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HomeMy WebLinkAbout09-19-12 (2) 1505610143 REV-1500 Ex (o,-,o> OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 12 0134 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 202 20 2841 OZ 18 2012 Decedent's Last Name Suffix DONOVAN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Date of Birth 10 24 128 Decedent's First Name MI BETTY J 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 prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required 6 Decedent Died Testate (Attach Copy of Will) ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. between 12 31 ~~and~tl(datge5~f death ~ 11, Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A WEIGLE ESQUIRE 717 532 7388 First line of address 126 EAST KING STREET Second line of address City or Post Office SHIPPENSBURG State ZIP Code PA 17257 REGISTER WILLS USF:~'NLY N ~. ~ ~ ~ !~ ~k . ~!~-. • C!%, _ ..... .. ~ ~ ~ D LED ~!? ]y __.. `- 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. SIGNA RE QF PERSON RE ONSIBLE FO ,FILING RETURN DATE ,~~ ; ../ .~ 1 ., ~--e,~., l "1C,~-->C,~~ Dixie Lee Coons ADDRESS' ~h~ ei;~s'~u,r 1~~~~ 9 Fur ace Hollow Road PA B7 SIGNA R OF PREP R R THAN EP S A -IVE DATE ~' `~ Jerry A. Weigle Esquire ~--1~_ ~,~ 126 East King Street, Shippensbur~,~PA 1505610143 Side 1 1505610143 ~. ~ ~,~, J REV-1500 EX Decedent's Name: DOtIOVatI, Betty J. Decedent's Social Security Number 202 20 2841 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 9 2, 7 8 0. 0 0 2. Stocks and Bonds (Schedu-e B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4. 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 2 0 , 8 6 7 . 4 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 8 , 0 0 8 . 8 0 7. Inter-Vivos Transfers & Miscellaneous f~on; Probate Property arate Billing Requested Se 7 ............ p (Schedule G) ^ . 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 121 65 6 .27 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10 , 3 4 4 . 3 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 2 , 8 7 5 • 2 7 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 13 , 219.63 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 10 8 , 4 3 6 . 6 4 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. 10 8 , 4 3 6.64 , TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 10 8 , 4 3 6. 6 4 1 s. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18. at collateral rate X .15 . 19. Tax Due ........................................................ ......................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 1505610243 0.00 4,879.65 0.00 0.00 4,879.65 J REV-1500 EX Page 3 Decedent's Comalete Address: File Number 21-12-0134 DECEDENT'S NAME Donovan, Betty J. STREET ADDRESS 416 West Main Street CITY STATE Walnut Bottom PA ZI P 17266 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 4,400.00 231.58 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 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) 4,879.65 4,631.58 248.07 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 :............................................................................... x b. retain the ri ht to desi Hate who shall use the ro ert transferred or its income :.................................. ^ ^x 9 9 P P Y ^ c. retain a reversionary interest; or ............................................................................................................... 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? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? .................................................................................................................. x 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 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)]. 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. ~ Rev-1502 EX+ (11-08) ~, SCHEDULE A t , ~ ~ REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Donovan, Betty J. 21-12-Q1~4 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 which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) z Rev-150r~ EX+ (6-98) ~ SCHEDULE E ,fi . r .~ ,~ ~ . CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donavan, Betfy J. 21-12-0134 Include the proceeds of litigation and the date the proceeds were received by the estate . A!I property jointly-owned with the right of survivorship must be disciosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Century Link -refund at cancellation 9.05 2 Commonwealth of PA -final pension benefit 273.53 3 County Tax Proration at real estate settlement 115.52 4 Elizabethtown Insurance Company -refund at cancellation 24.09 5 J. C. Taylor Insurance -refund of auto premium 47.00 6 PA Department of Revenue - 2011 property tax rebate 500.00 7 PA Treasury Department -state income tax refund 96.00 8 School Tax Proration at real estate settlement 1,033.05 9 U. S. Treasury - 2011 federal income tax refund 169.00 10 United Healthcare Services -refund 36.60 11 M & T Bank Checking Account 32906 4,206.65 Accrued interest on Item 11 through date of death 0.00 12 M & T Bank Checking Account 71222 92.98 13 1969 Chevrolet Chevelle Malibu 7,550.00 14 2003 Chevrolet Cavalier Sedan 4,964.00 15 Personal Property -per appraisal 1,750.00 TOTAL (Also enter on Line 5, Recapitulation) I 20,867.47 . (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1501 EX+ (6-981 ~ t ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Donovan, Betty J. 21-12-0134 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Dixie Lee Coons ADDRESS 9 Furnace Hollow Road Shippensburg, PA 17257 RELATIONSHIP TO DECEDENT Daughter B. 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 ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 10/21/2002 Adams County National Bank Certificate of 16,000.00 50.000% 8,000.00 Deposit 160483 -opened 10-21-02, joint with Dixie L. Coons, daughter A 10/21/2002 Accrued interest on Item 1 through date of 17.59 50.000% 8.80 death TOTAL (Also enter on Line 6, Recapitulation) I 8,008.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) ~ REV-115y1 EX+(10-06) ~ ~, COMMO ERITANCE TAX RETURNANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Donovan, Betty J. 21-12-0134 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT ~JUMBER ,Q. FUNERAL EXPENSES: B. 1 See continuation schedule(s) attached ~ 1,660.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s1 Commission oaid State Zia 2, Attorney's Fees See continuation schedule(s) attached 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationshio of Claimant to Decedent 4,000.00 4. Probate Fees Register of Wills, Cumberland County 277.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 4,406.86 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 10,344.36 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Donovan, Betty J. 21-12-0134 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Coons Garage -opening and closing grave 1,170.00 2 Cumberland Memorial Gardens -engraving 490.00 H-A 1,660.00 '' Attorney Fees 3 Weigle & Associates, P.C. -partial payment of attorney fee 2,000.00 4 Weigle & Associates, P.C. -balance of attorney fee 2,000.00 H-B2 4,000.00 Other Administrative Costs 5 Ausherman Brothers Real Estate -appraisal of real estate 300.00 6 Commonwealth of PA -transfer of Chevelle 103.50 7 Cumberland Law Journal -advertising Letters Testamentary 75.00 8 Donna Brobst, Tax Collector - 2012 real estate tax 280.01 9 Kough's Oil Service 187.96 10 Kough's Oil Service 90.44 11 Linda K. Klein -notary fee 20.00 12 Lowe's -dehumidifier for real estate 238.48 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Donovan, Betty J. 21-12-©134 ITEM NUMBER DESCRIPTION AMOUNT 13 News Chronicle -advertising Letters Testamentary 104.75 14 PPL 34.85 15 PPL 28.95 16 PPL 23.23 17 PPL 21.59 18 PPL 51.83 19 PPL 67.23 20 PPL 34.82 21 Real Estate Settlement Expenses -including deed preparation fee ($220.00); overnight fee 2,318.53 ($15.00); realty transfer tax ($927.80); tax certification fee ($20.00); and 2012 school tax ($1,135.73) 22 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 23 Register of Wills, Cumberland County -filing Family Settlement Agreement 75.00 24 Snoke's Tax Service - 2011 tax preparation 42.00 25 Sollenberger's Title Transfer -transfer of Cavalier 109.50 26 Terry L. Sheffer, Auctioneer -appraisal of personal property 125.00 27 UPS -return DISH receiver 9.19 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Donovan, Betty J. 21-12-0134 ITEM NUMBER DESCRIPTION AMOUNT 28 Weigle & Associates, P.C. -reimbursement for postage, xerox copies, and long distance 50.00 telephone calls H-B7 4,406.86 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ~ Rev-1512 EX+ (12-08) SCHEDULE 1 t~~ `~.~ ~~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donovan, Beaty J. 21-12-0134 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, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) . ,.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Donovan, Betty J. ~ 21-12-01 34 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTI' DECEDENT (Words) ($$$) Do Not List Trustee s TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Dixie Lee Coons Daughter 100% 101,059.84 9 Furnace Hollow Road Walnut Bottom, PA 17266 Total 101,059.84 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a pr o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) LAST `GILL AvD TESTA:~~2~T I, BETTY J. DONOVAN, of R. D. ~~ 1, Box 329, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved husband, MERLE W. DONOVAN, absolutely. THIRD. In the event my said husband predeceases me or is not living on the 60th day following my death, ~I then give, devise and bequeath my said estate to my daughter, DIXIE L. COONS, on a per stirpes distribution basis. FOUF.TH. In the event that any beneficiary of this my Last Will and Testament is under the age of eighteen (18) years, I then give and bequeath said beneficiary's share to and appoint as Guardian of any property which passes under this T~Till or otherwise, IRVIN W. BOWERS, JR., of R. D. ~~ 2, Shippensburg, Pennsylvania, AS GUARDIAN, NEVER- THELESS, to invest and re-invest the same until the said beneficiary reaches the age of eighteen (io) years,__with the following powers in addition to those presently g ivy. b y law ~; ~ cr =J - 1 L ~ ~ -...: _. ~ .c U~ " ;• ,~~-~ ~: . ___ =.. ~_~ ~. ~~- ;, , -/ U ~.: MARK & WEIGLE -ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG. PENNA. 17257 A. The power to expend the income towards the health, suapor~ and maintenance, and education, includir,.g a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power to expend the principal, within the discretion of the said Guardian, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; C. The power to sell any and all real estate, within the discretion of the said Guardian; P. The power~to distribute the balance of principal and interest, if any remaining,~when the said beneficiary reaches the age of eighteen (18) years, without the necessity of a formal adjudication of the Guardian's account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; E. The principal of the Guardianship and the income theref rom shall be free from the debts ,.liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, nor to attachment or execution under any legal, equitable or other.process for the enforcement of judgments or claims of any sort against them, either individ- ually or collectively; F. In the event the above mentioned Guardian is unable to accept the Guardianship, I then name, constitute and appoint MARY R. BOWERS, of R. D. ~~ 2, Shippensburg, Pennsylvania, as Guardian, with the same powers hereinbefore stated. FIFTH. I nominate, constitute and appoint my husband, MERLE W. DONOVAN, to be the Executor of this my Last Will and Testament; if he be unable to fulfill the duties of Executor, I then nominate, constitute and appoint my daughter, DIXIE L. COQNS, to be the Executor of this my Last Will and Testament. SI7~TU. I direct that neither my personal representatives nor Guardians shall be required to give bond for~the faithful performance of their duties in any jurisdiction. /f /~,. ~~ - 2- MARK & WEiGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG. PENNA. 17257 I~t WIT'VESS ~,1HEREOF, I, BETTY J. DONOVAly, have hereunto set my hand .and seal to this my Last G1ilI and Testament, written on three pages, the first two pages signed for identification purposes only, this~>>_.l day of ,.;?~:~ L,~~:..=--~~- 1983. firs 7 ~ ;.. ~; ~ ,,'%~ { SEAL --~ j~'=--. _ .~' ..._.~~~' ~ ,~~.:i.;~~--r,~-may.-rr~ , - ~ ) _ %~ /r ~If ~ This instrument was by the Testatrix, BETTY ..T. DONOVAN, on the date hereof, signed, published and declared by her to be her Last TrJill and Testament, in our presence, who at her request and in her presence and in the presence of each other, ~we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, BETTY J. DONOVAN, the Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that -3- MARK & WEtGLE - ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG. PENNA. 17257 b r ~ ,f r - -~~- "ree and volorrltar~- ao~ fir _..e _ ~-_ ~-_ -==-=i~ _-"--=..sec. and t>at i signed it as 1_l~. t S~~Torn or affirmed to and subscribed before me by Betty J. Donovan, the Testatrix, this ~~j ~~ day of `~,~r, 19 83 . ~~~ ~ ~~ ~~~~ t ~u~ ~? C.r.+-~Jwiri 6~sC~~~if ~ Q~.i~iiu -ensbura~ PA Cumerland Goun:y Shipp - 27, 1966 3,~yronmissEon Expires July COMMONWEALTh OF PENNSYLVANIA SS. AND ,; ~~-~-= . ,` .: ~~, ;~" COUNTY OF~UMBERL ~ r ~/j ~~~~...._ ~~_-~_... / ~ r. ~~ ~~,{,~jj ~/ and /~ ~ ~ ~ , We - .,- ..r -~ ~ ' - ~ ualified ~'J ~~ whose 'names are signed i,o the foregoing instrument, being duly q the witnesses ~ t• ose and say that we were present and saw Testatrix sign and according to law, do dep meet as her Last Will; that she signed willingly and that she execute the instru ee and voluntary act for the purposes therein expressed; that executed it as her fr he hearing and sight of the Testatrix signed the will as witnesses; each of us in t ur knowledge the Testatrix was at that time eighteen (18) and that to the best of o e and of sound mind and under /n~o constraint or undue influence. or more years of ag ~ ~ .' ` :~.~.-~"F.-.~ Y- ~ `~ : Lit , _._~ ~~ . %~ -- - ~ ff !E S~,~orn or aff'i ~ ed to rid sub$crib~f before me b i ~-------fT ~ lw~tnesses, f- "`~ - 1 ~~, 19 83 t hi s J~~ =~C.d ay o f ~^~:~,~-'L... Srippensbu~-G,~ PA Gumbertand Coun~jt _L}- My Commission Expires Juiy 27, 18th ARK & WEIGLE -ATTORNEYS AT LAW - 115 EAST KING STREET - SHIPPENSBURG, PENNA. 17257 M ~~ '-, ! 5 --~ ~..~~ ------ _ Lri~: tree and ~iOliari`.3~'t' G _ -= --- _ _'= _ `-----=~-' _- --'~........ and t~a~ I signed it as - Sworn or affirmed to and subscribed before me by Betty J. Donovan, the Testatrix, this ~~j ~~ day of ~~~ 19 83 . ~~ i ~ P~;~~ r• rod{~~. .rr., A1j$y of Sa~ls~t.~ ~~3, ~' ,,.~ o? Cum :erland Counter Shiprensb~ra. PA ~7 1866 ray Commission Expires July - , ,; J~ .y~ f' /, r _ ~ }•,~ .'~ .ter _ -.-~" ~` it f~ . ~~ COMMON4IEALTfi OF PENNSYLVANIA SS. COUNTY OF~..CUMBERLAND a ,~ t ~~ }~ ~~ ~~ rY ~ ~ n ) , `--,__ ,! _. ~ ,~ / ~ x:~f/, ,~ and - - _ ~ '~~" _- p ualif ied fl ~~ whose 'names are signed t,o the foregoing instrument, being du y Q the witnesses ~ t. e and say that we were present and saw Testatrix sign and according to law, do depos , ,;.,~;,: ~il~gl~i~~~~ ~ ~A.'Settlement Statement (h1UD-'I lillllll a ~ OMB Approval No. 2502-0265 ~~ ~ .- . .. FINAL FHA 2, ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: ~] VA 5. Q Conv. Ins. 12C2357SHERIFF 600164056 , Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown Items marked . "(p.o.c)" were paid outside the closing; they are shown here for inforrnational ur os d Name & Address of Borrower: p p es an are n ot included in the totals. hn K. Sheriff Karla L Good E_ Name & Address of Seller: F. Name & Address of Lender: , . W. Main Street, Walnut Bottom, PA 17266 The Estate of Betty J. Donovan 416 W. Main Street Walnut Bottom PA 17266 Members 1st Federal Credit Union , , 5000 Louise Drive, Mechanicsburg, PA 17055 Propert Locati y on: 6 W Main Street H. Settlement Agent: I. Settlement Date: 08/03/2012 . tlnut Bottom, PA 17266 South Central Home Settlements, Inc. Telephone: 717-532-7387 Fax: 717-532-6552 Disbursement Date: 08/03/2012 ulh Newton Township, Cumberland County Place of Settlement: 126 East King Street, Shippensburg, PA 17257 TitleExpress :~ ~ , 0. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 1. Contract sales price 92,780.00 2. Personal ro ert 3. Settlement charges to borrower (line 1400) 3,858.82 4. 5. I•ustments for items paid b seller in advance 6. City/town taxes to 7. County taxes 08/03/2012 to 12/3112012 115.52 8. School Taxes 08103!2012 to 06/3012013 1,033.05 9. 0. 1. 2. 0• Gross Amount Due from Borrower 97,787.39 0. Amounts Paid b or in Behalf of Borrower 1. Deposit or earnest money 1,000.00 2. Principal amount of new loan(s) 88,141.00 3. Existin loans taken sub'ect to 4. Credit far amount paid 375.00 5. 6. 7, 9. 3. 'ustments for items unpaid b seller ~. City/town taxes to 1. County taxes to 2. School Taxes to 3. 4. 5. 6. 7. 8. 9. ~• Total Paid byffor Borrower 89 516.00 I. Cash at Settlement fromlto Borrower Gross amount due from borrower (line 120) 97,787.39 Less amounts paid by/for borrower (line 220) t. Cash ~X From ~ To Borrower rc epo mg u en or is co a ion o m arena ion is a tma e a menu es per unle ~I d'' I 89,516.00 8,271.39 response or co e m re 401. Contract sales price 92,780.00 402. Personal ro ert 403. 404. 405. Ad'ustments for items paid b seller in advance 406. Cityltown taxes to 407. County taxes 08!03!2012 to 12/31/2012 115.52 408. School Taxes 08/0312012 to 06130/2013 1,033.05 409. 410. 411. 412. 420. Gross Amount Due to Seller 93,928.57 500. Reductions In Amount Due to Seller 501. Excess deposit (see instructions) 1,000.00 502. Settlement charges to seller (line 1400) 2,318.53 503. Existin loans taken sub'ect to 504. Payoff of first mortgage loan 505. Payoff of second mortgage loan 506. 507. 508. 509. Ad'ustments for items unpaid b seller 510. Cityltown taxes to 511. County taxes to 512. School Taxes to 513. 514. 515. 516. 517. 518. 519. 520. Total Reduction Amount Due Seller 3,318.53 600. Cash at Settlement tolfrom Seller 601. Gross amount due to seller (line 420) 93,928.57 602. Less reductions in amount due seller (line 520) 3,318.53 603. Cash OX To ~ From Seller 90,610.04 enl process .n, u 1 rsp ays a wnenlly valid OMB conlyd number, Na confidentiality is assured; Ibis dis4osure is mandalorygTl~is is designed to provide the ponies Ito a RESPA covered lransaclio wish nfartnalion dunn9lhe mp e e ious editions are obsolete Page 1 of 4 HUD-1 ,Broker Fees ~mmission Iine700 as follows: Paid From Paid From to Borrower's Seller's to Funds at Funds at pion paid at settlement Settlement Settlement Pa able in Connection with Loan . origination charge (Includes Origination Point % or $0.00) $830.00 ou dit (from GFE #1) . r cre or charge (points) for the specific interest rate chosen Your adjusted origination charges $110'18 (from GFE #2) r. Appraisal fee (from GFE A) 940.18 to 75. Credit report (from GFE #3) to )6. Tax service t0 (from GFE #3) )7. Flood certification to from GFE #3 )8 from GFE #3 to )0. Items Re wired b Lender to be Paid in Advanc e )1. Daily interest charges from from 08/03/2012 to 09/0112012 @ $8 7537/da y . )2. Mortgage Ins. Premium for months to (from GFE #10) 253.86 )3. Homeowner's insurance for (from GFE #3) months to State Farm $423.00 P.O B* (from GFE #11) C )4 months to . . from GFE #11 100. Reserves De osited with Lender 101. Initial deposit for your escrow account )02. Homeowner's insurance 4 months $ 35.25/month $141.00 (from GFE #9) 465.48 ..,, )03. Mortgage Insurance months $ O.OOlmonth $0.00 )04. City Properly Tax months $ 0.00/month $0.00 )05. County Property Tax 7 months $ 23.33/month $163.31 )06. School Taxes 3 months $ 96.58/month $289.74 )07. Aggregate Adjustment $_128 57 00. Title Char es 01. Title services and lender's title insurance 02. Settlement or closing fee to from GFE #4 ( ) 1,091.50 03. Owners title insurance ~ n 04 t Pn(t?rC tlriP In Cllr'.1n rn (from GFE #5) 22.00 ur. Agent's portion of the total title insurance premium $732.27 08. Underwriter's portion of the total title insurance premium $128.23 09. Wire Fee to Orrstown Bank $12.00 10. Overnight Fee S to outh Central Home Settlements l $15.00 11. Deed Preparation Fee , 15.00 to South Central Home Settlements I $ 12. End 8.118.1 , to SCHS A ent for Conesto a Title In $50.00 220.00 13. ClosingSvcLtrICSL to SCHS A ent for Conesto a Title In $75.00 14. ALTA Short Form Loan t SC o HS A ent for Conesto a Title In $100.00 00. Government Recordin and Transfer Char es 01. Government recording charges 02. Deed $62 00 (from GFE #7) 158.00 . Mort a e $96.00 Release $0.00 03. Transfer taxes 34. City/County tax/stamps (from GFE #8) 927.80 Deed $927.80 Mort a e $0.00 ~5. State Taxlslamps Deed $927.80 Mort a e $0 00 )6. . Deed $0.00 Adnrtnano en nn 927.80 u. purvey )3. )4 TaY r'artifir•~tinn Goo ious editions are obsolete Page 2 of 4 HUD-1 - - ~ ~ ~ _ - ~ ~ ~ t r 3,858.82 2,318.53 i outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. ,rh Estimate (GFE) and tiUD.1 Cha r es ~ M ncrease HUD-1 Line Numbe _ Good Faith:Estimate - ,e (points) far the specific interest rate chosen r # 801 830 00 HUD i gination charges # 802 . 830 00 # _803 110.18 . 110.18 # 1203 940.18. 940.18 hat in Total Cannot IncreaseMore Than 10% 927 80 927.80 cent recording charges ,~ 1201 Good Faith Estimate HUD-1 ;~ 238.00 158.00 f ` , - , . ~ ~ ' ' Char es That Can Ch n $ 238.00 158.00 -80.00 or 33 6 a a Initial deposit for your escro - . 134% w account Daily interest charges from # 1001 ' Good Faith Estimate HUD-1 Homeowner's insurance ' ' # 901 $8.7537/da 416.68 465.48 .Title services and lender's title insurance # 903 148.81 253.86 Owner's title insurance # 1101 500.00 423.00 - # 1103 1,316.75 1,091.50 # 23.20 22.00 Loan Terms # Your initial loan amount is Your loan term is Four initial interest rate is tour initial monthly amount owed for principal, interest, and any mortgage nsurance is :an your interest rate nse? .ven if you make payments on time, can your loan balance nse? :ven if you make payments on time, can your monthly amount owed for rineipal, interest, andmortgage insurance nse? toes your loan have a prepayment penalty? goes your loanhave a balloon payment? [ otal monthly amount-owed including escrow account payments j V V V I ^ You do not have a monthly escrow payment for items, such and homeowner's insurance. You must pay these items directly 0 You have an additional monthly escrow payment of $155.if that results in a total initial monthly amount owed of $596.79. TI mortgage insurance and any items checked below: Q Property taxes Q Homeown Flood insurance :e: If you have any questions about the Settlement Charges and LCo]an Ter ms Itsted on this form, please contact your lender. ous editions are obsolete `" ~ HUD CERTIFICATION OF BUYER AND SELLER red the HUQi Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and e on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. . Sheri S,~" /_/` f ~ /] ~ PITr ~~ Karla L Good ~he Estate o Betty J. Donovan ~he HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to 6e isbursed in accordance with this statement. C ~ _ ~;__,. ETTLEMENT AGENT - ~ `- ~ ' ~` DATE 2NING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON JVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. ious editions are obsolete Page 4 0 ,~ MBTBarik 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services ~eigie &~ Associates, ~'. ~. Attorneys at Law 126 East King Street Shippensburg, PA 17257-3397 Re: Estate of Betty J. Donovon Social Security: 202-20-2841 ' Date of Death: January 18, 2012 Phone 888-502-4349 F ax (302) 934-2955 April 13, 2012 Dear Sir or Madam: Per your inquiry on April 10, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: l . Type of Account ;. Checking Account Account Number 10432906 Ownership (Names o~ Dixie L. Coons (POA) Betty J. Donovan Opening Date 01/05/1994 Balance on Date of Death $4, 206.65 Accrued Interest $ .00 Total -- ------------ - - ------------------------------- $4,206.65 2. Type of Account Checking Account Account Number 9843771222 Ownership (Names o~ Dixie L. Coons(POA) Betty J. Donovan Opening Date 06/01/2007 Balance on Date of Death $92.98 Accrued Interest $ .00 Total _ ___ . _____ ..._.---- - - $92.98 ~ ~ 4 3. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Current Balance Installment Loan 12044442621944998 Betn~ J. Doriol~arz 1229!2003 $1912.14**This amount is not to be used for payoff purposes. Fora payoff balance, please call 1-800-724-2440 $ .00 ** This balance is not a payoff balance For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the King Street at 717-532~t132. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement. Sincerely, Valarie Mercer Adjustment Services 1969 Chevrolet Chevelle Malibu 2 Door Hardtop Prices, Values & Specs Window Sticker... Page 1 of 1 ~„ NAQA ~~ O ~ I D ~ S The Power of Vehicle Information NADAguides.com 1969 Chevrolet Chevelle Malib u '~ `~~ 2 Door Hardtop `~ NADAguides.com Price Report ~` Original Low ;`~ Average MSRP Retail i Retail Base Price $o $12,150 ` $14,000 options: ADD-350 V8 ENG 15% 15% ~o~~l- PI~~C~ ~ ~ r; Manufacturer note: FOR CALLAWAY CORVETTES, PLEASE SEE "CALLAWAY CARS INC". Value Explanations ~ Close Window 1/29/Z012 High Retail $20,000 15% ,~' Prices shown are retail consumer values and to be considered as selling prices. Trade-in values are to be determined by local dealers and are generally lower than values shown. Low Retail Value This vehicle would be in mechanically functional condition, needing only minor reconditioning. The exterior paint, trim, and interior would show normal wear, needing only minor reconditioning. May also be a deteriorated restoration. or a very poor amateur restoration. Most usable "as-is". Some of the vehicles in this publication could be considered "Daily Drivers" and are not valued as a classic vehicle. When determining a value for a daily driver, it is recommended that the subscriber use the low retail value. Note: This value does not represent a "parts car". Average Retail Value This vehicle would be in good condition overall. It could be an older restoration or awell-maintained original vehicle. Completely operable. The exterior paint, trim, and mechanics are presentable and serviceable inside and out. A "20-footer". High Retail Value This vehicle would be in excellent condition overall. It could be a completely restored or an extremely .well maintained original vehicle showing very minimal wear. The exterior paint, trim, and mechanics .are not in need of reconditioning. The interior would be in excellent condition. Note: This value does not represent a "100 Point" or "# 1" vehicle *. * "100 Point" or "# 1" vehicle is not driven. It would generally be in a museum or transported in an enclosed trailer to concourse judging and car shows. This type of car would be stored in aclimate-regulated facility. ADVERTISEMENT ~ ... 1 i ~~ LO v '~-~'' ~~~ Copyr+clht 2Q12 National appraisal Guides Inc. All R+gl~is I:ese+ved. http://www.nadaguides.com/Classic-Cars/1969/Chevrolet/Chevelle-Malibul2-Door-Hardto... 1 /29/2012 2003 Chevrolet Cavalier LS Sedan 4D Used (:ar Yrices -Kelley 13iue nook rage ~ of 4 . .. ;.~ ~ ~-,: ZiF COt7c: ii2ob i Sign in (or ~igr~ up} home f car values ~ cars for sate ~ car reviews ! kbb top picks ~ research toots Popular at KBB.com ~~;•~ Nome > Car Values > Chevrolet > Cavalier > 2uQ3 > Sfyie > Optans > Condition. > Chevrolet Cavalier 20Q3 go LS Sedan 4D ~ ~~ :.. 2003 Chevrolet Cavalier ~~ ~~~.~~~~ t LS Sedan 4D ~~. .v ._ Mileage: 48,539 cl^~ang° Like this car w ..«r,- ._ .. ~' edit options change style pricing ! photos specs (; kbb expert review consumer reviews ratings compare Pry i•$~~~ See Trade-In/Sell Values • • cellent $6,Q14 Verity Coriditio: i • Very Good $5,739 • Good _ $5,6I4 • Fair ~~ $4,964 ~ ~` Used Cars for Sale near Watnut Bottom 24G~ +rhevroiet Cavalier for Sale hear You ~ 8e1o4': 81u2 6cok Value` view att 'lkis2tl on tf~e Suo9ested Retal Value Excell~it LO~dIL~On dnd the b'S° v21iid2 CJitfi(IUraL'On. KR L'r[CiG'flll,ill t~llY Ati:' PRIIGRE.fI~'UE GET ~t~t~R FREE QUOTE NOVA! ~, Entcr ~~^" ?IP Codc: ~r~. adve+ti~ement ;~+h~ a6sj Buyer s Resources What can I afford? C.oiCUieir yuUrn~•oaih!}' DdyTc;li 1~i~.ciltlj~ ~Jt21':@~ CaiS j I ij% SaVc;l i_.;a r5 ScIJ° Cct ~ ~ ~ ;' http://www.kbb.com/chevrolet/cavalier/2003-chevrolet-cavalier/ls-sedan-4d/?vehicleid=l 8... 1/29/2012 APR-04-12 04:35 PM ~ .u. • SHETTER,TERRY 7172641445 Tev~vy L. Shelter, LLC ~t wct~o,~,eer/Appra+'~a.L Serv~,c~ 365 Musser Road, Shippznsburg, PA 17257 717-264-3885 Ah~raitiai fior: [atate of Betty Jane t7onovan 416 West Main Street, Walnut Bottom, PA 1?26f~ 1")~tte: 4-4- I2 1'I'1:M f1PPRAjSAI, VAt.[JL 1_iy i n~ Rvo)n C'c~ucl~ SU.OU ~rec:n swivel sluCi'ed c:hait's 40.t10 '1'V c;ntertainmcnt center 25.00 ('u('Ic;e (~,hle and end stands 45.00 11c~mc fntcric~r 25'O0 2 ~,lidcr rocker, 100.1)0 I)inin~Zc~~m: ~~:rvcr 35'()0 Oak rc-ckrr 40.00 ~I)inin~ rcu~ni ttthte and chairs 200.00 !)ry sink b0.O0 I utch 100.00 Kitchen: "I'cthlc; and 4 chairs 100.00 ~I~it~•I, 1'V 35.00 ~t;~nd• 25.00 W~i~hc~r and dryer 125.01) titc~vc: ' 25.~~ ltc i ~i~,tt•utc~r 75.00 i~~~~~, panti ~~,~ di~ll~s 50.00 ti~win~lic~c~m: C>rc:ck tiweej~c;r 35.00 ticwin~; n~~tchinr 10.00 titancl 5.00 f~c:clrcx~n~ #_~~..: ~irCCn b~dn~~m suite 100.00 Wuc~dc~n uhctit 15.00 P. 01 _2 04:36 PM SHETTER,TERRY 7172641445 P. 02 ~3E'C~!'UC1i11 # ~_: 1)c~uhlu heci I )rc~tic~r ~~nd vanity Ni~,ht stands Iia.S~mt~nt: tii~i~b<~arc1 titi~c TOTAL: ] 00.00 50.00 45.OU 75.00 50.00 1 750.00 1~(~l~lini~~(, H't-;l;: $125.00 ACNB BANK April 19, 2012 Weigle & Associates PC Attn: Jerry A Weigle 126 E King St Shippensbut•g PA 17257 RE: Estate of Betty J Donovan Dear Mr. Weigle: The following information is being provided as per your request: Acct. Type Account No. Balance at Accrued Ownership D.O.D. Interest to D.O.D. Certificate of 160483 $16,000.00 $17.59 Jt w/ Dixie L Coons Deposit Date Opened/Joint 10/21 /02 Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122. Sit'iCerely, /~ 1 f: Barbara J War r ACNB Bank Deposit Services epresentative II acnb.com • acnbbus6ness.com • P.0. Box 3129, Gettysburg, PA 17325 • Phone 717.334.3161 • Toll Free 1.888.334.ACNB (2262) V lr~ ~~~~ ,,, --_ ,~ --, HO ~ ~ I I~ Ii Previous Balance ~ + Advances ~Ol i l 6~'12~ & Debits i "Payments ~'z Credits + ~A'vCE CHARGE ~ + Life Insurance Char + Late Charges ge + Other Charges New Balance 'eriodic Rate ~orrespo~~ng ~~~~ ERCE:YTAGE RATS verage Daily Balance 'Nt~ppE aCti~RGE ~_ Periodic Rate 2vIENT PERIOD 02/13/12 .OUNT' `vU~1~iBER ~T42621944998 BETTY ~ DONOVAN WALNUTMgIN ST OTTOM pq page 1 of 4 STATEMENT PERIOD 01/17/12 02/13/12 ACCOUNT NU 12044482621 g M B ER Home E ~ssa ~~ Lire Of Credit Acco Billing Date ~t SWtltlla 13 796 Cun'ent Due Date 02/13/12 Days .~ B~ Amount P~ d Period - 03/09/12 Over bus Statement 28 17266-9718 Credit I,' $ 0.00 emit Amou Past Due Amount nt $ 0.00 :~9.~ :...:.............:.:.:--; :-.. - .... ----- $ 0.00 Draw Period - - . - _-_`"`' Expiration Date ~~~~~ : ~<:.<::~:~1~;;~}t~ Credit Limit 12/16/13 Available Credit $ 40,000.00 - Finance Charge YTD $ 40,000.00 ~~' LL'vE OF CREDIT, AI~v~ PERCENTAGE ~ ,$-1,27 -- FLVA_~CE CHARGE ~ 2.9'745% RATE 1 `~'~ BALA=VCE S , BASK ~~'~IARv $ 1,917.89 $ 0.00 $ 1,920.26 $ 2.37 $ 0.00 $ 0.00 $ 0.00 $ 0.00 TOTAL $ 1~9I7.89 $ 0.00 $ 1, 920.26 $ 2.3 7 $ 0.00 $ 0.00 $ 0.00 $ 0.00 0.0088797°/a 3.2500%~*# ~ $ 956.07 $ 2.37 Please see ~ ++erse Side for ~Planatlop of ®n~t~ ~~~ ~~~~s W MA N NOVAN NUT ST 30TTOM pA 17266-9713 5e return this gent. ~ stub with your ank You. TOTAL AMO UNT E ~CLO SED IS $_ Please make checks Payable to: M&T BANK P•O• BOX 62146 BALTIMORE, MD 21264-2146 ~% 5 Z 2p~~~pppD~; t, >y 4 ~' 26 2194494A1-.