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Home My WebLink About02-06-13J 1505610105 REV-1500 IX (o2-vvj (FI) 11 (rp enna lvania OFFICIAL USE ONLY PA Department of Revenue P "" " Y County Code Year File Number Bureau of Individual Taxes `"`~`"~` PO BOx z8o5ot INHERITANCE TAX RETURN Harrisburg, PA t71ze-o5ov RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name SuNx Decedent's First Name MI Orndorff Kenneth L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Retum (Date of Death Pnor to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Requiretl death after 12-12-82) ~ 6. Decedent Dietl Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Bozes (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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nurat(ar _.. Thomas P. Gleason ~ (717)~i2-3270 w ~ ~ m rn a _ -*n _o ~I R OF WI USE~II.h7 ' *t x c~ I ~ v ~ n ~ m m First Line of Atldress m ~ ~: ~) - ' Z ry c O 49 W. Orange St. o ~ ~ "~ ~ -TI m ~ ~ Second Line of Address p C ' C7 `_ - ~I ~ N I m T.. ~ City or Posl Offce State ZIP Code D DATE FI (1 ~ Shippensburg PA ' 17257 correspondents a-mall address: tomgleason c@tomgleasonlaw.com Under penalties of perjury, I declare that I have examined This return, including accompenying schedules antl statements, and to the best of my knowledge and belief, h is Vue, correct antl complete. Declaradon of preparer other than the personal representative is based on all information of which preparer has any knowledge. TORE OF PERSON RESPONSIBLE FOR FILINr~ETURN ~ A t--;_ r ~ I':, , ... _ T' 1CP C' c r DATE 02/05/2013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE J DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J ~` J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number ' 161-40-1610 Decedent s Name: RECAPRULATION 1. Real Estate (Schedule A) ........................................... .. 1. 96,000.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 1,007.50 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 41,377.31 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 37,254.95 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7.. 420,745.88 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ', 596,385.64 9. Funeral Expenses and Administratlve Costs (Schedule H) ................. .. 9. ', 32,619.56 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)........... _ .. 10. 19,979.63 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. I. 52,599.19 12. Net Value of Estate (Line 6 minus Lina 11) ............................ .. 12. ' 543,786.45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ ~` ~~' an election to tax has not been made (Schedule J) ...................... .. 13. - 0.00 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14.. 543,786.45 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable a[the spousal tax rate, or transfers under Sec. 9116 0 00 . (a)(1.2) X .0_ 15. ~ 0.00 16. Amount of Line 14 taxable ~~~~ -- ~.... ..._.. at lineal rate X .0 45 543,786.45 I 16. 24,470.39 17. Amount of Line 14 taxable "". .... _.. _~.. ._._.. __.._... at sibling rate X .12 0.00 ': 17. 0.00 18. Amount of Line 14 taxable _; 0 00 ' ~--- 0 00 . atcollateral rate X .15 ig . ._-- 19. TAX DUE .... ....... ......... ......... 19 24,470.39 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Kenneth L. Omdoff STREET ADDRESS 44 Sand Bank Rd. - --___ CITY _.._ _. ._. __ __..._ _.- ---- STATE ' ZIP Shippensburg ', PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2, line 19) 2. CreditslPayments A. Prior Payments ___. __..__ 0.00 B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Llne 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the diference. This is the TAX DUE. (1) 24,470.39 Total Credits (A+ B) (2) 0.00 (3) 0.00 (4) (5) 24,470.39 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 trensferred .......................................................................................... ^ b. retain the right to designate who shall use the property trensferted or its income ............................................ ^ c. retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ~C 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 "intrust For" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual re0rement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of iransfers 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 far disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers tc or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adop0on. REV-1502 Ex+ (12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERRANCE Tax RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF. FILE NUMBER: KENNETH L.ORNDORFF All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defned 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 fads. Real property that is tolndyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 Real Estate located at 39 Sandbank Road, Shippensburg, PA (See attached settlement sheet) 96,000.00 TOTAL (Also enter on Line 1, Recapitulation,) ; 96,000.00 If more space is needed, use additional sheets of paper of the same size. oPP.~MENipFy O Zo ~* ~Ilhl~ o1V~ eqN OEVE~ B. Type of Loan ,a. Settlement Statement (HUD-1) OMB Approval No. 2502-0265 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. ^ VA 5. ^Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name 8 Address of Bonower: E. Name & Address of Seller: F, Name & Address of Lender: Douglas E. Bolinger Christinea Young, Executrix Bank of Landisburg Olive R. Bolinger Estate of Kenneth L. Orndorff p.O. Box 60 411 Touchstone Drive 39 Sandbank Road Shertnans Dale, PA 17090 Carlilse, PA 17013 Shippensburg, PA 17257 Property Location: G H. Settlement Agent: I. Settlement Date: January 10, 2013 . 39 Sandbank Road ~ Thomas P. Gleason Place of Settlement: Shippensburg, PA 17257 49 West Orenge Street Shippensburg, PA 17257 f Seller's Transaction count Due to Seller ales price $95 000.00 rro e or Items paid by seller in advance faxes to $ 0.00 res - to $ 0.00 ants 1/10/2013 to 06/30/2013 $506.16 res to $ 0.00 count Due to Seller $95,506.16 ns in Amount Due to Seller: it cha es to seller line 1400 $1,116.47 ran s taken sub'ect to first mort~ a e loan to Orrstown Bank $14,044.21 second mortgage loan ssistance $5,000.00 For Items un aid b seller taxes to $ 0.00 .xes 01/01/2013 to 01 /1 0201 3 $6.75 sots to $ 0.00 xes to $0.00 duction Amount Due Seller $20,167.43 Settlement tottrom Seller count due to seller (line 420) $95,506.16 actions in amount due seller (line 520) $20,167.43 ~X to from Seller $75,336.73 ® TiwrpeFarms.com 7 00.~Total Real Eatale Broker Fees % Paitl From Paid From ' Division of Commission line 700 as Follows: Borrower's Seller s 7 01 to Funds at Funds ai 7 02, to Settlement Settlement 7 03. 7 04. 6 8 00. Kems Pa able In Connactlon with Loan 01. Our od ina6on cha a $700 to the Bank of Lantlisbu from GFE # 1 8 8 02. Your credit or the a ints for the s ecific interest rate chosen from GFE # 2 03. Your ad ustetl od ination cha es a able to Bank of Landisbu from GFE A $ 700.00 8 8 8 8 04. A sisal fee to: ' $700.00 POC b borrower from GFE # 3 05. Credit Re rt to: from GFE # 3 06. Tax service to: from GFE # 3 07. Flood ceroficetion to: Bank of Lantlisbur from GFE # 3 30.00 8 06. 8 09. 8 10. 1 111. '8 12. 8 13. 8 14. 9 00. Items Re ulretl b Lender to Be Paid in Advance 9 01. Dail interest a from to r da from GFE # 10 9 9 9 02. Mort a e insurance remium for monthsto from GFE # 3 03. Homeowner's insurance for 1 eare to $1 050 POC from GFE # 11 p4. $ 0.00 $ 0.00 9 05. 1 000. Reserves De osltetl wtth Lender 1 001. Initial de stt for ur escrow account from GFE # 9 $ 0.00 1 002. Homeowner's insurance months $ r month $ 0.00 1 003. Mort a e insurance months $ er month $ 0.00 1 004. Pro a taxes months $ er month $ 0.00 1005. School taxes months 5 er month $ 0.00 1008. months $ r month $ 0.00 1007. A re ate Atl'ustment enter as a n save 1008. 1100. TKIe Cha es 1101. Title services to: Thomas P. Gleason Es uire from GFE # 4 $450.00 1102. Settlement or closin fee [o: Thomas P. Gleason Es uire $50.00 850.00 1103. Owner's fi6e insurance from GFE # 5 1104. Lendefs title insurance to: 1105. Deetl Pre aragon b Thomas P. Gleason Es uire $85.00 1108. Nola Fees 1107. Document Pre radon to Monison Law Offices $150.00 1108. Untlerwdters rtion of the total tt6e insurance remium 1109. Abstract/tille search fee tc: 1110. Wire fee 1111. 1112. 1200. Government Recordin antl Transfer Cha es 1201. Government recordin char es to: from GFE # 7 1202. Deetl 582.00 Mort a e 2 at $82.00 Releases 1203. Transfer taxes ta: from GFE # e 8188.00 1204. Ci /Coon taxlstam s $950.00 8950.00 1205. State tax/stem s $950.00 $950.00 1206. Memorandum of Lease to Recorder of Deetls 1207. 1208. 1300. Atlditlonal Settlement Cha es 1301. R uiretl services that ou can sho for from GFE # 8 1302. 1303. 1304. ~ ~II a abl Bo $31.47 1305. 1306. 1307. 1308. 1400. Total Settlement Cher es enter on Tines 103 Section J and 502, Sectlon K $2,516.00 $1,116.47 CERTIFICATION I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and bell it is a true and accurate statement of all receipts and disbursements made on my a nt or by me in this Vanlsacticn. I further cerTN^fy that I have received a copy of the HUD- ettement Sta ment. Q-. 1. 1.~ ~ ~ Seller Buyer Christinea ung, Execu 'x ouglas E. Bolinge Estate of Kenneth L. Om m Seller Buyer To the best of my knowledge the HUD-1 Settlement Statement which 1 have preparetl is true and aaurete account of the funds which were received and have been or will be tlisbursetl by the u^fn~~~dersignetl ans part of lament Of this transaction. C yo l C ~~S-.Yement Ageni ~/lD (~.. Ci(~ ^-s ® ThorpeFwms.com $7p0.00 8700.00 8950.00 $850.00 Nob: Ilyou nave ems pueaeans eheN Na Setllemenl Cheryes end Loan Taime Ilelea on llvs (oen, pbaea wMaclyour lentlar. PrcNOUe BEI~IOO afa oospleb MUd"I NLAO CER7IFlCATION OF BUYER AND SELLER I haw narefuAy mviavbtl th HUD7 SeWemem Statement Bntl m the best of my knorAetlpe aIM tbflef, ll b e tma antl amreb atabment of ell receipts and Msbwaeme+Aymatle onmy aaoum orby me bNis henaegbrt I funkier mnpy Net I Mw received q copy m th HU0.1 Setpemam Statement E. Bolinger .~ c ~~ ~X-Fcv-- Sa~f Chdsfinee Young, Ez cuNx Esffie of Kenneth L. Omdorlf Tha HU61 Ssttlenront StabmeM xidM I hew prepared Is a uue antl acazeb aocelml of pda aanseNOn I have ceuwd orvaA cause the (once b be tllabunmtl m accertlence vAN Nb sbbmem. SEiTLEAAEf1(AGENT r DATE WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMEMS TO THE UNRED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON COtdNCT10N CAN INCLUDEA FINE AND IMRISONMENT. FOR DETAILS SEE TITLE 1A: U.S. CODE SECTION 1001 AND SECTION 1010. Fravb~~ ~diilons e2 J..~:..2:e ~_ a n ? HUD-1 REV-a5o3 E%+ (&va) Pennsylvania iil DEPFRTMENT OF PEVENUE INHERITANCE TAX RETURN SCNEpULE B STOCKS & BONDS ESTATE OF FILE NUMBER KENNETH L.ORNDORFF All property jointly owned with right of survivorship must be disclosed on Schedule F. tf more space is needed, insert additional sheets of the same size REV-i5o8 E%+(o8-iz) SCNEDIILE E pennsylvania Lrl DEPARTMENT OF REVENUE CASFIr BANK DEPOSITS & MISC. INHERRANCE TA%RETURN PERSONAL PROPERTY RESIDEM DECEDENT ESTATE OF: FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIP170N OF DEATH 1, 2010 Ford Focus (See purchase data from Jennings Chevrolet in Chambersburg) 10,500.00 2. Cash on hand 7,478.14 3. I RA Distribution 1, 800.89 4. Payment from Dan Hershey Auction 189.00 5. Refund from Patronage Capital 45.52 g. Refund from Highmark Blue Shield 462.03 7, Refund from GM protection plan 649.13 g, Refund from Nationwide Insurance 137.40 g. Sale Remington 22 cal rifle to Richard J. Omdorff 175.00 10. Refund from Medico 49.73 11. Funds received from Gettel's Salvage for scrap aluminum 35.85 12, Proceeds received from TL Sheffer Autioneer for public sale of personal property occuring on May 21, 2012 17,935.26 13, Refund check from US Treasury for overpayment of 2011 taxes 188.20 14, Sale of Remington 30-06 and Remington 270 to Christinea Young 700.00 15. Sale of Westemfield 16 gage shotgun and Remington 30-06 to David E. Omdorff 525.00 16. Refund received pursuant to sale of 39 Sandbank Road for payment of School Taxes. 506.16 TOTAL (Also enter on Line 5, Recapitulation) $ 41,377.31 If more space is needed, use additional sheets of paper of the same size. ~~.~.~ CHECK cxEVtwterotnsxoeaECAatuc,ex CONTROL NO. 49129 ISSUED BY: MCBRIDE,RENL~°°N°a CHAMBE95BURG,PA77201 PAGE 1C .CHECK FiACR.^~RQU."tD AREA Ct9AK ES CCiCR GkADU+ l'~OA T ~ v P ~ hl ..:4p 1 .~~ `i. _.'° Y mil r .~ °O~ JENNINGS CHEVROLET OLDSMOBILE CADILLAC, INC. O A n~ ~~ 340 North Second SVeet F & M TRUST '+J P.O: Boz 457 cne~,.w~, Pa mbi 49129 - 1 Chambersburg, PA 17207 _.> i71FY1: ` :' Fi15Y 7kBfi,AMDEINT-; - , AAiI:#INT 0>= ~NEGK . -< 16FEB12 ******10,500 DOLLARS 00 CENTS *****10,500.00 JENNINGS CH~F7/~tOLET OLDSMOBILE CADILLAC, INC. TO THE ORDER OF ESTATE OF KENNETH L ORNDORFF , } ~~~ \ AIIT~Q~~e~~7UPE ' n•049i29i1' 1:0 3 1 304 3061: LOrrt43366n• DETACH AT PERFORATION BEFORE DEPOSITING CHECK REMITTANCE ADVICE REV-TSOg E%+ (oi-io) ~ Pennsylvania DEPARTMENT OF REVENVE INHERITANCE TAX RETURN RESIOEM DECEDENT SCNEDIILE F 70INTLY-OWNED PROPERTY ESTATE OF: KENNETH L.ORNDORFF If an asset became jointly owned within one year of the decedent's date of death, it must ba reported on Schedule G. SURVIVING JOIN TENANT(S) NAME(S) I ADDRESS I RELATIONSHIP TO DECEDENT A• Christine L. Young (aka Christinea Young) 44 Sand Bank Road Shippensburg, PA 17257 B. C. 70INTLY OWNED PROPERTY: Daughter ITEM NUMBER LETTER FOR ]DIM TENANT DATE MADE JOIN DESCRIPr10N OF PROPERTY INCLUDE NAME OF FINANCIAL INSIRUrION AND BANK ACCWNT NUMBER OR SIMILAR IDEMIFYING NUMBER. ATTACH DEED FOR JOINRY HELD REAL ESrATE. DATE OF DFATH VALUE OF ASSEr %OF DECEDEM'a IMERESr DATE OF DEATH VALUE OF DE(FDENr5 INIERESr 1. A. 04/21100 Orrstown Bank Checking Axount No. 102000404 4,470.86 50 2,235.43 2. A. 08/23110 Orrstown Bank CD No. 4000038909 10,008.48 50 5,004.24 3. A. 08123110 Orrstown Bank CD No. 4000038911 20,034.90 50 10,017.45 4. A. 07/08109 Orrslown Bank CD No. 4000033667 9,987.71 50 4,993.86 5. A. 07108109 Orrstown Bank CD No. 4000033666 9,973.11 50 4,986.56 6. A. 03/30/09 Orrstown Bank CD No. 4000032223 10,017.29 50 5,008.65 7. A 03130/09 Orrstown Bank CD ND. 4000032222 10,017.52 50 5,008.76 TOTAL (Also enter on Line 6, Recapitulation) $ 37,254.95 If more space is needed, use additional sheets of paper of the same size. 0.EV-1510 E%+ (OB-09) Pennsylvania DEP0.PTMENT OF PEVENUE INMERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER KENNETH L. ORNDORFF 12110921 This schedule must be completed and Flled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ~fA NUMBER DESCRIFfION OF PROPERTY iNawE me NWE of mE rnwsea~, mDP PaanoNSnIP ro oECeoalr ano me are aFTRWSeac aTraaaCDPr OFTME OeEn mR Heal esTare. DATE OF DEATH VALUE OF ASSET % OF DECD'6 INTEREST EXCLUSION IF ]PMICPHLE TAXABLE VALUE 1. Orrstown Bank CD No. 4000042556 established as joint account on 17,001.57 50 17,001.57 0811112011 with Christine L. Young (aka Christinea Young) Daughter 2 Orrstown Bank CD No. 4000041041 established as joint account on 8,311.85 50 8,311.8E 03124/2011 with Christine L. Young (aka Christinea Young) Daughter 3 Orrstown Bank CD No. 4000040576 established as joint account on 10,718.90 50 10,718.9( 0212212011 with Christine L. Young (aka Christinea Young) Daughter 4 Orrstown Bank IR4 Account No. 1498 with Christinea Young as beneficiary 370,569.18 100 370,569.1E 5 Federated Money Mkt. Acct 60934N625 with Christinea Young as benefciary 14,144.38 100 14,144.3E TOTAL (Also enter on Line 7, Recapitulation) # 420,745.88 If more space is needed, use additional sheets of paper of the same size. REV-1511 E%+ (10-09) ~ Pennsylvania SCHEDULE H DeRARrnEnr Dr REVENUE FUNERAL EXPENSES AND INHE0.mANCE TA%RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER KENNETH L.ORNDORFF Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Fogelsanger-Bricker Funeral Home 10,994.40 z. Greencastle Bronze 8 Granite for Memorial Stone 2,620.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 5,250.00 Name(s) of Personal Representative(s) ChflStinea YOUn9 _ _ _ street Address 44 Sandbank Road city Shippensburg state PA zIP 17257 Year(s) Commission Paid 2013 _ _. _ __ 5,250.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address ___ __ __. __ __ _. _ _ city _.. __ _._ _____ State _._ZIP _. Relationship of Claiman[to Decedent _ _ 4. Probate Fees: 348.50 5. Accountant Fees: 6. Tax Re[um Preparer Fees: 7 Mountain Foot Gun Shop for appraisal of decedent's guns 250.00 B. Estate Publication in Cumbedand Law Journal 75.00 s. Estate Publication in Sentinel 168.30 to. Transfer Tax for sale of real estate located at 39 Sandbank Road 950.00 >>. Seller's Assistance to buyer of 39 Sandbank Road for closing costs. 5,000.00 tz. Deed preparation and settlement fee for 39 Sandbank Road real estate. 135.00 -rr~,~ Flzo~v~ arcw2.~~ti~ aaa;~.~ti.~ taa~:e_ I.s,a.~c~ TOTAL (Also enter on Line 9, Recapitulation) ; 32,619.56 If more space is needed, use additional sheets of paper of the same size ESTATE OF KENNETH L. ORNDORFF SCHEDULE H ADDITIONAL PAGE 13. Payment to Vivian Coy, Tax Collector, for property taxes for 39 Sandbank Road property. $1,338.36 14. Payment to John D. Young for labor to help prepare for Estate sale of personal property. $120.00 15. Payment to Michael McBeth for labor to help prepare for Estate sale of personal property. $120.00 Total on this page $1,578.36 REV-1512 EX+ (12-12) ~,~Jpennsylvania SCHEDULE I i~il DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERRANCE TAk RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDEM ESTATE OF FILE NUMBER Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Mortgage payoff to Orrstown Bank 14,044.21 2. Monthly mortgage payments to Omstown Bank between date of death and sale of property (1/1012013) 1,884.72 3. Monthly payments to Adams Electric between date of death and sale of property (1/1012013) 423.86 a. Monthly payments to Borough of Shippensburg for water between death and sale of property 184.86 5. Stoltzfus 8 Heiman Roofing for new roof priorto death 2,126.33 6. Payment to H. Anthony Adams for preparation of 2011 tax return 327.00 7. Payment to Carl Bert Surveying 300.00 8. Payment to Nationwide for homeowners insurance 414.00 9. Century Link for telephone bill 34.27 10. CCS Medical for diabetic supplies 24.71 11. Stoken Opthalmology 8.11 12. Norland Family Practice 70.00 13. Rocky Mt. Mowers for servicing of mower 83.52 ta. Young's ATV Shop for servicing of ATV 56.02 TOTAL (Also enter on Line 30, Recapitulation) I; _.. 19,979.63 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (O1-10) ~ pennsylvania SCHEDULE J OEPARTMENi OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDEM ESTATE OF: FILE NUMBER: KENNETH L.ORNDORFF RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS Of PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1.1 2. ~! 3. 4. Jeffrey Omdorff, 99 Shippensburg Mobile Estates, Shippensburg, PA David Omdorff, 488 Furnace Hollow Road, Shippensburg, PA Richard Omdorff, 43 Sand Bank Road, Shippensburg, PA Christina Young (aka Christinea Young) 44 Sand Bank Rd Shippensburg lineal (son) lineal (son) lineal (son) lineal (daughter) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1R OF REV-1500 COVER SHEET, AS APPROPRIATE. 11 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 13 OF REV-1500 COVER SHEET. $ [f more space is needed, use additional sheets of paper of the same size. 25 25 25 25 LAST WILL AND TESTAMENT OF KENNETH L. ORNDORFF KNOW ALL MEN BY THESE PRESENTS, that I, KENNETH L. ORNDORFF, of 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 all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment by my Executor of all my legal debts, burial expenses including my grave marker and my federal estate and state inheritance taxes together with the cost of administration of my estate as soon as may be conveniently done following my death leaving all specific bequests free of tax to the legatee. SECOND: I give and bequeath my 760 Remington 30.06 rifle and my Springfield 30.06 rifle to Christina Young. THIRD: The rest and residue of my estate, be it real, mixed or personal, of whatever nature or kind, I give, devise and bequeath to my children, Jeffrey Orndorff, David OrndorfF, Richard Orndorff and Christina Young, in equal shares, share and share alike, per capita. FOURTH: I name H. Anthony Adams to be my Executor of this my Last Will and Testament. Should he fail or cease to act, I name Christina Young to be my Executrix of this my Last Will and Testament. If administration of my estate should be necessary in any jurisdiction where my Executor is unable to qualify or if my Executor deems it necessary for any other reason, I give to my Executor the power to designate any individual or corporation with trust powers to serve with my Executor or in my Executor's stead. I request that no security be required of any Executor, including an Executor named pursuant to the preceding sentence. References in my will to my "Executor" are to the one or ones acting at the time, except where otherwise specifically provided. I grant my Executor the powers set forth in 20 Pa. C.S. §§ 3311-3332 and 20 Pa. C.S. § 780.6 respectively. My Executor may distribute tangible personal property passing to a minor to any adult person with whom the minor resides, and that person's receipt shall be a sufficient voucher in the accounts of my Executor. [x WITNESS WHEREOF, I, KENNETH L. ORNDORFF, to this my Last Will and Testament set my hand and official seal, this ~~ day of 2009. `I` ~_~.~/ ~ ~ (SEAL) ENNETH L. ORNDORFF~- Sworn to and subscribed, declared and Published by KENNETH L. ORNDORFF, as His Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at his request, And in his presence and in the presence Of each other. ~~- COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, KENNETH L. ORNDORFF, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. 71~~.fatt ~ rKENNETH L. 0 DORFF Sworn to and acknowledged, before me, By KENNETH L. ORNDORFF, the Testator, This ~ fn day of 2009. --.~~-- Notary Publit coMMONwe~ua'fl of reNNSnunNu Notarial Seal Bolo, C Nowryberlend Cowry Mycommbawn E,cWres May st, 2oio COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF.CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses, and that to the best of our knowledge and belief the Testator was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or• undue inFluence. Swom to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this _~ day of ~ 2009. Notary Public COMMONWEALTH OF PENNSYLVANIA H. Mtlwny A~dems, N~a4ary PubUc sr~an.a,ro 6oro, cunmenana Camry My CoaaNsalon E~Irea May 31,2010