thirty-five (35) feet to a point on line of lot now or late of Leland Calaman; thence West along the latter lot one hundred twenty (120) feet to a point on North East Street, thence North along said Street thiry-five (35) feet to the place of BEGINNING. BEING Lot No. 44 as shown on Plan of Lots known as the "Henderson Addition," and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in the Plan Book No. 2, page 27. BEING the same premises which Paul J. Creasey and Gloria J. Creasey, husband and wife, by deed dated April 3, 1961 and recorded April 3, 1961 in the Office of the Recorder of Deeds, in and for Cumberland County at Carlisle, Pennsylvania, in Deed Book "D," Volume 20, Page 810, granted and conveyed to Eugene E. Stout and Evelyn E. Stout, husband and wife. THE SAID Eugene E. Stout having died on May 2, 2007, thereby vesting the entire fee simple title to the above described premises in Evelyn E. Stout, his surviving spouse, whose Estate, is the GRANTOR herein. TOGETHER with all and singularways,waters,water-courses, rights,liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise appertaining, and the reversions and remainders, rents, issuesand profits therof; and also all the estate, right, title, interest, use, trust, property, possession, claim and demand whatsoever of the said Evelyn E. Stout at and immedately before the time of her death, in law, equity or otherwise howsoever, of, in, to or out of the same: TO HAVE AND TO HOLD, the same buildings, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said, Grantees, their heirs and assisgns, to and for the only proper use and behoof of the said Grantees, their heirs and assigns, forever. AND the said Grantor does covenant, promise and agree, to and with the said Grantees their heirs and assigns, by the presents that he the said Grantor, has not done, committeed, or knowingly or willingly suffered to be done or committeed, any act, matter or thing whatsoever whereby the premises hereby granted, or any part therof, is are, shall or may be impeached, charged or encoumbered, in title, charge estate, or otherwwise howsoever. IN WITNESS WHEREOF, said Grantors have hereunto set hand and seal the day and year first above written. Signed, Sealed, and Delivered in the Presence of ~j ~~v ~~/ ~~~ ~ ~- (SEAL) EU ENIA ALE MILLER, Co-Executrix of the Estate o Evel n E. Stout / ~ (SEAL) ARB LEI EL, o-Executrix of the Estate of Evelyn .Stout rIr Commonwealth of Pennsylvania }ss. County of Cumberland On this, the y~ day of May, 2012, before me, the undersigned officer, personally appeared EUGENIA GALE MILLER and BARBARA DALE LEITZEL, Co-Executrices of the Estate of Evelyn E. Stout, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal Q~ t'i~Z~ (SEAL) P Publio ~ C6nniMgi E~ip y~ tb~'16 / do hereby certify that the precise residence and complete post office address of the within named Grantee is for :~;~~;;}~~ _ A. Settlement Statement (HUD-1) OMB Approval No. 2502-0265 ;°~ -` ' B. T pe of Loan 1.©FHA 2.^ RHS 3.^ Conv. Unins 6. File Number. 7. Loan Number. 8. Mortgage Insurance Case Number: 4.^ VA 5.^ Conv.lns RE12-122 120139526 496-1179563-703 C. Note: This form is tumished to give you a statement of actual settlement costs. Amounts paid to and by the stttbment agent are shown. Items marked ' ' (p.o.e.) were paid outside the dosing; they are shown here for informational purposes and are not inducted in the totals. D. Name 8 Addross of Borower: E. Name 8 Address of Seller. F. Name 8 Address of Lender Randolph L. Kincade Estate of Evelyn E. Stout . Real Estate Mortgage 70 West South Street 613 North East Street Network, Inc. Apt. $5 Carlisle, PA 17013 70 Grand Avenue, Ste. 109 Carlisle, PA 17013 ~ River Edge, NJ 07661 G. Property Loation: H. Settlement Agent: TIN: 613 North East Street Orchard Settlement Services, LLC Carlisle Borough 1 Irvine Row, Suite B Phone: (717) 249-7867 Carlisle, PA 17013 Carlisle, PA 17013 Parcel : 02-20-1800-131 Place of Settlement: I. Settlement Date: 5 / 9 /2012 1 Irvine Aow, Suite B County: Cumberland Carlisle, PA 17013 Funding Date: 5/4/2012 J. Summary of Borrower's Transaetlon K. Summary of Sellers Transactlon 100. Gross AmourK Dus From Bortovrsr 400. Gross Amount Dus To Seller 101. Contract sabs rice 138, 000.0 0 401. Contred sales rice 138, 000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower (line 1400) 7, 980.69 403. 104. 404. 105• 405. Adjustments for kerns paid by seller in advance Ad ustmsnts for trams paid by seller in advance 108. City/town taxes: 406. CityQown taxes: to to 107. Counlytaxes: 5/4/2012-12/31/2012 486.38 407. Countytexes: 5/4/2012-12/31/2012 986.38 to to 108. Assessments: 408. Assessments: to to 109. 409. 110. School Tax 5/4/2012-6/30/2012 256.75 410.SChoo1 Tax 5/4/2012-6/30/2012 256.75 111. 411. 112. 412. 120. Gross Amount Ow From Borrower 146, 723.82 420. Gross Amount Due To Seller 138, 793.13 Z00. Amounts Pald ey Or In BahaN of Borrower 500. Rsductloro In Amount Dw To Seller 201. Deposit or earnest money 1, 000.00 501. Excess deposR (see instructions) 202. Prindpal amount of new loan s) 134, 501.00 502. Settbment cha s to seller (line 1400) B, 003.49 203. Existin loan(s) taken subject to 503. Exisfin ban(s) taken sub' to 2~' 504. Payoff of first mortgage ban 205. 505. Payoff of second mortgage loan 206. lender credit 600.00 506. 207. seller credit 6,698.99 507. seller credit 6,698.99 208' 508. 209. 509. Ad ustmsnts for items unpaid by seller Adjustments for items unpaid by seller 210. CityRown taxes: 510. CilyRown taxes: tO to 211. County taxes: 511. County taxes: to to 212. Assessments: 512. Assessments: to to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Pald B lFor Borrower 192, 749.99 520. Total Reductlon Amount Dw Seller 14, 652.43 300. Cash At Settlemerrt FromlTo Borrower 600. Cash At Settlement To1From Seller 301. Gross Amount due from borrower (line 120) 146, 723.82 601. Gross amount due to selbr line 420 138, 793.13 302. Less amounts paid b lfor borrower (line 220) 142, 799.99 602. Less reductions in amount due selbr (line 520) 14, 652.43 303. Cash ®From ^ To Borrower 3, 973.83 6 03. Cash ®To ^ From Seller 129, 090.70 ..o~,,,,,,,y ou,ven ,~~ nns w~wcuon or mrormauon is estimated at 35 minutes per response for collecting, roviewing, and ropoBng the data. This agency may not tolled this information, and you are net required to eompbte this form, unless k displays a currenty valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. ® 2009-2011 Easy Soft Provrous editions are obsolete. Page 1 of 3 HUD-1 Exhibit "I" mt Charges Fik Number. RE12-122 L< rnl Real Esgq Broker Feea Division of Commission (line 700) as follows 701. $6,567,55 toHOOke, Hooke a Eckman 702. S to 703. Commission paid at settbment ~- 704. 600. Items P able fn Conneetlon With Loan 801. Our origination cha e 802. Your credit or cha ints for the a c interost rate 803. Your ad)usted origination charges R E Mortgage Net 804. Appraisal fee to MMC eOC 5400 (B) 805. Credit report to CIS Information Services 808. Tax service to 807. Flood certification to Wolters Kluwer Fin. sezv; 095. 901. Dallyinteroatchargeafrom5/4/2012 to 5/31/2012 @ 519 9496/da . y 902. Mort age insurance premium for 0 month t (from G s o Dept. of HUD 903. Homeowner's insurance for 1 (from 1 ears to Erie insurance 904, tram G 905. 1000. Reserves De fled With Lender 1001. Initial de sit for ur escrow account 1002. Homeowners insurance 9 months @ 47 .25 Per mo from 0 1003. Mort a insurance months @ 5189.00 per mo 1004. pro taxes 4 months @ 61.55 per mo S 1005. School taxes 12 months @ 137.38 per mo S296.20 1~' S1, 698.56 months @ er mo 1007• ate Ad ustment 5 1100. TIUe Cha S-935.20 1101. Title services and lenders tole insurance 1102. Settlement or dosing fee (from G 1103. Owners titb insurance Old Republic Title Co. 1104. Lenders title insurance Old Republic Title Co from GI . 1105. Lenders tftie poi' IimR S1, 033.75 1106. Owners Otte oli limft 5134, 501.00 5138, 000.00 1107. enYs portion of the togl insurance romi um S 1108. Underwriters onion of the total insura nce premium $ 1109. End. 100, 300, 8.1 ~ CPL to Old Republic Title Com any 1110.Overnight/Email/dire to Orchard Settlement Servic 5225.00 es, LLC 1111.NOtar to Cash 569.00 1200. Govsmmsnt Rscordl and Transfer Cha es 520.00 1201. Government rocordin cha ea Recorder of Deeds 1202. Deed 562.00 Mort a e 599 00 from GF . 1203. Transfer taxes Release $ 1204. City/County taldstampa: Deed $ from GFI 00 Mortgage S1, 380.00 1205. State taxJstam :Deed $1 380 , . 1206 Mort a e S 1207. S 1300. Addidonal Settlement Cha es 5 1301. R wired services that ou can sho for 1302. from GFE 1303. 1304. final water/sewer to Carlisl 8 Paid From Paid From Borrowers Sellers Funds at Funds at Settlement Settlement _ 6,567. GFE a2 tGFEA 1,095.00 GFE •3 25.00 GFEafi) 56.18 X10) 403.50 =~) 1,331.70 !11 567.00 ~~__ 1,698.55 1,392.75 15.00 380 1,380.0 e orou h -acct 006936 1305.2012 count taxes to Tax Collector POC $738.65 (S) 55.69 1306. 1307. 1308. 1400. Total Setltement Cha engr on Imes 103 Seetlon J and li02 Ssd9on K awe ce 7, 980.69 8, 003.94 reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, O is a true and accurate statement of all roceipts and di burs nts made on my acco nt or by me in this transaction. I further ce rtify that I have received a copy of the HIED-1 Settlement Statement. ~~~ ~,~ . ndolph Kincade Buyer/BOrrower Es e of Ev yn E t Seller r ~~ ~ _, , ,.._ _ _ _ _ BuyerBorrower • • ••--~ r~oru,w is a true ana accurate account of this transaction. I h~e saosed or will cause the funds to beVO„a' sbursed i rdance with this ment. r and Settle en ervices, LLC 5/9/2012 Settlement Agent Dat WARNING: k b a vkne make false statements to the United States on this or an other aimiWr form. Penalties u n con ® 2009-2011 Easy S .Previous editions aro obsolete. vle8on can include a sne or im sonment Page 2 of 3 HUD-1 Exhibit "I" .harges That Cannot Ineroase HU0.1 Line Number Our origination charge #801 Your credit or charge (points) for the specific rate chosen #802 Your adjusted origination charges #803 Transfer taxes #1203 Government recording charges #1201 Appraisal fee ~~ Credit report #805 Flood certification #807 Mortgage insurance premium #902 Initlal deposit for your escrow account #1001 Daily interest charges #901 Homeowner's insurance #903 TRb services and lender's title insura nce #1101 Owners tRb insurance #1103 Loan Tsrms 1,095.00 1,045.00 0.00 0.00 1,095.00 1,045.00 1,385.00 1,380.00 175.00 156.00 400.00 925.00 20.00 56.18 10.00 10.00 1,331.70 1,331.70 1,936.70 1 978 88 ~ 42.18 or 2.189 1 1,863.00 1,698.56 19.94 403.50 360.00 567.00 1,153.75 1,342.75 0.00 15.00 ®2009-2011 Easy Soft. Previous editions are obsolete. Page 3 of 3 Exhibit "I" HUD-1 •----• •• ,~~ •~a•a a~~r yuusuons aoouc me ~ettiement Charges and Loan Terms listed on this form, please contact your lender. Form 7~9 Department of the Treasury 1 Donor's first name United States Gift (and Generation-Skipping Transfer) Tax Return (For gifts made during calendar year 2010) - See separate instructions. idle initial 2 Donor's last name ., „___~_ . . 4 Address (number, street, and apartment number) 613 North East Street 6 City, state, and ZIP code n 152-14-0346 5 Legal residence (domicile) 7 Citizenship (see instructions) c 8 If the donor died during the year, check here - ~ and enter date of death _ _ _ _ _ _ _ 9 If you extended the time to file this Form 709, check here - ~ -----"---'-'----------- Yes No :' ------ E _~ 10 Enter the total number of donees listed on Schedule A. Count each person only once. - .~ 11 a Have ou the donor y 1 ~ t' ~ Y ( )previous) filed a Form 709 (or 709-A) for any other year? If "No," skip line 11 b - b If the answer to line 11 a is "Yes "has our address Chan ed since ou last filed Form 709 or 709-A ? X 12 Gifts by husband or wife to third parties. Do you consent to have the gifts (including generation-skipping transfers) made ~ by you and by your spouse to third pansies during the calendar year considered as made one-half by each of you? (See instructions.) (If the answer is "Yes," the following information must be furnished and your spouse must sign the consent shown below. If the answer is "No," skip lines 13-18 and go to Schedule A.) ~ _13 Name of consenting cnnnca • is were ou married to one another durin the entire calendar ear? see instructions 16 If 15 is'No,' check whether ~ married ~] divorced or ~ widowedldeceased, and give date (see instructions) .- 17 Willa ift tax return for this ear be filed b ours ousel If "Yes "mail both returns in the same envelo e. 18 Consent of Spouse. I consent to have the gifts (and generation-skipping transfers) made by me and by my spouse to third parties during the calendar year considered as made one-half by each of us. We are both aware of the joint and several liability for tax created by the execution of this consent L m z d `o wnsenung spouse's signature - 1 Enter the amount from Schedule A, Part 4, line 11 Date - 2 Enter the amount from Schedule B, line 3 ~ ~ ~ 1 3 Total taxable gifts. Add lines 1 and 2 ~ ~ 2 4 Tax computed on amount on line 3 (see Table for Computing Gift Tax in separate instructions) 4 5 Tax computed on amount on line 2 (see Table for Computing Gift Tax in separate instructions) 5 6 Balance. Subtract line 5 from line 4 7 Maximum unified credit (nonresident aliens, see instructions) 6 ~ 8 Enter the unified credit against tax allowable for all prior periods (from Sch. B, line 1 col. C) g 9 , Balance. Subtract line 8 from line 7. Do not enter less than zero ~ 10 . Enter 20% (.20) of the amount allowed as a specific exemption for gifts made after September 8 9 E ~ , 1976, and before January 1, 1977 (see instructions) 11 V Balance. Subtract line 10 from line 9. Do not enter less than zero ~ 10 K 12 ~ Unified credit. Enter the smaller of line 6 or line 11 11 13 N Credit for foreign gift taxes (see instructions) 12 14 Total credits. Add fines 12 and 13 ~ 13 ~ 15 a ~ Balance. Subtract fine 14 from line 6. Do not enter less than zero 14 16 Generation-skipping transfer taxes (from Schedule C, Part 3, col. H, Total) 15 17 Total tax. Add lines 15 and 16 ~ 16 18 Gift and eneration-ski ~ ~ ~ 9 Aping transfer taxes prepaid with extension of time to file 17 19 If line 18 is less than line 17, enter balance due (see instructions) 18 , • 19 0 00 00 20 If line 18 is greater than line 17, enter amount to be refunded Under penalties of perjury, I deGare that I have examined this return, including any accompanying schedules and statements, and to the best of my 0 knowledge and belief, it is true, correct, and complete. DeGaration of preparer (other than donor) is based on all information of which preparer has ~ Sign any knowledge. Here ~ May the IRS discuss this return with the preparer shown below (see U " ~ J ~~ instructions)? ayes No ~ Signature of or to s PrinUType preparers name Preparers ignature ~ Paid ~ ~- Date w Preparer Ste hen Tile ~..: ~ '7 3/28/2C Q Firm's name - Fre & Tile Use Only Firm's address - 5 South Hanover St. Carlisle PA 17013 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see the separate instructions for this form. (HTA) ~/y/~ ~O~ O Check U if PTIN self-employed P01q Firm's EIN - 7F 17) 243 5838 Form 7~9 (2010) Exhibit "J" Form 709 (2010) Evel n Stout 152-14-0346 Pag, ' Com utation of Taxable Gifts Includin transfers in trust see instructions) A Does the value of any item listed on Schedule A reflect any valuation discount? If "Yes," attach explanation. ~ .Yes ~ No~ B ~ Check here if you elect under section 529(c)(2)(B) to treat any transfers made this year to a qualified tuition program as made ratably over a 5-year period beginning this year. See instructions. Attach explanation. Part 1-Gifts Subject Only to Gift Tax. Gifts less political organization, medical, and educational exclusions. (see instructions) B A • Donee's name and address C G Item • Relationship to donor (if any) D E F H • Description of gift Donors adjusted Date For split Net transfer number Value at gifts, enter (subtract • If the gift was of securities, give CUSIP no. basis of gift of gift date of ift • If close) held enti g '~ of col. G from Y ty, give EIN column F col F) 1 Susan Mac a' Bhaird 100 000 10/26/2010 100 000 72 Vista Road ~ 0 100 000 Berwick RA 18603 ~~~"~' 0 ~r , x 0 Cash ift to Dau hter F~<. 0 0 :.~; 0 Gifts made b spouse-complete onl if you are splitting ifts with our spouse and he/she also made gifts. 0 ~~ ~ o ~-. o ~.p~ ~~ rar[ ~. Haa amounts from Part 1 column H _ U Part 2-Direct Skips. Gifts that are direct skips and are subject to both gift tax and generation-skipping transfer tax. You must lis he gifts 100 in chronological order. B A • Donee's name and address C G Item • Relationship to donor (if any) D E F H • Description of gift 2632 b For split Net transfer number () Ddnor's adjusted Date Value at election basis of ift gifts, enter (subtract • If the gift was of securities, give CUSIP no. out g of gift date of gift '/: of • If Gosely held entity, give EIN col. G from 1 column F col. F) Gifts made b spouse-complete only if you are splitting gifts with your spouse and he/she also made Part 3-Indirect Skips. Gifts to trusts that are currently subject to gift tax and may later be subject to generation-skipping transfe,ax. You must list these gifts in chronological order. B A • Donee's name and address C G Item • Relationship to donor (if any) r D E F H number • Description of gift 2632(c) Donor's adjusted Date For split Net transfer election Value at gifts, enter (subtract • If the gift was of securities, give CUSIP no. basis of gift of gift date of gift '/: of • If closely held entity, give EIN col. G from ~ column F col. F) 0 0 0 0 0 0 v 0 r. 0 0 0 0 Gifts made b spouse-complete onl if you are splitting ifts with your spouse and he/she also made gifts. 0 0 0 0 0 0 a o - Total of Part 3. Add amounts from Part 3 column H 0 o '- (!fmore space is needed, attach additional sheets of same size.) ~ 0 Form 7~9 (2010) '~ Exhibit "J" ~~ o) 152-14-0346 Taxable Gift Reconciliation Total value of gifts of donor. Add totals from column H of Parts 1, 2, and 3 1 100 i ~ Total annual exclusions for gifts listed on line 1 (see instructions) y 3 Total included amount of gifts. Subtract line 2 from line 1 3 100 I Deductions (see instructions) ~ ~ ~ ' 4 Gifts of interests to spouse for which a marital deduction will be claimed, based on item numbers of Schedule A q •---------------------------------- 5 5 Exclusions attributable to gifts on line 4 6 Marital deduction. Subtract line 5 from line 4 6 0 7 Charitable deduction, based on item nos. less exclusions 7 8 Total deductions. Add lines 6 and 7 9 Subtract line 8 from line 3 9 100 C 10 Generation-skipping transfer taxes payable with this Form 709 (from Schedule C, Part 3, col. H, Total) 1p 11 Taxable ifts. Add lines 9 and 10. Enter here and on pa a 1, Part 2-Tax Computation, line 1 11 Terminable Interest (QTIP) Marital Deduction. (See instructions for Schedule A, Part 4, line 4.) 100 C If a trust (or other property) meets the requirements of quailed terminable interest property under section 2523(f), and: a. The trust (or other property) is listed on Schedule A, and b. The value of the trust (or other property) is entered in whole or in part as a deduction on Schedule A, Part 4, line 4, then the donor shall be deemed to have made an election to have such trust (or other property) treated as qualified terminable interest property under section 2523(f). If less than the entire value of the trust (or other property) that the donor has included in Parts 1 and 3 of Schedule A is entered as a deduction on line 4, the donor shall be considered to have made an election only as to a fraction of the trust (or other property). The numerator of this fraction is equal to the amount of the trust (or other property) deducted on Schedule A, Part 4, line 6. The denominator is equal to the total value of the trust (or other property) listed in Parts 1 and 3 of Schedule A. If you make the QTIP election, the terminable interest property involved will be included in your spouse's gross estate upon his or her death (section. 2044). See instructions for line 4 of Schedule A. If your spouse disposes (by gift or otherwise) of all or part of the qualifying life income interest, he or she will be considered to have made a transfer of the entire property that is subject to the gift tax. See Transfer of Certain Life Estates Received From Spouse in the separate instructions. 12 Election Out of QTIP Treatment of Annuities ~ Check here if you elect under section 2523(f)(6) not to treat as qualified terminable interest property any joint and survivor annuities that are reported on Schedule A and would otherwise be treated as qualified terminable interest property under section 2523(f). See instructions. Enter the item numbers from Schedule A for the annuities for which you are making this election - 3 ~ Gifts From Prior Periods If you answered "Yes" online 11a of page 1, Part 1, see the instructions for completing Schedule B. If you answered "No," skip to the Tax Computation on age 1 (or Schedule C, if applicable). See instructions for recalculation of the column C amounts. Attach calculations. A C p Calendar year or B Amount of unified Amount of specific E calendar quarter Internal Revenue office credit against gift tax exemption for prior (see instructions) where prior return was filed for periods after periods ending before Amount of December 31, 1976 January 1, 1977 taxable gifts 1 Totals for prior periods I 1 2 Amount, if any, by which total specific exemption, line 1, column D is more than $30,000 3 Total amount of taxable gifts for prior periods. Add amount on line 1, column E and amount, if any, on 2 0 line 2. Enter here and on page 1, Part 2-Tax Computation, line 2 . 3 0 (If more space is needed, attach additional sheets of same size.) Form 7~9 (2010) Exhibit "J" Form cos (2o1a) Evel n Stout ~ Computation of Genera Note. Inter vivos direct skips that are completely and exemptions claimed) on Schedule C. Part 1-Generation-Skipping Transfers A Item No. B (from Schedule A, Value (from Schedule A, Part 2, col. A) Part 2, col. H) Gifts made ift ~~-an~ppmq 1 auded by the C ester Tax -' ~ exemption must still be fully reported (including value C Nontaxable portion of transfer D Net Transfer (subtract col. C from col. B) 0 0 Part 2-GST Exemption Reconciliation (Section 2631) and Section 2552(a)(3) Election Check here - ~ if you are making a section 2652(a)(3) (special QTIP) election (see instructions) Enter the item numbers from Schedule A of the gifts for which you are making this election - 1 Maximum allowable exemption (see instructions) '-----'---'---------- 2 Total exemption used for periods before filing this return , 3 Exemption available for this retum. Subtract line 2 from line 1 4 Exemption claimed on this return from Part 3, column C total, below _ _ . 5 Automatic allocation of exemption to transfers reported on Schedule A, Part 3 (see instructions) . 5 Exemption allocated to transfers not shown on line 4 or 5, above. You must attach a "Notice of Allocation." (see instructions) 7 Add lines 4, 5, and 6 8 Exemption available for future transfers. Subtract line 7 from line 3 e_~ ., v-. o.. ~u~npuianon A g ttem No. Net transfer ~ (from Schedule (from Schedule C, GST Exemption ~ C, Part 1) Part 1, col. D) Allocated Applicable Rate 5 Generation-Skipping Transfer Tax (multiply col. B by col. G) 0 Gifts made 0 0 r~ ~~ -~-~x:,~ i.,~_ ~,~ 0 Total exemption claimed. Enter here and on Part 2, line 4, Total generation-skipping transfer tax. Enter here; on page above. May not exceed Part 2, 3, Schedule A, Part 4, line 10; and on page 1, Part 2-Tax line 3, above p Computation, line 16 . (!f more space is needed, attach additional sheets of same size.) Exhibit "J" 152-1 .~ o,~. 0 Farm 709 (2010) Y ~V ~~ ~ ~~ -~ 1-~~;~ ~:.