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Home My WebLink About05-01-13 J1505610101 REV-1500 EX�°'_'°> 4'�! PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes �`"pT"`�,� County Code Year Fde Number FaE�E�� Po gOx Zso6oi INHERITANCE TAX RETURN � "�° "' � s � � r�� 1', `�; �j` �" Harrisburg,PA��1z8-o6o� RESIDENT DECEDENT �r,, � �� „�, , �. ,�;, ENTER DECEDENT fNFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY -� _ � x r� �� Ff�; �_ '�s +„� ��: �� 4, u a �. � ��r � � �� DecedenYs Last Name Suffix DecedenYs First Name MI Wrb' ..hR Ws- ,.e+- ....'6 Y��. §K� x3%'^R � F '�n� Y`e..- n nY'Y.k �,�.. . J' � c M�R "1,�� . �� M k�` ��{j��o�S�,� .w,�!��E.�� (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI - q�:�, .€.a..ace�i:#s�..;� e� . a�� . a . . ,�,;Nr� �.��a:uc�sw�: £��.v. �y ��e ea . nI / �- � fr � � � ' ° , � � �� "',�4 ��.�,�� ;� , ��.,,.� Spouse's Social Security Number r� � THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � �'� � � �;� ,��, REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died lestate Q 7.Decedent Maintained a Living Trust ,� 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received p 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 T0: Name Daytime Telephone Number � � ..w��qf�na� w.- M� .. . .. . .:� t�� > m ;tnn�=��° � �- ;� . D �' '� E"(.� . �� /� n1 � � �V � � � � ? ��' 3 � �„ . �:��.�,u� � �� .,.�.:��fl�,.��:�� .� .,� REGIS OBVVILLS �ONL`� -$ .'T7 � r"" r�•;� � First line of address � � �� F-' �, .aa�. � �wx -a a �g+ �+:� �.��tt;m� ar3�, • --. -��:-�u�g zr �-..x �.' ,�„r+�.� �"'� �y ,r � ��'� � � t ��' � `� � � f z � � '� � c�' . � �.y . x � � a , , ..,.. �,j��,��,�;��,., ,...w..��a��.��:tM� �a��,��. �tt�, � ��=_.x .� :�.: , . . � . , ' - � . =� �� ` w J Second line of address � - �� ff-� 4�a.=�,� f��,�� - t- , ' � `j��' , �� G,�� / ; �L� EY� �t� ��Y a�:. , �� n! c.�; W• �' City or Post Office State ZIP Code :�ATE FlLED � ��► �xf�. � � S-`��U'�`� _ p�. ; �` ; , n.� � �RG ��. CorrespondenYs e-mail address: ,�,J(,�„�)� Under penaities 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. SIGN RE OF PER RE�N�^�OR FILIvNG�TURN�C Z/��C�i� ) ��i�'/� �l� L� 7 /' Y �� ADDRESS r /1/ .��'N�CiFI.'�.i� .�.� , /�.1��" �'c,�°_�� / ;1 ,.'L�- ?�s'C� � SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ° DATE it_i�Q ADDRESS � � �� NIf�' _._._ .�__ ._ PLEASE USE ORIGINAL FORM ONLY Side 1 � 15�5610101 15�561�101� � � 15Q5610105 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: Jc��E.�/�l r:J �� '�� C�r�'�f.�J __._._.___.___� RECAPITULATION ' 1. RealEstate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. . 2. Stocks and Bonds(Schedule B) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. • 5. Cash, Bank Deposits and Miscellaneous Personai Property(Schedule E}. . . . . . . 5. � � � ! � ��+� � 7 6. Jointly Owned Properfy(Schedule F) p Separate Billing Requested . . . . . . . 6. . 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested.. . . . . . . 7. . 8. Totat Gross Assets(total Lines 1 through 7). . . . . . . . . . . ..... .. . . . . . . . . . . . 8. �' �. f / 3 � �• � � 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . . 9. . 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . . 90. � . 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. , 12. Net Value of Estate(Line 8 minus Line 11} . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. , 13. Charitable and Governmental BequestslSec 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. • 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_ • 16. • 17. Amount of Line 14 taxable at sibling rate X .12 • 17. ;� 18. Amount of Line 14 taxable " �' v� at collatera(rate X.15 4 1$• �' 19. TAX DUE . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 19. �r 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p $ide 2 � 1505610I,05 150561Q105 � REV-1500 EX Paoe 3 File Number �, `;i � � �t, Dec�dent's Complete Address: � `�� 5 � `i DECEDENT'S NAME �� s.E � �t!��£ �1 � I-��,�.� �J _. G=��1 N �� • C��-��-'� ��c �� ;�C� ��=1T� STREET ADDRESS / Q � _�C�� .��f� _ __ - _ _ `��_��t4�fG�i /��1a,�- _ _ �'��.�,�/' �1 r r 1. , f�� / �� 0 l 1 _ _ _ _ _ ._ , -_-- -- -_ _ _ ___ CITY STATE ZIP �C �r /�.� � iv�S Tax Payments and Credits: �J��}'� 1. Tax Due(Page 2,Line 19) (1) 2. CreditslPayments � A.Prior Payments __ --- —_ _ B.Discount __ __ __ Total Credits(A+B) (2) 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 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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 propsrty transferred:......................................................................................... ❑ � b. retain the rignt to designate who shall use the property transferred or its income:........................................... ❑ �f c. retain a reversionary interest;or......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ 6]C 2. If tleath occurred after Dec. 12, 1982,did decedent transfer property within one year of tleath without receiving atlequate consideratian?.............................................................................................................. ❑ � 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 containsa beneficiary designation? ........................................................................................................................ ❑ �( IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. . � ; ., For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of 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 decedenYs lineai 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 decedenYs 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. � 1505610101 � REV-1500 Ex�°'_1°> � OFFICIAL USE ON�Y PA Department of Revenue pennsylvania �E^�^TMF�*�F^E�E��E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN �F �'�''�� PO BOX 28o6oi � � � k�� + � �:� harrisburq,PA��28-0601 RESIDENT DECEDENT �� t- � F � � � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDY�'YY .� � � � �� Suffix Decedent's First Name MI •f'� C ` ��(V�:1�� YJ i ` ��F K� � l`� ��'fi� � � � �� '- �a;�� ,�� . � ��A �-�,��,� �. ��« ,, � �' �� (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix gS^ pouse's First Name Ml �4�'� I, � � � �, � � b., � L �I, ` y; t: �� , I � �, ,t r s �� " � ks � z ¢ ¢z N s E' 0 . . °� .. . i'� a t�,' ,k� �F',��. � � � ��'', � Spouse's Socia{Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � �- 'x` � REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2. Supplemental Return Q 3. Remainder Return(date of death prior to 12-13-�32) p 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received Q 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 T0: Name Daytime Telephone Number k, � r $ �� " � �m�.L� �� ;N��- �� ;M�� '�� .� .��x�� 'i �; 3 3 � �5,, REGISTER OF WtLLS USE ONLY First line of address a�.�� sz�. � . . : ��•s�•,�euae,c� ... `� "'� �. � � � ' � ��. E i " e �, � / ��.�' � � � �: �' F`', � � k � S� r, i �, :a�'_' � em-,�ZZ,�,�-.x�. . ::��a:t,� _�r�..qt�.,-u�° ,:R.,�r�.:�as�:a.��=: Second line of address ri%f... � - "S�`t K � � � h � . ..... � �C`"/�'� �/Q��: � I �tJ�� '� 0 sr4 ��` f q ��-�,,�„�.,�� ,� ,��: �� ,�. . � � r� .. ,�� .. City or Post Office State ZIP Code DATE FILED �,�:. ��:�_�3a=��;:�, �,�r�� ;�� v ,�:..� �.�� _�� . �:�. , T.,��„,�:- �� ,�,,-.. � �)a / N��i��r � C.a � �{ UF;R �b� ' �:. �r�• �. �j � /.. 1� (,/� Z �I�� Q : �>�,,..�.,ra ., .��.z.. E.+�`s��, . ., ,��* �s �'..��v�., �.,x�� _. , -^�rz�.,eaPS� ,<.�u�� .��,a� CorrespondenYs e-mail address: fU:.7�v � 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. SIGNA RE OF PERS R PONSIBLE OR FILING RETURN �� DATE ,�.,,." � �.�, ��r: u�'�•�.2 � �� ,r9��'�1 7�/� ADDRESS 11/_�" �.N�:�'G/.�� .�/�� -,1��.�'/�/�'e.��'� �,� % i�,�,�G'---��r'- '�a� SIGNA TURE OF PREPARER OTHER THAN REPRESENTATIVE DATE i�L� ADDRES�S/� /l11l� _ �.� PLEASE USE ORIGINAL FORM ONLY Side 1 � 15056L0101 150561QLU�, � J 15056101�5 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A). . . .. . .. . . . . . . .. . . .. . . .. . . . . . . . . .. .. . . . . . . . . . 1. , . 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . 2. . 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. , 4. Mortgages and Notes Receivable(Schedule D) .. . . . . . . . . . . .. .. . . . . . . . . . . . 4. . 5. Cash, Bank Deposits and Miscellaneous Personat Property(Schedule E). . . . . . . 5. J� L. / % �i � g�.: / � 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . . . . . . . 6. . 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested.. . . . . . . 7. ., 8. Totai Gross Assets total Lines 1 throu h 7 . . . . . . . . . . . . . 8. �` "' rJ ' �r � ( 9 ). . . . . . . .. . . . . . .. i�'L � ! .,'�o '• � 9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. . . . . . . . . . . . . . 9. , 10. Debts of Decedent, Mortgage Liabilities, and Liens(Schedule I) . .. . . . . . . . . . . . 10. ' , 11. Total Deductions (total Lines 9 and 10). . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . 11. ' � e� . . 12. Net Value of Estate(Line 8 minus Line 11) . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . 12. , 13. Charitabie 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. , 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__ . �6. , 17. Amount of Line 14 taxable � � � �� .,'�, � at sibling rate X .12 s 17. ;;; 18. Amount of Line 14 taxable ` j at collateral rate X .15 . �g. ' ; �' ,, r,� �,.,, - , 19. TAX DUE . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . 19., �r „ _� � 20. FILL IN THE OVAI IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Side 2 � 150561�105 1505610105 � REV-1500 EX Page 3 File Number Decec�ent's Complete Address: 1�7 � .�� -- c.�<7 3 j � DECEDENT'S NAME �„ ,. . _ � , �., ., -- v��_pf�I_��_ 1�r _1��L.J�I }�� ,F1�1 C_�1�' }'_��_� ;�� ,1��s� 1� vr�i� C'��.��-" STREET ADDRESS 1 - — --- --/�7_�'�-;��.-�__��`.�.A�____—_ ._ �`��- ^ -- -- - — —__ _ ___ 1.`�.�.1''-� --- ('/J��P i�� :. , Pf't /;)� 1l ------__ _---_ __- -------------- , __ _____----------__-- -�----------- CITY STATE ZIP _ ,�� L J / : � ,�-. Tax Payments and Credits: �� 1. Tax Due(Page 2,Line 19) ��) 2. Credits(Payments A.Prior Payments ----------- B.Discount __----------__---- Total Credits(A+B) (2) 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4� 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) .a � Make check payable to: REGISTER OF WILLS, AGENT. �.� ��, � . -e � �� .� . �,�.k. :�� .�� _��. p�� f. w s. � � � � „ �. m�, � �" � � � .,��`�: .�, .�.. � n � r��.?:-��_. , .. ��.__ �,w . , � � T , 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:............................................ ❑ �] c. relain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. !f death occurred after Dec. 12, 1982,did decedent lransfer 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? ........................................................... � �(f ............................................................. IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. , ,.�" . 1 p fP . . ._. '.'�;: . � ,w.L�� '�� 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 isR 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 1,200C: . 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 decedenYs lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S. §9116(a)(1)j. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(aj(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-15J2 EX+ (0?-10) ,�, . � ��r pennsylvania SCHEDULE A : DEPARTMENT DF RE'✓ENUE iNHeRiraNCE rnx RETuaN REAL ESTATE RESIDENT DECi=DEN7 ESTATE OF: FILE NUMBER: j`,�� P/.�,.�,�� /y�. %�� 1�, �� s-�.. �� 3 �c� All real property owned so�ely 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 Cet�veen a willing buyer and a willing seller, neither being compelled to buy or sell,both having reasonabie kr.owledge of the reievant facts. Real property that is}ointly-owned with right of survivorship must be disciosed on Schedule F. �` ' Attach a copy of the settlement sheet if the property has been sold. ' ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VAWE AT DAT� NUMBER OF DEATH � DESCRIPTION �.. _�-___ 1 , __'.-�_ -.-- .�%�J �'��,�F�� C�� .�� ' I , i I TOTAL(Also enter on Line 1, Recapitulation.) $ u If more space is needed,use additional sheets of paper of the same size, REV-1503 EX+(6-98) , , s. ` _ SCNEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDFNT ESTATE OF FILE NUMBER .�0,;� �h��'_�� 1E1 /�.A� �-�/.�-` ��'� � All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM � VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. �� TOTAL(Aiso enter on line 2, Recapitulation) $ (If more space is needed,insert additionai sheets of the same size) REV-1504 EX+(1-97) ,. SCNEDt�LE C � ' �� CLOSELY-HELD CORPORATION, COMMONWEALTH Of=PENNSYLVANIA PARTNERSHIP OR INHERI7ANCE TAX RETURN RESIDENT DE=CEDENT SOLE-PROPRIETORSHIP ESTATE QF FILE NUMBER _y� r�la�� 1�1 . ��1F� MArJ C�� _; -- c��s �-� Schedule C-1 or G2 iinclutling all supporting Information)must be attached for each closely-held corporation/partnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER ! VALUE AT DA7E NUMBER ___ DESCRIPTION OF DEATH 1. ��_�� TOTAL(Also enter on line 3, Recapitulation) $ (If more space is needed,insert addltional sheets of the same size) REV-1505 EX+(6-98) -�� SCHEDIJLE C-1 ' `� CLOSELY-HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA:X RETURN STOCK INFORMATION REPORT RESIDENT DECEDFNT ESTATE OF FILE NUMBER �pJ � P��J�-'., -��L ��I� .�.� �/ _s - �3�� ' �-- — 1. Name of Corporation___ _ _State on Incorporation Address _____ _ Date of Incorporation City_ _ _ State Zip Code__ _ Total Number of Shareholders 2. Federal Employer I.D. Number _ __ Business Reporting Year 3. Type of Business______ Product/Service 4� TYPE TOTAI NUMBER OF NUMBER Of SHARES VAIUE OF THE STOCK VotinglNon-Voting SHARES OUTSTANDIN� PAR VALUE OWNED BY THE DECEDENT DECEDENF'S STOCK Common � Preferred _ $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, Position,______ Annual Salary $ __Time Devoted to Business 6. Was the Corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes C] No If yes, provide amounY of�ndebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . ❑Yes ❑ No If yes, Cash Surrender Value$ _ Net proceeds payable$ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑ No If yes, ❑Transfer ❑ Sale Number of Shares Transferee or Purchaser ___ __ Consideration $____ Date Attach a separate sheet for additional transfers and/or sales. ` 9. Was there a written shareholder's agreement in effect at the time of the decedenYs death? . . .� Yes ❑ No If yes, provide a copy of the agreement. 10. Wasthe decedenYs stock sc>Id? . . .. . . . . . . ..... . . . . . ........... . . . . . ... ... . .. . . . . . . . . ❑Yes ❑ No If yes, provide a copy of the agreement of sale,etc. 11. Was the corporation dissolved or liquidated after the decedenYs death? .... . . . . . . . ... . . . . . . ❑Yes ❑ No If yes, provide a breakdown of distributions received by the estate,including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . ❑Yes ❑ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • • � • � � A. Detailed calculations used in the valuation of the decedenYs stock. B. Complete copies of financial;;tatements or Federal Corporate Income Tax returns(Form 1120)for the year of death and 4 preceding years. C. If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copres. D. List of principal stockholders at the date of death,number ot shares held and their relationship to the decedent. E. List of officers,their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedenYs stock. ^ Qf more space is needed,insert additional sheets of the same size) REV-1506 FX+(9-00) , SCHEDIJLE C-Z � PARTNERSHIP I' COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN INFORMATION REPORT I RESIDENT DECEDENT ESTATE OF FILE NUMBER —� __., ��;�Pt�1f:�►�.:-12��.Nr.� �.I --2-�� :> µ c�� 1. Name of Partnership__��_ _Date Business�ommenced_ _ Address ___ Business Reporting Year _ City _.__ State Zip Code__ 2. Federal Employer I.D. Number _ 3. Type of Business_____ ProductlSenrice _ _,__ _ 4. Decedent was a ❑General ❑ Limited partner. If decedent was a limited partner, provide initial investment$ 5. � �� "�, � ..�. ;� + , �w ',��. fi . �:°� , �.''�`#£ :�� .'G��.Y �'�fx ��. f l�� ' "t y'S, x �`"'[`� +�m $ °e nri . �.. . ,�1 f , ru A. I — ----— — -- t�— ---- - — B. � C. D. --- —�— � ----- ------ i _— � ----- - — 6. Value of the decedent's interest$ 7. Was the Partnership indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes C] No If yes, provide amount of indebtedness$ __ _ __ 8. Was there life insurance payable to the partnership upon the death of the decedent? . . . . . ❑Yes ❑ No If yes, Cash Surrender VaYue$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior ta 12-31-82? ❑ Yes ❑ No If yes, ❑Transfer ❑ Sale Percentage transferred/sold Transferee or Purchaser ___ Consideration$_ _Date Attach a separate sheet for additional transfers andlor sales. 10. Was there a written partnership agreement in effect at the time of the decedenYs death? . . . . . . ❑Yes ❑ No If yes, provide a copy of the agreement. 11. Was the decedenYs partnership interest sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes,provide a copy of the agreement of sale,etc. 12.Was the partnership dissolved or liquidated after the decedenYs death? . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 13.Was the decedent related to any of the partners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, explain 14.Did the partnership have an mterest in other corporations or partnerships? . . . . . . . . . . . . . . ❑Yes ❑ No if yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each inlerest. � • • � • � � A. Detailed calculations used in the valuation of the decedenYs partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns(Form 1065)for the year of death and 4 preceding years. C. If the partnership owned real estate,submit a list showing the compiete address/es and estimated fair market valuels.If real estate appraisals have been secured,attach copies. D. Any other information relating to the valuation of the decedenYs partnership interest. REV-1507 EX+ (1-97) � .��'��. SCNEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER ��_;�-pia��:: /�?� J,��l��,� ��,-� - � �� 3 �� All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER __ DESCRIPTION OF DEATH , �J�,._:,�, /��.�r�T��G� �.,�� r� ,.� ��-�L �/3�, S�� . �� ,, � �� t�/�� ; � �� L � �� :�,,,o �.� P� i � � �.��. .� <<:�,� � r v � ��TcA �� /�,�i�of ,� �1�� — i�� E /'��e i�' �ti, �� '��f� �,�'ti I �7.� �'/�''c� �,1�c�S'�f.� �;�. ��'�r_� ,��1_�=j° �� T/�� /'�1�� f�.��U�F� - �. /�S.��sS�� l�A��v� AS o� /��/,� ,�` ` �� ..�v- �c��_s�' G�-ti4..S� /'.S� J . �,%c:? , �C'��y �- �-- �.��-��.� l_ C_"�v�Tr�",� /��u�� i C� ��. �� 1 � �.� �a�� /�i'�-1,e�� _ TOTAL(Also enter on line 4, Recapitulation) $ �lj�� ,j U J •. J� (If more space is needed,insert adtlitional sheets of the same sizej ry s—�,q rr .... :� ,_ _ _. L�.' .. i. � ' :�, . y _. . .l �_ � � . ��n rorR a—saas �xo�e r,o<«,� B00E4t.�� f'�Gf�7`'� �'�Pd1�S��,Vt�NIA Januury 1964. Use Optional. 5ervice,nen's Readjustme�it�,ct (38 Tl. S. C. A. 6J4 (a)). Ac- ceptable to Federal National Mor�gage Association. MO�Z'rG.AGE THIS INDENTURE,made the � �`�'Y day of � ' ' in the year of our Lord oue thousand nine hundred and i ,i t,'�� tittl` l l ;'�i:a.� �, ,BETWEEN �, _ � l,ir i) �I r i t�i_ I i .: t� ) �i �i.7 L 7 i r �` I ! � � - � �j r ___ _ _ . .. _ .-- .._ _ - s '' '�� ' f-� : r�' � o (hereinafter called Mortgagor) and � I1 1 I,� ) 't f'h{1_�� I i" ��'t, � �.__�� :�_�:�' _ �� -:��`__ - - -_ _ - � � - - � ,a corporation organized and existing under the laws of Lt.� ��; ;1 :� .'.rett_!t':t ��' 1'�1 u�S 1�.r �i�;. _ ... ._ _ _ _. and having its priucipal of�ir.e and post-office address in i'ii i,;�.�1�1�%ii�: - - - - - -. . � _ _ _ � _ _ __ (hereinafter called 141ortgagee): WITNESSETI3: Riortgagor in and by a Bond duly executed and sealed by Mortgagor, bearing eveu dai;e herewith, stands held and firmly bouud unto said]IIortgagee,in the sum of 1'?,T!::it+:�• }:c��.1:,,.t�ry - - - -. _ _ ._ _ _ ___ _ .. Dollars ($ =' '�' '- . ), lawful money of the United States of America, conditioned for paymeiit unto i�Tortgagee of the prin- cipal sum o� i ;,.t �' �.,.! , �;: ._� _ _ _ _. _.. _ _ _ _ _. Doltars ($ :.; ,� » _ .), iawful money as aforesaid,�,vith interest at the rate of I��iir :��iir ,��1�•-�1 ]_� - - - -- -- per centurn (�';� %) per annwn on the unpaid balance thereof until paid, said principal sum and interest to be paid in mcnth]y installments of � i t,,; •, ,,;� ;' '1(.I? � " ` - " -" - ` - - Dollars ($ t;t�«`7'..i ),commencing on the first day of , -f '• - f'��:.� , 1.9 „�<;, and continuing thereafter on the first day of each month u,itil such debt is fuliy paid, except that,if not sooner paid, the final payment thereof shall be due and payable on the first day of ? , , 19 �is�.,with the privilege to Nlortgagor, at his option,to prepay at any time, without premium or f'ee, the entire iizdehtedness or any part thereof not less than tlle amount of one installment,or one hundred dollars ($l0U),wtuchever is lesN. 5aid Bond is further conditioned (in part) as is quoted below, the Mortgagor herein being designated therein as the Obligor and the Mortgagee herein being designated therein as the Obligee: 1. Obligor shall pay unto Obligee, in addition to and concurrently with, such menthly instalfinents of principal and interest, the following snms: (a) A aum equal to the ground rents,iP any, next due, plus the premiums that will next become due and payable on policies of fire and otl:er hazard insurance covering the premisea described in the Mortgsge of even date and tn�hich secures this Bond, plus taxes, assessments, and seaer and water rents, next due on the premises covered Uy said Mortgage (all as estimated by the Obligee, and of which the Obligor is notified) less all sums already paid therefor divided by the number of montha to elapse before one month prior to the date when such growid rents,premiums,taxes, assessments,niid sewer and water rents, will Uecome due, sueh sums to be held by Obligee in trust to PaY said groimd rents,premiums, taxea,assessments, and.sev�er and water rents. (b) The aSSregate of the�amonnts payable pursuant to subparagraph (a) and those payable on thie debt shall be paid in a single pa5ment each montli, to be applied to the following items in the order etated: (I) ground rents, taxes, assessments, seQVer and esater rents,fire and other hazard insurance premiums: (II) interest on this debt;and (III) aznortization nf the principal of t.his debt. Any deficiency in th.e arnount of any such aggregate monthly payment shall,unless made good bv Obligor prior to the due date of the next such payment, constitute an event of defai�lt hereunder and under said Mortgage. At OUligee's option, 061igor will pay a "]ate charge" noc e�ceeding four per centum (4%) of xny instalLmenr_ when paid more t:han fifteen (lb) days after the due date thereof to cover the ezti-a e�pense involved in handling de]inquenE pxyme�ts, bu[ such "late charge" shall not be payable out of the Proceeds of any sale made to satisfy the indebtedness secured hereUy, utiless such proceeds are sufticient to�diseharg�the entire indebtedness and all proper coets and expenses seeured thereby. 2. If the total of the payraent�s made by Obligor, under (¢) of paragraph 1 preceding•, ehnll exceed the amotmt of nayments actually made by Obligee for ground rents, t�es, assessments, sewer or water rents,or insurance premiume,as the case may be, euch excess shall be credited on subs�quent payments to be made by Obligor for sach items. If, however, such mont�hly payments shall not be sufI'icient to pay sueh items when the saine shall Uecome due and payuble,then Obligor shall naY to Obligee any amount necessary to make up the deflciency within thirty (30) daye after written notice from Obligee stati�ig 1;he amounb of the deficiency, which noticF: may be given Uy mail. If at any time Obiigor shall tender ta Obligee, in accordance with the provisions hereol', tl�e full payment of the ent.ire indeUtedness represented hereLy, Qbligee shall, in computing the amount of such indebtedness, credit to the a.ccount of Obligor any credit balance remaiuing under the provisions of (a) of paragraph 1. If there shall be a default under any of the nrovisions of this Bond and the MortAage securing the same, which results in a public eale of the premises covered thereby, or if the propesty is otherwise acquired after default, Obligee shall applv, at the time of ihe commenczment of such proceedings or at the time the property is otlierwise acquired, the balance then remaining to credit oY Obligor under Qa) of parasrnph 1, as a credit on the Interest accrued and unpaid, and tl��.e balance on the principal tl�en remaining vnpaid on this Bond. '. Obiigor shail pay io Jb;:gee aIl grcu.,u ran�o,ta...e�, ass�sments, se�zr an�?.wat=_r ren*a, aad all othe: charges and clair.�s a�sessed o::�vie3 a±srp Cime�p any lawful authority upon the premises covered by the Mortgage securing this Bond, which, by any present or future la�v or laws, ahall }�ave priority in lien or yxyment to the deLt representecl Lereby and aecured by said Mortga�e, and provision for the paymenb oY�vltich is not otherwise made herein,such payment to be anxde by Obligor within thl�.ty (3��) days after demand by Obligee�, atating the amount. � i:1nU{��,1�.;'�SL }'f�L��?FA��t i. Obligor shall noL commit �or pennit waste; and sliall maintain the propertv in as good coudition as at present, reasonable w�_ur and tear ezcepted. Upon any failure Ao to maintain, 061igve, at its option, may cauae reasonable�naintenance work to be performed at the coat of Obligor. 8. Obligee shall have the right to pay any ground rents,tasea,assessments, sewer and water rente, and all other charges and claime which Obligor has agreed to pay under the terms hereoi`, to advance and pay any sums of money th�t iu its judgment may be neceasary to perfect or preserve the title of the premises covered � by the Mortgage securing tihia Bond, or for insurznce premiums or for any autliorized maintena❑ce work. Any amount or amounts so paid or advanced ehall be added to the principal debt, shatl'hear interest at the rate pmvided for in the principaL indeUtednes3 f.rom the date of pa3�ment or advance, and shall Ue eecnred 6y said Mortgage ratably with eaid nrincipal debt and interest thereon. OUligee, at its ontion, also shxll be entitled to be subrogated to any lien, claim, or demand paid bp it, or discharged with money advanced by it and aecured by said I1lcrt:.;age, The payment.s and advances so made shall be pa.yable in approximate]y eyual monthty �ayments extending ocer snch period as msiy be agreed upon by Obligor and Obligee, Unt not beyond the dae date of the final installment of tlie Urinci�al debt. Fai]ing to agree on the maturitY, the whole of the sum or sums so pa��.d uradvanced sh;ill bc due and paya6le thirt,y (30) days after demand by Obligee. �J. �The ]ien of the Mortgage securing this Bond shall remain in full force and efPect durink any pos��onement or a�tensimi of the i.ime of payment of the indebtedriess, or any parC thereof, secured by said n4ortgage. ]0. UP�n the request of Obligee, Obligor shall execute sind deliver a supplemental bond or Londs for the sum or sums advanced or ��aid by Obligee for the alteration, modernization, or imnrovement of the mortgaged property madq at Obligor'a request; and for maintenance r�f said property, or ground rents, taxes, assessments, sewer and water rents, and a11 other charges and claima assessed or levied againat said property by any lawful authori.t�-, or for any other purpose elaewhere autl�orized hereunder. Said bond or bonds shall be secured by said Mort€age on a��arity with and as fully as iP the amountei stated in such bond or bonds� were ��art of that stated in ihis f3o�d. Said suppiemental bond or bonds shall bear interest at the rate Provided for iri the principal indebtedness and shall be payaUle in apProximately equ:sl monthly payments for such �eriod as may Ue agreed unon by Obligor and Obligee. Failing to agree on the maturity, the whole of the sum or sutns so advxnced or P��id shall Ue due and nayable thirty (30) days after demand by Obligee; but in no event shall any such maturity or due date exteud beyond the dt�e d¢te of the final installment of the principal debt. ]1. If said indebtedness I;e xuarant.eed or insured under the Servicemen's Readiustment Act, ae amended, such Act and Regulations issued tl�ereunder and in effect on the date hereof ehall.govern the rights, dutiea, and liabilities of tlie partiea.hereto, and avy provisions of this or�other instrumznts e_cecuted in connection with said indebtednese whir.h are iei.r,onsistent with said Act or Regulations are hereby amended to conform thereto. 12. If, at anp time, a Writ of Fieri Facils or other execution is�roperly iesued unon a judgment obtained upon thiia Bond, oe I�y virtue of the Wnrraiit of Attorney heret:o attached, or if a �Writ of Scire Facias ia issued or any other appropriate action or pioceeding to foreclose a mortg�age is instituted upon or under the Mortgage securing this Bond, an attorney'e commission of {J.i%:-; per centum ( �;' oJo) of said principal debt ahall be payable, and recovered in additio�to all principal and ii�terest and all oLher recoverable eume then due,besides costs of euit. 13. If any defieiency in the atnount of any aggregatie monthly paytnent mentioned in (b) of paragraph 1 shall not Ue made wood by Obligor prior to the due detr. of the next such payme:at, or if default be made at any tim�e in any of the cuvenants and agreemenGs herein, or in the!liorlgae,re securing this Gmid, then and in every s�ch case, ihe vrhole principal debt sh:all, at the option of OUligee, become doe and payahle iinmediately. PaSment tl�ereof and all interest accrned thereon, witli an attorney's commission as hereinbefore mentioned, may be enfnrced and recovered at once, anyt:hing herein contained to the contrary notwithstanding. Mortgagor, for and in consideration of the aforesaid debt and for better securing the pa.yment of the same, with interest, as aforesaid, and all other ,uins recoverable under the terms of this Indenture unto 14lortgagee, and ii� consideration of the further sum of One Dollar ($1) unto biortgagor paid by Mortgagee, at and before the sealing and delivery hereof, the receipt�vhereof is hereby acknowledged, hath graiAted, bargained, sold, aliened, enfeoffed, assigned, released, and confirmed, �nd by tl�ese piesents dotli grant, bargain, sell, alien, enfeoff, assign, release, and confirm unto Mortgagee, AI.L the following-described propei�ty situate in the a ,,, ; . � __ _ __ _ .. of i. � ,. i ;; -, _ . ,County of , ., ,: _ _ � and Commonweslth of Penns}�lvania;to wit: ,_< . , , � � i i,. . �- r, .. � ,. i� . �._1 I'�r �[7 t -. ��- � � , ,. .i= � �i�_ _ . J . 1 l _ , I� � � . � �. .., il i �=-` ' '�1_„�i,i._.: (:l.l �- .�i.i;:' I.!1 i.! , (C' � i i {;r'..i . o. .1 ,: .y.�_..�?— '-��. ._.... .-,.�.i I _ . .: _. .. �_.. � . �_,�i��; ��t31:!. . �r ? � ,1=' '! ,F S . f>��, i 7"ri�. ��L l. " i C .��'�,i ;r .,� �,�'_ i� , l; I, . � - it � � Y.�` � ? ( �;-,a- i �. � �7-��} l, ;�(' I ;��;(, , 1 � ,� , !�,� � i�( �� , ,. , _...,. - -, , 1 , _ . . - _ _ .-��;,-.-� ,1�`��_ �.� �f: �, r -!i��,f_ ?.�1 lk-.��-''�.�1 �)I' iy=. �.'�L 1�Ir, -�F�� -r•-i . )11.1.' ,ic �T'..-., - � c .=.: _.i."._ I ..._ . .. �' r'1 :i.�. , - _. -,.\ _. . .; � f ..?+_t:l ,,.., .il�lr, '�. .t.. ?1; . �:t".. .;f'..7.!1 !. -_t . ..� _ . ,. - . .. _ � . . , . . . _� . . . . . . . . ,,.. . . ., a . .. �. , .. . . .. ... ''`T y 4 . �. ;iy, ,.� �.;� �-� • {' _., . . ..:11't"i7 ti 't` i� � r _ ;' > > ' t 5 � li�,l`tit.a �..i`'. St Il� �;.C'�fal2:iaS ST111C,'Y1 i3E'i �,:C`8'.il Ye I�l'��.?p �111:'� =�'".I]9 1),.' . � l, ;:±.�t;ture 11;:: i , 7; , a.: , '. �- . .:1!'. � t.'. '`��,1 '�::.i! i '.=� i32 c��.�.�t"1�. . �I..�� ' ."..;. ': ..�i',/�.° -1_'1 .. S-� . L . . . .... .� • _ ]� �. .. � .� � . �� . ' � . .. . r . - . . � ) .i . ,�' . .. , - r�. , .. . .." , ' - .. . . �.�� .... . - r. � . .. .. . . _ . �.".. . �.: ,� - . . . . . �.. .. .. ,. � . . . . n .. ., . _ � . ��'�.-_ .. !t , . . . .�i�.. . -. . !� ... - .. .... , _ . , , �, 5 .. , , . ._ . . � e .1 ._�..!- ., .• i. . .. . ..,, . . . r. , . . . .. .. . �� . . .. . .,,. . .,� , . . � . „ , �.,. , � ,J �. .� j , . .... . , • (�'.)fJN��..r��- PAG't.��:�� 'i'(�UETI3FR witln all and singular t.he buildings, impro�J�i ients,and fixtures�on said premisFS,as well as all additions or improve- meiits now or hereafter rsiade to said premises, streets, alleys, passages, wavs, waters, water courses, rights, liberties, privileges, her�ditaments, and appur.tenauces �vhatsoever thereunto belonging, or in any wise appertaining, and the reversions and remainders, rents,isaues, and profits thereof, and in addition thereto the j'ul:cwing described household appliances,whicii are, and shall be deeme� to be, fixtures and a part of the realty, and are a portion of 1;he security for the indebtedness herein mentioued, namely, ____________ ::� �� . ;- , _ _. t . �"' ,�'_'1 ",�__ .' �=— ^� '� � _'__'"J,c '_'__'"_ � . .. ��.._ :.r_j. _ ___'____' ____.____ " _ "__'_'___"__._____'____"___"___' _' - _ __'_"___'__""'__"'__' _"__"____""___"___"____'__"_____' _" " " "_ ' "' "____" provided, however, that the Mortgagor shalt be entitled to collect and retain the said rents,issues, and profits until default hereunder: TO HAVE ANU 'CO HOLD said property, hereby granted, with the appurtenances, unto said Mortgagee to its own use forever: ;i � � ,� ,.,�� . .... ,.. .. .�,. . . _ - �_ ... I'r�> _.,.. All of the abo�re quoted provisions of said Bond are incorporated in and are constittient parts of this Mortgage. In the eveiit of an;y bi•each of any covenant, condition, or ar;reement of said Bond, or of this 117ortgage, it shall be lawful for Mortgagee to enter i.ipori all and singular the land, buildings, and other rights, corporeal and incorporeal,granted b3� thi,s 11Tortgage, and to take possessio�i of t;he same, and of the fixtures and equipnlert therein, and �o have, hold, nianage, lease to axiy person or persons, use and cperate i,l�e same iii sucti parcels and on such terms and for such periods of tiine as I1Iortgagee iva,y- deein pr�per in its sole discretion, 14Yortgagor agreeing that he shall and will,whenever requested by Mortgagee so to do, assi;i�, transfer, and deliver urito Mortgagee any lease or sublease; and to collect and receive all rents, issues, and profits af said Pliort�aged Preniises and ever,y part thereoi; for all of wliich said Bond shall be a sufficient warrant whether or not such lzase or sublease has beeii assigned; and to tn�ake froin tiiYie to time all reasonable alterations,renovations,re��airs,and z•eplaceiuent�thereto. After deductin�; the cost of all such alterations, renovatiotis, repairs, replacements, the expenses iiicideiit to taki�ig and retainir.g possession of the mortgaged property the nianagement and operation thereof, and of keeping the same properl�-irisured, to apnly an,y residue of sucl� rents, issues, aud profits to the payment of (a) all ground x•ents, taxes, charges, claims, assessiiients, sewer and �uate�• rente, and any other liens tl�at inay be prior in lien or payment to the debt�ecured by this Mortgage, �vith inte�est +.hereon, (b) prezniums for said insurance, with i�iterest thereon, (c) the interest and priiicipal due and secured by this Mo�-tgage�vitli all costs and attorney's fees; in such order or�;�riority as Mortgagee may determine, any statute, law, custom, or use to the c�ntrary notwithstanding. The taking of possessio�i of the mortg•aged premises by Mortgagee, as herein provided, shall not relieve any default by Mort- gagor, or prevent the eiifoi•cement of any of the remedies provided by said Bond, or its attaclied Warrant of �lttorney, or this Mortgage. The remedies provi.ded by said Bond, this Mortgage, and said Warrant of Attorney for the enforcem�nt of the payment of said Bond, or any other indebtedxiess therein provided or secured by this Mortgage, and for the performance of the covenants,conditions, and agreements of said F3or�d or this Mortgage are cumulative and concurrent,and may be pursued singly,or successively,or tagether, at the sole discretiou o]' NTortgag•ee, and may be exercised as often as occasion therefor shall occur. PROVIDED, tliat in case default shall be made in the payment of any installment of principal and interest, or any other pay- rneiit hereinabove or in the conditions of said recited Bond pi•ovided for, or in the keeping and pex�far�mance by tt�e Mortgagor of any covenaiit or agreement coxitained therein or in this iVIortgage to be by said Mortgagor kept and perforined, in the manzier and at the time specified for t}�e performance thereaf,such default will entitle Mortgagee forthwith to sue out a��rit or�Vrits oF Scir2 Facias upon this Indeuttu e of 111ar-t�age, or to ivstitute any other appropriate action or proceeding to f�.reclose a rnortgage, and to proceed thereon te� judgmei�t and esecution, for recovery of said principal debt or suin and all interest thet•eon and all other sun;s hereby serured, together�vith aii attorney's commission for collection,as aforesaid, and costs and etpenses of sucli p�-�oceedings,aud to pursue any and all other appropriate legal or equitabie remedies in such cases provided without further stay of execution or other proeess, aiiy law, usage, or cust:orn to the contrary notwithstanding. Mortgagor expressly waives and reliricruishes all beriefit that may accrue by virtue of any aiid eeery law made or to be made exempCing the mortgaged premises or any oti_ier preruises or property whatever, real or personal, froni attar_hinent, levy, or sale under execution, or aiiy part of the proceeds arising from an} sale tliereof, and all benefit of an,y stay of execution or other process. l�fortgagor hereby waives and relinquishes unto and in favor of the 1VIortgagee, all benefit uiider all la«�s now in effect or here2fter passed to relieve the 1VIortgagor in any manner from the obligations assumed in the I3ond for wtiich tliis Indenture is security,or to reduce the amount of the said Bond to an,y greater exte�it i,han+he amount actually paid for the premises he,reb�-inortgaged at the sale thereof in a,ny judicial proceedings upon the said Bond or by virtue of the VVarrant of Attorney attached to said Bond or upon this Indenture: BUT PROVIDEI) .ALWAYS, nevertheless, that if said Mortgagor shall pay or cause to be paid nnto the said Mortgagee, the aforesaid debt secured b,y this 11lortgage, when and in the manner hereinbefore mentioned and appointed for payment of the same, together witli interest and a11 other sums hereby secured, then and from thenceforth, as well this present ItdDENTUFE, and the estate hereby granted, as cveli as said recited E�ond, shall cease,detern:?ne, and become void, anything hereiubefore or in said Bond contained to tlie contrai�y notwithstanding. i�this Mortgage is exec,uted by more than one person as Mortgagor,the liability of eacl�shall be joint and several. The covenants, conditions, and provisions contained in said Bond, in this Mortgage, or in said 4�Tarrant of Attorney shall bind, and the benefits and advantages thereof shali inure to, the respective heirs, executors, administrators, cuccessors, vendees, and assigns of the parties hereto or thereto; and whenever used in said Bond, in this Mortgage, or �:n said �,'Varraut of Attorney, the singular nuinber shall inctude the plural, the plural the singular, the use of any gender shall be applicable to all genders, and the term "Obligee" or "Nfortgagee" shall include any payee of the indebtedness represented by said Iiond, or secured by this i�iortgage, or mentioned in said�Varrant of Attorney,or any transferee thereof,whether by operation of law or otherwise. I6-51188-3 BDOK�C�� PAGEc.��t1 IN �VITNFSS WAEREOF, Mortgagor hereunto sets his hand and seal. Dated the day �nd year first hereinabove writt�n. Signed,sealed,and delivered in the presence of— _ ,� F,�' � � y� � , ; ,� -----`-� --�_c_t��—,1��=�1 1`�t�-�.-�'?�r_c-�-�_ [sEnL] ��r=,lc; LFon H.Lf.ri�r._r; -------------------- - --- -------- - ----------------------- ------- ----- __ SPAL] ----- ------ ��X---iC��2 c-�f �. _ ,��F i� - � - -�--` ------ -- --- ------- � ---- -- ---- — � � - -------- I 1'-, ," --- --- J ' t -' -�-��;�-c_.' .�--ufllil;: �1. �1;v1 a��C7 CERTIFICATE OF EtESIDEIVC� I, ,do hereby certify that the correct address of the within-named Mortgagee is L'� � . tsr�� _ ;r=•^t� i'�i t �;-�_�c�_n!-��;� �I?,.•;,1i�i-�. _ .�. Witness my hand tY�is , .: � day of � � 1�,g c;�{ ; _. _`-� , ..� �'` �-------------------=-----------------=------ --------------------------- � Agent of L17ortgagee. COMIIIONWEALTII OF YN:NNSFLVANIA, ss: COUNTYOF ._,... � :e..„,:: _.z-� On this ""'� day of „�' ,,4.D.19 �i�a,befo�e me, _ ; � . _ .v..� l ,.,�. � s,._.,; �_.o. : ....;.,,r� ;s.:,. .L..,_.�.,r3' Y�.::�-a..- ��.�,k,< .. ... ,w .. � ._ , _ _., t... .. ..=v,.. .. a.. ... .�t; _. .. .._..e!u��.. came�heabove-named �.�.�n,.�:,Li Lt�.��d r� �i��iEsl'�! ti�i �i � ..r�lil __ ,. �1�:�_L.�i�tii i i i� �.;,�'� and acknowledged the within indenture of Mortgage to be �1;��i' act and deed, and desired the same to be recorded as such. WITNESS iny lia�id and seal,the day and year aforesaid. RECORDED-OFF16E CF THE CLEitK OF COUNTS & �`' � � , } ---- ------ ----- RE60RDER OF DEEDS >3 . , .`�J. NIy commission expires '' �1 ,.S€ ',,,�,g.� � f ,,. , , . �, '� • 1 �Y �,,�rY3� ` �, i+i� �y' � E�a{%��.�.�.�.,.� `^" b' "m'_��.. .Z' d ��;;'�. �f P^ £�';: . CUMBERLAHD COUNTY x"s "' ,-r�Z� ��ti � � _,r PEfVNSYIVAtiU cs ,; .�_ "`s 6 �� ,` �,,s. , . ;�? �� ' j� .._,�2��a�C� ,��.�ry��_�........F FF I �� •�� bC: �,� : ��1 .o-....._. �.t . ,f _� �•q� t�' � _ . .__ . _ ..� { t f. �M,:'�w.l... .sS ky � � "�, � (, \ ��,I F ' � F.,' ,.N"�� {S� F" .�.�. % , ,tY.. r �,,y � �� . �'s .�� _—___._s—___.__.._.�� .,�..� - _� ; _---�::�T�� .� � w a� � � p U � 'l'� � .-�"i {� O �.� � " � 'p .,� ` ':! � '� ; � `�° � ::� .. �� -0 � +� ;� �,r. � � .:, � � a .� � ,;6 E, F� �_,, � � A � �' „ � „ '-- w � k O � �" � �� L � ..�_ � �� .� � y .. „ i _ , �[ i^^� � =� :-a V• ?y 1 �;; y ! � '.7... 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C.) —('"'i rti N DEBBIE LUPOLD,TREASURER TAX PAY E R'S C O PY 98 S ENOLA DRIVE; ROOM 101 KEEP THIS PORTION FOR YOUR RECORDS ENOLA,PA 17025 TEMP - RETURN SERVICE REQUESTED � � � • � . �i�i��i,inri�ili,i�n�il�l�iillii�i�il�l��il�ilniiinill��il� 072765**"""""*""AUTO"*5-DIGIT 17102 HELMAN.GERALD L�JOSEPHINE M ' IIIII IIIII II II II IIII IIII IIIII IIIII I II III� C!O DANIEL P HELMAN 1115 ENTERLINE RD HARRISBURG PA 17110-2806 To review the assessment data for this property, go to: www.courthouseontine.com>AssessmentOffice>Cumberland>PropertyRecords. Then enter control# 09001536 and password CUJXVTNB ___. . _ _ _ __ __ . _ _ _ .. __ _. . ____ _ _ _ ___ _ _ __ _...._. .. ...._._ _.. . ...... _ � . � . . . � - � � • � � :• -• Payable To; DEBBIE LUPOLD,TREASURER Office Hours: MON THRU THURS 9AM�4PM 98 S ENOLA DRIVE; ROOM 101 CLOSED FRI 8 HOLIDAYS ENOLA,PA 17025 Bill No: 2883 PHONE(717)901-9392 Bill Date: 3/1/13 Control No: 09001536 MAP NO: 09-13-1002-045. Desc: 109 ARNOLD ROAD Assessed Value: Land:39,000 Improvement:93,500 Total: 132,500 Discount Face ena ty LOUIS PARK LOT 109 CountV RE 2.131 $276.71 5282.36 310.60 Acres 0.32 Deed 0015X00108 County Lib 0.143 $18.57 $18.95 $20.85 � Munic.R/E 0.957 _ $124.26 _ $126.80 $139.48 $1.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer: HELMAN,GERALD L 8 JOSEPHINE M TAX AMOUNT DUE C/O DANIEL P HELMAN � $419.54 $428.11 $470.93 1115 ENTERLINE RD If Date Of Pa ment is on 3/1/13 hru 4/30/13 5/1/13 thru 6/30/13 7/1l13 or ater HARRISBURG PA 17110-2806 -r'a�'"�" `-•n2y�� ,�� c _j - �, ....r,' �.`�!`- ,.t',r` �� f •�� • •� �•� • ��• .��• �� • • _ _ _ _ _ _ _ _ _ _ __ _ _ ._ TAX PAYER'S COPY- KEEP THIS PORTION FOR YOUR RECORDS � . � . . . �- � � • � � � :� -• Payable To: DEBBIE LUPOLD,TREASURER Office Hours: MON THRU THURS 9AM�PM 98 S ENOLR DRIVE;ROOM 101 CLOSED FRI&HOLIDAYS ENOLA,PA 17025 Bill No: 2883 PHONE(717)901-9392 Bili Date: 3/1l13 MAP NO: 09-13-1002-045. Control No: 09001536 Desc: 109 ARNOLD ROAD Assessed Value: Land:39,000 Improvement:93,500 Total: 132,500 I LOUIS PARK Discount Face Penalty LOT 109 Acres 0.32 Deed 0015X00108 County RE 2.131 5276.71 $282.36 $310.60 � County Lib 0.143 $18.57 $18.95 $20.85 (II IIIII I'll IIIII II I II I II (III I I�II i Munic.fZ/E 0.957 $124.26 $126.80 $139.48 Tax Payer HELMAN,GERALD L&JOSEPHINE M C/O DANIEL P HELMAN TAX AMOUNT DUE $419.54 $428.11 $470.93 1115 ENTERLINE RD If Date Of Payment is on 311/13 thru 4/30/13 5l1/13 thru 6l30/13 711113 or Later I HARRISBURG PA 17110-2806 To review the assessment data for this property,go to: www.courthouseonline.com>AssessmentOffice>Cumberland>PropertyRecords. Then enter Control# 09001536 and password CUJXVTNB TAX INSTRUCTIONS - READ CAREFULLY If serviced by a mortgage company,forward one portion of this bill to company immediately Keep remainder for your records. If you require an official receipt. send your check,two copies and a self-addressed stamped envelope. If not paid by 12/31/2013 this bill will be returned to Tax Claim Bureau for collection and filing of a lien againsi your property. Faiure to receive a bill does not relieve you from liability for prompt payment. No partial payments or postdated checks will be accepted and payment must be received or U.S post marked by the due date. �l�Zj,au! REV-15o8 EX+(11-10) �� `��'� pennsylvania SCHEDIJLE E oEPARTMENT oF RE,�EN�E CASH, BANK DEPOSITS & MISC. INHERITA"�E TAX RET�R'� PERSONAL PROPERTY ' RESIDENT DECEDEN-�- ESTATE OF: FILE NUMBER: ��- ,j .�� /�� . �,1��.M�q.,J �; s- ��0 3��- Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH /'i � �..� c: �_�_�� /�� `�,.�� s�S �,�n--� N E�.� �.1'i �'� � �'�C�,�v ,, �j�' � '�O�� J /� ��T. �� '�/� °2 '? 22_ U c`�' — .7 v,�;E ��'N�:�,1� /��. %�F�l_�/a �./ �;��qi _ fJ�r�;��>�J) C% �!,/J.��. ,� %,l��t� �..� �Fx�c �/%�r'� _, ,Z . �"�► C �:a� � � �'�� .�5�; %8' 7_.3 �� v��i�,� F.,� l.l� ,��/ �.�.;=- C f� , �� l � c�� S �� -�- ;�,��.� S°i i� � �l �� S� -- �;"�-�;�;�' c./1 L. ,�l�l�r.� l,.l �S`i.�a%E� ��c"��,,,�C—� �/�� %/��I �L ,� j-J��Ni.� � �C�F� v%�'?� TOTAL (Also enter on Line 5, Recapitulation) $ �/ � ��. / � If more space is needed, use additional sheets of paper of the same size. YNI: Kank National Associa.tioi� �� CBA�� Certification Status on File PN02725 ACCOUNT REGISTRATION AND AGREEMENT LEGAL TITLE � TIN Home Phane # Work Phone# Email Address � 'e5T Of JOSEPNINE M HELMAN DECD 46-6697361 DANIEL P HELMAN EXTR 194-44-9206 (717)233-6254 ACCOUNT ADDRESS FOREIGN ADDRESS 1115 ENTERLINE RD HARRISBURG PA 17110 Check appropriate box for fe�deral ta�classification(required): � IndividuaUsole proptietor �C Corporation �S Corporation �Partnership �Trustlestate ❑ Limited iiability company.F,nter the tax classification(C=C corporation,S=S corporation,P=pattnership)__ �Other(see instructions) Certification of Owner: Under penalties of perjury, I certify that: (1) The number on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subjec[ to backup withholding because: (a) I am exempt from backup withholding, or(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding,and (3) I am a U.S. citizen or other U.S.person. If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return,you must cross out item (2) in your certification. � Check this box if you are a non-resident alien and complete W-8 BEN. � Check if Exempt Payee - Status does not apply By checking this box the only purpose this doeument will serve for is a to individuals. See instruction �or the W-9 form Sienature Card for the account. It will not serve as a W-9. available on the IRS websit��. Account Agreement: By signing this Account Registration and Agreement and/or by using the account, by requesting and/or using and/or later adding any account related services, including but not limited to Debit CardiA'TM Card, Overdraft Protection, PNC Bank Online services, I agree to be bound by the terms and conditions of PNC Bank's Account Agreement lor Checking Accounts and Savings Accounts, PNC Bank's Account Agreement for Certificates of Deposit, or IRA CDs, as applicable, and Schedule of Service Charges and Fees, as well as other terms and conditions that may apply to my PNC Bank account, account features and/or services. I agree that my account is subject to approval by PNC Bank. ACCOUNT# PRODUCT BRANCH EFFECTIVE DATE APPLICATION DATE APPLICATION�# 5113272208 ICK 00108 04/08/2013 04/08/2013 1-lEWOFD6 The Internal Revenue Service does not require your consent to any provision of this document other than the certi�cation required to avoid backup withholding. � `,� ;� `� °j ,'�A �" __._�; DANIEL P HELMAN _ X �/ ��„ F j�� ''�� 6 ��L�`�, �°` ..,��.. Signatuce --� X Signature x Signature X Signature X Signature X Signawre PNC Bank internal use onl�instructions: Please forward this form in the clear plastic envelope with the red insert to CIF. lt can also be mailed via interoffice mail to CIF-Mail Stop: P7-PFSC-04-F EFORM122014-7012 Performance Checking A�count Statement �� a PNCBANK P'_�]C Bacik Primary accoiint number.51-1427-8396 Page 1 of 3 For the period 03/22/2013 to�4/79/2073 Ni_imber of en�dosures:0 001496� C� For 24-hour banking,and transaction or � EST OF GERALD L HELMAN DECD �interest rate inform��tion,sign on to DANI EL P HELMAN EXTR PNC Ban�k Online Banking at pnacom. 1115 ENTERLINE RD n' Forcustomerservicecall1-888-PNC-BANK HARRISBUR6 PA 17110-2806 Monday-Friday: 7,4M-10PMET Saturda�/&Sunday: 8 AM-5 PM ET Para servicio en espan"ol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK � Write to:Customer Service PO Box 609 Pittsburgh PA 15230-9738 �Visit us at pnc.com � TDDterminal: 1-800-531-1648 For Ue:uvig unpaircd ctients only Performance Checking Est Of Gerald L Helman Decd Daniel PHelman Extr Interest Checking Account Sum�nary Account number: 51-1427-8396 Overdraft Proteetion has not been established for this account. Please contact us if you would like to set up this service. Orerdrait Coverage-Your account is currently0pted-Out. You or your joint owner may revoke your opt-in or opt-out choice at any time. To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions. Call 1-677-588-3605,visit any branch,or Sign on to PNC Online Banking,and selectthe"Overdraft Solutions"link underthe Account Services section to manage both your Overdraft Coverage and Overdraft Protection settings. Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 45,653.?4 .39 3,099.40 42,554.18 Average monthly Charges balance and fees 43,591.83 -00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 8 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions (i 0 O Interest Summary As of 04/19,a total of$7 A9 in interest was paid this year. Annual Percentage Number of days Average collected Interest Paid Yield Earned�AFYE) in interest period balanceforAPYE this period 0.01% ;9 43,591.83 .�4 � PN D M LT01-J O B79160-N40-N N N N N N-00 2-00 2851 Performance Checking Account Statement For the period 03/22/2Q13 to 04/79/2013 fO� For 24-hour information,sign on to PNC Bank Online Banking EST OF GERALD L HELMAN DECD � `—'on pnc.com. Primaryaccount number:51-1427-8396 Account number:51-1427-8396-conlinued Page 2 of 3 Activity Detail Deposits and Other Additions There was 1 Deposit or Other Addition Date Amoun[ Description totaling$.34. �>4;��9 .3� Inte�-es�Yayment Checks and Substitute Checks Check Date Reference Check Date Feference number Amount paid number number Amount paid number 1]1✓ l,880.U0 0�/>8 o�so5,7s�; l 15�'� - 1��.71 (�4!1 G o�s�sc�7s ll?� 6717 04%O] ors4:3��501 11'7 �� G�.00 04!]('� o��os�oo ��`� � :��J3..ri0 O�jO� pi541430rS1 7�8 � :i0.00 0�},%��i O�f041J7�+ *Gap in checksequence There were 6 checks listed totaling $2,458.38. Online and Eleetronie Banking Deduetions There were 2 Online or Electronic Banking Date Amount oescription Deductionstotaling$747_02. ��/O� ��3.78 Yayment,E-Cl�eck Cl�eckpa5�nit Nationwide Mutua O]13 6�},%lri , /'4i.�4 Paymen�,E-Check Paymeu�s Vervou Financia Ol]6 t/ Other Deductions Tliere were 2 Other Deductions totaling Date Amount Description $500.00. O�i-'f) �•,�50.00 VVitl�drawal Te104U0001('i01601:i 04;'l:,' �?�i0.00 V1'i�tidrati�al Te.l 0�0U07U�304 OUl7 Daily Balance Detail Date Balance Date Balance Date Balance Date Balance 0:�/2� 4Fi,653.`?4 O�iO] 4�,45('i.07 04%L �„718.74) f)�kilf� 4�'�554.78 (73�%;'� 43,7`I:i.�4 0��/05 43,0(i�.Ci`7 Q4j]�i �?,641.5K � 03 j`?9 4:i,ri`�3.�4 0-1 j OS 4`?,9G8.7') 0�i lfi �}��iFi�.8�1 Buyin;? Relinancing? Go with the bank you l:now. �l�oday's interest rates are at near-historic lows.lf you are planning to buy a ne�v home or refinance your existing loan to lower your rate or monthly payment,talk with a PNC Mortgage Loan Ufficer today! Stop by your local PIvrC Bank branch or call 8»-892-63�j. YNC is a registered service rnark of"I�L1e PNC Financial Services Group,lnc. ('PNC"j. PNC Mortgage is a division of PNC Bank, :Vati�>nal Association,a subsi�liary of YNC. fill ]uans are provided i�y PNC Bank,National Association and are subject te credit:�pproval ai�d properry appraisal. (c} 2013 1'he PNC Financial Services Uroup,Inc.A1l righr.�reserved. PNC Bank,Nationat Association. �lember FI)]C. PNC Mortgage is:�n Equal Housing I,ender. .� REV-1509 EX*(1-97) , � SCHEDULEF COMMONWEALTHOFPENNEiYLV,4PJIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDEMT ESTATE OF FILE NUMBER �osE�%��f" -- l`�r'� �C.1� A .�J ��r,��% 3 � If an asset was made joinl within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S,'NAME ADDRESS RELATIONSHIP TO DECEDENT A. �c�.�.1� B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MAOE Include name of friancial institution and bank account number or similar identifying number.Attach DATE Of DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real eslate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. Ja 1 � - 1� rvll J� TOTAL(Also enter on line 6,Recapitulation) �I!, $ (If more space is needed,insert additional sheets of the same size) REV-1510 EX+ (08-09j � � � ` pennsylvania SCHEDULE G oePaATMENT oF ae�E��uE INTER—VIVOS TRANSFERS AND INHER�TANCE TAX RETUkN MISC. NON—PROBATE PROPERTY RESIDENT DECEDENT ESTAT�OF , FILE NUMBER ��s�P�-�r.�e�� . .�-�,J�l M.� �� l,�> .� - �;�� 3 £�� 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 DATE OF DEATH %OF DECD'S EkCLUSION TAXABLE ITEM INC�U�E THE NNME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THEi DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST !IF APPLICA6LE) VALUE 1. ^a N�.,� E; � � � i � i � � , � � TOTAL (Also enter on Line 7, Recapitulation) $ � If more space is needed, use adtlitional sheets of paper of the same size. REV-1511 EX+(10-06) � . ��, SCFIEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER --�-' '�' o I ��E Fl��,�`��r �'-JCl�� / �� s'�� Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL E:XPENSES: , /��a �'�,��,�. G�A.s C�E�/�� F� ��'.� ;� /, ��o. � o — A .� ', �'�/�'I/a%i v „J SFi�c Z�;� E'� o�� '?5�"..Q C ,�iMv�� c1 f�. �s,. �<:f•, ,�J�4;,-�1 U.l-� .,J � .f� � ��J � , k'da/�' � t �;�) �� ►J E _S%� �� .J ��,F� � � �u < <� ��- / �7io � � /��-,��F S� �'- '� � � �,-- ��:� _ �� - �-Zz lJ ��, `� � B. ADMINISTRATIVE COSTS: � 1. Personai Representative's Commissions Narrie of Personal Representative(s) 1�� I Street Address City—_._ - _ State_ Zip Year(s)Commission Paid: , 2. Attorney Fees ��f� 3. Family Exemption:(if deced nt's address is not the same as claimanYs,attach explanalion) I� I Cla�mant � .� I I Street Atldress ' c�cy ____ __ ___ State Zip Relationship of Claimant to Decedent r► ///►►► 4. Probate Fees �/��. / 5. AccountarYs Fees ��1f�` ) 6. Tax Return Preparers Fees �//�. � ��' TOTAL(Also enter on line 9, Recapitulation) $� �'�(��D (If more space is needed,insert additional sheets of the same size) REV-1512 EX+ (12-08) � � pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAx Rf=T�R" MORTGAGE LIABILITIES & LIENS RESIDENT DECE:DENT ESTAT OF FILE NUMBER ,��:5� �/�1/�J ��./'�,�� '.,� �'- <�O ��5�- 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 OFDEATH 1. �/�/�.� E._ f—�.� � �I �I � I TOTAL (Also enter on Line 10, Recapitulation) $ II'more space is needed, insert additional sheets of the same size, REV-1513,EX+ (01-10) ' � pennsylvania SCHEDULE J DEPARTMENT OFRE:VENUE � INHERITANCETAX�iE:TURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER; �---• � . `� _��'^�_� - � � ��'— �J .�� RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER "JAME:AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under ,� �''� � �.� Sec.9116(a)(1,2).] �. N/l� ��J�/ �.., 1. ��v) �'�y 1�_ / : �C'��/�ly.f'�/ C'��U%c�,t� Si,7� �e�� llu/C"� � � �_ i 1�// S (:=��j�/i--J� �CO�� --/"✓I��Fr� � G�✓� L 'L /-�}�,�"i.�. �c,,�'� ��} /-% 1/0— ��'J� C�� 3� R; �?�� .I %:a;�'� �..: 1� /� ("�/ -�_.> ,-�� 3- �>��"� �ri�� (�i0�E:��*' �A L�� .SJ�/q�'� � �c;�,Q.�.�1� �� _� v�� r�v� L �;/�:�,�v C,��/�� c�'`�'�c� �� i 1' ENTER DO�LAR AIhOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF RFV-1500 COVE=R SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS � A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT"AKEN: j 1. /� � - !�/l.�1LJ� �': � B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: �. �� , � TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needetl, use additional sheets of paper of the same size. F REGISTER OF WILLS CERTIFICATE OF i CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA �� , � No. 2013- 00384 PA No. 21- 13- 0384 Es ta te Of: JOSEPHINE M HELMAN (First,Middle,LasU Late Of: EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY � Deceased Social Security No: WHEREAS, on the 4th day of Apri1 2013 an instrument dat�ed August 31st 2004 was admitted to probate as the last will or JOSEPHINE M HELMAN (Fi�st,Middle,LasU late of EAST PENNSBORO TOVI/NSH/P, CUMBERLAND County, who died on the 27th day of March 2013 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Regi:�ter o:f Wills in and for CUMBERLAND County, in the Commonweal th of Pennsyl`rania, hereby certify that I have this day granted Letters TESTAMENTARY to: DANIEL P HELMAN who has dul_y qualified as EXECUTOR(R/XJ and has agree�a' to administer the estate according to law, a11 of which fully appea.rs of record in my office at CUMBERLAND COUNTY C�OURT HOUSE, CARL/SLE, PENNSYL VANIA. IN TEST.IMONY WHERF;OF, I have hereunto set my hand and affixed the seal of my office on the 4th day of April 2013. � , � ' n � '�f �' i �� egi il \ � f, � i puty **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, i,AST) � LAST WILL AND TESTAMElVT OF JOSEPHINE M. HELMAN I, JOSEPHINE M. HELMAN, of Enola, Cumberland County, 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 revok�r�g all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. Fu�ther, I direct that my body be cremated and that my remains be disposed of a � as my personal representative shall deem appropriate. �4 .� SECOND ,E, �-=�, c �—' '� i'�T1 y I give, devise and bequeath all the rest, residue and �inderg� m�;e�tate to c+� �. �cs , �:.s . ,.� -'� � my beloved husband, GERALD L. HELMAN, absolutely and i��f�e �imple if h�� swrvives • • : � .' _..:. . ;� :7 ;'- me by thirty (30) days. t � - , �' `� � ^' F �, I �M1� �`r THIRD . .. c:. �- :-:7 .,. In the event that my husband, GER�,LD L. HELMAN, fails to survive me_by thirty SAIDIS 30 da s g' q Y SHUFF, FLOWER � ) y , then I ive, devise and be ueath all the rest, residue and remainder of m & LINDSAY �rroeNe��s•nr•in�ti- estate, as follows: 2I09 btarket Street c��„u H��, �A �q) One half (1/2) to my son, DANIEL P. HELMAN, or his is�ue, per stirpes. (B) One half (1/2) to DANIEL P. HELMAN, IN TRUST, NEVERTHELESS, for the benefit of my son, JAMES W. HELMA!V, upon the following terms and conditions: ' FIFTH Nn addition to the powers conferred by law, I authorize any personal representative, trustee or guardian acting under this instrument, in his/her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal property; (b) To exercise any options to subscribe for stocks, bonds, or other investments. (c) To join in any plan of lease, mortgage, consolidation, exchange, `K reorganization or foreclosure of any corporation in which my estate or any trust i �.�a may hold stocks, bonds or other securities; .,� ._� °' (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any � � property, real or personal, which at any time may form part of my estate, for the .3 '�- payment of debts or taxes, or for any purpose of administration or distribution, for �, \ � such prices and upon such terms as they, in their sole discretion, may deem ` �� -' wise, and to execute and deliver deeds of conveyance or transfer thereof; (e) To make settlements and compromises on such terms as they, in :hG�� s�ie aiseicti�i� r��ay aeem wise without the necessity of obtaining any court approval thereof; SAIDIS SHUFF, FLOWER (f) To make distribution hereunder either in cash or kind, as they, in & LINDSAY n�-roRNetis•,�T•�,�w their discretion may deem wise; 2109 Market Streel Camp Hill, PA (g) To terminate any trust created hereunder, and pay the residue out- right to the beneficiary, when my Trustee determines, in his discretion, that the 3 � size of the trust has so diminished as to make its continued administration in trust impracticable. SIXTH In the event that my Trustee hereinabove named shall be unable to continue to act as trustee by reason of his death or incapacity, I nominate my daughter-in-law, Debra Helman, to serve as successor trustee. SEVENTH I do hereby nominate, constitute and appoint my husband, GERALD L. HELMAN, to act as Executor of this my Last Will and Testament. Provided, however, that if he is unwilling or unable to act as Executor, I direct the duties of Alternate Executor be performed by my son, DANIEL P. HELMAN. EIGHTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, JOSEPHINE M. HELMAN, have hereunto set my hand and seal to this my Last Will and Testament, consisting of four (4) typewritten pages, the first three (3) of which bear my signature in the margin for identification, this Sl u day of ,�� ;- `_ , 2004. ; J SAIDIS �.�,,.,y.a,.��.i,,.w �r.� 1; , -�,�� H�t SHUFF, FLOWER J.C�SE�HINE M. HELMAN, Testatrix & LINDSAY ATTORNEI'S•AT•LA W 2109 M�rket Street Camp Hill, PA 4 ' Signed, sealed, pubiished and declared by the above-named Testatrix, JOSEPHINE M. HELMAN, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. ,- �-- ",� °�t'W..i�t-��'-,�--`��,;t�.c.:.-1 ADDRESS 1 rc�.�:� �t,�.C� .; ;a�_.,. .� __ _ � �, �; F�' a ��;,�"._. /' , — r , _ � , ' � ,��, � � ��; � _. _.�.._ ADDRESS :x� � �� ' � '��' _ � . y� �� ; ; : ,� � ,� ; d , ��--' .�. ��:�r:� c� � ��- COMMONWEALTH OF PENNSYLVANIA . : ss. COUNTY OF CUMBERLAND . WE, JOSEPHINE M. HELMAN, j��n�� = �/nc�-�-°r Tand,;:��f,�' �� T�:.�o�� = .._._�. the Testatrix 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 Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witness and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. f�/ �i .�.n ,/'�. ✓ `VJ .:-.i�'S-:�.'32r�v.--9 JO �EP ' IN�E M. HELMAN, Testatrix ,-� '��'G�-ti�`1�.,�t�,, ��;- �' ` �'- � �. -� -�,�. Witne.�s � % `';` 1�� i / �°�'�' !''\, '�j't ,__ � 1Nitness�,. ' `t��: SAIDIS Subscribed, sworn to and acknowled ed before me b JOSEPHINE M. SHUFF, FLOWER g y & LINDSAY H�LMAN, the Testatrix, and subscribed to and sworn or affirmed to befo�e me by 4rroKVevs•nT•uu- ,'`��;;;� � �' w ~�° _ - 8t1C� ��. � :�-t, o Yf` witne�ses, thlS �`1' - day Of �} r. ... � I.,. 2109 Market Street �� "` 2��4. � j�- ' /r //� J � � Camp Hill, PA r �_..� �i� f, COMMONWEALTH OF PENN YLVANIA .(�IOt�fy PUb IC Notarial Seal Sallie Allshouse, Notary Public Camp Hill Boro, Cumberlend County My Commission Expires Mar. 29, 2008 5 COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND � , � R! I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 4th day of April, Two Thousand and Thirteen Letters TESTAMENTARY in common form were granted by the Register of sai d Coun ty, on the estate of JOSEPH/NEMHELMAN , late of EASTPENNSBORO TOWNSH/P (Fi�st,Middle,Last) in said county, deceased, to DANIEL P HELMAN (Fus4 Mrddle,Lastl and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of sai d offi ce a t CARLISLE, PENNSYLVANIA, thi s 4 th day of April Two Thousand and Thirteeri. File No. 2013- 00384 PA Fi 1 e No. 21- 13- 0384 Da te of Dea th _ 3/27/2013 S. S. # — - � � r � �' � �j n� � % 'l./ eg sY r i!s ' � � �� '�� Deputy NOT VA.LID WITHOUZ' ORIGINAL SIGNATURE AND IMPRESSED SEAL � REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA . i�, , R No. 2012- 00392 PA No. 2 7- 12- 0392 Es ta te Of: GERALD L HELMAN (Firsr, Middle,Lasil Late Of: EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: GtTHEREAS, on the 2nd day of April 2012 an instrument dated August 31st: �'004 was admitted to probate as the Iast will of GERALD L HELMAN (Fiist,Middle,Last) Iate of EAST PENNSBORO TOWNSHIP, CUMBERLAND County, who di ed or. t:he I I th day of March 2 012 and, WHEREAS', a true copy of the will as probated is annexed hereto. THEREFORF;, I, GLENDA FARNER STRASBAUGH , Register c>f Wills in and for CUMBERL�AND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARYto: DANIEL P HEL MAN who has duly qualified as EXECUTOR(R/X) ar�d has agreed to administer the estate according to Iaw, a11 of which fu11y appears of reco��d in my offi ce a t CUMBERLAND CDUNTY C'OURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTI�ONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 2nd day of April 2012. �� . ..��..�--��__ � ! � �,r� ��l�"� �� '��'�-�`'�.. ;'i ;l,-i r ,-� �. � , . �,� ��r� � i�� { ` `y�''�- egFSter of WiH,s��- f �.�� h�-'.t i ik � � 4 � \ /,s �� )i� '� ��' t � '��.��. f, .��_�.'�;�.� s '`ti,`.- � � Deputy i````_ **NOTE�* ALL NAMES ABOVE APPEAR (FIRST, MIDD.L,E, LAST) , i� _ _ _ _ _ _ . , I , . � _ I , „ . . � � I i ; LAST WILL AND TESTAMENT .., � � �-.-. OF �^;'�� _ � �z �--% _ r— GERALD L. HELMAN �� ' ;��=' �� <::�;� N ,.. �?�' � -;; Jy : --- I, GERALD L. HELMAN, of Enola, Cumberland County, Penns�vania, b�ng '., '-'� - ._. � o ti � sound and disposing mind, memory and understanding, do hereby make, pubfish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and the expenses of my last illness and funeral from my e�tate as soon after my death as conveniently may be done. Further, I direct that my body be cremated and that my remains be disposed of .,� � as my personaf representative shall deem appropriate. , SECOND C I give, devise and bequeath all the rest, residue and remainder of my estate to � my befoved wife, JOSEPHINE M. HELMAN, absolutely and in fee simple if she survives me by thirty (30) days. THIRD In #he event that my wife, JOSEPHINE M. HELMAN, fails to survive me by thirty SAIDIS 30 da s then I ive, devise and be ueath all the rest, residue and remainder of m SHUFF, FLOWER � l Y � 9 q Y & LINDSAY ATT'OKNEI'S•AT.�,�,- estate, as f�ollows: 2109 M1larkel Street Camp Hill, PA �A) One half (1/2} to my son, DAN�EL P. HELMAN, or his issue, per stirpes. (B) One half (1/2) to DANIEL P. HELMAN, IN TRUST, NEVERTHELESS, for the benefit of my son, JR,MES W. HELMAN, upon the fallowing terms and conditions: - - - - _ � --. . ._ :,- _ - _ . I � ' `��. , � T , 1 (i} To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, and to use, pay and apply the income and principal or so much tnereof as in Trustee's sole discretion may be necessary fo the health, maintenance and support of my son, JAMES W. HELMAN. The payments authorized by this trust shall be made by my trustee directly ta said JAWIES W. HELMAN, provided that, in the sole opinion of my trustee, he shall ha�re the ability to handle properly the funds so paid, or may be made direcfly to � any person, entity or institution entitled to such payment by reason of services rendered or to be rendered to said JAMES W. HELMAN. � {ii) The amount to be paid to or for the benefit of JAMES W. HELMAN �� shall be determined from time to time by his �eeds, and the times of said � \ ,��, payments shall be determined by such needs, provided that payments be made � at least monthiy. (iii) All payments of principal and income hereby given shall be free frorr� anticipation, assignment, pledge or obligations of the beneficiary, and shall not be subject to any execution or attachment. (iv) AI1 principal and accumulated income not so applied during the lifeti!me of JAMES W. HELMAN, shail be distributed according to the terms of his Wif1, or, in the absence of a Wi1f, according ta the intestate laws of this SAIDIS Cammonwea{th. SHi3FF, FLOWER & LINDSAY ATTORNEI'S•AT�LA W FO U RTH 2I09 Market Street C�mp Hill, PA I direct that any and a{I inheritance, estate, and transfer taxes imposed upon rn estate passing under this Will ar otherwise shall be paid out of the p�incipal af m residuary estate. 2 I I , -�, -- - / . , • � • . , i I � FIFTH � in addition to the powers conferred by Iaw, I authorize any personal representative, trustee or guardian acting under this instrument, in his/her absolute discretion: � (a) To retain in the form received, or to sell either at public or private � sal� any real or personal property; (b) To exetcise any options to subscribe for stocks, bonds, or other investments. �� (c) To join in any plan of lease, mortgage, cansolidation, exchange, reoFganization or foreclasure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; � (d) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as they, in their sole cliscretion, may deem wise, and ta execute and deliver deeds of conveyance or transTer thereof; (e) To make settfements and compromises on such terms as they, in their sole discretion may deem wise without the necess'rty of obtaining any court app�oval thereof; SAIDIS f To make distribution hereunder either in cash or kind, as they, in Sfi[1FF, FLOWER � � & LINDSAY ATTORNEYS•AT�LAW their discretion may deem wise; 2109 Market Streel Camp Hill,PA (g) To te�minate any trust created hereunder, and pay the residue out- right to the beneficiary, when my Tr�stee determines, in his discretion, that the 3 � ' " i � ' � • • ' . • ', ' � I; size of the trust has so diminished as to make its continued administration in trustl i impracticable. ;� S1XTH � In the event that my Trustee hereinabove named shall be unable to continue toj i act as tr�astee by reason of his death or incapacity, i nominate my daughter-in-law,; Debra He�man, to senre as successor trustee. SEVENTH j I do hereby nominate, constitute and appoint my wife, JOSEPHINE M. HELMAN, to act as Executrix of this my Last Will and Testament. Provided, however, that if she is unwiliing or unable to act as Executrix, I direct the duties of Alternate Executor bei ; performed by my son, DANIEL P. HELMAN. EIGHTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performarnce of their duties in any jurisdiction. IN WITNESS WHEREOF, I, GERALD L. HELMAN, have hereunto set my hand and seal �o this my Last Will and Testament, consisting of four (4) typewritten pages, the first three (3) of which bear my signature in the margin for identification, this _3I !� day of �`— , 2004. SAIDIS �'� �/ �� SHUFF, FLOWER /1.�- r} !.G►�^� & LII�IDSAY GERALD L. HELMAN, Testator A']'1'OKNEYS•AT•LA U' 21D9 Market Streel Camp Hill, PA 4 (f I - -_ __ __ _ � , ,, _ _ . i . . , . " . , �, . I • � . � i ! i � ,� � Signed, sealed, published and declared by the above-named Testator, GERALD L. HELMAN, 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 2i s�' �-�, l� � �— �- . �'° �� . P,�- _ DDRESS �� iI,CY�" �y� � �/� �- - --�� 1 COMMOf�WEALTH OF PENNSYLVANIA . . 5S. COUNTY OF CUMBERLAND . WE, GERALD L. HELMAN, 7'ttoeKRs�. �.-ow�e_ and �f�-/�I�j��,�,—th8 Testator and witnesses, res pectivel y who s e n a r r i e s a r e s i g n e d t o t h e f o r e g o i n g o r attached instrument, being first duly sworn, do hereby decfare to the undersigned authority that the Testator signed and executed the instrument as his Last Wifl and Testament and that he signed willingly and that he executed as his free and vofuntary 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. �!!�A"`�•" � /yy�A.A /.� GERALD L. HELMAN, Testator � � �_ Witne �� , a � —^ itness , SAIDIS � SHUFF, FLOWER Subsc�ibed, sworn to and acknowfedged before me by GERALD L. HELMAN, the & LINDSAY �stator, and subscribed � and �worn or affirmed to befo �e by ATTDftNEYS•AT'•LAIV and F-Yif/! ��L..-��/✓�ln es� II1�CJ � �$y �f 2109 Market Street b 20Q4. '�•+•+f Camp Hi11, pA � �, � � 1 � / - / % COMMONWEA(,TH OF PE V IA ('�/ U IIC Notarial Seal Saliie Allshouse, Notary Public CamQ Hitl Boro, Cumberland County My Commission Expires Mar. 29, 2008 S � _ __ _ _ _ _ -- � COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND .r I, GLENDA FARNER STRASBAUGH Regi s ter for the Proba te of Wi I1 s arrd Gran ting Letters of Administration in and foz- CUMBERLAND County, do hereby certify that on the 2nd day of Apri 1, Two Thousand G�nd Twel ve, Letters TESTAMENTARY in common form were granted by the �'egister of said County, on the estate of GERALD L HELMAN , late of EAST PENNSBORO TOWNSH/P (Fiist,Middle,Lasl1 in said county, a'eceased, to DANIEL PHELMAN /Fi�st,Middle,Last/ and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 3rd day of April Two Thousand and Twelve. File No. 2012- 00392 PA Fi 1 e No. 21- 12- 0392 Da te of Dea th 3/1 1/2012 S. S. # '�' 1 ��' � ` (' , -..�-�,.' ' j� � 1��.1`� �� '�!�' � egister O i . i � � � �, � . 1 � ;��1� �, , ,� ; l, -� J �y-� Deput NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ,��,: , _ _ �_!(��d�:A L �E<�iSTRA R'� �.,�� .��.��I�� :�� .�, , . ; �',�wFCNING� it i�� illegaf tc� �i�p�ic:ai�� t#�;,.. ; , ,,� �,7�-�r:�ta ,��! ��_ ; 1-��E� ?�,r �F,� ��rtii�ii.,�!:� � �� . � � � � �"� F \,�. � � � REV-1514 EX+(12-03) SCMEDULE K , , LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF ! /} } FILE NUMBER .,.� i J ��r' /- F�( / 1 J Y .'v �N� _ S> V 1..� J G.' This schedule is to be used for all single life,joint or successive life estate and term certain caiculations. For dates of death prior to 5-1-89, actuarial factors for singie life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of cleath from !i-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ❑ Wifl ❑ intervivos Deed of Trust ❑ Other • NAME(S)OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABIE � /�� — _ ❑ Life or ❑ Term of Years ��iv ❑ Life or ❑Term of Years CI Life or ❑Term of Years CI Life or ❑Term of Years ❑I Life or ❑Term of Years ---- — — r�n 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ __�� 2. Actuarial factor per appropriate table �r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � Interest table rate–0 3 1;2% ❑ 6% ❑ 10% ❑ Variable Rate % 7 " n 3. Value of life estate(Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ �--� , � � NAME(S)OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF dEATH ANNUITY IS PAYABL£ ❑ Life or ❑Term of Years ❑ Life or ❑ Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑ Term of Years --- — n 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ _ � � 2. Check appropriate block below and enter carresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . . __�� Frequency of payout–❑ Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12) ❑ Quarterly(4) I� 5emi-annually(2) ❑ Annually(1) O Other( ) Z 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ _ n/�� 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " � � --�___111_�_T�___ ___—__ 5. Annuity Factor(see instructions) � Interest table rate–❑ 3 1/2°% ❑ 6% ❑ 10% ❑ Variable Rate °fo _ �f� 6. Adjustment Factor(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /� � . . . . . . . . . . . . . . . . . . . . . ��3 7. Value of annuity– It using 3 1f2°fo, 6%, 10°l0,or if variable rate and period payout is at end of pericd, c:alculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ � If using variable rate and period payout is at beginning of period,calculation is: . / ^ (Line 4 x Line 5 x Line 6)+Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ %t/ " � NOTE:The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return.The resufting life or annuity interest(s)should be reported at the appropriate tax rate on L_ines 13 and 15 through 18. (If more space is needed,insert additional sheets of the same slze) _ _ REV-1644EX.�3-oa> INHERITANCE TAX - SCNEDULE L COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INYASION O� TRUST PRINCIPAL FILE NUMBER �,�j��U.5 � I. ESTATE OF �� ,�^�i��i� Jv�E�/�IJ.�E� . �Last Name) (First Name) (Middle Initiai) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This scheduie is t.o be used for all remainder returns when an election to prepay has been filed under the provisions of Section T14 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) ^ B. Name(s)of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estat� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . . . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . . . . .$ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . . . .$ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 3. Value of Unincludable Assets . . . . . . . . . . . . . . . . .$ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ E. Total Value of trust assets (Line C-6 minus Line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ F. Remainder factor(see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder value(Line E x Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: � A. Invasion of corpus __ ��,� (Month, Day,Year) B. Name(s) of Life Tenant(s) Date of Sirth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpusconsumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ --- - D. Remainder factor(see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . . -- E. Taxable value of corpus consumed (Line C x Line D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) — , oEV•16a5 EX+ (7-85� INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION ��3_�v� �� INHERITANCE TAX RETURN n � RESIDENT DECEDENT -ASSETS— FILE NUMBER I. Estate of �L ��,A � �;, S - �� '_J� �%� • (Last Name� (First Name) (Middle Initial) I1. (tem No. Description Value A. Real Estate (please describe) �'��( �` /�,,�'E��s��="�(� �:�V Q��J�j-� � U 7�' 10� �1�?�r��.,� �t.l�� W S o.� �'�a�.�, Pfi i >>�.� � , _ r �►��C� �� '"c��n„ �f'E,/' 1��1�!' �.7 c,r�J�'�� Fi�'�c �1J L C,�au��,/ _,2fsi i��1�E ��l� `��. �.rv� �7��.J � /�i v,��c,�,� � ,^�A��,�i �� '� i...� Er � �� Z. � i� � C_ �' ^ ) �,�i�/" -1� �,/J e j,�/ �C./j.�- L /�/✓ //�j� i E; ��-�'�-� Total value of real estate $ � (include on Section II, Line C-1 on Schedule L) �,�C, S�►; , �'+ B. Stocks and Bonds (please list} , /�'� Total value of stocks and bonds S (include on Section I1, Line C-2 on Schedule L� C. Closely Held StocklPartnership (attach Schedule C-1 and/or C-2) (please list) ./�/�� Total value of Closely HeIdlPartnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) �(,�J ft�� Total value of Mortgages and Notes S (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) n ,v/.�r Total value of CashlMisc. Pers. Property S _ (include on Section II, Line C-5 on Schedule l) ��• TOTAL (Also enter on Section II, Line C-6 on Schedule L) $��G �Qu�• �;,'� (If more space is needed, attach additional 8'/: x 1 1 sheets.) DEBBtE LUPOLD,TREASURER TAXPAYER'S COPY 98 S ENOLA DRIVE;ROOM 101 ENOLA,Pa 17025 KEEP THIS PORTION FOR YOUR RECORDS TEMP - RETURN SERVICE REQUESTED � � � • � � iiii��i�ini�i�ili�i�n�il�l�iillii�i�il�l��il�ilniinisll��il� 072765"'""*""*'*"'AUTO'*5-DIGIT 17102 HELMAN,GERALD L�JOSEPHINE M I III IIIII IIIII II I IIII IIIII IIIII I III IIII III C!O DANIEL P HELMAN 1115 ENTERLINE RD HARRISBURG PA 17110-2806 To review the assessment data for this property, go to: www.courthouseonline.com>AssessmentOffice>Cumberland>PropertyRecords. Then enter control# 09001536 and password CUJXVTNB ._._ ... __ . ..._ ____ ___ __ __ __..___ _._. ___._ .__.__. _ __ _ _ _ .. __ __ _ ..._ _. .. . _____.. ._ � � • ` ' • ' � � • + � � : • '• Payable To: DEBBIE LUPOLD,TREASURER Office Hours: MON THRU THURS 9AM�PM 98 S ENOLA DRIVE;ROOM 101 CLOSED FRI 8 HOLIDAYS ENOLA,PA 17025 PHONE(717)901-9392 Bill No: 2883 Bill Date: 3/1/13 Control No: 09001536 MAP NO: 09-13-1002-045. I Desc: 109 ARNOLD ROAD � Assessed Value: Land:39.000 Improvement:93.500 Total: 132.5q0 LOUIS PARK Discount Face ena ty LOT 109 Countv RE 2.131 $276.71 a282.36 310.60 Acres 0.32 Deed 0015X00108 County Lib 0.143 $18.57 $�8.g5 $20.85 I"��"� Munic.R/E 0.957 $124.26 $126.80 $139.48 II 1111 IIII II IIII IIIf $1.00 FEE FOR ADDITIONAL RECE P Tax Payer: — HELMAN,GERALD L 8 JOSEPHINE M TAX AMOUNT DUE C/O DANIEL P HELMAN $419.54 �428.11 $470.93 1115 ENTERLINE RD If Date Of Pa ment is on 3/1/13 thru 4/30/13 5/1/13 thru 6l30l13 7!1/13 or Later i HARRISBURG PA 17110-2806 `,;a��- �„�t,��` �� f_".�� .� /�%' � • � .� �� • . � � �� •� �•� . ��. .� • • _ _. _ _ __. _ _ _ . _ _ TAX PAYER'S COPY- KEEP THIS PORTIC�N FOR YOUR RECORDS � . � . . . • - � � � � � � :� -• Payable 70: DEBBtE LUPOLD,TREASURER Office Hours: MON THRU THURS 9AM�tPM 98 S ENOLA DRIVE:ROOM 101 CLOSED FRI&HOLIDAYS ENOLA,PA 17025 Bill No. 2883 PHONE(717)901-9392 Bill Date: 3/1/13 MAP NO: 09-13-1002-045. Controi No: 09001536 Desc: 109 ARNOLD ROAD AssPSSed Value: Land;39.000 Improvement:93,500 Total: 132,500 � LOTI09ARK Discount Face Penalty� Acres 0.32 Deed 0015X00108 County RE 2.131 $276.71 $282.36 $310.60 ' County Lib 0.143 $18.57 $18.95 ffi20.85 IIII��IIIIIIIIIIIIIIIIII�If(i�tf�fII�I��+lll+l+ll+ Munic.R/E 0,957 $124.26 $126.80 $139.d8 I I I li II I I I I iax Payer HELMAN,GERALD L&JOSEPHINE M CIO DANIEL P HELMAN TAX AMOUNT DUE $419,54 $428.11 $470.93 1115 ENTERLINE RD If Date Of Payment is on 3/1/13 thru 4l30/13 5/1/13 thru 6/30/13 7/1/13 or Later I HARRISBURG PA 17110-2806 J To review the assessment data for this property,go to: www.courthouseonline.com>AssessmentOffice>Cumberland�PropertyRecords. Then enter Control# 09001536 and password CUJXVTNB TAX INSTRUCTIONS - READ CAREFULLY If serviced by a mortgage company,forward one portion of this bill to company immediately Keep remainder for your records If you require an official receipt,send your check,two copies and a self-addressed stamped envelope. If not paid by 12131/2013 this bill will be returned to Tax Clairr� Bureau for collection and fiting of a lien against your property Faiure to receive a bill does not relieve you from liability for prompt payment. No partial payments or postdated checks will be accepted and payment must be received or U.S post marked by the due date. 7�iaor(c�ou! REV-1646 EXt (3-84) INHERITANCE TAX ' �► SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION � --�G/J INHERITANCE TAX RETURN J� RESIDENT DECEDFNT -CREDITS- FILE NUMBER( J-�� ' �VC�� L>T �/ �—+ I. Estate of�`��_�C.,� ,�a;� j��l,J� �� ! �Last Name� �First Name) (Middle Initial) II. (tem No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) �`J,�l-E Total unpaid liabilities ! $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) ��/�J� i i I i Total unpaid bequests S __ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B'" above) that are not included for tax purposes or that do not form a part i of the trust. � Computation as foPlows: �� , Total unincludable assets S � _`_ (include on Section I1, Line D-3 on Schedule L) Ill. TOTAL (Also enter on Section II, Line D-4 on Schedule L) 5 (If more space is needed, attach additional 8'/s x 11 sheets.) ^ REV-1647 EX+ (02-IC) . . pennsylvania SCHEDULE M :�+oEPARTMENT�,F�,E�EN„E FUTURE INTEREST COMPROMISE INHERITANCF TAX P'�ETURN RESt�ENT�FCFOEraT (Check Box 4a on REV-i5oo} ESTATE OF FILE NUMBER _.--- ��'�-��'_�J �. f��L .1��,� � �/� -- �c�,3� This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982. This schedule is to be used for all future interests where the rate of tax that will be applicable when the future interest vests in possession and enioyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ❑ Will ❑ Trust ❑ Other I. Beneficiaries NA1�1E OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. ..� �a_ 2. 3. 4. 5. II. For decedents who ciied on or after Jufy 1, 1994, if a surviving spouse exercised or intends to exercise a rlght of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such ��ithdrawal right. ❑ Unlimited right of withdrawal ❑ Limited right of withdrawal III. Explanation of Compromise Offer: �i�C�'�J'�,.– IV. Summary of Compromise Offer: 1. Amount of future interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 2. Value of Line 1 e�xempt from tax as amount passing to charities, etc. ,f (Also include as part of total shovan on Line 13 of REV-1500.) . . . . . . . . � lv�� 3. Value of Line 1 passing to spouse at appropriate tax rate �%�� Check one. ❑ 6%, ❑ 3;'o, ❑ 0% . . . . . . . . . . . . . . . . . . . . 5 {Also include as �art of total shown on Line 15 of REV-1500.) —' 4. Value of Line 1 taxable at lineal rate / Check one. ❑ 6°fo, ❑ 4.5°!0 . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also indude as part of total shown on Line 17 of REV-1500.) . . . . . . . . � 6. Value of Line 1 taxable at collateral rate (15%j (Also indude as part of total shown on Line 18 of REV-1500.) . . . . . . . . 5 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . S i(...� If more space is needed, use additional sheets of paper of the same size. REV-1649 EX+(08-09) � �ennsylvania SCNEDULE O DEPARTMENT OFREVENUE INHERITANCE TAXES RETURN ELECTION UNDER SEC.zii3(A) RESIDENT DECEDENT (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER ,�nS�Pl-�1�J �`. �'l � /�FL,MA � ��/�' _ �� 3 Do not complete this schedule unless the estate is making the election to tax assets under Sectiorr 2113(A) of the Inheritance and Estate Tax Act. If the election to more than one tr�ust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust(marital, residual A, B, by-pass, Unified Credit,etc.). If a trust or similar arrangement meets the requirements of Section 2113(A)and: a.The trust or similar arrangement is listed on Schedule 0 and b.The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,then the transferor's personal representa- tive may specifically identify the trust(all or a fractional portion or percentage)to be included in the election to have such trust or similar proper- ty treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property i<.;included as a taxable transfer on Schedule 0,the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a tax+�ble asset ori Schedule 0.The denomi- nator is equal to the total value of the trust or similar arrangement. PART A: Enter the descriptian and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 2113(A) trust or similar arrangement. Description Value �v '"_' Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 2113(A) election to tax is being made. Description Value �.�� Part B Total $ If more space is needed, use additional sheets of paper of the same size. IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION PURSUANT TO Pa. O.C. Rule 5.6 THIS NOTICE DOES NOT ti1EAN THAT YOU WILL RECEIVE A�'Y MONEY OR PROPERTY FROV1 THIS ESTATE OR OTHERWZSE YVhether you will receive any money or property will be determined whnlly or partly by the decedent's will. If the decedent died without a will, rvhether you will receive any money oY property will be determined by the intestacy laws of Pennsylvanicr. BEFORE THE REGISTER OF WILLS COLJTiTY OF�� 1J'�'��RCIvi �.1(� >PEIVNSYLVANIA �� IN RE: ESTATE OF � ..1 - � MA� �-J ,Deceased File Number,G�l.�` ��% :SS TO: ► � J � • � � (Beneficiary) ,. � ^ �- (Address) Please take notice of the death of the Decedent and the grant of Letters to the personal re resentative(s)named below.The Decedent died on the day of � � /1'! C f� , ��i� ,a resident of [.�J� n /�''_l.�`�.�.J� County,PA. The Decedent died: �testate(with a will)or ❑ intestate(without a will). You may have a beneficial interest in the estate as follows: n.� ,.)-�` - - (If additional space is needed,use separate sheet) The name(s),address(es)and telephone number(s)of ali personal representatives appointed are: NAME ADDRESS TELEPHONE /11�..J t°` If the Decedent dLi,edl testate,the will has been filed with Office of the Register of Wills of_ !' �/, /4'►.�.�'�_/�� County. If the Decedent died intestate,a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of �,�1�}' County. Cl�� T �' u2T �usc'_ �. CvuR%,�i.�cS'F T e Register's address is J "� .� ' /S c? = ,znd telephone nu:nber i�',? )G,�c��- 5��_� F.-.��py of the Will or Petition may be obtained by contacting the Re,��;ter of Wills and paying the charges for dup�:cation. oR�e .S(��Q,�'1�. GJ �5� ��n�,�._ �c`'?c'Fe C/�i��'. Signnture ajPerson Filing this Form �� l�'� � �Y<��/�'?,'�� rJ Name ojPerson Filing fhis Form /� f.s�.�.J��' .:,� J� ,t�.t�'--�' Capacity: �personal Representative Address ❑Counsel for Personal Representative �5�o�' �' - �� ,� J'� �� '�_L'� �'�/ '� � �?�.5�'�-< �`%` Telephone CERTIFICATION OF NOTICE UNDER Pa. O.(:. Rule 5.6(a) REGISTER OF WILLS C(�r�3_�1��,� COUNTY, PEiVNSYLVANIA NameofDecedent:��Us� /`/�� • /�y�11�'",� N Date of Death:c� � /t'I/�� c'�/' _5 File Number:��J��° U�.�� _ i Date Letters Granted: � ��! � ��/ � To the Register: I certify that Notice of Estate Administration required by Pa. O.C.Rule 5.6(a)of the Orphans' Court Rules wa�served on or mailed to the following beneficiaries of the above-captioned estate on ,�,1�. , . Name: Address: �_�� (If more space is needed, attach separate sheet.) Notice has now been given to all persons entitled thereto under Pa.O.C.Rule 5.6(a)except: �� D�te� rl— � ��.��.�'/��,��„ l F�`��i�;� —�,�� 5igitntu�•e oJPer-on Filing this Form � Capacity: �Personal Representative ❑Counsel � ' Q/�, ��'c� .%� '�/.�->.s� ,�1 Name of Person Filing lhis Form //�S��.N�,�li.�� ,�� Address L-� �.��:�� ;,�� ' i,��—��- �^I � � �.s�.s= c��...s�_ Telephone Form RW-08 rev./0.I3.06 Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF C��./►? %P��'�� l� COLNTY, PENNSYLVANIA Name of Decedent: 7c�� Yj�J� �'� • ,�a�� /1 /� � Date of Death:�,R�.�� ?i� File Number: ��'� � S �`T _ Pursuant to Pa, O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: l. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . . ❑Yes �(No 2. If the answer is No, state when the personal representative reasonab�believes that the administration will be complete:��"��c_ D� �c�S�.��.1 C l`y�� f t� �► .�,.��,/�z__� v�/�1D� �',�JJ!� , �°'� / �7v��i w� �C i°l�c� f L1� /•�`�/ �J�� /cU?c� C��.�' C��.��T ...J�, �',E��/ i��L.S�J` 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . . . �Yes 0 No b. The separate Orphans' Court No. (if any) for the personal representative's account is: ,�`!l -1 ! c. Did the personal representative state an account informally to the parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes �No d. Copies of receipts, releases,joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. -, Date �l "6�,�� (.._l-� �� / /'liG'k�.��fjl��,�,�yY��J'��""`�,�? �1( � Signnfure ojPer,c.-:ti Filing this Form Capacity: �Personal Representative ❑Counsel �,�.�� /�E�'�/,� �.! Name ojPerson Filing thrs Form //l S"F.�j�'.�'/r�.Ic� ,��..�/� Address �-��.��'�S� ✓', �1� ,/ i/10 -��Sc� �'�� ) � �.�.s- �"� �� Tefephone INVENTORY REGIS'TER OF WILLS OF��, ✓',��i�l/v,J � COUI�iTY, PENNSYLVANIA CON[MONWEALTH OF PENNSYLVANIA � SS � �� •� (�� _ COUNTY OF File Number Personal Representative(s;l of the Estate of �c� � ��/� � �'� ��+� deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsyivania except that which appears in a memorandum at the end of this inventory. n �' I verify that the statements made in this Inven- '� ,�F-'xf'CU),��' tory are true and correct. 1 understand that false state- ments herein are made subject to the penalties of `,f}�� _� i? ��'�f�'� �r 18 Pa.C.S. � 4904 relatin; to unsworn falsification to 'L '�� authorities. Attorney-- (Nanze)_�,�/� _ (Sz�preme Court LD. .'Vo.) (Address%_ (Telephone)_ DATE OF DcATH LAST RESIDENCE��`� /Q�,�`jj�I /Qy�fQ��,�,a�"/�f ,� ��L,� FIGURES NI�ST BE TOTALED �.,, / J`��i� � ,��CCt'J/�C. r�C� �I /O� �/�'�I�Z,� /�.�/`�� /�� c:1' G� C� F'�l_'�✓, ,��7 ��% <�.� � �'' .,�DS� /�/��- �7• ��`�1.�1.� �.1,�E�i�� .�'/`7`f, ��.ii � �, ��C .F��._/:. � �' ' Z� S �� ? i� �-^�4:, �/�? ��-� �'.�.� l f�. ��- ,- .a v„� � - ,q��7'�:� s;�� z a � C_ �1�,,�.� -,� �xEc ��3r�1 -� �'�v.� �'.�%<- /'. / r / � ,��Lf�GJ, ->�7�' /� C ��JJ�.�.J��-C` C_ `�'��E'.�G� l. .till-�./� ......J��.. �� ' � �i� _�� -�� ,� � �� Z.� S� .!�-/?i2 1, �',�U( � . /`��' / '�O�'� � - �9��i.#�. S�% /�/ � ''� �S3 S'� _ ��//� (////�•�/�pf( //�� //)/ �, �� J V ' �!f ✓�.r/ �^� / / ' / , l�y�J/1� /� � / lY/f�� (r (Attacli additional sheets as needed) TOTAL: -S?`�`�i��" �$80 NOTE The Memorandum of real esta[e outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item,but such fit�res should not be extended into the total of the Inventory. (See ZO Pa. 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