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� 1505610140
REV-1500 EX �°,_,°,
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 280601 INHERITANCE TAX RETURN
Harrisbury, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 9 7 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYWY Dete Of Birth MMDDYYYY �
0 8 2 9 2 0 1 2 0 9 1 0 1 9 2 0
DecedenYs Last Name Suffix DecedenYs First Name MI
S H E P A R D B E T T Y �
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's�ast Name Suffix Spouse's First Name ' MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Q 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death
prior to 12-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust 1 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
� 9.litigation Proceeds Received � 10. Spousal Poverty Credit(date of death � 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schk,�)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL�C Ij�ORMATIdN`$HOU B�IRECTED T0:
Name D�jrr�elepho�lum� r,,�
't. —<- °, :°;
I V 0 V . 0 T T 0 I I I '��r'� 2�4� 3-� 3��3 4 1
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::_ I�EGI�TER OF WILLS jJS��ONLY �
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First line of address �, ., ,
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M A R T S 0 N L A W 0 F F 2 C E S � - '
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Second line of address , ----
1 0 E A S T H I G H S T R E E T
City Of POSt OffiCe State ZIP Code �_.._ __. DATE FILED I
C A R L I S L E P A 1 7 0 1 3
CorrespondenYs e-mail address: IOTTO(p�MARTSONLAW.COM
Under penalties of perjury,I declare that i have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,corcect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT�����EC.-L�i�.✓F��+'c-� G� N ����_ � ��I I �
ADDRESS
2 WESLEY DRIVE CARLISLE PA 17015
SIGNATl�2E P R OTHER THAN REPRESENTATIVE
`` � � ATEy �o � 3
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ADDRESS
10 EAST HIGH STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 � �
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J 1505610240
REV-1500 EX
DecedenYs Social Security Number
oecedent's Name: B E T T Y J • S H E P A R D
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 1 2 0 0 0 0 . 0 D
2. Stocks and Bonds Schedule B 2. 6 1 6 . 2 3
! ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 Personal Property(Schedule E). . . . . . . 5. 5 5 8 6 . 2 �
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 2 5 � . 1 8
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. 4 2 6 1 9 , 0 1
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 7 0 0 7 8 . 6 9
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9� 2 6 6 5 6 . 9 3
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 4 � 5 . 8 6
��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 8 0 6 2 . 7 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 7, 4 2 � ], 5 . 9 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. ,
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 1 4 2 � 1 5 . 9 �
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 - � . � O 15. O . � �
16. Amount of Line 14 taxable
at lineal rate X.0_ 0 . 0 0 �g. p . 0 p
17. Amount of Line 14 taxable
at sibling rate X.12 � . 0 � 17. Q . Q �
18. Amount of Line 14 taxable
at co��atera�rate x .�5 1 4 2 0 1 5 . 9 0 �s. 2 1 3 0 2 . 3 9
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2 1 3 � 2 • 3 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 150561024� J
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.e�r -
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2i i2 09��
DECEDENT'S NAME
BETTY J. SHEPARD
--- - _- -_ _.-- --- - - --- -- _--- - _ - _ _ ____ _ __- _ -
STREET ADDRESS
22 Wiltshire West
-- _ _____ _ _-- - --- ------ - �--- __— -- - ____ _
I--
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
�� Tax Due(Page 2,Line 19) (1) 21,302.39
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 21,3G239
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred: ...................................................................... � 0
b. retain the right to designate who shall use the propeRy transferred or its income; ............................... ❑ 0
c. retain a reversionary interest;or ................................................................................................ ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Q
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ Q
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑X ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
� The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, undE
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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REV-1502 EX+(01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BETTY J. SHEPARD 21 12 0971
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
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. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Real property located at 22 Wiltshire West, South Middleton Township,Cumberland County, 120,000.00
Carlisie,PA 17013;known as Tax Parcel No.40-24-0760-139,being described in Deed dated
November 18,2005,and recorded at Book 272,Page 3285,that was conveyed to
Betty J. Shepard,decedent herein. See attached settlement statement.
TOTAL(Also enter on Line 1,Recapitulation.) a 120 00(�.1}0
If more space is needed,use additional sheets of paper of the same size. � �
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REV-1503 EX+(6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FlLE NUMBER
BETTY J. SHEPARD 21 12 0971
AI{property jointly-owned with right of survivorship musl be dis�losed on Schedule F.
ITEM VALUE AT DATE:
NUMBER DESCRIPTION OF DEATN
1. 18 shares of MetLife stock at$34.235000 per share,CUSIP 59156R108 616.23
See attached.
TOTAL(Also enter on line 2,Recapitulation) $ 61�i�3
(If more space is needed,insert additional sheets of the same size) ^
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REV-1508 EX+(��-�0) -
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
BETTY J. SHEPARD 21 12 0971
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Rowe's Auction Service-personal properiy 1,526.68
2. Wells Fargo Checking Account No.xxxxxx6428 3,807.54
See attached.
3. Wells Fargo Savings Account No.xxxxxx6431 0.01
See attached.
4. Metropolitan Life Insurance Company,Policy No. 14136464A in the amount of$1,000 0.00
Payable to estate.
5. Highmark-refund ??0.43
6. Comcast-refund `�� 61
TOTAL(Also enter on Line 5,Recapitulation) $ 5 58�i.?7
If more space is needed,insert additional sheets of paper of the same size ' �
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REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY �
INHERITANCE TAX RE7URN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BETTY J. SHEPARD 21 12 0971
If an asset was made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Rita A. Carpenter 2 Wesley Drive Niece
Carlisle,PA 17015
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY °/a OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMIIAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFY�N�NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 7/26/1 l Wells Fargo Savings Account No.xxxxxx6982 2,414.34 50. 1,2Q7.17
See attached.
2. A. 7126/11 Wells Fargo Checking Account No.xxxxxx 1225 100.02 50. 50.01
See attached.
TOTAL(Also enter on Line 6,Recapitulation) $ 1 257",f 8
If more space is needed,use additional sheets of paper of the same size.
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REV-1510 EX+(OS-09)
pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER•VIVOS TRANSFERS AND
INNERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHEPARD 21 12 0971
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes,
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIPTO DECEDENTAND DATE OF DEATH %OF�DECD�S EXCLUSION TAXABLE
NUMBER THEDATEOFTRANSFER.ATTACHACOPYOFTHEDEEQFORREALESTATE. VALUEOFASSET INTEREST pFnaPUCAS�e) VALUE
1. RiverSource Life Insurance Company 42,619.01 100.00 42,614.O1
Annuity Contract No. 4920-3394212
Beneficiaries: Rita Carpenter and Kay Johnson,nieces
See attached.
TOTAL (Also enter on Line 7,Recapitulation) $ 42,619�.0 1
If more space is needed,use additional sheets of paper of the same size. ^�
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REV-1511 EX+(1Q-Q9)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND •
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHEPARD 21 12 0971
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Auer Cremation Services of Pennsylvania,Inc. 1,�01.00
2. Baughman Memorial Works,Inc. 8'76.20
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s}of Personal Representative(s) Rita A. Carpenter 6,068.00
Street Address 2 Wesley Drive
City Carlisle State PA Z�p 17015
Year(s)Commission Paid: 2013
2. Attomey Fees: Martson Law Offices 8,334.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Register of Wills,Cumberland County 32"7.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7, The Sentinel,advertising 20G.16
8. Cumberland Law Journal,advertising 75.00
9. Register of Wills, filing fee for Inheritance Tax Return 15.00
10. Stock valuation report I.55
1 l. Death Certificate for John L.Harris 10.00
12. CenturyLink 9.31
13. Clean house pending disposition of property 200.00
14. Met-Ed pending disposition of property 273.87
I 5. Sewer and water bill pending disposition of property 345.95
16. UGI pending disposition of property 159.87
17. State Farm,homeowner's insurance pending disposition of property 58.31
18. Realty transfer tax 1°l0, sale of property 1,200.00
TOTAL(Also enter on Line 9,Recapitulation) $ 26 656 93
If more space is needed,use additional sheets of paper of the same size. �
.R„„
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
BETTYJ. SHEPARD 21 12 0971
DecedenYs Name Page 1 File Number
Schedule H -Funeral Expenses �Administrative Costs -B7.
ITEM
NUMBER DESCRIPTION AMOUNT
19. Tax certification fee,sale of property 10.00
20. Resale Certificate f'i0.00
21. Final water/sewer invoice i 1.92
22. CPI,service call to fix fumace pending disposition of property ?6l.29
23. United States Treasury,income tax S�t8.00
24. Real estate commission 6,000.00
SUBTOTAL SCHEDULE H-B7 7,001 2 l
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REV-1512 EX+(�Z_08)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT� �
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDENT DECEDENT �
ESTATE OF FILE NUMBER
BETTY J. SHEPARD 21 12 0971
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Lifeforce-elder care account payable 1,19Q.00
2. Met-Ed-account payable 9 2�
3. Highmark-account payable 206.65
TOTAL(Also enter on Line 10,Recapitulation) $ 1,405.86
If more space is needed,insert additional sheets of the same size. �
F��
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
BETTY J.SHEPARD 21 12 0971 �
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under '
Sec.9116(a)(1.2).]
1. Rita A. Carpenter Collateral 1,257.18
2 Wesley Drive Sch.F
Carlisle,PA 17015
2. Rita A.Carpenter Collateral 21,�C�9.50
2 Wesley Drive Sch. G,Item 1
Carlisle,PA 17015
3. Kay B.Johnson Collateral 21,3(k9.51
3107 W.Colorado Avenue,No. 189 Sch.G,Item 1
Colorado Springs, CO 80907
4. Gary G. Braught Collateral 24,534.93
1931 Reservoir Drive 1/4 of residue
Carlisle,PA 17013
5. William G.Braught, II Collateral 24,534.93
1466 Overseas Highway 1/4 of residue
Marathon,FL 33050
6. Rita A.Carpenter Collateral 24,534.93
2 Wesley Drive 1/4 of residue
Carlisle,PA 17015
7. Kay B.Johnson Collateral 24,534.92
3 l07 W.Colorado Avenue,No. 189 1J4 of residue
Colorado Springs,CO 80907
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size. ��
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LAST W1LL AND TESTAMENT
I, B�"1'1'Y J. SHEPARD, of South Middleton Township, Cumberland County,
Per�r�sylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be my Last Will and Testament, hereby revoking any and all former Wills or
Codicils made by me.
l.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death Taxes (whether such taxes may be payable by my estate or by any recipient of any
:,_�ropert�-) shall be paid frorn my residuary estate as soon as practicable after my decease and as
part oI�the administration of my estate. IVIy Exectztrix shall have no duty or ohligation to obtain
i�eimhursement for any such tax so paid, even though on proceeds of insurance or othcr property
not passing under this will.
2.
1 give and devise the entirety of my estate (including but not limited to my reside�ce al 22
Wi(tshire 'West, South Middleton Township, Cumberland County, Pennsylvania), boih real and
personal property, unto my nieces, Kay B.Johnson and Rita A. Carpenter and my nephews,
Gary G. Braught and William G. Braught II in equal shares. Howevcr, should any of the heirs
preeiccease me or fail to survive me by thirty (30) days, their share shall be distributed to their
issue, per ,tirpcs, and in default of any such then-living issue, such share shall be distributed to
rny surviving niece(s) and/or nephew(s) .
3.
I norriinate, constitute and appoint my niece, Rita A. Carpenter, as Executrix oC my
e,iaie. iii tne event si�e is unw;lling ur u�3abli; tr� so a�t, th��� 1 appcint my 7iec�, �:a�� Iz. Ju�nsa7,
as EYCCUtrix of my estate.
4.
( dircct that my F,xecutrix shall not�be required to filc a bond or secure the faithful
perforrnance c�f her duties in any jurisdiction. �
�.J •
/ J
initials
Page 1 of 2 Pages
. .. . _ . .. . . . _ .�^� . .
5.
I authorize and empower my Executrix in her sole and absolute discretion, to purchase <�r
otherwise acquire and retain my investments of which I die seized or any real or personal
property of any nature, to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant
options in regard to any or all property of any kind forrning a part of my estate for such terms and
such prices as she may deem advisable; t� borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same, to compromise any
daims or dcmands of my estate against others or of okhers against my estate; to make distribution
in kind and to cause any share to be composed of cash, property or undivided fractional shares in
property different i❑ kind from any other share; to employ agents, attorneys and proxies and to
clelegate �o tiicrn �uch pow;;r as my Executrix con�;ders ciesirable and to pay reasonable
compcnsalion for such services as may be rendered by such aaents, altorneys, and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, 1 direct that my Executrix shall have the power to conduct an inventory of any safe
deposit box necessary to administration of my estate.
1N W1TNE�WHEREOF I have hereunto freely, voluntarily and of sound mind set my
signature thas�day of _ /.��,.�„1 , 201 l.
�
.���'
C ���
Betty J h ard
SIGNED, PUBLISHED AND DE,C�,�RED by the above-named T�statrix, as and for her
Last Will and Testament, in the precence of us, who at her request, have hereunto subscribed out
names as witnesses thereto, in the presence of said Testatrix and of each other.
� / � �
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Page 2 of 2 Pages
_ �,�,�
� ° ��''+a ��DMo`���No 2502-0T6S
i(!�f�
. A. Settlement Statement(HUD-1)
'••»o.�.�'`�
e.ryn.a�o.�
1❑FHA 2 Q RHS 3.�X Conv.Unina. 8. Fib Numbec 7. Lwn NumDer B. Mortqape Inaunnce Gee Number
4 Q VA 5 Q Corn.ins. 9518.3 GRAHAM 13893e9
C Nota: 7MS kHm is NmisMtl b pne you�a4l�ment of sctuN eeflNmenf costs.Ampunts pW to an0 DY����nt spsnf ers shown.
ttems me�ked'(p.o.t.)'we�s Pad oufaltle fM tbairp;IMY Ne slpwn Asrs br inhMneliorrN PWP�s Mtl 1rs mf indudsd in Ilro tWals.
0 Name aM Addresa ot Bortowec E.Name snd Adtlreaf of Selbr F N�me�nd AAdrass o1 LerWer
R�avW Gwham end Esfate o1 Betly J.SMp�rd Su�qush�nn�Bank
Robin H.Gnham 22 WiMS�ire Weft Street 3501 ConooM Road
39 Oer0y6nite Ohve C�Aisk,PA 17915 VoA,PA 17A02
CaAisle,PA 17015
G Properry Loaatron. H Setthment Aqsnt: I. Seflbmenl 6�1r�.
22 W�nahiro Wmt Stieet M�rlwn Deardodl Willi�me Otto G�iroy b Falbr
Carliab,PA 17015 10 Eatt Hgh Streat Apnl 21.2013
CumCedefW Couny,PennayWania Gdbb,PA 170�3 Ph (717)717-33�1
Pl�cs ol Sslllemsnf.
10 EM Hph Strset
Grlisl�,PA 17013
J. Summ� of Bonovwlt 6niaaetbn IC Summ� M SNNr�tr�maetlon
100. Grm�Amount Due ham BoROrrsr: 100.Grou AmauM Qw to Se11sr.
107 Contract s�bs nca � 120 000.00 �01.ConhW�aly nce "�.20.000.00
102. Penonal 102.Psnonal ro s
103. SenbmeM Cha s to BortaMr line 1100 7,191.19 tOJ. �
104 �61.
105. 105.
wtm�Mr for Mwns b ENMr M�Av�nc� Ad wlm�/or M�ms M ldNr In advanp
106.Coun R .Taaas W25113 M 01A1n1 Y11.84 106.Coun R .Tnm M!lS113 l0 01A7/1� 211.
107 SehoolT�:et 01/25H3 Io 07I01I1� 16l.81 t07.SChooITW� 04QS/1J to 07/01113 1E1.67
I08.Assasfm�nts to �pE.MNamaMt lo
109 Homeownx bwciNion Duss 012SI1 J to 01/01It� 1,191.11 1p9.Homeowns�Aseocialbn 0ues W/lSI13 ta 01101/1! 1,191.f 1
t 10. 410.
111. 411. ~-
112. 412. J
/I0.Orou AmouM Du�irqn 8omo�wr 12E,161.55 170.OroM Amount DW to SNIN 121.587.38
200.AmouMS Psld or In O�IrM of Bonow�r 600.RWy�ybns In AmouM Dw SNMr: .-
201. il or Nmeat mo� 1 000.00 501. Eypqs �N inaliVdions
202 Pnnc 1�mouM ol rrow lo�n s BO 000.00 502.Se1Wrr�nt eM to SNkr Lins tt00 7 699.89
201 Ena1i b�n t t�kan lo ' S0]. Eai�t Iwn�t�k�n s � M ��
2M.Cme for tOY.�obn�C 183.95 SW.P First �
205 Mp -
206. ,SOB. .�
207. 50�. A diab.a rowe� .��
208. Spt. .�-.
209. � 509. "-
Ad ustm�nb 1or Ibm�un Itl SNNr for M�m�un W S�IMr �
210.Coun !f .Axas to � 510.Coue rt .Tws lo �
21 t.5chool Taze� ro ' 5t 1.SMool T�n� to �
212.As�sssmaMS to 512.Ausumenq Io � �
213 513.
21�. 514. , .�.
215. 515. -'--
216. 518. �
2t 7. 517. ��
s�e. sie. _..
219. 519.
Y20.TotatValtl Boerwwr 81.183.95 620.ToWRWuetlonAmouMDu�lNNr � 7.699B9
�00.Cah�t SNtlNn�nt haMo BPnowlr W0.CMh�t a�ltlMn�nt tWhan DNMr
301.Gros�mwuM d�»irom 8orrw�er lins 120 � 12B 781.55 E01.GrMt xnoimf du�lo S�Mr fins 120 t21 587.36
302. Leu artrount �id /for Bonowsr lins 220 ( 87,183 85 BOJ.LeY isdudant dus SNMr IiM 520 ( 7,699.6
]OJ.C»h XO From � TO Bortmwr �7.617 60 l07.CaA �To � Frpn SNbr i, ��3.887 67
'PMU aNW�W tlnn0 h'�IBI. 31.M1Mwlll.a VYNpIy(i)
7he undengnetl ne� pe recei of a k�qc�opy ot thi J�sts�emsnt b�ny snachmenb roferrea io heroin
BOrrower Setbr
R �vM raham Estate of ,J aMn
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w��qM�Wa lam w�MS+tl MpM�onwM�vMa OMB wva mnbr No m�IMwAMry n���un0.m�A�tlo�un w^urWMY TIY�i�O�MP'�b perW iM V�bw ro�qESV�m�nU ImucYan ml�i�to�mlu�
J�MVy OM N1tlMMn1 M1m�t
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(9518.3 GRANAMN57B 3 GRAHAM/111
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_ _ _ _ _ _
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.Settlement Cha q
700.Tofal R�N E�taM lroM�►hw t E,000.00 a�a F�o�, r�.m From
Dinsion o/crommisaior�(line 7Q0J u/dMws:
8orroweYa SNlera
01 5 8,000.00 to S W Banetl Reel Eatats Funde n c-unee n
702.S to Senbmsnt setnsmem
703.Commi nn ak at ttbment 6
TSM. -
705
lOD.Ibms Pap�AM M Comweflen wN�Le�n -'
B01 Our o��naGon cM InGudn O�inNWn PoitH 1.p00p%or fE00.00 j 1 895.00 from E 11 �
802.vour crstli[or M� 'nU Mr Ihs� �c int tt rats ch 7 7 .00 hom FE
803.Y r�d�ust -in tion cha Irom E M 3
8W. rsisal fee lo n I l i d oluHOn L from F 71 .
805.CredN Re n to CoreL ic CraACO (rom GFE t3 28.00
808.Ta�wrvice to Bank Irom F B0. --
80�.Flood certifiqtion to ro i F rv irom FE N 12.50�
8� 1r m F
B09 m FE N !
810. from GFE tJ
E11. (hom GFE t3)
lOO.Ibm�R�Niind M lwdw b M MN In AMwiw
901.Dai mterost th� es han W21I73 to 05107n3 7 57.670000/d from GFE R10 5J.89
902.Mortga inaunncs premium M� monM�to (from GFE�YS) �
903.Homeowner's inaurance ior 19 ys�n ro Shte Farm (from GFE f11) PD.C.f20z.001B1'
� (trom GFE R11)
905. (from GFE NU) Y
1000.R�evw wM�lwkw
1001.In81al depoait for yourlsuow account (from GFE�19)
1002.HomeowneYa ineunnca monM� f 18.83 per month S !
1003.Mo insunnca montAS f r mont� f
10W Pro e �ares =
Coun /T .Taxe� months f r monM
School Taxea moMhs S per monM
1005 _.�
tU�6. moMhi S 1�918 psr monih S
1007. montht S per month S �
1008. f ._._
1009. s ,-...
1t00.TItl�CMryw '
t 107.Tdk xrvioes and brWer's filb insur�nca (from GFE 14) 1,t55.00
1102.Setllement or closin fN S
t 7OJ.Owners titk insunnce to 01d RpuDlk Ntlionsl Tilb Iniunna Compa 1�GFE 1'S) 210.00
11 W.Lantlats tNb insunrroe to Old RspuAlic Natqnal Titb Inwnnea Comp�n ; 990.00 ��
t t05.Lendar's fMla poli limit S d0,000.00 �
11p6.Ownsr's litb pol� limil f 170.000.00 _._._
110Z Agsnfs ponion o/tha lolal titb insunnce prsmium to Mulaon D��rdoill Willi�mt OIIO Gil 8 F�II f 1,020.00
110E Undenvrilers poAion of Ms IoUI tMk imunncs prsmium to ON Rpublic N�tional TNN Inwnna Comp� f 1 E0.00
1109.Closmq Service Letter OW RepuDlic N�tion�l Tilb In�unnca Comp�ty 75.00
1110. s
1111 S "-
1112. f �
1113. f
1300.f7or�nMnM�t MN TrrMh�
1201.Govsmment rocordin t�a to CumheAaM Coun Rscorder of Destls from GFE f7 770.00
1202.DeeC f 62.00 S 108.p0 Rels�tsa f OM�r S
1203.Transter taYes M CumbaAaM Co4�t/Raeordsr of peaES (irom GFE fE) 1,200.00
t204.C ICoun taahum f 1 200.00 S �`
1205.Sl�te ta�/ata S 1.200.00 3 1,2pp.pp
1206 -'-
1207. _.`..
1]00.Addltlo�W lMtlMlwK ClyrpN
1301.Required servica Mat un ahop Iw (Irom G E/6)
1J02.Taa CertKr�lion Fee to Robsrt C.Gimt S � 10.00
130J.20t3 TovmMqlCouny T�aes Io Robsh G Caim�,Tat Cdbclor S � 307.�7
UW.IndialwnFee b �tM Vil ConOo S 1E0.00 �
1305 Re�als Certifiub lo Properly Manqemenl.Inc. f 150.00
1306 Final W�ISdSSa�r M S.M.T.M.A. S Acd.M01718Y � 31.92
U00.TolY aMtlMnwK ChwyM(wMR en LN�1 .1�etlM J MM lOZ. I() ).194.18 1,699.EY
•a.a ow.w a dow er�a+nm.�nsL�.Wn0.�.o,.wuq�ry(.� •�.
e'/W�q WP 1 u11M pMw+ArN.11r�9��b^c'w�P��W��Oy��0/d pp]f J af tlw IMw q�brnw�
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Mert artlorff Williama Olto Gilroy 8 Fslbr,Settkment Agent � �
Page 2 of 7 HU�-t
(9518.3 GRAHAMI9518 3 GRAHAM,71-,
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._. _ _. __ . ._. _. _ _ . __ .. - .._�,T� ._ -
Estate Valuation - MetLife
Date of Death: 08/29/2012 Estate of: Estate of Betty J. Shepard
Valuation Date: 08/29/2012 Account: 11051.1
Processing Date: 10/O1/2012 Report Type: Date of Death
Number of Securities: 1
File ID: 11051.1.shepard
Shares Security Mean and/or Div and Int Security
or Par Description High/ASk Low/Bid Adjustments Accruals Value
1) 18 METLIFE INC (59156R108)
COM
New York Stock Exchange
08/29/'1.012 34.49Q00 33.98000 H/L
34.235000 616.23
Total Value: $616.23
Total Accrual: $0.00
Total: $616.23
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.0)
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RiverSource '��
April 25, 2013
RiverSource Life Insurance Company
829 Ameriprise Financial Center
Minneapolis, MN 55474
RiverSource Distributors, Inc.
Rita Carpenter (Distributor), Member FINRA. Insurance
Estate of Betty Shepard and annuity products are issued by
2 Wesley DR RiverSource Life Insurance Company.
Carlisle PA 17015
Contract Owner(s): Betty Shepard
Contract Annuitant: Betty Shepard
Contract Number: 9920 - 3394212
near Rita Carpenter:
You recently contacted us by phone or mail regarding the contract listed above. Please accept
our condolences for your loss.
We are providing the following information you requested for your records:
� The date of death value of this contract is $ 42,619.01.
If you have any questions or further service needs, please call Client Services at 1 (800) 333-
3437. Gontact Professionals are availab!e Manday through Frida•,�from 7 a.m. to 6 Q.m., Central
time.
Sincerely,
Client Services
02012 RiverSource Life Insurance Company.All rights reserved. 9409(9/12)
S c.�. �, z�i`n 1