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HomeMy WebLinkAbout04-24-13 1505611180 --� REV-1 500 EX(02.11)(R) pennsylvania PA Department of Revenue OFFICIAL USE ONLY DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg,PA 17128-0601 RESIDENT DECEDENT 211 l,+! ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01,1,72013 Decedent's Last Name Suffix Decedent's First Name MI PECK SHIRLEY E (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 BOXES BELOW 0 1.Original Return 2.Supplemental Return 0 3.Remainder Return(Date of Death Prior to 12-13-82) 4.Limited Estate Q 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 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9.Litigation Proceeds Received Q 10.Spousal Poverty Credit(Date of Death 11.Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY 7172435838 Ig4TER OF r " S U36 Y First Line of Address b- T— z:0 C� �rn ;z Q? ::0 � 5 S. HANOVER ST. ;;Ic Second Line of Address a City or Post Office State ZIP Code DA E FIL d> CARLISLE PA 17013 Correspondent's e-mail address: R F R E Y@ F R E Y T I L E Y. C O M 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 SIGNAT RE OF PERSQMlkMONSIBLE FQ ING IJETURN DATE ..� 1`�•1� ADDRESS 245 FROST ROAD GARDNERS PA 17324 SIGNATtRTIP17IR N REPRESENTATIVE DATE ADDR SS 5 SOUTH HANOVER STRE.6y, CARLISLE., PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611180 1505611180 1505611280 REV-1500 EX(171) Decedent's Social Security Number Decedent's Name: SHIRLEY E PECK RECAPITULATION 1. Real Estate(Schedule A). . . . . . . .. ..... . . .. . . . . . .. . . . . . . .... . 1 165300 . 00 2. Stocks and Bonds(Schedule 8).. . .... .. . . . . . .. . . ... . . . . . . .. .... . . . 2. NONE 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . 3. NONE 4. Mortgages and Notes Receivable(Schedule D).. . .. . ...... .. .... 4. NONE 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)... . 5. 158787 . 00 & Jointly Owned Property(Schedule F) =Separate Billing Requested 6. 51020 . 50 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) =Separate Billing Requested... .... 7. 5276 . 00 8. Total Gross Assets(total Lines 1 through 7)... . ............... . ... ... 8, 380383. 50 9, Funeral Expenses and Administrative Costs(Schedule H)................. 9. 21831. 00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)..... ........10. 5000.00 11. Total Deductions(total Lines 9 and 10).. . . . . . . .. .... ..... . .. . . . . . .. 11. 26831. 00 12. Net Value of Estate(Line 8 minus Line 11).. . .. .. .... . . . . . . . . . . .. .. . . 12. 353552. 50 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. 353552. 50 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 15. 0. 00 16.Amount of Line 14 taxable atlinealrateX.o 45 353552- 50 16. 15909. 86 17.Amount of Line 14 taxable at sibling rate X ### 17. 0 . 00 18,Amount of Line 14 taxable at collateral rate X ### 18. 0. 00 19.TAX DUE. .... . . . . ... . ...... ........ . ... . . .. . ... ... . .... ........ 19. 15909. 86 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 1505611280 1505611280 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21-13-0108 DECEDENTS NAME SHIRLEY E PECK STREET ADDRESS 68 PINE SCHOOL ROAD CITY STATE ZIP GARDNERS PA 17324 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 15909.86 2. Credits/Payments A.Prior Payments 16000.00 B.Discount 800.00 Total Credits(A+B) (2) 16$00.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill In box on Page 2,Line 20 to request a refund. (4) 890.14 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT z�:.��;W��;,;;r.�«ss:.;�:;�«:�2�,��>,:.r. �t,:�.>,.,.r�.•.��.,�,�$�>;,,, ;.�u«.::.>�,..Yi..,rr.�,:�,w.k�.�.;,,K,,ry.�>,,�.�,�x�L 23. sl>sL4 �.; 2 �3L7°',. :1. .S 4. u"s6 fi :,'a .,?>,.R :_•S,il ;TS YF,a<I,... ,.,,?>.+ ..?i, '9"w''.T'�">'iS^Jvf•: =;°Y,:'t'A'<a=;;r: �_,... gs .�..Y wa..�.y p,.w>.. s ��..�<?!%: , .'n .... <... :.. ..< .. .. ....« 1. .. ::... ..,. ... H•;;:', :A`,ST` ...f. _a !>.. NaY,,, ru, u.: ,3, 3 x., :�,>�i:,.4 ..xr>z.S fro>" J°c¢o., .,h>:.• vF>4k A::M, r:,f •LP::, >„4 ,n y.>w �:F':f;F> ;�3' Xt; ,.fvc>°O;'., �'. .6Lf.»1. is;<i�,o.•✓ v.3`£ie.. ,",� ,s,,. :>.,. Zu.��i3.�°..,sE�'', .,z�Y.>�i:'it';#c,�'u�..�,r's3:FSS.`;�.^�s%k�>•✓o',k`s:s,»:sa.wmz,..,.•,..�>.:.,...3:i<>->.>>_>3,,., .,.,r•,.�,>.+?;�s'`;y;:`a<a,h:l,SU:;Ah�r x?�r.�;,r>.,s:$..,.5.,...'.�:z'�.»r:;.,»}a.,rs,rs:u,.5'::,•:.i.�;£'r>i'..#r"s,._,,.w.:..:..`w...a>Ea',>.z,6.r3•,<ex�'r¢:,.>sr a.>xno.,. „k2,,.^a.3u....>....:.#s:> :b>?�a°z''m'. 'ted, �rr,s�>X•,:cs«;.,r>3�,.... 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........................................... Q IR c. retain a reversionary interest............................................................................................................................ ❑ IR d. receive the promise for life of either payments,benefits or care?.................................................................... 2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................ [� 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?............ ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which - - - - contains a beneficiary designation?....................................................................................................................... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. •Y �q d`�f' ,HE, ,X ,F:^fY. <:+'w `a ,:6.f .f"0..: :^2'.0. •.P:.•.:�..✓n. .G' M5^•:# ". ":,. r>.;. ... a:3'� .,2�<„rr2 4. �.v�>Sr.<L.0......•,,;. eo,... 1� ...2 .v. 2 .•�+.,. . .. :.�r .."'>v 4. :?;� 3 S' £ ..,K+n.., "�'F..n m'n`/.^, 3 2•>tS s ii '^� a,.:rn7..2,•s, •Ya,max �L,. .h^,• ,r..E✓z �. z, �' e � f u � ,� .K,z¢n ,�',,.-r^ki: :��zn�:• xa:se <3 , ra.;<.�;,,., .r ¢,�,. �e 3:- �> :a s .* .- a_ �v .; 'r .>.:>...3r.?�'a..�,..z::....�`�»v_,.��...,..,�h.,£ z�.>J>yu.:.s�izx ..�,.7;�; u,,.e.,z, .,.o.:..,.z:, .J,...e.. .<...:�>..� 'w.s4i,_r....?r.... ..; .-... �,......_.: .;.,:.�,r a£.,..�,s� -.:H...>:.r�»>ex.e an..x•„-;•,Aa,�:,`'•^'.,,'3-t,.:,s.�°....�,-z�xr'n .,r.>�,L:�.w.z9�:�.rSa�.c.>:�•.� m":����.��aA��.Y`>:a:.,.��,.,.. 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(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+(01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirley E Peck 21-13-0108 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM Attach a copy of the settlement sheet if the property has been sold. VALUE AT DATE NUMBER Include a copy of the deed showing decedent's interest if owned as tenant in common. OF DEATH DESCRIPTION 1. 68 Pine School Road, Gardners. Assessed value attached 165,300 TOTAL(Also enter on Line 1, Recapitulation.) $ 165,300 If more space is needed, use additional sheets of paper of the same size. RE1l-1508 EX+('t-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirley E Peck 21-13-0108 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 PNC Bank Account No.41700202980 53,976 2 ACNB Account 1946145 100,257 3 2001 Honda Accord 3,554 4 Miscellaneous personal property 1,000 TOTAL(Also enter on line 5, Recapitulation) $ 158,787 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-{AWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirley E Peck 21-13-0108 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. Kenneth Peck 245 Frost Road Son Gardners, PA 17324 B. C. 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. 5/5198 Certificate of Deposit No.640119313 10,019.00 50.00% 5,009.50 2. A 11/21/00 Certificate of Deposit No. 154009 92,022.00 50.00% 46,011.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL(Also enter on Line 6, Recapitulation) $ 51,020.50 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE V pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & RESIDENT EDEN TURN MISC. NON-PROBATE PROPERTY RE5 @ENT DECEDENT ESTATE OF FILE NUMBER Shirley E Peck 21-13-0108 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST of APPLICABLE) VALUE 1. MetL.ife Annuity 5,276 100.00% 0 5,276 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL Also enter on Line 7 Reca itulation $ 5,276 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Shirley E Peck 21-13-0108 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hollinger Funeral Home 12,131 2. Honorarium to Mt.Victory United Methodist Church 500 3. Honorarium to Minister 200 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: 9,000 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 21,831 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 RESIDENT DECEDENT MORTGAGE LIABILITIES&LIENS ESTATE OF FILE NUMBER Shirley E Peck 21-13-0108 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. DEP Bonding secured with certificate of deposit Decedent's 112 share 5,000 TOTAL(Also enter on Line 10,Recapitulation) $ 5,000 If more space is needed,insert additional sheets of the same size. Property mapper Cumberland County, PA MO i0e w ;. 60 PIKE SCHOOL * .. PIN: 40-39-2214-003 IV Owner: PECK,SHIRLEY E Land Use Code: 101 Property Aorreaqe: 2.05 ML Square Feet: 900 " F A r`1. ••«` .� Assessed Value ! '.NA Building A--,sa-scd Value 5: 9blQul'"LL w f "hi ET Sale Price$ i IL #. PM 'fo lain S rd Copyright 2011 Esri. All rights reserved. Wed Mar 20 2013 02:49:49 PM. 68 PINE SCHOOL ROAD PIN: 40-39-2214-003 Deedbook: 00109-01177 Owner: PECK, SHIRLEY E Land Use Code: 101 Property Type: R Acreage: 2.05 Square Feet: 900 Taxable Status: T Clean & Green Status: Land Assessed Value $: 66600 Building Assessed Value $: 98700 Total Assessed Value $: 165300 Sale Price $: 1 Sale Date: Tue Aug 9 1994 08:00:00 PM Year Built: 1952 Municipality: SOUTH MIDDLETON TWP Height in Stories: 1 Type of Dwelling: DETACH Primary Exterior: Vinyl Basement Percentage: 50 Air Conditioning: AC Total Rooms: 4 Bedrooms: 2 Full Bath: 1 Half Bath: FEB-07-2013 09:20 From:PNC BANK 7174858767 To:8436441 P.2/2 r U. !tii ; it/:1.)A1Y1 rire, 7 PN- -'',c 1`cbruary 6, 20J3 lady Y:aw PNC Bank Mount holly Bruc1) R P. Sliirley E Peck SSN: 185-28-1499 DOD: 01/17/2013 Lear. SirlMadam: Yn resTonse.to Vni)r TN. i.test for Date of Death(DULL)balances for the customer noted abnve, our lecards show the following- Curd cate of Deposit A t`i-c111nt* 41700.*2980 hstabli4hed: 71129/2000 KINMET11 h PECK U��U t,�ttl�ul-r ;� 'i'�,y'1i,'/E+ l_:�4 ac�;rueclinterest ?least note chat this of ire.prnVides date of death balances 1w ckposit accounts(1ttAs,CDs,Checking and Savings) 'Vf►re do not process axay fmincisl trwuhtt 6ui m provide statements. If you tamed asti;1muce with any of thest ilens,F1mgi-•r-All 1498-,PNC-BANK(1-888-762-2265)nr ctop t y your locxl FNC Bauk branch Sincerely, National Fi=dal Services Cetitor PRC Bank,N.A. Member FDIC rhty rnu_,irsacyc is intended far the;ue of the individual of entity to which it is addressed Irnd may �:�antaih in f`arroia Lion that is prlvileyed, cdi fdential and exempt from diceloeure uhdar gpplkab& lams. If the reader of this message u not the Wended reciptent or the cmVloyee or affent responsible for defiverin:thus message to the intended rcclpie4 you are.hereby notified durt any dxcspmination,distribution or copying of this communications is,sMaly prokibitad If you have mc:eived this cownu►ucation in error,pleaxe not#y me imrnediafrly by reply or by retephorte at 80# 762-1775 and immediately destroy this faxed document Page Iof1 ACNE BANK February 4,2013 Frey&Tiley Attn: Robert G Frey 5 S Hanover St Carlisle PA 17013 RE: Estate of Shirley E Peck Dear Mr. Frey: 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. Super NOW 1946145 $100,253.40 $3.33 Individual 5/5/98 Account Certificate of 154009 $92,000.00 $21.51 Jt w/Kenneth L Peck 11/21/00 Deposit Certificate of 640119313 $10,000.00 $19.42 A w/Kenneth L Peck 3/8/95 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. Sincerely, Barbara J W r ACNB Ban Deposit Se ices Representative II acnb.com*acnbbusiness.com•P.Q.Box 3129,Gettysburg,PA 17325•Phone 717.334.31 fit •Toll Free 1.888.334.ACNB(2262) 2001 Honda Accord DX Sedan 4D Trade In Values-Kelley Blue Book 3,'20,13 2:39 PM .......... ..............-1-1........................ ............ ............... .......... .......... ...... .............. .............. ................................ ............. ............. 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I ....................3 � when values change advertisement why ad (updated weekly) ................ ............ ................ ............. ....................... Helpful resources from kbb.com New Cars You Might Like Write a Review Check Specs Sell Your Car Own it?Love it?Tell us, Know your car inside Use our Tips&Tools. 2014 Honda Accord and out. V*.w Cars for Sale Get a Used Car Report near Carlisle http://www.kbb.com/honda/accord/2001-honda-accord/dx-sedan-4d/7veh...rade-in-seil&mileage=85000&category=sedan&pricetype=private-party Page 1 of 3 MetLife P.Q,Box 14592 Des Moines IA 50306 MetLife March 7, 2013 Kenneth Peck 245 Frost Road Gardners PA 17324 RE: METLIFE INSURANCE COMPANY OF CONNECTICUT CONTRACT 2201231 DECEASED Shirley Peck Dear Mr.Peck: Thank you for your request for a lump sum distribution of the above-referenced contract. Our check in the amount of $4,221.01 will arrive under separate cover. The reportable portion of your proceeds is $5,276.26. Due to your request for tax withholding, $1,055.25 has been withheld for Federal taxes. Please be advised that a tax Form 1099-R will be mailed to you by January 31,2014. If you have any questions, please contact your representative or call our Customer Service Center at 1-800-874-1225(Broker Dealer Channel), Monday through Friday between 9:00 a.m. and 6:00 p.m., ET. Si e ely�f` �... is Herdlein Sr.Annuity Representative-Post Issue Processing MetLife Annuity Operations and Services Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address, phone number,date of birth,and social security or tax identification number. Changes may be submitted to the address provided above,by calling our Customer Service Center at the phone number provided above,or by contacting your Representative. Hollinger Funeral Home&Crematory, Inc. Eric L.Hollinger,Supervisor 5o1 North Baltimore Ave. • Mount Holly Springs,Pennsylvania 17o65 (717)486-3433 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED 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 reason in writing below. If you selected a funeral that may require embalming,such as a funeral viewing,you may have to pay for embalming.You do not have to pay for embalm- ing you did not approve if you selected ngeTents such as mation or immediate burial.If we charged for embalming,we wil explain why below. For the Service of S �n`emu d c �k Date of Dearth Charge to: ��.�`Fe-F�. L_ =t 2` M rt.o., f:.t^rl3.,i X15 l-1 3'7 4 Name Address City State. A.CHARGE FOR SERVICES SELECTED- Other clothing 1.PROFESSIONAL SERVICES Services of Funeral Director/Staff......S Cremation um...................S Embalming .....................5 (Description) Other preparation of body OTHER $ $ ..............................$ SUB-TOTAL OF PROFESSIONAL SERVICES..........Al $ TOTAL MERCHANDISE SELECTED.................B S 5o S C.SPECIAL CHARGES: 2.FACILITIES AND SERVICES Forwarding of remains to Use of facilities and services for $ viewing(Visitation/Wake) .........S (Funeral Home) Use of facilities and services Receiving of remains from for funeral ceremony ............S S Use of facilities and services for (Funeral Home) Memorial Service S Immediate Burial •••.•...••..•...•$ Use of equipment and services Direct Cremation .................$ for graveside service.............S $ Other use of facilities SUB-TOTAL OF SPECIAL CHARGES ................0 $ D.CASH ADVANCED ..............................$ Opening Grave ..................$ SUB-TOTAL OF FACIIIITFS/EQUIPMENT...........A2 Ste_ Cemetery Equipment ..............$CASO 3.AUTOMOTIVE EQUIPMENT Lot and Deed ...................$ Newspaper Notices-Local ..... .$ Vehicle to transfer remains to Funeral Home Newspaper Notices-Out-of-town .�..$ e t2 kA�.t-Ar„�� Local .........................$ Telephone&Telegrams ............$ Hearse(Casket Coach) Airfare ........................$�,_ Local .....................,....$ Cl /Mass OfferingS� Limousine Pallbearers .....................$ Local .........................S Certified Copies of the Death ........$ tei 0_ Family car Certificate ......................$ Local .........................$ Flower=or Floral disposition Police Escort ....i......#. $ Flowers.... .....�)4:-.........$ C% Local .........................$ Vault Service Charge...............$ Lead car/clergy car $ Local .........................$ l± — $ Car for pallbearers r _$ Local ...........................$ $ Out of town transportation ..........$ $ $ S TOTAL OF ADV .....................D $1 . SUB-TOTAL OF AUTOMOTIVE EQUIPMENT.........A3 $ We charge you for our services in obtaining: TOTAL OF PROFESSIONAL SERVICES, (specify tasb advances that are marked-up) FACILITIES AND AUTMOTIVE �'y-� EQUIPMENT ....... .tN4�`•t.�a.r.. 4k . .....A$ B.CHARGE FOR MERCHANDISE SELECTE SUMMARY OF CHARGES A.Professional Services,Facilities and Casket.........................5 Equipment,and Automotive (Description) C%- ...k� Equipment ......... .........$IS � M �+ _ 1f-Jr� B.Merchandise�o �'_- ....................S Other Receptacle .................$ C.Special Chang es ..................$ (Description) D.Cash Advances ..................$ ,Q Outer burial contain ........�..$ 1 SQL TOTAL OF ALL SECTIONS....................... $ (Description) �..� PAID AT TIME OF OR PRIOR TO ARRANGEMENTS ...........0,K. AVA 1...... $—&,W_�u Acknowledgement cards.... .. ....S BALANCE DUE .............. $ Register book(s)........... $ REASON FOR EMBALMING G+ Memory folders ........... ...t. �- V�kA -y a't Lt a Lr flS Prayer cards .............. .....$ If any law,cemetery,or crematory requirements have required the purchase Temporary grave marker............$ of any of the iteq listed above,the or requirement explained below. Burial clothing.......... .......$ `°r. I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested.I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected.'l represent that I have sufficient funds available for payment of the cash price for the goods and services selected.I also agree to ma�e payment of$J.Z 1*5.0S'within -SO days.I agree to be jointly and severally liable with anyone else who signs below.A late charge of per month amounting to 4f /_per year will be applied to the unpaid balance beginning '-,' k days from the date of this agreement.I wilralso pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs i• include attorneys'fees,court costs and other costs.Any additional services or merchandise ordered or requested after the date of this agreement will be considere rt of this agre ,pd nt thereof will be reflected on the final bill or statement. (Seal) l 11 1 R I LC'1 (Purchaser) —T (Date) (Seal) �.La (Purchaser) (Licensed funeral DireyWT i�PentuyyWania Funeral Directors Association WH rE Funeral Director YEU.OW Funeral Director PINK Customer form-600 Revised 1/04 LAST WILL AND TESTAMENT OF SHIRLEY E. PECK C-) C `�' M I, SHIRLEY E. PECK, of South Middleton Township (mailing address: r,� c_ C-' School Road, Gardners, Pennsylvania 17324), Cumberland County, Pennsylvania, b g- sound and disposing mind,memory and understanding, do hereby make,publish and I= C7 this as and for my Last Will and Testament hereby revoking and making void any and all me at any time heretofore made. rn co 1. I direct my hereinafter named Executor to pay all of my just debts and q*, expenses as soon after my death as may be found convenient to do so. I direct that my�nertcl services and the interment of my body be as rwy said Executor shall deem appropriate. l direZ.-x a that all transfer,inheritance,estate and death taxes which may be payable on account of rriy de n-h t shall be paid from the residue of my estate regardless of whether the assets upon which such " taxes are based are included in my probate estate. it3 0 f 2. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate,up to a maximum of the amount allowed as an exemption I; or credit for purposes of federal estate tax which at the present time is $600,000.00, I give, devise and bequeath to my hereinafter named Trustee,in trust,to receive and to invest the same, and to pay the income arising therefrom at least annually to or for the benefit of my husband, Robert L. Peck, so long as he shall live, and at his death the same shall terminate and be { distributed to my son,Kenneth L.Peck,provided he shall survive me by a period of ninety(90) j days,his heirs and assigns,but should he fail to so survive me then to such of his legitimate issue as shall survive both my husband and me,their heirs and assigns,per stirpes. No title in a trust hereby created, or in the income accruing therefrom, or in its accumulation,shall vest in any beneficiary and no beneficiary shall have the right or power to sign, transfer, assign, anticipate or encumber his or her interest in said trust, or the income therefrom, prior to the actual distribution thereof by the Trustee to such beneficiary. Further, neither the income nor the principal of said trust shall be liable in any manner,in the possession of the Trustee,for the debts,contracts or engagements of any beneficiary. ,fl 3. All]of the rest:residue and remaind,r of my estate which has not hereinbefore been disposed of,I give,devise and bequeath to my husband,Robert L.Peck,his heirs and assigns, to the exclusion of my children,born and unborn,provided he shall survive me by a period of ninety(90)days,but should he predecease me or fail to so survive me,then I give,devise and bequeath the same to my son,Kenneth L.Peck,his heirs and assigns,provided he shall survive me by a period of ninety(90)days,but should he fail to so survive me then the same pass to such of his legitimate issue as shall survive me by a period of ninety(90)days,their heirs and assigns,per stirpes. 4. Should neither my said husband,Robert L.Peck,or my said son,Kenneth L.Peck, survive me,nor any legitimate issue of his survive me by a period of ninety(90)days,then the same shall be distributed as follows: a. 10% to the Trustees of Mount Victory United Methodist Church, Gardners, Pennsylvania,to be used for such purpose or purposes as the Trustees of said Church shall deem best; .b. 45%Q shall be divided equally among the sons and daughters of my brothers and sisters who are living at that time;and c. 45% shall be divided equally among the sons and daughters of my husband's brothers and sisters who are living at that time. 5. Any share or portion of a share of any trust created hereunder or any other property of mine that is not disposed of under any other provisions of this Will shall go and be distributed to my heirs-at-law. 6. If my husband and I should die under such circumstances that the order of our deaths cannot be established by proof,it shall be conclusively presumed for all purposes of this Will that my husband survived me. Page 1 of 3 Pages 7. I direct my Executor to pay out of the property which would otherwise become a part of the residuary trust, hereinabove established, all estate, inheritance, transfer and succession taxes,including interest and penalties thereon,which may be lawfully assessed by reason of my death. I hereby waive on behalf of my estate and right to recover any part of such taxes,interest or penalties from any person,including any beneficiary of insurance on my life and anyone who may have received from me or from my estate any property which is taxable as a part of my estate. 8. I hereby nominate,constitute and appoint my husband,Robert L.Peck, as Executor of this my Last Will and Testament but should he predecease me or fail to qualify or cease serving as such, then in such event I nominate, constitute and appoint my son, Kenneth L. Peck, as alternate or successor Executor,and I further direct that neither of them shall be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. 9, I hereby nominate, constitute and appoint my said husband, Robert L. Peck, as Trustee of each trust hereinbefore created,but should he fail to serve or cease serving as such, then in such event I nominate,constitute and appoint my son, Kenneth L.Peck, as alternate or successor Trustee of each trust hereinbefore created. 10. In addition to the powers conferred by law, my Executor and my Trustees hereinbefore named are empowered: a. To invest any part of the trust corpus in such securities, investments, or other property as may be deemed advisable and proper,irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation,the stocks,bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations;to consent to the leasing,mortgaging or sale of the property of any such corporations; to make any surrender, exchange or substitution of such stocks, bonds or other securities as an incident to the merger, consolidation or reorganization of such corporations; to pay all assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations;to exercise any option or privilege which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which may be required in connection therewith;and generally to have and exercise as to all such stocks,bonds and other securities,the powers of an individual owner who is under trust obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shall have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit,and upon such terms and conditions as shall be deemed proper,any part or parts of the trust estate,and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase moneys arising therefrom. e. To keep on hand and uninvested such money as may be deemed proper and for such period as may be found expedient. f. To compromise,settle or arbitrate any claim or demand in favor of or against the trust estate. g. In the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund,and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to incur for the proper discharge of fiduciary duties and for the proper management and administration of the trust estate. h. In making any division of property into shares for the purpose of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind,as shall be deemed most expedient, and in making any division or distribution in kind may allot any specific security or property or any undivided interest therein to any one or more of such shares,and to that end may appraise any or all of the property so to be allotted and the judgment as to the propriety of such allotment and as Page 2 of 3 Pages to the relative value for purposes of distribution of the securities or property so allotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution thereof. i. To register any shares of stock or other assets of any trust in their own names or in the name of a nominee. 11. All powers, duties, and discretionary authority granted to my Executor and my Trustee,or their successors,may be exercised without posting any bond and without obtaining any order or approval of any court,and without any notice to or consent of anyone. i 12. If any provision of this Will shall be unenforceable,the remaining provisions shall nevertheless be carried into effect. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on three(3)pages,this 10th day of August, 1994. (SEAL) Shirley E.Pec # 4: Signed, sealed, published and declared by SHIRLEY E. PECK, the Testatrix above- named,as and for her Last Will and Testament,in our presence, who,in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting { witnesses. is y� 4 t fs. I i, i i, r6l -