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HomeMy WebLinkAbout09-26-12 (2)~~ 15056bOb43 ~"~ ~ Expr.lo) pA Dspadment of Revenue psnnsylvanla Burqu of Mdiufdual Taxes °°""°"x"11°"' Po eoxstloeot INHERITANCE TAX HsrdsMug, PA 17128.0601 RESIDENT DECE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Dealh 177 24 5408 12 28 2x11 DeoedenPs Last Name Suffix C7~ARBC (11 AppNCabM) Enter Swvlvlnp Spowe's IRformMion Bsiow Spouse's Last Name Bollix Spows'a Social Security Nurnher FILL IN AVPROPRMTE OVALS BELOW OFFICML USE ONLY Year rM.Hwr ~ 21 ~°l 0056 Date of Bldh os o7 isZa t~osdsnl's Fkst Name MI DEANS D Spouse's First Name MI THi3 RETURN MU87 BE FILED IN DUPLICATE WITH THE REGISTER QF WILLS Q i. OripYUl Rasm ^ 2. Supplamenlsl Rehm ^ 3. RemslMsr Rstum Idala of deaN pAorto iZ-tbeih ^ 4. LMssed txlate ^ as ~ d ~MCw 1 ^ S. Fedxad EaWe Tax Ralum Req~Yrod ® a.lAp~.nw~ ~ ^ 7. ~~ l;oire*~ ~ Q TWelNumberofSsbDaposNtlsooes ^ 8. LiBpaYM HreCaada ftaraiwd ^ te. ~~~ ^ i t.~) ~ Oar SaG 8118(ly COARt'SPONDt.NT • TigS SECTION MUST SS CQMPLETS0. All. CORREaPONDEnCE AND COMFIDENTIAL TAX Y~OAW710N SNOULO YG DIRECTEDTO: Name DSylims TsNphone Number RYAN P 3=NSY 717 2 34 -4121 ,.,~ .,. REGISTER OF First Ilse o}address ~ ~ ?" v~;, 2 I.ED~YIQE DRIVE SUITE 2 ~~,- Second Ilne of address ~7 DATE FILE --i CNy or Post Office 31ate ~p Cede LSMOYNE PA 17043 Ryan P Siney 2 Lemoyne Dove, Sulte 200, Lemoyne, PA 17043 Side 1 ~~ r°? rrrn ".?"3 ~ C ~~ ..n K~ L 15056bOb43 1505610b43 - 1505610243 REV-1500 EX Decedent's Social Security Number ~'"r•u'^" Clark, Deane D 177 24 5408 RECAPITULATION 1. Real Estate (schedule A) ....................................................................................... 1. 134 , 014.00 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely HeW Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 6 Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 3 6 , 93 6.2 4 8. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 8. 7. Inter-V'rvos Trenaars & Miscellanreous ryo~Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Oross Aasea (foal Lines 1-7) ..................................................................... 8. 170 , 950.24 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 6 , 616.8 9 10. Deba of Decadent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 272.65 11. Toal Deductlona (foal Lines 9 & 10) ................................................................... 11. 6 , 88 9.54 12. Net Value of Esaa (Line 8 minus Line 11) .......................................................... 12. 164 , 0 60.70 13. Charitable and Govemmenal 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. 164 , 0 60.7 0 TAX COMPUTATION - 8EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9118 15 0 . 0 0 (a)(1.2) X .00 16. Amount of Line 14 taxable 0 00 16 0.00 . at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 . at sibling rate X .12 . . 18. AmouMofLtnel4taxable 164 060.70 1e. 24 609.11 r at collateral rate X .15 r 1s. Tax Due .................................................................................................................. 1s. 24,609.11 20. FILL IN THE OVAL IF YOU ARE REQUESTIN<i A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0056 DECEDENT'S NAME Clark, Deane D STREET ADDRESS 2912 Marion Road, Camp Hill, PA 17011 CITY STATE PA ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credita/Paymenta A. Prior Payments B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to nsquest a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 24,609.11 0.00 (5) 24,609.11 Make Check Pa able 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 trensferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without roceiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or aewrity at his or her death?....... ^ ^x 4. Did decedent own an Indivktual ReOroment Account, annuity, or other non-probate property which contains a benefidary 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 January 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 iNing a tax rotum are still applicable even 'rf the surviving spouse is the only benefidary. For dates of death on or after Juty 1, 2000: • The tax rate Imposed on the net value of transfers from a deceased child 21 y 2 rs of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparont of the child is 0 percent [72 P.S. §9116 (a) (. )] .The tax rate imposed on the not 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. §911 B (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloodd or adoption. (1) Total Credits (A + B) (2) (3) (4) nvasn Fx. (et-0al SCHEDULE A REAL ESTATE wawiam~xrri a r~r+avwu+w inmm~~rrxnetum hearovrt otcEaErrr ESTATE OF FILE NUMBER Clark, Deane D 21-11-0056 Ap ntal P~wpertY owned eaaly a u • tenad In cameo moat M nporlad at dN ~rkat vaMw. Fair markM vaw k tleensd u the pica et rfiltli pvparty would ba swiianpetl baween • buyer antl a wimp sNlsr, naitliar bans canpslad h) buy a aNl, Dolh haMrrqp rua~onabls knowtetlpe of ar rolsva-M facti. Raaf propnty whleh N JoYMlyownad wM epM d awNOrahlp must W dbdoaW on sehaduM F. Aeaeh. wpy d en. at+ awe H a. vrop.Ry hu bean aoW InclWe a copy or lM MW ahowbq dacadanra Intaeat H owned u taunt In common ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Resl Property - 2812 Merlon Road Camp HIII, PA 17011 134,014.00 Valued per Settlement Stabment attached hereto as Exhibit "C" TOTAL (Also enter on Line 1. Recapitulation) I 134,074.00 (H mac apace is nsedsd, additiond piles d t!w same aze) Copyright (c) 2009 form software ony The Lackner Group, Inc. Form PA-1600 Schedule A (Rev. 11-08) coewoHV~xrn ov rsrsarwus~ e•rwfreMear~xnartsw asaoarr k~cEOarrr SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER Clnrlr_ f]wwnw D 21-71.11058 lncNm• m• . a Nnpsson snd tln as si• Proaw• xar• naiad oY th• ••ua. AN Pr•P•rtY wIM 1M Ayllt a saMVOnMdP mon t» al•elo••d on seMduN F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Fukon Bank -Checking Account #22188378 12,878.26 Valued per Date of Death Valuatlon Letter Attached hereto as Exhibit "D" 2 Real Property - Deposit on Sale 16,100.00 3 Peroonsl Properly -Sold at auction which Included 6,267.46 1886 Mercury Marquia VIN ir2MELM76WXSX648830 Attached as Exhibit "E" 4 Encompass -Refund of Premium 100.00 6 Golden Living Center -Refund of overpayment 2,181.64 8 Highmark Insurance -Refund of Premium 3.84 7 Hlghmark Insurance -Refund of Premium 403.84 TOTAL (Also enter on Line 6, RecapkulaUon) I 36,836.24 (H moro .pace is needed, additional payee d the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1800 Schedule E (Rev. 8-g8) REV•11N EXt t10-0tf) COM~~o~1, ~?F~ 1~ANIA SCHEDULE H FUNERAL EXPENSES 8~ 1DMINISTRATIVE COST; ESTATE OF FILE NUMBER Clark, Deane D 21-11-0056 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Sae continuation schedule(s) attached 405.00 B. 1. ADMINISTRATNE COSTS: Personal Representative's Commissions Name of Personal ReproseMative(s) Street Address City State Zio Year(s- Commission paid 2. Attomev's Fees Tucker Arensberg, P.C. 2,600.00 3. Family Exemption: (If decedent's address is not the same as dafmant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 377.60 5. Accountant's Feea 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 3,084.38 Bee continuation schedule(s) attached TOTAL (Abp enter on line 8, Recapkubtion) 6,366.89 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-7600 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Clark, Deane D 21-17-0056 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Rolling Greens Cemetery -Burial 406.00 H-A 406.00 2 ~thor Administrativo Cp'ts Borough of Camp HIII -Sewer 1/1/12 - 3/31/2012 160.00 3 Borough of Camp Hill - Sewer 4/1/2012 - 80/30/2012 160.00 4 Encompass • Automobile Insurance 607.00 6 Floyds Garage - AutomobNe Tires, inspection, Emissions 643.81 8 Penn Waste - UUlkies 4/1/12-8/30/12 46.76 7 Pennsylvania American Water - Utllitlea 2/2012 14.88 8 Pennsylvania American Water -Utilities 0312072 14.88 8 Pennsylvania American Water - Utilkies 04/2012 15.67 10 Pennsylvania American Water - Udlkles 0412012 14.71 11 Pennsyhrenla American Water - Utilkies 0612012 g,77 12 PPL - Utilkies - 0212012 12.16 13 PPL - Utllitlas 03/2012 11.71 14 PPL - Utilities 0412012 12,84 Copyright (c) 2002 form aoriware only The Lackner Group, Inc. Form PA-1600 Schedule H (Rev. 8-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Clark, Deane D 21-11-0056 ITEM NUMBER DESCRIPTION AMOUNT 16 PPL - Utilities 08!2012 4.81 18 Shipley Energy - Utllities for maintenance of real estate 813.48 17 Shipley Oil - UUlltles for maintenance of real estate 402.08 18 The Cumberland Law Journal -Estate Advertising 78.00 18 The Sentinel -Estate Advertising 201.78 20 UGI - UtltliUes - 01/2012 17.03 21 UGI - UdlWes 2/2012 38.83 22 UGI - UtillUes 03/2012 1.87 23 UGI -Utilities 0412012 16.42 24 UGI - Utilities 08/2012 14.44 H-87 3,084.38 ~,,. Copyright (c) 2002 form eoflware only The Lackner Group, Inc. Form PA-1600 Schedule H (Rev. 6-98) Rev+1N2 EX~ (72-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8k LIENS cow~orevE~tni of veraerwnw~ iw+earw+x~r~xAEtum+ aia~oekr kax~Nr ESTATE OF FILE NUMBER Clark, Daane D 21-11-0056 awes aeab xwWna bY1ae eseetlent PNer to esaa~ aut nwWnsa unpsa at ms asb a auM, mewaoo wrarnMaa.e nrAleel.:puwa. (H more spats is needed, additlord pages of ttro same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1600 Schedule 1(Rev. 72-08) acv_uu mac. ~~.au SCHEDULE J 6O1" "~~""'" BENEFICIARIES ESTATE OF FILE NUMBER Clark, Deane D 21-11-0056 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSONISI RECENING PROPERTY DECEDENT (Words) (SSS) I TAXABLE DISTRIBUTIONS [include outright sppousal • distributions, and transfers under Sec. 9116 a 1.2 1 Robert D Brlllhart Friend 100eiG of 417 Valley Strsst Residuary Estate Mechanicsburg, PA 17066 Total Enter doper amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a ro ate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOT AL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE Copyright (c) 2009 form soflwere only The Lackner Group, Ins. Fonn PA-1600 Schedule J (Rev. 11-08) Estate of Deane D. Clark, deceased Estate No. 2012-00056 Re: PA Inheritance Tax Return List of Exhibits A. Death Certificate B. Letters Testamentary issued by Cumberland County Register of Wills on January 13, 2012, including Last Will & Testament of the Decedent dated November 23, 2004. C. Settlement Sheet for Sale of Real Property D. Fulton Bank Date of Death Valuation Letter E. Personal Property Auction Statement HBGD8:129710-1 028205-157187 HIOS.GO> REV 101/0~1 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 17927884 Certification Number ,n rlrv neeoe ~ / rwNr m ~X3wvEXrr a.cx XiI This is to certify that the information here given correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origir certificate will be forwarded to the State Vi. Records Office for permanent filing. /~,,,,,,,, ~ ~ DE~i 3 0 X2011 Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTN • VRAL RECORDS CERTIFICATE OF DEATH (See inatructlons Xllld szemolXn on rsYSrasl ,. srwd a.XXe.X sAdN lb,e. _ .. _ .._ .._ X. OIII tl Dwn I~br~ aa. YrO ~ Deane D. Clark l 7 ma e 1 7 ~4 _5408 Dec.26,2011 9. XX,• Ilal BYOay) Uda 1 IO,eXn 1 & D•b d atle 7. atl•bYa 4 Pbo• d O•di 83 Y... o•e• "°" r.Xr oear va. June 7, 1928 Philadelphia, PA bXXre ^ m / ^ scw ^. swea ^ wtleaaX ^ a.: s,.ely !0. ~a•M d O••0 r dX, sda 7b d cXXY Xa F•c~X Nrn Pndb,aXYm~ Xle•aX•d W ire6er) 9. NW O•XXSrI d wgYar Oe~n7 No vw Is. RXr:MwkXn YNR ebtlc WnXX, •b. Cumberland East Pennsboro Holy Spirit Hospital ~w.b ~ .ba W , l 11.0•eeer•t•UYW tlwaew awd ~.O•MeYX gNdY/a1 g ed9 t21Yw OrNA •ew b M i8 OXXXaeM EaoXw (sXXXIry aiX Xa+•Y a•r mnyXbd) ,I. Marl 8WC Wnbd N•ra MaeXa 1S BuNhg SPaa• @ dl•, OX• nalrn mmX) Xemd Fuuea U s Nla•wE Ob e :Y d n ww•IpWYY warehouse mgr old stora . . , a•X I • l9 BYrd•ry l9,aabuX l?12). CeipX (1J nA). 1 . ge ^Yr w 2 3 widowed ,e °"a."'""'°"a`.wl'e.d.°X,/'a"',"Y°,~°°e•) °'wa.''X Penns lvania °b°.~ar' y 2912 Merion Rd. +Te ^rawwdzeuo.eb T„X, ~d""w°"p 1T`sb" uYO ++ Cam Hill PA 17011 r nv •• ~~~ u er an ,Te.~o ~ uwedrn Camp Hill ~„~ ,s rrew NXew ~Y, mar, Yt.,uXXQ Harry H Clark ,a Ywr• NenwlFFtl, n+eae nwYeeXXewM . Katherine Lyons w. bbmwW. sbw Rw• / PoXA ss bbnwe. Ye~rq Xaaw sa.d. dNlbwA wr. •Is wal Robert D. Brillhart 17 Valle St. Mechanicsbur PA 17055 21a IMYed OI,pwYion ~ ^bawwe ^awtllon 811" ^""°°1bo 9V X,A DY•dd~aXeon QX•nX4 aeX, s•Xp ZIe PIXwtlOYpXXYm Mwadw•MaX. Qa•M•~X SaXwdb•1 tla luwbn (Cw/bw,Yb,eY rrl n 'WiOi""'"a0°'rsiAn°'°'me ^ OXea • ~ H IbeleY Lhrrr/CaaarT ^ Yw^ N• Jan.4 2012 • Rollin Green Cemetery g Camp Hi11,PA17011 T1L YFlM pm•r lapaXw Xe wwdQ XXEllwa•rnpY ~Naw as MawdipN - FD-013163-L Musselman FH&CS,324 Hummel Ave.,LAmoyne,PA17043 p ~b~wt Y~ierr~da~rin tt iotl. dnq rn•XS.ar..ienYa •Yba.ls4+~••ab XW ale. uow. wnh•r zt or slew Nuri. M~wr~ rMXwu•tlerrt ,fit! a R (L z~ 2a r ~ ~~ ~ A w„a, z~. ni. a pert p m rmna.ua M•ds. M. seal / se. wr cr• Y Yndkr Ewd.r / caa. ~ a. w•ei ow mn a.wrn a ourm~ l r} ~ Q f AI. f PM. ~ ^ Yw No cause of XzX~Tx law uumwYae..ne...nr~l..l ~ MXa s1. PY11:6WM~X~a-dXwXeX, b1u44aesipYlua~Nditly a•YMhbM.WNOT enYe YnlaW MrrM raAw•na•4 ~ OrYb Ono ima iw until a e NbY Xae r d r.n . EaYairr htlml n•da9 bYw udeXXbX ruw ynb Ml. Xs d•a• Uw CaibuY b ^Yw ^ParY p X , a x r X e ad eh•eigMArp.WaYy ar our m•wiXw. ~ X ^ N ^ ae~ O~XNbX " e R • Uwuae m~a i w.,X N ewF{ } . ACUTE ~FSPI ~A-To lZy Ff4lwi=r ~ X9.XFUnW: ^ Ou blar•~•4~ulk i Ntl pXawl dYn pYYw u.c _ l T~ Y mldruY,Xal/, s C I~N ~~ST~UIr ~tG ~~T t'~l )t~~ ' ^R•pwldY'Addwb _ . l~ b rar ldW rXw e. 1 lUl~ Ou b (a w s asepan aq: i ~Yr YNpspLYalp C i ^ ~ Yt gpaa die IY ls• `d w c M"Y'~'M ~ ~• ~ ^ du b lw r • m~wiww •h Nol pare, bd agwX q erl• b, r•a a ~ i etloa eM ^ Iievwn 1 P9we den M peY M•r ~WrwNeep•/ PblomuR! XXb. NYr•Adoery iiOge MneltlY Rbrb CaiYWon 3,. MYXwdOra )d. 9r. Drld X~•, 111wX4 atl.Ywl 9Qp..Owob Nal M•YOm.M ~Fwety. ~~&~ d ,/ ' dc...aown ^xaniYd• K~s~ 0. ~(~ / I ^ Yw ~. ^ Yr ^ No ^ Awdae ^ MAq Xw~bn s0L TbY tl F;XY 7r. XlaX tlY/aA7 se. X TwpYYb~ b'XX (~weX/9 J741caeon dHaJ (9eM dry /bau wYl ^ 9daib ^ Gabe Nad OeMwae ^ Yr ^ N• ^ DiMrlOpu•br ^ Peeaga ^ i'•d••Ylw Y ar'AP•ep' >,<hd,aldaaMXwp • ~eXM XM•bb•1PXX•Y/r weX,bXwuwda.w dlw aaXwprpiaw lw paauawee•a as wngbYe lenZt) 9sb s4aba.a,ddC•eYU - /J~J TstlrW de~bia~Yep,4•seexyeMaabtlraw(•lad~ewXrr Wltl_________________________________^ ! j • XrgXa•ia ud welrbs McYxn(Ph/den seapwri4el•M rd ~' b l s9e.lrine•Nwbel s9dow a0w 1YYa4 M.Y••A T•Xr OXrdmX baulmpe,erhownewrewsw.er•.ar Prw,r n•wXWXI ine ...wr•,rm___------_- ^ • XbebY Erwlw,eaaw ------- M D G- 4 8 ~~ • ~ °I . Z /7t l On sr rtl•d•wmneew rtl/a bwdlyetla•bq•Y~e•R ewaewww rertl•r,ep •ne pbr,utl tlrblM meeeyy uk maswd•w. ^ s1.NUr em ManX diawn 1110 Caw•tl OIX4 CwpME Pea ~I TYX•/RM ~• ~7+•• aiX ora - lal ~ la I ~ I ~ I ~~°~8"tT" QA w ,'r~d2~ N L0. pH 17c~i( ~so N 21 ~~(:~P ~+'(( 3 . ~ REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2012- 00056 PA No . 21- 12- 0056 Estate Of : DEANS D CLARK !first, Middle, Last) Late Of : CAMP HILL BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 177-34-5408 WHEREAS, on the 13th day of January 2012 an instrument dated November 23rd 2004 was admitted to probate as the last will of DEANS D CLARK /First, Middle, Lash late of CAMPH/LL BOROUGH, CUMBERLAND County, who died on the 28th day of December 2011 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: ROBERT D BRILLHART who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 13th day of January 2012. n ~~ n A egrs er o / I~l ~d ~ ~ ~J ~~~~ 0/(All ' **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) '~ r~r LAST WILL OF i DEANE D. CLARK ^ CLE= ~ ~ _ ~~i~r!...yrjti..~ ~~ 1: ~wi. i, Ir ',~ C~;~ i ' 11.1' ~A I, Deane D. Clark, of 2912 Marion Road, Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. 1. I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration ofmy Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. 2. I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executor, and all property subject to all such powers shall be included in my Estate. 3. I hereby give and bequeath all of the rest, residue and remainder of my property, real, personal and mixed to: Robert D. Brillhart of 417 Valley Street, Mechanicsburg, Pennsylvania. 4. In the settlement of my Estate, my Executor shall possess, among others, the following powers to be executed for the best interest of the beneficiaries and in my Executor's sole discretion: (a) To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or ~ 1 f~ interest therein, whether owned by me severally or in conj unction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and cleaz of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor in this paragraph 4(a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executor shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets aze distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. (d) To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as she or he shall deem wise, without being restricted to so-called "legal investments". (f) To mortgage real estate and to make leases of real estate. ~- 2 ~,~. b D, (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other. (h) To vote any shares of stock which form a part of the Estate and to otherwise execute all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (j) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by my Executor with respect to any person, profit sharing or other retirement plan in which I am a participant. (1) To do all other acts in judgment of my Executor necessary or desirable for the proper and advantageous management, investment and distribution of my Estate. 5. Any person who shall have died at the same time as Testator or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased him. 6. I nominate, constitute and appoint Robert D. Brillhart to be my Executor. In the event of the death, resignation, refusal or inability of Robert D. Brillhart to serve as my Executor, I nominate, constitute and appoint Anthony J. Foschi, Esquire to serve as Executor. My Executor is specifically relieved from his duty or obligation of filing any bond or bonds. ~L~ U~ ~~- 3 D, D C, IN WITNESS WHEREOF, I, the said Deane D. Clark, hereby set my hand to this my Last Will, typewritten on and consisting of these four (4) sheets of paper, at the bottom of each of the preceding pages of which I also have placed my initi s, on this L 3 day of November, 2004. 1 J ,~~ ~ . Deane D. Clark ~~ / ~~l.a 4 On this 7i~ day ofNovember, 2004, Deane D. Clark declared to us, the undersigned, that the foregoing instrument was his Last Will, and he requested us to act as witnesses to the same and to his signature thereon. He thereupon signed said Will in our presence, we being present at the same time. We now, at his request, in his presence, and in the presence of each of us, hereby subscribe our names as witnesses thereto and have placed our initials at the bottom of each of the preceding pages. By so doing, each of us declares that he believes this testator to be of sound mind and memory. residing at ('~leC.~~,~e,~fa~~Q f~''~ residing at ~~~ ~Q ~-hju;r h'-"~ ~~ residing at !~~~~'j1 ~~~1~'G'~,~~~-- v 172139 COMMONWEALTH OF PENNSYLVANIA COUNTY OF SS. I, Deane D. Clark, testator, whose name is subscribed to the attached foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed such instrument as my Last Will, and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged 7~3 day of November, 2004. before me, by Deane D. Clark the testator, this Deane D. Clark ~' otary ubli My Commission Expires: ANTHONY J0. FOSCHISN~' lower Allen T ., CurbeA°~aridPCounty M Commission sn ~ 1 5 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF We, 1!~ witnesses whose names aze signed to the attached foregoing instrument, being duly qualified~ccording to law, do depose and say that we were present and saw Deane D. Clark, the testator, sign and execute such instrument as his.Last Will; that such testator signed such instrument willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of such testator signed such Last Will as witnesses thereto; and that to the best of our knowledge, such testator was at that time 18 or more years of age, of sound mind and under no constraints or undue influence. Sworn or af£nned to and subscribed before me by b1f ~ 1~4 417,~t-~Ci~ VC~„~ ~ t, je,_„ ice ,,,,,~~ ~~ witnesses, this z ~ day of November, 2004. -~~~~~ WITNESSES: My Commission Expires: :172139 NOTARIAL. SEAL. ANTHONY J. FOSCHI, Notary Public Lower Allen Tw ., C~ rberland County M Commission fires Au st 11, 2005 ~ a,~~ t .~°~~, nrua urn ~~mmat A. B. AN: ---- U S DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1. ,FHA 2. FmHA 3. X CONV. UNINS. 4: VA 5. CONV. INS. . . SETTLEMENT STATEMENT 6. FILE NUMBER: 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: 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 (POC]" were paid outside the Dosing; they are shotvn here for informational purposes and are not included In the totals. 7.0 3/86 (LEMOYNE-2812-MERTON.PFD/LEMOYNE-2912-MERIOWIB) D. NAME AND ADDRESS OF BORROWER: Lemoyne Land Corp., Inc. 319 South Third Street, P.O. Box 31 Lemoyne, PA 17043 E. NAME AND ADDRESS OF SELLER: Estate of Deane D. Clark by Robert D. Brillhart, Exec. 2912 Merion Road Camp Hill, PA 17011 F. NAME AND ADDRESS OF LENDER: Centnc Bank 4320 Linglestown Road Harrisburg, PA 17112 G. PROPERTY LOCATION: 2912 Merion Road Camp Hill, PA 17011 H. SETTLEMENT AGENT: 23-2083839 Kerwin 8 Kerwin, LLP I. SETTLEMENT DATE: June 26 2012 Cumberland County, Pennsylvania Tax Parcel No. 01-20-1854-089 PLACE OF SETTLEMENT Centric Bank - 1625 Market Street Camp Hill, PA 17011 , 101. Contract Sales Price 151,000.00 _ 401. Contract Sales Price 151,000.00 102. Personal Pro 402. Personal P 103. Settlement Cha es to Borrower Line 1400 3,404.75 403. 104. 404. 105. 405. 106. Sewer Bill 06/27!12 to 07/01/12 6.59 406. Sewer Bill 08/27/12 to 07/01/12 6.59 107. Coun Taxes 06/27H2 to 01/01/13 404.48 407. Coun Taxes 06/27/12 to 01/01/13 404.46 108. School Taxes 06/27/12 l0 07/01/12 20.36 408. School Texas 06/27/12 to 07/01/12 20.36 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 154,836.16 200. AM U P D Y OR I 8 RROWER: 420. GROSS AMOUNT DUE TO SELLER 500. REDO T NAM NT DUET SELLER: 151,431.41 201. De it or earnest mone 15,100.00 501. Excess De sit See InsWctions 202. Prins al Amount of New Loans 120,800.00 502. Settlement Char es to Seller Line 1400 2,317.41 203. Existi loans taken sub ect to 503. Exisfin loans taken sub' ct to 204. 504. Payoff of first Mortgage 205. 505. Pa ff of second Mort a e 2~• 506. De sit retained b seller 15,100.00 207. 507, 208. 508. 209. us ens or ems n a e er 509. us ens or ems n / e er 210. Sewer Bill to 510. Sewer Bill to 211. Coun Taxes to 511. Coun Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. ~ 515. 216. 516. 217. 517. 218• 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 3 L NT R W 135,900.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 0 . AT SETTLE NTT FRO EL 17,417.41 301. Gross Amount Due From Borrower Line 120 302. Less Amount Paid 8 !For Borrower Line 220) 303.. CASH X FROM TO BORROWER TL. ..~J~~, J1--1~.. , .,_~_l _._. _e 154,838.16 ( 135,900.00 18 936.16 601. Gross Amount Due To Seller Line 420 602. Less Reductions Due Seller Line 520 603. CASH (X TO ] ( FROM SELLER 151 431.41 ( 17,417.41 134,014.00 ...~~.~.v..~...........~ .................y.. ,..w,r.. v, v wu.r.,mw wNr u, Nayva w~ u~ uns Borrower Lemoyn gd{~forp-_~s-- _r""~"~ ~~~~ Michael R , sl ent a any aaacnmen[s rererrea to nerem. Seller Estate gLL~eane D. Cle[k Robert D. Brilihart, Executor HUD-1 (3-88) RESPA, HB4305.2 PAID FROM PAID FROM Division of Commission line 700 8S FOIIOWS: BORROWER'S SELLER'S t0 FUNDS AT FUNDS AT 702. ~ 10 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704, to oen n tnation ee ° to 802. Loan Discount % to 803. Documentation Fee to Centric Bank 250.00 804. Fk>od Certification to Centric Bank 19.00 805. Wire Transfer Fee to Centric Bank 25.00 806. Mori a e Ins. .Fee to 807. Assumption Fee to 808. Fkxxi Certificate 809. 810. 811. 901. Interest From 06/26/12 to 07/01/12 (a~ $ /day ( 5 days %) 902. Mo a e Insurance remium for months to 903. Hazard Insurance Premium for 1.0 are to 904. 905. 7001. Hazard Insurance months $ er month 1002. Mo a e Insurance months $ er month 1003. Sewer Bill months $ er month 1004. Coun Taxes months $ er month 1005. School Taxes months Q $ per month 1006. months $ er month 1007. months $ per month 1008. months er month 1101. Settlement or Ck~sin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Attome s Fees to Shumaker Williams PC POC:S0.00 1105. Document Pre aretion Deed to 1106. Note Fees to Kerwin & Kerwin, LLP 20.00 10.00 1107. Attorney's Faes to includes above item numbers: 1108. Title Insurance to Stewart Title Guarant Com an 1 113.75 includes above item numbers: 1109. Lender's Covere e 1 0,800.00 963.75 1110. net's Coverage 151,000.00 150.00 1111. Endorsements? ,00,710,900 to Stewart Title Guaranty Company 00.00 1112. Incoming Wire Fee to Mid Penn Bank 10.00 1113. Closin Service Letter to Stewart Title Guarant Com an 75.00 1201. Recording Fees: Deed $ 63.00; Mort a e $ 76.00; Releases $ 139.00 1202. Cit /Coun Tax/Stam s: Deed 1,510.00• Mo a e 1,510.00 1203. State Tax/Stam s: Deed 1 510.00; Mo a e 1,510.00 1204. 1205. Ass' nment of Rents to Recorder of Deeds 23.00 1301. Surve to 1302. Peat Ins action to 1303. Ovemi ht Fees/Posta a Fees to U.S. Postmaster 20.00 1304. 2012 Coun /Boron h Taxes to Janet Miller, Tax Collector 787 41 1305. Tax Certification ~ to Janet Miller, Tax Collector 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K 3,404.75 10 00 2,317.41 By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this t/wo-page statement. v ~ Certified to be a true copy. Kerwin & Ke Settlement nt (LEMOYNE-2572-MERTON 1 LEMOYNE-2912-MERTON 116 ) S€P, 14.2012 11;SbAM FFC COMMERCIAL CREDIT September I4, 2012 Thcker Arensberg Attorneys 2 Lemoyne Drive Suite 200 Lemoyne, F.A, 17043 Dear Mr. Siney, ~~ ~~ LISTENING 15 JU5T THE BEGINNING.' RE: Deane D. Clark, deceased Decezuxber 28, 2011 N0, 808 P, 2 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following account was open at the date of death.: Checking #2219-36376 bate of death balance $12,879.26, opened 9/5/96, titled in her name alone with Robert D. Brillhart as Fower of Attorney If you have any other questions, please feel fine to contact me at (717) 327 2497. Sincerely, ~a 3oshua A. Crroff Credit Confirmation Processor This inftri?ta;i4n is f~~rnishe-d as a matter C!husinses c t1R2Sy in ansu~ !n ,~acr iregus~; nn!! is for your cbn5 3ntiai uSZ only, The Dank furrise!~?9 !his ;n;e!m,ti4n Goes not re; r::sa,^t Gr gUar9nt9e the a~~DUr2ey..a^'NietE'less c?r ra!iEi:i}!ty st =ha intormatevrt „aviLer~. No r8:~^."obi;:ty ds Etssufr,•~°G by ;he 5a?~c or arty o? ns of€icers, 2r*.plo}fees or a~,srts. A,n y cY~nian it$reis) ~xpre9s9d is sbj9ct to c"an~8 :~-i?hou? ngtipa 1.800.FULTpN_4 • fultonbank.com Falran Bank, NA Mvm4or FDIC. Member of chc Fulwn Fx~andal FantilK ,^ Little II~E Eichelberger, Auctioneer Dillsburg, PA 17019 Phone Number (717) 432-0006 PA License # AU. -001954L -/~S atement of Public Sale Held For EI~ENSES Advertising ..................................... -•---............... T ~ ~~ Insurance ...................:........................................ ... ° 1~~~' 39 Auctioneer's Commission.~~ ~~' ................................. oJ ~ Cl7 Real Estata Commission..{.. `~?.....~~~ ~. ~~ :.............. _ .%O~© . Clerk's Commission ................................................ Runners Pay .................................................................. c~ ~ ~ . C(0 ' 4FQ1 ~'~t~--, I n MisceIlaneous ExpensesS4~. ~~. ~. ~.~J.~~ ........:.........~Y' •~QJ~ ~ ~ Total Ezpense .............................................»........»...~Q ~ ~~ RECEIPTS Gross Sale .......................................................... ~ d ~~ Q c~ Less Expenses ....................:............................... C~('~,~Z .~ . Less UncoIIected Amount ......................................... Total Net.of Sale ...................................:............... W ~ ~~.. ~ ~D I received s~0~<.a~-.~ from proceeds of the listed salt on "~" ~ ~ ~~~~ ~ ~ Sigaatur Date " ~~ ~ ~---