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Home My WebLink About09-24-121505610105 REV- i, 5 oO EX (o2-ii) (FI) J.1 / ; ,,~ ~ j ~~-`'„"~ ~~ OFFICIAL USE ONLY PA Department of Revenue pennsylvan DEPhRinEHi Df RCVCHUf Coun Code Year File Number Bureau of Individual Taxes tY PO BOX 280601 INHERITANCE TAX RETURN 21 12 0045 Harrisburg, PA 1128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 164-28-0438 12/28/2011 02/07/1935 Decedent's Last Name Suffix Decedent's First Name MI Keller George W (tf 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 CIS 1. Original Return O 2. Supplemental Return p 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Com romise date of p ( O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Jane M. Alexander (7171 dR7~R1d First Line of Address 148 S Baltimore Street Second Line of Address City or Post Office State ZIP Code Dillsburg PA 17019 ~"~ ~ =.' REGISTER S USE OI~IL~' C/a C~ _ '~ '_z" a~ -' ~ _. ..p ~y ~ .~ ITATE FILED rv -`O Correspondent's a-mail address: 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 PERSON RESPONSIBLE FOR FILI G ETURN DATE , AUUKE55 _ - 273 Camp Ground Road, Dillsburg, PA 17019 SIGNATU~2E O~REPAR~ O~±~I~R~ A~iC=~PV~TI C~%~'--~~~~/ n/ ~j~ ~ `'/ ~-- 148~IBaltimore Street, [~illsburg, PA 17019 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 J 1~ r--~ ~~.. •: 7 1 ,.'r; ~~ ', ~J t"1'7 '",~,~ h~) 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: George Wade Keller 164-28-0438 RECAPITULATION 1. Real Estate (Schedule A} ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C} ..... 3. 4. Mortgages and Notes Receivable {Schedule D) ........................... 4. __ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6,364.01 6. Jointly Owned Property {Schedule F} O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets {total Lines 1 through 7) ............................. 8. 6,364.01 9. Funeral Expenses and Administrative Costs {Schedule H) ............. ...... 9. 960.57 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 9,434.25 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 10,394.82 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. -4,030.81 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. -4,030.81 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 16. Amount of Line 14 taxable at lineal rate X .0 __ 17. Amount of Line 14 taxable 15. 16. at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 0.00 __ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1,50561,0205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 2112-0045 DECEDENT'S NAME George Wade Keller STREET ADDRESS 66 Ashburg Drive Apt. 108 CITY Mechanicsburg STATE ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _____ _ ___ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5) 0.00 0.00 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. Ditl 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}]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. i ~~ ~aenns~~van~~ L DEPARTf~!ENT OF REVENUE ~'AC,~f ~~~~ ®E~~sITS 41_ WITG"~a iNHERiTANCE TAX RcIURN ~~~s~~~L ~~~P~~T~ RESIDENT DECEDENT ESTATE OF: FILE NUM~EFt: George Wade Keller 2112-0045 Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly awned with right of survivorship must be desclosed on Schedule F. If more space is needed: ~~se additional sheets of paper of the same size. ._ ...~.. X11 Rol~t~e ~S ~V, Dills~l«-~; ~~~ ~°~~ } ~ ~~ ~ ~~~?~~~~~ ~ ~ ~- X918 ~ ~~~,~esseislisedccro°s.c~~~r~r ~_~_._,___.. i ;` ,~ ~. %~ ~n l t / .. 1 / _~ ~~ ~.. , ~_.. ~ e T r; ,! ~~ ~ ~~~'~ ...-~ ~` 1, f l ,. .__ N W- ____ * __._. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www. mem tiers 1 st.org Main Switchboard: (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext_ 5312 TeleBranch: (800) 237-7288 3288 1 AV 0.350 11286-3288 I.,~III~~~III~„~~~III~I~~I~I~~~I~~I,I„I,~I~Il~e~l~~ll~~~ll~l GEORGE W KELLER C/O DEBRA HUBBARD, EXECUTRIX 273 CAMPGROUND ROAD DILLSBURG PA 17019 Statement of Accounts Dec 25, 2011 thru Jan 24, 2012 Account Number: 70016 Balances at a Checking : Savings Certificates Loans: Money Manac Swipe 5 YTD Glance 0.00 5.00 0.00 3,061.85 dement : 0.00 Reward : 1 .45 Page : 1 of 3 Your current Member Loyalty Rewards level is Silver. Your aggregate balance as of January 1st is $10,462.64. An aggregate balance of $15,000 and having 3 products will move you to the Void level. Want to earn some extra cash? Take advantage of our CASH4U referral program. Ask an associate for details. CHECKING ACCOUNTS 0011 -CHECKING Dec 25 "°"°"`'""" "~'~"~'""" Ba/ance Forward ~ Additions Subtractions glance Dec 31 Deposit Swipe 5 Rebate 0.35 243 86 -~ ~ -, Jan 03 Deposit Transfer From Share 0000 352.21 596 42 Jan 03 Deposit Transfer From Share 0000 1,119.20 . 1 715 62 Jan 03 Withdrawal Transfer To Share 0000 1 129.20- , . 586 42 Jan 05 Withdrawal , 437.12- . 149.30 OFF SET PSL Jan 05 Withdrawal 149.30- 0.00 CHECK/NG C/osed "'This is the fina/ statement presenting information on this product''"' '` "' Please retain this final statement for tax reporting purposes " * '' 20» Dividends Paid 0.00 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Dec 25 Ba/ance Forward er 75 _ ~5 - Dec 31 Deposit Dividend 0.250% 0.02 75.17 Annua/ Percentage Yield Earned 0.320"/o from 12/01/20 > 1 through 12/31/20 / Jan 03 Deposit ACH FOOT LOCKER INC. 352.21 427.38 TYPE : PAYMENT ID : 1371575540 CO : FOOT LOCKER INC . Jan 03 Withdrawal Transfer To Share 0011 352.21- 75.17 Jan 03 Deposit ACH XXSOC SEC 1,129.20 1, 204.37 ID: 3031036030 CO: XXSOC SEC Jan 03 Withdrawal Transfer To Share 0011 1,119.20- 85.17 Jan 03 Deposit Transfer From Share 0011 1,129.20 1, 214.37 Jan 03 Withdrawal ACH XXSOC SEC 1,129.20- 85.17 MBR DECEASED RTN AS R15 Jan 05 Withdrawal 80.17- 5.00 Jan 24 Ending Ba/ance 5.00 - - - Continued on following page - - - REG'-x511. EX-i- ;LCD-0'?;z -i ~ pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER George Wade Keller 2112-0045 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: ~' Auer Cremation Services 584.07 B, 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name{s) of Personal Representatives} Street Address City Year{s} Commission Paid: State ZIP 250.00 2. Attorney Fees: Jane M Alexander 3, Family Exemption; (If decedent`s address is not the same as claimant's, attach explanation.) Claimant None Claimed Street Address City State ZIP Relationship of Claimant to Decedent a. Probate Fees: Register of Wills, Ctunberland County 101.50 5. Accountant Fees: 6, Tax. Return Preparer Fees: ~~ Amy Hambright- Notary Fees 15.00 8. Filing of Inheritance Tax Return 10.00 TnTAL (Also enter on Line 9, Recapitulation) $ 960.57 If more space is needed, use additional sheets of paper of the same size. V ~R R~~iATII~I~ ~~R~I ~ ~~~ ~~ PENN ~~~~ANIA I.N. 4100 Jonestown Road, Harrisburg, PA 17109 1-800-720-8221 Fax 1-717-541-9943 Shawn E. Carper-Supervisor Charges are only for items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items you have not selected, we will explain the reasons in writing below. If you have selected services that may require embalming, you may have to pay for embalming. You do not have to pay for embalming that you did not approve. Embalming is not required for duect cremation or immediate burial. Embalming is not required by law, except in certain special cases. If you are charged for embalming, we will explain why below. STATEMENT OF GOODS AND SERVICES SELECTED ~ `" ..Date of Death tDate of Arrangements $\ A j. t~.< } ! L! [ Charge to: .-~ .v . ,. ~:. ,1 4. :.a, ~ ., :.. , ~ .M. ,.,. a ~~- . 4.d a ..: •'. a , _. .C. , ... , ~! __. .. - .. .. 5 Name .vaoress City State Zip Code Phone Number A. SPECIAL SERVICES: D. AUTOMOTIVE EQUIPMENT: .; , ~.: Direct Cremation ................ - `' ' . . ••••••••••• ~•••~ Removal Venicle.... _ _ _ Nationwide Guarantee Program ............... Lead Car and/or/Clergy Car.. _ Worldwide Travel Protection ............... Family Car (Sedan or Limo). TOTAL SPECIAL CHARGES .................. ' '`' Service Vehicle.............. .., E ....:. . .. . TAL OF AUTOMOTIVE EQUIPMENT........ B. PROFESSIONAL SERVICES: .,: , ~ ~..: +..: F~... . Services of Funeral Director and Staff... '~~ `V" ' ' `~' ' ~" Dressing and/or Cosmetizing .................. Facilities and Staff for Memorial Service...... Crematory Charge .............................. ~~ t.~ ~t.... ~n ~ ~. Staff and Equipment for Memorial Service.. Private ID Viewing .............................. Witnessing the Cremation ..................... Packaging and Forwarding Cremated Remains by Registered Mail .................. Personal Delivery of Cremated Remains..... Scattering of Remains over Land or Sea...... TOTAL OF PROFESSIONAL SERVICES....... ~~' ~`~ ' ~` "' C. MERCHANDISE: Register Book .................................. . Memorial Folders/Prayer Cards ............... Thank You Cards....... ~,. ,...Y~.. Rememberance Package. W:'.•~='.~ . ~. `:~ ~:°~ `. " Urn(s).':-:. ~71 r ~~~• ~ ~' /'~ r,e''r -'.. ~r 1 'r (Description) ~ :. ~-~ ~ ~~ a ... 4~ 4~ ~ - ~ r _, ° , ~, . ~ x r ~~.. Urn Burial Vault Container .............. ~--` ~ ~ --' • ' ~~~~ ...... ,~..~r_. (Description) Veteran Flag Case ................................. Grave Marker/Monument ........................ `i : f.., 4:'? 1 ~~ C~. ~ I. f~'1 "d"1 4 V . c7 ~a 9 .. `~ 1 ! : ;C7' ~, TOTAL MERCHANDISE `'''•` `'s" E. CASH ADVANCE ITEMS: Grave Opening .................................... Cemetery Equipment ............................. Newspaper ,., Newspaper .,. Newspaper ,,, Clergy ................. ..... Church/Sexton/Organist/Soloist ................ . F 1 owers .............................................. . County Coroner Fee ............................... ..._ ~.~ . ~;, ,,,- Certified Copies of the Death Certificate....... ...... :~ v, w~ ;:~ ~, TOTAL OF CASH ADVANCES ....................... SUMMARY OF CHARGES: pedal Charges . ............................. ' : y, ~ry ;~Ji B. Professional Services .......................... C. Merchandise .................................... D. Automotive Equipment ............................ .. , E. Cash Advanced Items ......................... ~~ ~ ~,~ SUBTOTAL ................................................ .~ ~ ; _ ;:. , ~. CREDITS ..................................................... ~ ~~ .., ~s .. . N TOTAL DUE ................................................ , ~, , ,;,, PAID .......................................................... jY BALANCE DUE ............................................ Because our packages are sold at a reduced fee, no refund will be given for changes. If any legal, cemetery, or crematory requirement has required the purchase of any of the items listed above, we will explain the req irem»n~ below. . _ ~.~l~.I~ .. .. , . . ~ 1T1 .I. I"? ^ ~ ~i °1 _ ~. ~..._~ l.t ~. ;` ~ ~ t ~ ~ \ ~ { ._..- t- ~+x:".' .1 , ~ 'a! ,' _ ~` __ .. ~ E, "K°` e:~ _r, f1 ~ X -~-~- _ ~~ o ~ I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. acknowledge receipt of a copy of this Statement of Goods and Se -, iced elected. I repr-psent that I have sufficient funds available for payment of the cash price for the ~~ z goods and services selected... I ~l~o~_agree to make payment of $, .., , within days. I agree to be jointly and severally liable with anyone else who signs below. A late charge of "- • -~ ' per month amounting to °` "'" per year will be applied to the unpaid balance beginning days from the date of this agreement. I will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement will be considered part of this agreement and the cost thereof will be reflected on the final bill or statement. (Seal) (Seal) ~;'r tU l:llaJC1-/ ¢ ~,.' > r~ ! (Licensed Funeral Director) (Date) ~} 1 t d ,~ ~ ,/ ,~ r ~-..: (T~atel RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 1/11/2012 Cumberland County - Register Of Wills Receipt Time: 13:49:49 One Courthouse Square Receipt No.: 1068358 Carlisle, PA 17613 KELLER GEORGE WADE Estate File No.: 2012-00045 Paid By Remarks: JANE ALEXANDER HEA ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 45.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 5223 ---------------- $101.50 Total Received......... $101.50 si~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAY, RETURPd MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Georae Wade Keller 2112-0045 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses, If more space is needed, insert additional sheets of the same size, ~ Send Inquires to: 5000 Louise Drive Main Switchboard: (800) 283-2328 ~ PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 DeC 25 , 2011 thru Jan 24 2012 MEMBERS t°~ Mechanicsbur , PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 9 iizs~-3zss Account Number: , 70016 `~""""`°'~°"'°" www.memberslst.org TeleBranch: (800) 237-7288 Page : 2 of 3 Date Transaction Description Additions Subtractions Balance - 20 > > Dividends Paid 0.16 LOAN ACCOUNTS - * .._ 0014 -USED VEHICLE N __ Date '" Transaction Description Amount Interest Fees Principal Balance = Dec 25 Ba/ance Forward 5 , 677.52 `"_- Jan 17 Payments 5,765.45- 76.30 11,63 5,677.52- 0.00 W - USED VEHICLE C/osed ° ' *'`7his is the final statement presenting information on this product'''''' * _ ' * * Please retain this final statement for tax reporting purposes "'` 2011 /nterest Paid 453.13 0016 -UNSECURED Date Transaction Description Amount Interest Fees Principal Balance Dec 25 Ba/ance Forward 3 , 232.79 Jan 05 Payments 149.30- 58.53 0.00 90.77- 3,142.02 Jan 05 Payments 80.17- 0.00 0.00 80.17- 3,061.85 Jan 24 Ending Ba/ance 3 , 061.85 Annual Percentage Rate 10.490% Daily Rate .028739% 2011 /nterest Paid 379.59 0015 -PERSONAL SERVICE LOAN Annual Percentage Rate : 11.000% Variable Rate PAYMENT INFORMATION Previous Balance : 433.20 New Balance : 3,061.85 Minimum Payment: No Payment Due Payment Due Date : No Payment Due. Next Payment Due Date After Statement : No Payment Due Balance Eff Subject to Interest Late Interest Date Transaction Description Amount Charged Fees Principal Rate *" Jan 05 Payments 437.12- 3.92 0.00 433.20- 0.00 OFF SET FEE SUMMARY TOTAL FEES FOR THIS PERIOD 0.00 - - - Continued on reverse side - - - N r1 O N N e-1 O w 4-1 O a r-1 O O O O O O O l0 lf~ r O N 0 0 N ~-- O N N O `"'i N N O r-1 r O N O ~ ~ N O1 r r u O ~ G4 ~+ O w ° o ~ W o ~ ~ a -~ ~ U 1' ~-, .. 4-, to o ,•- ~ ri o ~ ~~ ~ ,t ` O ¢~ lf1 O 00 O N M to 0 00 O O O ri lf1 O ~ O • O O 11 •-I d~ O N [~ O O '~ l~ O O N \ 01 ri O M M a v p ~ M \ ,~ ~ M .. O ~ ~ W c~ (h ~I Q ~ 4-1 W ~ M ?r O1' a ~ (~ W "' ao .. .. o +~ ~ U a ,~ ~ ~ ~ w ~ ~D PU Jti N (~ ~ H J-1 ~ H a Q ~ a ~ 0 ~ ~ ~ .. 0 °~ ' ~~ a A u ~ -~ v ~~ 0 L(~ r O N M O r O O O O O O 0 cYi 0 0 0 N O O O r O c Q m H N U ~--• ~ N ~ N ~ ~ ~ C C t~ N ~ ~ H I~ ai,.` ~1 W ~~-+.4 "~~. Send Inquires to: 5000 Louise Drive Po BOX 40 Mechanicsburg, PA 17055 wwvy.membersl st.org Main Switchboard: (800) 283-2328 EZ call: {717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (800) 237-7288 3288 1 AV 0.350 11286-3288 l...lll,,,lll,,,,,,t-1.l..1.l,,,l„1,~~,1„l,l~,,,l„ll,,,l-,l GEORGE W KELLER C/O DEBRA HUBBARD, EXECUTRIX 273 CAMPGROUND ROAD DILLSBURG PA 17019 Statement of Accounts Dec 25, 2011 thru Jan 24, 2012 Account Number : 70016 Balances at a Glance Checking: 0.00 Savings : 5.00 Certificates : 0.00 Loans: 3,061.85 Money Management : 0.00 Swipe 5 YTD Reward : 1.45 Page : 1 of 3 Your current Member Loyalty Rewards level is Silver. Your aggregate balance as of January 1st is $10,462.64. An aggregate balance of $15,000 and having 3 products will move you to the Void level. Want to earn some extra cash? Take advantage of our CASH4U referral program. Ask an associate for details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Dec 25 Ba/ance Forward 243.86 Dec 31 Deposit Swipe 5 Rebate 0.35 244.21 Jan 03 Deposit Transfer From Share 0000 352.21 596.42 Jan 03 Deposit Transfer From Share 0000 1,119.20 1,715.62 Jan 03 Withdrawal Transfer To Share 0000 1,129.20- 586.42 Jan 05 Withdrawal 437.12- 149.30 OFF SET PSL Jan 05 Withdrawal 149.30- 0.00 CHECK/NG Closed * *'7his is the final statement presenting information on this product'`'` * * * * P/ease retain this final statement for tax reporting purposes * * * 201 > Dividends Paid 0.00 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Dec 25 Ba/ance Forward 75.15 Dec 31 Deposit Dividend 0.250% 0.02 75.17 Annual Percentage Yie/d Earned 0.320"/o from 92/0 x/2017 Through 12/31/20 ~ 9 Jan 03 ~ Deposit' ACH FQOT L ,~IIIgI,C~: 32:21 427.38 _ =-~RT~'PL ~1'~Al'M~f~~ `F'4~1~75540 C0: FOOT' LOCKER INC. ,fd ~ :1tll~itl~~~fi'"~f-a'i•`r$f~r"`fo ~Share'~ 0(?11: ,, 352.21=- 75.17 Jan 03 Deposit ACH XXSOC SEC 1,129.20 1, 204.37 ID: 3031036030 CO: XXSOC SEC Jan 03 Withdrawal Transfer To Share 0011 1,119.20- 85.17 Jan 03 Deposit Transfer From Share 0011 1,129.20 1,214.37 Jan 03 Withdrawal ACH XXSOC SEC 1,129.20- 85.17 MBR DECEASED RTN AS R15 Jan 05 Withdrawal 80.17- 5.00 Jan 24 Ending Balance 5.00 _ _ _ f :nntini iPri nn fnllnwin~ nacre - - - x ~ a ~~ r.iYaR ~ '9 ~ -k~ _. - - ~~~~ ~~ REAL ESTATE SERVICES e-~~ CJcI-Y l~ ~ aN 1 The Estate of George Keller c/o Debra Hubbard 273 Camp ground Road Dillsburg, PA 17019 RE: 66 Ashburg Drive Suite 108 To the Estate of George Keller: Enclosed is the Security Deposit Transmittal for the above referenced apartment. As you can see, $218.59 is owed at this time. To avoid further action, please remit payment by cashier's check or money order, made payable to SS Gardens LP, within fifteen (15) days of the date of this letter. Please mail the payment to: SS Gardens LP 146 Pine Grove Circle, Suite 200 York, PA 17403 Please cal! me at 717-718-2995 if you have any questions. Sincerely, ---~_ Jod~ Rosier Collections Manager Springwood Real Estate Services Agent for SS Gardens LP Enclosure R/Letters/LETTERS MANUAL/Collection Letters/Collection Letter 1 -Estate - Conv or After ls` Year Rev. 11 /3/ 10 Property of Springwood Real Estate Services ® Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ,7 BENEFICIARIES ESTATE OF: FILE NUMBER: George Wade Keller 2112-0045 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. I Gary C. Schreiber ~ Stepson ~ 100% of residue 8 East Main Street, Apt. 3, Shiremanstown, PA 17011 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 TAX IS NOT TAKEN: 1. N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. N/A 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. LAST WILL AND TESTAMENT I, GEORGE WADE KELLER, of the Township of Silver Spring, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revol:ing and n~al;ing oi~ all fon:~:,r wins and codicils b-y me at anytime heretofore n;ade. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated unto my wife, namely, MARIE KELLER, if she survives me by as many as sixty (60) day, absolutely and in fee simple. THIRD. If my wife, namely, MARIE KELLER, does not survive me by as many as sixty (60) days, then and in that event, I give, devise and bequeath my entire residuary estate unto my step-son, namely, GARY C. SCHREIBER, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my wife, namely, MARIE KELLER, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint GARY C. SCHREIBER, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, GEORGE WADE KELLER, have hereunto set my hand and seal to this my Last Will and Testament, which consists of two (2) typewritten pages to each of which I have affixed my signature this 24`x' day of May, A.D., Two Thousand Seven (2007}. (SEAL) G OP.GE `~~jAD KELLER LAW OFFICES SNELBAI<ER ~ BP,ENNEMAN. P.C The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by GEORGE WADE KELLER, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. 2.C-~--- COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND ,~' , ~~~-`ter -~ L.J l SS. We, GEORGE WADE KELLER, RICHARD C. SNELBAKER and JANE J. GOONEY, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~ Te ator ;' t ness i fitness .,~v °~,'~> r .A ~.. Subscribed, sworn to and acknowledged before me by GEORGE WADE KELLER, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. GOONEY, the witnesses, this ~ '/'`' day of May, 2007. ~,- LAW OFFICES "~ 1 ~.. W~ ,! ~~{ ~ ~~ f ~~ `~t t~---- n is - SNELBAKER Lt l Notary PUb11C BRENNEMAN. P.C. -2- COMMONWEALTH Or PENNSYLVANIA Notarial Seal Susan L. Matrazi, Notary Public Mechanicstwr~ 13oro, Cumbefi2nd County My Commission Fires Nov. 24, 2007 Member, Pennsylvania Association of Notaries ~:,,