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HomeMy WebLinkAbout12-21-121505610101 REV-1500 °` t°~_~°' ~ OFFICUIL USE ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number NEi~N1MENT OF NEVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~ / / D / 3~ Harrisburg, PA 1128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Decedent's Last Name Suffix R ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ~~~ Spouse's Social Security Number Date of Birth -~ MMDDYYYY ~i ~yl ~i 9 / Decedent's First Name MI 8 Y o NT ~~~ Spouse's First Name MI ~ ILL"IZ~ ^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return p 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD^Bfi DIRECTE O: Name ~ DaytiQgg Telephone c berms! ~'1 e ~ S sH / L /// 7~~ 09 First line of address Second line of address City or Post Office State ~ N / cs u~G ZIP Code bE 1~R OF iKq.LS ~S ORLY :a.". ~ ~ ~ ~~`I ...0 N ~ " ~"' r..a ~7 DATE FILED 170 975 Correspondent's a-mail address: CeSh/.e/Q/s ,3~ L~d/!lC4S1~'• //~~ Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN F ERSON RESP S FOR FILING RET DATE /2~~0~/Z ADDRESS ~/~4NC J. ~E E/Z T //B S. //larkef ~SfN, /ylech4a~cs6Ht~, i/ /~oS,r SIGNATURE EPA R OJ~ER TH EP NTATIVE DATE x ~' /! /~. ZO / y ADDRESS e'H~¢~LES ~. 5~~~ ~ 6 GrlOUSer ~Q~I ~ ~° IQ/1 icS N ~- ~ 70.55' PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX n n Decedent's Social Security Number Decedent's Name: Byi20/V ~. /pE~/~iDE',~2 T l 7 ; ~ ~:r ~ ~ <~ 7 ~ RECAPITULATION 1. Real Estate (Schedule A) ................ ......................... 1. ~ : 7,; / ~ 0 a.. p ~ ,..~ .... p'~ s.v.« 2. Stocks and Bonds (Schedule B) ....................................... 2. , . ~" .,.~ ~~~~~ ~:4~ 3 '0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. - 0 Q '•~ 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~ ~ ~„ ,,; . ~,:::. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ D -~ c} , 7 a 3'> I3 3~ ?7 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. F ~ ,r 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property "~'~ ~ ' (Schedule G) O Separate Billing Requested........ 7. J ~~ ~~, ~ ~ 1 Q 8. n 8. Total Gross Assets (total Lines 1 through 7) ............................. 9 ,,~, f/ ~ 7 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. F ~O ,,. / J `7 r,~i~..: 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~~~~k ,; ~ 3F 11. Total Deductions (total Lines 9 and 10) ................................. 11. 3 " Q R ~ ( ~] 5 12. Net Value of Estate Line,8. minus Line 11 ... ~ ~~~ _~ '. ~ 2 / ~ ~; 13. Charitable and Governmental Be nests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ~ b ............. 14. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ~ ~ ~ 9 a S ~ 9 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~ ' `- ~~ ""'~ "~"~~ ~,`' '~ ~" ' ~~ ~ ~~'~" 16. Amount of Line 14 taxable `„ ~ ' "'~'''` ~~~~krnFx `'~` "`~'` '~~~`~~~* $ p p at lineal rate X .0~ .. ;-17' ~° ~ . "1 S ~ 7 ' 16 $ a- ! 7 O 7 17. Amount of Line 14 taxable `°'~~?r~pr1~,~,-~. ~- ` at sibling rate X .12 ~ D~~ a ~ 17. ~~ • D 18. Amount of Line 14 taxable .~ `'' _~i~ '~~' ~"`~'~ at collateral rate X .15 ~ ~ D ~ ~ •' 18. "' ~ ~ ~ 19. TAX DUE ..................................:..........,........ ~fr~ t ~.. ~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 O J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 6UREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-060 7 RECEIVED FROM: /tQ.fe~ ~'/~//y REV-7762 EX(11-98- PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015554 REPPERT NANCY J 1 18 S MARKET ST MECHANICSBURG, PA 17055 told ESTATE INFORMATION: SSN: FILE NUMBER: 2111-1304 DECEDENT NAME: REPPERT BYRON L DATE OF PAYMENT: 02/07/2012 POSTMARK DATE: 02/06/2012 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 8/201 1 REMARKS: NANCY REPPERT SEAL CHECK# 509 AMOUNT ACN ASSESSMENT CONTROL NUMBER 101 ~ S 10, 687.50 TOTAL AMOUNT PAID: S 10,687.50 INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.28O601 HARRISBURG, PA 7 7 1 28-060 7 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFF{CIAL RECEIPT NO. CD 015561 REPPERT NANCY J 1 18 S MARKET ST MECHANICSBURG, PA 17055 ESTATE INFORMATION: ssty: FILE NUMBER: 211 1 -1304 DECEDENT NAME: REPPERT BYRON L DATE OF PAYMENT: 02/08/201 2 POSTMARK DATE: 02/07/201 2 couNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 8/201 1 REMARKS: CHECK# 510 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 56,412.50 TOTAL AMOUNT PAID: s,. . INITIALS: HEA SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1500 EX Page 3 Decedent's Complete Address: File Number 2 ! _ ~ ~_ /30[1 DECEDENT'S NAME 8~,~1 L. ~E~°/~~ T __ STREET ADDRESS CITY ~I ~rY~/)!/~LrS ~u~G r*' - STATE /"~ ZIP ~ 70 SS Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsJPayments A. Prior Payments ~ 6~ ~//~• ~ * /D 6 ~T• SD •- ~ /7 /cb. o0 B. Discount ~ 33750 1r SE ?,S~ = 7DO.oo 3. Interest fi ~~ 75~~ °D /~. ZSo.oo 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. (1) d~. 787, $8 Total Credits (A + g) (2) ~~ Qqp, 0 0 (4) Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~' ~ 9/ J, J"~l Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. .......: ^ b. retain the right to designate who shall use the property transferred or its income : .................................... ........ ^ c. retain a reversionary interest; or .................................................................................................................. ........ ^ 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" or payable-upon-death bank account or security at his or her death? ...... ........ ~ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................................................................ ........ ^ ,cam t,J 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 172 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(x)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(x)(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(x)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointty-owned with right of &urvivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 77iou ~il-ro~i~ Cu~ta:.t ~rcG~t •i~ /anca! improved .6~ a dwc/% louse ~, ~ /~i~v~~ e~' h~~ehan;~sbti~, C urn b~alid L'o K,nttJ ~ tic-+~n s~Erarua, , k.~.ewn ar~d nc~n, b_ ~d ~.s -a0 5d~f{,i Ma.rkef oSfire~>F, hav;n5cc ~,~~r ic~e~rt}i ~er nv. /6 - 23- D S6 S- Dso ar-cj clbe;nl~ ono,rc ~ ~>~+c~ a..-ly de scr'~ bcd a#- lar7c j n ~ d ccc~' ~tQ,t«! (o ~cb, 2otz ~M Nr~ J. ,I~~ pPc~-t, as b~cc~.l~r;x, -~ Susann ~ ~- RLP pc+-t 3r; ~ I~ ~. Ka Su sari tia 2ep- Pu-t $r~ I I aid ~C¢ -Same said Na.m~.t~ 3 ''~d'P~'"t, (~our,~ ~5Sc5s~/ Ya.luc amd rnwlf- pr;u-- ~ s eta d.o.d. ctr~. ~s ~' 11ows: TOTAL (Also enter on line 1, Recapitulation) I s ~ys ~0, ~~ (N more space is needed, insert additional streets of the same size) TaxDB Result Details Detailed Results for Parcel 16-23-056 DistrictNo 16 Parcel ID 16-23-0565-050. MapSu ftix HouseNo 120 Dirtctiun S Street MARKET S7'ItEE"r Owned REPPERT~ [3YRON L C/O PropType C2 Prop Desc LivArea CurLaadVal 29000 CurlmpVal l 1b400 CurTotVal 145400 CurPretVal Acreage .08 C1CrnStat TaxEx l SaleAmt t 5ale:No OS SaleDa 03 SaleCe '0 Sa1cYr 00 DecdBkPage 00220-00603 YcarBlt HF File Date H F_Approval_Status Pabelofl ~5-050. in the 2010 Tax Assessment Database http://taxdb.ccpa.nrt/dztails.asp?id=16-23-0565-050.&dbsclect=l l 2!28/2011 ,~~ IINII Tax Parcel Number: /b" o? 3 - O.s6 ~' OS7' THIS INDENTURE MADE THE 6f~, day of ~I-K,u-r~ . , in the year of our Lord two thousand and twelve (2012). BETWEEN NANCY J. REPPERT, as Executrix of the Estate of her late father, BYRON L. REPPERT a.k.a. BYRON LEIBOLD REPPERT, deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, and the same said NANCY J. REPPERT, in her individual capacity as a specific devisee and SUSANNA R. REPPERT BRILL a.k.a. SUSANNA REPPERT BRILL, in her capacity as a specific devisee, Grantors, and SUSANNA R. REPPERT BRILL a.k.a. SUSANNA REPPERT BRILL, married woman, and NANCY J. REPPERT, single woman, both of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantees. WHEREAS, the said Byron L. Reppert a.k.a. Byron Leibold Reppert, was vested in his lifetime with title to the premises hereinafter described, in the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said Byron L. Reppert a.k.a. Byron Leibold Reppert, departed this earthly life, testate, on the 18`s day of November, 2011, and Letters Testamentary were duly issued to the said Nancy J. Reppert, by the Register of Wills of said Cumberland County, docketed to No. 21-11-1304; and WHEREAS, the lands herein-mentioned and conveyed were specifically devised in the Last Will and Testament of Byron L. Reppert a.k.a. Byron Leibold Reppert, dated January 9, 2006, in Item 2 thereof, as follows, to wit: "I specifically give and devise my real estate located at 120 South Market Street in the Borough of Mechanicsburg, Cumberland County, Pennsylvania to my daughters: SUSANNA R. REPPERT BRILL and NANCY J. REPPERT, in fee simple absolute, to hold as joint tenants with right of survivorship ..." Said specific devise was reconfirmed by a Codicil dated September 26, 2011, to the said Last Will and Testament, as follows, to wit: "Property known as 120 South Market Street in the Borough of Mechanicsburg, Cumberland County, Pennsylvania to my said daughters: NANCY REPPERT and SUSANNA REPPERT BRILL." NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Nancy J. Reppert, Executrix, as aforesaid, for and in consideration of the sum of ONE and No/100ths ($1.00) DOLLAR, and other good and valuable considerations, to her in hand paid by the said Grantees, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bazgained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confum unto the said Grantees, their heirs and assigns, they to take and hold the same as joint tenants with right of survivorship and not as tenants in common as per the terms of the said Last Will and Testament above-recited and quoted: ALL THOSE CERTAIN PARCELS OR TRACTS of land situate in the Borough of Mechanicsburg, Cumberland County, Pennsylvania, as more particularly bounded and described as follows, to wit: Lot No. 1: BEGINNING at a point on the curb line of said South Mazket Street, at corner of property now or formerly of Orville Myers; thence by said property now or formerly of said Myers, a distance of one hundred fifty-five (155) feet six (6) inches to Weaver Alley; thence by said Alley, South a distance of twenty (20) feet to the corner of Lot No. 2 hereinafter described; thence along said Lot No. 2, East a distance of one hundred fifty-five (155) feet six (~ inches, to the curb line of said South Market Street; thence along said curb line of said South Market Street, North a distance of twenty (20) feet to the place of BEGINNING. Lot No. 2: BEGINNING at a point on the building line of said South Mazket Street, at corner of Lot No. 1 hereinbefore described; then South along said building line, a distance of four (4) feet to a point or pin at corner of property formerly of William H. Moyer, now or formerly of Gleim; thence West along the line of said property now or formerly of Gleim and also along the line of property now or formerly of Weber, a distance of one hundred forty-seven (147) feet, more or less, to an Alley; thencc northward along said Alley, a distance of four (4) feet to a corner of said Lot No. 1; thence along the same eastward, a distance of one hundred forty-seven (147) feet, more or less, to the place of BEGINNING. HAVING thereon erected a two and one-half story brick dwelling house numbered 120 South Market Street, Mechanicsburg, Pennsylvania. BEING THE SAME PREMISES which Mabel M. Vogelsong, single woman, by her deed dated April 19, 1968, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book "S," Volume 22, Page 912, granted and conveyed unto Byron L. Reppert and Bertha P. Reppert, his wife, they taking title thereto as tenants by the entirety. Subsequently thereto, the said Repperts, by their deed dated May 26, 1978, and recorded in the Recorder's Office aforesaid, in Deed Book "U," Volume 27, Page 850, granted and conveyed unto themselves the same said premises, each of them taking and holding title to an equal undivided one-half (''/z) as tenants in common and not as tenants by the entirety. Subsequently thereto, the said Bertha P. Reppert, also known as Bertha Peplau Reppert, departed this earthly life, testate, on the 8'" day of June 1999, and Letters Testamentary were duly issued to the said Byron L. Reppert, as Executor and docketed to No. 21-99-1011 in the Office of the Register of Wills in and for Cumberland County, Pennsylvania. The duly probated Will of the said Bertha P. Reppert, a.k.a. Bertha Peplau Reppert, provided in Paragraph 2 therein for the establishment of a testamentary trust distributing all income therefrom to, and with a right of invasion for her surviving spouse, the said Byron L. Reppert. In relation thereto, the said Byron L. Reppert and his four (4) adult daughters, to wit: Cazolynn R. Sears, Marjorie L. Reppert, Nancy J. Reppert and Susanna R. Reppert Brill, all joined in a PETITION FOR COURT APPROVAL AND CONFIRMATION OF FAMILY SETTLEMENT AGREEMENT, DISCLAIMERS IN FAVOR OF SURVIVING UNREMARRIED WIDOWER, AND DISSOLUTION OF TESTAMENTARY TRUST, all of which appears more fully at large in the Register's Office aforesaid. In accordance with said PETITION, the Honorable George E. Hoffer, P.J., on the 20a' day of March 2000, issued an ORDER approving the prayer of said PETITION. Accordingly, the said Byron L. Reppert, in his capacity as Executor of the Estate of the said Bertha P. Reppert a.k.a. Bertha Peplau Reppert, granted and conveyed unto himself as her surviving and unremarried widower, all of her individual one-half (''/z) interest in and to the premises by his Executor's deed dated May 1, 2000, recorded in the Recorder's Office aforesaid in Deed Book 220, Page 603, thus unifying a full and absolute title in fee simple in himself. His said Estate is the Grantor herein. TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees, their heirs and assigns, forever. AND THE SAID GRANTOR, Executrix, as aforesaid, her successors and assigns does covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. THIS GRANT AND CONVEYANCE IS REAL ESTATE TRANSFER TAX EXEMPT UNDER SECT. 1102.C.3.('n AS A TRANSFER FOR NO OR NOMINAL ACTUAL CONSIDERATION OF PROPERTY PASSING BY TESTATE SUCCESSION FROM A PERSONAL REPRESENTATIVE OF A DECEDENT TO THE DECEDENTS' DEVISEE. IN WITNESS WHEREOF, the said Executrix of the Estate of Byron L. Reppert, a.k.a. Byron Leibold Reppert, deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written. ALSO IN WITNESS WHEREOF, the said specific devisees have also set their respective hands and seals the day and year first above written. Signed, Sealed and Delivered in the Presence of/~ , _ i~!%~i~;(l/ ~'/ ~ (SEAL) ancy J. R pert, ~ xeo t x of the Estate of B ON L. REPPERT, a.k.a. BYRON LEIBOLD REPPERT, Deceased ~~~ C~ Nancy J. R ert, in het~irldividual capacity as a snecifi devisee a.k.a. ANNA REP1~')gRT LL her in v~dual capacity as a specific a see COMMONWEALTH OF PENNSYLVANIA ) , SS: COUNTY OF CUMBERLAND ) On this, the ~p~day of __.~f~ A.D. 2012, before me a notary public, in and for the Commonwealth of Pennsyly 'a, personally appeared NANCY J. REPPERT, known to me (or satisfactorily proven) to be the person whose name is subscribed as Executrix of the Last Will and Testament of Byron L. Reppert, a.k.a. Byron Leibold Reppert, and in her individual capacity as a specific devisee and acknowledged that she executed the same in such capacities. IN WITNESS WHEREOF, I hereunto set my hand an official seal. Notary Public My commission expires: (SEAL) Op~gNYVEALTH OF PENNSYLVANIA Nohri11 ~ry Pubilc CMMs E. SMMd~ ~. C~12 My COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) On this, the ~ day of A.D. 2012, before me a notary public, in and for the Commonwealth of Pennsyl~ ia, personally appeared SUSANNA R REPPERT BRILL a.k.a. SUSANNA REPPERT BRILL, known to me (or satisfactorily proven) to be the person whose name is subscribed in her individual capacity as a specific devisee and acknowledged that she executed the same in such capacity. IN WITNESS WHEREOF, I hereunto set my hand an official seal. r Ci'/l~~ L ~ f~i~ Notary Public My commission expires: (SEAL) ~~~{ of pENNSYIVANIA Neprgl5sel cflsrlK E. SMslds IN, Ndery PuWk Monroe?v+P•.cumWA.lu~ra~ ®12 ~ eon d rtes rylernDSr, Panral~^~ CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: 120 South Market Street Mechanicsburg Pennsylvania 17055 _ Attorney for Grantee ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 Instrument Number - 201203789 Recorded On 2/7/2012 At 12:44:2 0 PM * Instrument Type -DEED Invoice Number -101572 User ID - SW * Grantor - REPPERT, BYRON L * Grantee - REPPERT, SUSANNA R * Customer - ATTY CHARLES E SHIELDS III * FEES STATE WRIT TAX $0.50 STATE JCS/ACCESS TO $23.50 JUSTICE RECORDING FEES - $16.00 RECORDER OF DEEDS PARCEL CERTIFICATION $10.00 FEES AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 MECHANICSBURG SCHOOL $0.00 DISTRICT MECHANICSBURG BOROUGH $0.00 TOTAL PAID $66.50 * Total Pages - 7 Certification Page DO NOT DETACH This page is now part of this legal document. I Certify this to be recorded in Cumberland County PA of c ,~{ RECORDER O~ r~ao * -Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 002J1NR IIII~INIINNN~I~gl~l REV-1503 EX+ (6-98) SCHEDULE 6 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCKS & BONS RESIDENT DECEDENT ESTATE OF ~Y/~Da ~. ~EP~E~~ FILE NUMBER 21 • lr- /30~ All property jointly-owned wRh right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~~ ~/DELlTy /NI~,EST A/E~t1TS ,¢GCowtifs: l 5~a~ i9~ s~. (gj ~«..s3 d3 ~~~ ; ~s~, ~~ F.'u/e/.~y F;n/ Tr. ~~aify D:/ Incm. ~C.) fa~c/.f~' ~urifor/ Tr. ~i. rein. 1.+t 908. 7G S S/i. Q ~/7. ,~~ %S ~r Z/. 60 (~~ f ~del~ Secs fd G.-~ r,~ ~, s T~ c n~. ~~t 3 7q o~ s~~ ~/7 ,~ :6 ~ 6 33.90 ~~ ~Q/stO/Son ~C1~G-" crlf/~t cLcCcl) a TA- NuS /rrN~(,,p~ F>uN11 ~ SHIN2ES, ~f. Mo_ y5~ a?o3 7! o ,~~ r~/~. DO~o S~i. Q ~r5"~f. ~3 y~~l ~f, 933. ~ 7 ~SeC /%t~KQ/iorl ~C//(!" It~RGLttA~> ,3• ~o~r,~E,¢sT /.Vri~~s ro.~s ~~wry ~kvd _. 3, OZS. 3~z0 ~ ~/S.g/ {47, 831,Zy ~Shar~s /i ~0 B ~S/iarts p~ ~/X/~1aR S~vP.~C B~ f3anto o~tfti~1Cr9-'' S. ~: ~ (Sgr/) h; ~ 7. sg ~/ /v ~7, 4~/ = avc. {7,.sU X; 008 _ ~7~ S~oo,~ see eale~.IQli'on sheet- u#a~h~l) l/9 sl4rrs D~ L'o~wr»at s}~f:~'~{ (~rKc~Gl~:~/~ingne%e% fh:. H9, 6S /0 5/P Y~ = 4 t~P__ 'Sf9. D~ X !/9 = S, ~3G. 9S ~scc CalPula I~,ih s`ieef ,rJfkc~ui/~ ~u e~tn. sher.~') TOTAL (Also enter on line 2, Recapitulation) S ~ 3B. ~b 7. / 9 (lf more space is needed, insert additional sheets of the same size) ~..sf' of ~y~~ ~. ~PPE2 ~ -~ _ ~-~~ENo. a/-//- ~30~ G . ~ ,~DkiiOie~ ,To~s/~S BROr~F,~ji9fGF ,~T, /yv_ ,270 - 075 z2 - /- 2 _. _ ++ ,¢, ~S, o0v ~ rs/u~ G~ L',y~:f4/ L'orp. _ ~~ ~%~~vrice 9Q3~ le~~itYa~ue ~~SST_o9 ~ ~ t _ _ _ _ _ ~ySS7.o9 ~. ~Ft~r. Tnt: fD rlo.c,/ en ?fc~i- ~ .Zrr, 79 ~.ZQ7g . . _ ~_ Sec Y4~u af7io,~f ~itr.~ ~t/f/a cl~ •~J _ _ _ .... _ 1. 7 ~ ~ ~(~P,~4Nl D Co~'~ot.~Ofi7`~'p ~i/YiN6r 'LO. ,~CB~~ _. . a ` ~ :~~ ~irrocsts ~,~o~csent ~ixe. D~~~~r~ ~fao~.s~-~ S~i,~~s ~ ~,~~s :. ~~ /~~' L~DASi~~rrr~e ~sc~t~ Cestlf G'e~~cs~orr~'erae. . ~p /~ !d UU/!!.Q/"S ~ ilD~ Dn~,ti iS 7h~ 5 S ,L~ ~, I~ Cc/11%ccl in f~Cc ~~i,%ip%r~CS k ~~ ~ € ~ /~ t ~ r~a~et/1I ~ o/te /jurs~ !c/7/xQt /~,- _~~an I~ ~D. Sew _~~~°~i G1 _Q ~~~~ ~ia~cr /`!/.C S~b~l ~~r~ ~ ,.~c_ _,!/~uc.~css. ~ a.e i ui~'.ir F ~S .TD !~~/, ail -~ __ L~_,AG . _~w~oa„~~ ,~ ,~i~r ~ ~~ ~/1.. __ G1S~, f _ _ G~ _ _1f ~i?l~rr . _~.r.%fs _. ~ocr~r- s~~ was s~~~/ }_ ~sor ~ a~~vr /n~~ 4~0~. ~ ~ ~ h~~~i F rf _G~c_ fir.// ~/c Q S~~,p/C~x~;~21Q,/ /~~r_~rrh .:_~_ f ... i~ 1 _.._ ......... ................ !i :i ik ....., _ f ........ .... is ~ e_ _ _ .._.. .. i F ~. t_~.. .. .. ... .... ... .... .. _... j f _. . l 1 ~o _ >~ F P.P-- .z".~i_ if t :,~ii JANUS February 13, 2012 CHARLES E SHIELDS 6 CLOUSER RD MECHANICSBURG PA 17055-9751 REFERENCE: 02096125 JANUS VENTURE FUND D SHARES ACCOUNT NUMBER 203760402 BYRON L REPPERT Dear Mr. Shields: This letter is in response to a request for Janus account information. The balance provided below is unaudited. Date Fund/Account Number Transaction Share Price Shares Dollar Amount 11/18/11 45/203760402 Balance $54.93 818.006 $44,933.07 The account referenced above is the only active account on file directly with Janus. In order to re-register the account accordingly, Janus requires the following: 1. A completed Account Application from Ms. Reppert. If the account will be re-registered and redeemed to the estate, the enclosed Trust/Estate Account Application should be completed. 2. An inheritance tax waiver for the state of PA. 3. A signature guaranteed letter of instruction signed by Ms. Reppert. A signature guarantee assists Janus in protecting its shareholders by financially guaranteeing the validity of the signature, and is a standard requirement for many financial transactions. A notarized signature does not offer the same warranties as a guaranteed signature and therefore cannot be accepted for this transaction. Janus encourages you to contact a financial institution, such as abank orbroker-dealer, to have your signature guaranteed for your request. Please return the requested documents, along with a copy of this letter for our reference, in the envelope provided. Upon receipt, we'll proceed accordingly. ~ "''... ~~ r~.• .y ~".us Di~trihut ~r_ _. C' 5 . D::iro~t S: , f~envr-_r C~ ;3~:;<.... ZAUJAN5011 If you have any questions, or if Janus may be of additional assistance, please contact us at 800- 525-3713 or visit us online at janus.com. Representatives are available Monday through Friday from 9:00 a.m. to 6:00 p.m. Eastern Time. Sincerely, ~~ r Mike Worley Investor Services Enclosure(s): Copy of Original Letter of Instruction (pg 1) Account Application Trust/Estate Account Application Form Letter of Instruction -Sig Guar >t ~~~ JJY Y~iY Ti-1f`N!'~' February 19, 2012 CHARLES E SHIELDS III ATTORNEY AT LAW 6 CLOUSER RD MECHANICSBURG, PA 17055 Dear Charles E Shields III: We are responding to your request for information regarding Byron L Reppert's Fidelity Investments account(s). All information in the enclosed valuation report(s) is (are) based on assets in the Fidelity account(s) as of the date indicated on the report(s). Valuation information is provided through a third party valuation service provider. Fidelity does not warranty the accuracy of this information for any particular purpose, nor does Fidelity provide legal or tax advice. Consult with an attorney or tax professional regarding any specific legal or tax situation. We hope this information is helpful. If you have any questions about account holdings or need instructions on how to transfer the ownership of the accounts, please visit us at Fidelity.com and search under "Change Account Registration" or call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m. to 6:30 p.m. Eastern time. Sincerely, Carla Goins Carla Goins Fidelity Investments Account Re-Registration Services Representative Our file: W893793-19FEB 12 LGLTR2/DDODCNFM 531298.1.0 Brokerage Services provided by Fidelity Brokerage Services LLC Member NYSE, SPIC Clearing, custody and settlement services by National Financial Services LLC Member NYSE, SPIC P.O. Box 770001, Cincinnati, OH 452'7'7-0034 r w N N 0 .~., +~ a .--, O t~ W ~ ~i CrN ~~~ ~ N rtf 2i -• ~ ~ f~, ~ O m ~ ~ R~'~ A N N H P . .7 W 1-) ~ `~ ~--i -~ O-~H ~ ~ ~H1~ Ulm 7 U ~~A tAQ AFC W C~ •• W H •--~ N O .. [~ N W t.f) S-1 ri O i N -.-~ NFCl.r~~ yJ u1 1J N U ri W ~ R: N Rf O ~ ~ U S-i U] U O ~ ~ \ ~ ~ J-1 O ~ }-". ~. .-1 a-i N .--i H ~ 0 0 0 N N N \ \ \ 0o ao rn r-i e--i a--1 \\\ ~"'~ c--f N H c-+ o .. ~ ~ ~ RS A A A ~ ~ O -ri W ••i U] O ~ to t6 N O ~ U ~ .-i O Rf td Sa A ~ a 't3 -~ m \ 3 O a x FC 0 0 0 ~ ~ O ~ O ~ O O .-I N N '~ ~ p c--1 N pp M M lD O~ a--1 [~ N .~-1 ~ ~--I ~ ~ ~O ° ° 0 O t1'1 o o 0 O l~0 O 0 0 O H ~ 0 0 0 O l11 lp ~ ~p ~--{ ~ ~--1 n ~-{ 1.1 ~ J..1 ~ ~ ~ ~ ~ ° ° `„~ ~n o ~ o 'a' .o 0 o 0 ~ d, 0 0 0 o ~ io ~ ~o ~ ~ ~ ~ .--a ~ ~ A A o~ -~ ~ W A x z z z z ~ ~ ~ ~ U H ~ ~ `CS J-.1 ~ ~ ~7+ ~ ~ ~ ~ a ~ ~ Aw zz ~ ~ ~ ~ ~ w ~ x a • W .,i .--~ ~ ~ C .--i E-~ v t 2 ~ H L~ E w N >' Q [~ o ?+ H f~ o H ~ .-r ~ -.-i -.i H r-~ \ ~ '2S N ~~ ~ U a W ~~ ~ •-~ aH~oo W H ~ -r ~W~oo ax~m , AA~\ W W ~ H A ~\ W [~ ~ .-i A ~r\ u~ A Q U~ H Cs. W~ H ~~ H x ~ H ~, v~ ~c-+ H P: ~ .--i C:,C7~H ~ ~ rn ~ ~ ~ p o [~ (A S-1 ~ N ~ N ~ ° Ql [~ M N 2S ~, a ~ ° °` ~ `-' ~ ~ ~ O O O N .--~ '-1 O .~ W r-1 (~ ~ ~ ~--~ tIl ~' N ~ W !--) C.' lp c-1 ~D ~-i ~D - ~O N ~ M c I r-1 'O M M H ~ _ r--I N (rl ~ O O rn ~-, t~ N ~-+ ~ ~ ~ ~ c~ S•a O ~ U ~ ~ .y 1-~ r--1 O c~ F ~ O H cn t'. O _,i m N N .~ O W O H N - t~ U ~~ H O .~ y ~-. ~ R'. ~ O -~ U U •~ cn ~ ~ a ups, ~ 9 N m - 0 -r., ~ ~ ~ o •--~ ~ o ~ o N M ~ N ~ a ~M v ,~ U] M W w o0 O H 00 1J ~ J-~ O~ a~ ~~ :n N ~ ~ W ~y W ~ ~ O -~ U 3 O ~ ~ U N ~ c~, O R, m 3 ~-I O ~. O N _,.~ E+ Northeast ~ Investors Growth Fund CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD CORNER OF TRINDLE AND CLOUSER ROADS MECHANICSBURG, PA 17055 March 2, 2012 Dear Charles Shields, Thank you for contacting the Northeast Investors Growth Fund. Northeast Investors Growth Fund P.O. Box 2168 ~ Denver ~ CO' 80201 855.755.6344 ~ www.northeastinvest.com Per your request, please find enclosed the Date of Death Valuation statement for Byron L Reppert's Individual Account number ~~45. The enclosed statement provides the account balance as of November 18, 2011. If you have any questions regazding the enclosed information please contact our Investor Services Department at (855) 755-NEIL (6344) Monday through Friday 9:OOam to 8:OOpm EST. One of our Northeast Investors Growth Fund Investor Service Representatives will be pleased to assist you. Enclosure(s): Original Request Account Statement(s) Northeast Investors Growth Fund Summary Account Statement Mailing Address: BYRON L REPPERT 120 SOUTH MARKET STREET TOP FLOOR MECHANICSBURG PA 17055-6395 Account Holdings on 11/18/2011 Fund Shares Owned Price NORTHEAST INVESTORS GROWTH FUND 3,025.3820 15.81 USD Account Registration: BYRON L REPPERT Account Number. 77345 SSNlTIN : On File Total Value Total Cost Basis Cost Basis / Shan: 47,831.29 USD NA NA "Total Account Value in USD: 47,831.29 ' Total Account Value inGudes all applicable funds Year-To-Date Earnings Summary On 11/1812011 Income _ Short Term Fund Total Div Lona Tenn Dividend Caaital Gains 8 STCG Cauital Gains NORTHEAST INVESTORS GROWTH FUND 0.00 USD 0.00 USD 0.00 USD 0.00 USD ' Total Account Earnings in USD: 0.00 p.pp 0.00 0 ~ ' Total Account Earnings inGudes all applicable funds Transaction Summary From 11/18/2011 to 11/18/2011 Activity in NORTHEAST INVESTORS GROWTH FUND Trade Date Transaction Tvae Gross Amount Price Per.Share Share Amount Shares Owned 11h8l2011 Beginning Shares Balance 48,012.81 USD 15.87 USD 3,025.3820 3,025.3820 Printed By: Erika Gearhart. Print Date and Time: 2/29/2012 03:27 PM. Fund Group Name: NEIGFunds Page 1 of 1 SAN Historical Prices ~ Banco Santander, S.A. Sponsored Stock -Yahoo! Finance 6/22/12 9:52 AM f3evr User? !~ay!siar '~iyn in r.:! Make Yf My Hdmapage ?a:E t+;y y l'::!~:e;>, _---._ Search ~ Search Web :. ~~ IivF.tE IYVESTSFiG hEVdS PER54NAL F!tfAN::E "rtY PORr!~^J1.IUS EXCL.USi+IF"~S Get Quotes ~ Fri, Jun 22. 2012, 9:52AM EDT - US Markets dose in 6 his and 8 mins __ _. _. _.__ Dow 10.51% Nasdaq *0.32% C _ __. -......... ' ~ ~G6ooAr'f , i; ~ SAN Banco Santander, S.A. (SAN) -NYSE Add >b Portfolb Like •:~ 6..38 t x.29 (4.76%~ 9:52AM EDT-Nasdaq Real Time Price Historical Prices oat Nisterical Pikes fur: ;, Set Dsts Range _ ~ Daly Stag Date: ° Mov ' r E 18 i 2011 Eg. Jan 1, 2010 pweeky End Datr. ~ Nov - K'• `18 , 2011 ~ ~ly Dividends Ony First I Previous I Next ~ Last Prtces Date Open High ow Close Vdume Adj Cbse" Nov 78, 201 t 7.52 ~ 7~.58//1 7.41 7.45 2,909,800 6.98 Cibs~prioe adjusted for diHdenda and splits. p First ~ Previous j Next ~ Last ?art Dovvnioad to Spreadsheet ! . S~ ~ ~ ~, -" / y. ! ~ _ ~7 r Currency in USD. ----- ~ " i J O a x loo 8 = 7, s-bo.+~ Copynpht O 2012 Yahoo! Inc. Atl rii)hte reserved ,~cp r- c; - ~„^vw c:;.r, Acs • ~s ..i &ar : •--.py 9 s ~ ~~7: ,,..::; sm..;;~;<.u. • Yahoo! -ABC News Network Quotes for NYSE, Nasdaq and NYSFJImsz are Real-time artd StlulCed from Nasdaq Last Sale wtlefl available. tf not available from NLS, quotes will appear delayed from primary listing souse. See also delay times for ; !.~, ex:!aar~cs. Quotes and fitter information supplied by independent provident identified on the Yahool Finance :•trer F:ac,:a.pudes are updated 9utDMeticatly, txI wifl be fumed oft after 25 minutes of inactivity. puotes ere deleye0 at least 15 minutes. AM infonnatlOrt provided "es is" for infonnetwnai purposes arty, not intended for trading purposes or advice, Neither Yahoo! nor any of independent providers Is liable for airy informational errors, incompleteness, or delays, a for airy actions taken kt relienoe an Iniorrnation contained herein. By accessing the Yattool site, you agree not to redistribute the information found tlteretn. Fundamental company data provided by ;:a:r:.ca: K:. Historical mart data and dotty updates provided by Cornrr,ca~;, `3y.t;;n:s !r.. „!;, international hislodcal chart data, daily updates, ftmd summary, Fuld pertormance, dividend dale and Momingster index data provided by ti~~ r~i~sia: ir,•. http://finance.yahoo.com/q/hp?s=SAN6a=10&b=l8dre=2011&d=106e=18bf=2011i1ig=d Page 1 of PRU Historical Prices ~ Prudential Financial, Inc. Comm Stock -Yahoo! Finance 10/15/12 5:19 PM `tiaw i~tser? R.eq:ste~ Sif~, i..; :x.-.' Make Y! My Nomepage 'f:.~r ; Y' ~ s a~oa' _.__ - y Search ~~ ; € g~ereh yVeb i r ttC3tllE it~tVESTtNG NEY~S PER5UNAL FINANCE M11Y PpRTF(3LIf?S EXC:.USiVES ~~ _ i € ~ Get Quotes Finance Search Mon, Oct 75, 2012, 5:19pm EDT - US Markefs are Cased Dow f'0.72°1• Nasdaq 10.66% bb t iiges. ` + S PRtJ r w"'..t'a~. o '~w Prudential Financial, Inc. (PRU) -NYSE Add to PorNolio . uke ~~ 56 • ~ ~ ~' 0.61 ~ ~ .U9%? 4:01 PM EDT i After Hours :56.66 0.00 (0.00%) 4:29PM EDT -Nasdaq Real Time Price Historical Prices r.t Hlstorlul Pries: for: f--~°-'~"~-~ I o _.__ __ _ __ Set Date Range ,._............__._ _ : 1:...._...., r,....:...~, ~..,...~ Start Date: i Nov : ; € 18 I ~ 2011 ~ Eg. Jan 1, 2010 ~N ~_~_r < ; ___ >_.. _. __ -.~-_i r__,_.~..._.~ i...........__.._...y ~ End Date: Nov , i ig A2011. M: IW,;.MOnthly )Dividends Only GetPtices ; First ~ Previous ~ Next ~ Last Prices Date Open High Low Close Volume Adj Close• Nov 18, 2011 49.81 ! 49.85 ~ 48.44 48.53 9,723,400 48.53 Nov 18, 2011 ~ ~ 1-,~ Dividend ` Ckue price adjusted for dividends and splRs- First ~ Previous ~ Next ~ last Download to Spreadsheet ~ 4, 'r ~ ~~' ~~ _ ~~. O ~ ~ ~ ~~ ~' D Currency in USD. cv X ~~y ~ ~310~ys~ http://finance.yahoo.com/q/hp7s=PRUba=lObb=l8bc=2011bd=lobe=l8bf=2011bg=d Page 1 of 2 PRU Historical Prices ~ Prvdert'al F~rancfal, Inc. ~omm Stock -Yahoo! Finance 10/15/12 5:19 PM Copyrignt 6> 2012 Yahoo! Inc. All rights reservrd :: y ' ,.,,,,,: J:e ;; vrm~ Y Sesvi.e - ;a;.yny;:~, . „ ., . , . -. F ., ~,~ -Yahoo! -ABC News Network Quotes are real-time for NASDAQ, NYSE, and NYSE MKT. See also delay times for other arch:.al^ges. All information provided "as is" for informational purposes only, not intended for trading purposes or advice. Neither Yahoot nor any of independent providers is liable for any infonnatkxral errors, incompleteness, adelays, or for any actions taken in reliance on information contahed herein. By accessing itte Yahoo) sRe, you agree rwt to redistribute the Information found therein. Real-Time continuous streaming quotes are available through our arEJY i'S r. s.:rvee. You may tum streaming quotes on or off. Fundamental company data provided by ;;apital ik. Historical chart data and daily updates provided by Cor':r:dity `~.ratsn~a Inc. iG 51. Intematronal historical chart data, dally updates, fund summary, fund performance, dtvldend data and Morningstar Index data provided by ~teminastar, irc. http://finance.yahoo.corn/q/hp?s=PRUba=lObb=l8bc=2011bd=lobe=186f=2011&9=d Page 2 of i 02/10/2012 15:20 7177319245 Peter B Arnold Financial Advisor 3780 Trindle Road Camp Hill, PA 17011 Charles Shieids,lll Fax Sheet (Broker/Dealer Use Only) Feb 10, 2012 DATE 4 NUMBEROFPAGES including Dover sheet COMMENTS: Hi, TO EdwardJones 795-?473 FAX tVUME3ER Karen L Wilson (888) 599-2772 FROM FAX NUMBER Attached is the Date of Death Valuation for Byron Reppert's single account. Also attached is an account holder information sheet for the Executor's Information 8o we can create the estate account, in addition, we will need the E.IN for the estate account. This Information can be faxed beck to us. Please let me know if you need additional information. Thanks, Karen Please call our office with any questions. Phone: (717) 731-1672 For Braker/~ealer Use Only The information contained in this facsimile message i8 intended only for the use of the individual or entity to which it is addressed and may contain information that is legally privileged and/or confidential. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately b}r telephone. Thank You. PAGE 01/04 02/10/2012 15:20 7177319245 ~~ ~ ~ ~ ~ ~~ II'~Ia Q Q a .~. r ~ cn aD ~ y ~ ~ A p W IV -• O ON ? ~.~.J ~ m D ~~ ~ ~ ~ oW O v y ~ p '~ t~ ~ C7 n m Q s ~ Q O w ~ o m C o ~ O ? uai p~ ~ ~ ~ ~ ~' ~ ~' ~ cAi ,,o~ ~p n ~ ~ N T ~ ~ o ~ ~ ~ ~ w O pi ~ ~ Q. fD ~ n W~ y m ~ 0 Q Q ~ ~ ~ ~ O. N U ~ A y m y ? n~ O m y C ~ bs fN fH !~ EA b~ 4A fA fA fA sA N N ~ G G .... ~ ... ~ W _ _ ~. 4 ~ _~ n OD CD g <. ~ ° ~ d o Q a o 3 ~- o ~_ ~ ~ ~~ ~ ~ ~ ~ ~ O o ~ ~ ~ Vj ~ O <D ~ .r O ~q~ ..- P1 (D Q O N ~. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Q Q 0 ~ ~ ~ ~ N ~ lD~+. ~ ~ O n~ Q ~~ ~~ o ~' ~ p ~ S~ ~~ o~ ~_ 7 `. R ~ 4 ~ O Q a ~ 7 ~?. N vi ~.. _ ~ t~ A~ N, ~ Q c - ~ ~_ a ~ o'er ~ P~ m c c v°i ~ ~ ~ a coo ~ ~~ ~' a ~. m v; ~ mo ~ ~ N 4 o efl ~o ~ ~ PAGE 82/04 ~ C r~ ~ m ~ t0 ~ '~'- m 3 D 0 z m N O O A N_ N nyi A~ m ~_ C w O ~u m N O_ N a3 `~ 0 02/I0/2022 15:2' 7177319245 o m ~ ~' Q _ .~. ~ ~~ ~m ~N ~~ 03 ~a ~ ~~ N ~ ~ m ~P'a o ~ c ~ ~a ~. wg 0 .~. '~' ~ ~: ~= o~ ~ ~' o ~' ~~ ~_ O -s g O ~ O y. O cn ~ C O .. ~O ~g p~ c_ 3 - N A C'f G R~ ~ Q1 ~ a ~. ~o ~~ ~~ PAGE 03/04 J. da ~- t31 ~- ~ ~i W J N J ~ J O Cp 00 V ~ (J~ A W N -+ `f1 ~Q and QO V pp~~ I ~ _ S m ~, c m_ =- v 0 1 v/ w co Z7 K m fA 69 b"! fA fH to fFf fA EIl 44 fA fA EA bN fA H { ~ A a ~ '~ ~ ~ ~ b r ~. ~ N ~ /9 A (O ~ 3 » is N 111 f11 EA f11 {tl ~! t1f fJ1 111 4A tlf fA 111 ~ p ~ O ^~ x oc ~ C V ,~ ~ ~ , c00 ~ fA EA EA ER EA bA 4A (~ Ep fp 6A b9 FR FA H1 EA ~ iA _ 3 O ~r. ~v c 0 z -- 0 `~ ~ ~ m ~ (QA ~ vS' y O 3 ~ 8 ~ ~ v a ~ Q ~ c ~ ~ ~- r. Az W O 3 o O H M S N S y N N N 7 D T tp N ~~++ i= y ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INtIERITANCE rAx RETURN RESIDENT DECEDENT PERSONAL' PROPERTY ESTATE OF: ~ y RD f' . L • ~~~~~nT FILE NUMBER: A/ ~.l - ! l - / 30~( Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must tie disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ • ,AMC ~~fiYK ~Gr~: f, B,!' ~[~Ies ~f ~` ~3// ! ~Z ~ ~ ~~ ~/oo oG~- o0 ~StG vQ/ua {Tan /ear ,~'nr~ ~rdC ~~~ ri1~.tC~~) F~~o~' af' a-~rctss Ccts~ bn.la,~~~ w, .Edward ~v~es ~l^b~,tr~G ~C.t;`~ `f }"~a.-f~ wl I~e:~.~.nol -rro-~ F7~,,,~,~ /Ua.~'o-~~ .~isu.r. rc.•'rnsccr. - ~`~ e~, ~sp~~.~ty. ~s 5 ~~~- d ->~ram l~l. S,. Incas a ~y i9r1 C.~,oSe. o u~' ~x,,rs e,,, a,~ 8.oo ~ n CoAAe. ~ (I 0 ~D f ao. '1 ~ c~ n d ~orn ~. ~~' ~ ,~w L4'I ue ~ c1 Close o uf' 16 g_ °° 'p-~,rsan w~ i r~ Gornc ~ ~~~ ~~ ~`~3, eo pERsoNA•i!.Ty ~+ 1(E ~ s' ~ ~ ~ .Sac /1?P.~10 a~}a~~ 1n~" ,~,~'/yli ZGq~ !/Q ~!~`G~O/t~ ~ TOTAL (Also enter on Line 5, Recapitulation) ¢ ~ jOd, Y7 q, ~~ If more space is needed, use additional sheets of paper of the same size. Cec, 28. 2C1' 1 ~:3~A"~ P'A'C BANK P1V~ LEADING ~F wdY December 28, 2011 Charles E Shields III Esq. 6 Clouser Rd Mechanicsburg, PA 17055 RE: Byron L Reppert SSN: 179-14-7110 Dop:1l-is-2ol 1 Dear Mr. Shields: No, 8950 P, 1/2 In response to your requcst for Date of Death (DOD) balances for the customer noted above, ow records show the following: Certificate of Deposit Account# 31100230416 BYRON L REPPERT DOD balance: $ 100,000.00 + 0.00 accrued interest Interest paid 01-01-2011 thru 11-18-2011 $ 960.95 YTD - ----- -. Checking Account - ' ~~ Accourn # 5070084089 , ~~ !}BYRON L REPPERT r~ NANCY J REPPERT DOD balance: $ 26,477.50 + 0.03 so~n~ontafest_..______./` Interest paid O l -Ol -2011 thru 11-18-2011$ 8.96 YTD Established: 06-OS-2002 Established: 10-13 -1980 Please note that this office provides date of death balances for deposit accounts (IR.As, CDs, Checking and Savings}. We do ~aot process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-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 i i Page 1 of 2 Cec. 23. ~~' ~ ~c,36AM PNC BANK No. 8950 P. 2/2 This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged confidential and exempt from disclosure under applicable la~v. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby noted tha[ any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. i Page 2 of 2 ward ones 20> >~ ~~.y Maryland Heights, MO 63043 MAKING SENSE OF INVESTING 00000222 O1 MB 0.404 O1 TR 00007 EJCCDDI I I~~II'~~"IIII~IIII~illa~~II~I~I"11'~111~~11~I1~I~1~1~II1~II11~~ EST OF BYRON L REPPERT NANCY J REPPERT EXEC t 18 S MARKET ST MECHANICSBURG PA 17055-6329 Check Number 129069217 Account Number 851-16614-1-8 Account Registration EST OF BYRON L REPPERT NANCY J REPPERT. EXEC 118 S MARKET ST MECHANICSBIIRG PA 17055 ~ .rte r~ -., ~ ~ ~ ~,., ~ 3~ .; t - ~; _ , ~E ' ~ a~2~~2~~~ , a , `F19 L ~ t' ~, Y. .Y L Y e> y ~ ,ordeYtq~ ~ ~ t~'i290692L7~N ~:0 7 19 2 38 28~:030L?81?4u' Don't stand in a line at the bank. Ask your Financial Advisor how yon can have money sent dtrcctw rn vnnr hsnlr ........,,.. ~~~ Pennsylvania National Mutual Casualty. Insurance Company ~ ~,,4-i, r311 :PENN NAIIOI~iAL P_o. Box zssl • HarHsburg, PA 17105-2361 ® ItVSURANCE (71~ 2s4-asal ~uC,~.~~ ~ ~'t~ ~ 1 y''°~ ?oticy: Disbursing 'POSIT3VE PAY DATE CHECK NUMBER 07/20/2012 00.687440 ***58.00 PAY FIFTY-fiIGHT AND 00/10.0 DOLLARS RETURN THIS'CHECK IP INCOBI213CT. TO THE **RBPPSBT BY'RQN L*• wFUlsFrye~.N,,t THIS CHECR WID IF NOT PR&SBNTED -0RDER FOR PAYNENT hrITHIN 30 DAYS OF NANCY ' .7 RFsPPERT Q ~~~ 118 S MARKET ST ~9~G/L G~~"" MECHANTCSBURG PA 17055 ¢,,«~°,,~F AufnorizedSignaWre U SECURITY FEATURES INCLUDED. DETAILS ON BACK 8 11'00 68 ? 4 4011• ~.O 3 L i00 2 ~ 5~: 20 ? 9 9 SOO 2 9 7 3 311' __ _ __ _ _ _ PC11RSy~VAlila N8t50I1A1 M111tI1A1 CA3ilR~Ty'TII3HYADC6 COII1pAli~ PLEASE DETACH AT PERFf)RATION LINE BEPORIt DEPOSITING -THE PAYEE ACRNOi1LEDGES T'HE USE OF THE ATTACHHD CHECK TO BS SETTLSMSNT IN FIILL OF ACCOONT AS HEREIN STATED -s•rcnnci an (1Of,R74.4(1 INVOICE NUMBER / v J v PURCHASE ORDER DATE IM/OICE AMOUNT DISCOUNT NET AMOUNT 2012/07/16BP REEL1~ Q~T P11T 37550 130 07/16/2012 58.00 0.00 58.00 TOTALS 5 s. o 0 0. o 0 5 s.-o 0 ~, t `YI E/y10 ,~; /fERSoNA~L ~y !i•¢Gu~ T!o/f~ _~~_T Or'_ _~31'.~~ 4. ~P~PPE7~T _ _ __ __..__ _ _1~ic~tio•__ •?l-._~l -~.~ey_. .._ _ _ __ ~ may,,,, __ _ _ _._ ._... DO _.. _. _. ._ _P_.44SfG_~"_ __. _ _-_ __-- _. - -- - -.. _.. _. .. _..- ._ 00 __ _ 1~ .._- 6 Gr/noc~/ .. _ - _ ---- -_ _ !~i~ .~..a_er~ l~~/~ . . __ ---_ ---- _ fi .Qo (O~vv _ ~/~ ~3Sor/`cc~ ~lt~vA13~__G~` _..r~f 1~~ 64r,._!~/~~.t .G'Q.~t .~ _ _ _ man .__._ _~/'Ril?~ls~ ~jj4l~ /'619 - _ a __ _ __ ~ n~D •. ~Sina//h!/il~~_~r/r G'o~~fi®~C/ __ _ _ Ia• OD _.. __.._.-. __ _ _ n _ _`l LL ~ _ __ __ _.____~y ___was~_~1 ______ . . ~2 /1'16IbGo ~: ~~kSoNi4-LTy ~/A~Gt~{~¢ ??o~IJ _ _ Ll-//N~~ _ ---- _ ______ __~.~ L.. a.~!!_1~./~f0~rf~.p!1_ (1L!!!A~~G ~e I~-~~i1~g//I ,~ '_ - ; . ___ __ _ _ _¢~D.vO _ . _ ®~~ ~~ _ _ ~t,.L _ ~ .... __ ..~~ ._ _._ `Java~G~1 _ _ .. _. k!~_ h/~~ ria~ coo - R~4 ~'~° _._ __ _._ 7SD _ _ __ _- ~ _. _ _ _... _ _ . __ _ ~(cD o0 __ _ - _ _ __ __ _ _ _ -~ ....~~c.Lie~f _ __ _ __ ._ _ _ _ . _ _Y .- .. __ ~~•l_a!s _.~6/e w./~ Z ors ~fl, 00 ~. _.__ ._ _yS :_ tSr_na~/ __7 cyst _ _ . __ _ ._ __ s~o __ _ _ _ .. _- _ _ .~D _ _. _ _ ~f,~ _ Q~q~ ,~J. _y~~~ ~~ut_ Tv (c~s~br~`e~o~~r~~~irv ra,/ue~_ .. _ - o ~" _ __ _ _ _ _ --.5~,~.. _ _ ~q _ 6cd _ _ ~jp, ofl _ _ sl~_ ~d ~b/e ~.tl /sip _ _ ~j~ __ _ _, _ ~c~4d) ~. 3 ~ /~~yto ~E;' P~Rso N~Ty ~~-L cc~-7to~ - aEV-,sos oc, t,An SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RE (DENT DECEDENT ESTATE OF ~Y~b~ L , 2E~P~T FILE NUMBER Z~` !~ - ~~ ff an asset was made joint within one year of the decederrt's date of death, it must be reported on Schedule G. SURVMNG JOINT TENANTS} NAME ADDRESS RELATIONSHIP TO DECEDENT A. IJA-NC y S. RE~PE'R.T /!8 5, /jtar~lef $~ alQ fifer B. C. JOINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial inst+tuGon and bank accwnt number or similar identifying number. Attach dew {~ jgnyy~y ~ estaM. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF Df;ATH VALUE OF DECEDENTS INTEREST 1. A. /d~/j/~ P/I/L' /.~i~Yk (.~1CC~(//~/ ~ .~ Sb7 ODD ~{D~ 9 d ~6, y~7.Sb .5D~o ~/3, ?3B.7S a. ~• do. /¢~/: ~i1~ ~ D.o.A. an ~i'(Cix l ~r ©. 03 .02 (see ANC 43~-'K l~~lic~oa /eJ~- a~ckd) TOTAL (Also enter on line 6, Recapitulation) i 13, oZ 38, 77 (ff more space is needed, insert additional sheets of the same size} SCHEDULE G INTER-VIVOS TRANSFERS ~ ~INHE TRIM ~LT(H~OFAPXERNETtY~LNANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT 'ATE OF ~ YRDAJ ~- • R~PPERT FILE NUMBER pZ/-//-/30 ~ This schedule must be completed and filed i(the answer to any of questions f thnxgh 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY uxzuoE T"E wwE of T}iE TwwsFE"EE. TNE3a REiATgNSMPTO DECEDENT AND THE DArE °FT'ws~at. ATTACH A CDPY OF THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ' ~ ¢/~-/ T~ec/s r ~e ~ .~~aars ,~ r FiRsr ~~oH~ /3~/K D~ Mir~'t/NT~r~J,,d~: #- 'i~/108~D ~~(,~ G~~ '~i10~ D77.9,2 IoD~D -O - ~y~p~ oT7.9.2 ~~.) ~. L~. ~/TF~. C. ~RrDlyll~- ~ ~A. rS ~ ~~/D~~F/ ~~d~h~) ~5~0, 07?.9Z /00~ o - XySp~ 077, f2 ~C~ C.~. ~/TF" S'usan~a (~ 1~~pert' ~ 4~!/0 8~{2 ~d~ttr) ~~D, 0~7.9,Z /Ol~ --o -- ~p D77.9z ~D.) C'.1~. `` ~'F ~' /Yt afty one !.. Q~Pert ~ '~/10~~3 ~d~er~ 7~~D,077.q.Z. /OD/p '_'D - ~}iD, o77.9Z // CS~e !~alKahl/1 /ever a~~a/) ~. "T~P~/sF~ ~N O~rN " sT ox Ac~o~tits ,¢ T Lc)~7.l~ ~QGO •~i0{~rfNTi¢GE ~st~tJOS. -~ Ll~f,ZGS ,~,gseGO ~Dv/M/Ti~,LC CDMnt4o/-l ~'fbCK f~fNO ~#` 3z/Q- 3 X41 D34 5156 ~, r ~ z. ~8 s ~. op '`/9. ~B ~ ~z~, &~3•!vb ~a/, X73. `6 /od ~o .-o - Uzi, 83.66 ~iB.) W .EZ1S Fifti2Go ~¢D v~Al TAGS o PPo1lZ - Tuivi7Y ~ltND ## 3Z/Z-- .~~ o/ 993/78 ZT7. d$S Q ~3syS= 9 s~9 7S ~`l, 829.75 /oo$ -D- Pc 9, g~9,7., , . Bow/ ITo~S 2(4) >E ~iB~ dre ~bble ~ u~1 shaves ~ ~ a.bo-~ re{tren~t~ r ~t~) dar~~htorS ~ dcrtclen~. Set /Rlua~'ioh ~f~er' a-lf'a~h~d~ TOTAL (Also enter on line 7, Recapitulation) I S / q ~~ ©/ 7. 61 (If more space is needed, insert additional sheets of the same size) FEB-14-2012 01:28PM FROM-First National Bank of Mifflintown 2 North Main Street PQ Box 9ti Mifflintown 'A ~ 7059 717.436-2144 717-436-2:.45 www.fnbmiiflintovm.COr'n Fax 717 436 2389 T-810 P_001/003 F-667 To: CHARLES E SHIELDS, Ill Froms D. HACKENBt=RGER, FNBM Fax: 717-795-7473 Pages: 3 with cover Phone: Date: 02114!2012 Re: BYRON L REPPERT cc: Urgent ^ For Review ^ Please Comment ^ Please Reply ^ Please Recycle • Comments: Please accept my apologies for the delay in response to your request. The following informati xt is accurate as of the date-of-death of Mr. Reppert. You ma~~ contact me at 717-436-2144, or by e-mail dhadcenbergerQfibmifftintown.com Thank Y ~u, ~-~ac~~i~r~guJ a Deb CONFIDENYIALITYNOTlCE The documents ;accompanying this telecopy transmission contain confidential information belonging to the sender which is legally protected. The information is intended only for the use of the individual or entity named above. IF you are not the intended recipient, you are hereby no~ied that any d'~sciosure, copying. distribution or the taking of any :ae6on in reliance on the contents of this telecopied information is strictly prohibited. If you have received this tele,~py in error, please immediately noGty us by telephone to arrange for return of the original documents to us. FEB-14-2012 01:28P1~I FR0~1-First National Bank of tdifflintown 717 436 2389 OjMflllinlow~ PO BOX 96 ~NIIFFLINTOWN PA 17059 itESPONSE TO ACCOUNT' INQUIRY T-610 P.002/003 F-867 TO: CHAR LES E S~If1;LDS, TIT DECEAE1vT: BYRONL REPPERT DATE OF DEATH: 11/18/2011 SOCIAL S.ECURZ'fY#: 179-14-7I 10 WC held aC[:ount (sl in which this t~rrr-rlrnt Karl a., ~ntPrPef at tArA limn .,F~,;~/t,.s~ .i..~*1, .~~ f:.~~,,...... ACCOUNT OWNER(S): BYRON L REPPER'f, !TF NANCY TEAN REPPERTY Type of A+.count: CERTTFICATE OF DEPOSIT Account #:4110840 Principal Balance at D.O.U: $ 40,000.00 interest Rate: 3.9500% Original t opening Date: 07/03/2008 Interest to DOD: $77.92 ACCOUNT QWNER(S): BYRON L LEPPERT, ITF CARL LYNN R SEARS Type of A~~count: CERTIFCATE OF DEPOSIT Account #: 4110541 Principal Balance at D.O.D: $ 40,000.00 Interest Rate: 3.9500% Original ()peniag Date: 07/03!2008 Interest to D.O.D: $ 77.9? ACCOXJI`~T OWNER(S):BYRON L LEPPERT ,ITF SUSANNA R REPPERT Type of Account: CERTIFICATE OF DEPOSIT Account #: 4I 10842 Principal $a[ancr at D.O.D: $ 40,000.00 Interest Ratc: 3.9500% Original Opening Date: 07/03/2008 interest to D.O.D: $ 77.92 .Penalty is v.laived on withdrawal ofd edent's fund before ~t~aturity: Yes No Safe Deposit Box: Yes No First Comn.unity Financial Corp. sloe er securities: Yes No Trust Dcpt. Accounts: Yes No Authorized Sign tune/ Title Date FEB-14-2012 01:29PM FROM-First National Bank of Mifflintown 717 436 2389 T-B10 P.003/003 F-86T - = II ~_ ~ r PO BOX JG MIFFL).I~ITOWN PA 1.7059 1tESPONSE TO ACCOUNT INQUIRY TO: CHARLES E SH.lELDS, III DECFDEI`~~T: BYRONL REPPERT DATE OF DEATIi: 11/18!2011 SOCIAL SECURITY#: 179-14-7110 We held ac~:otint (sl in which this decedent had an interest at the time Of his/her death aS follows: ACCOUNT OWNER(S): 13YRON L 1ZEPPERT, ITF MARJQRIE L REPPERT Type of A ccot-nt: CERTIFIC/~T); OF DEPOSIT Account #: Frincipat Balance at D.O.ll: $ 40,000.00 Interest Ratc: 3.9500% Original 1)pcning Date: 07/03/2008 Interest to DO.U: $77.9? ACCOUr~ T OWNER(S): Type of A ccount: Account #: Principal Balance at D.O.D: $ Interest Rate: Original [)pening Date: lntcrest to D.O.D: $ ACCOUr(T OWNER(S): Type of Account: Account #: Principal Balance sit D.O.D: $ Interest Rate: Original +~pening Date: Interest to D.O.D: $ Penalty is ~.vaived on withdrawal of decedent's fund before maturity: Yes No Safe Depo~.it Box: Yes No First Community Financial Carp. stock or other securities: Yzs No Tnist Dept Accounts: Yes No ~~~E- -Q / ia.. Authorized Sig ature/ Title Date :~W~?i5 i ~eCi f3 {c'~1P::31"t l:%ifi F F 6[t lf.~$:: r'. t~i. .: ~.J~iC _ -B SSd ~15C~, i'i ~,1~, -,', i February 14, 2012 Chazles E. Shields III Attorney-at-Law 6 Clouser Road Mechanicsburg, PA 17055 Reference: 01427543 Deaz Mr. Shields: Thank you for informing us of the passing of Byron L. Reppert. We valued his association with us. The late Byron L. Reppert held individually registered accounts in the Wells Fargo Advantage Common Stock Fund (3219) and Wells Fargo Advantage opportunity Fund (3212). The account values aze provided in the following table as of the date he passed away, November 18, 2011: Account Number Share Balance Share Price Account Value 3219-3201036456 1,122.878 $19.48 $21,873.66 3212-2401993178 277.285 $35.45 $9,829.75 Information in this letter is historical and may not reflect the current account balance. Please refer to statements for actual holdings and detailed information. Investment values may fluctuate. Mr. Reppert had named the following transfer on death beneficiaries on both accounts: Cazolynn R. Sears 20 Scofield Rd. Pound Ridge, NY 10576-1330 Marjorie L. Reppert 10 Hill Rd. Jim Thorpe, PA 18229-1101 Nancy Jean Reppert 118 S. Market St. Mechanicsburg, PA 17055-6329 Susanna R. Reppert 116 S. Market St. Mechanicsburg, PA 17055-6329 (Continued on back page.) Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Company, provides i~rvestment advisory and administrative services for Wells Fargo Advantage Funds®. Other aff Bates of Wells Fargo & Company provide subadvisory and other services for the Funds. The Funds are distributed by Wells Fargo Funds Distributor, LLC, Member FINRA/SIPC an affiliate of Wells Fargo & Compa~ry. _. .i i ~ :., i.cf~. ~J fi~wci GEiGR~.I.-}a=. .', ..."; <I ."- 'J.1 , The appropriate forms are enclosed. If you have any questions or need additional information, please call the Transition Team at 1-800-274-3863 and reference #13156258. Representatives are available from 9 a.m. to 4 p.m. Central Time to assist you. Sincerely, Q•~ Lois A. McGarry Client Relationship Team REV-1511 EX+ (10.06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ' ESTATE OF ,~yle0/1~ L . ~~ P,PE ~T FILE NUMBER 02/- //-/30 5~ Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. t FUNERAL EXPENSES: . e/'G//-Q.~ron Sow: ~ D~ ~znna. ¢ gs. OG ~. Sopl,%~s /hirktf, J e~ ~' w~ !~%/ i ~~inf o~ 1~eed ~/, 2 y~ eo 3 i~ob:ntl~ Sub, D~jan:sf /-t/ononarium ~~~ s;oo y. Fi!/ews/i:~ l'o~rrir.ffrc, ?~:.~:f ~Y~ye%~/ Clru.~/,, ksc Q~ ~ i V~ C` ~ " ~ ~ f S, sl vnvrnt~ ca/ iu~1i, kOV ~' YaayGl Ti/~,t E rZ SU, 00 (P, i¢icer Cr~la/~or~S ~~"' /~trti, ct. f3 30, 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) /V~¢/Y~'y ~T. .2EPPE~T lv~/1/~ 1~ SVeet Address /~r7 S. /j/Ark~ f City /yI ech an i cs 6srn~ State __~ Zip /70 $S Year(s) Commission Paid: 2- AttomeyFees ~//~~~ ,~- Slit/aS ~' ~~~~ SQO~00 3• Family Exemption: (If decedent's address is not the same as daimanYs, attach explanation) Claimant NO ONF EL/G/SLE /NONE Street Address City State Zip Relationship of Claimant to Decedent 4- p Probate Fees ~q/ D/ /~j/J~/ iSS/YG oT ~f~j~f ear f 'f-~cafct' ~/57 sD 5• ((__ _~_~ Accountant's Fees ~ ~~ ~!`~~ GIB /4SSK. - CoMp~S ~t ~V14cj ~ ~GE6 t , ~s H --e~ td4a~P~4 ~fo,uG• ~[fr ~kp~- / L y1 Y!7[J•O~'~ 6• Tax Retum Preparer's Fees p }~ P~ 41, 1 p t{(S , K~~S ~P.~• ~ '700 r BO ~. if?e;lq b. Div ChtS. F. S/„ G/Q/s 9r ~' .l~.I/al, f S. C . (~z/.p/~.) ~ ~ y-oo /~dv<rt.•sin~ ;~ ~tc Cun~b~~land low 1o~rn41 ~ 00 7S 9 ~d/'GI'/isin' :n fl+c ~sr/~ s/e csr!nfi~e / . ~ ~ ~ 7 ~ /0. F,lin~ ~ah~ri f,4nc~ ~ww G~c~rh ~ ~ ~Qc9:sfr~- e~ ~i//s 15.00 /~~ ~R/s~it~se~ro/ /O~"o~ca~ rcc ~ ~PC~9%sY`cr mJF Gai!/s 35t~.oo 11 See Ponfi~c uv~ion s/i~ct/ TOTAL (Also enter on line 9, Recapitulation) $ a, g .J -oZ ~ ~ 7 ' (If more space is needed, insert additional sheets of the same size) _ .~ T d ~ rte ,l3y,E~o/1/_L. ~~~P~,1QT ,'LEND. ~/-~// /.3~~ nn / 4~tt4~ ~ __ .. _ _. f to ~%S?? /3. i_ _%r:- ~~t~~y ~SfnrcT ~rvc~.__~.- T.fie ~bs~,x~ v _ ~ 3S aD_ _ __ __ .. dd _/7. } f _ lad%n~f ftC 41~._ .~Q~li~a~ ON - - ~_ ~~Gnti~~ S~c.~C ~'~!1t1Mt!~ ~~o sZ _~ . .._ _ _ _ ._ _" /~ /~einr6. Ta_..(~/1~5....~-__~!!caGgS__~ _Zar_. ~L~p~l.P-d.. ~^~-'.~ - __ _ _ _._ . __.._ _ _ , f Gil nys, ~ _ _ ~-5~ __~~is,-- e~ _ __ _ _ . ~~~s~ . ~ _ ___-- __ ~ aas: ~-D __ _ _ ~~- . f ~%a-~: _ ~j _ . ,?5• ~ - ~iiClG7~s L_ _ ~- Q~/c~ f S. e . ~~~~~Z _. ~ /6 -_D° /7_ /P~:.~6. ~ G'/ras. F_ S`tii~/~s 1! fir- insurc~l rt~.Sttrcd _ _.- 0 may) -Ia `~'h~ll~~nrs _ - _ _ __ _ _ _ __ '/b.~S /~ //'',' - ~!vv/~L/" ~(/yt0/'iafS .. _~~r _ r~~•.ng, G~ _ - p _ ¢.~30. oD _ _. _ _ _. L ~ ~ _ . pX aZ/7i _ _ ~0/lOr ~+aa r~~ /~li~i ~.r~r _ ~o~7o/S ~uri~ ~~DD. o0 __. _ .. _ ' ~ -- r!-.._ f ~ a~ _ , ~ _ ~h_ ~r,S, .. ~tr~r6 _ ~~ - ~wncr~/ L,yacl~a _ _... _ _. 582, zz ,?~. ~ _ - _ .. (,~ll/Y>lf!h/J.. o~/'$~-- ~e/iX6.. l~r _~pril.~//1 _ __ ~b5. o0 _. _ __ _ __ a~ f __~~~i!'~ vlerilit~ ~r _~ra~ri y ~/DD. ~ _ __ r~/°L _ _ ~lo~ /9 a~. ~ ~~;~n _ _ _ _ _ ~~3_ ~~ _ _ _ ___ _ _ _ d7 I _ C~•r.~ ~iw~ _ _ ___ ._- _.. ___ _ _ _ __ ~'~38 a~. ~ ,, _~ ;~ ii __ u~z _ _ _ _ __ _ _ _ _ ___ _ t~ ~ __ __ _ REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & LIENS ESTATE OF 8 Y ~ ~ ~ . REPPEQT FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~. 3. S. ~. 7. ~. !v. ~• ~x. /3. /y r ~S. L.;ll;an IQ~Per~, Chttk drawn ffj3Jf1, Clen,,rcc~ Sw~trtuen>f' ~' dod Bx tf/12~/-I/ ~fC.iisd. !e ~-r arie /~ L - //~iau"t ~o r- X-.n Qs ,~rtes~s CIQKq~G ffC ~f/C//1l~r~ r1 d use " ~4h i X14 ~ ~is~i Ncfwo~k J ~ uGI SNSP !~t t /1.t t'1r1a ~i~ G~r,,fed 6vt>~t,6v~- l~P./`i Zoq pilga~/e ~/t~/f!~ ~iAntZt/G /S/ca/~i •~ihGr~ y~~ ~.~! /1/t~lvat~ ~jP,valrr Q Phi ~~S L• fc .iir . ~~S,oo ,7 So, o0 ~D, t7O /22,65 s/7. ~S' j~/D, 00 "/6.9/ .r 38, 6Z '/os.~o ins, ~7 33.8'0 f//7.bS ~~ i~ '~ ySo, ~7 ~i. ~s TOTAL (Also enter on fine 1G, Recapitulation} $ 1, Sr~~. 3s (It mote space is needed, insert additions{ sheets of the same size; REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES eslwlt ur FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE Dol Not List 0 DIECEDENT eels) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] t. ~~RocyNN oP. sEA-Rs daltgl,~tx % of res;da~ duo Sco{ic%d 02oad ~'o~nd ~2~d~~ NY /057(0 ~. M ~4 QTbi2/F L , /lEP~EIZ T Cla cc9 ~ tG r t~~ ~ resid a e /O f/,-// /poach ' ~QofGcr ~iA~K~ ~ A i/1~ Thorpe, ~/T /~ Z29 rr~iwc~t ~"~~4st, -r..'~MC 3 /Vi~/YCY ~?- /2F PpElZ T qua f j~r ySl ~~ ~Sic~lu e // $ S. /7larkc f ~SL~ /y/cc~ a~ ~ es 6~rr~, ~'~ /Toss' y2 of sp¢c;~•'cc d~;s~r ,tea! eta at /zo S. MO~k~t Mechan~ e Q 6uny, ~ Sec Po~r>iitl~,t~s'v~- vn ~e 2) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTfONS ON LINE 13 OF REV-1500 COVER SHEET S >/ ~!!y St pq ~~~ ,~N~o ~.~ ~~ ~, insert a~rtanai sneers of the same size) REV-1513 EX+ ~~1-iA) ~ pennsylvania ~t7EPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: (,~/~E 2 -SHEET By~eo/11 L. ~~~~er 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) ~: sus~N~a R. ~P~cRr /~iplLL //6 S, /ytark~~ Sf. /J9e~tian;csdHry, P~4 /7o ss" .s ~. II i. ,~QNGELlCA~ 8£~T,i G¢ R~PPE,PT ,l~it/GL .Ti~C'G~ v^~i~RS is !l%!/ T~ Lance ~~s~er, NY ~oso9 FILE NUMBER: ~/- l / -/ ~o5t RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trusteefsl OF FSTnTF d~h~ ~'nsnddaa~~ ~~ o~/+~sidae ~.Z, d 1~ „5"~P.G/hG 4~/yy dGV:sed real astQl`~ cE~ 1Z0 5. /na ~ kd~ S~ mc~h~vn; ag~j, P• Corn plat bcd room Sui~ - p;c~ura of ,8e.~fha ,P~pperf ~j'I'LLn4~soh ' picfu~e DI~ 1~'e~ ducks Cross:r~ raa-• t SeG Cs,I~,IS/tk.Zl~en on ,~a9 a .3, ~ I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ~ If more space is needed, use additional sheets of paper of the same size. KtV-1513 tXf (U1-lUJ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: ~p~GE 3 CoivTil-l. SNE~T~ SCHEDULE BENEFICIARIES BY~eoN L. R~PPF~2T FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY REponryotS iy~ Trunee~s~~ AMO~~~A~ARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] ~. CED.4r~ BI'ZlLL ~rrind4~et~hfBr OAK fau,r c~r4w ~ 16 s. ma.~/<cf St. Chcst /h~chan~csbKr9, f'A ~7oss 8: ZifCN~y ~~/LL Sin-yrnnldsan oaK Commode .SZ f~ros4aect Sf: HuMrnc~.$~seu/I, PA /703 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE I3 OF REV-1500 COVER SHEET. ~ sr •~ ~~~~~~ ~ya« .a ~~revea, use aaouronai sneers of paper of the same size. ~ ~ ~ ,,~ l ` ~~~~ ~~:~ 2~ ,~ ~~, ~ %~ i "~ 4,~i i~~~C:C.I~~G fir ~.y ~ , `~ y~ ~ ~~ f,~/,~ -y ~.~/ 7S ~/ JJ ~ ~ /} ~ ~- E% y V G~ L" "' f ~'[I~, /V~_c` q i/ ~JY1[.t-- /~ =L.~~l.'i~~/~cl~- ~ 1%~~" a~G~ ab~ ~ LAST WILL AND TESTAMENT OF BYRON L. REPPERT I, BYRON L. REPPERT, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. 1 specifically give and devise my real estate located at 120 South Market Street in the Borough of Mechanicsburg, Cumberland County, Pennsylvania to my daughters: SUSANNA R. REPPERT BRILL and NANCY J. REPPERT, in fee simple absolute, to hold as joint tenants with right of survivorship. The death taxes, expenses, fees, and charges and the like which may be assessable against the value of this devise shall be paid from the general residue of my Estate to the extent that it is sufficient to so provide. I specifically state herein that this devise is not meant in any way to denigrate my love and affection for my other two daughters. 3. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath to be divided and distributed as follows, after the payment of all death taxes that might be due thereon: Equal shares amongst my said four (4) daughters, per stirpes: CAROLYNN R SEARS, MARJORIE L. REPPERT, NANCY J. REPPERT and SUSANNA R. REPPERT BRILL. 4. I nominate, constitute and appoint my four (4) daughters, CAROLYNN R SEARS, MARJORIE L. REPPERT, NANCY J. REPPERT and SUSANNA R REPPERT BRILL, to be the Co-Executrices of this my Last Will and Testament. In the event that any of them shall for any reason be unable or unwilling to act as such Co-Executrix, the remaining Co-Executrices shall serve in her/their place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of ~ibLtu.~ty- , A.D. 2006. (SEAL) B ON L. REPPERT Signed, sealed, published and declazed by the above-named BYRON L. REPPERT, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses.