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11-02-12
J 150567,1188 f REV-1500 Exco2-„1cF,l ~-~_ pennsytvania OFFICtAt_ USE ONLY PA Oepartrnentof Revenue xrx*rca~oxu:2.::: Bureau of Individual Taxes County Code Year Poeox2soao, INHERITANCE TAX RETURN Harrisburg, PA ,7,zs-oso, RESIDENT DECEDENT 21 12 C7 3. Remainder Return (Date of Death Prior to 12-13-82) © 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes CJ 11. Election io Tax under Sec, 9113(A} {Attach Schedule O} ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 204 OL 0035 0l 30 2012 Decedent's Last Name Henschen (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Socia[ Security Number FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return [~ 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will} C~ 9. Litigation Proceeds Received MMDDYYYY Date of Birth MMDDYYYY 06 30 1919 Suffix Decedent's Frst Name MI Leah R Suftix Spouse's First Name Mi THIS RETURN MUST BE FILED iN DUPLICATE WITH THE REGISTER OF WILLS Cl 2. Supplemental Return © 4a. Future Interest Compromise (date of death after 12-12-82} CI 7. Decedent Maintained a Living Trust (Attach Copy of Trust) I~ 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) CORRESPONDENT -This section must be completed. Ali Correspondence and Confidential Tax Information Should be Directed to: Name Daytime Teiephane Number Robert C • Saidis, Esquire ?1,? 243 6222 File tJ~mber 0218 REGISTER OF WILLS USE ONLY Rrst Line of Address Saidis, Sullivan & Rogers Second Line of Address 26 W• High Street City or Post Office Carlisle C~ State ZIP Cade PA 1?013 ~z7 ---_- ~-, ._ t ~? `~,~a'r~ Fi~ED ~ i7 1:., -~ --' ~.~,"3 _"`~ c; . ::; -_~ ~` ..._. ,_~ ~ ~~:.- ; .,.,:. __ ~-, Correspondent's a-mail address: CSaldlS@SSt-attorneys.com it is true, carrectand complete. Declaration of the preparer other than personal representative is based on all inforrnaY:on of which preparer has any knowledge. ~~ ~ /1Z GNATUREOFPEpS SPONSIBL FOR FILING RETURN ~_ DATE ~I +/ / ' -~ ~ ~(1 _~J~ ca;t~~ `.'`.7~i ~ ~ r0 / 1 v ~ }~~ ~/~.f' .~ n ~ (i U ~ .D~ Q (lJ ~H/^~. See schedule attached ,~ / ~''~~ ~',, ~,. Ro e rt C . Saidis E s uire ~/ ~-- ~ ~ ~ ADDRESS 26 W. Hi>~h Street, Carlisle, PA 17013 __ PLEASE USE ORIGINAL FORM ONLY Side 1 1505611,188 15056111,88 J ~ti r Estate of: Leah R. Henschen Sharon L. DeVenney 100 Burnt House Road Carlisle, PA 17015 Co-Executrices Nancie M. Booth 1703 Timber Lake Drive Salisbury, MD 21801 204-01-0035 J Rev-1500 EX (FI) Decedent's Name: Leah R Henschen Decedent's Social Security Number 204 O1, 0005 RECAPITULATION ~ 18 , 0 0 0 • 0 0 1. Real Estate (Schedule A) . • • • • . • • • • ............................... 1 • 323,842.34 2. Stocks and Bonds (Schedule B) •••••••••••••••••••••••••••••••••••• 2• 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • • • • • • 3. 4. Mortgages and Notes Receivable (Schedule D) ... • • • • • • • • • • • • • • • • • • • • • • 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5. 1, 9 4 , 5 0 5 - 5 2 6. Jointly C+wned Property (Schedule F) D Separate Billing Requested • • • • • • 6. 6 7 , 3 9 9 • 7 8 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 8 5 , 0 5 4 - 0 0 (Schedule G) O Separate Billing Requested • • • • • • 7. 8. Total GrossAssets(totalLineslthrough7).•.•••.••••••••••••-•••••••• 8• 988,801,•64 6 7 , 5 9 2.31, 9. Funeral Expenses and Administrative Costs (Schedule H) g• 1, 7 , 0 4 8 • 7 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10, 84,641,•05 11. Total Deductions (totalLines9and10) ...••••••••••••••••••••••••••• 11• 904,160.59 12. Net Value of Estate(Line8minusLinell)•..•••••••••••••••••••••••••• 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 ' 0 0 an election to tax has not been made (Schedule J) • • • • • • • • • • • • • • • • • • • • • • 13. 9 0 4 , 1, 6 0 • 5 9 14. 1 ( ) ....................... Net Value Sub'ect to Tax Line 12 minus Line 13 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 ' 0 ~ (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 9 0 4 ,1, 6 0. 5 9 16 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 • 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 • 0 0 at collateral rate X .15 18. 19. TAX DUE .................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REGIUESTING A REFUND OF AN OVERPAYMENT Side 2 1,50561,1288 1,50561,1,288 1,50561,1,288 0.00 40, 687 • 23 O.oo 0.00 40,687.23 [- J Rev-1500 EX (FI) Page 3 Ilnr~ni^Innt~c ('_mm~lc~tP ~f1C~CP_CC' File Number 21 12 0218 DECEDENTS NAME Leah R. Henschen STREET ADDRESS 624 Belvedere Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 40,687.23 2. Credits/Payments A. Prior Payments 39,592.03 B. Discount 1,250.00 Total Credits (A + B) (2) 40,842.03 3. Interest (3) 0.00 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. (4) 154.80 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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. retainareversionaryinterest ••••••••••••••••••••••••••••••••••••••••••••••••••• Q d. receive the promise for life of either payments, benefits or care? • • • • • • • • • • • • • • • • • • • • • • • • • • • Q 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ••••••••••••••••••••••••••••••••••••••• Q ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? • • Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which containsabeneficiarydesignation? ••••••••••••••••••••••••••••••••••••••••••••• 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. Sect. 9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1.995, 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 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. Sect. 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-t5o2 EX+~ot-to) pennsylvania SCHEDULE A INHERITANCETAXRETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Leah R. Henschen 21 12 0218 All real property owned solely or as a tenant in common must be reported atfair 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. If more space is needed, insert additional sheets of the same size. OMB Approval No. 2502-0265 `s- ~ + HUD-1 ~ I ~ ~ * ~~ A Settlement Statement HUD-1) ~ . I 4F~ r,C Page 1 of 3 FJ,~~ UE~il;~ . Type of Loan e FHA 2. ^ RHS 3. ~ Conv. Unins . 6. File Number: 7. Loan Number; 8. Mortgage Insurance Case Number: VA S. ^Conv. Ins. 401201828-CB 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 "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. . Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender ATTHEW CANDLAND AND JENNIFER SHARON L. DEVENNEY, EXECUTRIX AND SUNTRUST MORTGAGE, INC aNDLAND NANCIE M. BOOTH, EXECUTRIX OF ESTATE 901 SEMMES AVENUE, 356 SECOND AVENUE OF LEAH R. MYERS, A/K/A LEAH R. RICHMOND, VA 23234 (KESVILLE, MD 21784 HENSCHEN 624 BELVEDERE STREET CARLISLE, PA 17013 . Property Location 24 BELVEDERE STREET, ARLISLE, PA 17013 OUNTY: CUMBERLAND 4RCELID:04-22-0481-042 DWNSHIP: CARLISLE BOROUGH of Borrower's Transaction I S ummar . ss Amount Due from Borrower 00 G ro . . 000.00 246 01. Contract Sales Price , 02. Personal Pro ert line 1400 b 613.69 5 orrower .03. Settlement char es to , i04. 105. r in advance ll id b ' se e ustment for items a Ad 106. Cit /Town Taxes 15/12to 01/O1 13 08 504 08 / 107. Count Taxes 1327.2900 r . t08. Assessments 2012 to 7/1/2013 15 8 653 08 $2 / / L09. School Taxes 3 026.17/ r , , 110. 111. 112. ount Due from Borrower A G $254,770.85 m ross 120. or in Behalf of Borrower Paid b t y s 200. Amoun 500.00 1 201. De osit or earnest mone st Mort a e Inc T S f , 241 544.00 ru un rom 202. Princi al Loan Amount t ' o ect 203. Existin loans taken sub 204. 205. 206. 207. 208. 209. ll d b ' er se ustments for items un ai Ad 210. Cit /Town Taxes 211. Count Taxes 212. Assessments 00 4 000 213. Seller Paid Closin Costs . 214. 215. 216. Z17. 218. 219. r Borrower f id b $247 044.00 o / 220. Total Pa t from/to Borrower tl S emen et 300. Cash at 120 77D 85 $254 301. Gross amount due from borrower line 220 li . , 00 247 044 ne 302. Less amounts aid b /for borrower om To Borrower h X F C . $7,726.85 r as 303. The Public Reporting Burden for this collection of information is estimated at 35 min collect this information, and you are not required to complete this form, unless it dis is mandatory. This is designed to provide the parties to a RESPA covered -ransacti • ute play on w _ , , s a currently valid OMB control number. No confidentiality is assured; [ms orscrosure ith information during the settlement process. ,v1 t Initials H. Settlement Agent SECURED LAND TRANSFERS, LLC 485 ST. JOHNS CHURCH ROAD , SHIREMANSTOWN , PA 17011 Phone:(717)901-8342 Place of Settlement I. Settlement Date 08/15/2012 1068 HARRISBURG PIKE Disbursement Date 08/15/2012 CARLISLE, PA 1201828-CB HUD-1 Page 2 of 3 Settlement Charges ___ 10. Total Reat Estate Broker Fees ;14520.00 Paid From Paid From Division of Commission line 700 as follows: Borrower's Funds Seller's Funds I1. 7260.00 to Hooke Hooke and Eckman At Settlement At Settlement )2. 7260.00 to ERA-NRT LLC l3. Commission aid at settlement 14,520.00 )4. ...- - - )1.Our on ination char e 2 998.90 from GFE #1 )2. Your credit or char a oints for the s ecific interest rate chosen - 9 359.83 from GFE #2 )3. Your ad usted on ination char es from GFE A - 6 360.93 )4. A raisal Fee to CR Consultin from GFE #3 425.00 )5. Credit re ort to CREDCO from GFE #3 28.00 )6. Tax Service from GFE #3 )7. LOL Flood Cert. Fee to CORELOGIC from GFE #3 6.00 1R ___ )0. Items Required by Lender to Be Paid in Advance Daily interest charges from 08/15/12 to 09/01/12 @ 24.82/day SunTrust (from GFE #10) )1' Mort a e Inc $421.94 J2. UFMIP to De artment of HUD from GFE #3 4,154.33 ~3. Homeowner's Insurance Erie Insurance Exchan a from GFE #11 926.00 ~4. IOO.Reserves Deposited with Lender IO1.Initial de osit for our escrow account from GFE #9 1 313.35 102 In zard Ins. Reserve 4 Month(s) @ 77.16 per Month(s) SunTrust Mortgage, $308.64 )03. Mort a e Ins. Reserve SunTrust Mort a e Inc )04. County Property Taxes 6 Month(s) @ 108.39 per Month(s) SunTrust $650.34 Mort a e Inc )05. School Taxes 2 Month s @ 252.18 er Months SunTrust Mort a e Inc 504.36 )06.A re ate Accountin Ad~ustment to SunTrust Mort a e Inc - 149.99 )07. 1O0.Title Charges tO1.Title services and lender's title insurance to Secured Land Transfers LLC from GFE #4 2 080.00 25.00 102. Settlement or closin fee to Secured Land Transfers LLC 225.00 t03.Owner's title insurance to Secured Land Transfers LLC from GFE #5 20.00 104. Lender's title insurance to Secured Land Transfers LLC 1 760.00 105. Lender's title olic limit 241 544.00 106.Owner's title olic limit 246 000.00 107. Agent's portion of the total title insurance premium to Secured Land $1,602.00 Transfers LLC 108. Underwriter's ortion of the total title insurance remium to TRGC-Sale 178.00 109.Insured Closin Protection Letter to TRGC 75.00 110. Processin /Tax Cert. to Secured Land Transfers LLC 15.00 2O0.Government Recording and Transfer Charges 201. Government recordin char es from GFE #7 140.00 202. Deed 62.00 Mort a e 78.00 Releases 203.Transfer taxes from GFE #8 $2,460.00 204. Cit /Coun tax/stam s Deed 2460.00 Mort a e 205. State tax/stam s Deed 2460.00 Mort a e 2,460.00 206. 3O0.Additional Settlement Charges 301. Re wired services that ou can sho for from GFE #6 302. Pest ins ection to AnS Ins ect POC B 45.00 303. Home Warrant to American Home Shield 600.00 304. Electrical Re air to Mountain View Electric LLC 200.00 305. Home Ins ection to AnS Ins ect POC B 330.00 306. Final Water/Sewer to Carlisle Borou h Office 170.87 307.2012/2013 School Real Estate Taxes to Carlisle Borou h Tax Account 3 026.17 400.Total Settlement Charges (enter on lines 103, Section J and 502, Section K) ;5,613.69 ;21,002.04 you have any questions about the settlement charges and loan terms listed on this form, please contact your lender. Settlement agent is not responsible for content of :nder's assessments on HUD. he seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorations and reserves are based on gures for the preceding year or supplied by others or estimated for the current year, and in the event of any change for the current year, all necessary adjustments will be lade between borrower and seller directly. Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller. have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is true and accurate statement of all receipts and disbursements lade on my account or by me in this transaction. 1 further certify that I have received a copy of the HUD-1 Settlement Statement. SUYERS \ ~ SELLERS v~^~/-' Estate of Leah R. Myers, a/k/a Leah R. Henschen Aatthew Can land By: Sharon L. Devenney, Executrix Jennifer C la ~~~C ~~ .~\ By: Nancie M. Booth, Executrix /~ fhe HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will ca~`use the funds to be disbursed in accordance with this statement. Settlement Agent Date 08/15/2012 10130/12 10:26 AM OMB No. 2502-0265 ;~.,,: ~ - _, A. U-S. D@parbnent of Noosing B. Type of Loan I {~} ~ j ~ and Urban Development ` I~ N .l 1. [ ]FHA 2. [ ] RHS '3. [)Conv. Unins. 4. [ ] VA 5. [ ]Conv. Ins. 1 + \_ , } ,! t~~~~ . J ~~ ;. ~ 6. File Number 7. Loan Number I '-"-='"~` ~ Settlement Statement 8. Mortgage Ins. Case No. tote: This form is furnished to give you a Staten-lent of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked ("POC") were paid outside the closing: they are shown here for information purposes and are not included in the totals. ame of Borrower: Donna Marie Hinshaw ame of Seller: Estate of Leah R. and Homer E. Hanschen ame of Lender: NIA roperty Location: 35 Cambridge Court, Carlisle, PA 17013 ettlement Agent: Ronald E. Johnson, Esquire lace of Settlement: 78 West Pomfret Street, Carlisle, PA 17013 ttlement Dale: Proration Date: October 31, 2012 :. J. Summary of Borrower's Transaction .. {C. Summary"of Seller's"Transaction' .. Gross Amount Due from Borrower " ' -, 400. Gross Amount Due°to Seller Contract sales price $72,000.00 401. Contract sales price $72,000.00 Personal properly 402. Personal property Settlement charges to borrower (line 1400) $1,993.00 403. 404. 405. stments for items paid by seller in advance :° Adjustments foritems paid"by seller' jn.adJance City/town taxes 406. City/town taxes County faxes 10/31/12 to 12/31/12 $115.24 407. County taxes 10/31/12 to 12/31/12 $115.24 Assessments 408. Assessments School taxes 10!31/12 l0 6/30113 $1,108.40 409. School taxes 10/31/12 to 6/30!12 $1,108.40 Cando Assoc fee 10/31/12 l0 1/1/13 $450.00 4i0. Condo Assoc fee 10/31/12 l0 1/1/13 $450.00 411. " 412. Gross P.,tnount Due from Borrower: $75,666.64 420. Gross Amount Due to Seller $73,673.64 Amounts Paid bybr in Behalf of Borrower 500." "?Reductioriin Amount Due to'Seller Deposit or earnest money $2,000.00 501. Excess deposit (see instructions) Principal amount of new loan(s)' 502. Settlement charges to seller (line 1400) $5,113.71 Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 504. Payoff of first mortgage loan 505. Payoff of second mortgage loan 506. 507. 508. 509. dments for items unpaid by seller . Adjtstments foritems;iinpaid by seller` •; ~ ,: City/town taxes 510. City/town taxes County taxes 511. County taxes Assessments 512. Assessments 513. 514. 515. 516. 517. 518. 519. Total Paid bylfor Borrower $2,000.00 520. Total Reduction Amount Due Seller: $5,113.71 Cash at Setllementirom/to Bdrrower ` ~' ` ° ` 600. - :Cash at Settlemenf to/from'j5elleri ' Gross amount due from borrower (line 120) $75,666.64 601. Gross amount due to seller (line 420) $73,673.64 Less amount paid by/for borrower (line 220) $2,000.00 602. Less total reduction in amount due seller(line 520) $5,113.71 CASH (x)FROM ()TO BORROWER $73,666.64 603. CASH ()FROM (x)TO SELLER $68,559.93 STITUTE FARM 1099 SELLER STATEMENT -The information contained in Blocks E, G, H and I and on line 401 (or, if line 401 is asterisked, lines 403 and 404), 407 and 400-412 (applicable part of buyer's real estate tax reportable to the IRS) is important tax information and is being furnished to the Internal Revenue Service. i are required to file a return, a negligence penally or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has een reported. .ER INSTRUCTIOtJ - If this real estate was your principle residence, file form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax i; for other transactions, complete the "applicable parts of form 4797, Fonn 6252 and/or Schedule D (Form 1040). ue required by law to provide (Settlement Agent) with your correct taxpayer identification number. do not provide (Settlement Agent) with your correct taxpayer identification number, you may be subject io civil or criminal penalties. r penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. L. Settlement Char es - 10/30/12"10:26 HM ;File Number: 700. Total Real Estate Broker Fees $72,000 x 6 % _ $4,320.00 Paid From Paid From Division of commission (line 700) as follows: Borrower's Seller's 701. $2,160.00 to Spencer & Spencer Funds at Funds at 702. $2,160.00 to Hooke, Hooke 8 Eckman LLC Settlement Settlement 703. Commission paid at settlement $4,320.00 704. 600. Items Payahle in Connection with Loan ,; _.. , 801. Our origination charge (GFE 1) &02. Your credit or charge (points) (or the specific interest rate chosen (GFE 2) 803. Your adjusted origination charges (GFE A) 804. Appraisal fse to (GFE 3) 805. Credit report to (GFE 3) ` 806. Tax service to (GFE 3) 807. Lender Fee (GFE 3) 800. Flood Check fee to 809. 810. 811. 812. ` 900.. Items Required by Lender to Be Paid in Advance 901. Daily interest charges (GFE 10) ~: 902. Mortgage insurance premium (GFE 3) 903. Homeowner's insurance , (GFE 11) '. 904. 905. 1000:- -; Reserves Deposited with Lender " - ); ;~ 1001. Initial deposit for your escrow account (GFE 9) 1002. Homeowner's insurance 1003. Mortgage insurance 1004. City properly taxes 1005. County property taxes 1006. School property taxes 1007. Aggregate Adjustment 1008. 1009. - 1,100: ,Title Charges ' ` - % . 1101. Title services and lender's title insurance {GFE 4) 1102. Selllement or closing fee to Andrews 8 Johnson 1103. Owners title insurance (GFE 5) $746.00 1104. Lender's title insurance ~ ' 1105. Lender's line policy limit 1106. Owner's title policy limit $72,000.00 1107. Agent's pdrti6n of the total title insurance premium $559.50 1108. Underwriter's portion of the total title insurance premium $186.50 1109. Lenders Endorsements 1110. Closing Protection Letter to Stewart Title Guaranty Co. 111 1. Email fee to Andrews & Johnson 1112. Overnight fees to Andrews & Johnson 1113. Notary fees r 1200:. . Government Recording and Transfer Charges - - . 1201. Government recording charges (GFE 7) $62.00 1202. Deed$62.00 Mortgage Release$ _ 1203. Transfer laxek :(GFE 8) 1204. City/County tax/stamps $720.00 ~ $720.00 $720.00 1205. Slate tax/starrips $720.00 , 1206. 1300. - Additional Selllement Charges - 1301. Required services that you can shop for (GFE 6) - 1302. Andrews 8 Johnson -preparation of Power of Attorney $45.00 1303. Carlisle Borough -final water/sewer -acct no: 013133 $73.71 1304. AHS Warranty $420.00 1305. 1400. Total Selllement charges (entered on lines 103, section J and 502, section K) $1,993.00 $5,113.71 __......_...._....................,,,, .,..,~..a„ ,,,~ , ,,,,,_, ~~,,,~,,,~,,, „a,a,,,r, ,, a„~ ,,, ,,,n uesr or my xnowiedge and beuet, a rs a True end accurate statement of all receipts and disbursements made on my account or by me in This Iransaclion. I further cenity that I have received a copy of HUD-1 Selllement Stalemenl. To the best of my knowledge, the HUD-1 Sellle ~ Stalemenl which I have prepared is a True and accurate accorint of the (untls which were received and have been or will be disburs the undersigned as part of e s I enl of Ihls Iransaclion. i ~~~~ (~ Itlemenl Agent) Dale - ~ELLER'S ANDIOR PURCHASER'S STATEMENT Sellers and Purchasers signature hereon acknowledges his(Iheir approval of tax proralions and signifies !heir understanding Thal prorauoris were based on taxes (or the preceding year, or estimates for the current year, and inlhe even) of any change for the current yea, all necessary adjustments must be made between Seller and Purchaser, likewise any default in delinquent taxes will be reimbursed to Title Company by the Seller. - Title Company, in its capacity as Escrow Agent, is and has been aulhonzed to deposit all fuhds it receives irl Ihls Iransaclion in any financial inslilulion,~whelher affiliated or not Such financial inslilulion may provide Title Company computer accounting and audit services directly or Through a separate entity which, i(affilialed with Tllle Company, may charge the financial inslilulion reasonable and proper compensation Iheretore and retain any profits therefrom. Any esaow fees paid by any party involved in this transaction shall only be for checkwribng and input to the computers, but not (or aforesaid accounting antl audit services. Title Company shall not be liahle for any interest or other charges on the earriesl money and shall be under no duly to invest or reinvest funds held by it al any lime. Sellers and Purchasers hereby acknowledge and consent to the deposit of the escrow money in financial institutions with which Title Company has dr may have other banking relationships and further consent to the relenflon by Title Company and/or its affiliates of any and all benefits (including advantageous interest tales on loans) Title Company andlor its affiliates may receive from such financial nulilulions by reason or their maintenance of said esaow accounts. The parties have read the above sentences, recognize Thal the recitations herein . re matedhl, agree to same, and recognize Title Company is relying on the same. P is r Sellers WARNING: II is a come to knowingly make false statements to the United Slates on This or any other similar form. Penalties upon conviction can include a tine antl imprisonment For details see: Title 18; U. S. Code Section 1001 antl Section 1010- REV -1503 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 All property jointly-owned with right of survivorhsip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 $15,000 Bear Stearns Cos. Inc. Corporate Bond 15,000.29 See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached $15,000 Bear Stearns Cos. Inc. Corporate Bond interest -See attached 37.50 valuation -held in Delta Equity Services Corporation Account #39K-218749 - statement attached 2 American Cap LTD -See attached valuation -held in Delta Equity Services 4,306.54 Corporation Account #39K-218749 -statement attached 3 AT&T Inc. -See attached valuation -held in Delta Equity Services 20,440.00 Corporation Account #39K-218749 -statement attached AT&T Inc. Dividend -See attached valuation -held in Delta Equity Services 308.00 Corporation Account #39K-218749 -statement attached 4 Canadian Oil Sands LTD -See attached valuation -held in Delta Equity 3,690.75 Services Corporation Account #39K-218749 -statement attached 5 Covidien PLC - See attached valuation -held in Delta Equity Services 1,127.06 Corporation Account #39K-218749 -statement attached Covidien PLC Dividend - See attached valuation -held in Delta Equity 4.95 Services Corporation Account #39K-218749 -statement attached 6 Frontier Communications Corp. -See attached valuation -held in Delta 880.88 Equity Services Corporation Account #39K-218749 -statement attached 7 Glaxosmithkline PLC -See attached valuation -held in Delta Equity 74,362.68 Services Corporation Account #39K-218749 -statement attached 8 Kraft Foods Inc. -See attached valuation -held in Delta Equity Services 13,935.70 Corporation Account #39K-218749 -statement attached 9 Loral Space & Communications -See attached valuation -held in Delta 0.00 Equity Services Corporation Account #39K-218749 -statement attached 10 PPL Corp. -See attached valuation -held in Delta Equity Services 13,795.00 Corporation Account #39K-218749 -statement attached 11 Verizon Communications Inc. -See attached valuation -held in Delta 32,415.46 Equity Services Corporation Account #39K-218749 -statement attached Total from continuation Schedule(s) 143,537.53 TOTAL (Also enter on line 2, Recapitulation) 323,842.34 (If more space is needed, insert additional sheets of the same size) Estate of: Leah R. Henschen Schedule B -Stocks and Bonds Item Number Description Verizon Communications Inc. Dividend -See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached 12 Apollo Invt Corp - -See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached 13 Duff & Phelps Util Corp Bd Tr -See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached Duff & Phelps Util Corp Bd Tr Dividend- See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached 14 Lord Abbett High Yield FD -See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached 15 Oppenheimer Multi St Municipal -See attached valuation -held in Delta Equity Services Corporation Account #39K-218749 -statement attached 16 Du Pont E I De Nemours & Co. -See attached valuation -held in PNC Investments Account #097-132098 -statement attached 17 Exelon Corp. -See attached valuation -held in PNC Investments Account # 097-132098 -statement attached 18 Johnson & Johnson -See attached valuation -held in PNC Investments Account #097-132098 -statement attached 19 Kimberly Clark Corp -See attached valuation -held in PNC Investments Account #097-132098 -statement attached 20 Lilly Eli & Co. -See attached valuation -held in PNC Investments Account #097-132098 -statement attached 21 Southern Co. -See attached valuation -held in PNC Investments Account # 097-132098 -statement attached 22 Altria Group Inc. -See attached valuation -held in PNC Investments Account #097-132098 -statement attached Page 2 21 12 0218 Value at Date of Death 434.00 2,238.00 18,787.50 105.00 56, 322.74 18,288.34 5,058.50 3,943.75 6,542.00 10,658.25 4,703.10 6,286.35 10,170.00 TOTAL. (Carry forward to main schedule) ...... 143,537.53 Estate Valuation Date of Death: 01/30/2012 Estate of: Estate of Leah Henschen Valuation Date: 01/30/2012 Account: Delta Equity Servic es Corporation Processing Date: 03/29/2012 Report Type: Date of Death Number of Securities: 15 File ID: Hensche n, Leah Estate Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 15000 BEAR STEARNS COS INC (07387EFR3) Financial Times Interactive Data DTD: 07/22/2009 Mat: 07/15/2029 6~ 01/30/2012 100.00190 Mkt 100.001900 15,000.29 Int: 01/15/2012 to 01/30/2012 37.50 2) 532 AMERICAN CAP LTD (02503Y103) COM The NASDAQ Stock Market LLC 01/30/2012 6.19000 8.00000 H/L 8.095000 4,306.59- 3) 700 AT&T INC (002068102) COM New York Stock Exchange 01/30/2012 29.38000 29.02000 H/L 29.200000 20,990.00 Div: 0.44 Ex: 01/06/2012 Rec: 01/10/2012 Pay: 02/0.1/2012 308.00 9) 150 CANADIAN OIL SANDS LTD (13643E105) COM Other OTC 01/30/2012 29.79000 29.42000 H/L 29.605000 ~ 3,690.75 $) 22 COVIDIEN PLC (G2559F113) SHS New York Stock Exchange 01/30/2012 51.63000 50.83000 H/L 51.230000 1,127.06 Div: 0.225 Ex: 01/26/2012 Rec: 01/30/2012 Pay: 02/22/2012 4.95 6) 208 FRONTIER COMMUNICATIONS CORP (35906A108) COM New York Stock Exchange 01/30/2012 4.29000 4.18000 H/L 9.235000 880.88 7) 1656 GLAXOSMITHKLINE PLC (37733W105) SPONSORED ADR New York Stock Exchange 01/30/2012 95.07000 44.79000 H/L 99.905000 79,362.68 8) 365 KRAFT FOODS INC (50075N109) CL A New York Stock Exchange 01/30/2012 38.33000 38.03000 H/L 38.180000 13,935.70 9) 25 LORAL SPACE & COMMUNICATIONS (656962198) SHS NEW The NASDAQ Stock Market LLC 11/22/2005 0.09200 0.00800 H/L 0.025000 N/A Last price available on 11/22/2005 10) 500 PPL CORD (693517106) COM New YorY. Stock Exchange 01/30/2012 27.72000 27.96000 H/L 27.590000 13,795.00 11) 868 VERIZON COMMUNICATIONS INC (92343V104} COM New York Stock Exchange 01/30/2012 37.62000 37.07000 H/L 37.345000 32,415.46 Div: 0.5 Ex: 01/06/2012 Rec: 01/10/2012 Pay: 02/01/2012 939.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0) Date of Death: 01/30/2012 Valuation Date; O1/30I2012 Processing Date: 03/29/2012 Estate of: Estate of Leah Henschen Account: Delta Equity Services Corporation Report Type: Date of Death Number of Securities: 15 File ID: Henschen, Leah Estate Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 12) 300 APOLLO INVT CORP (037610106) COM The NASDAQ Stock Market LLC 01/30/2012 7.57000 7.35000 H/L 7.960000 2,238.00 13) 1500 DUFF & PHELPS UTIL CORP BD TR (26432K108) COM New York Stock Exchange 01/30/2012 12.59000 12.96000 H/L 12.525000 16,787.50 Div: 0.07 Ex: 01/12/2012 Rec: 01/17/2012 Pay: 01/ 31/2012 105.00 14) 7490.256 LORD ABBETT HIGH YIELD FD (59900N300) CL C Mutual Fund (as quoted by NASDAQ) 01/30/2012 7.57000 Mkt 7.570000 56,322.74 15) 2572.2 OPPENHEIMER MULTI ST MUNICIPAL (683940308) ROCH NAT MUN A Mutual Fund (as quoted by NASDAQ) 01/30/2012 7.11000 Mkt 7.110000 18,288.39 Total Value: Total Accrual: Total: 5276,980.39 5275,590.99 5889.95 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. 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(gyp ~ n ? ~ ~+ ' < C _ ~ Q O M _ Lf N ~ O ~ ) ~ m Q- N W iR O N O O O ~+'~ W v ~ ~ p _ ~ Q ~p a D ~~ m IJf N O O O O O tJi In O O O N r.~ s, ee CD ~' 0 _~ 0• 0 AA~ iii vM n 0 ~_ ~~ C fD s. li n d D 0 c Z c w 7c N 00 v -~. 7Q d A M /~ N tk o -~ 000 -`~ o N T o ', 00 0 0 0 0 0 o p C `o 0 0 o w a d : ~ ~ N N N N N N a ~ N S ~. ~ °~ ~ ~ -, ~ v+ C ~~ -n ~n~ r ~~' D -v O m z z~~~zn0 . v _ ~ m rl S C= 2 y C Z fD p rn Cl ~ D D m O p m ~ ~ D o0 2 C z Z Z m ~~-w p ~ p p ~ p of m p n m m W 3 C ~ < G C -I ~' p ~ ~ D ~ ~ z ~ ~ G Z T v w °' o-- ~ ~ yr wo o n0 -NI ~ ~ „ ~ ~ o o n o „~ , ~i, 1.1 -a W L-°i ~ii ~ m O G i z D '~ = n ~ o op ~o O ~ .~, = O ~° z n O ~ ~ w~ z ~ n p m ~ J ~ ~ n m Z r ~ O ~ ~ ~ ~ z C ~ ~ ~ N f'1 ~ m ~ z o n -~ o N C =z ~ ~ ~ ~ o ~ ~ ~ z D O ~ Q O w z rl N ° o i v D -'-' O ~ o n .~ D p ~ D ~n -o w ~ O ~ o o N n n C N ~ D J ~ T ~D N ~ ~ ~ o_ n -,~ m s °' ~ _. 00 00 a r. ~ s ~ , o ° c Z s m f ~ '~ N O S F ~ ~~ ~ ~ O fo r ~ o n ca ~ ~ a n ~ co ~ v V ~ N o Q °w, a °~ ~ o `~ l0 O CO V O ;P ~ ~ ~ W O O pp ~p O O C C C C ~ _ ~ 0 _ ~ O G O Q o l~ 1~1 ~ C ° ~ o o r9 ~ a+ -i o ° S °-~ a0i ? m p 1 N d N r,~, C d S d 1 H a a S.. ~ W O ~ ~ ~ _ v _ °~ vi O v+ = vi ~ a, v, O v _ , 7C C ~ ~ d o ~ C f~ ~ ~~ y ~ a ~' p D ~ ~ =. ` ° r c ~~ c ~' ~ ^ °' C C "' ~ Z ~ n _" m ~ Z T, ~ c ~ o v o y T i/1 "'~ VI -~-I v r- O -„ ~ zD~ v O T p ~ z O ~ ~ n ~ ~ n ~ z= z ~ N O m w ~ ~ r w v n T O D ~ n ~ D ~ Z T O -~ ~ n z N V w w v N O 0 0 0 0 0 0 o v, ~~ N N N ~p W O c m m = rn Di X m n X m `~' p yD x rn a `~ "'i - -~ --~ _ _ z z z ~ ~ m ~ m m o= p ~ ~ N= 0 l/'~ rn V1 -° Z C= o D o W ~` -° z ~ C S N ~m = m -r,W O ~ ~rn ? ~ ~ ~ ~~ D = n n ~ ~ O v, p = ~ C ~ o -~ ° ~ ~ Dr m- ~ _ Q 00 r m ~ o ~ O ~ ~ c O O ~ ~ C Z ° ~ C vz ~ Dz ~ ~n z~ ~ nz C -=i o C n ~ O Z ~ n n D O - -D D -. ~n v D Z°r ~ O w= 2°n o ~-~ O ~ ~ n J -o p n z~ _, C n rn z~ nD v nD -P ~ m ~ l~0 ~ v v O ~ C Q G O ~~ , V1 ~ w o tQG _ ~ N N ~ ~ C ~, ~ C ~ 0 C ~ ~ C ~ ~ C N ~ ~ ~~ ~ 3 ~_ 0^ N ~. a C ~a A .. '^n i a 7 rt '~ O~ d O_ O N O_ N O W N O N cn (^D, W C7 ~ cn m Q, • ~ ~ coo ca W c < ~ o ,~ ~. 0 o Cn cQ c ~ cn ~ `~~< ~ D CD ~ (D O to ~ ~ n ~ to o o N o ~COw r ~ (7 ~ D CO W n 0 ~~ d ...{ , 0 0 0 0 0 0 0 ~~ ~ 3~ ~, cn 0 j ~ ~ ~ ~ \ ~ ~ ~ ~ n T -+ i W W -~ -- 0 0 0 0 U~ O Z ~ ' t~J ICJ t~J tJ N I~J ~J -• z D N ~ ~ o i o! i ~z ;~ ~ i r1 C~ C7 CJ ~ J J ~J O o ~ ~~ ni rb n~ ru rt, n, - .C .~ O ~ T_, t3 ~J 'Ci ~ ~ ~, rV [ G G C o o ~ •7 ~+~ ~ r ~i C/ i ~ V~ l/i V~ V~ Vi Vi V~ ~ ~{ I 5 ~ va J -" ._. .- r. r. ~_. r. ~ W ~ C w Cr ~i vo y ~ 41 ~-' ni Z ro r _ W 0 rr I a ~ n, T i ~ ~ C ~ ~ ~ ~~ i ~ a d I ~ o ~ I o _c 1 ~~ ~~ i r1 '~ ~ m ~ c i Uq c~ r~ r l 1 r r W r~,u0000Cu -- ;y n i I ri rn r'ri rr\ rn I fl -• -t 'C "C '~ ~ ~ -1-1 -Tl Tl -T, Tl T, C C_ C C C C ~~ 'T'zzzzzz ~ C7 ~ ~ CJ ~ m v v v v~~ ~~ C C C C C C ~ ~ ~ ~ ~ ~ ~ n n n n n n _ = S = D 3> D D D D n ~n v, v, ~n ~n i i i i ~ I i ~ ~I 1 . m m r r-I r-n rI . m ~.. -- ~o In o co Cf~ ~; 1-.. ~I ~ CJ Ul W .{=~ U~ -{=- l~~ ~ O CO 6~ O O G O'. -~ G to ~l G O G ~I 'a Yr V1 ,o -r -_ =- o~~ in u, -~- w - a, m ~ ~ -- .'«, O~ Cn ~~ rn rn o rn r~ ~ ~ ~' O i 0 O lL lG -F V ~1 v ti v ~ ~ s 0 `° °S, ~ ~ ~ ~ _ ~" fD s p~ ~ ~, ~„ Q a ~ ~ ~ K ~ a d a ~ ,~ v ~~ m ~~ Q ~• ~ r O c a N Q v ~' O a B 0 C O O O O -~ N iD N W W IJl t0 W Q1 00 0 0 0 0 o p w w ~ c i ~ _ ~~ tv ~ _ t~J \ _ h-1 ~ d _ ~ N a a a. wz~ o~ O~z Z fD oo~`:~. ono z Cv, n ~'ri0 z„-,z W O~ m 0 ~O m~ = ~ C ~ o o mD rn ~~ ~ z j. CTN'mn aD n ~ ~ m ~ ~ ~ m 7c Z m m m ~ ~ ~ v, ~ T' C z m n f"T7 -Nj ~ rn n -r ~ C m QJ C ( ~ ~ m CJ ~ C, O z Crtl, -i --• ;v u, D ~~ ono ~ ° m ~ C z o ~ o Z ~ n v, D= m OnIW Z ~ z ~ ~ m ~ ~ m ° O ~ ~ v, rn - tio ~ V ~ r' 'n z oz -°~ ° _ ~ o~ o m -~ n m n o O r- ~ ~ w-n ~' °~ ~z ~ C N C (l ti - N -~ ~ z ~ z ~' z n \ N D ~ m ~ Oo G ~! m n z ~~ O O ~ <> --i ~ v -rI ~; r,-. ~ /~ ~7 n ~ y rn ~ ~ W ~^ ~n n O D W T ~ ~ O C7 O O O lJt l0 O O l0 O N C C C ~n vl ~n ~D D ~ - v ~ ,ter y. l i ~,-~ C- ~l~' /^_~ (`-'--. _, r -P l.n O O O C v, ° ~' ~ ~ z~ d r O ~. ~ n~ rt ~.. C~ ° n 9. ~ ~ ~ c cp Q ~ c e ,-.. ~ ~ c ~ O' „~~„ ' ~ err ~ W ~' rl n H ~ O. `° n ~ tD t0 ~ .~ ,~' cp Z O O O ~p `.~ p rp m ~y' a~ cv ~ r+ ~ ~ y+ .m ~.m ~i ~ CD ~~ ~~~, ~o n 8 ~c~ oN ~o ~ ,~ ~ ao~ my ~ w ~ ~ ~, ~ v c~~ ~ ~ ~ ~ a. n A n o ~ ~ m = ~ ~ii ~ o ~~ ~ ~ ~ ~ O ~~ o m ~ ~ m ~ cn cr c ~ ~ C ~ o a> ~•~ a c n ~ ~ ~ ~ o ~, ~ ~ ~ to ~ ~ c v ~ ~_ ~ ~' ~ ~° ~ c c a o' ~ ~ o O n S~ _o ~~ ~~ ~~ an? ~ N ~ ~ C ~-~ ~ ~~ n j O n ~ ~• C n ~+ (D ~ ~ ~ ~ ~ _ ~_ O ~ ~ ~ tD ~ ¢1 n C ~ {~ n- ~n v~ ~ w m "~ ~ ~ ~ o ~ c ~ ~ O A~ pp ~ ~ Z O = ~ ~ CIS .C ~ ~ ~ ~ (CD ~ O O c ~ -~... ~ ~ ~ 7 (D (D -' IC O ~ C ~ d ~p lD C ~ 2 ~ ~ ~ N ~. ~ b' ~ 3 r- S v ~ `~ ~ u> ~ 0 0 O ~ rC ~ O ~ C p W ~ (D -~ ~ ~ ~ ~` c CrJ N ~ s c~ t 6_ ~ -. N •-• ~ O W O f,U "" Oo ~ t~O O ~ ~ 3 ~ ~ N ~ (,,) (p ~ 00 O O OD ~ !~ ~ •v o =~ 00 a ~~ ~~ a= 3I to N• (D (n O ~ oo v 0 2 v' -; c~ ~ o m o ~ ~ ~ m ~. -n ~ O -, o0 0 = m ~ ~ ~° ~ so ~ 0 ~ oo°o a ~ A ~' Q') O O ~~ ~ ~ ~D o O N ~..~ to C a ~ ~ V) Q ~ Q (D 10 O O ~D (=D N O O~ ~ Cn Q1 W O O W uNi O co'.n ~ ~ Vi ~`Cj- ~. ~ ~ p~ ~ ~ O- C ~ p• (n O l/1 "` .-. '~1 ' ~ ~ ~ o ~ m oT ~ o ~ xr '~ m o cn c ~ ~ ~ c °o ~o °~ ~ ~ O O C ~ ~ .C _ ~o ~_ ~ ~, ~0 3~ ~~ '- 8 v ~ ~ ~ v a v ~ ~ ~- ~ ~ _ o o a ~' c -o ~ -p tD • p, is ~-n w ~ ~ ~ o~ Z two f+o o ~ _;' ~ ~i ~ ~ g N :Q OD o0 0 o bo m c ~ ~i oOO ~ wo r.~ . ~ o .~ ~ 2' a ~ `~~ ~ 0 0 0 c o `a N o =• c ro ~ ~. _ o ~ a -~ o o N N ~~ w o n o ~ ~ ~ o o .~ ~ ~ A d a. ~! N C d a ~: I~ .-~ ~~ v I~ cn a 'G r~ a 0 0 _O 1 N O_ N O W N O_ N u, ca w ~~ ~ n~c~ m ~ w ,.m m~ ~ -- .n t0 W c <. ~o~•~. 0 o cn cn c ~ m c~ ~ ~ m ~ A ~ ~ co o v, .~ ~~oo ~~ o ° w o ~ `D w r `~ (~ ~ o• cD cti W CJ C CT ~D w !~ N v lf? 1 N N G~~ ZT'- ~~ ~ w na ~ T ~ N ~w N v N m ~n i fD r °i v w ~_ S O ~ G > ~ S ' v < ,~ , S_ - 7 > ~ r > r ~ n , w 1 N ~ C 7 ,n a ~. j' K 7 ~ °-- O ~ Cn o ~ o ~ ~< o u> ~ sv = o ~- n ~ = c o ~ -o ~ a T ~ n: o ~ ~ -°o o~ ~ ~ ~ ~ ~ ~ ~ ~. cn -o A, ,< r ' .' _ cn cn cn ~' c o ~ _.., c~ ~ m . ° ~ ? -` ~ u i o "'"' o ° c n. m ~ G < n ~ O ~ ~ oo m p, ~ c m v ~ u, < a. 3 ~ n a. n~ ~ ~ u, ~' ~ - ° ~ c°n cn • o =• 3 A, m ~ '_` m D `c ~ m ~ ~ ~ W ~ ~ a ~ = ~ o v m o. ~- ~ R, o- a ~ ~ m ~ ~ cn ~ ~ v , ~ O ~ O ~ ~ '~ ~ T . ~ ~ Q to ~ = ' = ~ ~ ~ ~ Cn ~ ~ ~ ~ _ CD ~ ( l D N ? N ~ m ~_ to ~ ~ o °' ~- O ~ v c o o -~ o a. ~ N ~ ~ ~ ~ > > v m ~ o ~ tc ~ ~' o • ~ ,c- ~ ~ o N ~ m ~' ~ -v cn o au o ~ ~ 3 c ~_ ~ ~ ~ CX, cn ~ _ C O O ~ -.. O o m ~ LU O Lv C (/~ --. ~ ~ ~ ~ ~ ~ ~ (Q .,,C n C1 ~ m n ~ n~ O C1 ~ • ~ m Q- ~ n O O C iv to ~ m m m o O ~ C ~ m n In C m m v ~< d O O -• C N = ~- ~ O n- m C7 Sv ~ O ~ (a ~ (D : C] ~ T O O N O ~ ti ~ - C1 Cn _, ~ ~ cD (/~ p iv (~ . '--' . _ v A~ (D C ~0 C' 'O C) ~ N m ~ O ~ m ~ ~ ~ O ~ ~ A.) ~ _ -. ~ C • O ,D - r2 p ~ ~ ~ (~ (/~ cn- C Q ~ ~ ~ ~ o m m ~< ~ D Q ~ N p C ~ ~ ~ ~ c -., - ~ n- m c ~ ~ ~ ~- O ~ c m tD c N c ~ -' ca c~ ~ ~ - -° c ~ ~` -G _ r o C7 o -o 0 ~ ~ ~ O Q -~ ~ ~ ~ ~ - w m m O Q ~ 'o ~ m c c ~ C < m u i ~ ~ - ~ < a _ ~ m ~ O" Q c 6 ~ 'D C O tp f7 O ~ ~ Vl - a c ~ ~ - ~ n G ~ ~, ~ ,< ~ O ~ m m tp O u, -0 3 a O ~ Cn C1 = ~ cn 6 ril n~ -Q c n A~ ~ p m A~ = .-« ~ - Q ~ p~ tD m m (C - i ~ O ~ n Q- m ~ m iv n m ~ n~ n c N ~ O^? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ C ~ m ~ ~ ~. m ~ O _ K m c ~ ~ ~ 1] n ~ rn Q ~ c U) ~ m 3 ~ ~ l/> ~ cn ~ G C n m ~ Q m ~ !n m A~ O _. n- m ~ ~ ~ +~ ~_ N ' O Cn m m C -.. ~. G CD Q.. ~ ~ ~ N ~ N ~ U~ ~ "` O =, ~ ~ ~ ~' ~ ~ ~ ,D ~ D O ~ ~ m ~ ~ ~ O m O a' m L1 C1 CT ~ ~. C m ~, ~ w o - „~ ~- ~ cn ' ~ n ° u' ? u, ~ °- cn CD a>' a, m ~? m ~ c ¢, o c~ " c o .n ~ ~ a o > >" A, in m A ro ~ in ~ m X °' ~ w ~' N ~' o- ~ g- ~ ~ cn o D ~ ~- ~ ca Ko 0 ° o ~' m ~ o ~ o ~ ° o m -° o ~_. v°i ~ g ° ~ ~ u' ~' 3 • ~ ~ ~ m O v o can ~ to C c- ~~~~~ n C~ ° °' Q ~ ~ ° g ~ c ~ ~ ai ~ ~ ~ umi ~ ~ C m i n ~ 3, ~ = no 5 p m '~ - ~ d u' m m v' cn s Cn ~ ~ ~ a , -o m ? "D Q ~ ~ O O n• ~- p, ~ a ~ o c ~ m ~ (D m < -., o ~ K ~ ~ m ~ ~ O ~ m ~ O ~ X C N O ~ = m ~ ~ , ~ ~ . ~ ~ ~ O (n Al 'O ~ CO ~ ~ N ~_ a N n m m = n m ~ (D ~ ~ .~ -D ( n ~ ~ ~' O (~ ~ d t<D ~• Sv f7 n O n to O - -~ -. O< ¢~ = p ~- ~ O n. ~ O (n m _ ~ -p ~j ~ C C ,~ Q (D C m C7 `~ ~ ~ C C1 -, n n O ~ ~/ ~ `'C C.J C O ~' m '"- . (D t/~ to . 0 m ~ ~ ~ m ~- ~ ~ O tC] n ~ 0 ~ L1 ~ A~ ~ ~ tp C ~ ~ n ~ O _ Q !/~ O ~ K m. m m O ~ -` ~ . ~ ~ -.. ~ D_ N ~, ~ m . ~ C O ~ n `'C to n: _~. LD ~ m ~ C O C ~ ~ L1 m (n ~ O m l1D d m ~ ~ ~ ~ ~ ~- O ~ ~ ~C Q C ~ ~ ' p Vl ~ (~ O ~ _ ~ ~ • ~ ~ ~ ~ Q" ~ CA m C C ~ O ~ A _~ m CO ~ C C m n cD d O _ ~ ? C ~ O Q. ~ O ~ = C `< K - Cn -d (~ ~ C -- -p C ~ "D O ~~ ~ n m ~ O ~_ ~ ~- ~ N~ D m m ~ t B O O O v O ~ ~ ~ O O~~~~ to ' Q O n ~ ~ ~. ~ ~ i U ~ D ~ m (n Al ~ -_-_ ~ tp A~ O ~ .~ u' in ,~ cn 2 ~ - ~ ~ N - ~ cn o ~ ~ ~- ~ ~ ~ O .--. Vf c a~ a, ~ ~: ~ o - tD ~ ~ a m .~ ~ cv - sv O ~ -- c ~ Oo ~ s ~ O o ~ ° o ~- o s a ~ ° m o ~ c ~ c o- ~ ~ ~ ~ ~ D 3 > u ~ .¢ ~ cn ~ _ ~ O ~ c ~ ~ ~. ~ o m n ~I (m!) G- 1 C7 _ .. ~ O m m O L1 O f7 Cn ~ ~ ~ ~ O ~ u, m _ _ = ~ m su N ~. m O C (!) O "~ O O ~, `< m -d ~ O p=j ~ ~ ~ m co 3 c~ cn O 2- c A) Z CD ~ CD ~ O p~ .< m o_ o ~ ? o m < `'C a m ~ ~ ~ ~- ~ n ~ ~ ~ m ~ = o < _~, Q - ~ v' ~ O ~. m co =. ~ ~ ~ ~ ~ ~ m ~ C ~ ~ ~ ~ ~ ~ - m (!f C2 ~ cfl n ~ ~ (a p C '~ ~ m ~ - m m `G ~ -- Sll ~ tU . O ~ m A, - ~ .< c ~C Q v •C O - -o to n ~ -., ~ ~ O ~ l/7 K ~ ~ CKD ~ - -. ~ Ct N L7. C'i ~ - [n "D m iU n ~ O n ~ ~ ~ O -n 3 co N N C CT C O con -D fl% N ~ gym, C ~^ T u, ° sv Q> ~, ~ O ~ C ~ ~.. (D =- ~; o ~- c , CS ~ ~~ c cn u, `~ c Q tt? tD in R, -. ~ ~ ' [,? - u, J~ c> c ~. _ ~ m _ ii r' - ~ c (D tD Ql o - ~; - O --: n ~ _ - ri C f7 O - C ~ n ~ 3 _ -c ~ ~ O ~ O - ~ 3 _-.. ~ .-. J w cn " ° ~ tl) ca Cn Cn o c Q ~ < (n m ~< ~ ~ m N O ..r o ? o a. m ~ ~ ~ D -p ~ _ ~ ~ n Cn ~ o ~ • o ~° ~ C ~ ~ ~ ~ n ~ Q ~ ~ ~ ~ ~ Q ~ ~ ~ ~ ° ~ ~ ~ ~ ~ ~ ~ ~ ~ Q " - ~- o ~ ~ m a CD ~ n- v O O o cn c ~ ~ m C ~ O ~G CC _ A~ G = O m n ~ ~ r- -,' C7 ~. ~ - CD ~- ~ (n `C umi ~ O ~ `< C ~ m ~ In O Q- O t{D _ ~ ~ O ~ ' O ~ C ~ Q O-- ~ ~ tQ ~ ~ m m ~ O m 'O O ~ Q ~ K m ~ O n d ~ - ~ ~ ~ ~ n ~ C A~ ~ ~ - ~ ~ - Q. ~ c ¢~ O (n ~ ~ ~ -` C ~ ,c n ~ ~ Q VJ --' O C ~ C) ~ G _ ~ f7 _ m In n. < O N ~C _ n m O ~ t1 Al 6 Q- ,,,~'~ Q_ Q ~, - U ~ n =. Al m ~ ~ ~ N ~ ~ d X O ~- sv ~ 0 o CD O N f7 ~. (/) K ~ ~ CD O~ C m n tp n ~ ~ ~ (D O (n O ~ ¢7 .~ (D CD O~ C m ~' ~- ° fv ~ fn n ~ d ~ o N ~ ~ m , O ~ ~ ~ m 3 rn ~ ~ ~ ~ ~ O ~ ~ ~ m c tom ~ m = - C T. ~ O ~ ~ ~ -. ~ • o ~ O in ~ t0 O c C - = o n ~ v c fn O =• ~ ~ n _ ~ p ~ O O C 'O O t i2 O C ~ ~ ~ tp ~ ~ ~ ~ C~ ~• > > ~ ~ D ~ m ~ m ~ ~ ~ N tD = i u ° ~ = 3 °- a, 0 ~ ~ ~ v, in m m -o to ~ o c o -` ~ ~ cn C7 ~ ~, ° v i - o' ~ ~ o; m -~ ~ ~ .-. o O -~ ~ p O m m C~ K ~ m m Su O tp ` _ m "` 3 ~ C ~ ~ ~ C ~ -Ca ~ ~ ~ C C m in (p n ~ L' LZ ~ ~ N ~ C (D ~ ~ ~ (A- < ~ ~ ~ ~ N ~ = C -D O 3 ~ m C ~ C' ~ m Q' c O ~ n Cn O- ~ ' ~ ' ~ Q m O O "' ~ ' -C ~ Q ~ ~ U i _ ~ Q. m C m ~ "D ~ ~ ~ v + C W m 'n - . _ N ~ - ~ ~ ? tv ~ ~ D ~ ~ ? ~ ~- (D U1 ~ C7 n Q Q- cD ~ m "O N n O ~ O Sv `< Q p p _ [n _ O fn `< ~ ~ m X C ~ "~ (~ ~ -p ~ ~ n ~ ~ ~ ~ "~ ~ ~ O C ~ ~ O ~ Sv p m ~ O Q ~ m N ~ N O KO LU Q tp UOi ~ m C7 ^` ~ - _ v> ~ 3 O° = . Q ~ O C (D (~ ~ n ¢~ '•C (D m ~ ~ Cn ~ ~ N O ~ ~- . ~ ~ ~ ~ ~ Q. ~ "~O Q ~ (D n O a ~ ~ n ~ - C7 O O ~ ~ ~ ~ C N m m ~. ~ n C7~ ~ .,,C CD tv `Z n ~ ~ ~ ~ tU .C c ,,,~ o p' n m m ~ Cn (n < ~ ~ ca to - ? N m c O C A p <~ O - t7 - -. = ~ d C p ~ ~ 00 ~ ~ In ~ 3 ~ - C D m O_ n ~ ~ ~ j .C Al O m to to N ~ ~- ~ O ~ O Q `~ O ~C n c o Q _ `~ m~ v D~ to ~ O<~ m _ ~~ c~ m m _ VOi 3 c~ ~ o ~ o - ~ ~ ~ ~ (~ ~ ~ C- ~ L1 Q ~ o ~ Sv Cn ^` ~ O O Q' to ~ ~ tD ~' tD ~ O Q ~ ~ - p - ~ '~ p' N ~ CAD to m - z ~ .~ O 3 ~ C2 n (~D ~ - Q --.. L1 . - ~ > m tD ~' ~ to C o o ~ m ~ m ~ ~ can N w~ W H 0 c ~D a a n 0 c ~_ Z C 3 W 7~ N tD O d '~ fD N N /1 N ~ O O w N ~ _~ O o0 o n -~ ~ ~ °' m m o70 a 7 S F O ~ C Z ~ (D S ~ ~ (D ~ N O ~' F 7 (D r o n ~ d c o Q, o a n. ~. o `< 7 a eo m 0 .. • ~ • • • • • ~ ° _ ~ cn ~ . ~ co rc ~ ~ -i -i --i ? --i -1 _D D ~ _ _ ~ to ° ~ ~ O ~! ~~~° ~~ ~ m m m m cn ~ -o ..« m cu ~ ~ 3 n CD o ^~ cn Z c ~ ~ ~ ~ ~ a = ~ ~ ~ °, o ~ o o ~ o ~ m Q- C~ ~' ~' ~ "' w ~ n ~ 3 ~ ~ a m m ~ m Q. -a ~ ~ _ .n ~ o'~ ~' ~ m ~ ~ ~ ~ u~ w > > ~ ~ ~ ~ o ~2' ?~ > o . ~ n ~ o '~. m m a~ ~ m ~~= m O m ° o~ ~ 2 ~ v ~ ~' ca c• ~ ~ c-n .' ~ ~ C7 ~ ~ ~ ~ ~• c p, ~ w ~ ~ cn o m -, ~ c m ~ n- -n ~ ~- ? r o ~ ~ v a' ao ~ . a ~ ~ ~ • ~ _ ~ C7 ~ ~ C7 0 ~ ~D "p N ~ ~ d ~ Ul c ~ ~' O ~ _, ~ ~ ~ ~. ~. m ~• ~ ~ ~°• ~ ~ ~ a ~ cn ' _ ~" m ~2 .~ ~, ~• ~ cn n m ¢, 3 c 3 ~ n ~ ~ o ~ ~ ~ ~ ~ a ~ ~ a O a~~ ~~ ° a ~~~a ~ d ~~N ~o~ ~~ ~ c ~ ~ (D ~ o ~ ~ C N ~ ~ O CD ~ ~. O• ~ ~ Q- n l~~D ~ ~ ~ n 3 N• ~• Q O 3• o ~ ~ ~ ~• ~ ~ ~ a. o ~ • 01 _ ~ n ~ n N~~ N C~ C ~ . ~ X Q ~ ~ ~ ~ ~ n rt CD CD ~ ~ Q ~ U" `~ (D ~ N ~ ~ (D CD = C (D "d ~-_~ ~ TI O ~ ~• ~ ~ O ~ p ~ ~ ~ ~ r ~ ~ d N ~ ~ ~p• C ~ n ~ n ~ =. ~ '~ o ~?« (U ~ ~ ~ ~ p ? ~ `C `~ O ~ ~' n d- W n ~ cu .~ o ~ = ~n m ~ -- r. ~+ . c~ m ~ m w sv ' Q, ~ v> .2 ~ O O w 1 i c m ~ ~~ n. ~; m .~ ~ p ~ d ~ ~ ~ X .o~o !~ p '~ ^ ... ~ '~ . ?3 ~ x ~~ m u, S- -o -; n ~ •2 s,=u,•D m ~ sv ~. ~ N a ~ ~ ~ ~' o' < ~ • ~ ~ m ~- O O m ~ my ~ ~ ~n -3`~ '! O 3 m a. w?< -~' ~ m Z O o ~ Q N ~ m• a. ~ ~ ~ ~ N -.. ~ O ~ ~C ~ ~ ~ ~ !y C7 "O ~ O ~ o c ~ ~ ~ N . - -~ ~ Qp c z-.,~ ~ O ~ _ ~ ~ ~ N ° `~ 3 n Q" ~ =- W O cn .~ ~ ° ~ O c N Q ~ ~ --1 `~ ~ ~ N ~ ~ (~ ~ ~ ~ O (D O o p ~ O n 3 " ~ p (D C ' (n ~ d ~. O ~ n O ~ Q7 ? ~_ CD n ~ _ ~ O ~ N ~ ~ ~ -. CD ~ n n (D n ~ ~ p• ~ ~ A~ ~ ~ _ ° ~~ _~ ~ ~ ~; 0 ° n ~ ° ~. O ~ ~ ~ ~ O (D 7S' ~'` Estate Valuation Date of Death: 01/30/2012 Estate of: Estate of Leah R. Henschen Valuation Date : 01/30/2012 Account: PNC Investments Processing Dat e: 03/06/2012 Report Type: Date of Death Number of Securities: 7 F ile ID: henschen.estate.val Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 360 ALTRIA GROUP INC (022095103) COM New York Stoc}: Exchange 01/30/2012 28.50000 28.00000 H/L 28.250000 10,170.00 2) 100 DU PONT E I DE NEMOURS & CO (263534109) COM New York Stock Exchange 01/30/2012 51.01000 50.16000 H/L 50.585000 5,058.50 3) 100 EXELON CORP (30161N101) COM New York Stock Exchange 01/30/2012 39.73000 39.19500 H/L 39.437500 3,943.75 9) 100 JOHNSON & JOHNSON (478160104) COM New York Stock Exchange 01/30/2012 65.71000 65.13000 H/L 65.420000 6,542.00 5) 150 KIMBERLY CLARK CORP (499368103) COM New York Stock Exchange 01/30/2012 71.61000 70.50000 H/L 71.055000 10,658.25 6) 120 LILLY ELI & CO (532457108) COM New York Stock Exchange 01/30/2012 39.45500 38.93000 H/L 39.192500 9,703.10 7) 190 SOUTHERN CO (842587107) COM New York Stock Exchange 01/30/2012 45.11500 44.69000 H/L 49.902500 6,266.35 Total Value: $47,361.95 Total Accrual: $0.00 Total: $4-7,361.95 i Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. 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(If more space is needed, insert additional sheets of the same size) REV-1507 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 REV-1508 EX+(11-10) ~ pennsylvania SCHEDULE E lit PAR T'dF N_J (J b~ ii F'.V~.N[1} CASH, BANK DEPOSITS, & MISC. INHERITANCETAXRETURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Leah R. Henschen 21 12 0218 Include the proceeds of litigation and the date the proceeds were received by the estate. ----- ------ All property jointly owned with right of survivorship must be disclos~ce -on 5c-hedu(eF. -- ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PNC Investment Account 097-132098 Cash (See attached statement of 157,394.60 account attached to Schedule B) 2 Household Furnishings -sale proceeds 1,229.25 3 Series EE Savings Bond M45952246EE in face amount of $1,000.00, issue 1,341.20 date 11/1992 (See attached valuation) 4 Series EE Savings Bond M45952247EE in face amount of $1,000.00, issue 1,341.20 date 11/1992 (See attached valuation) 5 Blue Cross Refund 208.69 6 Refund from State of New Jersey -refund of money held for taxes 5,691.00 7 Refund for County Taxes for 624 Belvedere Street 504.08 8 Refund for School Taxes for 624 Belvedere Street 2,653.08 9 Federal Income Tax Refund for 2011 16,656.71 10 Delta Equity Services Corporation Account #39K-218749 Cash -Transfer on 2,116.19 Death to Decedent's children, Sharon L. DeVenney and Nancie M. Booth (See attached statement with Schedule B) 11 Refund for homeowners insurance 634.17 12 M&T Investment Group 550.40 13 M&T Investment Group 2,511.31 14 Refund for County Taxes for 35 Cambridge Court, Carlisle, PA 115.24 15 Refund for School Taxes for 35 Cambridge Court, Carlisle, PA 1,108.40 16 Refund for payment of Cambridge Condo Association Fee 450.00 __ TOTAL (Also enter on line 5, Recapitulation) 194,505.52 If more space is needed, insert additional sheets of the same size Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 01/2012 Page 1 of 1 Total Price Total Value Total Interest YTD Interest $1,000 00 $2,682 40 $1,682.40 $0.00 Bonds: 1-2 of 2 Serial # Series Denom issue Next Final Date Accrual Maturity Issue Price Interest Interest Rate Value Note 11/1992 :05/2012 r 11/2022: $1,000; M4595Z246EE EE $500 00, $841.20 4.00% $1,341.20 t . ,000:11/1992.05/2012;_11/2022 $1 EE M45952.247EE $500 00, „ $841 20 4.00% $1341,20. _ . , Totals for 2 Bonds; $1,000.00 $1,682.40: $2,682.40 Notes NI Not Issued NE :Not eligible for payment _ _.. PS,.. Includes_ 3 month interest penalty_ __ ____ ______ _ MA :Matured and not earnin interest http://www.treasurydirect.govBC/SBCPrice 3/8/2012 REV-1509 EX+(01-10) Pennsylvania SCHEDULE F IS4~PAFt1fsF N7 C7t HrVFlv;i £. INHERITANCETAXRETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Leah R. Henschen 21 12 0218 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Sharon L. DeVenney 100 Burnt House Road daughter Carlisle, PA 17015 e c. JOINTLY-OWNED PROPERTY: ITEM NUM. LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OFPROPERTY. INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCTNUMBERORSIMILARIDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASS ET %OF DECD'S INTEREST DATE OF DEATH VALUEOF DECEDENT'S INTEREST 1 A 8/12/10 Orrstown Bank Checking Account 106005651 4,866.60 50.000 2,433.30 made joint with Sharon DeVenney on 8/12/2010 per letter dated 4/12/2012 (See attached signature card) 2 A 11/8/11 PNC Checking Account 5114034439 made 29,780.14 50.000 14,890.07 joint with Sharon DeVenney on 11/8/2011 per letter dated 3/6/2012 3 A 8/23/00 Orrstown Bank Savings Account 706001155 10,000.00 50.000 5,000.00 made joint with Sharon DeVenney on 8/23/2000 per letter dated 4/12/2012 (See attached signature card) 4 A 11/8/11 PNC Savings Account 5113282713 made joint 90,152.81 50.000 45,076.41 with Sharon DeVenney on 11/8/2011 per letter dated 3/6/2012 TOTAL (Also enter on Line 6, Recapitulation) I 67,399.78 If more space is needed, use additional sheets of paper of the same size. VKK~~1 ~VW 1~I BANK A Tradition of Excellence April 12, 2012 Saidis, Sullivan & Rogers Gv ~r ~~~ ~li~ii vti~.~. Carlisle, PA 17013 To Whom It May Concern, This letter is in correspondence for a request of information on January 30, 2012 for Leah R. Henschen account numbers 106005651 and 706001155, account balances, opening dates, interest, and revision dates. On February 24, 2012 Sharon Devenney stopped in to Orrstown Bank and we were provided with a death certificate for Leah R Henschen and a Short Cerificate. The checking account 106005651 was opened on August 12, 2012 and the savings account 706001155 was opened August 23, 2000. The accounts had become joint with Sharon Devenney on August 24, 2010 which I have included a copy of the signature card showing this. The account balance in 106005651 as of January 30, 2012 was $4866.60 and in 706001155 was $10,000.00. At that time Leah R Henschen's was still on the accounts, Leah was removed on February 24, 2012 which I have also included a copy of the signature card showing this information. There was no interest paid before January 30, 2012 on either account for 2012. If there are any further questions please contact Vanessa L Albri ght by the information listed below. Vanessa L Albright Customer Service Representative Orrstown Bank 717-240-0801 valbright@orrstown. con 1.888.ORRSTOWN r.~.~zr~a~a~c ~~~~c~vo-~eis4Eas~ ,re-,~~.»~rra orrst:awn Bank Stonehedge Office 427 Village Drive Carlisle, PA 17013 (888) 677-7869 BR: 6 OWNERSHIP OF ACCOUNT -PERSONAL PURPOSE ^ INatvlouAL ^ . JOINT - -WITH SURVIVORSHIP land not as tenants in common) 1 ' JOINT - NO SURVIVORSHIP fas tenants in contmoni ^ TRUST -SEPARATE AGREEMENT: REVOCABLE TRUST DESIGNATION AS DEFINED IN THIS AGREEMENT Name and Address of Beneficiaries: ReSt,zbmitTt : N Combine: N Eyewire: N OWNERSHIP OF i4C000NT -BUSINESS PURPOSE ^ SOLE PROPRIETORSHIP ^ CORPORATION: ^ FOR PROFIT ^ NOT FOR PROFIT ^ PARTNERSHIP BUSINESS: COUNT.' & STATE OF ORGANIZATION: AUTHORIZATION DATED: DATE OPENED 0 8 ~ 12 ~ 10 gy Michelle M Ulme INITIAL DEPOSIT S ^ CASH ^ CHECK HOME TELEPHONE # (717) 243 -8525 BUSINESS PHONE # DRIVER'S LICENSE # F-MAIL __ EMPLOYER MOTHER'S MAIDEN NAME Name and address of someone who-will always know your location: BACKUP WITHHOLDING CERTIFICATIONS TIN: 204-01-00.35 © TAXPAYER I.D. NUMBER -The Taxpayer Identification Number shown above (TINT is my cornet taxpayer identification number. © BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me .that I am no longer subject to backup withholding. ^ EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. SIGNATURE: I certify under penalties of perjury the statements checked in this I section and that 1 am a U.S. citizon or other U.S. person fas defined in the i iructian~i. ~."".."r J J t ,-' {Date) CIF# H02 0~?2 ACCOUNT ~ '' NUMBER lprap05651 ACCOUNT OWNER{SI NAME & ADDRESS Leah R Henschen Sharon L Devenney 624 Belevedere Street Carlisle PA 17013 - --- © NEW ^ EXISTING TYPE OF ®CHECKING ^ SAVINGS j (ACCOUNT ^ MONEY MARKET ^ CERTIFICATE OF DEPOSIT ^ NOW ^ This is your {check one): 50+ Interest Check Permanent ^ TQmporary account agreement. Number of signatures required fvr withdrawal 1 FACSItv11LE SIGNATURE(S) ALLOWED? ^ YES ® NO [x 7 SIGNATUREtS) -The undersigned certifies the accuracy of the information hefshe has .provided and acknowfed~es rfrceipt ofi a completed copy , of this form. The undersigned authorizes the frnancral institahon to verify cradtt and employment history and-or have a Credit reporting agency prepare a credrt report an the undersigned, as individuals. 7he.undersigned also acknowledge the receipt of a copy and agree to the terms of the following agreement(s) andfor discfosurelsi: ® Terms & Conditions ~ Truth in Savings ~ Funds Availability ® Electronic Fund Transfers ~ Privacy ~ Substitute Checks © Cvmmvn Features ^ X Leah R Henschen I.©. ~ D.G.B. 06/30/19 f ~~ , ~.. ~ I``t`...a-~ ;. Sharon L Devenney ~' I.D. # D.O.t3. 06/18/49 (3): X I.D. #! D.O.B. (41. X I.D. #1 D.O.B, ^ Authorized Signer (Individual Accounts Only? X I.D.# D,Q.B Signature Card•PA MPSC-LAI-PA 7011;2009 Bankers rJY-`+[t'rtt5 iu roolters Kluwer Financial Services 'Pi 7 992, 2009 Page 7 ct 7 ~Orrs totan :Batik Stonehedge Office 427 village Drive Carlisle, PA 17013 (888) 677-7869 BR: 6 OWNERSHIrrP--OF ACCOUNT -PERSONAL PURPOSE ^ INDIVIDUAL u Q JOINT -WITH SURVIVORSHIP land not as tenants m cumrnoni ^ JOINT - NO SURVIVORSHIP (as tenants in commoni ^ TRUST -SEPARATE AGREEMENT: ^ REVOCABLE TRUST DESIGNATION AS OEf=iNED IN THIS AGREEMENT Name and Address of Beneficiaries: ReSubmitlt: N Combine: N Eyewire: N pWNERSHIP OF ACCOUNT -BUSINESS PURPOSE ^ SOLE PROPRIETORSHIP ^ CORPORATION: ^ FOR PROFIT ^ NOT FOR PROFIT ^ PARTNER-SHIP BUSINESS: COUNTY & STATE OF ORGANIZATION: AUTHORIZATION DATED: DATE OPENED 08/23/00 By Michelle M f:71me 1NITtAL DEPOSIT S CI CASH ^ CHECK ^ HOPAETELEPHONE # {717) 243-852.5 BUSINESS PHONE tJ DRIVER'S LICENSE ~ E-MAIL. EMPLOYER MOTHER'S MAIDEN NAME Name and address of someone who will always know your location: BACKUP WITHHOLDING CERTIFICATIONS TIN: 204 -01-0035 ® TAXPAYER I.D. NUMBER -The Taxpayer identification Number shown above (TINE is,rry correct taxpayer identification number. BACKUP WITHHOLDING - I am not subject to backup withholding either because (have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified rite that I am no longer subject to backup withholding. ^ EXEMPT RECIPIENTS • I am an exempt recipient under the Internal Revenue Service Ragulatinns. SIGNATURE: I certify under penalties of perjury the statements checked in this section and that 1 am a U.S. citizen or other U.S. person 1as defined in the instructions?. ~,j' ~._~_.f` 1`~ , ,>'9t-ter,. r,. , ~/j :~• ~i ~/,n~rs ~j , tDate) C:LF## H02fl422 ACCOUNT ' ~' NUMBER 7060011.55 ACCOUNT OWNERtS( NAME & ADDRESS Leah R Henschen Sharon L Devenney 624 Belevedere Street Carlisle PA 1')01.3 Revised Date: 08/24/10 ^ NEW ~ EXISTING TYPE OF ^ CHECKING ~ SAVINGS ACCOUNT ^ MONEY MARKET ^ CERTIFICATE OF DEP051T ^ NOW ^ _ This is your (check one): Statement Savings !J Permanent ^ Temporary account agreement. Number of signatures required for withdrawal 1 FACSI(VIILE 51GNATUREtS) ALLOWED? ^ YES ~ NO [. SIGNATUREiS1 -The undersigned .certifies the accuracy of the information helshe has provided and acknowledges .receipt of a completed copy of this farm. ?he undersigned .authorizes .the financial institution to verify credit and employment history and)or have a credit reporting agency pr~iare a credit report on the undersigned, as individuals. The undersigned also acknowledge the receipt of a copy and agree to the terms of tho following agreementisi andlar disclosurefsi: Terms & Conditions ~ Truth in Savings ®Funds Availability Electronic Fund Transfers ~ Privacy ~ Substitute Checks ~ Common Features ^ _ __ 1~------~-~-- :~,i ,y ~'ILeah R Henschen LD. ft p.O.t3. 06f 30/19 ~-' j ~ ~ 1 f2): 1 ) J' / } ~`'f Sharon L Devenney Oj ~,~ I.D. # D.0.6. 06/18/49 _~ S31; x I.D. ~ D,O.B. f41: X I,D, # D.O.B. ^ Authorized Signer ilndividual Accounts Only1 X I,D.~ D.O.B. Signature Gard-PA. Bankers 5ystems'"' Wouert: Kluwer Finanriel Services .O t 992, 2009 MP$C •LAZ•PA 10i 1 /'L009 ParJe i o, 1 ~~ ~, ti ~` ; ~~. March 6, 2012 Sharon L DeVenney 100 Burnt House RD Carlisle PA 17015 RE: Leah R Henschen SSN: 204-01-0035 DOD: 01/30/2012 Dear Sir/Madam: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5114034439 LEAH R HEN S CHEN SHARON L DEVENNEY DOD balance: $29,779.96 + 0.18 accrued interest Savings Account Account # 5113282713 LEAH R HEN S CHEN SHARON L DEVENNEY DOD balance: $90,114.18 + 38.63 accrued interest Established: 11 /08/2011 Established: 11 /08/2011 Investment Account The decedent maintained Investment Account 97132098. For further information, you may call the Brokerage Department at 1-800-762-6111. Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call l -888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 2 REV-1510 EX+(08-09) Pennsylvania -~ IJr V'AR7te F~N~f (7±~ f2}"~:V~~Nii ~'. INH ERITANCE TAX RETURN RESIDENTOECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAME OFTRANSFEREE, RELATIONSHIPTO DECEDENT& DATEOFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 Gift to Sharon DeVenney on 3/11/2011 6,500.00 100% 3,000.00 3,500.00 2 Gift to Sharon DeVenney on 3/25/2011 6,500.00 3 Gift to Robert DeVenney (son-in-law) on 3,250.00 100% 3,000.00 250.00 4/1 /2011 4 Gift to Robert DeVenney (son-in-law) on 3,250.00 4/5/2011 5 Gift to Robert DeVenney (son-in-law) on 3,250.00 6/3/2011 6 Gift to Robert DeVenney (son-in-law) on 3,200.00 11 /4/2011 7 Gift to Nancie Booth on 4/24/2011 6,500.00 100% 3,000.00 3,500.00 8 Gift to Nancie Booth on 6/20/2011 6,500.00 9 Gift to Craig Booth (son-in-law) on 6/20/2011 3,500.00 100% 3,000.00 3,500.00 10 Gift to Craig Booth (son-in-law) on 8/3/2011 6,500.00 11 Gift to Sharon DeVenney on 1/6/2012 13,000.00 100% 3,000.00 10,000.00 12 Gift to Robert DeVenney (son-in-law) on 6,500.00 100% 3,000.00 3,500.00 1/6/2012 13 Gift to Nancie Booth on 1/2/2012 13,000.00 100% 3,000.00 10,000.00 14 Gift to Craig Booth (son-in-law) on 1/2/2012 13,000.00 100% 3,000.00 10,000.00 15 2004 Buick LeSabre given to Sharon 5,104.00 DeVenney on 2/24/2011 (See attached Kelley Blue Book value) 16 Gift to Robert DeVenney (son-in-law) on 6,500.00 1 /23/2012 TOTAL (Also enter on Line 7, Recapitulation) ~ 85,054.00 If more space is needed, use additional sheets of paper of the same size. Kelley Blue Book ~~ '~`<; ~ ~ ~ ~ ~~~~~~/ BLUe Book The Trusted Resource` ~~_ Your Blue BookQ Value .. Trade-In Value Excellent $5,529 i Very Good $5,429 i a Good $5,104 ~ Fair $4,404 2004 Buick LeSabre Style: Custom Sedan 4D Mileage: 6526D Vehicle Highlights Page 1 of 2 MPG: City 18/Hwy 27 Doors: 4 Drivetrain: FWD EPA Class: Large Cars Country of Origin: United States Max Seating: 6 Engine: V6, 3.8 Liter Transmission: Automatic Body Style: Sedan Country of Assembly: United States http://www.kbb.com/buick/lesabre/2004-buick-lesabre/custom-sedan-4d/?vehicleid=2005... 9/27/2012 aavemsemenc ~~~r a~~. REV-1511 EX+(10-09) r~ pennsylvarna SCHEDULE H uENnKi~~F'vrnf kiVrriit FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See schedule attached 5,524.99 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 25, 000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: See schedule attached 31,953.61 TOTAL (Also enter on Line 9, Recapitulation) ( 62,478.60 If more space is needed, use additional sheets of paper of the same size. Estate of: Leah R. Henschen Schedule H, Part A -Funeral Expenses Item Description 1 Sharon DeVenney, reimbursement for payment to Westminster Cemetery Mausoleum 2 Sharon DeVenney, reimbursement for payment to Second Presbyterian Church 3 Sharon DeVenney, reimbursement for payment to Hoffman-Roth Funeral Home & Crematory, Inc. 4 Sharon DeVenney, reimbursement for payment to Jeff Gibelius, pastor for memorial service 5 Sharon DeVenney, reimbursement for payment to Sue Yeingst -harpist for funeral 6 Sharon DeVenney, reimbursement for payment to Deb Bramburg -church coordinator 7 Sharon DeVenney, reimbursement for payment to Jack Larson -pastor at grave site 8 Sharon DeVenney, reimbursement for payment to Gary McCarron - musician 9 Sharon DeVenney, reimbursement for payment to Judy McCarron -soloist 10 Hoffman-Roth Funeral Home 11 George's Flowers TOTAL. (Carry forward to main schedule) ..... . Page 2 21 12 0218 Amount 1,861.00 358.21 445.86 150.00 50.00 250.00 150.00 50.00 50.00 2,020.00 139.92 5,524.99 Estate of: Leah R. Henschen Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item ~r Description 7 Fee for Checks for Estate Account 8 Sharon DeVenney, reimbursement for payment to Zeiglers -moving items from Decedent's house into garage 9 Sharon DeVenney, reimbursement for payment to Hilton's Lock Service - change locks 10 Sharon DeVenney, reimbursement for payment to Register of Wills - probate fee 11 Central State Overhead Door Service - repair of garage door opener 12 Reimbursement to Nancie Booth for payment to hotel for her lodging while in Carlisle 13 Reimbursement to Sharon DeVenney for payments to Nells for cleaning and repairs 14 Reimbursement to Sharon DeVenney for payments to Walmart for cleaning and repairs 15 Reimbursement to Sharon DeVenney for payments to Lowes for cleaning and repairs 16 Reimbursement to Sharon DeVenney for payment to Home Depot for cleaning and repairs 17 Reimbursement to Sharon DeVenney for payment to Northeastern Supply for cleaning and repairs 18 Tuckey Mechanical Services, Inc. -annual maintenance 19 James E. Holland, CPA -preparation of income tax returns 20 Lowes -materials needed for 624 Belvedere Street 21 Gerald Brown -labor for repairs 22 Seller's payment of closing costs for sale of 624 Belvedere Street real estate 23 Realtor Commission to ERA-NRT, LLC from sale of 624 Belvedere Street, Carlisle, PA property TOTAL. (Carry forward to main schedule) ..... . Page 3 21 12 0218 Amount 17.99 541.01 262.22 577.50 149.12 406.79 113.00 51.34 402.40 9.00 21.58 66.50 900.00 423.59 500.00 4,000.00 14,520.00 22,962.04 Estate of: Leah R. Henschen Schedule H, Part B -Administrative Costs Miscellaneous Expenses Item Number Description 24 Title services to Secured Land Transfers, LLC for sale of 624 Belvedere Street, Carlisle, PA property 25 Transfer tax paid to Recorder of Deeds for sale of 624 Belvedere Street, Carlisle, PA property 26 Home Warranty to American Home Shield regarding sale of 624 Belvedere Street, Carlisle, PA property 27 Electrical Repair to Mountain View Electric, LLC regarding sale of 624 Belvedere Street, Carlisle, PA property 28 Final water/sewer bill to Carlisle Borough for 624 Belvedere Street, Carlisle, PA property 29 Payment of 2012/2013 School real estate taxes to Carlisle Borough for 624 Belvedere Street, Carlisle, PA property 30 Reimbursement to Robert DeVenney for payment of materials to clean up and repair items per Sales Contract 31 George Thomas Hicks, Jr., Tax Collector - 2012/2013 School Taxes 32 Hilton's Lock Service, Inc. 33 Reimbursement to Addison Warner for plane fare 34 Sharon DeVenney, reimbursement for payment to Walmart for cleaning supplies for house 35 Reimbursement to Sharon DeVenney for payment to Carpet and Tile Mart for new linoleum flooring 36 Realtor Commission to Spencer & Spencer from sale of 35 Cambridge Ct., Carlisle, PA 37 Realtor Commission to Hooke, Hooke & Eckman, LLC from sale of 35 Cambridge Ct., Carlisle, PA 38 Transfer tax paid to Recorder of Deeds for sale of 35 Cambridge Ct., Carlisle, PA 39 Final water/sewer bill to Carlisle Borough for 35 Cambridge Ct., Carlisle, PA property Page 4 21 12 0218 Amount 25.00 2,460.00 600.00 200.00 170.87 3, 026.17 242.82 1,671.79 39.22 296.20 30.00 229.50 2,160.00 2,160.00 720.00 73.71 TOTAL. (Carry forward to main schedule) ...... 14,105.28 REV-1512 EX+(12-08) r pennsylvania uFNafti~:.c~ car urv~ri,~~ INH ERITANCE TAX RETURN RESIDENTDECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 Report debts incurred by decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cambridge Condo Association -Condo fee 675.00 2 PPL Electric Utilities 28.55 3 PPL Electric Utilities 43.01 4 PPL Electric Utilities 42.54 5 Century Link 62.33 6 PPL Electric Utilities 68.15 7 PPL Electric Utilities 28.97 8 Miller Insurance -premium 763.32 9 Miller Insurance -premium 748.00 10 CTI Network 35.95 11 Century Link 61.64 12 PPL Electric Utilities 52.85 13 Cambridge Condo Association -Condo Fee 675.00 14 AT&T Mobility 79.07 15 PPL Electric Utilities 13.24 16 ADT Security Services 173.97 17 Borough of Carlisle -water bill 72.90 18 Borough of Carlisle -water bill 224.70 19 CTI Network 35.95 20 Century Link 65.67 21 AT&T Mobility -security system 79.07 22 Encompass Insurance -home owners insurance for 624 Belvedere Street 242.00 Total from continuation Schedule(s) 12,776.86 TOTAL (Also enter on Line 10, Recapitulation) 17,048.74 If more space is needed, insert additional sheets of the same size. Estate of: Leah R. Henschen Schedule I -Debts of Decedent, Mortgage Liabilities, and Liens Item Number Description 22 and fire insurance for 35 Cambridge Ct. 23 PPL Electric Utilities 24 Century Link 25 PPL Electric Utilities 26 PPL Electric Utilities 27 AT&T Mobility -security system 28 Comcast Cable 29 Century Link 30 CTI Network -Internet 31 PPL Electric Utilities 32 Cambridge Condo Association Fee 33 AT&T Mobility -security system 34 Encompass Insurance -homeowners insurance 35 PPL Electric Utilities 36 Sharon DeVenney, reimbursement for payment to Century Link 37 Sharon DeVenney, reimbursement for payment to AT&T 38 Sharon DeVenney, reimbursement for payment to CTI Networks -Internet 39 Sharon DeVenney, reimbursement for payment to PPL Electric Utilities 40 Borough of Carlisle -water bill 41 George T. Hicks, Tax Collector -county/township taxes for 35 Cambridge Court 42 Sharon DeVenney, reimbursement for payment to Safe Haven Quality Care, LLC 43 Sharon DeVenney, reimbursement for payment to Safe Haven Quality Care, LLC Page 2 21 12 0218 Value at Date of Death 20.27 61.64 98.22 13.29 79.07 32.05 61.73 69.90 99.02 675.00 79.17 247.00 11.30 61.73 79.17 71.90 188.17 72.90 689.64 2,984.00 1,808.00 TOTAL. (Carry forward to main schedule) ...... 7,503.17 Estate of: Leah R. Henschen Schedule I -Debts of Decedent, Mortgage Liabilities, and Liens Item Number Description 44 Sharon DeVenney, reimbursement for payment to Kough's Oil Service 45 Sharon DeVenney, reimbursement for payment to PPL Electric Utilities 46 PA Department of Revenue -state taxes 47 PPL Electric Utilities 48 PPL Electric Utilities 49 CenturyLink 50 Borough of Carlisle -water bill 51 Borough of Carlisle -water bill 52 George Hicks, Tax Collector -county/township taxes for 624 Belvedere Street 53 Kough's Oil Service 54 ADT Security Services -security system 55 West Shore EMS -ambulance bill 56 Capital Tax Collection Bureau -local taxes 57 PPL Electric Utilities Page 3 21 12 0218 Value at Date of Death 311.34 27.06 1,688.00 63.98 169.30 61.73 72.90 72.90 1,300.75 286.90 173.97 994.54 40.00 10.32 TOTAL. (Carry forward to main schedule) ...... 5,273.69 REV-1513 EX+(01-10) r : pennsylvania SCHEDULE J urNnkir'aF'U? ar- urv~~i;* INHERITANCETAXRETURN BENEFICIARIES RESIDENTDECEDENT ESTATE OF: FILE NUMBER: Leah R. Henschen 21 12 0218 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).j Sharon L. DeVenney daughter 347,819.63 100 Burnt House Road Carlisle, PA 17015 Nancie M. Booth daughter 347,819.62 1703 Timber Lake Drive Salisbury, MD 21801 Andrea M. Warner granddaughter 104,260.67 826 N. College Street Carlisle, PA 17013 Addison R. Warner grandson 104,260.67 4026 Mary Circle, #5 Las Cruces, NM 88001 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15TH ROUG H 18 OF REV-1500 COVER SH EET, AS APPROPRIATE. zz NON-TAXABLE DISTRIBUTIONS: 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. If more space is needed, use additional sheets of paper of the same size. REV -1514 EX+(4-09) r, pennsyluania pENnaiMF'v; Ot Hkv~N;:t INHERITANCETAX RETURN RESIDENTDECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN ;k Box 4 on REV-1500 Cover Sh FILE NUMBER This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest below and attach a copy of it to the tax return. n Will n Intervivos Deed of Trust ^ Other NAMES OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable •••••••••••••••••••••••••••••••••••••• 2. Actuarial factor per appropriate table •..••••••••••.••••••••••••••••••••••••••••••• Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate % 3. Value of life estate(LinelmultipliedbyLine2) •..••.••...•.•••••••••••••••••••••• NAMES OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ••••••••••••••••••••••••••••••••••••••• 2. Check appropriate block below and enter corresponding number ....................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other { ) 3. Amount of payout per period •••••••••••••••••••••••••••••••••••••••-••-•••••••• 4. Aggregate annual payment, Line2multipliedbyLine3 .••••••.•••.•.•.•••••••••••••••• 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate % 6. AdjustmentFactor(Seeinstructions)••••...••••••••••••••••••••••••••••••••••••••• 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 X Line 5 X Line 6 • • • • • • • • • • • • • • • • • • • • • If using variable rate and period payout is at beginning of period, calculation is: (Line 4 X Line 5 X Line 6) + Line 3 NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size. RED-,847 EX+,02_,0, SCHEDULE M >t~ Pennsylvania FUTURE INTEREST COMPROMISE UFHAF-I rsE N' £JF REVLNC1 i- INHERITANCETAX RETURN (Check Box 4a on Rev-1500) RESIDENT DECEDENT ESTATE OF FILE NUMBER Leah R. Henschen 21 12 0218 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interestes where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited ri ht of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of future interest • $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) . $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One Q 6%, Q 3%, ~ 0% . $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one ^ 6°/a, ~ 4.5% . • $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also include as part of total shown on Line 17 of REV-1500.) • $ 6. Value of Line 1 taxable at collateral rate (15%) (Also include as part of total shown on Line 18 of REV-1500.) • $ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) • $ If more space is needed, use additional sheets of paper of the same size. REV-1649 EX+(6-98) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCETAXRETURN (SPOUSAL DISTRIBUTIONS) RESIDENTDECEDENT ESTATE OF FILE NUMBER Do not complete this schedule unless estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made. (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF LEAH R. HENSCHEN I, Leah R. Henschen, of Carlisle Borough, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my ~-~ SAIDIS, FLOWER ~ LINDSAY A['iC)RA'EYS~AT UN 26 Wesc Higli Street Carlisle, PA last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate in such amount as they shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the 1 purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate as follows: A. One-third (1/3) to my daughter, Sharon L. DeVenney, per stirpes; B. One-third (1/3) to my daughter, Nancie M. Booth, per stirpes; C. One-sixth (1/6) to my grandson, Addison R. Warner, per stirpes; and D. One-sixth (1/6) to my granddaughter, Andrea M. Warner, ~IS, FLOWER ~ LINDSAY pTR~RNEYS•AT•N1V 26 West High Street Carlisle, PA per stirpes. Provided, however, that if any beneficiary under this Will has not attained the age of forty (40) years at the time of my death, then I give, devise and bequeath that beneficiary's portion of my estate that would not otherwise be distributed outright to the beneficiary, together with any other property which may be added, in separate trusts, unto ORRSTOWN BANK, Carlisle, Pennsylvania, upon the following terms and conditions: A. To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, and to use, pay and apply the income and principal or so much thereof as in Trustee's sole discretion may be necessary for the maintenance, support, medical expenses and education of the beneficiary. 2 B. The payments authorized by this Trust may be made by my Trustee directly to the beneficiary, if, in the sole opinion of Trustee, he or she is of such age and ability to handle properly the funds so paid, or may be made directly to any institution entitled to such payment by reason of services rendered or to be rendered to the beneficiary. C. The amount to be paid for the benefit of the beneficiary shall be determined from time to time by the need of the beneficiary, and the amounts and times of said payment shall be determined by such need, provided that payments be made at least monthly. D. All payments of principal and income hereby given shall be free from anticipation, assignment, pledge or obligations of beneficiaries, and shall not be subject to any execution or attachment. E. The principal and accumulated income shall be distributed as follows: (1) One third (1/3) of all principal and accumulated income shall be distributed by my Executrices to the SAIDIS, FIAWER ~ LINDSAY ATiC)IiNEY&AT•L~\4 ' 26 West High Street Carlisle, PA beneficiary as soon as reasonably practical after the date of my death . (2) One third (1/3) of all principal and accumulated income shall be distributed to the beneficiary five (5) years from the date of my death . 3 (3) The balance of all principal and accumulated income shall be distributed to the beneficiary ten (10) years. from the date of my death. (4) The distribution schedule set forth above is subject, however, to adjustments by the Trustee or Executrices to insure that no principal or accumulated income is held in trust beyond the beneficiary obtaining the age of f orty ( 4 0 ) years . THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH In addition to the powers conferred by law, I authorize any ~~ SAIDIS, FLOWER ~ LINDSAY 2G West High Street Carlisle, PA personal representative, trustee or guardian acting under this instrument, in his/her absolute discretion: `~ (a) To retain in the form received, or to sell either at public or private sale any real or personal property; (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; 4 (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as they, in their sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (e} To make settlements and compromises on such terms as they, in their sole discretion may deem wise without the necessity of obtaining any court approval thereof; (f) To make distribution hereunder either in cash or kind, as they, in their discretion may deem wise. FIFTH ~~ SAIDIS, FI:OWER ~i LINDSAY ATTORNEYS•AT•L11V 26 West High Street Carlisle, PA I do hereby nominate, constitute and appoint my daughters, Sharon L. DeVenney and Nancie M. Booth, to act as Co- Executrices of this my Last Will and Testament, provided however if either one is unwilling or unable to serve, the survivor shall serve as Executrix of this my Last Will and Testament. SIXTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. 5 IN WITNESS WHEREOF, I, Leah R. Henschen, have hereunto set my hand and seal to this my Last Will and Testament, consisting of six typewritten pages, the first five of which bear my initials in the margin for identification, this ~/ day of 2010. ~'°~ ~ / ~r Leah R. Henschen, Testatrix Signed, sealed, published and declared by the above-named Testatrix, Leah R. Henschen, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of sai esta rix and of each other. ADDRESS 26 West High Street `- Carlisle, PA 17013 ;~~ ~"'~-- ~- ~~ C~~" ADDRESS 26 West High Street 1 Carlisle, PA 17013 SAT.DIS, FIAWER Si LINDSAY nrmarr~vs•nT LA~V 26 West High Scree Cazlisle, PA 6 CON~IONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND WE, Leah R . Henschen, l" )~/l ,,~~ 1~., ~.~jGr /s and J~ ~j~/') ~~~ , the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix: signed the Will as witness and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~~~ Leah schen, Testatrix -_ Witness SAIDIS, FLOWER ~ LINDSAY 26 West High Street Carlisle, PA ~,/ j Witness Subscribed, sworn to and acknowledged before me by Leah R. Henschen, the Te tatrix, and subscribed to and sworn or affirmed and j c~ ~~s~ ~-~~-p f" to before ~me by ~ witnesses, this c~Y~ day of ~-~~~~- 2010. N to Public ~~WEALTH OF PENPtSYLVAN~A Notarial 3ee1 Yvonne Sersoh, Notary Publlc Camp HIN t3oro, Cumberland County My Commisslon Fxplras Feb. ~ ~ 2012 7 Memtier, Pennsylvania Assod3tlon Notarks