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HomeMy WebLinkAbout08-16-12 (3)4 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 2 6 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 7 3 0 5 7 2 3 0 2 2 6 2 0 ~1 2 0 3 1 7 1 9 3 8 Decedent's Last Name Suffix Decedent's First Name MI G R I F F I E C H A R L E S p (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 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required OX 6. Decedent Died Testate ~ death after 12-12-82) 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 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 M A T T H E W A M c K N I G H T 7 1 7 2 4 9 ~;,3 5 3 First line of address I R W I N & M c K N I G H T P C• Second line of address 6 0 W E S T P O M F R E T S T R E E T City or Post Office State ZIP Code C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: SIGNATII E F PERSON R~tSPO IBS F R FILIN RN TE ~ sir. unoer penalties of per)ury, 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. ADDRESS 184 PINE SIGNATU CHOOL ROAD GARDNERS ~~ -,-, --, ._,_:~ +~_.._ _..~._.~ ti r-r~ 0 PA 17324 OTHER THAN REPRESENTATIVE ADDRESS 60 WEST POMFRET STREET CARLISLE L 1505610140 PLEASE USE ORIGINAL FORM ONLY Side 1 DATE ~ 3~ ; PA 17013 1505610140 ~ h~~ ~ ~,, 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: CHARLES 0- GRIFFIE 2 0 7 3 0 5 7 2 3 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2 4 5 0 0 0, 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 2 3 1 4 8 , 4 5 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ................... ..... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ..... .. 5. 2 ? 9 5 8 3 , 2 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 6 6 5 4 , 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ..... .. 7. 6 6 9 6 3 , 0 8 8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 6 2 1 3 4 8 . 7 3 9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 5 4 2 8 9 . 6 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 1 9 8 5. 8 1 11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 5 6 2 7 5. 4 6 12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 5 6 5 0 7 3. 2 7 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. 5 6 5 0 7 3. 2 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. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 5 6 5 0 7 3. 2 ~ 16. 2 5 4 2 8. 3 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. TAX DUE ................................................ .... ..19. 2 5 4 2 8• 3 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVE RPAYMENT ^ Side 2 1505610240 1505610240 J ' continuation of REV-1500 Inheritance Tax Return Resident Decedent CHARLES O. GRIFFIE Decedent's Name 21 12 0267 Page 1 File Number Correspondents Name MAT T H E W First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E Correspondent's a-mail address: A M c K N l G H T M c K N I G H T P C. Daytime Telephone Number 7 1 7 2 4 9 2 3 5 3 P O M F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 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. SIGNATURE OF PERS ESPONSI R FIL G RETURN DATE ADDRESS PO BOX 49 PERU ME 04290 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 0267 DECEDENT'S NAME CHARLES O. GRIFFIE STREET ADDRESS 8 JOSEPH DRIVE CITY STATE Zlp BOILING SPRINGS PA 17007 Tax Payments and Credits: ~~ Tax Due (Page 2, Line 19) (1) 25,428.30 2. Credits/Payments A. Prior Payments 24, 000.00 B. Discount 1,271.42 Total Credits (A + B) (2) 25,271.42 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 156.88 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 : ................................ ...................................... ^ a b, retain the right to designate who shall use the property transferred or its income; ............................... ^ 0 c, retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, 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. ..._. x ~, tttr.` a 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(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. 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 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: CHARLES O. GRIFFIE _ 21 12 0267 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 jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. I8 JOSEPH DRIVE, BOILING SPRINGS, PENNSYLVANIA I 245,000.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation.) I $ 245,000 00 If more space is needed, use additional sheets of paper of the same size. w RtV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CHARLES O. GRIFFIE 21 12 0267 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. SERIES EE SAVINGS BOND - R138073930EE 2. IMORGAN STANLEY SMITH BARNEY ACCOUNT NUMBER 724-00272-14 564 TOTAL (Also enter on line 2, Recapitulation) ~ $ VALUE AT DATE OF DEATH 166.48 22,981.97 23,148.45 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: CHARLES O. GRIFFIE 21 12 0267 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 ~ VALUE AT DATE DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -APPRAISAL ATTACHED 84,216.00 2. MEMBERS 1ST FEDERAL CREDIT UNION 1 513 86 SAVINGS ACCOUNT #412909-00 , . 3. MEMBERS 1ST FEDERAL CREDIT UNION 19 652 91 SAVINGS ACCOUNT #412911-00 , . 4. MEMBERS 1ST FEDERAL CREDIT UNION 5 45 SAVINGS ACCOUNT #300208-00 . 5. MEMBERS 1ST FEDERAL CREDIT UNION 5 242 10 INVESTMENT SAVINGS ACCOUNT#412911-05 , . 6. PNC BANK -CERTIFICATE OF DEPOSIT #31500314411 18,909.29 7. I PNC BANK -CHECKING ACCOUNT #5140185054 I 22,180.68 8. PNC BANK -SAVINGS ACCOUNT #5003706554 36,051.85 9. PPG RETIREMENT SERVICES (ING) 91,811.06 TOTAL (Also enter on Line 5, Recapitulation) I $ 279 583 20 If more space is needed, insert additional sheets of paper of the same size RSV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: CHARLES O. GRIFFIE 21 12 0267 If an asset was made 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. WILLIAM G. GRIFFIE, JR. 184 PINE SCHOOL ROAD BROTHER GARDNERS, PA 17324 B. BONNIE L. GRIFFIE 184 PINE SCHOOL ROAD GARDNERS, PA 17324 SISTER-IN-LAW 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 % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 2003 1/2 INTEREST -LOT OF LAND SITUATE IN ARNOT, 13,308.00 50. 6,654.00 BLOSS TOWNSHIP, TIOGA COUNTY, PENNSYLVANIA TOTAL (Also enter on Line 6, Recapitulation) I $ 6,654 00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER CHARLES O. GRIFFIE 21 12 0267 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 yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (iFAP~LicAeLE) 1. MEMBERS 1ST FEDERAL CREDIT UNION 66,963.08 100.00 IRA #300208-17 BENEFICIARY: JOSEPH W. POMPEO TAXABLE VALUE 66, 963.08 TOTAL (Also enter on Line 7, Recapitulation) ~ $ 66, 963 08 If more space Is needed, use additional 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 is i A i t ur FILE NUMBER CHARLES O. GRIFFIE 21 12 0267 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. HOLLINGER FUNERAL HOME B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP AMOUNT 12,356.10 2. AttomeyFees: IRWIN & McKNIGHT, P.C. 20,500.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 411.50 5 Accountant Fees: LARRY WALTER 575 00 INCOME TAX RETURNS . 6. Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA 375 00 FIDUCIARY TAX RETURN . 7. REGISTER OF WILLS -FILING FEE 30 00 8. THE SENTINEL -ESTATE NOTICE . 200 16 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE . 75 00 10. NOTARY FEES . 25 00 11. REGISTER OF WILLS -SHORT CERTIFICATE . 16 00 12. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY . 160 00 13. CLOSING COSTS ON SALE OF REAL ESTATE . 19 285.00 14. PODS -STORAGE , 280 89 TOTAL (Also enter on Line 9, Recapitulation) $ 54 289.65 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ tSTATE OF FILE NUMBER CHARLES O. GRIFFIE 21 12 0267 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. ROBERT C. CAIRNS, TAX COLLECTOR -PERSONAL TAXES 4.90 2. CRUMAY PARNES ASSOCIATES, INC. -MEDICAL 227 38 3. IWS OF PENNSYLVANIA -TRASH 40.47 4. ROBERT C. CAIRNS, TAX COLLECTOR -REAL ESTATE TAXES 504.90 5. MSHMC PHYSICIANS GROUP -MEDICAL 180.27 6. ERIE INSURANCE -HOMEOWNERS INSURANCE 281.46 7. HOLY SPIRIT HOSPITAL -MEDICAL 42.50 8. MET-ED -ELECTRIC 293.02 9. PINNACLE HEALTH HOSPITALS -MEDICAL 152.50 10. VERIZON -TELEPHONE 26.35 11. CARDIOLOGY DIAGNOSTIC, LLC -MEDICAL 35.00 12. COMCAST -CABLE 197.06 TOTAL (Also enter on Line 10, Recapitulation) I $ 1,985 81 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES _... r.. ~ .,. . CHARLES O. GRIFFIE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. JOSEPH W. POMPEO 609A GENEVA DRIVE APT 3D MECHANICSBURG, PA 17055 FILE NUMBER: 21 12 0267 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal AMOUNT OR SHARE OF ESTATE 565, 073.27 REMAINDER I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. j,A ~'T WILL AN.I~ TESTAMENT of Marian E. Griffie I, MARIAN E. GRIFFIE, of South Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate. TWO. My Executor or Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or ~~d3 Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. _. I devise and bequeath all of my estate of every nature and wherever situate to my husband, CHARLES O. GRIFFIE, providing he shall survive me by thirty (30) days. F_. Should my husband, Charles O. Griffie, predecease me or die on or before the thirtieth (30th) day following my death, then all of my estate, real, personal and mixed, wheresoever situate, of which I may be entitled at the time of my death and any property over which I may have or may hereafter acquire any power of appointment, I give devise and bequeath to my son, JOSEPH W. POMPEO, to be held IN TRUST, together with any other assets received by the trustee (hereinafter collectively referred to as the residue), under the following terms and conditions. A. If JOSEPH W. POMPEO is then living, the trustee shall hold all the residue of my estate in a separate trust for the primary benefit of my said son, who is disabled. In providing for the establishment of this trust for the benefit of my said son, I am aware of the special circumstances and disabilities affecting JOSEPH W. POMPEO which may cause or will cause him to be eligible for various local, state and federal benefits and entitlements, as well as possible assistance provided by various private agencies and organizations. The primary purpose of this trust is to assure that JOSEPH W. POMPEO achieves his maximum potential and leads as full, independent and normal a life as possible. To that end, it is my wish that the trustee view himself not only as trustee in the traditional sense, but also as protector, guardian 2 and advocate for my said son. Correspondingly, the trustee shall expend the income and principal of the trust in ways that best further these goals, and under the following terms and conditions. 1. The trustee, within his complete and unfettered discretion, shall apply the income and principal of the trust in furtherance of the purposes of the trust as set forth in Paragraph A. above and generally to enhance the life of my son, JOSEPH W. POMPEO, if living, but only to the extent not provided for by insurance or by Federal, State, Local or any other assistance programs of any nature whatsoever, including Supplemental Security Income benefits under the Federal Income Maintenance Program as then existing. To the extent that benefits are not made available to JOSEPH W. POMPEO for other than basic living expenses, including food and shelter, the trustees, in their absolute discretion, may distribute from income and principal, for the benefit of JOSEPH W. POMPEO, for his needs other than basic support. Any income not so expended shall be accumulated and added to principal. For the purposes of this provision, non-support purchases include, but are not limited to dental care; uru'eimbursable medical and dental expenses, not covered by Medicare or Medicaid, including plastic and reconstructive surgery, diagnostic work and treatment, rehabilitative training and experimental medical services; psychiatric/psychological services; occupational therapy; prosthetic devices; dietary needs and supplements; custodial care or supplemental nursing care; recreation, cultural experiences, outings and travel, including payment for others to accompany JOSEPH W. POMPEO; telephone and television, including cable television; reading and educational materials; Internet access; exercise equipment; unreimbursed therapy; purchase of a primary 3 residence and related insurance. The trustee's discretion in making distributions authorized hereunder is absolute with regard to distributions from the trust estate, and shall be binding on all interested persons. The income and principal of this trust may therefore be used as judged necessary and appropriate as a supplement to, but not to supplant, such Federal, State, Local or other assistance, and to the extent the income of this trust is not used, the trustee may accumulate the income and add it to the principal of the trust. This trust is for the primary benefit of my son, JOSEPH W. POMPEO, and his present and future needs shall be considered first. 2. The trustee is empowered to collect and expend on behalf of my said son JOSEPH W. POMPEO, all governmental financial assistance benefits to which he is otherwise entitled; provided that such funds shall not be co-mingled with the other funds of this trust. 3. In the exercise of discretion with respect to income and principal distributions for JOSEPH W. POMPEO, if any, the trustee shall bear in mind my express desire to preserve, to the greatest extent possible, this trust's assets for the benefit of my son, JOSEPH W. POMPEO. The foregoing sentence is in no way intended to limit the sole and absolute discretion of the trustee with respect to such distributions or to give any remainderman any right to challenge any distribution made by the trustee in the proper exercise of such discretion. Rather, said sentence is intended to aid the trustee and any Court or administrative agency in properly interpreting my intent in establishing this trust, namely, that the needs of my son, JOSEPH W. POMPEO, be provided for only to the extent that governmental benefits and entitlements and other resources are either unavailable, inadequate, or have been exhausted. 4 4. If for arty reason, the special circumstances and disabilities affecting JOSEPH W. POMPEO should cease to exist, such that he will no longer be eligible for various local, state and federal benefits and entitlements, as well as possible assistance provided by various private agencies and organizations, then it is my wish that the Trustee, at his complete discretion, elect to terminate this trust, and distribute the remaining principal and interest to directly to my son, JOSEPH W. POMPEO. 5. If any governmental agency determines that this Trust is an "available resource" to be utilized and exhausted to pay for services for JOSEPH W. POMPEO, otherwise provided by public funding, then the trustee may, at his complete discretion, elect to terminate this trust, in which case the trust assets may be distributed in accordance with paragraph six (6) below as if my said son, JOSEPH W. POMPEO, was then deceased. 6. Upon the death of my said son, JOSEPH W. POMPEO, or in the event he should predecease me, the principal of this trust as then constituted, together with any accrued and undistributed income thereon, shall be distributed in the following manner: A. One Hundred (100%) percent thereof shall be distributed, in equal shares, unto the children of my son, JOSEPH W. POMPEO, per stirpes. B. Should my son, JOSEPH W. POMPEO die without surviving issue, then One Hundred (100%) thereof shall be distrubted, in equal shares, unto my brother-in-law, WILLIAM G. GRIFFIE, JR. and my brother LEON E. BUCHER. 5 C. If, at the time of distribution, any income or principal shall be payable to any person who is under the age of twenty-one (21), the trustees shall hold such income and principal until such person reaches the age of twenty-one (21) and shall be entitled to apply such income and principal to the health, maintenance, education and support of such person without the appointment of any guardian or committee or any authority of court. D. All shares of principal and income shall, until actual distribution to the respective beneficiaries, be free from the debts, contracts, alienations and anticipations of any beneficiary or beneficiaries, and the same shall not be liable to any levy, attachment, execution or sequestration. E. Upon the death of any income beneficiary, any accrued, accumulated or undistributed income held or received by the trustee shall be paid to the person or persons for whose benefit the principal producing such income is continued in trust or to whom such principal is distributed under the terms hereof. F. All dividends on shares of a corporation, forming a part of the principal, which are payable in the share of the corporation itself of the same kind and rank as the shares on which such dividend is paid shall be deemed principal. FIVE. I nominate and appoint my brother-in-law, WILLIAM G. GRIFFIE, JR., and my brother, LEON E. BUCHER to serve as Co-Trustee, or the survivor of the as Trustee, of the trust created in Paragraph Four of this my last will. 6 SIX. I nominate and appoint CHARLES O. GRIFFIE, to be the Executor of this my Last Will and Testament. Should he fail to qualify or cease to act as Executor, I appoint my brother, LEON E. BUCHER, and my brother-in-law, WILLIAM G. GRIFFIE, JR., Co- Executors, or the survivor of them, executor of this my last will. SEVEN. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (30) days. EIGHT. No Executrix, Executor, Trustee or Guardian acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. NINE. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. TEN. The validity and administration of any trust established hereunder and any questions or disputes relating to the construction or interpretation of any said trusts shall be governed and construed in accordance with the laws of the Commonwealth of Pennsylvania. [THE REMAINDER OF THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK] 7 ACKNOWLEDGMENT AND AFFIDAVIT WE, E. GRIFFIE, MATTHEW A. MCKNIGHT and TRACI D. SMITH, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~ ~~ ~.~~ MARIAN E. GRIFFIE T EW . MCKNIGHT .C~~/~ r' TRACI D. SMITH COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MARIAN E. GRIFFIE, the testatrix herein, and subscribed and swo to before me by MATTHEW A. MCKNIGHT and TRACI D. SMITH, witnesses, this'-- day of November, 2010. ,, Notary Public ^^rfnnhnn~~~ ICDt rlc ~~r~~~.~^`fl ^ ~~Jt~lt'.tlrt~_lr~t_, ,. .. ~~ t a .~ . iv 1 •. ~i.i l lI~LJIG{ C:E S@aI I<a~~n ~,. (roe!, i~~ata~% Pub!!c Ca i~~ie {~or~. C•Gn'l~rr~r~ Court N. ~eniement Statement (HUD-1) - - .~ r 6~~uw;~ B. T e of Loan 1.O FHA 2.^ RHS 3.D Conv. Unins 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4.^ VA 5.^ Conv. Ins RE12-151 1253920 C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked " .o.c. "were aid outside the closin • the are shown here for informational ur oses and are not included in the totals. D. Name 8~ Address of Borrower: David F. Yeager, Jr. Darlene M. Yeager 875 Franklin Drive Manheim, PA 17595 E. Name & Address of Seller: Estate of Charles O. Griffie 8 Joseph Drive Boiling Springs, PA 17007 F. Name & Address of Lender: Susquehanna Bank 3501 Concord Road York, PA 17402 G. Property Location: 8 Joseph Drive South Middleton Township Boiling Springs, PA 17007 H. Settlement Agent: Orchard Settlement Services, LLC 1 Irvine Row, Suite B Carlisle, FA 17013 TIN: Phone: (717) 249-7867 Parcel : 40-12-0349-109 County:. Cumberland Place of Settlement: 1 Irvine Row, Suite B Carlisle, PA 17013 I. Settlement Date: 6/25/2012 Funding Date: 6/25/2012 J. Summa of Borrower's Transaction K. Summa of Seller's T ransaction 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract sales rice 245 000.00 401. Contract sales rice 245 000.00 102. Personal roe 402. Personal ra e 103. Settlement char es to borrower line 1400 8 , 3 4 8.3 0 403. 104. 404. 105. 405. Ad'ustments for Items aid b seller In advance Ad ustments for items aid b seller In advance 106. Cit /town taxes: 406. Cit /town taxes: to to 107. Coup taxes: 6/25/2012-12/31/2012 260.73 407. Count taxes: 6/25/2012-12/31/2012 260.73 to to 108. Assessments: 408. Assessments: to to 109. 409. 110. School Tax 6/25/2012-6/30/2012 26.20 410. School Tax 6/25/2012-6/30/2012 26.20 111. ~ 411. 112. 412. 120. Gross Amount Due From Borrower 253, 635.23 420. Gross Amount Due To Seller 245 286.93 200. Amounts Paid B Or In Behalf Of Borrower 500. Reductions In Amount Due To Setter 201. De osit or earnest move 2 000.00 501. Excess de osit see instructions 202. Princi al amount of new loans 130 000.00 502. Settlement char es to seller line 1400 18 085.00 203. Existin loans taken sub'ect to 503. Existin loan s taken sub'ect to 204. ~ . 504. Pa off of first mort a e loan 205. 505. Pa off of second mort a e loan 206.A raisal Fee POC 960.00 506. 207. Credit re ort Fee POC 25.84 507.Escrow-inheritance taxes 19 000.00 208. Seller assist 1,200.00 508. Seller assist 1,200.00 209. 509. Ad ustments for items un aid b seller Ad ustments for items un aid b seller 210. Cit /town taxes: 510. Ci /town taxes: to to 211. Coun taxes: 511. Coun 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 Paid B /For Borrower 13 3 , 6 8 5.8 4 520. Total Reduction Amount Due Seller 3 8 , 2 B 5.0 0 300. Cash At Settlement From/To Borrower 600. Cash At Settlement TolFrom Seller 301. Gross Amount due from borrower line 120 253 635.23 601. Gross amount due to seller line 420 245 286.93 302. Less amounts aid b /for borrower line 220 133 685.84 602. Less reductions in amount due seller line 520 38 285.00 303. Cash ©From O To Borrower 119 999.39 603. Cash ®To 0 From Setter 207 001.93 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for conecung, reviewing, and reporting the data. This agency may not collect tnis information, and you are not required to complete this form, unless it displays a currentty 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. Previous editions are obsolete. Page 1 of 3 HUD-1 ~, vcaucn~c~~• vna~a~ca nIC IVUIIID@f: KralZ-151 Loan Number 1 75'~4~n 700. Total Real Estate Broker Fees Paid From paid From Division of Commission line 7 0 as follows: Borrower's Seller's 701. $7 845.00 to RE/MAX 1st Advanta a Funds at Funds at 702. 5 512.50 to Hooke Hooke & Eckman Settlement Settlement 703. Commission aid at settlement 15, 195.00 704. referral fee to Sellstate Grou Realt $1837.50 800. Items Pa able In Connection With loan 801. Our on ination char e $ 8 95.00 from GFE #1 802. Your credit or char a oints forthe s ecific interest rate chosen -975.00 from GFE #2 803. Your ad'usted on ination char es from GFE A -80.00 804. A raisal fee to ALS Inc . /A raisal Lo istic Solutions from GFE #3 9 60.00 805. Credit re ort to Kroll Factual Data Cor from GFE #3 25.37 806. Tax service to Tax Service Provider of Final Investor from GFE #3 70.00 807. Flood certification to CoreLo is Flood Services from GFE #3 12.50 808. 809. 810. 811. 900. Items Re uired B Lender To Be Paid In Advance 901. Dail interest char es from 6/25/2012 to 7/1/2012 @ $13.8019/da from GFE #10 82.81 902. Mort a e insurance remium for 0 months to from GFE #3 903. Homeowner's insurance for 1 ears to State Farm from GFE #11 698.00 904. 905. 1000. Reserves De osited With Lender 1001. Initial de osit for our escrow account from GFE #9 2 173.87 1002. Homeowner's insurance 3 months @ 54.00 er mo $162.00 1003. Mort a e insurance months @ er mo 5 1004. Pro a taxes 5 months @ 4 2.0 8 e r mo 5 210.4 0 1005. School taxes 13 months @ 159.83 er mo $2 077.79 1006. months @ er mo 1007. A re ate Ad'ustment -27 6.32 1100. Title Char es 1101. Title services and lender's title insurance from GFE #4 1, 320.75 1102. Settlement or closin fee 1103. Owner's title insurance Old Re ublic Title Co. from GFE #5 575.00 1104. Lender's title insurance Old Re ublic Title Co. $1, 008.75 1105. Lender's title olic limit $130 000.00 1106. Owner's title olic limit $ 2 4 5 0 0 0.0 0 1107. A ent's ortion of the total insurance remium S 1108. Underwriters ortion of the total insurance remium S 1109. End. 100 300 8.1 & CPL to Old Re ublic Title Com an $225.00 1110.Overni ht/Email/Wire to Orchard Settlement Services LLC 567.00 1111. Notar to Cash 520.00 1200. Government Recordin and TransferChar es 1201. Government recordin char es Recorder of Deeds from GFE #7 160.00 1202. Deed 62.00 Mort a e 98.00 Release S 1203. Transfer taxes from GFE #8 2, 450.00 1204. Ci /Count tax/stam s: Deed 5 Mort a e S2, 450.00 1205. State tax/stam s: Deed 5 2 4 5 0.0 0 Mort a e S 2, 4 5 0.0 0 1206. S 1207. 1300. Additional Settlement Char es 1301. Re uired services that ou can sho for from GFE #6 1302. 1303. 1304. Home warrant to Home Warrant of America 420.00 1305. Tax certification to eob Cairns 5.00 1306. Home Radon Termite b Water to Al ha Home POCB $615 1307. Se tic certification to Rosenberr 's Se tic 450.00 1308. research & co ies to RE MAX 1st Advanta a 15.00 1400. Total Settlement Char es enter on Ilnes 103 Section J and 502 Section K 8, 398.30 18, 085.00 I ha efully reviewed th HUD-1 Settlement tatement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made one _~ my count by qn s lion. I further rtify that I have received a copy of the HUD-1 Settlem ~n S tement ~ ^~~\`w~sc~ ~ ~ ~ ~ ~~ ' d F. Yeager Jr . Buyer/Borrower Estate of Char s 0. G if Seller Darlene M. Yea er ~~'~ Buyer/Borrower Seller This Se ement ~atem~it which IY~e prepa~redlis a t/ue and a urate account of this trensaction. Iwe taus r will cause the funds to be disbursed in accordance with this statement. , e ~~r lI'' t Orc ar S'ett'lement Services, LLC JVARN) G: It is a crime to knowingly make false statem~ m 2009-2011 Easy Soft. Previous editions are obsolete. 6/25/2012 Settlement Agent Date Page 2 of 3 HUD-1 ` ~~~ o T Charges That Cannot Increase HUD-1 Line Number Our on ination char a #801 Your credit or char a oints for the s ecific rate chosen #802 Your ad'usted on ination char es #803 Transfer taxes #1203 Government recordin char es #1201 A raisal fee #804 .Credit re ort #805 Tax service #806 Flood certification #807 Initial de osit for our escrow account #1001 Dail interest char es #901 Homeowner's insurance #903 Title services and lender's title insurance #1101 Owner's title insurance #1103 Loan Terms ': ~~ f -_ .895.00 895.00 -975.00 -975.00 -80.00 -80.00 2,450.00 2,450.00 160.00 160.00 460.00 460.00 25.37 25.37 70.00 70.00 12.50 12.50 727.87 727.87 0.00 or 0.00 1,917.96 2,173.87 13.80 82.81 648.00 698.00 1,320.75 1,320.75 575.00 575.00 Your initial loan amount is $130, 000.00 Your loan term is 30 Years Your initial interest rate is 3.8 7 5 Your initial monthly amount owed for principal, interest, and $611.31 includes any mortgage insurance is ©Principal O Interest ^ Mortgage Insurance Can your interest rate rise? D No. ^ Yes, it can rise to a maximum of %. The first change will be on and can change again every after . Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than %. Even if you make payments on time, can your loan balance rise? ~ No. ^ Yes, it can rise to a maximum of $ . Even if you make payments on time, can your monthly ~ No. ^ Yes, the first increase can be on and the monthly amount amount owed for principal, interest, and mortgage insurance rise? owed can rise to $ . The maximum it can ever rise to is $ . Does your loan have a prepayment penalty? ©No. ^ Yes, your maximum prepayment penalty is $ . Does your loan have a balloon payment? ~ No. ^ Yes, you have a balloon payment of $ due in years on . Total monthly amount owed including escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. O You have an additional monthly escrow payment of $255.91 that results in a total initial monthly amount owed of $867.22. This includes principal, interest, any mortgage insurance and any items checked below: O Property taxes ~ Homeowner's insurance ^ Flood insurance O school taxes ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. © 2009-2011 Easy SoR. Previous editions are obsolete. 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Kline Lending Insurance Support Specialist March 7, 2012 Estate of: CHARLES O. GRIFFIE Date of Death: 02/26/2012 Social Security Number: 207-30-5723 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org ~~~~e~~~ APR 2 ~ 10~~ PRIMARY OWNER: SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established IRA CERTIFICATE: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary MARIAN E. GRIFFIE 300208-00 11 /14/2002 $5.45 $.00 $5.45 Charles Griffie 11 /11 /2002 IRWIN & WIcKNIGH~' \ LAW OFFICES ~ ~;~ ~~~ v ~., ~{,~ 300208-17 03/22/2011 $66, 908.54 $54.54 $66,963.08 Charles O. Griffie (primary) Joseph W. Pompeo (secondary) *Rollover from IRA certificate 300208-16, originally established 06/02/2009. M MB RS 1ST F_ DERA ,RE N N n ~~~ ~` I Danielle A. Kline Lending Insurance Support Specialist March 7, 2012 Estate of: CHARLES O. GRIFFIE Date of Death: 02126/2012 Social Security Number: 207-30-5723 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org d PNC ~.~ao~ucmewaY Mazch 12, 2012 Matthew A McKnight Esq. Irwin & McKnight P. C. 60 W Pomfret St Carlisle, P,A. 17013-3222 RE: Charles 0 Griffie SSN: 207-30-5723 DOD: 02-26-2012 Dear Mr. McKnight: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31500314411 CHARLES 0 GRIFFIE DOD balance: ~ 18,$77.76 + 31.53 accrued interest Interest paid O 1-01-2012 thru 02-26-2012 $ 0.00 YTD Checking Account Account # 5140185054 CHARLES 0 GRIFFIE DOD balance: $ 22,150.67 + 0.01 accrued interest Interest paid 01-01-2012 thru 02-26-2012 ~ 0.35 YTD Savings Account Account # 5003706554 CHARLES 0 GRIFFIE DOD balance: $ 36,051.75 + 0.10 accrued interest Interest paid 01-01-2012 thru 02-26-2012 $ 4.32 YTD Safe Deposit Box T1~e decedent maintained safe deposit box # 650 CHARLES 0 GRIFFIE Located at: Mount Holly Branch 21~V Pine St 1VIt. Holly Spz~ngs, PA 17065 (717) 486-3416 Established: 06-28-2007 Established: 04-01-1963 Established: 08-29-2002 Page 1 of 2 Please mote that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking nand Savings). We do not process any financial transactions; or provide statement9. rf you need assistance with any of these items, please call l -SS8-PNC-BANIG (1-gsg-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message f~s intended for the use of the individual or entity to which it is addressed and mcry contain information, that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, yvu are hereby notified that any dissemination, distribution or copying of this communications is strictly prvhabited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and irrimediately destroy this faxed document. Page 2 of 2 ~~NG February 30, 2012 CHARLES O GRIFFIE ESTATE W GRIFFIE JR & L BUCHER CO-EXEC 184 PINE SCHOOL RD GARDNERS, PA. 17324 ING U.S. Retirement Services PPG Plan Administration One Heritage Drive North Quincy, MA 02171 Tel: (888) 774.4011 RE: Charles O. Griffie- PPG Employee Savings Plan Account Dear Mr. Griffie Jr.: We are sorry to learn of the death of Charles O. Griffie. On behalf of PPG and ING, we express our sympathy to the Griffie family. Our records indicate that the Estate,.af (;~fiarles 0:~~ 'ffie is the named=beneficiary of the proceeds payable from the account of Cfha~r"I'es O. Griffie. An acc unt has been established in the name of the estate using the Tax Ider~fification Number of the est to as the account number. A Personal Identification Number has een established and is bein ailed to your address under separate'' cover. ~ ~ ~ Under the Plan ou are re uire o take a final distribution of the beneficia account no later ~ ' y q ry C~ than six months from the date that the funds are transferred to the beneficiary. If a cash distribution is made to the estate, a mandatory 10% federal income tax withholding will ~ be applied to the taxable portion of the distribution. In addition, if applicable, we are required to withhold any mandatory state tax. Please read the enclosed Special Tax Notice Regarding Plan Payments, specifically Section IV (Surviving Spouses, Alternate Payees, and Other Beneficiaries), prior to requesting your payment. You may also want to consult a professional tax advisor prior to requesting a payment from the PPG Employee Savings Plan. If you have any additional questions or concerns, or to process a distribution of the above- mentioned account, please feel free to contact the PPG Industries Plan Information Line at 1-888-774-4011. Sincerely, ING Retirement Services ~, / PPG Industries Plan Administration Unit ~ V ~~' ~~ ,~ ..~ Enclosure 1 (%Uf' ~~~ L a-~ ~ ~ .~ ,,.~ ~~ ~ ~, I.0 0 Aiail Payment To: _ TSD LOCKBOX O BOX 306 ~ ' IANSFIELD; PA 16933-0306 "F~11 Payment-Amount ~. fixes are due and payable Prompt:paymttit is.regnested. - _ - Discount Face ' Penaltx ~RIFFIE, CHARLES O ETAL . Control# 001- 00020756 354.16 361.39 397.5', /O WILLIAM GRIFFIE 3R 01-02.10-041.:....,000 84 PINE SCHOOL ROAD Det~led Acres: 66 `; p~;y JUirAUG SEP-OCT NOV-DEC . ~ARDNERS PA 17324 30 BUTTERNUT STREET : . ~ THIS ~' LOT/CANII' ~_ ,;,o ,, _ ;. - Last Day to Pay: 12/31/2011 ~ he homestead exclusion is the lesser of the homestead ass ent or 13308 UNPAID REAL ESTATE TAXES he farmstead exclusion is the lesser of the farmstead ass ent or 13308 WILL BE RETURN]® TO TAX axes are due and payable. Prompt payment is requested. CLAIlI~S BUREAU 12!31!11 'you desire a receipt, enclose aself-addressed, stamped enve e. all collector for tnforma6on on access forhandicappetUdisabled persons:.. 70011590010000~D30100000000000000000000000000012047000132526 )11 SCHOOL REAL ESTATE ~uthern Tioga School District a1c:=CleclFS:Pavalile'To. . . ~trthem Tiogga School District 70j638 2iS3 - - - - a0 Payment To: CSD LOCKBOX ~ BOX 306 ANSFIELD, PA 16933-0306 installment 3 ~ 001- 000103 ~ Ea erlt~R :Prom: .: ~x~ce~ ;~~_:. HARLES O ETAL GRIFFIE, C _ 120.47 13252 _ C/O V~iZL,Aivi GRIr'r~--, C - - ^ ~:~.p:I_ ,. s = _ By Af{er -- - - -- - -- 184 P1NE SCHOOL ROAD GARDNERS PA 17324 .. ~rrn . ~ ~upcltar 10/31/2011 10/31/2011 Parcel- 01-0210-041.-.....,000 _;j- ~ - : '" Conttot# 001 - 00020756 - ?001159001000010301000354160003613900039?530D012046000000006 ~~{ Detach and teti~ with payment )11 SCHOOL REAL ESTATE ~uthern Tioga School District Installment Z ~ 001-000103 ake~ Clrecles : `" able To: ~ . :. ,= -- ::Pa ert to best ~ ~ sum .... _ - :._ , ; ::. ~- --- ~uthezti Tioga School District GRIFFIE, CHART FS O ~'AL . , ~ 120.46 132.51 70)638-2183 C/O WII.LIAM GRIFFIE JR ~ PA1t Ten ~. By After 184 PINE SCHOOL ROAD s ail Payment To- GARDNERS PA 17324 ~~~ 09/30/2011 09/30/201 I CSD LOCKBOX Parcel: 01-02.10-041:.....,000 - - ~ BOX 306 ANSFIELD, PA 16933-0306 Control# 001 - 00020756 = - 7007,159001000D1030100D00000~~0000000000000000012046000132510 .~ ~ ~, J ~ RU .. ~(~ ~~ t 4.a `,~. f; ~; i1 ~; ~. ~~~ ; ~~ ~~ ~' Tax Parcel No. Ol -020756 DEED f~f MADE this ~ ~ day of ~/1!~ ,two thousand and three (2003), BETWEEN CHARLES GRIFFIE and 11~IARIAN E. GRIFFIE, his wife; RONALD GRIFFIE and PATRICIA GRIFFIE, his wife; WILLIAM GRIFFIE, JR., and BONNIE L.GRIFFIE, his wife, all of Cumberland County, Pennsylvania; and DONALD GRIFFIE and DARLENE GRIFFIE, of Adams County, Pennsylvania, parties of the first part, hereinafter called GRANTORS, AND CHARLES O. GRIFFIE and MARIAN E. GRIFFIE, husband and wife, as to an undivided one-half (1/a) interest; and WILLIAM G. GRIFFIE, JR. and BONNIE L. GRIFFIE, husband and wife, as to an undivided one-half (ih) interest; all of Cumberland County, Pennsylvania, parties of the second part, hereinafter called GRANTEES WITNES5ETH, that in consideration of One and No/100 ($1.00) Dollar, in hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey to the said Grantees, their heirs and assigns as tenants by the entirety between husband and wife, and as tenants in common between the two married couples, ALL THAT CERTAIN lot of land with improvements thereon erected, situate in the Village of Arnot, Bloss Township, Tioga County, Pennsylvania, know and designated as Lot No. 41 in Block No. 10, bounded and described as follows: BEGINNING at a point in the centerline of Walnut Street where the southern boundary line of lands of the Commonwealth of Pennsylvania, Department of environmental Resources intersects said centerline; thence along the centerline of Walnut Street the following courses and distances: South 10 ° 20 ' 35 " East, a distance of 98.15 feet to a point, South 32° 24' 29" East, a distance of 67.89 feet to a point, and South 47° 59' 30" East, a distance of 53.18 feet to a point, the southeast corner hereof; thence along the centerline of a proposed street, North 82° 11' 36" West, a distance of 243.39 feet to a point, the southwest comer hereof; thence North 7° 48' 24" East along lands of Lester Griffie, a distance of 175 feet to an iron pin, the northwest corner hereof; thence South 82° 11' 36" East, along lands of the Commonwealth of Pennsylvania, Department of Environmental Resources, a distance of 125 feet to the centerline of Walnut Street, the place of BEGIl~1NING. CONTAINING 0.664 of an acre, more or less, as surveyed on March 1 Z, 1975, by Boyer ,~,' a., '~_-; : . C~ - L, ~ r..--.'.1 ~.-,-n g I _t _~ # ~; 7: K ~ r. - ~.,. 6"hf4 ~. ~ j--pl!! Hollinger Funeral Home & Crematory, Inc. Eric L. Hollinger, Supervisor March 3, 2012 Joseph W. Pompeo 8 Joseph Dr. Boiling Springs, Pa 17007 The Funeral Service for Charles 0. Griffie: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Traditional Services $ 5150.00 Merchandise Woodbridge Pecan 3295.00 Clark Aluminum Vault 1795.00 Memorial Package -Register Book, Memorial Folders, Acknowledgement Cards, Bookmarks No Charge AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advance Grave Opening Certified Copies of Death Certificate (15@ $6) Flowers Sentinel Newspaper Patriot Cemetery Equipment Minister Engraving Stone 700.00 90.00 318.00 126.18 211.92 350.00 125.00 195.00 BALANCE $ 12356.10 501 NORTH BALTIMORE A'~ENllE • MOUNT HOLLY SPRINGS. PENNSYL`DANIA 17065 • (717) 486-3433 • FAX (717) 486-3215 www.I1o11ingerfunera111ome.com