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HomeMy WebLinkAbout04-02-13 1505610101 REV-1500 Ex`°'-7°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes "v" County Code Year File Number PO BOX 28o6oi INHERITANCE TAX RETURN _ Harrisburg,PA 17128-0601 RESIDENT DECEDENT �� 13 b0 S ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01/03/2013 05/07/1937 Decedent's Last Name Suffix Decedent's First Name MI RITZIE WALTER C (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1.Original Return O 2. Supplemental Return O 3, Remainder Return(date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) CiD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe iDeposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Thomas E Flower, Esq (71743-5513 ER OF Ywltbs US NO U7 `7 r` K� I C- � G7 --7 First line of address r— ` Flower Law, LLC Second line of address �' �, 77-1 , 10 W. High Street A City or Post Office State ZIP Code _DATE�LED Carlisle PA 17013-2922 Correspondent's e-mail address: Tom @Flower-law.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements.and to the best of my knowledge and belief, it is true.correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S OF PEF3SON RESPONSIBLE TURN Per' ��'� ADDRESS Douglas A. Ritzie, 925 S. 29th Street, Camp Hill, PA 17011 SIGN TUR OF PR OT THAN REPRESENTATIVE TTE l ADDRESS Flower Law, LLC, 10 W. High Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: WALTER C. RITZIE RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . . . . .. .. . . . . . . . . . . . 192,000.00 2. Stocks and Bonds(Schedule B) 2. 2,745.89 . . . ... .. . .. . .. . . . .. . . .. . . . .. .. . .. . . .. . . 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. 646,961.51 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . 6. 317,710.91 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested., . . . . . . 7, 460,098.94 8. Total Gross Assets(total Lines 1 through 7). . .. . . . . . .. .. . . . . . . . . . . . . .. . . 8. 1,619,517.25 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . .. . . . . 9. 56,215.94 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . .. . 10. 112.50 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . 11. 56,328.44 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . .. . . . . . .. . . . . . . . . . . . . . 12. 1,563,188.81 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . .. .. . . . . . . . . . . . . . . . . . 11 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . .. .. . .. . . . . . . . . . . . . . 14. 1,563,188.81 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._ 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 1,563,188.81 16. 70,343.50 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE . . . . . . .. . .. 19 70,343.50 .. . .. .. . . . .. . .. .. . . . . . . . .. . . . ... . . . . . . . . . . . .. . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME WALTER C. RITZIE STREET ADDRESS 505 DEUBLER ROAD CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 70,343.50 2. Credits/Payments A.Prior Payments 66,800.00 B.Discount 3,515.68 Total Credits(A+B) (2) 70,315.68 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 27.82 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:......................................................................................... ❑ X❑ b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ ><❑ c. retain a reversionary interest:or.,................................................................................................ ............ ❑ x❑ d. receive the promise for life of either payments,benefits or care?..................................... ❑ n 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................. ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ x❑ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A,sibling is defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(11-08 pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WALTER C. RITZIE 21-13-0055 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 betNeen a willing buyer and a willing seller,neither being compelled 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 decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 DWELLING HOUSE AND LOT,505 DEUBLER RD,HAMPDEN TWP.,CUMBERLAND CY. TAX PARCEL NO. 10-20-1848-346,ASSESSED WITH CLR 1.0 AT$192,000 192,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 192,000.00 If more space is needed,insert additional sheets of the same size. Property Mapper Cumberland County, PA < 0 > V V-7 /' Parcel Search Features selected : 1 505 DEUBLER ROAD - PIN : 10-20-1848-346 Deedbook: 0023K-00854 Owner: RITZIE, WALTER C & ROSALIE S Land Use Code : 101 Property Type : R Acreage : 0.2 - Square Feet: 1672 - � Taxable Status : T Clean & Green Status : Land Assessed Value $ : 44600 Building Assessed Value $ : 147400 Tota I Assessed Value $ : 192000 Sale Price $ : Sale Date : Year Built: 1970 Municipality: HAMPDEN TOWNSHIP Height in Stories : 1 Type of Dwelling : DETACH Primary Exterior: Brick Basement Percentage : 75 Air Conditioning : AC Total Rooms : 7 Bedrooms : 3 Full Bath : 2 Half Bath : REV-1503 EX+(9-11) pennsylvania SCHEDULE B DEPARTMENT DF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER WALTER C. RITZIE 21-13-0055 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 211 shares Banco Sanander common stock @ 8.195 per share 1,729.15 2 29 shares MetLife Inc common stock @ 35.06 per share 1,016.74 TOTAL(Also enter on Line 2, Recapitulation) $ 2,745.89 If more space is needed, insert additional sheets of the same size REV-15o8 EX+(11-10) "� pennsylvania SCHEDULE E DEPARTMENT or REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WALTER C. RITZIE 21-13-0055 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. Susquehanna Bancshares, Inc:certificates of deposit(7)joint or ITF predeceased wife Rosalie S Ritzie 317,534.72 2. ACNB Bank CDs(2)joint with predeceased wife Rosalie S Ritzie 239,601.46 3, Members 1st FCU savings account 5.00 4. Series EE US Savings Bond#L521441450EE,0211994 53.03 5. Wells Fargo CD#24-741-209-1806491,joint with predeceased wife Rosalie S Ritzie 80,181.30 6. 1996 Mercury Sable GS, 101,920 miles(Kelly Blue Book value) 2,348.00 7. 2003 Lincoln LS Sedan,57,491 (Kelly Blue Book value) 7,238.00 TOTAL(Also enter on Line 5, Recapitulation) $ 646,961.51 If more space is needed, use additional sheets of paper of the same size. " ' VA } JNTFpEig."GFL\ � v 3\ v. 949V ti� IT \ ( \\�\� A it IM-1. i E !i` \ � a \ ti K ti Y a .. Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 02/2013 Total Price Total Value Total Interest YTD Interest $25.00 $53.08 $28.08 $0.36 Bonds: 1-1 of 1 Issue Next Final Issue Interest Serial # Series Denom Date Accrual Maturity price Interest Rate Value Note L521441450EE EE $50 02/1994 03/2013 02/2024 $25.00 $28.08 4.00% $53.08 Totals for 1 Bonds $25.00 $28.08 53.08 Notes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest: penalty MA Matured and not earning interest http://www.treasurydirect.gov/BC/SBCPrice 2/18/2013 w It p •• r f w O 7 w co O O O N O N N A N u, r-' w rrt rt � � � � � � •Fx• V N d C O CD m r-+ (p O M' m ON O w Aw. w ID 0 v 0 0 O O w b ° (D � 0 a .'may 1�j Q 0 5 l V O CI (n O W rt N ►� L3 (D (D O O W ITI_a K � O O � w N w y OrQ O F2 p a (71 � CD " eb " o w co 0 A rt O O rt pO m ryC' CA d erto Ul y' vii °»�a N o ro Ul 17� ul CA + z o ro O C, O 'o N 00 ra F p A N y 90 10 O Ul CL n A January 29, 2013 FLOWER LAW, LLC Integrity 10 W. High Street Carlisle, PA 17103 Re: Estate of: Walter C.Ritzie Social Security#: 167-30-0093 Date of Death: 01103/2013 Dear Mr. Douglas A. Ritzie, Executor I am writing in regards to the letter in which you sent inquiring about accounts that Mr. Walter C. Ritzie held at Integrity Bank. Mr. Ritzie held several accounts including a Joint Savings Account 401004300 with Rosalie S. Ritzie which was opened back in 06-12-2003 with an interest rate of 0.25%. This savings account then became Joint with Sandra Ritzie Albrigh,starting statement cycle as of 09/30/2011. The Date of Death balance as of 01/03/2013 was $26,150.27. Mr Ritzie also had a Joint Certificate of Deposit 1000744 with Sandra Ritzie Albright, which was opened in 12/08/2005 and the interest rate was 4.89%at that time. The Date of Death balance as of 01/03/2013 was$13,311.95 Mr Ritzie also had a Joint Certificate of Deposit 1034833 with Sandra Ritzie Albright, which was opened in 04/09/2009 and the interest rate was 3.203% at that time. The Date of Death balance as of 01/03/2013 was$135,248.80 If I can assist you further,please feel free to contact me at(717)920-4900 ext. 233 orjlara@integritybankonline.com Sincerely, — _e uan C, Lara Integrity Bank–Camp Hill Customer Service Representative .1145 M,trket.Stseet. Ganp NU.PA 17011 •Phone:717-9201-4900.877-I-HAVEIT•Fa=717--920-4904•www integntybankonGne.tntn Z/Z b06bOMLIZ jug8 R4 j6a4ul Wb Se:60 6Z-uP C-MZ Integrity Bank Integri v 3345 Market Street B A N K Camp Hill,PA 17011 Phone:717-920-4900 Fax:717-920-4904 F acs' ' e Transmittal To: rLOL✓EjZ JP Fax: 71 LID-2 I From: fLeA,,J 1-4/til Date: r— 2- 1 - I3 Re: Pages: 2 (including cover) 0 Urgent 0 For Review 0 Please Comment 0 Please Reply 0 Please Recycle This fax is confidential and intended solely for the use of the individual or entity to which it is addressed If you are not the named addressee you should not disseminate, distribute or copy this fax,please destroy the fax and notes the sender immediately by phone if you have received this fax by mistake. Zvi V06VOe6ZIL )Ue8 fi4p6a4UI WV 8Z:60 6Z-UeC-810Z A MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 233021-00 D-ate Account Established 07/21/2003 Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $5.00 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 233021-40 D-ate Account Established 07/19/2011 Principal Balance at Date of Death $144,144.16 Accrued Interest to Date of Death $17.61 Total Principal and Accrued Interest $144,161.77 Name of Joint Owner Douglas Ritzie Sandra Albright Jennifer Ritzie Date Joint Added 07/19/2011 07/19/2011 07/19/2011 CERTIFICATE OF DEPOSIT: Account Number/Suffix 233021-43 D-ate Account Established 11/26/2010 Principal Balance at Date of Death $14,679.95 Accrued Interest to Date of Death $1.95 Total Principal and Accrued Interest $14,681.90 Name of Joint Owner Douglas Ritzie Sandra Albright Jennifer Ritzie Date Joint Added 11/26/2010 11/26/2010 11/26/2010 M_E1VIBEK DE�REDIT UNION Tessa L Klugh Lending Insurance Support Specialist January 30, 2013 Estate of:WALTER C RITZIE Date of Death: 01/03/2013 Social Security Number: 167-30-0093 5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwwmemberslst.org CENTRIC 4K We Revolve Around Ynu. February 1, 2013 Thomas E. Flower, Esq. Flower Law, LLC 10 W. High Street Carlisle, PA 17013 Re: CD 3010910 Dear Attorney Flower: My apologies, I should have noted, indicated,that the Certificate of Deposit 3010910, had a joint owner, but all three children are beneficiaries: Douglas Ritzie Sandra S.Albright Jennifer Ritzie I hope this clears up any future questions. rdially, ='r /'- Mary Anne . Bayer Assistan ice President Branch Manager Silver Spring Branch Centric Bank 6480 Carlisle Pike Mechanicsburg, PA 17050 717-591-1360(T) 717-591-1363 (F) 4320 Linglestown Road Harrisburg,PA 17112 T 717.657.7727 F 717.657.7748 www.centricbank.com CENTRIC B A NX We Revolve At wnd'(ou. February 1, 2013 Thomas E. Flower, Esq. Flower Law, LLC 10 W. High Street Carlisle, PA 17013 Re: Walter C. Ritzie Estate Dear Attorney Flower: As.you requested in the correspondence dated,January 22, 2013, 1 am sending you all information pertaining to the requests outlined in your correspondence. Mr. Ritzie had two Certificates of Deposit; 3010910 and 3052818. At the date of death,January 15,2013 the values and owners were as such: CD 3010910—owners Walter C. Ritzie and Roselle Ritzie (deceased) Value-$29,288.87 a. CD 3052818—owners Walter C. Ritzie, Douglas Ritzie,Jennifer Ritzie &Sandra Albright Value- $73,693.46 Original date of CD December 14,20112 Year Term with Joint owner Douglas Ritzie;Sandra Albright and Jennifer Ritzie were added to the account on January 3, 2012. If you have any other questions,concerns or need additional information,do not hesitate to contact me at 717-909=8370. Cordially, 0/ 'u Mary Ann , ayer Assistant Vice President Branch Manager Silver Spring Branch Centric Bank 6480 Carlisle Pike Mechanicsburg, PA 17050 717-591-1360(T) 717-591-1363 (F) 4320 Linglestown Road Harrisburg,PA 17112 T 717.657.7727 F 717.657.7748 www.centricbank.corn � t UPEVIOUS < SUBMIT > EXIT lk1 3010910 ,guy k Or gin:11 amount 20,670.43 Next pay date Tuesday, July 30 2013 - i CL rrent balance 29,340.05 YTD int 111.18 > IMAGE _ _ . .. _. ._ ,._ scref fit . > SCAN }tIE4V IMAGE ® PRINT IMAGE ® IRAN SET I& eurreire h -Pay; > SCAN BACKWARDS — eta Paced T/C Q�ssr�ptic►n Amount j 8p _-_- 1 r30119 171 INTEREST ADDED BACK 607.50 24,585.72 1 7t30f09 171 INTEREST ADDED BACK 612.75 25,178.47 #i rs sWv, Used > BOTTOM I Q9M 0 171 INTEREST ADDED BACK 638.44 25,816.91 i°wOM sots" 7130M 0 171 INTEREST ADDED BACK 643.96 26,460.87 ° ex0fikied Ire the�ion 1 r.)8111 171 INTEREST ADDED BACK 670.96 27,131.83 of glaq Co�rtwl F'ietd' 7 29P 1 171 INTEREST ADDED BACK 67616 27;808.59 1 f30M 2 171 INTEREST ADDED BACK 705.13 28,513.72 7.(30M 2 171 INTEREST ADDED BACK 715.15 29,228.87 AM 7f30M 2 151 RATE CHANGE 1.590% 29,228.87 7131 M 2 151 RATE CHANGE .124% 29,228.87 ,��"'� .... 70112 151 RATE CHANGE .750% 29,228.87 { 1130/13 171 INTEREST ADDED BACK 111.18 29,340.05 Unfold=Eff,Source,6at,Seq,Ser Previous !► : Parameter Help PREVIOUS G SUBMIT > EXIT K4 COMMt k, PREVIOUS < 'SUBMIT > EXIT 0$2$1$ k Original amount 72,746,88 Next pay date Thursday, February 14 2013 Currentbalance 73,774.20 YTD int 80,74 cu�t�"� � +auurrt 1t1EW IMAGE ® PRRIT IMAGE ® IRAN SET pumreiit�a �;rat day • Posted !TAG Descrlptlan i Amount �dk 12/15111 151 RATE CHANGE 1,290% .00 12115M 1 10 REGULAR DEPOSIT 72746.88 72,746.88 OMOW o 12/15/11 210 EFFECTIVE DATED ACCRUAL ADJUST 2.57 72,746.88 Co.p € ' 1/f 3112 171 INTEREST ADDED BACK 79.70 72,826.58 ap r t,-"'I explained agthe;;Fun�llr�+ 2/14M 2 171 INTEREST ADDED BACK 79.79 72,906.37 of the Field' 3/I 4112 171 INTEREST ADDED BACK 74.72 72,981.09 ��rc 4113112 171 INTEREST ADDED BACK 79.96 73,061.05 1 5/14112 171 INTEREST ADDED BACK 77.46 73,138.51 Laam 104> 6/14112 171 INTEREST ADDED BACK 80.13 73,218.64 7/13112 171 INTEREST ADDED BACK 77.63 73,296.27 , 8/14112 171 INTEREST ADDED BACK 80.30 73,376.57 9114!12 171 INTEREST ADDED BACK 80.39 73,456.96 "Yl 10/12112 171 INTEREST ADDED BACK 77.88 73,534.84 = r. 11114/112 171 INTEREST ADDED BACK 80.57 73,615.41 Unfold=Eff,Source,l3at,Seq,Ser Previous Nbre PREVIOUS <v SUBMIT > EXIT �t R i Rm ■ PREVIOUS. < SUBMIT > EXIT w:l 3052818 r Or gina amount 72,7416.88 Next pay date Thursday, February lA 2013 t;urrentbalance 73,7741,20 YTDint 80.741 oustc�rtlet's nat�e�aaa VIEW IMAGE ® ' PRINT IMAGE ® TRAN SET 16 der ai m' current balance„next pair Posted :TIC 1 DescroUoti Amowd 1211412 171 INTEREST ADDED BACK 78.05 73,693.46 these ls,a"�O+atstrot” ; 11413 171 INTEREST ADDED BACK 80.74 73,774.20 fWd is.prosent-3 It useG to pe+famt; ame search +oparat�ss that one �Wained in the;fun of# *-Co ntroi Eield . team snore.> {k R i Unfold=Eff,Source,8at,Seq,Ser Previous ± ..__ __-__-. _ _.___- _ __-_. ® I PREVIOUS [ SUBMIT > EXIT 1:1 ACNB BANK February 5, 2013 Flower Law LLC 10 W High St Carlisle PA 17013 RE: Estate of Walter C Ritzie Dear Mr. Ritzie: The following information is being provided as per your request: Acct. Type Account No. Balance at Accrued Ownership Date D.O.D. Interest to Opened/Joint D.O.D. Certificate of 162024 $175,945.35 $3,408.27 Jt w/ Rosalie S Ritzie 1/15/03 Deposit Certificate of 174163 $58,054.97 $2,192.87 I/T Rosalie S Ritzie 1/15/08 Deposit Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at(717)339-5122. Sincerelv, Barbara J Warr ACNB Bank Deposit Services kepresentative II acnb.com•acnbbusiness.com• P.O.Box 3129,Gettysburg,PA 17325 •Phone 717.334.3161 •Toll Free 1.888„334.ACNB(2262) Susquehanna' February 7, 2013 Susquehanna Bancshares,Inc. 26 North Cedar Street P.O. Box 1000 Lititz,PA 17543-7000 Tel 1.800.311.3182 FLOWER LAW LLC Fax 717.625.4478 10 W HIGH STREET CARLISLE PA 17013 RE: Walter C Ritzie Estate DOD: 1/3/13 SS#: XXX-XX-0093 Tracking# 308321 To Whom [± May Concern: In response to your letter of January 22, 2013, we have prepared the attached list of accounts. ® There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sincerely, Dawn M Berrier Deposit Research - Reporting Department Lead 1-717-625-6546 DMB/aed D o o : o o n w ❑ w w o o o o uQ 0 C�EL CD °h CD CD (D CD CD v 0 CD CD � � (D vwi CD -s > (D ^t van C~ yn > n > n � n n � CD' n CD gip' N CD. C• 0 CDC CD CDC N CD CD CD N' CD ~ �. N N CD y r N � CD R w cn D 0. d D d D d D O O O O O O O O O O O CD rC O o oN t� C aq z � y P� w O (D W N N O O N W vi A N > b d CD N N .- N N �] C/1 A7 o o w w o rn rn w w o z CD C`p C cz V] CD a CD CD 69 O (p O c 00 w N AA J OAO O F•j d .fl 69 69 n W cn N z N W 69 y N los 69 69 69 N N J p C�7 d O O D D d CD rD a � �• � y N w C'1 � d g o tz bo � my LA � w w c' N � z owe A e y CD 0. a R zyn .. kA o� oo Cd y Y Z c.j x y O -J z b's y N d � � y a � d y m w c w w w w w ° w ° w ^* °'� o n e:r A? A� ;= t�., w A? rr O CDh - (D CD CD CD CD CD CD CD F c CD EV N N �+ CV r7 CV �* N �7 N L�l .[j [�tj N �j l�l N. �j [J ► 1 (D N !D N !D ro CD CD CD 0 CD N CD CD H CD lD Cp CD CD CD t74 CD a w C) a d d d d d d d y 00 0 0 0 0 0 0 0 0 00 =r H n O O O O O O O O O O CD O O N O O O O O O O n ON O �p o -r� ONO OUPI N O Cr � O p .�. w N w 1p �D a1 a1 O m lt- p H Z d `! O J N J N to O A X00 A �p Ch 00 --I �� O n K � d � CD cAi� vAi N iQ A 0 H p .or Af o � Ci177 C CL H CD � Y 46S 69� 69 G09 69 4�A n O1 o " A w o 01 `p 01 N A J Oo O Q\ H d 69 bq ils 1E.09 N W A 6�9 N J J N fah n O OJ1 p O O 10 N H �D to W (-h 9 b9 69 69 69 y N A N 69 69 69 W N y OJ g O J N N N J _ O c.n A J O A 00 �O 01 A 01 W p �H � m �? a trri n n p o 0 n C)0 o w � w w p w -r7 w r CD NO � yd df� a. to - a y w CD Y .Q V) y n -� W rn oOOO t � w t" %N � w N n * o �o O z t-J � y ZI A ^O `''ti tN o°10 trJ C7 REV-1509 EX+(oi-io) yj pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY—OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WALTER C. RITZIE 21-13-0055 If an asset became 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.Sandra R.Albright 227 Skyline View DAUGHTER Carlisle, PA 17103-8119 B.Jennifer L. Ritzie 1513 N. 2nd Street DAUGHTER Harrisburg, PA 17102-2510 C. Douglas A. Ritzie 925 S.29th Street SON Camp Hill, PA 17011 JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 12112/11 [A&C]Americhoice FCU accts.(6)##31557-01,-60,-62,-64,-68,&-69 196,801.88 1/3 65,600.63 2. C 03126/10 [C]Susquehanna Bancshares,Inc.CD#3000150151 15,958.26 1/2 7,979.13 3. AB 11110/10 [A.B&C]Orrstown Bank CDs(5)##3725,38640,385668,39476,39781 307,771.32 1/4 76,942.83 4. AB 01103/12 [A,B&Cl Orrstown Bank CD#4000043136 39,851.96 1/4 9,962.99 5. AB 01103/12 [A,B&C]Centric Bank CD#3052818 73,693.46 1/4 18,423.37 6. AB 11126/10 [A,B&Cl Members 1st FCU CDs(2)##233021-40&-43 158,843.67 1/4 39,710.92 7. A 09130/11 [A]Integrity Bank svgs.#401004300 and CDs(2)##1000744&1034833 174,711.02 1/2 87,355.51 8. C 08/29/03 [C]Wells Fargo CD#24-741-207-1951586 23,471.05 1/2 11,735.53 TOTAL(Also enter on Line 6, Recapitulation) $ 317,710.91 If more space is needed,use additional sheets of paper of the same size. ORRSTOWN BANK A Tradition of Excellence February 5,2013 Flower Law, LLC 10 West High Street Carlisle, PA 17013 Fax: 241-4021 Re: Estate of Walter C. Ritzie Social Security Number 167-30-0093 Date of Death 1/3/2013 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CERTIFICATE OF DEPOSIT Account No.- 4000037725 Account Type- 60-119 Month Growth CD Date Opened- 5/21/2010 Joint Account(name/date)- Douglas A. Ritzie, Jennifer L. Ritzie, Sandra R. Albright, 5/21/2010 Balance- $33,786.83 Accrued Interest- $35.62 Account No.- 4000038640 Account Type- 60-119 Month Growth CD Date Opened- 8/9/2010 Joint Account(name/date)- Douglas A. Ritzie, Jennifer L. Ritzie, Sandra R. Albright, 8/9/2010 Balance- $7,503.84 Accrued Interest- $15.88 Account No.- 4000038668 Account Type- 60-119 Month Growth CD Date Opened- 8/11/2010 Joint Account(name/date)- Douglas A. Ritzie,Jennifer L. Ritzie, Sandra R.Albright, 8/11/2010 Balance- $15,027.35 Accrued Interest- $27.09 2695 Philadelphia Avenue • Chambersburg, PA 17201 Account No.- 4000039476 Account Type- Personal Jumbo CD Date Opened- 10/12/2010 Joint Account(name/date)- Douglas A. Ritzie,Jennifer L. Ritzie, Sandra R. Albright, 10/12/2010 Balance- $144,184.65 Accrued Interest- $172.95 Account No.- 4000039781 Account Type- Personal Jumbo CD Date Opened- 11/10/2010 Joint Account(name/date)- Douglas A. Ritzie,Jennifer L. Ritzie, Sandra R. Albright, 11/10/2010 Balance- $106,877.26 Accrued Interest- $139.85 Account No.- 4000043136 Account Type- 48-59 Month Growth CD Date Opened- 1/3/2012 Joint Account(name/date)- Douglas A.Ritzie,Jennifer L. Ritzie, Sandra R. Albright, 1/3/2012 Balance- $39,810.14 Accrued Interest- $41.82 Best Regards, q T R.Worthington Deposit Processing Clerk pAmeriChoice F E D E R A L C R E D I T U N I O N Building Relationships For Life February 7, 2013 Flower Law, LLC 10 W. High Street Carlisle, PA 17013 Re: Estate of Walter C. Ritzie Mr. Ritze, The decedent had one member number, 31557 titled Walter C Ritzie. Douglas A. Ritzie and Sandra A Albright were joint owners on the shares as listed below: Account 31557 Regular Savings (suffix 0001) —opened 02/05/2000 - Douglas added 1 1/14/201 l; Sandra added 12/12/2011 60 Month Share Certificate (suffix 0060) —opened 0l/25/2010 - Douglas added 11/14/2011; Sandra added 12/12/2011 60 Month Share Certificate (suffix 0062) —opened 07/12/2003 - Douglas added 11/14/201 1; Sandra added 12/12/2011 60 Month Share Certificate(suffix 0064)—opened 08/12/2003 - Douglas added 11/14/2011; Sandra added 12/12/2011 48 Month Share Certificate (suffix 0068)—opened 01/22/2009 - Douglas added 11/14/2011; Sandra added 12/12/2011 60 Month Share Certificate (suffix 0069)—opened 06/27/2009 Douglas added 1 1/14/2011; Sandra added 12/12/2011 I provided the original open date for share 62, 64, and 68. These 3 certificates have all matured and rolled for the next time period. Date of death balances are as follows: Account 31557 Balance Accrued Dividends 0001 - $ 740.27 $ 0.01 0060 - $ 51,410.22 $ 232.25 0062 - $ 84,715.64 $ 862.00 0064 - $ 27,706.69 $ 176.79 0068 - $ 16,872.59 $ 5.47 0069 - $ 14,070.20 $ 9.75 ' f Main Office: 2175 Bumble Bee Hollow Road* Mechanicsburg, PA 1705.5 * Phone: (717) 697-3474• Fax: (717) 697-3713 Website:www.americhoice.org � NCIJA Eae w<.tioum; )ppotunity LENDER --�- L ENDER CREllIT UNIONS' The above balances do not include the accrued dividends. These dividends were not yet posted at time of death. Mr. Ritzie did not have a safe deposit box with AmeriChoice. I have included Mr. Ritzie"s last statement for your records. Please feel free to contact me directly with any additional questions you may have. Sincerely, Bonnie R. Seagraves Operations Specialist Phone (717) 591-1282 Fax (717) 697-3713 Email bseagravesL&americhoice org Statement of Accounts AmeriChoice ,;,,,,,,,,,. ,zojd Oct 01, 2012 thru Dec: 31, 2012 F E D E R A L C R E D I T U N I O N Building Relationships For Life Account Number: xxxxxxx557 Account Balances at a Glance Savings: 740.27 Certificates: 194,775.34 WALTER C RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 New Relationship Reward Level is: General Page 1 of 3 Important Notice: Please note that your IRS tax forms(1098& 1099)for 2012 are contained in your December statement. Effective December 31,2012,the temporary unlimited share insurance coverage for non-dividend bearing transaction accounts will expire. Go to www.americhoice.org for more information. REGULAR SHARE - 0001 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 739.88 10-31 Deposit Dividend 0.200% 0.13 740.01 Annual Percentage Yield Earned 0.210%from 10/01/2012 through 10/31/2012 11-30 Deposit Dividend 0.200% 0.13 740.14 Annual Percentage Yield Earned 0.210%from 11/0112012 through 11/30/2012 12-31 Deposit Dividend 0.200% 0.13 740.27 Annual Percentage Yield Earned 0.210%from 12/01/2012 through 12/31/2012 12-31 Ending Balance 740.27 Dividends Paid Year to Date 1.55 60 MONTH CERTIFICATE - 0060 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 51,110.05 10-25 Deposit Dividend 2.330% 300.17 51,410.22 Annual Percentage Yield Earned 2.350%from 07/25/2012 through 10/24/2012 12-31 Ending Balance 51,410.22 60 MONTH CERTIFICATE will mature on 01/25/2015 Dividends Paid Year to Date 1,183.83 60 MONTH CERTIFICATE - 0062 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 83,780.98 10-12 Deposit Dividend 4.426% 934.66 84,715.64 Annual Percentage Yield Earned 4.500%from 07/12/2012 through 10/1112012 12-31 Ending Balance 84,715.64 60 MONTH CERTIFICATE will mature on 07/12/2013 Dividends Paid Year to Date 3,657.78 Phone: (717) 697-3474 Toll Free: (800) 240-4364 Fax Number: (717) 697-3713 Oct AmeriChoice 01. 2O12 thru Dec 31. 2012 rEoewxL Cnso /T vw /om Building Relationships For Life Page 2of3 Account Number: xxxxxxx557 60 MONTH CERTIFICATE ' OOO4 Joint Owner: SANDRA RALBR|GHT. DOUGLAS AR|TZ|E Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 27,401.00 11-12 Deposit Dividend 4.42OY6 305.63 27.708.09 Annual Percentage Yield Earned 4.50O96 from O012/2O12 through 11/11/2O12 12-31 Ending Balance 37,706.09 60 MONTH CERTIFICATE will mature onO8/12/2O13 Dividends Paid Year VoDate 1.196.31 48 MONTH CERTIFICATE - 0O88 Joint Owner: SANDRA RAL8R|GHT. DOUGLAS AR[TZ|E Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 16,706.63 12-31 Deposit Dividend 3,A41Y6 10590 10.872.59 Annual Percentage Yield Earned 4DU0%from 1O01/2O12 through 12/31/2012 12'31 Ending Balance 16,872.5$ 48 MONTH CERTIFICATE will mature on01/2212O13 Dividends Paid Year 1oDate 650.64 80 MONTH CERTIFICATE - 0069 Joint Owner: SANDRA RAL8R|GHT. DOUGLAS AR|TZ|E Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 13,960.14 12-27 Deposit Dividend 3.182Y6 110�06 14.07020 Annual Percentage Yield Earned 3200%from O9/27/2Oi2 through 12/26/2O12 12-31 Ending Balance 14\070.30 50 MONTH CERTIFICATE will mature on 06/27/2014 Dividends Paid Year toDate 43744 YTD SUMMARIES TOTAL DIVIDENDS PAID REGULAR SHARE 1.55 GO MONTH CERTIFICATE 1.183.83 60 MONTH CERTIFICATE 3.857.78 80 MONTH CERTIFICATE 1.196.31 48 MONTH CERTIFICATE 650.84 80 MONTH CERTIFICATE 437.44 Total Dividends Paid Year\o Date 7.127,55 AmedChoice Oct 01, 2012 thru Dec 31, 2012 F E D E R A L C R E D I T U N I O N Building Relationships For Life Page 2 of 3 Account Number: xxxxxxx557 60 MONTH CERTIFICATE - 0064 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 27,401.00 11-12 Deposit Dividend 4.426% 305.69 27,706.69 Annual Percentage Yield Earned 4.500%from 08/12/2012 through 11/11/2012 12-31 Ending Balance 27,706.69 60 MONTH CERTIFICATE will mature on 08/12/2013 Dividends Paid Year to Date 1,196.31 48 MONTH CERTIFICATE - 0068 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 16,706.63 12-31 Deposit Dividend 3.941% 165.96 16,872.59 Annual Percentage Yield Earned 4.000%from 10/01/2012 through 12/31/2012 12-31 Ending Balance 16,872.59 48 MONTH CERTIFICATE will mature on 01/22/2013 Dividends Paid Year to Date 650.64 60 MONTH CERTIFICATE - 0069 Joint Owner: SANDRA R ALBRIGHT, DOUGLAS A RITZIE Date Transaction Description Additions Subtractions Balance 10-01 Balance Forward 13,960.14 12-27 Deposit Dividend 3.162% 110.06 14,070.20 Annual Percentage Yield Earned 3.200%from 09/27/2012 through 12/26/2012 12-31 Ending Balance 14,070.20 60 MONTH CERTIFICATE will mature on 06/27/2014 Dividends Paid Year to Date 437.44 YTD SUMMARIES TOTAL DIVIDENDS PAID REGULAR SHARE 1.55 60 MONTH CERTIFICATE 1,183.83 60 MONTH CERTIFICATE 3,657.78 60 MONTH CERTIFICATE 1,196.31 48 MONTH CERTIFICATE 650.64 60 MONTH CERTIFICATE 437.44 Total Dividends Paid Year to Date 7,127.55 REV-1.51.0 EX 1 (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 WALTER C. RITZIE 21-13-1055 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 DESCRIPTION OF PROPERTY 'NCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH °-iI OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (TFAPPLICABLE) VALUE 1. Susquehanna Banc checking acct.at w.predeceased wife)ITF children: 19,699.91 100 19,699.91 Douglas A. Ritzie,Sandra Albright&Jennifer Ritzie,acct.opened 05/21/04 2 Susquehanna Banc CD ITF decedent's children: Douglas A. Ritzie, 30,764.28 100 30,764.28 Sandra Albright&Jennifer Ritzie,acct.opened 11/06/07 3 Susquehanna Banc CDs made joint within one year of death,payable to 181,476.80 100 6,000.00 175,476.80 children Douglas A. Ritzie&Jennifer Ritzie 4 Centric Bank,titled joint with predeceased wife, ITF(in trust for)children: 29,288.87 100 29,288.87 Douglas A. Ritzie,Sandra Albright&Jennifer Ritzie 5 MidPenn Bank CD#309003134, made joint within one year of death, 126,566.32 100 126,566.32 payable to son Douglas A. Ritzie 6 MidPenn Bank acct#309003161,ITF(in trust for)children: 78,302.76 100 78,302.76 Douglas A. Ritzie,Sandra Albright&Jennifer Ritzie TOTAL(Also enter on Line 7, Recapitulation) $ 460,098.94 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-U9; , pennsylvania SCHEDULE H 9 DEPARTMENT Or REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER WALTER C. RITZIE 21-13-0055 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' NEILL FUNERAL HOME, INC.-BASIC PROFESSIONAL SERVICES FEE 3,120.00 2. EMBALMING AND PREPARATION OF REMAINS 1,190.00 3. FUNERAL CEREMONY 395.00 i 4. TRANSPORT AND VEHICLE USE 1,085.00 5. CASKET 2,195.00 6. OUTER BURIAL CONTAINER 1,395.00 7. CASH OUTLAYS,INTERMENT,HONORARIA,DEATH CERTIFICATES AND OBITUARY 1,149.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 44,489.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 533.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. PUBLICATION OF ESTATE NOTICES:CUMB. LAW JOURNAL-$75;THE SENTINEL-$189.44 264.44 8. TAX RETURN FILING FEE 15.00 9. REGISTER OF WILLS,ADDITIONAL PROBATE FEE 350.00 10. ADDITIONAL SHORT CERTIFICATES 35.00 TOTAL(Also enter on Line 9, Recapitulation) $ 56,215.94 If more space is needed,use additional sheets of paper of the same size. Seller Neill Funeral Home,Inc. Contract.#-741 7 01 000378 3401 Market Street 3501 Derry Street Case.#-2RSR4732.0 Camp Hill,PA 170114428 Harrisburg,PA 17111 - (717)737-8726 717-564-2633 Kevin J.Shillabeer,Supervisor Stephen J.Wilsbacb,Supervisor Part One of Three Parts Statement of Funeral Goods and Services Selected/Purchase Agreement Date of Death 01/03/2013 Date of Service 01/08/2013 Name of Deceased Walter C Ritzie Date of Birth 05/07/1937 Deceased's Last Address 505 Deubler Rd City Camp Hill StatepAZip Code 17()11-2017 Purchaser's Name Douglas Ritzie Phone Number(717)731-0921 Purchaser's Home Address 925 S 29Th St City Camp Hill State PA Zip Code 17011 Co-Purchaser's Name Phone Number Co-Purchaser's Home Address City State Zip Code In this Agreement the words you and your refer to the Purchaser and the Co-Purchaser,if any,signing this Agreement.The words we,us and our refer to the Funeral Provider or Seller whose name and address appear above.For good and valuable consideration,which each party acknowledges receiving,you agree to buy the goods and services described below.You authorize us to prepare and care for the body of the decedent named in this Agreement and to conduct the funeral and services and incur the charges listed in said Agreement.We have the right to collect the total amounts due under this Agreement from any person who signs this Agreement as Purchaser or CO-Purchaser.(N/A indicates items ofservice and/or merchandise that are not provided) Charges are only for those items that you selected or that are required.If we are required by law or by a cemetery or crematory to use any items,we will explain the reasons in writing below.If you selected a funeral that may require embalming,such as a funeral with viewing,you may have to pay for embalming.You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial.If we charged for embalming,we will explain why below. SECTION I-SERVICES AND MERCHANDISE MERCHANDISE FUNERAL DIRECTOR AND STAFF SERVICES Casket or Alternative Container: Basic Professional Service Fee S 3,120.00 Manufacturer/Supplier PACKAGE OFFERINGS Model Name/Number DESERT SAND.147887 H Direct Cremation S n/a Material Immediate Burial -$ n/a Species of Wood Forwarding Remains $ n/a Type of Metal Receiving Remains $ n/a Weight/Gange $ n/a Interior Roselan Carel Crepe Interior,Rosetan Caret Cra $ n/a Exterior Color Brown Dual-Tone Exterior and Gad $ 2,195.00 CARE AND PREPARATION OF REMAINS Omer Burial Container: Embalming 795.00 Manufacturer/Supplier Other Preparation(specify) Model Name/Number Std Sentinel Cormer5 Material_Polystyrene liming over wacrete vault,)�_$ 1-395,00 Dressing and(asketine of Deceased $ 395 00 Urn: S n/a Manufacturer/Supplier $ n/a Model Name/Number $ "/a Material __$ n/a $ n/a $_ n/a USE OF FACILITIES AND RELATED SERVICES $ n/a Visitation $ n/A $ n/a Funeral Ceremony $ 395.00 TOTAL SECTION I_ $ 0 3R0 nn Memorial Service_ $ "/a SECTION If-CHARGES TO BE INCURRED BY US ON Graveside Service. n a YOUR BEHALF(Certain charges maybe estimated='a"means Other(specify): estimated.) E n/a $ n/a We charge you for our services in obtaining those items marked with an'X' $ n/a Cemetery $ 500.00 Crematory $ n/a TRANSPORTATION Clergy/Reliving Facility $ 175.00 Transferring Remains to Funeral Home $ 495.00 Musicians or Singers_ $ n/a Funeral VehiclelHearse $ 395.00 Certified Copies $ 180.00 Other(specify): Newspaper Notices— E n/a Service Vehicle $ 19500 Newsnaner Notice/3 charves TT Free $ 294.00 $ n/a _ $ n/a $ n/a $ n/a $ n/a S n/a $ n/a E n/a $ n/a $ n/a S n/a $ n/a OTHER GOODS AND SERVICES $ n/a E n/a Memorial Booklet. $ n/a $ n/a Service Folders $ n/a $ n/a Prayer Cards $ _ $ n/a n/a Acknowledgement Cards $ n/a $ n/a Memorial Package___. $ n/a $ n/a $ a _ $ n/a $ n/a $ n/a TOTAL SECTION II_ $ 1.149.00 $ n/a $ n/a $ n/a TOTAL SECTION I CHARGES $ 918000 $ "/" TOTAL SECTION II CHARGES $ 1.149.00 $ n/a $ n/a TOTAL SECTION I AND SECTION II CHARGES E 10 529.00 _ a n/a $ n/a _ $ n/a $ n/a PURCHASER'S INRnT LS D TE aS5'INITIALS AND DATE —_ -- — $ n/a Part Two of Three Parts Name of Deceased Walter C Ritzie Contract#-741101000378 Statement of Funeral Goods and Services Selected/Purchase Agreement TOTAL SECTION I AND SECTION II CHARGES $ 10,529.00 SECTION 111-ALLOWANCES Competitor Match _ $ (465.00) $ Wit $ n/a $ n/a $ n/a $ —CIA - $ n/a $ n/a $ n/a TOTAL ALLOWANCES $ (465.00) SECTION IV-TAXES Taxable Items Section I+or-Section III_ $ n/a Less Deductibles $ n/a TOTAL TAXES 0 % $ 0.00 TOTAL CHARGES: Section(1)+(11)+or-(111)+(IV)= $ 10.064.00 Less Cash Received $ n/a Less Assignments of $ n/a Unpaid balance due by: 01/08/2013 $ 10.064.00 PAYMENT TERMS: You understand that no extension of credit by us,subject to federal or state credit disclosure,installment sales,or other consumer credit statutes,is contemplated by this Agreement You have no right to defer payment of any amount due under this Agreement You agree that you are personally liable for payment of the applicable balance due shown on the Statement of Funeral Goods and Services Selected by the due date indicated on the Statement. Such payment will be made to us at the address set forth in this Agreembnt Where the full amount due will not be paid prior to the performing of the services called for by this Agreement,you authorise us to inquire into your credit history. IDENTIFICATION AND DESCRIPTION OF MANDATORY ITEMS AND EXPLANATION OF EMBALMING CHARGE: We have identified and described below any legal,cemetery or crematory requirements that compel the purchase of any items listed in Pan One and we have explained why we charged for embahning. You acknowledge and agree that embalming and/or preparation of the remains may be performed at the facility of the above-referenced funeral home or at another facility that is duly licensed and equipped to provide such services. Embalming Exnressiv Authorized BvDouelas Rime Cemetery Requires Curter Burial Container You confirm that you have examined the service and merchandise items listed in Part One and found them to be correct and according to the arrangements selected and that prior to signing this Statement,you reviewed and approved a completed copy of this Statement. You also confirm that you have been informed of your right to select only such services and merchandise as you desire,and that you have the legal right to arrange the funeral services for the deceased named above. Acknowledgement of Disclosures/Disclaimer The Federal Trade Commission Trade Regulation Rule on"Funeral Industry Practices"requires certain disclosures and prohibits misrepresentations. The following is a checklist we ask those we serve to read and sign to verify that the funeral arrangement conference was conducted in compliance with the Rule. You,who made the arrangements for the funeral and final disposition of the above-named decedent,do hereby attest to the following: 1. You were given a General Price List effective on 10122n012 prior to discussing funeral arrangements or the selection of any funeral goods or services. 2. You were shown a Casket Price List effective on 1()/99/9(117 prior to discussing caskets. 3.You were shown an Outer Burial Container Price List effective on I OIr'm12 prior to discussing outer burial containers. 4. You were advised that the law does not require embalming except in certain special cases. 5. You were not advised that embalming is required for direct cremation,immediate burial or a closed casket funeral without viewing or visitation if refrigeration.is available, where state or local law does not require embalming in such cases. 6. You were not advised that any law requires a casket for direct cremation or that a casket,other than an alternative container,is required for direct cremation. 7. You were advised that state law does not require the purchase of an outer burial container or any of the funeral goods or services you selected,except as set forth on your Statement of Funeral Goods and Services Selected. 8.No claims were made to you as to the merchandise or services(embalming,casket,outer burial container)to the effect that embalming or the use of any merchandise available from us would delay the decomposition of the remains for a long term or indefinite time,or that any such merchandise would protect the body from gravesite substances.No representations or warranties were made to you about the Protective features of caskets or outer burial containers other than those made by the manufacturer. 9. You were advised that the funeral firm's cost for the items listed in Part One,Section Il,may be different based on volume or cash discounts or other professional/trade customs where permitted by state or local law. NOTICES TO PURCHASERICO-PURCHASER SEE PART THREE FOR TERMS AND CONDITIONS THAT ARE PART OF THIS AGREEMENT. DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACES. YOU ACKNOWLEDGE RECEIPT OF AN EXACT COPY OF THIS AGREEMENT. BY SIGNING THIS AGREEMENT,YOU ARE AGREEING THAT ANY CLAIM YOU MAY HAVE AGAINST THE SELLER SHALL BE RESOLVED BY ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A COURT OR JURY TRIAL AS WELL AS YOUR RIGHT OF APPEAL. Executed this 04 day of January ,2013 Purchaser's Name Douglas Ritzie Purchaser's Signature Q w Social Security# - - By: Kevin J Shiliabeer FD1013239 L Co-Purchaser's Name Type in Name License Number Co-Purchaser's Signature Co-Purchasers Social Security# - - Si�anae !attest that!have completed/reviewed this document as required by the Company's SOX Key Control Checklist. Print Name: Title: Signature: Date: REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER WALTER C. RITZIE 21-13-0055 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 BOSE CORP,BALANCE DUE ON RADIO INSTALLMENT PURCHASE 112.50 TOTAL(Also enter on Line 10, Recapitulation) $ 112.50 If more space is needed,insert additional sheets of the same size. _80 irF Bose® Payment Plan Statement February 26, 2013 WALTER RITZIE 505 DEUBLER ROAD CAMP HILL PA 17011 Below is an update of your existing payment plan with Bose Corporation. You are receiving this statement either because you requested an update on your account and/or there was a recent change to your remaining billing schedule. The remaining monthly installments will be automatically,deducted from the card we have on file on the Current Due Dates noted below. General Account Information Order#: P14934292 Order Date: 04/24/2012 Order Total: $476.95 Pay Terms: 11 Month Current Billing Plan Details Original Due Date Current Last 4 Digits Payment Amount Status Due Date Billed Date of Card Down Payment $64.45 Paid 04/25/2012 04/26/2012 5342 Installment 1 $37.50 Paid 05/25/2012 05/26/2012 5342 Installment 2 $37.50 Paid 06/25/2012 06/26/2012 5342 Installment 3 $37.50 Paid 07/25/2012 07/26/2012 5342 Installment 4 $37.50 Paid 08/25/2012 08/26/2012 5342 Installment 5 $37.50 Paid 09/25/2012 09/26/2012 5342 Installment 6 $37.50 Paid 10/25/2012 10/26/2012 5342 Installment 7 $37.50 Paid 11/25/2012 11/26/2012 5342 e / Installment 8 $37.50 Paid 12/25!2012 12/26/2012 5342 Installment 9 $37.50 Paid 01/25/2013 01/26/2013 5342 Q fk- Installment 10 $75.00 Paid 02/25/2013 02/26/2013 1347 Credit Details Wapplicable) --, Date Amount Type Last 4 Digits of Card Account Summary Paid Balance: $476.95 Open Balance: $0.00 Past Due Balance: $0.00 Total Credits: $0.00 Neat Billing Date: Last Billing Date: 02/26/2013 All previously communicated terms and conditions of your Bose payment plan are still applicable. If you have any questions regarding the status of your account please call our Customer Service Department at 1-800-700-1893, 8:00 AM-9:00 PM(M-F), 9:00 AM- 5:30 PM(Sat)ET. Sincerely, BOSE CORPORATION Customer Service Department BOSE CORPORATION,THE MOUNTAIN, FRAMINGHAM, MA 01701-9168 U.S.A. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WALTER C. RITZIE_ 21-13-0055 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Sandra R.Albright,227 Skyline View,Carlisle,PA 17103-8119 daughter 1/3 2. Jennifer L.Ritzie, 1513 N.2nd Street,Harrisburg,PA 17102-2510 daughter 1/3 3. Douglas A. Ritzie,925 S.29th Street,Camp Hill,PA 17011 son 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF WALTER C. RITZIE I, WALTER C. RITZIE of 505 Deubler Road, Camp Hill, Cumberland County, Pennsylvania, 17011, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I give my house at 505 Deubler Road, Camp Hill, to my son, DOUGLAS A. RITZIE. THIRD: I give all the rest, residue and remainder of my estate in equal shares to my children, DOUGLAS A. RITZIE, of Camp Hill, Pennsylvania, SANDRA R. ALBRIGHT, of Carlisle, Pennsylvania and JENNIFER L. RITZIE, of Harrisburg, Pennsylvania, in equal shares per stirpes. LASTLY: I nominate, constitute and appoint my son, DOUGLAS A. RITZIE, to be my Executor, of this my Last`Mill and Testament. If my son, DOUGLAS A. RITZIE does not survive me by a period of at least thirty (30) days, or is not able or does not serve for whatever reason, I then appoint my daughter, SANDRA R. ALBRIGHT, to be my Executrix, of this my Last Will and Testament. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, Walter C. Ritzie, have hereunto set my hand and seal to this my Last Will and Testament, this --day of QC+, 2012. Walter C. Ritzie,Testator Signed, sealed, published and declared by the above-named Testator, Walter C. Ritzie, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto,in the presence of said`Testator and of each other. ADDRESS ADDRESSi COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND WE, Walter C. Ritzie, James D. Flower,Jr. and C_I CL C,/ Vo y�/ , the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witness and that to the best: of their knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Walter C. Ritzie,Testator J es D. Flower,Jr.,Witness 2:Z M6 42y 00—/v Witness Subscribed, sworn to and acknowledged before me by Walter C. Ritzie, the Testator, and subscribed to and sworn or affirmed to before me by James D. Flower,Jr. and blzx>,� witnesses, this day of_DG , 2012. Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL THOMAS E.FLOWER,Notary Public Carlisle 8oro.,Cumberland County MYJ Prf'!T sr ii©n Expires October 26,20t4.__