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HomeMy WebLinkAbout03-28-13 (2) REV-1500 EX (01.10) 1505610140 PA Department of Revenue OFFICIAL USE ONLY Bureau of individual Taxes Casey Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 0 5 5 1 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 4 3 0 2 0 1 2 0 4 1 9 1 9 1 9 Decedent's Last Name Suffix Decedents First Name Ml K U T C H M A N S Y L V I A M (If Applicable)Enter Surviving Spouse's Informadon Below Spouse's Last Name Suffix Spouse's First Name All Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW © 1.Orighiai Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death prior to 12-13-82) x, ❑ 4.Limited Estate ❑ 4a.Future interest Compromise(date of ❑ 5.Federal Estate Tax Return Required death after 12-12-82) © 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ❑ 9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(date of death ❑ 11.Election to tax under Sac.9113(A) between 12-31.91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION fNUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C.) S U S A N J H A R T M A N 7 1c=7a 2 4 4; 0 RBG F us�t� ' CXD First lima of address C7 1 I R V I N E R 0 W < �r =r c. Second line of address i.Y City or Post Office State ZIP Code DATL��LED C A R L I S L E P A 1 7 0 1 3 corresponderWe e-mail address: susaniduncanhartmanlaw•com Under penalties of perp",I declare that I haw esamned No ream,IndudkV eoaxnpaft0V sdwduln and statements,and to the beet of my knowledge and belief, it is true,correct and comptata.Declaratlm of prop"other than the personal representative is based on as kttarnstim of which prepwr has any knowledge. SIGNATUiF PERSON RESfONSIBIIIE F1 ET FILING URN ADDRESS {Y 75 RUS. ELL ROAD CARLISLE PA 17015 SIGMA RE OF PREPAREf R� G ENTATIVE DATE _j t Rt1f 11_ P/b C4 lei, tL Ply 17,018 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedents Social Security Number Decedents Name: SYLVIA M. KUTCHMAN RECAPITULATION 1. Real Estate(Schedule A) .. ... ... . 1. ? 3 0 D . 0 0 2. Stocks and Bonds(Schedule B) .. ..... . . 2, 1 4 9 0 . 9 7 3. Closely Held Corporation,Partnership or Sote-Proprietorship(Schedule C) 1 4. Mortgages and Notes Receivable(Schedule D) 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ... .. & 1 6 2 2 . 7 5 6. Jointly Owned Property(Schedule F) [:] Separate Billing Requested 6- 1 8 1 6 0 . 0 2 7. Inter-Vivos Transfers&Miscellaneous N Probate Property (Schedule G) Separate Billing Requested 7, 1 2 9 8 4 1 . 6 8 & Total Gross Assets(total Lines I through 7) ..... . 8. 2 3 8 4 1 5 . 4 2 9. Funeral Expenses and Administrative Costs(Schedule H) ... . .. . . . .. . . . .. . 9. 2 0 6 2 4 . 4 2 10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . 10. 1 It 3 8 2 . 7 6 it- Total Deductions(total Lines 9 and 10) . .... ... . . . ... . .. .. 11. 3 8 0 0 7 . 1 8 12. Net Value of Estate(Line 8 minus Line 11) . . . .. . . . . . . . . . . . . . . . . . . . . . . . 12. 2 0 0 4 0 8 . 2 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 2 0 0 4 0 8 2 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X 0 _ 0 . 0 0 15. 0 . a a 16. Amount of Line 14 taxable at lineal rate X 045_ 2 0 0 4 0 8 . 2 4 16. 9 0 1 8 . 3 7 17 Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17 0 . 0 11 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 a 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 9 0 1 8 - 3 ? 20- FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 REV-1500 Ex Page 3 File Number Decedent's Complete Address: 21 12 0551 DECEDENPS NAME SYLVIA M. KUTCHMAN STREETADDRESS 343 N . 19TH STREET CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 9,018 -37 2. Credits/Payments 7,500 00 A.Prior Payments B.Discount 394 -73 Total Credits(A+B) (2) 7,894 .73 3. Interest (3) 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 26 to request a refund. (4) 0 . 00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,123-64 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; ............................... ❑ 0 c. retain a reversionary Interest;or ...... .. . . ........................................ ❑ nX d. receive the promise for life of either payments,benefits or care? ................ ............................. ❑ nX 2. If death occurred after December 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?.............._....... .............. ....................................................... ® ❑ 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)(1)1. 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 172 P.S.§9116(a)(11)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)172 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under, Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 LX-(01-10) pennsylvania SCHEDULE A OEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SYLVIA M. KUTCHMAN 21 12 0551 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 compeiled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned 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 decedents interest it owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 • 343 N . 19TH STREET, CAMP HILL, PA 87,300. 00 ' [SEE HUD SHEET ATTACHED] TOTAL(Also enter on Line 1,Recapitalahom) $ 87,300 .00 If more space Is needed,use additional sheets of paper of the same size. REV-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SYLVIA M. KUTCHMAN 21 12 0551 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH f. WELLS FARGO ADVISORS 11490. 97 ' [SEE ATTACHED] TOTAL(Also enter on line 2,Recapitulation) $ lit-190-97 (It more space is needed,insert additional sheets of the same size) i REV-1508 EX-(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.TAX IN R SIDE TED EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER SYLVIA M . KUTCHMAN 21 12 0551 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 DESCRIPTION OF DEATH 1. REBATE FROM PA TAXES 250 . 00 ' 2 • PPL REFUND 38 . 41 ' 3 • PROCEEDS NCR STOCK 398 . 15 ', 4 • AMERICAN WATER COMPANY REFUND 4 . 33 ' 5 . PAID SEWER BILLING - CREDIT -SALE OF HOUSE 102 . 67 ' [SEE HUD SHEET ATTACHED] 6 • SCHOOL TAXES PAID - CREDIT - SALE OF HOUSE 803 . 621 [SEE HUD SHEET ATTACHED] 7 • PENN WASTE REFUND 25. 57 ' TOTAL(Also enter on line 5,Recapitulation) $ 11622 -751 (If more space is needed,insert additional sheets of the same size) REV-1509 EX-(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SYLVIA M . KUTCHMAN 21 12 0551 U an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. JANET LUSH 75 RUSSELL ROAD DAUGHTER CARLISLE, PA 17015 B. WILLIAM KUTCHMAN 3014 DICKENSON AVE SON CAMP HILL, PA 17011 c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION PROPERTY % DATE DEATH ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF I NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTSINTERESTI 1. A. 9/09 SOVEREIGN BANK SAVINGS ACCT - 100 . 30 50 . 50 . 151 tt 1694302827 [SEE DOD LETTER ATTACHED] 2 • B . 5/97 SOVEREIGN CHECKING ACCT - 863.59 50 • 431.80 ' # 2331028826 [SEE DOD LETTER ATTACHED] 3 . A . 5/97 PNC BANK CHECKING ACCT - 35,231 . 11 50 . 17,615. 56 ' u 5000868961 [SEE DOD LETTER ATTACHED] 4 - A . 6/10 PNC BANK SAVINGS ACCT - 125. 01 50 - 62 . 511 tt 5112697589 [SEE DOD LETTER ATTACHED] TOTAL(Also enter on Line 6,Recapitulation) $ 18,160-021 If more space is needed,use additonal sheets of paper of the same size. REV-1510 EX-(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER SYLVIA M . KUTCHMAN 21 12 0551 This schedule must be completed and fled if the answer to any of questions i through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST prnraucneLEl VALUE 1. WESTERN NATIONAL LIFE INSURANCE 129,841 . 69 40 . 00 51,936 . 68 JANET K - LUSH - DAUGHTER - 06/2012 2 • WESTERN NATIONAL LIFE INSURANCE 1291841 . 69 40 . 00 51,936 . 68 ' WILLIAM KUTCHMAN - SON - 06/2012 3 • WESTERN NATIONAL LIFE INSURANCE 129,841 . 69 5. 00 6,492 . 08 ' SUMMER ROSE HOWARD-GRANDDAUG-06/2012 4 . WESTERN NATIONAL LIFE INSURANCE 1291841 . 69 5 . 00 61492 . 08' SIERRA ANN LUSH-GRANDAUGHTER-06/2012 5• WESTERN NATIONAL LIFE INSURANCE 1291841 . 69 5 . 00 6,492 . 08 ' KEITH EDWARD KUTCHMAN-GRDSON-06/2012 6 - AMANDA JEAN KUTCHMAN 1291841 . 69 5. 00 6,492 . 08 ' AMANDA JEAN KUTCHMAN-GRDDAUG-06/2012 TOTAL Also enter on Line 7,Recapitulation) $ 1291841 - 68 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SYLVIA M . KUTCHMAN 21 12 0551 Decedent's debts must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. MYERS—HARNER FUNERAL HOME 91131 . 00 2 - LUNCHEON 900 . 00 3 - ROLLING GREEN CEMETERY COMPANY 11730 . 001 4 - ROLLING GREEN CEMETERY COMPANY 225. 00 ' B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: p, Attorney Fees: DUNCAN & HARTMAN, PC 71500 .00 ' 3, Family Exemption:(If decedents address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. PmbateFees: REGISTER OF WILLS 369 . 50 5 Accountant Fees: 6. Tax Return Preparer Fees: RICHARD SIMPSON 200 . 00 ' 7. CUMBERLAND LAW JOURNAL 75 . 00 ', 8 - THE SENTINEL — LEGAL 178 . 92 ' 9 - FILING FEE 15. 001 10 - HELD IN RESERVE 300 .00 ' TOTAL(Also enter on Line 9,Recapitulation) E 2 0,6 2 4 . 4 2 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX,(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER SYLVIA M . KUTCHMAN 21 12 0551 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PA AMERICAN WATER COMPANY 80 . 47 2 - PPL 334 . 06 ' 3 - AT&T 66 . 17 ' 4 - PA AMERICAN WATER COMPANY 44 .05 ' 5 - AT&T 2 .65 6 - PPL 210 . 52 ' 7 - PA AMERICAN WATER COMPANY 45.06 ' 8 - PPL 180 . 53 9 - PA AMERICAN WATER COMPANY 50 . 57 ' 10 - PPL 167 . 63! 11 - DELUXE CHECKS 20 .50 ' 12 - HOUSE CLEANING 260.00 ' 13 - CARPET CLEANING - HOUSE 270 . 03 ' 14 - PPL 135.00 15- PA AMERICAN WATER COMPANY 35. 39 ', TOTAL(Also enter on Line 10,Recapitulation) $ 17,382 - 76 If more space is needed,insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent SYLVIA M. KUTCHMAN 21 12 0551 DecedenCs Name Page 1 File Number Schedule I-Debts of Decedent, Mortgage Liabilities,& Liens ITEM NUMBER DESCRIPTION AMOUNT 16- CAMP HILL BOROUGH - SEWER 176.75 17. PA AMERICAN WATER COMPANY 15.89 18. PPL 81.36 19. PA AMERICAN WATER COMPANY 89.06 20 - BOROUGH OF CAMP HILL -SEWER 165.00 21. PPL 125.14 22 . PENN WASTE, INC . 41 . 55 23 - REALTOR COMMISSION - SALE OF HOUSE 41660 . 00 [SEE HUD SHEET ATTACHED3 24 - DUNCAN & HARTMAN, PC - SALE OF HOUSE 325.00 [SEE HUD SHEET ATTACHED] 25. CITY/COUNTY STAMP FEE - SALE OF HOUSE 436 . 50 [SEE HUD SHEET ATTACHED] 26- STATE TAX -SALE OF HOUSE 436. 50 [SEE HUD SHEET ATTACHED] 27. 2012 SCHOOL TAXES - SALE OF HOUSE 21226-40 [SEE HUD SHEET ATTACHED] 28. TAX CERTIFICATION FEE - SALE OF HOUSE 10.00 [SEE HUD SHEET ATTACHED] 29. COUNTY TAXES - 1/1/13-2/4/13 - SALE OF HOUSE 69.94 [SEE HUD SHEET ATTACHED] 30 . HOUSE REPAIRS 2,340.50 SUBTOTAL SCHEDULE 1 11,199-59 Continuation of REV-1500 Inheritance Tax Return Resident Decedent SYLVIA M. KUTCHMAN 21 12 0551 Decedents Name Page 2 File Number Schedule i-Debts of Decedent, Mortgage Liabilities,&Liens ITEM NUMBER DESCRIPTION AMOUNT 31- LOWE 'S - HOUSE REPAIRS 789.20 32- PPL 93.11 33- US TREASURY - 2012 TAXES 31273.00 34 . STATE FARM INSURANCE 37.35 ' 35- PPL 87.88 SUBTOTAL SCHEDULE I 41280-54 GRAND TOTAL SCHEDULE $ 17,382.78 REV-1513 EX�(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: SYLVIA M . KUTCHMAN 21 12 0551 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustse(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include out7ht spousal distributions and transfers under Sec.91 i6(a)(1.2).] 1. JANET K. LUSH Lineal 75 RUSSELL ROAD 40% SHARE CARLISLE, PA 17015 2 . WILLIAM J . KUTCHMAN Lineal 3014 DICKENSON AVENUE 40% SHARE CAMP HILL, PA 17011 3 • SUMMER HOWARD Lineal 75 RUSSELL ROAD 5% SHARE CARLISLE, PA 17015 4 . SIERRA LUSH Lineal 1716 LINCOLN DRIVE 5% SHARE CAMP HILL, PA 17011 5 • KEITH KUTCHMAN Lineal 16 RUSTY CLAY RIDGE 54 SHARE FAIRVIEW, NC 28730 6 • AMANDA KUTCHMAN Lineal 134 ROBIN LANE, APT . fl 4 5% SHARE HUMMELSTOWN , PA 17036 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. H. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L TOTAL OF PART It-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed,use additional sheets of paper of the same size. __ I REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 7,500 • 00 Discount: 394 -73 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 _ — 1985 _ 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 _ 2000 2001 2002 2003 2004 2005 _ 2006 2007 — -.--- -- 2008 2009 — - -- 2010 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: LAST WILL TESTAMENT OF I, SYLVIA M. KUTCHMAN, of the Borough of Camp Hill, Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I bequeath certain articles of my tangible personal property in accordance with a written list made by me during my lifetime. In the absence of designation of such a list, said articles of tangible personal property shall be distributed to my children, WILLIAM J. KUTCHMAN and JANET K. LUSH, in equal shares. THIRD. I give, devise and bequeath my Stock Portfolio as follows: A. Unto my daughter, JANET K. LUSH, Fifty Percent (50%) share of my Wachovia Securities Account; B. Unto my son, WILLIAM J. KUTCHMAN, Ten Percent(10%) share of my Wachovia Securities Account; C. Unto my granddaughter, SUMMER ROSE HOWARD, Ten Percent(10%)share of my Wachovia Securities Account; D. Unto my granddaughter, SIERRA A. LUSH,Ten Percent(10%) share of my Wachovia Securities Account; E. Unto my grandson, KEITH KUTCHMAN, Ten Percent (10%) share of my Wachovia Securities Account;and F. Unto my granddaughter, AMANDA KUTCHMAN, Ten Percent(10%) share of my Wachovia Securities Account. FOURTH. I give, devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wheresoever situate as follows: A. Forty Percent(40%)unto my son, WILLIAM J. KUTCHMAN,or his issue, per stirpes. & Forty Percent(40°to)unto my daughter,JANET K. LUSH, or her issues, per stirpes. C. The remaining Twenty Percent (20%) unto my grandchildren, KEITH KUTCHMAN, SUMMER ROSE HOWARD, SIERRA A. LUSH and AMANDA KUTCHMAN, in equal shares, per stirpes. FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SIXTH. I hereby nominate, constitute and appoint my daughter, JANET K. LUSH, as Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of JANET K. LUSH, I nominate, constitute and appoint my granddaughters, SUMMER ROSE HOWARD and SIERRA A. LUSH as Co- Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this,my Last Will and Testament, consisting of two typewritten pages this day of Majalh 2007. rv\ Ktx SYLN4A M. KUTCHMAN Signed,sealed,published and declared by the above named Testatrix SYLVIA M. KUTCHMAN as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ZZ-11. �7 COMMONWEALTH OF PENNSYL VANIA SS. COUNTY OF CUMBERLAND I, SYLVIA M. KUTCHMAN, Testatrix whose name is signed to the attached or foregoing instrument,having been duly qualified according to law,do hereby acknowledge that I signed and executed the instrument as my Last Will;that I signed it willingly;and that I signed it as my free and voluntary act for the purposes therein expressed. SYL A M. KUTCHMAN Sworn or affirmed to and acknowledged before me,by SYLVIA M. KUTCHMAN this FS day F _- N=TAR of mafGh 2007, 1 Kathy L.Mblic Borough of Ca Co.,PA Notary P bl MY Commisst,2047 COMMONWEAL TH OF PENNSYL MANIA SS. COUNTY OF CUMBERLAND We, 5')Scan ( qtr "Vl and J OG r AGIGIIVS the witnesses whose names are signed to the attached or foregoing instrument,being duty qualified according to law,do depose and say that we were present and saw SYLVIA M. KUTCHMAN sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed;that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. U Sworn or affirmed to and subscribed before me by SuSaa S Martmall and �c7 c n T> f c l Q rYi witnesses, this 0,S day of 2007. N 0'taryZu ic (v—^NOTARIAL SEAL Kathy L.Mummert,Notary Public Borough of Carlisle,Cumberland Co.,PA My Commission Expires Aug.11,2007 A. Settlement Statement U.S.Department of Housing OMBApprovai Ho 2502-0285 and Urban Development (axpinm 11/3012009) B..-Type of Loan __.. _.... _.__.._. _^3 File Heroes _.... _._ 7.Loll Nuob' -. .... !8 Malgbpb InSumoe Cage Number 1 ❑ m FHA 2 ❑ FHA 3 ❑Conv.Unins. 4. ❑ VA 5. ❑Conn.166, P147174,003-13 C. Note: Thm form is,Paid o to is you a ahtamsni at actual seObtMm costs Amadine paid ro and by the aeMembnt agent are slwwn.items marked "{p.a c.}°costa paid aNada cbaug;they am shown!rem is i_M_o_rmelbnei pugwaea and not innWded in aro totals, D Name and Atldres5 alaw�pMt E HemeeMAdtlm"M%110r �f Name anO Atldm"dLMdM Barclay W.Fitzpatrick,Jr. Janet K. Lush, Executrix Mary Jane Casavant 125 N.30th Street Camp Hill 17011 G Properly Lonaon iH.sernermm Apanr. 343 N. 19th Street I Peter R.Wilson E Camp Hill Borough,Cumberland County Ple d �._..---�_--� 'I.SdWammt DiUf Camp Hill PA 17011 7700 Bent Creek Boulevard,Suite 140 (214113 Mechanicsburg PA 17050 1�aro2/4/ir 3 J.Summary of Borrower's Transaction K.Summary of SsIleN Tnmactmn 100. Gross Amount Dw From Borrower 400. Grose Amount Due To Son. 102 sewement nneyea w epmaaar ens r4W 2 065 00 403 _ _ tO 1W Adjustments for items paw by aster in advance Adjustments for Kerns paid by salter In ad"not rod. c;Nrtwm wm w 4ae,cnynam taus _ ro 107_twnly webs w eot. coanry mesa w 0.00 108. Ae"aNwnn b app AaanemMta 10 ,pa, Server 2!4113 m3J31f13 F -- 102$7 ape Sower 2!4!13 u,W31113 - 102.87 vp.School 214113_,_106/30/13 803.fi2 a1a.School„�_214/t3 w613t)ti3 � 803.82 111 --to- art. m _ .... nx __.__-... w _.1._._-.� 41z. .....___.__ ..a 115. w __._..-_,..A11 so 113 w ` 414. w 115 I 120. Oro"Amount Due From Borrower 90,271.29 420. Gross Amount Due To$*liar 88,206.29 200. Amounts Pala By Or In BshaN W Borrower 600. Reductiotm in Amount Due To SeIW T...__ . -. --- _. ._ mt_oepu_a«aamaamaq_. ..._..500000 a01. Euw a�oaasa t!a.bwwbecw!nt.._ - -i..� . mzP la,4nam a_ewaw_Is} _ aaz..-5enwnenl rnarq»mbswr pnr!spot __^ _L_ $094.40 203 .._241!W_e_.➢ .__ _._ __ ___"___i_ bid_. 207 ;PQ _ ..... _.. ._1 _._.. Adjsisunenb far ihnle unpaid bysNisr_--_ .. _. _..._. ___Adjust+nanm fw items unpsldMsaa«_. -. .. _. 210 CiT'UL- a._.___.._... w _ sm.citylWaItaxe._ Is gll_ _ _Cwn�daaa 1/1_/13--„w 2/4/13 ..._ 8994411. county taxes _1/1!13, w2/4/13 69.94 212 Assessmsna w all Asseurtwnu to Ttb. in � a13. to 2U, w 6141 71 s. b 61a.. 217 s1e w 229. tom!Pod By/For 13orir1wel 5.069.94 620. Total fus uctlon Amount ow Sella 8,164.34 300 Case At SHeamnR FmmRo flemoswr_ 609. Cash At 9NUament TolFrom Saber Sot 01vaeAemundm 4om eaten.,bar _.._.. .9027129 got cwsa una,m dwbwar(M,e.zm :` $8206.29 302 Lessamabepeaty-toloww,_Dww zzo} S _-506994 m2. Las.ratACama+n,lm_aa.Mme szpL _ _ ,8164.34) 393. Cash 0 From ❑ To Borrower 85,201.36 603. Cant ®To ❑ From SaMr 80,041.96 Section 5 Mika RW Estate SeblemeM Proeeduma AAA(RESPA)m4uirss section 4(a)of RESPA medWee Hod HUD devabp Sod immolate this the teliowing, a HUD noun devakp a SPWW tnmtmanon sooty m help Mandate form An be used at the farm of bm setlemenl M provide Na peso-borrowing moneY to Ormnoe the Purahaas M reedentlai real*stale discwsum of all chwipm unposed loan the borrower and"ear.These are to honer undsmmed IN nature and casts M met estate settlement senlces'. Ihed party disclosures that am designed to provide the bonoww min a Eaon lender must p wk*in*bod let to all applicants from wham it penment ovenna ion during the settlement puce"in cutler to IS a better mcervae a for when n prepaid a wrinen wokatfon to owulw molly to shopper. finance the patlmae of ressramiH ree ebtam:a Lomas must grinners,am The PQbft R"Wtmg Burden Mr one cpiledlan of edonnatWn a eeam ew distnbuM with ma booklet s Good Fears Esbmam M the sauMment coats to aveaoe area hour par respon".inaudol;the tine for ravieaing inMru4 that rid borrower is likely to incur in Connection with that"moment.These Lions,seeahm9 eabwp data Sources,gamemq and nminleNng the data disubwms am maedaton, needed.and completing and mvrowing the cotledpn of inkmnation This agency may 1mt coned M%infomnalmn,and you am not mounted to Oomipleta me ram,talked d diibpays a=nInty ndid ONIS Control ou nber r The mfamatwn requested does ool lard 4306 w coMrdemismy. Previous editions am obsolete Page I of 2 form HUD-1(3168) M Handbook 4305.2 L Settlement Chart ]ap iabl SO"Tt"CPnxelaebn weed on Pncs-s _67 300 00 q_ x• - .- — _ __. . . __.__0.99,F_ . Pem Fran Pam F. olvinon dCmareewn(I_ex]ooL°il^Ibwi' 0°r FuMa At At stern ]Ot f p ''. �, FuMaAI 702 S 703 Commhebn eam at sanlemea 4660.00 ]a Broker Fee 295.00, BOO. Ibma Peyabla In Connacbon Wkh Loan 00, Loan orgwboo FN % —_ 002. Loan paraur4 % I 001 ApixvawlFN b ON Lredl Repel to 005. LeMa'a Ine0ec010n Fee 800:.M.O._pVI Inewarba Appentlan FN b BW.AeaumpbnFN - - - 000. ._...__ 812. 900_Ihrm o1raA By LaMSr To as PaitliIAdvanea ExcluM urt dgnuka-xN pot DOI 902. M Ineurawa PremMlmM _—.WIrs _ -Y.rep 7.__ _ _.... _. . 9W Henbinueeap Preraym Xx _i._.._ 9 ___ ___.. —___—_—__ 905. 1000. Resarvss DepONKed YVkh Lsntlar _ __. IN, HazelalNurance mmlaf®!_ p1 mbnm .. 1002 F,wlyga wrowenos __.__-. ns^I^a�3._._. _R r-n!b_. 1003 Cgypop•ro raN 1p051006 Canty prap_aly uxa 1 moMllf�{ _. ___—P?r Toad! _ gnriwlasueanNb tone 1 ..nb'4n�s _ pa Ivr In 1_0m 1008. gWlegab gC00unkq galamunt 1100. Tlee C"ry"_,-_- 110, Sanbmerliwdwing _-- 1102 Awead a liw sarcb 10 _..._ _.. ..._.._.._ 1103 TBb exsanam b '' 'IN Tbaiaurany ,10s._obcuTem elm _----_ to Duncan&Hartman P.0 - 325.00 t,ro. Ndelyrea L upeeebvra Mama nunpn may...._. 1+ode rnN n.awlm _—ro Latsha Davis&,McKenna,P.C. _ 83400 __ - 1109. Lsro✓a oa°tea _... f _... :- 8730000 —�-- -._ •-_ 1200:Govammant staxwdlM and Trail" Can um Aamraa�l aaN oeee,_i _ _63.00 Mo a a s —— R NNa S _ - T__ 6300 02 12 cey{ewnlYlMaabmp:_ptaa f _^+w_➢1.ye s 436 50 _ 436 50 IIIIJ stile bvwmpa:ONe-=........ ___ 436.50 I 436.50 1zw. -�..-'-- - 1300..Additbnal,aaltlamatl Charges 13_01 SrrsZ-_ m t3p2 Pat bnPNlbn m - 1)(13 I rooa Tax Claim Bureau-2012 School Taxes , 21226.40 q06.Bambi Nevdle-Tax Certification Reimbursement 10.00 t3o] ,Joe. 14og. Tcbl 94Namenl Changes(enbr on gn.s 103 eaceon J and 602 aac0on KI 2,065.00 6 094 40 CERTIFICATION lure oRlul!/Ieof dla HU0.14Mlbmaa 5,/binerllOMbNanwYdm/b d arm belt,ab amw aM aa:urm wtanaddY reapla arb aYUraanenb m � Ian Ui'"^'��in W.�b.p n.I1W rN Wliben raNlada mpolFe HUPt LiLYyi.F Jan K.Lusts,Executrix Barely Fitzpatri�l Jr. _. Swr Mary J asavant Tales balamT HU618alYemNl bubrr,enl wnlrlllnare preNrNbamb rla.marw eaaxAd x18N we1aNlvea and lua aeenawu wdabeae by awndev wwnrnldaaeea.ebn Z N Zo1 ____ 0430 - ---—— 3— Peter Icon, V46RNIN '. bb•almarobgxnpfY rMbfdee aYlammbmeN Urkletl$bteam eaaarty oewaenear ball.Per WIN OPan Oaleblkkl ranlntl0oea irel elm v�pnsm!M11d.Fw awe age:Tpb 10 U.s.code Sadbn 1001 and serum rota. Prevbue edifims are obeelele Page 2 of 2 form HUD-1(3166) 10 Handbook 4305.2 R R C w � z8 pv° o cR_ c �c R �s E ° - lxxxx _ 8 OE a �a E 3n iV (a LM p CL o gY , <_z N� O .aJ, 8 YN QZ y� gTas TL �p Z fl aY V >O as 00 a m �3 $ LAC+ G NI- QQ 0 .. ` a dicw. Q G ..0 a g t` ^ g ° � R o �E 0 -� eR E V 6w`3 u CL a Z z E o aW°om 1 °� v ° try uf. a >w N a c7 +- F «c co Quo � z mc9 °c rTm ir iiw 2O >a E"4e�satwA cY w "- 0 O Z oh oz N � o �v �rR- � Mm � 0 }OD Y F TO _ O R O �CnC I aid C 75 E 16E� y¢ � Ea MCI 0 � � a Q LL QoD UF- SUN l0 Q Q _.. _.. _ _.. _.,..T. Sovereign Bank ESTATE OF Sylvia M Kutchman SOCIAL SECURITY#: 186-30-6123 DATE OF DEATH: April 30, 2012 Account#: 1694302827 Type Statement Savings Open date: 9/14/2009 In the name of: Sylvia M Kutchman or Janet Lush Date of Death Balance: $100.30 Int.(YTD) from 1/1/2012 to 1/24/2012 $0.05 Accrued interest to date of death: $0.00 Otherinfo: Account#: 2331028826 Type: Checking Open date: 5/1/1997 In the name of: Sylvia M Kutchman or William J Kutchman Date of Death Balance: $863.59 Int.(YTD) from 1/1/2012 to 4/26/2012 $0.04 Accrued interest to date of death: $0.00 Other Info Page 1 of 1 �]f7" �l�i� 5364 'v 0. �44 JL NC , LEADON*9 WAN June 11, 2012 Susan J Hartman Esq. Duncan&Hartman P.C. One Irvine Row Carlisle, PA 17013 RE: Sylvia M Kutchman SSN: 186-30-6123 DOD: 04-30.2012 Dear Ms.Hartman: In response to your request for Dare of Death(DOD)balances for the customer noted above,our records show the following: Checking Account Account##5000868961 Established: 05-27-1997 S"YLVL4 M KUTCHMAN JANET LUSH DOD balance: S 35,231.11 non interest bearing Savings Account Account#5112697589 Established:06-04-2010 SYLVIA M KUTCHMAN JANET LUSH DOD balance: S 125.01 +0,00 accrued interest Interest paid 01-01.2012 thru 04-30-2012 S 0.01 YTD Please note that this office provides date of death balances for deposit accounts(IRAs, CDs,Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items.please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Hank branch office. Sincerely„ National Financial Services Center PNC 13ank,N.A. Member FDIC Page l of 2 .. a,� . Lr"11JUMIN—At1UNAL L I f e I n s u r a n c e C o m p a n y QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 06130/2012 1-8004244990 #6WSCGWV •Contract Number XP217582 >02574 7624030 001 008129 •policy Date 02!230`2005 SYLVIA M KLITCHMAN •Annuitant Sylvia M Kutchman 1716 LINCOLN DR •Policy Type Non-Qualified M CAMP HILL, PA 17011-3955 .Agent L P L Financial Corp •Composite Annual Yield 170% l� Important Messages We are going green! Go on-line today at www.aannuityaccess.com to find out how to sign up for electronic delivery of your quarterly statement Account information Current Quarter Year-To-Date 04101/2012-06/30/2012 01101/2012-08130/2012 Beginning Value 129,841.69 128,898.87 Withdrawals (30,000.00) (30,000.00) Interest 707.23 1,650.05 Accumulated Value 100,548.92 100,548.92 Surrender Value 100,548.92 100,548.92 Your surrender value as of 06/30/2011 was$124,868.28. Deposits And Withdrawals Processed During This Quarter Date Amount 04/1912012 (30,000.00)