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Home My WebLink About02-05-131505611185 REV-1500 EX{02-11){FI) OFFICIAL USE ONLY PA DeperMentURevenue County Coda Year File Number Bureau W Individual Tawas PO BOX 280607 INHERITANCE TAX RETURN 21 12 D 659 Harrisburg, PA 7 17 2 9-08 01 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 168-34-9146 D6D32012 08231942 Decedent's Last Name Suffix Decedent's First Name M I GOSS JANE G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffx Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death ^ 4 Limitetl Estat ^ 4 F t I t Prior to 12-13-82) ^ . e a. u ure n erest Compromise (date of 5. Federal Estate Tax Return Required ® 6. Decedent Died Testate ^ death after 12-12-82) T. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 1 D. Spousal Poverty Credit (Date of Death ^ 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 7AX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID F• SPANG, ESQU IRE 717-262-2185 First Line oT Address 247 LINCOLN WAY EAST Second Line of Address City a Post Office CHAMBERSBURG State ZIP Code PA 17201 C "' ,^~ rr ~ b ^'I m ~ o SC~ ~ m inz nr ~ ~ cn -Iv ~v i Zv v '~ n o -n 00 'n ..n oc-"i ti ~~^ ' '~ qui7€ FILED e,~. ~ [n M O N TI correspondenrss-malladdresa: DFSaWCSLAWOFFICE•COM Under penalties of perjury, 1 declare that I have examined this return, InUuding accwnpanyutp achetlules antl statements, and to the best of my knowletlge entl belief, it is true, correct a d compl te. DeUeration of properer other than the peroonel repreaentadw is based on ell informa9on U which preperer has ny kn edge. SIG TTY S~N~ F (LING RETyIBbLy~ ~~~ ~ l ~3 NOR & SPANG, LLC 247 247 LINCOLN W9(Y EAS/f/ PLEASE USE ORIGINAL Side 1 1505611185 e MA647 3.000 HAMBERSBURG, PA 17201 D TE / /~/3 BURG, PA 17201 Y 1505611185 ,,,J 1505611285 REV-1500 F>( (FI) Decedent's Social Security Number 168-34-9146 _ Decedanfa Nema~ G O S S I A N RECAPITULATION 1. Real Estate (Schedule A) ........................ .... 1 2 4 5, () 0 0. 0 0 2. StOCks end Bonds (Schedule B) ..................... .... 2, 0 • O 0 3. Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C) - , g. ~ • ~ ~ 4. Mortgages antl Notes Receivable (Schedule D) q 0 . 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 3 4 9 , S 0 3 • ~ ~ 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g_ 0 , p 0 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .. 7. 414 , 9 $ 6 • 0 0 8. Totat Gross Aaels (total Lines 1 through 7) 8 1, 0 0 9, 4 5 9. 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ......... .... g, 116 ,19 5.0 0 10. Debts of Decedent, Mortgage LiabiNNes, and Liens (Schedule I) 10 ], , 971.00 11. Total Deductbna (total Lines 9 and 10), _ - 1 t 11$ ,166.00 12. Nat Value of Estate (Line 8 minus Line 11) - 12 891 , 293 • 00 13. Charitable and Governmental Bequesls/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , i 3. $ 0 , ~ 0 ~ • 0 0 14. Net Velue SuDJect to Tez (Line l2 minus Line l3) ,14. 841,293.00 7AX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Llne 14 taxable al the spousal tax rate, or transfers un er Sec. 9118 1 2 x o (a)( . ) . 0.00 15. 0.00 16. Amount of Line 14 xable at lineal rate X.04 o•ao 1s. 0.00 17. Amount of Line 14 taxable at sibling rate X .12 0• ~ 0 17. ~• ~ 0 18. Amount of Line 14 taxable at conateral rate x .15 8 41, 2 9 3.0 0 13. 12 6 ,19 4 •0 0 19. TAX DUE ................ 19. 20. FILL IN 7HE BOX IF VOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 OM4848 3.080 1505611285 126,194.00 a REV-1500 EX (Fp Ppe 3 File Number Tax Payments and Credits: t. Tax Due (Page 2, Line 19) (1) 126,194.00 2. CreditslPayments A. Price Payments 1 Q Q, 0 0 0. Q Q e. Discount 5, 000. QO Total Credtts(A+8) (z) 105,000.00 3. Interest (3) Q . Q Q 4. It Line 2 is greater than Llne 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In box on Page 2, Line 2010 r•qu~t a refund. (4) Q . Q Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (s) 21,194.00 Make check payable to: REGISTER OF WILLS, AGENT. ` ~I"' PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS i. Did decedent make a transfer and: Yes No a. retain the use or Income of the properly transferred ........................ ^ X b. retain the right to designate who shall use the property transferred a its income .......... ^ X c. retain a reversionary interest .................................. ^ d. receive the promise for life of either payments, benefhs a care? .................. ^ 2. If death occurretl after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate canskleragon7 .............................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account a security at his a her deaN? ^ 4. Did decedent own an Indivitlual retirement account, annuity, or other non-probate property which , contains a beneficiary designation7 ................................. ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. ~ .. Fa dates of death on or after July 1, 1994, and before Jan. 1, 7995, the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 3 percent [72 P.S. §9118 (a} (1.1) (ijJ. Fa dates of death on a after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or fa the use of the surviving spouse is 0 percent [72 P.S. §9118 (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 beneficary. Fa 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 fa 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 heneficlades is 4.5 percent, except as noted in (72 P.S. §9716(a)(1)j. • The tax rate imposed on the net value of transfers to a fa the use of the decedent's siblings is 12 percent [72 P.S. §9118(x)(1.3)]. Asibling is tlefined, under Section 9102, as an indivitlual who has at least one parent in common with the decedent, whether by blood or adoption. oxtasri zooo REV-1541 FC ~ (0140) Pennsylvania OEpAR'fM11Q(rOF REVENUE SCHEDULE A REAL ESTATE FILE NUMBER: Jane G. Gosa 21 12 0659 All real property owned solely or o a bnant in common must be reported at fair market wlua. Fair market veWa is deRned as the pdce at ahich properly would be exchanged between a willing buyer end a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real property that Is Jolndycwned with dght of survlvonshlp must be tllsclosetl on Schetlule F. swasa5 z.ooo If more space is needed, use additional sheets of paper of the same size. OMB No 2502-0265 Computer form published by LAW DISKS, 734 Franklin Avenue, Garden City, N.Y. 11530 516-741-5740 www.lawdisks.oOln DEPARTMENT OF HOUSING AND UR S A U BAN DEVELOPMENT HUD -1 UNIFORM SETTLEMENT STATEMENT . . . B. TYPE OF LOAN: 6. File Number 387 7. Loan Number [Xj N/A (Caeh) 8. Mortgage Insurance Case Number O Note: this form is famished to give you a staremwt of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(P.O.C.)" were paid outside the closing. They are shown here for informational purposes and are no[ included in the totals. Note: TIN =Taxpayer's Identification Number. D. Name and address otborrower E. Name, address and TIN of seller F. Name and address of lender Tyrone L. Stewart and Susan M. Stewart, Estate of lane G. Goss, deceased Tlvstees of The Slewart Family Tms[ Dated 5-5-03 8180 Michaux Drive Fayetteville, FA 17222 G. Property Location H. Settlement Agent: name, address and TIN 79 Di11erDrive Walker, Connor&Speng, LLC 26-1519482 Shippensbarg, PA 17257 247 Lincoln Way East Cumberland County Cham6ersburg, PA 17201 Place of Settlement L Settlement Dete: Office of Settlement Agenq above December 14, 2012 J. SUMMARY OF $ORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100 GROSS AMOUNT DUE FROM BORROWER: 400 GROSS AMOUNT DUE TO SELLER: IOI Contract sales price 245,000.00 401 Contract sales pru:e 245,000.00 102 Personal ro arty 402 Personal pro arty 103 BGrrower settlement charges (line 1400) 4,142.00 403 104 404 105 405 Adjtu'tmentsfor items aid by seller i n advance Ad7wbnenfs or items pnidb seller i n adgnnce 106 Co/Cwp taxes @/142012 to 12/312012 25.30 406 Ca/Cwp taxes 12/142012 ro 12/31/2012 25.30 107 School taxes 12/142012 to 6li02013 1,319.00 407 School nixes 12/142012 to 6/302013 1,319.00 IOS Assessments 408 Assessments 109 409 110 410 111 411 112 412 120 GROSS AMOUNT DUE FROM BORROWER 250,486.30 420 GROSS AMOUNT DUE TO SELLER 246,344.30 Z00 AMOUNTS PAiD BY OR ON $EHALF OF BORROWER: 500 REDUCTIONS IN AMOUNT DUE TO SELLER 20ID osit or earnest mon 2,000.00 SOI Excess de osi[(seeinstmctions) 202 Principal amount of new loan(s) 502 Settlement cha to seller (line 1400) 17,390.84 203 Existing loan(s) taken subject to 503 Existing loan(s) /aken subject [o 204 504 Payoff of first mortga eloan 205 SOS Payoff of second mortgage loan 206 60b 207 Seller's credit For water mitigation 4,800.00 507 Sellers credi[for wattt mitigation 4,800.00 208 508 209 509 Adjrts(men4 for hems unpaid by seller Adjusnnenlsfar items unpaid by seller 210 Co? taxes 510 Co/fwp taxes 211 School taxes 511 School tuxes 212 Assessments 512 Assessments 213 513 214 514 215 515 216 516 217 517 218 518 21g 519 220 TOTAL PAID BY/FOR BORROWER 6,800.00 520 TOTAL REDUCTION IN AMOUNTDUESELLER 22,190.84 300 CASH AT SETTLEMENT FROMfJ'O BORROWER 60D CASH AT SETTLEMENT TO/FROM SELLER 301 Gross amt due from bomowtt (Ln 120) 250',486.30 601 Gross amt tlue to selltt (Ln 420) 246,344.30 302 Less amt aid b /for borrower (Ln 220 6,800.00 602 Less reduction in amt due seller (520) 22,190.84 303 CASH [X] FROM BORROWER 243,686.30 603 CASH l~ TO SELLER 224,153.46 OSU65TITVTB PORM 1%Va, Provedl !rani Rvl &ICIe Tnnadionq Tea Vev bM SaW.eR $TATPAI6NT np info,melpr, wmeinM In Rb[W E. O, X,1 entl on IbmlVl (or Illine <cl u mlvbked.line603 a1g400 u ImPo~lem lee InhmuliomvM it belne NmuFpl la the Inlennl RCVenue $ervice.lf you ve,quw] to ak a rtlwn. a meligm[e pu11Y ac olM1tt Ivclun mvY be imluacd on pu i! IM1ie'nam is eryuircd b be rtgonei eM,M1e IR$ tltlmnim Ilul11 N9 MI hen rtryMd 1(IM1p rtnl eAau wu p+e mrm Inme. (khrm]119. Seknf YOw3km2 will, Pa'm IMO wen i!)vu M1atl a loo oe you dN not rtpb[e your Mme.l(IM1e rul wlMev'u,gl ywr main home, tryml IM Iryr9[lion on Form OM], sely of auslnne Pmpny, Porm fi]S3.InNnllmvl $ek Ineomq mWa, scM1WUk O, Pe,m 1 Wa. Ceplel Geine entl lusty. You mnel pmvi& the $PVemene Agme (in Hlxk H) wuF yvw mnal eepeyn idenliavlbn umbm'.IfynuW ml provide lhelvllemml agml wdh 5om rapep ~tlvmi(vlvn numW. pu may Ee aubjec la mvil or mminnl pmaMly impn+etlb/Iew. UnM penellie ntlcjurylceriry,M1n lbe numbersM1Ownon IFie uelemenl a mvvencl IuPoYV Nemianlion inlmhr. 700 TOTAL SALES/BROKER'S COMMISSION based on price $245,000.00 @ 6.00 % _ 14,700.00 PAID FROM PAID FROM Division of Commission line 700)as follows: BORROWER'S SELLER'S 701 $ 14,700.00 to ReMax Realty Agency FUNDS AT FUNDS AT 702 $ to SETTLEMENT SETTLEMENT 703 Commission aid a[ settlement 14,700.00 704 90l Interest from to $ /day 902 Mort age Insumnce Premium for months to 903 Hazard Insumnce Premiwn for years to 904 yearsto 905 I IOl Settlement or closing Fee to 1102 AbstmG or title search to 1103 Title examination 1104 Title Insumnce binder to 1105 Document reparation to Walker, Connor & S an ,LLC 150.00 1106 Notary fees ~ to Walker, Connor & Spang, LLC 5.00 10.00 1107 Atromeys fees ro (includes above item numbers ) 1108 Title Insumnce to Old Republic National Title Insumnce Co. (includes above item numbers 1109 Leader's wvemge $ '~+'9 a :x.u "' 's + 1,625.00 'L, ,,, k}# T °'. u'4 ~~q-~..iia 4=uG ~'7~~'- r° ~4}i)' ~^2~1 .'=` ~ ~_ ~- r ) d ~ 1110 Ownefs coves a $245,000.00 mss rl:s"~ tek^ 'zh-... ,a.z, 4," ~r$ 1111 Endorsements to 1112 Closing Service Letter to 1113 1900 COV F.RNMF.NT RECORDING AND TRANSFER CHARGES 1201 Recording fees: Deed $ 62.00 Mort e $ Releases $ 62.00 1202 City/ety tax/stamps: Deed $ Mortge e $ 2,450.00 1203 Smm tax stamps Deed $ Ma ge $ 2,450.00 1204 2205 statement of all receipts and disbursements made on my account or by me in this transaction. I Curther certify that I have received a copy of the HUD-I Settlement Cement. (%%//~~LJp>A~L~ ~~~2C/eL'~ Borrower ~~~ ~ ~ / ~ ~~~ ~~'-'~'e' " Seller /""""rt e"L,000,I~~" Borrower Seller To the best of my knowledge the HUD-1 Settlement Statement which I hove prepared is a one and accurate arcowt of the funds which were receivetl and have bee r will be disbursed by tl undersigned as par[ of the seltlemenl of this transaction. ~ Se¢Iemen[ Agent ~a~i `/~~/~ Date WARNING: [t is a crime [o knowingly rake false statements to the United Stales on this or any other similar form. penalties upon conviction can include a fine end imprisonment. For details see Title Ig U.S. Code Section 1001 end Section 1010. REV-1508 EXt (0&12) Pennsylvania OEPARTMEMOF REVENUE MHERITANCE TPJ( RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 7. Cash found at decedent's house 2 Cash found at decedent's house 3 Century Link refund 4 Coins appraised at 5 Comcast Financial Agency Corp refund 6 Commonwealth of PA tax refund 7 Enveatnet PMC Tactical ETF - Country & Sector Account #HTN-023728 and #HTM-086188 8 Farmers and Merchants Trust Company Money Management Account #7046421 Interest accrued to 6/3/2012 9 Farmers and Merchants Trust Company Checking Account #3321495 10 LL Bean Credit Card refund 11 Long Term Care Group, Inc. - cancellation of premium 12 Personal property and household goods including 2010 Lexua RX350 13 Public Opinion subscription refund 14 QSP Magazine refund 15 Real estate taxes pro-rated on settlement sheet 15 Social Security Insurance refund 17 State Farm Homeowner's Insurance refund 18 State Farm Homeowner's Insurance refund 19 State Farm Mutual Auto Insurance refund 20 State Farm Mutual Auto Insurance refund Total from continuation schedules . 1,358 100 78 4,149 34 493 216,833 59,259 16 28,092 25 302 34,495 64 20 1,344 1,463 746 271 64 13 284 2 W48AD 2.DDD If more apace is needed, use addltionel sheets of paper o(the same s¢e. Estate of: Jane G. Goss 21 12 0659 3ch®dule E (Page 2) Item Value at Date No. Description of Death 21 State Farm Mutual Auto Insurance refund 27 22 The Patriot Nawa subscription r®fund 257 Total (Carry Porward to main schedule) 284 CA.atL Is. S~'IDEL BUY * SELL ~ APPRAISE CflIhTS OI3) BOOKS f423 $nechbiII F.d: C'Ftsmbe-'sberg, Pet. i72Qi $3t. 7i?-~i63-425 s4,d#tA r1132d3 ra~1AvQ G. ~~~s c~'s~~r~ . ~f~~~ ~~ f'~', ~~~ ~9/Z ,~. 0. ~ ~^ 3.-l2.~ The Estate of Jane Goss Page 1 of 2 Marty B. Walker From: Rankin, Frank [frankin@financialguide.comj Sent: Friday, June 15, 2012 3:24 PM To: MBW@WCSLAWOFFICE.COM Cc: Rankin, Frank; Zeppa, Jamie Lynn Subject: The Estate of Jane Goss Good afternoon Attorney Walker, It was a real pleasure connecting with you last week regarding Jane and her estate. However, as we discussed, we both would have preferred it been under different circumstances. As promised, I am including in the body of this email a listing of the accounts I managed and advised on for Jane. The values, as indicated, are Date of Death values. Please feel free to reach out to us if we can be of any assistance to you or Jane's family. We want to be as helpful as possible. With regazds, Frank DOD - Suntlay, 06/03/2012 Fund Company Account Title Account # Account Value - Fritlay, 6/1/2012 MassMutual Evolution Jane's NO EVN46018908* $132,601 MassMutual Odyssey Select Fixed Jane's NQ OSL24700100** $107,141 Envestnet PMC Tactical HTN-023728/ HTM-088188 ETF -Country & Sector Jane's NQ HTM-088196*** $ 216,833 NFS - AAM Jane's IRA JAV-583820 $ 165,863 Putnam 529 FBO Austin 551276748 $ 4,659 Putnam 529 FBO Collin 551276742 $ 4,692 Position Summary Balance $ 631,789 6/18/2012 The Estate of Jane Goss p~ ~'i'v~;~Ci~1.L GROUP ~yp•R4 'Y-b'+4'v+?. XFntt•zf~451 !•£~bp:r arc: 717.763.7?6~, ext. 033 utinancial~roup_com ?age 2 of 2 Frank L. fiankin, CL'LC: l Managing Palmer 10O Corporate Center Drive • Suite201 ' Cramp Hill L'A 1701 l *A gzneral agency of Massachusetts Mutual Life Insurance Company. Frank L. Rsnkin is a. reeistcrcd representative of and offers securities, investment advisory, and financial planning services through MML Investors Serviczs, LLC. lnsurance offered through Massachusetts Mutual Life Insurance Company and other fine companies. This e-mail transmission may contain information that is proprietary, privileged and/or confidential and is intended exclusively for the person(s) to whom it is addressed. Any use, copying, retention or disclosure by any person other than the intended recipient or the intended recipient's designees is strictly prohibited. If you are not the intended recipient or their designee, please notify the sender immediately by return e-mail and delete all copies. Registered representative of and securities offered through MML Investors Services Supervisory Office: 1295 State St. Springfield, MA 01111-0001 (413) 788-8411 6/18/2012 CARL E. OCKER AUCTIONEER 4401 Philadelphia Avenue Chambersburg, PA 17201 (717) 264-6578 Personal Property Appraisal for Jane Goss Estate 79 Diller Drive Shippensburg, PA 17257 OFFICE 2 MAROON LEATHER RECLINERS ......................................... ........................................ 250.00 4 LAMPS ....................................................................................... .......................................... 20.00 3 BOOKSTANDS ......................................................................... .......................................... 10.00 2 DRAWER FILE CABINET ....................................................... ............................................ 5.00 OFFICE CHAIR, PAPER SHREDDER ........................................ .......................................... 20.00 OAK FLAT TOP DESK ...................................... ....................................................................40.00 TOSHIBA FLAT SCREEN TV, VCR ................................................................. ................. 150.00 FOYER OAK WALL STAND ........................................................................................... ................... 25.00 AERUS SWEEPER .............................................................................................. ...................35.00 LIVING ROOM 2 PC BLUE LIVING ROOM SET ....................................................................... .................100.00 2 OAK GLIDER ROCKERS &OTTOMAN ....................................................... ................. 200.00 OAK LAMP TABLE ........................................................................................... ................... 35.00 3 OAK NEST OF TABLES ................................................................................. ................... 50.00 BOSE RADIO ............:......................................................................................... ................... 75.00 BOYD BEARS ..................................................................................................... ...................20.00 BRASS LAMP ..................................................................................................... ................... 10.00 2 LONGABERGER BASKETS ........................................................................... ................... 25.00 SONY FLATSCREEN TV ................................................................................... .................200.00 UNIVERSITY ARM CHAIR ............................................................................... ................... 25.00 FRANKLIN MINT LIGHTHOUSE COLLECTION ........................................... ................... 30.00 HITCHEN 4 OAK BAR STOOLS ......................................................................................... ................. 100.00 BRAIDED RUGS ................................................................................................. ................... 20.00 LONGABERGER COOKIE JAR -POTTERY ITEMS, BASKETS .................. ................... 65.00 MICROWAVE ..................................................................................................... ................... 20.00 KEURIG COFFEE MAKER, TOASTER OVEN ................................................ ...................25.00 SHARP FLATSCREEN TV ................................................................................. ...................40.00 SMALL KITCHEN APPLIANCES, HOUSEHOLD ITEMS .............................. ...................20.00 SET PFHALTZCRAFT DISHES (WffiTE) ........................................................ ................... 20.00 DINING ROOM EMPEROR GRANDMOTHER CLOCK ................................................................... ........... 125.00 SERVICE FOR 8 TOWLE STERLING FLATWARE .............................................. ...........950.00 SET OF ENGLISH CHINA ....................................................................................... ............. 25.00 LONGABERGER BASKETS .................................................................................... ............. 70.00 BRAIDED OVAL RUG ............................................................................................. .............25.00 SET OF OAK TV TRAYS ......................................................................................... .............20.00 COUNTRY SCENE PICTURE .................................................................................. .............15.00 7 PC TEMPLE STEWART MAPLE DINING ROOM SET ..................................... ........... 250.00 VARIOUS CHINA & GLASSWARE PCS ............................................................... ............. 25.00 CARD TABLE & 4 CHAIRS .................................................................................... ............. 25.00 DEPT 56 ITEMS, BOYD, CRAFT ITEMS ............................................................... .............20.00 BACK BEDROOM SENTRY SAFE .......................................................................................................... ............. 20.00 BLANKETS ............................................................................................................... ............. 10.00 5 PC 1960'S WALNUT BEDROOM SET ................................................................. ............. 75.00 TOSHIBA FLATSCREEN TV .................................................................................. ............. 75.00 CHERRY STOOL ...................................................................................................... ............. 10.00 PROFORM TREADMILL ......................................................................................... ........... 100.00 WALNUT MODERN WALL CLOCK ...................................................................... .............10.00 XEROX COPIER ....................................................................................................... .............25.00 BLANKETS ............................................................................................................... .............10.00 COMMUNITY PLATE SET OF FLATWARE ......................................................... ............. 15.00 2 PR BINOCULARS .................................................................................................. ............. 10.00 2 BB GUNS ................................................................................................................ ............. 20.00 HOOVER CARPET SHAMPOOER .......................................................................... .............15.00 ORECK SWEEPER ................................................................................................... ............. 50.00 BISSEL SPOT BOT ................................................................................................... .............10.00 FILE BOXES ............................................................................................................. ............... 5.00 2 HAMPERS, BATH TOWELS, ETC ....................................................................... .............25.00 GARAGE 2 CROCKS ................................................................................................................. .............25.00 DIXON ZTR 3303 10.5 HP ZERO TURN RIDING MOWER WBAGGER .......... ...........450.00 2 WEED EATER GAS TRIMMERS ........................................................................ ..............40.00 TORO 6.75 PUSH MOWER ...................................................................................... ............. 25.00 4 METAL GAS CANS ............................................................................................... .............20.00 2 ALUMINI.JM FOLDING LADDERS .................................................................... .............. 20.00 CRAFTSMAN SHOP VAC ....................................................................................... .............20.00 TORO BLOWER ...................................................................................................... .............. 10.00 GARDEN TOOLS LOT BROOMS ........................................................................... ............. 20.00 TRASH CANS .......................................................................................................... ..............10.00 VARIOUS HAND TOOLS ....................................................................................... .............. 10.00 SIMPLICITY 5205 SNOWBLOWER ...................................................................... ..............75.00 GARAGE SHOP VAC .............................................................................................. ..............20.00 FOLDING LAWN CHAIRS ..................................................................................... .............. ] 5.00 2BAG WAGONS ..................................................................................................... ..............10.00 AMES LAWN CART ............................................................................................... ..............20.00 CLEANING CAR CARE LAWN CARE SUPPLIES ............................................... ..............20.00 2 PLASTIC UTILITY CABINETS ........................................................................... .............. 25.00 RCA REFRIGERATOR ............................................................................................ .............. 75.00 KENMORE WINE COOLER ................................................................................... ..............35.00 FOLDING STEPS ..................................................................................................... ..............20.00 2010 TOYOTA LEXUS RX 350 4 DR HATCH BACK 2GRFE, SUN ROOF HATCH BACK, 4 DR, BLACK LEATHER INTERIOR, 56284 MILES ................ ....... 27,000.00 REAR ENCLOSED PATIO WHITE TABLE W/4 CHARS, 2 SWIVELS, 2 STANDS ................................................. ..... 75.00 WEBER STAINLESS GAS GRILL .................................................................................. ...100.00 2 LLOYD PATIO CHAIRS ............................................................................................... .....20.00 3 WOOD STANDS ............................................................................................................ .....15.00 BEDROOM TWO 5 PC CHERRY BEDROOM SET ..................................................................................... ....400.00 JEWELRY BOX CONTAINING VARIOUS GOLD NECKLACES, GOLD RINGS, GOLD EARRINGS, COSTUME JEWELRY ................................................................... ....500.00 3 MATCHING WHITE GLASS SHADE TABLE LAMPS ............................................. ...... 20.00 ROBOT SWEEPER .......................................................................................................... ......25.00 SAMSUNG FLATSCREEN TV ....................................................................................... .... 150.00 QUILT RACK ................................................................................................................... ......15.00 HALL CLOSETS THROWS .......................................................................................................................... ......10.00 DEPT 56 HERITAGE VILLAGE COLLECTION ........................................................... ......75.00 LONGABERGER BASKETS ........................................................................................... ...... 20.00 BATH TOWELS, LINENS ............................................................................................... ......20.00 BEDROOM THREE FULL SIZE BED .............................................................................................................. ....... 50.00 OAK CHEST & NIGHT STAND .................................................................................... ....... 60.00 SAMSUNG FLATSCREEN TV ...................................................................................... ....... 75.00 BATH TOWELS, LINENS .............................................................................................. ....... 10.00 MODERN QUILT ............................................................................................................ ....... 25.00 LUGGAGE ....................................................................................................................... .......10.00 IRONS, STUFFED ANIMALS ........................................................................................ ....... 10.00 BASEMENT FAMILY ROOM MILK CAN ...................................................................................................................... ....... 10.00 OAK BOOKCASE ........................................................................................................... ....... 20.00 3 PC DINETTE SET ........................................................................................................ .......35.00 2 THREE DRAWER FILE CABINETS ......................................................................... ....... 15.00 OAK FLAT TOP DESK ................................................................................................... ....... 25.00 OFFICE CHAIR ............................................................................................................... ....... 10.00 OAK BOOKSHELF ........................................................................................................ ........ 15.00 2 LONGABERGER BASKETS ...................................................................................... ........ 20.00 MILK CAN END STAND .............................................................................................. ........10.00 2 LAY-Z-BOY RECLINERS .......................................................................................... ......150.00 LAMPS ............................................................................................................................ .......... 5.00 GE HUMIDIFIER ........................................................................................................... ........35.00 TURKEY CRATE ........................................................................................................... ........ 50.00 4 FOLDING CHAIRS/CARD TABLE .......................................................................... ........ 10.00 PANASONIC CD PLAYER, CD'S ................................................................................ ........ 35.00 6 PC WOOD KEY END TABLE, STOOL SET ............................................................. ........ 50.00 OFFICE CHAIR .............................................................................................................. ........ 25.00 SENTRY FLOOR SAFE ................................................................................................. ...... 125.00 BASEMENT STORAGE ROOM BARN WOOD/TREE BARK CLOCKS ......................................................................... ........ 20.00 PLASTIC/METAL SHELVING ..................................................................................... ........ 50.00 MILK CAN .................................................................................................................... .........10.00 WHITE FOLDING PORCH CHAIRS ........................................................................... .........20.00 CRAFT ITEMS, PLASTIC TUBS ................................................................................. .........20.00 METAL CABINET ........................................................................................................ ........... 5.00 LONGABERGER BASKET SLEIGH ........................................................................... ......... 20.00 OLD SLED ..................................................................................................................... ......... 15.00 CRACKLE GLASS VASES, DECANTER ................................................................... ......... 10.00 TOTAL GYM EXERCISER .......................................................................................... ......... 10.00 WOOD CRAFT ITEMS, TABLES, ETC .............................................................:................. 25.00 WORK BENCH WITH VARIOUS HAND/POWER TOOLS, SHOP VAC ..........................20.00 WHIRLPOOL WASHER &DRYER ................................................................................... 250.00 GOLF CLUBS ......................................................................................................................... 75.00 TOTAL .................................................. $34,495.00 I, DO HEREBY CERTIFY that I have examined the tangible personal property of Jane Goss Estate, 79 Diller Drive, Shippensburg, PA 17257 And do value and appraise the same at $34,495.00 as being fair market Value of said property on this date of June 13, 20 Date ~ ~ 3 ~ a' Cazl E. Ocker Appraiser REV-7510 E% • (08-09) pennsylvania OEPARIMENTOF REVENUE SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY Jane G. Goss 21 12 0659 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE OESCRIPRON OF PROPERTY INttSOET1fHwE0FT1ETRHIBFEgEE. T1EIR gEIATIOtSHP TO UELEDEM AIL TIE D41E OF1WYBFER ATfAWACCVY OF TIE GEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION IF A°PIICABLE TAXABLE VALUE t~ NFS - AAM Ira named beneficiary is decedent's estate 165,863 100.0000 0 165,863 2 Mass Mutual Evolution #6618908 - named beneficiary is decedent's estate 132,601 100.0000 0 132,601 3 Masa Mutual Odyssey Select Fixed Annuity account #OSL26700100 - named beneficiary is decedent's estate lo7,la1 loo.oooo o lD7,la1 4 Putnam 529 for t13e benefit of Collin Taylor account #551276742 4,692 100.0000 0 4,692 5 Putnam 529 Plan for the benefit of Austin Taylor account #551276748 6,659 100.0000 0 4,659 6 Shippensburg University Charitable Lead Trust (Qualified nonreversionary irrevocable grantor lead trust - not an estate asset and not a taxable transfer) See copy attached 0 0 0 0 TOTAL (Also enter on line 7, Recapitulation) $ If more apace is nestled, use eddRlonel sheets of paper d the same size. eWOBAF 2.000 GRANTOR CHARITABLE LEAD ANNUITY TRUST "The Jane G. Goss Grantor Charitable Lead Annuity Trust" THIS CHARITABLE LEAD ANNUITY TRUST ("Trust") is made and entered into on this 29`~ day of December, 2010, by and between JANE G. GOSS, of 79 Diller Drive, Shippensburg, Cumberland County, Pennslyvania, (hereinafter "the Donor"), within the meaning of Rev. Proc. 2007-45 and THE SHIPPENSBURG UNIVERSITY FOUNDATION of Shippensburg, Cumberland County, Pennsylvania (hereinafter the "Foundation" or the "Trustee"). This trust shall be known as the Jane G. Goss Grantor Charitable Lead Annuity Trust. All references to "section" or "§" in this instrument shall refer to the Internal Revenue Code of 1986, 26 U.S.C. § 1, et seq . WITNESSETH: WHEREAS, the Donor desire to transfer the assets identified on Schedule "A" to the Trustee and the Trustee desires to hold such assets upon the terms and conditions hereafter set forth; and WHEREAS, the Trustee agrees to receive, hold and administer such assets in accordance with this Agreement. NOW, THEREFORE, for and in consideration of their mutual covenants and promises, the parties agree as follows: ARTICLE i - FLT:DING THE TRUST The Donor hereby transfer and irrevocably assign to the Trustee on the above date, the property described in Schedule "A", and the Trustee accepts the property and agrees to hold, manage, and distribute the property under the terms set forth in this trust instrument. 797545,2 ARTICLE II -PAYMENT OF ANNUITY AMOUNT (A) In each taxable year of the trust during the annuity period, the Trustee shall pay to THE SHIPPENSBURG UNIVERSITY FOUNDATION an annuity amount equal to Five and One-Half Percent (5.5%) of the initial net fair market value of all property transferred to the trust, valued as of the date of the transfer. If the Foundation is not an organization described in § § 170(c), 2055(a), and 2522(a) at the time any payment is to be made to it, the Trustee shall instead distribute such payments to one or more organizations described in §§ 170(c), 2055(a), and 2522(a) as the Trustee shall select, and in such proportions as the Trustee shall decide, from time to time, in the Trustee's sole discretion. The term "the Charitable Organization" shall be used herein to refer collectively to the organization(s) then constituting tha charitable recipient, whether named in this paragraph or subsequently selected as the substitute charitable recipient. During the trust term, no distribution shall be made to any person other than the Charitable Organization. (B) The annuity period is a term of Ten (10) years. The first day of the annuity period shall be the date the property is transferred to the trust, and the last day of the annuity period shall be the day preceding the tenth (10~') year anniversary of that date. (C) The annuity amount shall be paid in equal semi-annual installments from income and, to the extent income is not sufficient, from principal. Any income of the trust for a taxable year in excess of the annuity amount shall be added to principal. (D) If the initial net fair market value of the trust assets is incorrectly determined, then within a reasonable period after the value is finally determined for federal tax purposes, the Trustee shall pay to the Charitable Organization (in the case of an undervaluation) or receive from uhe Charitable Organization (itn the case of an overvaluaticn) an amc,mt equal to the difference between the annuity amount(s) properly payable and the annuity amount(s) actually paid. z ARTICLE III -PRORATION OF ANNUITY AMOUNT The Trustee shall prorate the annuity amount on a daily basis for any short taxable year. In the taxable year in which the annuity period ends, the Trustee shall prorate the annuity amount on a daily basis for the number of days of the annuity period in that taxable year. ARTICLE IV -DISTRIBUTION UPON TERMINATION OF ANNUITY PERIOD At the termination of the annuity period, the Trustee shall distribute all of the then principal and income of the trust (other than any amount due to the Charitable Organization under the provisions above) in equal shares to such of the following friends of the Donor living at that time: Patrick A. Taylor, Kathryn Taylor Wilburne and Mazy Jane Taylor. ARTICLE V -ADDITIONAL CONTRIBUTIONS No additional contributions shall be made to the trust after the initial contribution. ARTICLE VI-PROHIBITED TRANSACTIONS The Trustee shall not engage in any act of self-dealing within the meaning of § 4941(d}, as modified by § 4947(a)(2), and shall not make any taxable expenditures within the meaning of § 4945(d), as modified by § 4947(a)(2). The Trustee shall not retain any excess business holdings that would subject the trust to tax under § 4943, as modified by §§ 4947(a)(2} and 4947(b)(3). In addition, the Trustee shall not acquire any assets that would subject the trust to tax under § 4944, as modified by §§ 4947(a)(2) and 4947(b)(3), or retain assets which, if acquired by the Trustee, would subject the Trustee to tax under § 4944, as modified by §§ 4947(a)(2) and 4947(b)(3). 3 ARTICLE VII -TAXABLE YEAR The taxable year of the trust shall be the calendaz year. ARTICLE VIII -GOVERNING LAW The operation of the trust shall be governed by the laws of the Commonwealth of Pennsylvania. However, the Trustee is prohibited from exercising any power or discretion granted under said laws that would be inconsistent with the requirements for the charitable deductions available for contributions to a charitable lead annuity trust. ARTICLE IX -LIMITED POWER OF AMENDMENT This trust is irrevocable. However, the Trustee shall have the power, acting alone, to amend the trust from time to time in any manner required for the sole purpose of ensuring that the annuity interest passing to the Charitable Organization is a guaranteed annuity interest under §§ 170(f}(2)(B), 2055(e)(2)(B), and 2522(c)(2)(B) and the regulations thereunder. ARTICLE X -INVESTMENT OF TRUST ASSETS Except as provided in ARTICLE VI herein, nothing in this trust instrument shall be construed to restrict the Trustee from investing the trust assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of trust assets. ARTICLE XI -RETAINED POWEP.S AND INTERESTS During the Donor' life, Debra A. Hess shall have the right, exercisable only in a non- fiduciary capacity and without the consent or approval of any person acting in a fiduciary 4 capacity, to acquire any property held in the trust by substituting other property of equivalent value. ARTICLE XII -GENERAL POWERS OF TRUSTEE The Trustee shall possess, among others, the following powers, both as to principal and income, to be exercised for the best interests of the beneficiaries, subject always, however, to all of the provisions and restrictions set forth in all other ARTICLES where inconsistent: (A) To retain any investments so long as the Trustee may deem it advisable so to do. (B) To vary investments, when deemed desirable by the Trustee, and to invest in every kind of property and type of investment, including securities owned, issued or underwritten by any corporate Trustee or any of its affiliates, or as to which such Trustee or its affiliate acts as investment advisor, as the Trustee shall deem wise. (C) To sell either at public or private sale and upon such terms and conditions as the Trustee may deem advantageous to the trust, any or all real, personal or intangible estate or interest therein owned by the trust severally or in conjunction with other persons, and to consummate said sale or sales by sufficient deeds, bills of sale or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon the Trustee in this paragraph or elsewhere in this instrument. (D) To pay all costs, taxes, expenses, and charges in connection with the administration of the trust. 5 (E) To vote any shazes of stock which form a part of the trust and to otherwise exercise all the powers incident to the ownership of such stock. (F) To select, employ and compensate any person, firm or corporation engaged in managing real estate or rendering investment counsel advice to advise the Trustee in making investments, managing securities or making decisions concerning the purchase, retention, sale or other disposifion of any part of the trust estate hereunder; to select, employ and compensate any attorney or firm of attorneys to render legal services to the Trustee with respect to the bust estate hereunder; and to select, employ and compensate any accountant or firm of accountants to render accounting services to the Trust. WHEREAS, the Trustee agrees to receive, hold and administer such assets in accordance with this Agreement. NOW, THEREFORE, for and in consideration of their mutual covenants and promises, the parties agree as follows: ARTICLE XIII -SURETY OF TRUSTEE The Trustee shall serve without the duty or obligation of filing any bond or other security. ARTICLE XIV -CONCERNING TRUSTEE (A) Any Trustee serving hereunder shall have the right to resign from such office at any time, with or without cause and without Court approval and to designate its successor. No successor Trustee shall be liable for the actions of the Trustee occurring prior to the successor Trustee taking office. (B) All references herein to the "Trustee" shall refer to the originally named Trustee(s) and to any successor Co-Trustees, as the case may be. 6 IN WITNESS WHEREOF, Jane G. Goss, as Donor, have hereunto affixed their hands and seals, and THE SHIPPENSBURG UNIVERSITY FOUNDATION, as Trustee; has caused this Grantor Charitable bead Annuity Trust to be signed by its duly authorized officers and its corporate seal affixed, all as of day and year first above written. WITN SS: ~__-% ~ f , - v~ ~. DONOR: ~~ "--{.SEAL) ane G. Goss ATTEST: ~~~IZ~' -1'lL4w-~ Direct` of Finance & Admin TRUSTEE: THE SHIPPENSBURG By: ~"Zc, resident & CEO i 7 SCHEDULE"A" 125.152 shares of PPL Corporation $ 3,279.38 RVS Tax-Exempt Bond Fund Class A 43,289.08 Cash 103.431.54 $ 150,000.00 WITNESS: ATTEST: ~~~ ~'lV~*~G. Direct23r of Finance & Admin (SEAL) DONOR: Goss TRUSTEE: THE SHIPPENSBURG By: President COMMONWE ,~T~Hp~ ,OF P NN YLVANIA COUNTY OF ~`VVVt ~ ~~t SS: On this, the ~~ day of ~1~l.li • 2010, before me, the undersigned officer, persopajly aCpp azed Y ` ~ ,who acknowledged [himself/herselfJ to be the /J ~~J ~ of THE SHII'PENSBURG UNIVERSITY FOUNDATION, a corporation, and that [he/she] as such officer, being authorized to do so, executed the foregoing Agreement of Trust for the purposes therein contained by signing the name of the corporation by [himself/herselfJ as such officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My l;ommtsston ~xptres SEAL) COMRAONWEHITH ~F ?~RNSYLYANfA Nofa:ssl Seal Jacqualine 1. drewbaugh, Notary Publ(c Shippensburg Twp., ~umberlantl Counly My Comntisston_8xt?3*s`NUg. 14, 2011 Fdember, Pennsq!vc:;lc I+.aaocia4ion of Notaries CONIMONWE T OF NNS VANIA ~~~' SS: COUNTY OF ~y'~,1VV~ J ``L~~ We, Jane G. Goss„ ~~ < and the Donor and the Witness, respectively, whose names are signed to the foregoing instrument, having been sworn, do hereby declaze to the undersigned officer that the Donor, in the presence of the Witness, signed said instrument, that they signed voluntarily, that each of the witnesses, in the presence of the Donor and of each other, signed said Trust as a witness and that to the best of the knowledge of each witness, the Donor were at the time of sound mind and under no constraint Subscribed and kn ~wledged befo • me by Jane G. Goss, the Donor, and subscribed and sworn to before me by o ~ ~ i the witness, all of whom personally appeazed before and aze known to me, to be the persons that signed or witnessed the within instrument, and acknowledged that they signed or 'messed a within instrument for the purposes therein contained, on this ~ day of 2010. COMMONWEf+."_Tt ~ O!=' P;NNSYLVHNtA Nct?ri~Ai;,eat Jacqueline:.. Drawaaugn, Notary Public Shippennburg Twp., Cumbarlend County nrty Commiasian Ettpires Au8. 14, 2071 Msmbmr, 4nnYYNonIC Assvalati9n et N~rlea (SEAL) REV-1511 E%+(1P98) pennsylvanla OEPMTAEMOF REVENUE SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF rat rvumxn dance (` r~,a 21 12 0659 Decedent's debb must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~, Chartwella Dining Services funeral reception 2,259 Total from continuation schedules ~ 14,449 B. ADMINISTRATIVE COSTS: 1. Personal Repreaentatlve Commissions: 33 , 189 Name(s) of Personal Representative(s) Martha 8. Walker Executrix Street Address 247 Lincoln Way East City Chatnbersburc State PA ZIP 17201 Year(s) Commission Paid: 2012 and 2013 2. Attorney Fees: 33,939 3. Family Exemption: (If decedent's address is not fhe same as Gaimant's, attach explanation.) Claimant NONE CLAIMED Street Address Ciry state ZIP Relationship of Claimant to Decedent 4. Probate Fees: 576 5. Accountant Fees: 6. Tar Return Preparer Fees: 7. 1 AmeriaGae propane delivery 295 Total from continuation schedules ~ 31,488 awavc zooo TOTAL (Also enter on Line 9, Recapit If more space is needed, use additional sheets of paper of the same size. Estate of: Jane G. Goes 21 12 0659 Schedule H Part 1 (Page 2) Item No. Description P.mount 2 Fogelsanger-Bricker Funeral Home 13,349 3 Wagonar's Memorials engraving on tombstone 1,100 Total (Carry Forward to main schedule) 14,449 Estate of: Jane G, Goya 21 12 0659 Schedule H Part 7 (Page 2) 2 Auaherman Hroa. Real Estate, Inc. real estate appraisal 350 3 Carl E. Ocker personal property appraisal 225 4 Carl Spidel coin appraisal fee 75 5 Commonwealth of Pennsylvania transfer car title fee 59 6 Cumberland Franklin Joint Municipal Authority 7/1/12 - 9/30/12 service 99 7 Cumberland Law Journal legal advertising 75 8 Dan 3taenatra Landscaping winterize lawn sprinkler system 95 9 FSM Trust Company fee to satisfy home equity line of credit 51 10 Penelec 959 11 IRS 2012 estimated federal tax payment 500 12 Pennsylvania Department of Revenue 2012 estimated personal tax payment 135 13 Reserve for miscellaneous final expenses 2,000 14 Seller's credit for water mitigation matter - sea settlement sheet 4,800 15 Settlement charges - see settlement sheet 17,391 16 Showalter 6 Miller, CPAs preparation of fiduciary tax returns 750 17 Southampton Township trash service 10/OS - 12/31/12 44 18 Southampton Township garbage service 07/01 - 09/30/12 44 Total (Carry forward to main schedule) 27,652 Estate of: Jane G. Goss 21 12 0659 Schedule H Part 7 (Page 3) 19 State Farm homeowner's insurance 1,185 20 State Farm car insurance payment 29 21 Tha Newa-Chronicle Co. legal advertising 97 22 Vivian F. Coy, Tax Collector real estate taxes 2,419 23 Zullinger-Brenize Outdoor Design s Maintenance lawn service for grub control 106 Total (Carry forward to main schedule) 3,836 ft EV451Z EX+(12.06) Pennsylvania SCHEDULE pEPARTMEM OF REVENUE DEBTS OF DECEDENT, WHERRANCE TAX RETURN MORTGAGE LIABILITIES 8r LIENS REaCFNIOECEDENT ESTATE OF FILE NUMBER Jane G. Goss 21 12 0659 Report debts Ineurretl by the decatlent prior to death that remained unpaid at the date of death, Inelutling unreimbursed metlical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ Century Link telephone service 88 2 Cheek 83626 written prior to death but clearing after death 100 3 Comcast Cable 100 4 Cumberland Franklin Joint Municipal Authority sewer service 04/01/12 - 06/30/12 99 5 Cumberland Valley Tree Service 120 6 Darlene Kelly, CPA fee to prepare final life tax returns 400 7 Debit transaction posted prior to death but clearing after date of death 35 8 L L Bean Card Services credit card debt 343 9 Penelec 215 10 Pinnacle Health Medical Services service rendered on 5/31/12 18 11 Sears Credit Cards credit card debt 234 12 Verizon Wireless 146 13 Zullinger-Brenize Outdoor Design 6 Maintenance lawn service on 05/11/12 73 ewasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX• (01-10) Pennsylvania pEPPRTNEM OF REVENUE INHERITANCE TAX RETURN RESIDEMDECEOEM SCHEDULE J BENEFICIARIES FILE NUMBER: J ne G. Goss 2 12 065 RELATIONSHIP TO DECEDEM AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS IlnGude outright apouael tlistdbutions entl transfer under Sec. 9118 (ej (1.2j.] 1, Austin R. Taylor Putnam 529 Plan 1270 Newburq Road Account OI551276 Shippenaburg, PA 17257 None plus 1/3 of 1/4 residue 2 Collin J. Taylor Putnam 529 Plan 1270 Newburg Road Account 11551276 Shippensburg, PA 17257 None lus 1/3 of 1/4 p residue 3 Debra A. Hesa 1/4 of residue PO Box 50 55 4th Street Biglerville, PA 17307 Nona 1/3 of 1/4 of r 6 Kathryn L. Wilburne 267 Middle Spring Road Shippensburg, PA 17257 None ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NOµTAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBIliIONS UNDER BECTON 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE ANO GOVERNMENTAL DISTRIBUTONS: 1 See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ; 50 000 748 of 742 of esidue awaeAl z.aao If more space is needed, use adtlldonal sheets of paper of the same size. Estate of: Jane G. Goss Ztem No. Description 5 Mary Jane Taylor 245 Middle Spring Road Shippenaburg, PA 17257 6 Patrick A. Taylor 1270 Newburg Road Shippenaburg, PA 17257 7 Scott M. Dupes 15554 Tangelo Slvd West Palm Beach, FL 33412 8 Steven R. Dupers 337 N. 25th Street Camp Hill, PA 17011 9 Taylor J. Wilburne 247 Middle Spring Road Shippenaburg, PA 17257 10 Tracy L. Dupes Frameli 5012 Sycamore View Drive Centerville, OH 45458 Schedule J Part 1 (Page 2) Relation None None Nephew Nephew None Niece 21 12 0659 Amount 1/3 of 1/4 of residue 1/3 of 1/4 of residue 1/3 of 1/4 of residue 1/3 of 1/4 of residue 1/3 of 1/4 of residue 1/3 of 1/4 of residue Estate of: Jane G. Gosa 21 12 0659 Schedule J Part 28 (Page 1) Item No. Description Amount 1 Shippensburg University Foundation Jane G. Goers Field Hockey Scholarship 1871 Old Main Drive Shippenaburg, PA 17257 50,000 ~. ~' N O WILL OF SANE G. GOSS ` ~ .~i x ~~ ~~ I, JANE G. GOSS, of 79 Diller Drive, Shippensburg, Cumberland Coun yl~ia is 17257, declare this to be my last will and I revoke all wills and codicils which I mad r `eto~e. First: I own all the furniture, rugs and other household effects situate in tome. ~ ~ct'n ~ a Second: I direct the payment of my debts and medical, funeral and administration expenses from my estate as soon after my death as conveniently may be done. Third: I give Fifty Thousand ($50,000.00) Dollars to SHIPPENSBURG UNIVERSITY FOUNDATION JANE G. GOSS FIELD HOCKEY SCHOLARSHIP. At my death, if this scholarship is fully funded so as to provide full tuition for a candidate, then the $50,000,00 shall be designated for SHIPPENSBURG UNIVERSITY FOUNDATION JANE G. GOSS WOMEN S ATHLETIC ENDOWMENT FUND. Fourth: My real estate shall become a part of the residue of my estate and distributed according to Paragraph Fifth of this Will. Fifth: I give all of the rest, residue and remainder of my estate, real and personal as follows: A. One-fourth (1/4) share shall be divided equally between COLLINJ. TAYLOR and AUSTIN R.R. TAYLOR, in care of their father, PATRICK A. TAYLOR, and TAYLOR JANE WILBURNE, in care of her mother, KATHRYN L. WILBURNE.. 13. One-fourth (1/4) share to be divided equally between my niece and two nephews, TRACYL. DUPESFRAMELI, STEVEN R. DUPES, and SCOTT M. DUPES, per stirpes. C. One-fourth (1!4) share equally to PATRICK A. TAYLOR and KATHRYN L. WILBURNE and MARYJANE TAYLOR, per stirpes. D. One-fourth (1/4) share to DEBRA A. HESS, per stirpes. Sixth: My Executor or Executrix, as the case may be, for any purpose of administration or distribution, may sell all or any of my property, real or personal, at public or private sale, for cash or credit, and may execute deeds or bills of sale. Seventh: I dtrect my Executor or Executrix, as the case may be, to pay out of the principal of my residuary estate all state inheritance taxes imposed upon or with respect to my estate, or any property in which I may have an interest, including any property not forming a party of my testamentary estate, but included in my gross estate tax purposes, at such times and in such manner as my Executor or Executrix, as the case tray be, in their sole discretion, shall deem advisable; and no such taxes or any portion thereof so paid shall be collected from or paid 1 by any other person, persons, or corporations by way of reimbursement, proration, apportionment or otherwise. Eighth: I appoint MARTHA B. WALKER, Executrix of this will. If MARTHA B. WALKER, for any reason whatsoever, is unable or unwilling to serve as Executrix or, having qualified, is unable or unwilling to continue to serve, I appoint PATRICK A. TAYLOR, as alternate or successor to MARTHA B. WALKER. Ninth: No fiduciary appointed in this will, and no duly appointed successor, shall be required to give or enter into any bond or security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of ~ n n~ ~i , 2010. - ' ~-) . GOSS Signed, sealed, published and declared by the above as and for a Iast will in the presence of us, who have hereunto subscribed our names as witnesses at the request and in the presence of the above and in the presence of each other COMMONWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN 5S: We, Jane G. Goss, ~ a y ~~ ~ F- Sv,a n~ and ~ . l ~ e f9. ,Arty , the testatrix and the witness respectively,. w ose~names are undersigned to the attached or foregoing instrument, being first duly sworn, do hereby declare to the mldersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witnesses and that to the best of their knowledge and testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. Jane G. oss, Testatrix i Witness \ ~ ~ Y V/ fitness Subscribed, sworn to and aclmowledged before me by Jane G. Goss, the testatrix, and subscribed and sworn to before me by ~ d v ~ ~ 1=. Socz ns and 7a.1; p r1. Me-t; z ,witnesses, this /~ ~. ay o /J~p~ _ , 2010. i Notaty ublic COMM ~NWEALTH OF PENNSYLVANU Notaria~ Seffi BmMaR. Mr~.lew. Notary Pudic Clmm6erebug Born, FranWin Cou>tY My Catmisek>r+Expiree OcL 2, 2010 Mrrmbsr, Pannr~rlvnnla Aseoplatbn of No1sAM Martha B. Walker, Esquire mbw@wcslawoffice.com Michael J. Connor, Esquire mjc@wcslawoffice.com David F. Spang, Esquire dfs@wcslawoffice.com WALKER, CONNO,R S PANG, LLB January 31, 2013 r.. 0 n ~ w Cumberland County Register of Wills ~ m 1 Courthouse Squaze m = ~, m Carlisle, PA 17013 ~ ~" I- a z ~ "' V: RE: Estate o Jane G. Goss 7c z ° ~ ca -° PA Filee No.: 21-12-0659 o c ~" ~ %U N Deaz Register of Wills: n N 247 Lincoln Way East Chambersburg, PA 17201 ~717~ 262-2185 Fax ~717~262-2187 www.wcslawofTce.com Julie M. Me[z Estate Paralegal ~ ~ m m ~ ~ a ~~ --i p m r41 ~~ o ~ m -±t r m r- o ~m Enclosed please find two copies of the REV 1500 for filing along with a check for $200.00 for the additional filing fee. A check for $21,194.00 is also enclosed for the additional inheritance tax that is owed. I have also enclosed our file copy for you to time stamp and return to me in the enclosed envelope. If you have any questions, please feel free to call me. V truly yours, ~ ~ VV~ ~'y1e~ ie M. Metz state Pazalegal Enclosures FROM: WAL ~~ 247 Lincoln Wz East ~ y C ~n~mb~~ ~ ss~~o, ~ ~9 ONNOR , ~ m_ SPANG ~~, F~x,~~~,z~z-z,g~ TO C ~~~, ~~~~ I a~~ d C~~,~I-~ Re~~s~~ ~F ~~~~s ~ C~~z~3~,~~ s~~~e G~~ [,s(e; ~~ ~~0~3 M f hull"~''i'Ih~'~II"I~~I~1'I 'll~lh~~"'~m!i'il~lil' ~,~~ xi ' ~ ~ ~~~ i ~