Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
12-10-12 (2)
J 151'156:,1,84 RSV-1~ 500 ~xtn~.,,:;rti OFFICIAL USE ONLY PA Department of Revenue pennrylvanla a.......°..N.,H Count Bureau of Individual Taxes y Code Year File Number PO Box z8oso> INHERITANCE TAX RETURN I, Harrisburg, PA t9iz8-o6ot RESIDENT DECEDENT ~~ ~' ~`~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 182-24-9880 05222012 09071927 Decedent's Last Name Suffix Decedent's First Name DUNLAP (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix JEA)`! Spouse's First Name MI H MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® t Original Return Q 2. Supplemental Return O 3. Remainder Return (date ct death prior to 12-13-82) O 4. Limitad Estate O 4a. Future Interest Compromise (date of Q 5. Faderal Estate Tax Return Required death after 12-12=82) (~ 6. Decadent Diod Testate O ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Aryach Copy of Trust) O 9. Litigation Prcceeds Received Q 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RYAN R. GAGER First line of address SAUL EWING LLP Second I:ne of address 2 N. 2ND STREET, 7TF~ FLOOR City cr Post Office State ZIP Code 7172577 W .~ rn~~ ~ y. r- ~ ~ iT1 cn =-~ 2 ~: a r., r-, ~ -0 ~~ ~... ~~ c :~ __~__ USE ttT~ jN .Y r--t F-~ 0 -,~ F _. ru U1 HARRISBURG PA ].7].01 Correspcndent's a-mail address:RGAGERQSAUL, COM Under penalties of perjury, I declare that t have examined this return, including accnrpanyir,p schedules and s`atements, and to the beet of my knowledge and belief, it is true, correct and com~lele. Declaration of preparer other than the personal representative s basod cn all information of which preparer has any knovtletlge. SIGNATURE OF PER ONRES~PONSIBLE EO~ FILING RETURN DATE ddD~1-~~r-e~~T_'" '~-' 1'->s{a, 11-,~ ft 12 726 HARDING S'PREET, NEW CUMBERLAND, PA 17070 SIG ~ E OF PREQy$tER O],t}ER THAN REPRESENTATIVE DATE Xf~ _~C7/ 11~~' -12 AD s - - 2 2ND STREET, 7TH FLOOR, HARR:[SF3URG, PA 17101 PLEASE USE O:CIGINAL FORtIt O:+fI.Y m C7 C7 nn ~~ of rI ~~ rn (J -4i Side 7 15U561118t( 1505611184 ],S11S67,],7,8t1 ~tCV-15000x(nzv:;r„ PA L'epartment of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes ~"""T"`"~""'°"°` County Code Year file IJumber Po Box z8o6ot INHERITANCE TAX RETUF2N - Harrisburg PA 19iz8-o6o> RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Rirth MMDDYYYY 182-24-9880 05222012 09071927 Decedent's Last Name Suffix Decedent's First Name MI DUNLAP JEADI H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® L Original Return Q 2. Supplemental Return Q 3. Remainder Retum (date c+ death prior to 12-13-82) Q 4. Limirzd Estate 0 4a. Future Interest Campronuse (date of Q 5. Federal Esfate Tax Return Required death after 12-12-8L) Q 6. Leccdent Di^d testate ' Q ~ 7. Decedent Main!ained a Living Tract 1 8. Total Number of Saie Deposit Boxes (; .Uach Copy o. Wilt) (Attach Copy of Trust) O 9. Laigation Proceeds Received Q 10. Spousal Poverty Credit (date of death Q 11. Election to tax under Sec. 9113(A) ~~ _ between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE C OMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE Name CTED T0: Daytime Telephone Number RYAN R. GAGER r.: r.~ 717~7a524 ti rn m r ,-. _ c7 irsl line of address SAUT, EWING LLP Sacond Lne of address 2 N. 2ND S'PREET, 7TH FLUOR City cr Post OfSce Stave ZIP Code HARRISBURG PA 7.71.01 Correspondent's a-mail address: RGAGERQSAUT~ . COM Rm1S{€ COF `a'Vlf~ U S~N~ f'- D f ~ ~_~ ~ ' ~ SY `~ ~ ~ ' CO t„S.r ~ 7 "1 ..'.' CJ ~; ~ c.~ ..: ~ -..i == ,J r-, -= ~ _- ' ~ fV i ry ~„ t-a G2 ~ DATE WIIBD ~ Under penalties of parjury, I declare that I have examined this return, including accompanying ?chedules and s'atements, and to the beet of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal re~resentativa s based cn all information of which preparer has any kn;wAetlge. SIGNATURE OF PER75T RE~~I~ FILING RETURN ~~ ~ - ~ DATF_ '~~ 11-.~ +.X 12 726 HARDING S'T'REET, NEW CUMBERLAI~TD, PA 17070 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE l'1 - _~ ;, HU:JK tJS - ---.- 2 N. 2ND STREET, 7TH FLOOR, HARRISBURG, PA _17101 PLEASE USE O:~iL;IN/~L FORR1 0:41.Y Side 1 ~, 15056],1],81) 15C1561,118~ J 1505611284 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: JEAN H DLTNLAP 18 2- 2 4- 9 8 8 0 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 0 2. Stocks and Bonds (Schedule 8) ..... _ ........................ ..... .. 2. 111 , 3 8 5.2 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0 . 0 0 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 1 , 7 $ 6.81 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. 119 , 8 92 .4 8 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested....... . 7. 74 , 4 8 0 . 3 0 8. Total Gross Assets (total Lines 1 through 7) ............................ . 8. 3 0 7 , 544.7 9 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 13 , 4 0 9 . 7 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. . 10. 161.81 11. Total Deductions (total Lines 9 and 10) ................................ . 11. 13 , 571.51 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 293 , 973 .28 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... . 13. 5 0 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 2 9 3 , 4 7 3 .2 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ 0. 0 0 15. 0. 0 0 16 Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X.12 293,473.28 17. 35,216.79 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. TAX DUE ......... .............................................. .19. 35,216.79 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505611284 1505611284 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: STATE ZIP PA '17070 JEAN HAYS DUNLAP STREET ADDRESS 726 HARDING STREET CITY NEW CUMBERLAND Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments __ _ _ 19 , 9 5 0 . 0 0 B. Discount 9 9 7. 5 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE File Number 21-12 - 0 7 3 4 (1) Total Credits (A+ B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 35,216.79 20,947.50 14,269.29 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 properly transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest .......................................................................................................................... ^ (~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non probate property, which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i}]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000. • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, exc ept as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (&12) ~` pennsytvania fii ^EFPRT MENT OF REVENl1E INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER JEAN HAYS DUNLAP 21-12-0734 All properly jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets otthe same size REV-1508 EX+ (08-12) ~`~i ' pennsylvania SCHEDULE E L~l °EP^RTMt"r °F RE~E"DE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JEAN HAYS DUNLAP 21-12-0734 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F ,~ nwic ~Na~e is nee°e°, use a°a¢ionai sheets of paper of the same size. ~. ~~~~ s~ ~ ~ at&t ~ ,~~~ d ~;~y """"""'AUTO"'3-DIGIT 170 00020310071075 071075 drlrrtllllrtlrtllPt411hlrttlrlrttlllltllntrltllprtttrrut, MISS JEAN HAYS DUNLAP 726 HARDING AVE ~,omputershare Computershare PO Box 43078 Providence, RI 02940-3078 Within USA, US territories b Canada 800 351 7221 Outside USA, US territories & Canada 781 575 4729 www.computershare.com/att NEW CUMBERLAND PA 17070-1436 Holder Account Number =_ 02002159671 I IIIIIII IIII VIII VIII VIII VIII VIII V I N D III VIII VIII VIII IIII IIII Record Date 10 Ju12012 Check Number 0015028774 SSNITIN Certified Yes sm...•...,~r.-...:. w.n:,..~.~, ...w.- ~,.~.~.w..o...a~rnor.. ..R .~:,R.,~:.-ar.,a,.._~ ....,o.. ~.:_-.~. .,,. rtw .. INIICSU078.DwnEq _PCIATT.I4iU31_2/071 075/1171 U75li . .,x_ .m,...» f....w....-...-..~.,y.~.nveum,+..m,,.,.r..:+x.:~vr.~sc~aa~a.~esta. n. u.N...,.,~.a..:~. AT&T Inc. -Dividend Payment ary-merA.M.Wrc.W.Fil'a..w.x ancrnu.r:..:ex.x!.xnaF ~eCi 'SC...WpIDn_w YFK'~~.'r:8:.s ..gem::b~'~.a...ween TSav.R~Ka':w&~R'1WAK3J @iBM: N~YCti 3NwaMe SSanN..vn'M169Ww.~v..-. •seu as4u~++.~RS+'rt Confirmation of Dividends Paid in Cash Payment Date Class Description Participating Shares Dividend Rate Gross Dividend ($) I Deduction Amount ($) Deduction Type Net Dividend ($) 01 Feb 2012 COMMON 46 $0.44000 20.24 0.00 NIA 20.24 01 May 2012 COMMON 46 $0.44000 20.24 0.00 NIA 20.24 01 Aug 2012 COMMON 46 $0.44000 20.24 0.00 N/A 20.24 Year-To-Date Paid 60.72 0.00 60.72 1UDC ATT "~' ooHxo~-aa i ~ ~ ~ '~ T~~~ ~ Highland Park Office If you have any questions, please call our Telephone Banking Center at 1-600-724-2440 Today's Date: Business Date: 08/21/2012 06/21/2012 Time; 09;25 AM Checking Deposit $1,350.45 *~~~2155 Total Balance; $17,108.57 Available Balance: $15,758.12 6113 /05 7 Thanks for visiting us today. We are happy to assist you! S d ® 0 0 0 ' C c ~ m ~ ~o ~ a M N N N o~ O o~ ~ N N N M O O_ x 0 D n d < N w ,~ v -i O y ~ ~ O O O ' A 0 d ~ ~ ~ ~ Q Z Z Z ~a C ' rn a m y 'O Q pp 00f T OOi ~ w a w d . .~ c a W N 3 a o i m N fC G 0 0 o a a a ~ N Q ° O 25S o A . v <' c: ' ~ G7 s apa d ~ cD m co ~ ~„~ ~ v v ~ ~ N ~ O ° °' c C M _~ e o00 ^y~0 0 0 0 0 0 0 0 0 3 0 Q D ~ ~ Z Z Z ` , _ ~ C D DD ~ ~ C fl. A ~ ~ ~ j 0. N --~ O O O V V V Z V_1 ~ n Q •y~ c o: <D 7 a y d 7^~ N 3 it i I I'IIIIII III VIII IIII Il~il I'lll ~ I~U I~IIII'll'I III IIII IIII ~ to ^ •~ ` ~ ~ Z ~ ~ ~ '~ a ¢ ~ v ~jn 4 y _ D A c m C ~.. ~. G7D Q y ~ o ~ r ' ZTp _ "' ~ ~ ~ ~ ~ C ~ z ~ M o 1~ _ V ~ _ _ /tip t' O N x i a: O . ~ ~ `o ~ o a Yja V ~ k 0 ~ I ~ ~ = r h v^ O w ,_, a ? m ~ c N a m ~ ~ ~ = C C a, Zn o - ? ~ ~ ~ D D #S ] x c ~ nc O ~ O m D cCi](C o 3cm o ~ n m m ~ ~ 'V , .~ ~ ~ I '= In Cn 9~ .~ ~ N 3 ~ ~ n o rn ~ ~>><. 9 '..o s ~ ~~~a 3 acm ~~~ .a ~ ~ ~ ~ ~ g 4 v - Vl V m~~ 0 rr ~ o ~ ° ~ ~ joooo3 o N o op ~ ~ ~ ~ cnwc OO c V A V _ ~ ~ ~ k O CJ1 O A ~ ~ ~ v N O ~ ~ ~ ~ ~ ~ O ~ .-r N N V V N O N - ~ ti (D ~ m m (D L d m W ifJ V C co^^ina o Q ~ ~ N N y o~iY o LooMm.~ ,~ r~ c-~ N c7 ~ Z ~. ~. ~ 5? y ^ L ~ orn~u -~ E d m tV O p - ~ o ~~ ~ p O O w , ~ ¢ m +. ~ U ~ ~ c U y ~ ~ ~ °~`~°E a f7 ~ ~ n' .b ..b U 3 ~- H ~ z ~ M ~ ~ ¢~ m O O ~ , ~ d • - ~ 4:. flJ V7 Q D 0 3 V G ~~ ~ O ~ Z 2 ~ E x 0 8 .a U mty > > = K V U! S C Q1 L_ a+ O S 0" RI fLl S 0 O ~' rn ~ ~ N ~ C) ~ - v o ti 0 ° - ~ ~~-- o ~ Q J O ~ ~ ~ j Z ~ Q Q :' _ SZ W _ [O ~ ~_ Q ~ ~ _~ ~ Q U _~ ~ _ ~(pW ~ Z ~+ Q. d ~~ D V ~/ V .~ •~ V ~L VJ Q~ L (O L y N f0 L N t6 c O a (O y f0 U O Q -yo ~ O ~j _N ~ ~ N ~ >~ C L ~ c m mt U vl 7 N ~ O d C O ~p U a~ a> y U ~ 7 p~ a ~, Y C O ~ ~ O ~_ C 0 N ~ o ~~ ~ c ~ m o~ ~ ,O O ~ O 'j C ~ O U ~ C cLL ~ +... N Vi f0 N .~. E U L W L 'C ~ 3 v V C fn ~ Y O C d T~ ~ ~_ ~ ,~ ~ [~6 0 z =' v d .~ O o n ~./ ha 7 a~ O C O •U C a o p E a fyq ~ O .a C d .~ 'C d C ~ a ~ S C ~~ C - N ~ ~' N V d ~ l6 ~ L y c 0 .Q .y d N W W U d 0 C d E T R a ~~~ ~~;~ n n n N N N N W ¢¢¢ Z Z ~ 2 NN O O O O O O O o 0 0 o c W ~ ~ m ~ri ui Sri ~ n n n N N N N W «° «° ~~~ U n n n Q a°po m m ~ h ~ z z z a 000 ~ ~~~ a ~ ~ ~ g 000 ~a J U U O F~- a a 0 X Z O V N N O V N N ~ ~ ~rn L ~ a ~ o o ~> '~." /w~~, W L N O7 m ~ O] ~ L \ ~ ` N N N O O N 1~ .~QMrv ~ ~ N tie Y ~ ;; ~ _~ V1 n m° rn m u~ m N - a o g r r ¢ . ~'-~ c U ~ - _ rv ~ E o m m ~ - o - O C C U o v v ~ ~ OQ ~.. ~~ < o _ 3 °- ~ I~ F ' ~s .x~ .v 3 3 a z ~ I` ~ ~ a 3) 1 _ .~ U _ O O C = ~ ~ 'd ~ ~ w 6 ~~ w~ O ~ r r a r V] VJ Q ~ ~ 3 U ~ C ~ ~ ~- ~ i Z 2 r a Q Q 'G ~ C~ ..i~ p` v t ~ y ~~ = = a=~ ~,r U d'U W c c ~ t ;a N O W I N rl I s ~ f C7 ~t RJ t E 4 ~ -~ o r p ~ ~ K ~ Q o aLl1n d W~ C S C S ~ ° ~'w¢ z ~ a O Q ~ ~ Z 8 q y fl ~``~~' h Q Z ~ ~ a ~ = Q m N ., v Z = C " y yyyd $ ~ t ~ "Y A ""x ' Q (p = Q V ~i ~ `` ~ r I' I'II IIII'' 'I'I IIII IIIIIIIIIIIIIIIIIIVIIIIINII~IU~I IIIIIIIIiiil ~ W Q to lQ U C .~ a C Q1 .; 0 C Q C~ L C O U ~j~ QaT V N z Q~Q ~m~ c uWi ~ d .; 0 4 Q Q O Q Z Z 2~ v !-~' 7 a d D ~ 4 ~1 0 ~ g o _O o 0 0 0 O 3 d O o ~ a H v v v N M ~ ~ vii ~i .Wn v~ (7 C d .' O C 1~"D ~og _-p Q' cvv O ~ ~ N N N C ` M M th ~ lp ~ ~ d y .U R a C Z Z Z b O 0 0 0 A ~~~ a _a ~~~ ~ ~ U U O V d F~- o N } V! N U d R N N N ry N N a ~ of ti ~ ~ 0 0 0 a -f- Lr !~ Q U r a O X 2 8 ^ N. Q~f ~, ~ a ~ o ~~ ~ ~ r ~ N o ~ a o o * ~ yy T N t T 'K ~ Q ~./ 6Y 1 N Y 4 lp ~ ao Q ro W N F v Q O LL f ~ I,~ W ! ~ I i O~ t- ~ J O -.. __ -' f' lD ,_. ~ ~ ~~ z ~ W I(1 T I V ~ ~ s o , _ .__ 1 of o ~ °o si o ; o ~,i s ~ v ~, 0 1 N I N Y -_ _- 6 N w r r ~ ~ ~~I O ~ ~ a I__...--_. _{ m d r ~.~~ ~~I Y ~.- -...__._ y C I ~ N ^ I ffl ~ ~I O Z O ~ y 0 o i~ 0 O ~~t ~ r< ~` ~,", ~t N c~ O N `L. ~~ C 988Zb0 a W F U w ff o , v } d w o H ~ m O ~ ~ d a ~ ~ w ~~ ~ W J U ~ ~ Q Q z°oZw Q LL , poO~ Z O ° ~ W ~' I~LL~ =~QU f- a O w Z `- 2 QzcoW U LL s ~ ~ r Z ~ } "'1 ~ > ao VI~b~R~flpII~~WbNI f61 .-~ ~~ _. ru 0 ti S IT Q~ m O ~ ~ `~ .~ ~ ~. Q oo ~ xp Q NW C ) ~ m LLQ O UW ~ $ "~~ ~ O~ w ~¢ m 0 a n ~ J o O Z pia z~° M aog ,V w ~¢~ Y F. = w v lL m ~ N ~ u 1~1 H N ~ U > o a o ~ w a Z u ~ W ~ d ~1 F~1 E„1 ~ of a ~ t w ~ ~' a ~I ~ vrvo~n3noo a~e.on na. ~ oaa oa +na-~nwm numinn 3x~s 9N OIS I~Otle 3„~OL LJ3: BlIS 1i8 p.13 otlOf p3 ~i3 J3tl 311V SW]1111]I~10 lIXV 5NJ3N] Lfl a 1'61 l m IL ~~ Lfl 0 O a O 4 s `~' s ~_ o~nt~er® Communications .«.««.««....«AU70""3-DIGIT 170 00010910040795 Q 4 Q ~ `I 5 {1111{I'1111111{~rirll{Iluldl{Illnrlll{~Ilrl'{{1'{Ii1'I'I{{II' MISS JEAN HAYS DUNLAP 726 HARDING AVE NEW CUMBERLAND PA 17070-1436 Computershare Computershare PO Box 43078 Providence,R102940-3078 Within USA, US territories 8 Canada 877 770 0496 Outside USA, US territories b Canada 781 575 2382 www.computershare.comlinvestor Holder Account Number 00003668835 I N D Record Date OOJun 2012 Check Number 0002442766 SSNIrIN Certified Yes OOICSOOfIS.DOMEQS. PGLF20N.235237_45RR7/040795/040795/il '.~" FRONTIER COMMUNICATIONS CORPORATION -Dividend Payment Dividend Confirmation Payment Date Class Description f Participating Dividend Gross Deduction Deduction Net I ShareslUnits l Rate Dividend ($) Amount ($} Type Dividend ($) 29 Jun 2012 COMMON 132 $0.10000 13.20 0.00 N/A 13.20 Year-To•Date Pald 26.40 D.00 26.40 1UDC F R O N '~"' OL'Stiiirll;l l- OOHXDA-PP f+u•i;IG At IP eSa=Etr1 a.I~ro r.,E w' + ,;f.!le.'.t .. ~uE 4:. .,~'~ ~I_ ~~I-i: _ /~rrr ~_-_ .~ i~u r, I~E .ter i~J'. iciJ:n<3 EUF4 _.4.,n R~Jk ftJ f„,i l~,;aS,q~CA.,J JOIC,L K.A~"llRE~ onfier• Bank of America sa•tz7a Cammunicebona Atlanta, Dekalb County, Georgia 611 GA PLEASE DEPOSIT THIS CHECK PROMPTLY. Pay $'""THIRTEEN DOLLARS AND TWENTY CENTS "«"" Pay to the MISS JEAN HAYS DUNLAP order of 726 HARDING AVE NEW CUMBERLAND PA 17070-1436 ~~~~ Computershare tnc. 250 Royall St, Canton, MA 02021 Se~~urify Faalurca Oar;l~ on B.ir:k. ++'000 244 2 766++• r:06 L i L 2788r: 335 900 5 29811' ~c er~2442766 39Jun~ $****13.20**** Computershare In Authorized Paying A nt Authorized SignaWre(s) ~~ ~~ N O] W (D N D n n ~ m - ~ ~ N m N a v° L O O V C'J h N N E v N [7 B O N N l x C 7 L .~ ~t ~ G _ ~ ~ a e ~ ~^ S 4 ~- ~ ~ c ~ O Q~ n lt) ~ N nm N n ~ ~ ~ c °o U d S m~ N y ` ~ ~ ei ~ m ~ ~ Q. maa ~ ~ ~ r ° ~ ~ . z ~iv E ~ ~ ~ .a~ x o z ~ ~ ~ v m~3 C4 ~ M ~ s d ~ ~ ~ ~ ' Q 2 Z ~ O O ~ a~i Z U L ~. _ _~ ~ O a C .a . ; 0 uy ~ ~ = Z _ ~ Q O ~ Q _ w rn = co C o ~ Q •°- - U Y ~ ~ o O ~ (/~ _ _ U o ~ g d ~ Z ~' J ~ ~ o - z n¢. ~ _ = ~ ~ ° p wz V U o _ }¢~ ~ = w Z - O Z ~ c ~ ¢ w -_ o~ ~ j=U ( (~ ~ p w U L ~~z o ~ ` W U F- ~ Z y IIIIIIIIIIIII IIIIIIIIIIVIIIVII IIIIIIIIIIIII'I'IIII IIIIII ~ IIIIIII D Z C d I ~ ~_ 0 O Q '~~i ~T 3 d D C v 0 3 ~ ~ O o ~ N ~^ H o ,o a .~ 0 ~ d C ~ d ~ 'a .~ 0 ~ w ~. C d H V ry a v=i G O d .` U ayi y m V m 0 0 aCi E d N a !"l ~C N z Q n/ Z LL 0 0° o a N V ~° N °o g N ` , V z v ~ a ~ N o c F A } a a 0 x 8 0 ^ c V 0 c Policy Number: LAC502529 Payee Name: Estate of Jean Dunlap Request ID: C6D6E Request Date: 07/24/2012 Request Amt: $152.92 EXPLANATION OF REFUND Refund due to death. Death 05/22/2012-08/16/2012 DAE Refund Number: 12829990 If you have any questions regarding this refund, please call our Service Center at (800) 331-1538. p fi ~~~~ a 9-~ ~2- ~ 3~, FORM NO 1249 03 C6D6E12829990 Unum is a registered trademark and marketing brand of Unum Group and its insuring su6sid iaries. _.. - {01662209 ~ ~ ~ Unum Life Insurance Company of America 1 unumm Individual Long Term Care-6203 ~---- -- 2211 Congress Street 5119 ~ Portland ME 04122 j ___ _ ----- -- fUMA44 C6D6E12829990 INN July 24,2012 j $152.92 Pay: One Hundred Fifty-Two Dollars and 92 Cents. Bank of America Hartford, CT Pay to me Estate of Jean Dunlap order of 726 Harding Street ~~~ ~L~ New Cumberland PA 17070 1459 95C _ LJ~ SECU RITV FEATURES INI;I U[1f-U. DETAILS ON 6ACK L:J. 11.0 i66 2 209 ill• i:0 L 3t900445~: 0000000665 2611' REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER JEAN HAYS DUNLAP 21-12-0734 If an asset was made jo+nt within one year of the decedent's date of death, it must be reported on Schedule G. S URVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSH IP TO DECEDENT A. MARGARET J. DUNLAP 726 HARDING STR$ET SISTER NEW CUMBERLAND PA 17070 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 SIMIUR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t. A 07-02-09 REAL ESTATE - 726 HARDING 175,000 50 87,500.00 2. A 06-30-00 2000 CHRYSLER CIRRUS 1,350 50 675.00 3. A 4 SILVER DOLLARS 4 50 2.00 4. A 17 HALF DOLLARS 8.50 50 4.25 5. A HALF DOLLARS 46 50 23.00 6. A $2 BILLS (22) 44 50 22.00 7. A SILVER DOLLARS 14 50 7.00 8. A LIBERTY DOLLAR 1 50 0.50 9. A CASH 400 50 200.00 10. A SOVEREIGN BANK - SAVINGS 574.85 50 287.43 11. A SOVEREIGN BANK - SAVINGS 2,689.48 50 1,344.74 12. A SOVEREIGN BANK - MONEY MARKET 5,436.49 50 2,718.25 13. A M&T SELECT 2,012.90 50 1,006.45 14. A M&T SAVINGS 7,854.65 50 3,927.33 15. A M&T MARKET ADVANTAGE 6,838.37 50 8,419.19 16. A M&T CHRISTMAS 185 50 92.50 17. A M&T CD 0,855.79 50 5,427.90 18. A M&T CD 6,469.87 50 8,234.94 TOTAL (Also enter on line 6, Recapitulation) $ 119 , 8 9 2 . 4 8 (If more space is needed, insert additional sheets ofthe same size -___ ~ ~'~.._ :~'?~~ kPei I~~`~=~,'.Er~OYN. FA FA%,:71i+Ii7~649S F', 00 ©MBTBank 51'AT'EN~FL+ 11' P„+F'[~L~O ~ F11~vE ' APR.19-MAY.18,2p12 1 OF 4 CO 0 06113M NM 017 MARGARET JANE DVNLAP JEAN H DUNLAP 726 F~ARDING ST NEW CUMBERLAND PA ~~070 Sa818 `:SE~~EiCTED AC~OCJNT. S~2Y' ACCOUNT ACCOUNT INTEREST EARNED MATURITY BNDSNG TYPE NT]MSER YF-Ak-TO-DATE DATE BALANCE MaT SELECT WITH INTEREST 000000029342155 0.08 4,504.46 m&x MARKET ADVANTRG£ 0150042167265x9 1.37 13,67x.05 M[d SELECT 12 MONTH CD 031003920512918 14.38 11-05-12 10,855.78 ~' ¢a&T sELECx 36 MONTH CD 031003920510491 31.10 10-17-10 16,a69.87* TOTA:, DEPOSITS ~ a5, 504.17 SNTEREST EARNED I3 INCLUDED TN YOUR TIME DEPOSIT ENAING $.AI,AA7CE ONLY IF rT HAS BEEN PAID TO YOUR ACCOUNT. :, ~,APCOUAI'T.;;,• MARGARET JANE DVNLAP M T SREST ': TITY,E >:', JEAx x nuNLAe ACCOUNT NO- 29342155 EZGHI.anm pp,RK INTEREST EARNED FOR STATEMcNT PERIOD 0.01 TnnnrrT.rm c+rnrtnnrnv ' BEGZNN~NG ',. ' 'E3kY'XI3CE ~." ~!I7EFOulTS & ':<: ::.~ :: ..:, .-,:~: :~. ;'. ,:'`.: ''"~i ~ii'9T33SR .. ~,r< E AS~'PAID S,;'f ct '. :..T >:;'~ .. :~ ::',:.:CttRRSNT. il. '. I `'SNi3ING:.j ': N0. AMOUNT N0. AMOUNT NO. AMPIINT 2,241.16 6 B 015.62 18 3 871.64 6 1 790.70 0.02 a,50a.a6 2f ("f-'(1rlATT T~f'T T<YY'1`lY POSTING: r, : -:.'. I'! 'i: i! ' ::: !::,! ... i', i ti ,~: ' ~. '.:'.' ::> £ . R,;4TION ::~:! ~ ~::. LaEBq$I1'S ~ INTERE81' ,&,.; .,. ...:, .., .:0'F. i£f.KS-~?&i A1HE1;;.. ..:zz;. ~ ":" ~:>ii' : '.`p.4IL5C. i ~ 73LLANE`E'.. '!. 04-19-12 BEGINNING BALANCE $2,241.16 D4-19-12 CHECK NL-MBER 5696 90-56 2,150.60 C4-23-12 CHECK NUMBER 5699 400.00 1,750.60 D4-24-12 CHECK NUMBER 5700 ~ 36.DD 1,924.60 04-25-12 CHECK NUMffiER 0055 800-00 914.60 05-07.-12 FIDELITY' INVESTM PENSION 99a.5a cs-ol-la DEposIT 890.10 OS-O1-12 R&TIREMENT PENSION 134.00 DS-O1-12 CHECK I4[1MEER 5701 36.00 2,995.22 05-02-1x CSTICAF2D PAYMENT CHECK ?YMT 000900000005703 938.66 x,056.56 DS-03-12 US TREASURY 303 XXSOC SEC 1 298.00 ~:~_-.-~_J-~c.% T~°. ~~_;~~~ ~1.~ ~~,1T~. LEr~io~lrl. Fa ©MBTBank FAX: 717+737+6498 P, 004 sTZ~~~E~ p~ron ;P~ .. APR.19-MAY.18,201a 2 OF 4 MARGARET ~7ANE DVNLAP J'~AN H DUNLAP nf~r'l1TTATT n(•T TV7TV PS7STYxU^ DATc^^':..' ~ "':;` :::~ ..> ~:: ~ - ~ TRAbF3A Tr .DS ~. <:. ::~'. 'D~S'~$k"1'S~zN, S'F.K£S1' '~:::'' ~.D..?L 1~l3 ':CK£CFSS<;'.f A~3ER ' . ~',~~~ .3UB'T LTiON3 ~-~i :AAIS~Y .. .. ~'EBLAL4CE~ ~!'~ -.'' OS-03-12 CHECK NUMBER 5704 50.00 3,305.58 OS-04-12 CHECK NUMBER $705 31.00 3,274.56 US-07-12 C:-tECK NUMBER 5706 500.00 US-07-12 BENEFITS PACKAG 8002513311 2.00 3,772.56 OS-08-12 CHECK NUMBER 5709 1.200.00 05-08-12 CHECK NVMBER 5706 36.00 1,536.56 OS-08-12 CHECK NUMBER 5710 168-OB 1,368-a5 OS-i0-12 ATG MONTHLY DDA TO DDA 115.00 OS-10-1z CHECK xLm>$£R 5698 20.00 OS-10-12 ATG MONTHLY DDA TO DDA 15-00 1,218.08 CS-11-12 tBATYONWYDE MUTVA CAECKPAYMT 000000000005711 264.65 963.83 OS-la-12 DEPOSIT 4,000:00 05-14-12 DEA06IT fi00.00 OS-14-12 CHECK NUMBER 5716 40.00 OS-14-12 CHECK NUMBER 5715 36.00 05-ia-12 CRECK NyMHER 5707 265.00 05-14-12 CX£CK NUMBER 5714 200.00 5,022.83 05-15-12 CHECK NUMBER 5712 45.00 OS-15-12 CHECK NUMBER 5713 18-00 4,959.83 05-16-12 INTEREST PAYMENP 0.02 06-18-12 CSTICARD PAYMENT CHECK PYMT 000000000005717 455.39 4,504-46 ENDSS~G SAI,ANCE 84,504.46 .. .... r !li fiH£OKS Ep,A17? SFSkiMARY ;: ~ :: - d.. .., 55 04-25-12 800.00 5696* D4-19-12 90.56 5698" 05-10-12 20-00 5689 04-23-12 4D0.00 5700 04-34-12 3b.D0 5701 05-O1-I2 36.00 57C4~ 05-03-i2 50.00 5705 OS-04-12 31-00 5706 OS-07-12 500.00 5707 OS-14-12 265.00 5708 OS-08-13 36.00 5709 05-08-12 1,200.00 5710 05-09-12 168.08 5712' 05-15-12 65-00 5713 05-13-12 18-00 5714 05.14-12 200.00 5715 OS-14-12 36.00 5716 OS-14-12 40.00 ANNUAL PERCENTAGE YZELD EARNED ~ 0.00 Y 1.'C"1-~~=-~",~~ ~'~~: i 1 . ~5 Ah~7 P~~TB, i,EP~~OYN, PA ~ FAQ:: 717+737+6498 P, U09 Q M&TB~ailk $3'11!ET4EL4T' PEkl-LOO <FAGE APR.19-MAY_18.2~12 3 OF 4 MARGARET JANE DVNLAP JEAN fi DVNL.AP EFFECTIVE SLILY 30, 2012, THE FEE FAR EACH DRY TxaT THERE >;5 A TRANSFER FROM YOUR SAVINGS, MONEY MARKET, OR CHECKING ACCOONT TO COVER ONE OR MORE OVSRDRAFTB IN YOUR CHECKING ACCOUNT WILL 8E $12.50_ TFiI3 FEE WILL BE CHARGED TO TAE ACCOUNT PROM WRICx TFj£ FUNDS WERE TRANSFERRED. THIS FE& DOES NOT APPLY TO A POWER cxECKING OR MYCHOICE PREMIUM CHECKING ACCOt7NT. '.~.~iCCOGJNT;'~,;'',i; MARGARET JPNB DUNLAP M ET ADVANTAGE < :;~z~ "::: ACCOUNT NO- 15004215726528 EZGHypND QARK INTEREST EARNED sOR $TaTEMEN'T PERIOD 0.33 .A.CCOUNT SUMMARY __.............._ ~' C ? ~7 E 7 C7 C7 .-~-- - S£GkI?NT.A1G SAT~ANCE -- ~ DEPDSZTB 6 ';OT'FfEA ~AI7DIT5 N ':~ 4i~xT.HD12AVtJlL$ & -0T'?;£R ~~~ 'CCiljR'b'NT' :: ' I2iTiSREST PASf/% )~[?D1PG BALANCE N0. AMOUNT NO- AMOUNT 13,558.72 1 17.5.00 0 0.00 0.33 13 674.05 04-19.12~SEGINNING BALANCE OS-10-12 ATG MONTHLY DDA TO DDA 0 5 -18 -12 1NT£R85T 8AYM8:sf 116.00 0.33 $13,558.72 13,673.72 13,674.05 ANNUAL PERCENTAGE YIELD EARNED 0.02 ~ ,tmo ~ ~~~OYN. PA ,., - ~ m•r,• )~ A~1 b.l (~1Vi~i Banff. FAY~,717+737+6490 F. 006 sE~xoPs ~A~ sr~~' APR.19-MAY.18,a012 ~ OP a MARGAgEx JANE DUNLAP JEAN H DUNLAP -----~-----4-----~-----p-----p-----p-----~----- %ACC'QSTNT3c3 MARGAR&T JANE DUNr•ap M&T SELECT 3 %;~s~r~5: ~,'': asAx x DUNLAP ACCOUNT' Np. 31003920510491 CURRENT INTEREST FLATS 0.5008 MATURITY DATE 10-11-1h HIGHLAND PARK 00.-19-12 BEGINNING BALANCE OS-17.1] ZNTEREST PAYMENT GENERAxEn B.77 $16,a63.to 36,469.87 M&T SELECT la MONTH D ACCOt7NT N0. 31003920512918 MATURITX LATE 11-OS-12 ~.~,A000.Wp?`1':`; MARGARET JANE D'Ut0'LAP CURRENT INTEREST RAT& 0,350'4 xSGxLAND PARK IlCCCITTNT IlC'TTVTTV :. EOSTING:: :BATE -I !; ;.; .::.. ,>., ' > ., I ..I T.[2P~Tf5AE'?`TON.D£'5CRTFTi0T1 !:? "i: DEP03i1'B,I012$Rffi6Q k~::OT1iER.Afi 'Y'FYOT~}S W'DRAWALS.:& EAT: . ~',':'.5U8 ~ : :~:A7lILY ' ~:! '" 04-19-12 BEGINNING 6ALANCE $20,855.79 ENDING EALANCE 10 855.79 •'~ END OF STATEMENT x* Kelley Rlue I3~ok <, r~ a(IVertisemen[ Your Blue Book Value 2000 Chrysler Cirrus Style: LX Sedan 4D •- Mileage: 30000 Yage 1 of 2 Trade-In Value _._ _. Fxceuent Vehicle Highlights 5969 Very Good MPG: City 17/Hwy 26 $919 Doors:4 Good $869 i Drivetrain: FWD Fair ~ i EPA Class: Midsize Cars $844 Countr f O i l U i y o r g n: n ted States Your Configured Options Our pre-seleRed options, based on typical equlpmen[ for this car. ^Options that you added while configuring this car. Engine Comfort and Convenience 4-Cyl, 2.0 Llter Air Conditioning Transmission Cruise Con6ol Automatic Steering Drivetrain Power Steering FWD Tilt Wheel EntelYainment and Instrumentation AM/FM Stereo Cassette Glossary of Terms Kelley Blue Book® Trade-in Value -This is the amount you can expect to receive when you trade in your car to a dealer. This value is determined based on the style, condition, mileage and optons indicated. Kelley Blue eook® Private Party Value -This is the starting point for negotiation of a used-car sale between a private buyer and seller. This is an "as is" value that does not include any warranties. The hnal price depends on the car's actual condition and local market factors. -,,. ^.~,:~- oya ~a ri span why aa5? Max Seating: 5 Engine: 4-Cyl, 2.0 Liter Transmission: Automatic Body Style: Sedan Country of Assembly: United States Safety and Security Dual Air Bags Wheels and Tires Steel Wheels http://www.kbb.com/Chrysler/cirrus/2000-Chrysler-cirrus/Ix-sedan-4d/?vehicleid=5649&int... 11 /6/2012 Kclley Flue Book Excellent Condition: 3% of all cars we value meet this cdteda. This car looks new and is in excellent mechanical condition. It has never had paint or bodywork and has an interior and body free of wear and visible defects. The car is rust-free and does not need reconditioning. Its clean engine compartment is free of Fluid leaks. It also has a clean title history, has complete and verifable service records and will pass Safety and smog inspection. Very Good Condition: 23% of all cars we value meet this criteria. This car has minor wear or visible defects on the body and interior but is in excellent mechanical condition, requirirg only minimal recondl[loning. It has little to no paint and bodywork and is free of rust. Its clean engine compartment Is free of fluid leaks. The tires match and have 75% or more of tread. It also has a clean title history, with most service records available, and will pass safety and smog inspection. Gaud Condition: 54% of all cars we value meet this criteria. This car is free of major mechanical problems but may need some reconditioning. Its paint and bodywork may require minor much-ups, with repairable cosmetic defects, and its engine compartment may have minor leaks. There are minor body scratches or dings and minor interior blemishes, but no rust. The tires match and have 50%o or more of tread. It also has a clean title history, with some service records available, and will pass safety and smog inspection. Fair Condition: S8W° of all cars we value meet this criteria. This car has some mechanical or cosmetic defects and needs servcing, but is still in safe running condition and has a clean title history. The paint, body andJor interior may need professional servicing. The tires may need replacing and there may be same repairable rust damage. © 1995-2012 Kelley Blue Book Co.~, Inc All rights reserved. S. 2011 Kelley Dlue auuk Co., Inc. AN tights reserved. 11/2/201 2 4 1/3/201 2 ed~bon far vennsylvama 17070, The spacl/IC rnlormabon required [o de[,!nnine the valor, h>r this partlcu(ar veMC1e rras supplreA by the person 9eneratiny mu rearort. VehiUe valuations are °plnlons arrAmay vary hnm vehicle to vehicle. Attual valuations w/ll vary baseA uA°n market mnditi°ns, sped/irations, vehcie condRbn °r other part/cu/dr drwms[ances pertinent to this particular veMOe or the tfansdc[I°n Or the pdrties [p [he [rJOSacbpn. m$ report is InfendeAPor the OAivldual use o/the person generating this report only and shall not he sold or bansmi[[ed to another party. Kelley afue 6°ok assumes no responsfbi)iry for errors °r omissions. (v. ]211 ]) Page 2 of 2 http://www.kbb.comlchryslerlcirrus12000-Chrysler-cirrus/lx-sedan-4d/?vehicleid=5649&int... 11 /6/2012 Kelley Blue Rook Your Blue Bookm Value 2000 Chrysler Cirrus Styles LX Sedan 4D _: Mileage: 30000 Private Party Value Exceuent Vehicle Highlights $1,474 ~ __. _~__ry._..~.. .____ _._......____ ' Very Good MPG: City 17/Hwy 26 $1 399 , Doors: 4 Good $1,349 Drivetrain: FWD EPA Class: Midsize Cars Fair $949 I Country of Origin: United States Your Configured Options Our pre-selected options, based on typical equipment For this car. n Options that you added while mnfguring this car. Engine Comfort and Convenience 4-Cyl, 2.0 Liter Air Conditioning Transmission Cruise Control Automatic Steering Drivetrain Power Steering FWD Tilt Wheel Entertainment and Instrumentation AM/FM Stereo Cassette Glossary of Terms Kelley 81ue Bookp Trade-in Value -This is tfte amount you can expect to receive when you trade in your rdr to a dealer. ThIS value is determined based on the style, torrdiiion, mileage and options indicated. Kelley Blue eookB Private Party Value -This is [he starting point for negotiation of a used-car sale between a private buyer and seller. This is an "as Is" value that does not include any warranties, The final pace depends on the car's actual condition and local market factors. Max Seating: 5 Engine: 4-Cyl, 2.0 Liter Transmission: Automatic Body Style: Sedan Country of Assembly: Unites Safety and Security Dual Air Bags Wheels and Tires Steel Wheels Page 1 of 2 http://vt~~w,kbb.com/chryslerlcirrus/2000-Chrysler-cirrusllx-sedan-4d/?vehicleid=5649&int... 11 /6/2012 adverti!ement why atls? Kelley Rlue Book Excellent Condition: 3°!° of all tars we value meet Mis criteria. ibis car kwks rcw ra r0 is of exmllent. mechanical condition. I[ has never had paint or bodywork and has an interior and body free of wear and visible defects. The car is rust-free and does not need reconditioning. Its clean engine compartment 15 free of Fluid leaks. It also has a clean title history, has complete and verifiable service records and will pass safety and smog inspeRion. Very Good Condition: 23°7° of all oars we value meet this criteria. This car has minor wear or visible defects on the body and interior but is In excellent mechanical condition, requiring only minimal reconditioning. It has little to no paint and bodywork and is free of rust. Its clean engine compartment is free of Fluid leaks. The tires match and have 75% or more of head. It also has a clean title history, with most service records available, and will pass safety and smog inspection. Good Condition: 54% of all cars we value meet this mteria. This car Is free of major mechanical problems but may need some reconditioning, Its paint and bodywork may require minor touch-ups, with repairable cosmetic defects, and its engine compartment may have minor leaks. There are minor body scratches or dings and minor interior blemishes, but no rust. The tires match and have 50°!0 or more of tread. I[ also has a clean title history, with some service records available, and will pass safety and smog inspection. Fair Condition 18°>6 of all cars we value meet this criteria. This car has some mechanical or cosmetic defects and needs servicing, but is still in safe running condition and has a clean title history. The paint, body and(or Interior may need professional servicing. The tires may need replacing and there may be some repairable rust damage. © 1495-2012 Keiley Blue Book Ca.~, Inc All rights reserved. 2012 Kzllzy Blue !took lo., Inc nil nghrs reserved. 11/Z,r2012-11, 8/2U1- Edrtron for Pennsylvania 1070. Tne specl)ic m/om+arlon required to grte~rnine fne valuz /or drls partlurlar vehltle was urpplie~d by the portion genera[Ing rhis report. Vohicie valudnon5 are °prnlOnS and pray vary (ran) veMCle m vehicle. nRUdl valuations will vary baszd upon market conditions, syeUficarlons, vehlfle condttron or other particular clrcurn5tances pertinent to thu par7cu7ar vefncle or the GansaRiun or [he parties [o me nansacfion. This report Slntended lnr [ne individual use a/the Verson yeneranny thrs repnr[ only dnd shall no! he sold or transmitted Cq another party. KMley aloe aooA' assumes nu respanslbllRy tDr errors o~ omissions. (+.12711) Page 2 of 2 http:/Jwww.kbb.com/chryslerlcirrus/2000-Chrysler-cirrus/lx-sedan-4d/?vehicleid=5649&int... 11 /6/2012 REV-.4,85 EX+ (o-r~0) ~ ~ SAFE DEPOSIT BOX COMDEPARTMENT OFPREVENUEANIA INVENTORY INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 Please Print or Type nni IcT aF nnnnal Frcn Rv RFPRFCFNTATIVF OF FWANCIAL WSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER BER SOCIAL S~CUR~'fY OR D~,ATH ~CE~TJFICATE NUM / (h[y,', (J~ l~/ V (~ J~ J DECEDENT'S NAME (LAST, FIRST, MIDDLEy!1. ,n ~~ ~ ~~ ~ ~ D A T E / OF D H1 i~ 6 `-1 1 1't ~.J`. ADDRESS OF DECEDENT (STREET) ~~ / ~`~ <~I~ ~L (CITY) t (STAT) l/Yn tom.! r ~ C~be~lctna~ ~ (ZIP ODE l ~J?u NAME AND ADDRESS~^O, F// PERSO(N~R(EJQUESTING THE OPENING OF THE SAF (NAME) ~I~ (~iJ~ ~/ .IJ Un J~ E DEPOSIT BOX (STREET NAME) y0 /) ~ ~ J I,~ ~~/ , (! _ ~T .m /„ ,~~'Z _7 (STATE) f y ~ ( O P ~ S J ( ~ ` jC / , I ~ ,/ N ZIP CODE) ljiJ~ !Ul OX OPENING P RESE NT AT T B TIONSHIP (1F A Y) TO DECEDENT, O PE O N( S) H E NAME, ADDRESS AND R A N R E L a. (NAME) ~ / / ~~f Cc~JL-~ (~ ~ (RELATIONSHIP)/ ~IStG~ (STREET NAME) ' 1. ~ /(~ .~ /I ~ ~~ I _ () -~ 2~~LJ GY ~-)I'..L! r' '~nn /~( _TY,~ „_ / (ST ,~ (JC / ,,,j( If L Ei l (.,_t/Yf'f (Z~ ~ fJ~ ~<X`-~t b. (NAME) ~¢1tlQ~'J/1~etCZ- fYl;i ~ t'~ ~ P) ~ R ( ~ T EL ~1O' (STREET NAME)., `~ ~ ` ~~ ( TY) (ST E) (J2,P COpE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) ~ n q ~ ~~ (STREET NAME) ~ , , , / ~ /, \ ~ ~~ L L I .~ ~ (~ (CITY} ~~ (ST4C;f~ l/ //11" ~ ~ (Z1p~pD~ 1 NAME OF PERSON A K QIG~AST ENTRY M I ~ ~ ~~~ /~ L f ~ ~ ` •/ D S T ED{TRy ATE~ IME ~ ~ A JFl~J1 `( ' 1' t NUMBER OF p~( E NT B R DATE OF~]ONTRAC,T/ TO (~ ~ TITLE UNDER WHICH BOX IS REQUE T E S D NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) n n~ //,,~~ b . (NAM1gEj~ Q~ n~ F'` ' " j`~ (STREET DRESS~~ ,'J„ ~ /!( ~"/ (STREETAD,~~ S )~~/ ~ ~ (CIT ~~~J-~~ (ST/,~) (~P~O~) lY', ~,C..W ~IIC-~'~/~ ATE) G (ZJ~ l NA ND TITLE OF EMPLOYEE TAKING THE INVENTORY 1 ~ ~ ~~~n ~ ~o~-n~J~ 0~ WAS A WILL IN THE BOX? YES ^ NO If yes, a. Date onf will: ///~~~ ,,~,, __~ ,__, b. Name and address of personal representative, if nametl in the will ,{ ,•, ~N~ o~ ~ -{ `~) l s / .~~ (,y7G~/ 1 / (NAME) (~l (~l,~.il G P ~/ ./~~ ,, I(1' / I~J(- (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) 1e f SAFE DEPOSIT BOX INVENTORY Page / _ o`_ INSTRUCTIONS - _--_ __ (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (ti) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION '--- _. ~5 ~~w-+C.-~ ~J l ~t,~ rS _ 1 r~lu~2~ c.~11~r5 - - l ~ -----_ _ --- -- -_- ~'~'1e~ llCchs -- ~ ~lr'C~f~.lQlG~ ~! ~ i! S~ U-~ ~tJ>~4~1 ..~~'a-fC L'~U~ i - ~(;:s fiu tjm ~ I~~~~ ~~- ' f ~' ~~ ~ it `?c~u ~,~ l ~ ~r'n _ _ ~ .-__-- --- - - ~ 7~ ~~ li )'l..J )~ _ --_. -_ _ --___- ~x ~~ ,~.f ~ 1~~5- ___ -- - - - --- ~~~~~p ~f ~ ~I ~ i ~ ~ .S~ --- - (..~~1~?, ~ lu IL' f~ C~i r.eVtwr~ 1 ~lc,~Cur~t.rz~t ~m IJ~ ~ k~ - e%~~.l~d t> ~1~r~c~../ C?rr~u~ -- 1 Z~I4 t~ r ~ ~P f ~ ,~ 1 ~ ~- --- - ~. ~ _ - - ~ ~~ ~ ~ -~ 1 ted l ~ _- --- e~ T b~t~~~s ~r ~ . ,, , _ -- __-_ _ ~ ` Y71~~ ~} t~ T~l~ ~ ~ ux~r ~:- _ I CERTIFY UNDER PENALTY OF PERJURY THAT TH A8 E RECORD IS PERSON RECEIVING COPY OF CORRECT COMPLETE TO THE BEST OF MY KNOWLEDGE ANp BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNA7U ^ __ -.. ~ SIGNAT~R~ .._ 1 '~~~ ~ ~ X ~1 r ~ fd~~~~ _ .-. _- 1 i „~~_ .. ___-_ RRINT NAM " //~{r~ ~ ,~ y /1 PyRI~N~T~IJAME AND CK R ~1~/ nBO ~. ELOW. ,~ i Z fl~K1C)O J _ - _-_ _ I PL~IGLL~Q~ f U!i~~ PRINT TITLE DATE CHECKA ORRIATG BOX ~~~~~ ~~~~VJ~~ J/f~ - ~'~'~~ ~ ~. ~ Fxecutor(trix) ~ Administralor(tnx) ~ WW Es[ata Rapiesen[ative Joint owner of safe deposit hox NOTE: Attach additional 8'Iz" x 11" sheet(s) if necessary or use duplicates of this page of form. ` ~ SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION ~~~ ~~h ~,~-en2e,~-f ~ 2~r~ ~Cfl ~~2m~d .. ~1 rfs ~ ~.r ~ f ~ ~ (.L~l -- ~.t- 1 G~ .~(,~;e~-l ~~ :ern t ~_tti~_ ~~I(:~ -fvckTS:fc.<.f.~i~n.~,~f - `emu c.~~et .~~- y1 C~G~ ~Pl-Uf r l~ i f 1I~ r ~ CiG~-~ t ~ n.~" ~~s'r' r'r~f ,,r ~iil ~ i ~.'I Ui ~ ~ ~1~+~ ~ ~~1~~~ ~ _ f ~~c~nfi~t.G' GC - L " ~ - ~ - i ~ ~ d l.~ ~ ~1 i i l e( 0-e~i um b~l~ ~'ic~la~s i ~kS~rc~n~ . cb'' ~ s -~rcvrl / ~ ~ l r ~~ r' ~~~ ~xvrn.e.~.t~ I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PRINT NAME PRINT NAME ANO CHECK APPROPRIATE BOX BELOW' PRINT TITLE DATE CHECK APPROPRIATE BOX' Executor(Irix) ^ Administrator(trix) Esta[e Representative ^ Joint owner of safe deposit box NOTE: Attach additional 8'/=" x 11" sheet(s) if necessary or use duplicates of this page or torm. RFV-485 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER ~ SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH ADDRESS OF DECEDENT (STREET) (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) NAME, ADDRESS AND RELATIONSHIP (1F ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. (NAME) ___ (RELATIONSHIP) (STREET NAME) ~ (CITY) (STATE) (ZIP CODE) • NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED _ --- (NAME) ._ (STREET NAME) (CITY) (STATE) (ZIP CODE) 1 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY _. - ---- DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ TITLE UNDER WHICH BOX IS REQUESTED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) b. (NAME) (STREET ADDRESS) (STREET ADDRESS) (CITY) (STATE) (ZIP COD E) (CITY) (STATE) (ZIP CODE) NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS A WILL IN THE BOX? ^ YES [~ NO If yes, a Date of will __ ___a _ b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) ~ (STREET NAME) (CITY) (STATE) (ZIP CODE) SAFE DEPOSIT BOX INVENTORY Page Gf INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be certificate number, date of certificate, name in which stock is registered, and name of company nated b desi , y g number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (8) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION arch ~ L~e~- ~ ~ -~- ~ ~, r ._ ~;/ .~ r f 5 - .CK t (~ - `~Yl~zf ~~f.Q f ~ r ~S ~~ YYIa-~ .~- (;~.~ n ~ ' r '~S~S 'Y~ ~ `~l~i... `r-' ~ ~ (1' ~ `tu i ~~us ~ ~ - 5 ru ~ h - l~c~ ._ , X-~~ - ~~ ~ ll~twl(1(.t.-~' , ~' '(~15 '" I~,LUI G~-1U1~C1 ' b / 1 ~ ~ ~ t)~~ 1 I ~'~ pp ~/ ~ ~/,~~ L, 5 ~ ~LL') L ~ l ~GL! .~ .~1lGZ (J(J~ ~~ (~ c~lUa U ~ ~ ~. ~~ a~ua ~~- ~s. ~;-c~ d~~~~~ j ~~ d~~~~ ~ blUe ~~~f fir. ~ /l~ l~~ ,~~ cr~'r~ I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECOR S CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW: PRINT TITLE DATE CHECK APPROPRIATE BOX: ^ Executor(trlx) ^ Administrator(Irix) Estale Representative ^ Joint owner of safe deposit box NOTE: Attach additional 8'h" x 11" sheet(s) if necessary or use duplicates of this page of form. REV-485 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH ADDRESS OF DECEDENT (STREET) (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) NAME, ADDRESS AND RELATIONSHIP (1F ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODEI c. (NAME) (RELATIONSHIP) (STREET NAME) (CffY) (STATE) (ZIP CODE) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED - -_ (NAME) - -.. _ (STREET NAME) (CITY) (STATE) (ZIP CODE) 1 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ TITLE UNDER WHICH BOX IS REQUESTED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX _ a. (NAME) b. (NAME) (STREET ADDRESS) ! (STREET ADDRESS) - ------- I - (CITY) (STATE) (7_IP CODE) --- ------- (CITY) _-.._ (STATE) (ZIP CODE) NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS A WILL IN THE BOX? ^ YES ^ NO If yes, a. Date of will : -_ _. b. Name and address of personal representative, if named in the will (NAME) ~ (STREET NAME) iCITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) (STREET NAME) (C D~V) (STATE) (ZIP CODE) SnFF nFP~sIT Box INVENTORY Page~of~ INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (8) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION ~ I ~~' ~ ~//~ d ~ tGMS ~ 1 ,~ ce~fi ~c~.t-e ~ ~m ~. ~~ Shar.~s - ~' ~~ t, ~s 1 ~ ivM ;~ /1 I~ ^ T U ~ ~ ~ r-~ ~ f1;~(1 ~ l ~ ~ - Q.Qf) I SuC'r~.-I S2~cX4~ 4~-c~t-P.~~ a ..ern; S ltd( ~ G..I ~ IY1 (.5 ~ `~/ -~ ' ~9 -J t !U t ~1S I I ~ fih~~ c ~ r o-~ b; r-~h - ~ ~ e , .~f (~ I~ P. h~ ~ ~ l ~ ~-2.f C iP~1 _ 11 ~ " ~~ , ~ t f ~L ~Ct,t U~ Y i ~(l~V~ ~iY ~ '.~Pl " . ~l~- ~ ~~~ ~ ~m ~s - -e.rdC~~ ~ ,ief~ 1 ~~~.~I: n ~ C~ - pan. ~- ~ f s-~~.~~ 14.S.t r~f2c l~ '~ z r. ~ . - ._ean cn~..~ ~l~ ~ inUe~ -~.e~~ ~~ I CERTIFY UNDER PENALTY OF PERJU AT THE ABOVE RECORD IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. PERSON REC ING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW. PRINT TITLE DATE CHECK APPROPRIATE BOX: ^ EzeCUtor(trix) ^ Administralor([rix) ^ Estate Representative ^ Joint owner of safe deposit box NOTE: Attach additional 8'/z° x 11" sheet(s) if necessary or use duplicates of this page of form. REV-485 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETI IRNFn Tn AanvF annRFCs COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER - DECEDENT'S NAME (LAST, FIRST, MIDDLE) - ---- ~.7 uATE OF DEATH r ADDRESS OF DECEDENT • (STREET) 1 (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE - __ ----- SAFE DEPOSIT BOX (NAME) (STREET NAME) (CITY) STATE ( ) (ZIP CODE) NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) ___ (RELATIONSHIP) (STREET NAME) _. (CITY) (STATE) (ZIP CODE) -- b. (NAME) -- (RELATIONSHIP) _- ---__ (STREET NAME) _- (CITY) (STATE) (ZIP CODE c. (NAME) ---~-- {RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) ' NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) (STREET NAME) CITY ( ) (STATE) (ZIP CODE) 1 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY I - DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ TITLE UNDER WHICH BOX IS REQUESTED --- NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) --- -- b. (NAME) (STREET ADDRESS) (STREET ADDRESS) I (CITY) (STATE) (ZIP CODE) ~ (CITYI STATE ( ) ) (ZIP CODE NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS AWILL IN THE BOX? ^ YES ^ NO If yes, a. Date o f will: b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, if any (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE Page ~ of SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION r ~ In ~ ~~ F ~U99 ~ ~ J d ~r ~v f ] ~ l 7 crn ~r r T -f i~ f l P ~.l'4' ~ ~r'~~tls U1Uc~l G - 1 U f - ~~ ~n ~~ (~•{UI` 7 ~ ~- lrX~ C`~ 1 ~~, pt - am ' l 1 DlY) r f' l ~~ t~5; C~!'L~(~ I '~iJr ~ YnJ~ ~ ;n ~C~rv~.~.f- r D c)rn ~ .'n -r~- `~-Fr ` ! ~Vi,i 1 ~ ' ~ ~ I~~ S' ~~~~ um /~t~ Cap h ..cr.rf ~ vm ll~ ~t,e r` _ f~ ~ f" ~ ~ fi5ll2.~ Cep`!,' ~21 - - ---- I CERTIFY UNDER PENALTY OF PERJURY THAT TH ABOVE RECORD IS' CORRECT AND COMPLETE TO THE BEST OF MY K OWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PRINT NAME II PRINT NAME AND CHECK APPROPRIATE BOX BELOW: PRINT TITLE DATE CHECK APPROPRIATE BOX ^ Executor([riz) ^ Administrator(Irix) ^ Estate Representative ^ Joint owner of safe deposit box NOTE: Attach additional 8'/Z' x 11" sheet(s) if necessary or use duplicates of this page of form. RFV-485 EX+ (g.00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX D{VISION DEPT. 280601 HARRISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER DECEDENT'S NAME (LAST FIRST, MIDDLE) DATE OF DEATH ADDRESS OF DECEDENT (STREET) (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) (STREET NAME) (CITY (STATE) (ZIP CODE) NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT A7 THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) b. (NAME) ~ (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) c. (NAME} (RELATIONSHIP) (STREET NAME) ~ (CITY) (STATE) (ZIP CODE) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) - - - ~o m~~i rvrirvi~l (CITY) (STATE) NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ TITLE UNDER WHICH BOX IS REQUESTED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) b. (NAME) (STREET ADDRESS) (STREET ADDRESS) (CITY) (STATE) (71P COPE) (CITY) (STATE) (ZIP CODE) NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS A WILL IN THE BOX? ^ YES [] NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will (NAME) (STREET NAME) c. Name and address of attorney, if any (NAME) (CITY) (STATE) (ZIP CODE) (ZIP CODE) (STREET NAME) (CITY) (STATE) (ZIP CODE) ~~ ~ IVIV IGI IL'l 11 ~~ ':. ~~!?.~.`?~'~;~ ~,ND MONEY MARKET WITHDRAWAL. DEI31T ~~',', ~ l;p,~l;l~ yYlG.r~~r~__~U~p -_--DATE OF WITHDRAWAL _`~ 1211 ~~' -- '~.. ~ i i'. ~ ~ -, ~ (} . i ~`~ ~ ~l~ W~nII~11'Lv~ -R,4,f/-`-___ Cam''-_'1111~L.~/SP~._ - I,. ~I, ,~;..I ~ ( ~` . } i i'i ~'y(iy ~l~-,YL,C ItY~(~~~L~~(~ _ __ Q /T ~L ~ ~ L ~~ ~JJ 17/7 / f SS lb 12B~1t7 ~1,r rr~, i~; r nlUP~1BER Far 11 digit Accounts Oniy ~S~ll 3338 ~ 5~-Isb~ ~:56~7111536~~: Sovereign Bank MD121 (2/1 t) ~.~',C E~{:?~ i~I tY, `~AIPING~ ND MONEY MARKET WITHDRAWAL. DEBIT ,il ` ~ i ~~~'.~/~f_f i1i.AP,lli= ~~~- ~wIH~-- DATE OF WITHDRAWAL -~ ~2Z ~ ~Z ti ~ ~~tiki ~F~Ta ~ !_ i_(-f~0 111/1f)U[~ I~ _ _~~~~ -.S~ -~ e'S~- c~.~ OG~ ..--. ,}~ ~ ~ ~l O S -~ ~ b ',~',~~i~ji i iii ,'~,.U ,~~r~y~.C lsS to ~ ts~1v Cxr ~ I~I~J /ar,i,,r~i;411 ~IIMLiER For 11 digit Accounts Only x:56 X7111536 ~~: , n F9ank MD121 (2/11) ~~~~Fr~.~:€`:.ii~Ca, ~A~INO~ AN MONEY MARKS WITHDRAWAL. DEBIT C;~~:; i()IVIEI~ NAME __1'-~.f-~ 2~ ~~~~ DATE OF WITHDRAWAL~~L? ~ ~(~ __ 1N~?lTTE:U AMOUNT -t'~ ~.-~"-~`^-~- a~ -~~~_~~ dl,lG-, i;ii51~~J~~IILI, f~~OL o~ '7~7 6SS ~' ~ (-1 ~~1 r-1 ~ I ! ~l ( /~ V ~^' 'V ~'w~_-- _- ___.__ ~ 55 (O ~ 2 Y1 l0 ~r~ITS P,,'~r i?!JPJT NUMBER For 11 digit Accounts Oniy ~ 5 ~ ~f ~ 7 ~ ~ ~I o ~: 5 6 i 7~~I 5 3 6 ~i: /" II'2064L921i' ~:23L37269L~: L200L2455311' T T T Please Tear Along The PeAoratlon Above To Detach Check T T T Sovereign B~lk,1 V.A. DETACH AND RETAIN FOR YOUR RECORC PART OF THE SANTANDER GROUP Memo: 07/27/2412 $*******~**8,700.82 ACCOUnt Holder: MARGARET J. DUNLAP Account Number: 2 Branch Number: 0057 2064192 OD1001 MA Rev. 12!' JEAN H DUNLAP MARGARET JANE DUNLAP Deposit Accounts Account Number Average Daily Balance Current Balance SAVINGS FOR MINORS 574113924 $2,689.04 $2,689.48 Total Deposits JEAN H DUNLAP MARGARET JANE DUNLAP Balances JEAN H DUNLAP MARGARET JANE DUNLAP Balances The interest earned and the Account Activity Date Description 06-07 Beginning Balance 07-06 Ending interest paid may differ depending on when interest is credited to your account. Additions Subtractions $8,700.82 Account # 571133738 Account # 574113924 Balance $2,689.48 JEAN H DUNLAP Account # 574178740 MARGARET JANE DUNLAP Balances IF'#~~E[I ~v ~ .n s a '~ '~~ -` ~'° ~.~.` ~ ~s' ~ ".~„ ~~ :~ ~araY....~'`..~' ` ~` r~k~,` nP„~~~kir.~P~ia~ ~. + $0.89 Average Daily Balance $5,435.63 page 2 nj3 571133738 Interest Earned this Period $0 18 Paid Last Year $2.12 Sovereign Interest Farnedthts Penod _ $0 89 Paid Last Year $9.49 _. .e ~,u~~.,~,~,~-__ ,~,~~~: IN CASE OF ERRORS OR QUESTIONS ABOUT YOilR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRl'CE TO THF, BANK FOR DEBIT CARD ISSUES: FOR ALL OTIiER ELECTRONIC TRANSFER ISSUES: Sovemigp Bank Sovereign Bank Attn: Ca[d Disputes Team Attn: Client Relations MAI MB3 02 OS 10-421-CRI Box 12646 P O P.O. Box 831002 . . PA 19612-2646 Reading Boston, MA 02283-1002 , Plcasc contact us if you think information about an clectronic transfer on your statement or receipt is wrong or if you need additional information about an electronic uansfcr on the statcmenl or receipt We must hear from you no later than 60 days after we scot you the FIRST statement on which the errorappearcd. • Tell us your name and account number. • Describe the electronic transfer error or the electronic transfer that you arc unsure about and • Tell us the dollar amount of the suspected error. explain as clearly as you can why you believe there is an error or why you need further information. If you tell us orally, we may require you to send your complaint or question in writing within 10 business days. We will promptly investigate the matter and call or write [o you wi0t an answer within 10 business days. [f we need more time, we may take up to 45 days to mveshggate your complmnt or question. If we do, we wdl credit your account within this 10-day penod for the amount you think is in erro[, so you wdl have [hc use of the money dunng the time it takes us [o complete our utvestigalion. If we ask you to put your complaint or question in wnlmg and we do not receive it within 10 business days, we may choose not to credit your account. For errors involving new accounts, point oCsale ppurchases or foreign nansac[ions, we may take up [0 90 days, to investigate you[ complaint or question For new accounts, we may take up to 20 business days to credo your account for the amount you think is in error. We will tell you the results of our investigation within 3 business days after completing our investigation ICwe decide there was no error, we will send you a written explanation. You may ask for copies of the documents we used m our mvestigatton. IN CASE OF ERRORS OR QUESTIONS ABOUT OTHER TRANSACTIONS ON YOUR STATEMENT You must contact us within thirty (30) days aRer you ceeeive your statement if you think a transaction, other than an electronic transfer, shown on yom statement is wrong or if you need more information about the transaction. You may contact yyour nearest branch or our Customer Contact Center at 877-SOV-BANK. Customers with visual impairments may call 800-428-9121 (TTY/TDD). We will investigate your dispute and tell you [he results of that investigation. page 3 oj3 571133738 -~~ M8i1'J3ank GF-269,~,o, WIP TRANSACTION DEBIT ORIGINATING COST CENTER EMPLOYEE NUMBER UTHOR.ZATION DATE ~ f v A O T# ;r ~. = 7 -'7 CUSI04Al=R N E (P I T) 'DESCRIPTION: \ --~ ^ PARTIAL WITHDRAWAL ^ CLOSING WITHDRAWAL ;~..~, , c`a-~~,ti ~ ~- ~~~ ~,.,~, C~ +ti ~, ~ CUSTOMER ID: ~ ~'-~ ~'t ~~~ - Original -Processing Work - ~ ~`; Copy -Branch CUSTOMER SIGNATURE: ~ ~ '' ~' 4. `""` f~' " " ~ ' " `' •. •' ~ (( SEQ. NO. !'~ C.j' .~ 2 1 9 0 ~ 8 ~ 1 t~~ `~ ~ 1 ~ ~ ~ ~ ~ ~ / i7~ . ` y~ ya.w~'nan~4lm.rvTr:sT r~.~.nw..rv.~,.r^~~...Y~~w.m~~n..u:w~.~n~m~-n++~nw6..MT++F'nr.~+LA~'.114N -' ... w4'kM~a~EwY~.. ~ .. ..T:1?+~'•'fn^p~^s"~'~+m~m..^~n--T. /~1 M&TBanlc GF.2eg,eno, WIP TRANSACTION DEBIT OR GINATING COST CENTER EMPLOYEE NUMBER i? , AUTHORI TION _ DATE A COUNT YY '- _6 CUS NAME(PRIN) S C~ I~ :~ I !~i~ I ~ I C I~I TAI .~I`~ I I i~ __ __ DESCRIPTION. pART1Al WITHDRAWAL CLOSING WITHDRAWAL ~" 1 ^ ~+= '~~cr ti fit,. ~ -~- 1 a c~fr_ ~I.>.~~~~~~`~ CUSTOMER ID: ~ :' Original -Processing work ~ j;. _ _~., +~. = f k 1_. " C ;z % a..-.- + ~ - , Copy Branch CUSTOMER SIGNATURE: _ . .. •- • jj ~~ 7 8 7 ~ ~ ~ ' ~ _ SEQ. NO. ~ ~ Q ( ~ ~) ~ r ~,.~-..- lL~`_ ~ 2 1 9 0 l.~ ~ ^ `~ r i G7 ~ . I~51 M&TBanlc GF269,~,o, WIP TRANSACTION DEBIT- ORIGINATING COST CENTER EMPLOYEE NUMBER r, AUTHORIZATION ~ DATE t. ! , , ~ . Z 1 ~" ~ ~~ ~ as-~i-~; 't{ '~„ ~r n 1 uESGRIrIIVN: ^PARTIAL WITHDRAWAL CLOSING WITHDRAWAL i\1 \t.~--~ _G ~ I,T~~ \'~' `. f CUSTOMER ID: ~ ! 11 1 J~tq-1 C J S ,1_ _ Original -Processing Work ~ ~ _ ~ i Copy -Branch CUSTOMER SIGNATURE: ~ t :~ ' z~' ` ' ` ~ ~y /~ ' '• SEQ. NO. 2 1 9 0 7 8 7 ~~ ~ ~ AMOUNT "...d._~:..~..:v..,i.,s....m....._.s:.:: ~":..w..~.c~::.k ......~ - ~5., ~• °~fi6v..___._,~«~:~s_.,c.b.:.:. _.-: .... , ,,..,rv„u...,. ... !;t.... ~.,::r.. c.; ..,.,.,,.a.,.-..~ ...,~.~..,,-..-~.ri ..~,. -~~- A,,,..,~ ~ M&TBanlc GF.~6918„0, ORIGINATING COST CENTER EMPLOYEE NUMBER ., AUTH~ TRANSACTION DATE ~ .-^ 4000U N , ~ ~ { ..-~ CUSTOM~EnRt~NAME (PRINT) . ~7~ '~'^~ ~~ ~ ~-t F-t' ~ ~ ~ ~ ~ ~~ ~ ~ 11 i A~#. C n ('~ ' ., ~ s1~ e._ '3. .,,r~i e. t"~ r1 «' DESCRIPTION: -.-~ ~ ~s4 ~ ~~ _ ~ t PARTIAL WITHDRAWAL LOSING WITHDRAWAL C CUSTOMER ID:~ Original -Processing Work ~ r~ ; Copy -Branch CUSTOMER SIGNATURE: ~ j' • -. f ,, SEQ. NO. ~` 2 1 9 0 7 8 ~ f LS/~ ~ ~ ~ ~~ ~ ~ ~ C.a~ ~~ Page: 1 Document Name: untitled PSBLCDAO Customer Service Workstation 16:46:05 EBRIJHRW Cert. of Deposit Account Balance 12/06/13 Account #: 31003920510491 Product: CDA SubCode: AL M&T BANK Title 1: MARGARET JANE DUNLAP SSN/TIN: 202206295 2: JEAN H DUNLAP Package: Region CEPA Status INACT - SM BUSN Maturity: 14/10/17 Restraint: N Current Balance $ 16,469.87 Last Deposit Amount: $ 6.77 Accrued Interest $ 6.09 Last Deposit Date 12/05/17 Int Pd Prior Cycle $ 6.77 Pledged Amount $ .00 BFF Indicator Date Transaction D/C Amount 05/17 INTEREST PAYMENT GENERATED C $ 6.77 04/17 INTEREST PAYMENT GENERATED C $ 6.99 03/16 INTEREST PAYMENT GENERATED C $ 6.53 02/17 INTEREST PAYMENT GENERATED C $ 6.99 O l / 17 INTERES`T' PAYMENT GENERA`ED C $ 6 . 98 1.2/16 INTEREST PAYMENT GENERATED C $ 6.75 11/27 INTEREST PAYMENT GENERATED C $ 6.97 F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous Date: 6/13/201?, Time: 4:48:00 PM Page: 1 Document Name: untitled PSAPCDAO Customer Service Workstation EBRiJHRW CERT. OF DEPOSIT ACCOUNT PROFILE 16:46:13 12/06/13 Account #: 31003920510491 Product: CDA SubCode: AL M&T BANK Title 1: MARGARET JANE DUNLAP SSN/TIN: 202206295 2: JEAN H DUNLAP Package: Region CEPA Rate .50000 Maturity: 14/10/17 Status INACT - SM BUSN Bonus Points: Term 00036 Restraint: N Promo Rate: Expiration: Yield 0.50 Opening Balance :$ 14,600.00 Date Acct Closed // Date Acct Opened 08/10/17 Date Acct Reopene d; Last Maint Date 08/10/17 Original Branch 6113 Branch 6113 Statement Cycle 18 Interest Pay Cycle IM Mail Code 00 Interest Pay Method: TA Last StatementDat e: 12/05/18 AIP Media Code Routing Number # 000000000 Final Maturity Date: Paid to Account#: N/A Current Issue Date 11/10/17 Withholding Code PC Prev Rate: .00000 Dormancy Date . F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous Date: 6/13/2012 Time: 4:48:09 PM Page: 1 Document Name: untitled PSBLCDAO Customer Service Workstation 16:46:36 EBRNHRW Cert. of Deposit Account Balance 12/06/13 Account #: 31003920512918 Product: CDA SubCode: AH M&T BANK Title 1: MARGARET JANE DUNLAP SSN/TIN: 202206295 2: JEAN H DUNLAP Package: Region CEPA Status OPEN Maturity: 12/11/05 Restraint: N Current Balance $ 10,855.79 Last Deposit Amount: $ 54.14 Accrued Interest $ 23.03 Last Deposit Date 11/11/05 Int Pd Prior Cycle $ 54.14 Pledged Amount $ .00 BFF Indicator Date Transaction D/C Amount 11/07 *RENEWED AT 0.35, MATURES C $ 10,855.79 11/07 INTEREST PAYMENT GENERATED C $ 54.14 11./05 *RENEWED AT 0.50, MATURES C $ 10,801.65 11/05 INTEREST PAYMENT GENERATED C $ 107.48 11/05 TERM CHG = 1.00, MATURES N $ .00 11/05 INT. ACCR. REPLACEMENT OLD= N $ .00 11/05 *RENEWED AT 0.50, MATURES C $ 10,694.17 F2. Options F3 Main Menu F6 Referral F11 Title F12 Previous Date: 6/13/2012 Time: 4:48:36 PM Page: 1 Document Name: untitled PSAPCDAO Customer Service Workstation 16:46:54 EBRNHRW CERT. OF DEPOSIT ACCOUNT PROFILE 12/06/13 Account #: 31003920512918 Product: CDA SubCode: AH M&T BANK Title 1: MARGARET JANE DUNLAP SSN/TIN: 202206295 2: JEAN H DUNLAP Package: Region CEPA Rate .35000 Maturity: 12/11/05 Status OPEN Bonus Points: Term 00012 Restraint: N Promo Rate: Expiration: Yield 0.35 Opening Balance :$ 10,627.54 Date Acct Closed // Date Acct Opened 09/05/05 Date Acct Reopened: Last Maint Date 09/1.1/05 Original Branch 6113 Branch 6113 Statement Cycle 18 Interest Pay Cycle 00 Mail Code 00 Interest Pay Method: TA Last StatementDate: 12/05/18 AIP Media Code Routing Number # 000000000 Final Maturity Date: Paid to Account#: N/A Current Issue Date 11/11/05 Withholding Code PC Prev Rate: .00000 Dormancy Date F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous Date: 6/13/2012 Time: 4:48:52 PM P,age:,l Document Name: untitled PSBLCD'AO Customer Service Workstation 16:47:08 EBRNHRW Cert. of Deposit Account Balance 12/06/13 Account #: 31003920513106 Product: CDA SubCode: AH M&T BANK Title 1: MARGARET JANE DUNLAP SSN/TIN: 202206295 2: JEAN H DUNLAP Package: Region CEPA Status INACT - SM BUSN Maturity: 12/12/12 Restraint: N Current Balance $ 1,145.56 Last Deposit Amount: $ 5.71 Accrued Interest $ 2.03 Last Deposit Date 11/12/12 Int Pd Prior Cycle $ 5.71 Pledged Amount $ .00 BFF Indicator Date Transaction D/C Amount 12/12 *RENEWED AT 0.35, MATURES C $ 1,145.56 12/12 INTEREST PAYMENT GENERATED C $ 5.71 12/13 *RENEWED AT 0.50, MATURES C $ 1,139.85 12/13 INTEREST PAYMENT GENERATED C $ 9.65 12/14 *RENEWED AT 0.85, MATURES C $ 1,130.20 12/14 INTEREST PAYMENT GENERATED C $ 34.49 12/12 DEPOSIT C $ 1,095.71 F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous Date: 6/13/2012 Time: 4:49:05 PM TaxDB Result Details Page 1 of 1 Detailed Results for Parce126-23-0543-149. in the 2010 Tax Assessment Database DistrictNo 26 Parcel ID 26-23-0543-149. MapSufTix HouseNo 726 Direction Street HARDING STREET Owned DUNLAP, MARAGRET JANE C/O & JEAN HAYS DUNLAP PropType R PropDesc LivArea 1434 CurLandVal 45600 CurlmpVal 128800 CurTotVal 174400 CurPrelVal Acreage 19 CIGrnStat TaxEx 1 SaleAmt 1 SaleMo 07 SaleDa 02 SaleCe 20 SaleYr 09 DcedBkPage 200922920 YearBlt 1952 HF File Date 10/20/2004 HF Approval_Status A http://taxdb.ccpa.net/details. asp?id=26-23-0543 -149. &dbsclect= l 6/27/2012 REV-1510 EX+ (08-09) j i1 pennsylvania SCHEDULE G C!-7 DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & INHERITANCE TA% RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN HAYS DUNLAP 21-12-0734 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV•1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY wc~uDErHENAruEOrmErRANSFEREE,THEiRREraTioNSHiPTOOeceDENTaND THEDaTEOFrRANSRERarracr+acoaroFrnEDEEOFORREa~ESrnrE DATE OF DEATH VALUEOFASSET %OFDECD'S INTEREST EXCLUSION IiFaPP~icaerEl TAXABLE VALUE t. WESTERN NATIONAL LIFE INS #AN208983 4,480.30 100 ~4,4eo.3o 70TAL (Also enter on line 7, Recapitulation) I a 7 4, 4 8 0. 3 0 {If more space is needed, insert additional sheets of the same size) ~~~' C~ ~°~i' ~ ~~~ ~~~' ~ ~I WESTERN J NATIONAL JEAN H DUNLAP 726 HARDING ST NEW CUMBERLAND, PA 17070-1436 Annuitant: JEAN H DUNLAP L i f e I n s u r a n c e C o m p a n y P.0. Box 871 Amarillo, Texas 79105-0871 1.800 424 4990 Policy No. AN208983 Issue Date: 03/28/2011 Report of your Annuity for the Contract Year Ending 03/28/2012 03/28/2011 03/28/2012 Accumulated Accumulated Value Deposit(s) Withdrawal(s) Interest Value .00 89,741.59 5,789.78 2,750.60 86,702.41 Your cash surrender value for 03/28/2012 is $83,951.81. The effective annual interest rate is 3.15%. This is your annual report and is provided for your information. NO ACTION IS REQUIRED ON YOUR PART. Thank you for your continued confidence in Western National Life. We realize that your Western National Life contract is an important part of your plan. We are dedicated to providing you with safety, liquidity, and a competitive return on your annuity. If we can be of service, or should you have any questions, please do not hesitate to call our service center that is located in Amarillo, Texas. Our toll free number is 1-800-424-4990. REV-1511 EX+ (10-09) SCHEDULE H Pennsylvania FUNERAL EXPENSES & !mil DEPARTMENT OF REVENUE INHERITANCE TAx RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ,TRAN HAYS DUNLAP 21-12-0734 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ PARTHEMORE FUNERAL HOME 1,811.97 2. CROSS ISLAND FUNERAL SERVICES, INC. 95.55 3. FOOD AND FLOWERS 400.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) SireelAddress City Year(s) Commission Paid: State ZIP 2. Attorney Fees 3. Family Exemption' (Ii decedent's address is not the same as claimant's, attach explanation) Claimant MARGARET J . DUNLAP Street Address 726 HARDING STREET City NEW CUMBERLAND State PA ZIP 17 0 7 0 Relationship of Claimant to Decedent SISTER 4. I Probate Fees 5. ~ Accountant's Fees 6. Tax Return Preparer's Fees ~. SENTINEL - ADVERTISE GRANT OF LETTERS 8. CUMBERLAND LAW JOURNAL - ADVERTISE GRANT OF 7,000.00 3,500.00 369.50 157.68 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 13 , 4 0 9 . 7 0 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ~' pennsylvania SCHEDULE I DEPARTMtNT DF REVENUE DEBTS OF DECEDENT, INHERITANCE Tax RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN HAYS DUNLAP 21-12-0734 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX~ (01-10) ~i~j pennsylvania OF PARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: JEAN HAYS DUNLAP SCHEDULE 7 BENEFICIARIES FILE NUMBER: 21-12-0734 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. MARGARET J. DUNLAP SISTER 1008 RESIDUE 726 HARDING STREET NEW CUMBERLAND PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: PINE STREET PRESBYTERIAN CHURCH 500 00 1 . 310 N. THIRD STREET, HARRISBURG, PA 17101 B, CHARITABLE AND GOVERNMENTAL DI57RIBU7IONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 5 0 0 . 0 0 If more space is needed, use additional sheets of paper of the same size.