HomeMy WebLinkAbout05-29-13 w .
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REV-1500�"°'"„`°�
PA Department of Revenue pennsylvaMe oFPIC1AL USE ONLY
Bureau of Individuat Taxes ^�"`" "`°"° County Code Year File Num6er
PO e0x z8o6oi INHERITANCE TAX RETURN ]�j
Harrisbury,PA i7u8-o6oi RESIDENT DECEDENT �1 / '✓ 6O��
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYVVV Date of Birth MMDDYYYY
09/02/2012 12/17/1924
DecedenPS Last Name Suifiz DecedenYs First Name MI
MUNSON THERESA (`,
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name SuRx 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
m 1. Onginal Retum O 2.SupplemenWl ReWrn O 3. Remainder Retum(Da[e of Death
Priorto 12-13-82)
p 4. Limited Estate O 4a. Fulure Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
m 6- Decedent Died Testate O 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy o(Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to 7ax under Sec.9113(A)
Belween 12-31-91 antl 1-1-95) �(,�ttach Schadul@9)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR IQ�II SHOULD BFDIRECA�O �
Name Day[i�T�1lphone N�er rn C�
_ c;� G�
HEDY DISIMONI (90��4�4-�73 "= t^ --�
' ��.
�'J t�r
-.:�REf8F5EEA OF LS UBE ONLY
First Lme of Address � � � �� - '
501 EWING STREET ,
Second Line of Address � �
J `ri
City or PoSt OffCe State ZIP CodO DA7E FILED
PRINCETON NJ 08540
correapondenrs e-maoi aaaress: Hedy.DiSimoni a@Infineum.com
Under penalties of perjury,I declare that 1 have ezamined this retum,induding accompanying schedulas and afatements,and to llie bas[of my knovAedge arM belie�,
tt is We,cortect end complete.Declaratlon of preparer o�her ihan the personal repiasentaWe is besed on all infortnation of which preparer has any knowledge.
SIGNATURE OF4 R N RE SIBLEfOR FILING RF�TURN DATE
�� 05/29/2013
ADDRESS
501 EWING ST E T, PRINCETON NJ 08540
SIGNATURE OF PREPA R OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORI(i1NAL FORM ONLY
Side 1
L 1505610105 1505610105 �
�
. . .
J 1505610205
REV-1500 EX(FI)
RECAPITULATION
1. Real EsWte(Schedule A). .... ... . . . . ........ . . . . ...... . . . ..... ... . ... 1. 114,000.00
2. Stocks and Bonds(Schedule B) . . ......... ... . .. .... .. . .. ...... . ...... 2. 3,7$4.00
3. Closely Held Coryoretion,Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 0.0�
4. Mortgages and Notes Receivable(Schedule D) . ..... . . . . . ..... . . . . ..... . . 4. 0.00
5. Cash,8ank Deposits and Miscellaneous Personal Property(Schedule E)... . ... 5. 32,262.55
6. Jointly Owned Property(Schedule F) O Separate Billing Requestetl ... . . .. 6. 50,531.23
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . . . .. 7. 0.00
8. Total Gross Assets(total Lines 1 throuqh 7)...... .. . . ..... . . . . ... ... . . . . B. 200,577.78
9. Funeral Ezpenses and Administretive Costs(Schedule H).... . .. .... . . . . . . .. 9. 12,630.71
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). ..... . . . . . .... 10. 2,482.8�
11. Total Dedudions(total Lines 9 and 10). ...... . . . . ..... .. . . ..... . . . . .... 11. 75,113.51
t2. Net Value of Estate(Line 8 minus Line 1t) . ... .. . . ..... . .. . ..... . . . . .... 12. 185,46427
13. Charitable and Govemmental BequesWSec 9113 Trusts for which
an election to taz has not been made(Schedule J) .. ....... . . ..... . . .. .... 13. 0.00
14. Net Value SubJeet to Tax(Line 12 minus Line 13) ....... . . . . ..... . . . . .... 14. 185,464.27
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 tazable
at the spousal tax rete,or
trensfers under Sec.9116
(a)(1.2)X.0_ 0.00 �5. 0.00
16. Amount of Line 14 taxable
at linea�rate x.0 45 185,464.27 �6. 8,345.89
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 �7, 0.00
18. Amount of Line 14 tazable
at collateral rate X .15 0.00 �8 0.00
19. TAX DUE . ... . . .. . . . . . .... 19. 8,345.89
. . ....... . .. . .. ...... . . . . ..... . . . . . .....
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAVMENT p
Side 2
� 1505610205 1505610205 J
,. �
REV-1500 EX(FI) Pa9e 3 File Number
DecedenYs Complete Address:
DECEDENT'S NAME
THERESA G. MUNSON
STREETADDRESS � � ��� � � �� �
33 Cambridge Court
cm __ srnre i iia _
Carlisle PA ' 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (t) 8,345.89
2. CreditslPayments
A.Prior Payments 0.00
B.Discount 0.00
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the diflerence. This is me OVERPAYMENT.
Pill in oval on Page 2,Line 20 to requeat a refund. (4) 0.00
5. If Line 1 +Line 3 is greafer than Line 2,enter the dAference.This is Me TAX DUE. (5) 8,345.89
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. ietain the nght to designate who shall use ihe property iransterred or its income .........................................._ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive ihe promise for life of either paymenfs,benefts or care?.........................................._.......................... ❑ �
2. If death occuRed afler Dec.12,1982,did decedent transfer property within one year of death
without receiving adequale consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for or payable�upon-death bank account or secunty at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuiry or other non-probate property,which
confains a benefidary 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 taz 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 disdosure of assets and
fling 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 ot 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)(12)j.
• The tax rate imposed on the net value of Vansfers to or for the use of the decedenYs lineal beneficianes is 4.5 percent,except as noted in[72 P.S.§9116(a)(t)J.
• The tax rate imposed on the net value of transfers to or for the use oi the decedenPs siblings is 12 percent[(2 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.
,
; _
LasT wrLL
I, THERESA G. MUNSON, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this to be my Last Will and revoke any wills previously made by
me.
1. I direct that any and all inheritance, estate and transfer taxes imposed upon
my estate passing under my will or otherwise, shall be paid out of the principal of my
residuary estate.
IL I devise and bequeath my entire estate to my two children, Hedy Louise
DiSimoni and Charles David Munson.
IIL I appoint Hedy Louise DiSimoni and Charles David Munson to be
executors of this my Last Will.
IV. I direct that my personal representatives need not file bond in this or any
otherjurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last
Will this 11`� day of March, 2003.
��.-tit.� �J . �����..�t"+�
(SEAL)
The preceding instrument consisting of one (1) page(s) was on the date thereof
signed, published and declared by THERESA G. Mi1NSON, the testator herein, as and
for her Last Will, in the presence of us, who at her request, in her presence, and in the
presence of each other, have subscribed our names as witnesses hereto.
��� �,/� ,,�/)
/ .��' l�-�rr C' �.f�� /.�-�_.,-�-i--.
r
_"�..��ta� �� r1-' ���;<<;
STATE OF PENNSYLVANIA :.
SS
COUNTY OF CUMBERLAND ::
We, THERESA G. MIJNSON, Frances H. Del Duca and Carol A. Monow, the
testator and witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as her Last Will and that she Uad signed
willingly, and that she executed it as her free and voluntary act far 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 her knowledge the testator was at that
time eighteen years of age or older, of sound mind and under no constraint or undue
influence.
�'�-�c- ,�'l• �t-x.e-c,�- -�!.r� _r.�, .5�<��' ,���;�
Testator � Witness
��'�-R-�. /Y !/ ����`�C' u�
,�(`�z'
Witness
REV-1502 EX+ (1242)
�pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERRANCETA%RENRN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
THERESA G. MUNSON
All rcal proDerty owned solely or as a tenant In ammon mutt be reported at hir market value.Fair market value is defned 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.
0.eal property fhat la Jolntty-owned wiM ripht of survivonhip must be dixloaed on Schedule F.
Attach a copy of the settlement sheet if the property has been wld.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIFf10N
1 33 Cambridge Court,#33,Deed Book 30V Page 1097,Carlisle,PA 17013 114,000.00
TOTAL(Also enter on Line 1, Recapitulation.) ; 114,000.00
If more space is needed,use additional sheets of paper of the same size.
APPRAISAL OF REAL PROPERTY
LOCATED AT:
33 Cambridge q,R 33
Deed Book 30V Page 1097
CarNab,PA 17013
FOR:
Hetly DiSimoni
AS OF:
09/02/2012
BY:
Susen B.BuMCholtler
orveroRietl ApD��el Services
35 E.Hip�Sireel,Suile'101
Cerliab,PA 7707
aue.burkholtler�gmail.mm
State Cetldrod Residentiel Appreuer,RL000659L
Porm GA1—"WinTOTP1"appnisal saftware 6y a la mode,inc.—1-806pLAM0UE
. • Summery Appraissl Report Diversifiad Appraisal Services
RESIDENTIAL APPRAISAL SUMMARY REPORT RNNn: 020412M
Ro Addmss'. 33 Camb' e Ct UnA A:33 Ci : Carisb Shte: PA
L Cade: 17013 Cou ', CumberlaM La al Deuri fion: �eed Boak 30V Pa e 1097
Assesmr'sParcelN� 40-20.1794-028:U2B833
TuYeac 2012 N.E.Taxes:52394 5 ecialASSessmeMs:$0 Bortawer if lica6le: n.a.
CurraM Owner of Hecord: Eatate o/7Tereae Munaon Ouu aM Ownar Tenent Market NeM ❑TmaM ulated qam VacaM
PraxtT e'. Condominium Olher descnhe HOA:5225 i n ear ermoMh
MarketArea Neme: Caduk Ma flefeance'. 20-1794 Census Trect 124
ProxlName: �mhntl eCouh Phase: 1
The ur se af tliis a �aisal is m tlevelo an a inian M�. Markel Value as defin ,or � oNer e af value descnba
This re ort retlxfs the fal6wi value d mt CurteM,see cammeMS�. CurreiR ihe Ins ecfion Dam is Ne E/fecM1ve Uam pehos xfive Pms ectne
roacMsde�ebedkriNse reisal: SelesComarisanA mach CostA mach IncameA mach SeeHecoicili�6onCommeMSenASweofWOrk
Pm e ' hts mised: Fee Sim le LeeseMlO Leased Fee Other descn6e
IMende011se: Toeetebluhvalueforstateinherilencetsn
IMendad Ilser s reme ar e'. Eaate of Theresa Munson
Cliert: Metl DiSimoni AAOress: 507 Ewin Street Princeton NJ 08540
reiser: Suaen B.Burk�olCer Addreas: 35 E.H' h Street Suile 101 Ca�lule PA 17013
Location�. Ilr6an SuburWn Hurel PraEominent CondominlumHoudng Pre�entLendUw ChenqelnLendUa
BuiM u0� �I Uver 75X ❑25�75% n UMer 25% Occupency pp�CE AGE Ono-Uni[ 70% �Not Likey
Growlh reh'. n flapiA �Stable ❑Slow �Owner $�000) (yrs) 2-0 Uid % �Likey' ❑In Pmcess•
Pmvem values �Incaasing ❑smble ❑oeclirvy ❑TereM 1zs Law 10 Mure-unt % 'To�.
OemanysuppN'. ❑SMrtaga �In Balance ]Over SuppN �VacaM(a5%) 780 Hi h 30 Comm'I 30 ffi
MarkeA Eme'. ❑llMar 3 Mos.�3-fi Mos. ]Over 8 Abs. ❑VecaiA >5% 145 Pred 28 16
Market Area BounAaries,Uescnpfian,aM Market CanEitions(incWding suDDO�for ihe above chaactensACS enA treMS): MarkM mMXbn aro nood wilh aupoN
entl tlemantl ao0���9 to be in Eeknce. Average maAcetinp time is 9010 120 tlava vrilh reasonade finenciiq terms beim reatliy ava'labb to
quelfietl buyen.The suDiect neinhborhood is borEereE bv Ritrwr Highxey Oranoe Stroet South StroM and Alkn Roed.
lnnng Classificatlan: Hg�DensAV ResideMial Oescnptlon: Enstirg um is permilletl in ihis zone.
lnnnp Compfance: �Legal ❑L al mncamorminp randfatAaretl ❑Illa al ❑No zoning
. G�ountl fleM(A aDDkable) $ 0/ CammeMS: None knwm
Highert d Best Ose as imD�oved(ar as propaseA per plans S specXicafions�: �PreseM use,ar ❑OMer use(e�lein)
ActualllseasafERectiveUate: SinobfamAVwntlominium Ilseasappaisedinihisrepart Si b(am'
Summary af fNAhes�8 Best Use'. Singb femily corMOminium
Utlltlles Public ONer PmviAer/�escnption OIF�XeImDrowment� Type Pu61k Privrte Oensily Awr e
Flx6icity � L Street Meratlem � ❑ 5¢e 7 irsltortMaroa
Gas ❑ � n.a. CuM1yGutler Concrete � ❑ TopoA�+VM Lewl
Water � [ Sidewalk Concrete � ❑ Yew Reaidentiel
SanAarySewer � [ StreelLighis Pob � ❑
Starm Sewer � [ Alla None �
Otlnr sim elemems: ❑InsNe Lot ❑Comer Lat ❑Cul de Sac 0 UMer auM UtlFlies �OIAer Eesuihe
FEMA 5 ec'I Fbod Hazard Area �Yes �No FEMN Fba0lane X FfMA Ma N 42041C0 FEMA Map Oate 03/18/2009
Sifa Cammema�. This�roiahborhootl u locatetl in a nice erea.Most Mmes aro niceN meinteined antl tM orounOS aro niceN landcrapetl wilh
maturo OlaMinga.The meture trcw eM ehru W hide the hiohwey aM cN Oam on tM street iroiae.Thero ia a m�c o(reside�rtiel end wmmeiciel
use in iM area.
Ua9 soume s far m ect iMaimaSon Ne' hDOr aM rt a reisel�e rt
PmectDescri uan ❑�etached ❑NawarTawnlnuse�Garden �Mid-Hise ❑Hi MNisa ❑Otlnr describe
GenenlDe�crlpHonotPro�eet Sub�eetPhue # ttProMdCOmplekA 8 NProkctlnmmplete #
xaf5rones 2 &GriarWalls Bnek Wtts 18 Phases 1 PlannedPhases
N oi Elevatars 1 Naof Sunc�e Shi lea I1nBs Completed i6 UMS 18 Phmed Wits
�Fxisting[Haposatl�Untl.Cans,Totel Y Perkinp 80 lliits Far Sale � Urvls far Sak � Onits for Sak
Oesign(Style) Mitl-nae Natia(spaceyuM) 7ry UMS Sold 16 UnAS So10 i6 Ilnils SoN
Actual Age hrs.) 29 Parkinp TyDe(s) Ger e b on etR UMS fleMetl 3 Wits HeMed 3 Uni6 flemed
EffettiveA rs. 75 �untParlanp Onsireet 6rmerOccup.Uni6 130wnerOCw .I1Mts 130wnarOccup.WAs
RoeciPnme Ocw c PrincialNesidenca SecoMHomeorFecrestionel TenaM
Is tM devdo er@uilder in coiNal oi Ihe Homeowners'Assaiafian A? Ves No
MenaBemeMGmup�. �Homeowners'RSSOCiafian ❑Oevebper ❑MaregemeirtApeM(nameafmareA�emegemorwmpairy�'.
Was Ne pmject c�eateA by the canvxsian oi elostinp builtlinp�s)inm a wndaminum? ❑Yes �Na If Yes,descnbe 7ie onAinal use nntl Aate M comersian.
Ne CCdfls apPlicable? ❑Yes [�Na �U�nown Havethe documeMS 6een reNewetl? ❑Yes 0 No Commm6:
Prol��Commarts(caMNOn,Qualily ai cansimcVOn,complefion strtus,elc�: This oioiecl u canai0erod to he in a�.eram to uootl conEition Thu's near
. major hiphwaya a�W with in roaaonehb commWinu tlutance to emobymeM shaooi�9 an pleees of wonh'D All unit haw a brick e�Gerior entl
��. am mnsidered to be in nootl conAilbn.
4,
,� Cammon ElemeMs and flxreational FaciM1ties: Lavms,sidewelka,cezebo.
�
�^�•,^^ CaqrqhlOYWlbyalamoCe,irc.ThiabimmeyEenpmducMUmadlietivMMUtwMMpamiaeim,haxrvx,elemotle,irc.mu�IbexlmvMeEpeEeMCe6kE.
L ryW PormGPCONDO—"WmTOTAL"appraisalwlNiarehyalamode,inc.-1-BOQAIAMODE 5�'eoo�
RESIDENTIAL APPRAISAL SUMMARY REPORT qNNa: 020472M
Summary af wMOmihum pml�i budpet areysis k�Me curteM year(rf anayzed): The D�oi�buOpet wes not oroNtletl to the aooreiser. Mowewr the
eporewer if not cualified to tletermiiro if thero are edeouate fees.
O�herfeesfor�heuseafihepmjecthcilAies�otherthanrepularHOACherAea��. Naneknawn
ComOared to other competitive pmjects M similar qualiry and desiAn,ihe subl��urvt charpe appeers [Hiqh �AvereA� �_]Law (M High ar Low,describe)
Aa Nem em/sDecial ar uresual chemctxisfics of the pmjact�ased on the contlaminum dacumeirts,HOA maetinps,or olhx i�Aarmation)kmwn to the appreiser?
,��Vas �No If Ves,Aescnbe aM e�lan the eMect on value aM madeqbiliry,
Y
�.
Wtt Char e:5 225 er momh X 12=$ 2 700.00 m eac Amual assassmert char e er ear er SF af GlA=$ 7.62
UfililiesincluAetlinttiellnAChere: None Heal � AirCantliAan Elechii Gas � Wakr Snver Cahle [i01he�
Source(s�usedkrphysicslcheaeterisficsaFpmperty�. CNmvinspectlon ❑HeviousAppraisalF@s ❑MLS �AssassmerrtentliuNecoMS ❑Pnorinspectlan
�Pm e Owner ❑Olher descri6e Data Sourcekr Gmss Livi Area AsseaameM roeorda
�� Gn�nlOnciptlen FatMOrDaoAptlon FauM�tlen ❑WA Buwnent �I WA HMhq
� FbarLacatian 2 FauMation Cor�erote Sla� None AreaSq.Ft. Type Fha
#afLevNS 7 Fate�imWalls Bddc CrawlSpacaNOne %FrcsheA Fuel Elx
DesiA�(Style) Ono-sto Boof Sudace Shin ba BasemeM None Cdliny
�5us6ng ❑Proposed Gutters 6 Ur�pis.Aluminum SumD�mp[� Walls Coqlnp
�' �UnderConstruction WiMowType D6Fhu Oampness ] Fbor CeMrel Yea
Actual AAe(Vrs.) 29 StormScreens yes Setllemem OutsiOe EMry Olher
EReclne A a rs. 15 IMeshtian
� hbrlorDue�tlen �ppYnEa �Itic ]WA�mmltle� GrStanp� ❑None
�, Fbors Ca et Belrigerata � Stlirs ❑ Freplace�s)#0 Waadstave(s)A O �Garage A �
��Walls D all NangyOven � UmpSpir I] Pa6o ❑Conred k
TnMFinish WooA Disposal � Scuttle ❑Oeck ❑pppi M
BeN Fbor Tde Dishwasher � Doorxay �;Parch TaGI Y af cars �
BaMWainsco� D II FeqM1bod ❑ FWar [Fance [�Assgned
Ooars WooO Mkmwave � Headd ❑ Pool �OwneO
WashepD u 0 Fnshed ❑ 9aka 5 ue+Y s
Finished area ebow rade corfei�u: 6 Nooms 2 Bedrooms 2 Bam s 1 688 S uare Feet af Gmss Livinp Area Abme Gnde
Are tln hea6ip and coalinA�r tl�e indiviaual uMS separatey metmed? �Yes ❑No Qf Na,aescrioe�
Atltlitlorel�eaWres'. Thia Cambritlpe CouR coMOminium a�e all b�ick on tM eberior.There aro hvo bedmom entl lwa full ba�hs
Uescnbe tlw condition of Me pmperty(including Ohysical,functiorel an0 eMemal ahsolescence�: The iMerior of the Mme ie in ewrape to good eondition.the heat
�m�was receMly roo�acetl.
i
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�Yn'lBSE2lLh AIE ' AIEMIfEVE8I81f)pfpf62I880f�f8115IBf5Y��M105YG�BCIpfOpCM�OfOIENfBB}'88BPfI0fLIMBEROC�1YEAi�E0IM1158OU��52I.
OamSaurces'. q��y�meMrecorda
�1 rt Prior 5ub'ect Sale/Gartsfar Areysis of salytransfer Nstory anyor airy curreM agreemem o1 salyGStinp: No aab of tM subiect orooehv has teken
Oate�. OB/22/1984 plece in tM peat throe vean.
Pnce: 75 400
Source s'.Coukhoux
2nd Prior Su6'ect Sele/Transfer
Dah:
Pnce'.
Saurce s:
��0�� CopyrqAt02W]py�I�moEe,irc.Thisbim mry he apmMCM u�unaMbE xiNau�writlm qimnYm,hvxrra,c W mode,in�.mu�be sbpMetlpeE W ceEkA.
Foim GPCONUO—"WinTOTAL"appraisal soflware by a la motle,inc.—1-806A1AM0�E ����
RESIDENTIAL APPRAISAL SUMMARY REPORT R�nNp,; 020412M
311LESCOMPAfli80NRPPRO�CHTf1VAlUE Xdeveb TheSalesCOmparisanAp machwasnotAerelopedforihis reisal.
FFATUHE SU&IECT COMPAPABLE SALE k 1 COIAPqApBLE SALE!2 COMPNWBLE SALE k 3
Address 33 Cambndpe Ct,p 33 29 Camhndpe CouA 23 Cambritlpe Court 15 Wilahire Weat
Cerlele PA 17073 Carliale Ce�luk Ca�luM
Pmject �amhritlpe Court Cem6ritlpe Court Camb�itlge CouM Mayappb VMege
Phese 1 1 1 �
Pmdm to Sub ect ::�: Lesa then 0.07 mibs 0.01 mile�N 3.35 mies SE
� ,
6ale Pnca 5 E . ,'�.;;�:5 114 900 '� "`:''x���'b 110 000 �`"',+ e.f`:S 723 000
SalePricyUtA S Is .n.E 68.BBIs k �` i.'S§ 66.95/s ft , fi`�'x$ 79.70/s ft:`4i ';+'r.,"
�ed5aurcas Coukhoux CauNhouse Court�ouse
VarAication5aurces MLS MLS MLS
VALUEAOJUSTMENB �ESCNIPTION DESCflIP110N +-SAd�ust OESCPIPTION +-SAdust OESCHIPfION +-SAd'ust.
Sales or Fmncinp Cbeinq wst -4,000 Cloaiip wst -1,000 None known
Carcessions Caa� Ceah Cas�
�rteMSalqTime esof09/2/2012 O4/02/207� 08/31/2072 03/OS/2011
N'Ms A raised Fee Sim e Fee Sim b Fee Sim Fee Sim b
Locatlon Aw Aeera e Aver Awre
HOA Fees flMaMh 225 225 225 145
Comman flemeMS en0 Lawn,sidewalka Lawns,sidewelks Lawns,sidewelks Lawns,siEewalks
flecreatiorel FacilAies Gazeba GazeEO Gazebo Gazebo
Floor Lacatian 2 1 -1 000 1 -1 OUO 7 -7 000
Yax ReeitleMial Residential ResiAeMial Reaitlentiel
Uesi n S le Ono-MO One-ato One-sto One-ato
�ual' NConstmction Bnck Brkk Bnek Vn Brick +p000
A e 29 28 29 18
CaMNOn Awra to ootl A�e e Awra Arar
A6oveGrade Tahl Btrma Baths Talal Bbms BeNS Tohl Btrms B�Ma Toml Bhma Batlu
Hoom CouM 6 2 2 8 2 2 8 2 2 fi 3 2
Gross Livi Fina 7 fifie .fl. 1 888 s .tt. �ggg s .tl. �555 s .k. �3 4U0
BasemerrtdFinished Norro Noiro None None
flaams Be6w Grade
FurefionalUti� Avera Avere e Avere A�er¢ e
Hea' Caali Heat um CA Heat um CA Heat um CA Fhe Ges CA
Ere EflicieMlhms No�ro None None None
Parki 1-car era e 1�car ara e 7rar a e None +5000
PorclyPatlWOxk None None None Petio
New heat 8 air No +5 000 No +5 000 No +5 000
Net Ad'uslmaM otal + - $ + - 5 3 000 + - $ 14 4�0
Adjustetl Sale Poce ;4� ,,":r:�;:. ,,�.
ot Gom arables ��t �'���v`a, , - § 11q g00 � S 173 00� � $ 137100
Summary of Saks Compansan Approach A 51000 oer mom etljusimeirt was made for ihe totel numDer of Sz 0�0 pe Dalh arM=1 000 0
hetl bath.
Sales o�ro antl 2 wero uiven iM moel mneitleretion ainm t�ene Iwmea arc in ihe�eme asaociation
a,o
Indkekd Vdue SeW Com Nwn roaeh S 114 000
���� Capy*'q�M21101ryelamoM,irc.ThisbimmeYaroP�cMumwMleExitliwtwrAMPeimiuim.hvxr.x,ahmotle.'n�.munbetlmaMeEpeAaMUetllletl.
Farm GPCON00—'�nTOTAL"appraisal solhvam by a h mode,inc.—1-800.ALAMOUE N20�7
RESIDENTIAL APPRAISAL SUMMARY REPORT FlbNO.: �20412M
INC01ffAPP110ACHT0VALUE Aeveb 0 ThelncamaA rwchwunotdevebeAfarthisepprvsal.
FEATOHE SUBJECT COMPAFPBLE BEMAL N 1 WMPAMBLE NEMAL M 2 COMPAHABLE NEMAL#3
Addmss 33 Cem6iitlpe Ct,#33
Cerkab PA 17013
Project CamDridge Court
P1186B 7
Probm to Su6ect •*� ' - ° `�"+
W
CurremMo NeM $ w�ku �v�.: �,,g�g ,« ,v sr✓;,."a; 8 ,,.<.�r,,'L�".s$
HenVGIA $ /s .fl. .z . ��.+.5 /s tt ;.,":;. 5 Is R ;'8 / it.
HeMCoiNOI ��Ves No Ves No� Ves� No Yes ���Na
Dam Source s
Oad of Lease s
Lacafian Averg
Yew
e Y9
CaNiAOn Aver to aod
AhaVBG�ade TdY BOma Betlu Total Bbms Batlu :.;=r'?::� Total Bbms BeNS "'�; ToW Btrms Baris
Haom CouN 8 2 2 .`�sl��'. ',.;;
Gfoss LiVf Afea 7 68B s .fl. 5 fl ^ 5 fl - 'a^�C. S fl
lPoYlies Iwludad
Summary of Income AppmacA pncluding suDDOrt br maAet mm aM GHMJ:
�;
0 irvan N Mo Madat flem$ % Gmss Nmt Mulfi liar =$ MEIabE VYUe NKame h
COSTAPPROACHTOVALIIE tt0eveb d TheCastAp raachwasnotdeve6padforihisaOD�eisal.
Summary of CostAppraach�.
IndlatedVdue :SdrCom onA raM 114000 CatA rouh(NEewb � Inmm� rweh(tlAevab d
Frel flawncilie6on The$ales Comcarison aDOroach heirq mnsidered tM moat accurate in arnvirw et my final ooinbn o/value The lix:ome
apomec�waa not coroiEeroO since this u einok famiN MrolFrw
THS epP�vsal is made�"as is", ❑ subl�m compleXOn per plaim aM specAica6ons on Me basis M a Hypothetiwl CoMNan tlret ihe imprwemerrts have been
completed, ❑su6jxt m Ne Fa6wing repairs ar atlera6ons on�he basis af a HyDO����Condi6on qwt ihe m0airs ar attxatians hava bean completeA, [�su6ject to
Nn falbwinp requirad inspection 6ased on ihe FalreoNinary Assumpfian thnt Ne coMNan or deficimcy Aoea mt require al[ere6an or mpaic AooraueE in eurreM
corWilion.
TNS r ort is also sub�ect to otlwr etical CoMiCOns an�Vor E�mrdire Assum Aam as s ectlied in iha atlached adden0a.
Bued on ths deg�es of In�peetbn ol ihe iuh�eet poperry,u IndlqbE 6ebw,MIMed 9aopa of Work,SGhment ol Auumptbn�snd Llmtllnq Condlllon;
enA AppnueY�GrIMMbna,my(our)Opinlon ol ihe Meilret Velus(or othar apeelAeA wlue type),u dellned henln,ol Me rsl properly thet I�Me�ubkcl
of ihd nport h: S 774,000 u of: 09/02/2012 ,whkh d ihs Nhdlw Ette ol ihlt eppnl�d.
M Indleeted�horo,ihd Opinbn ol Velus h�u6Net W Hypothetipl ContlMbnt�nd/or EaVSOrdlnery Apumpibn�Includad In thb rcporl. See ethehsd eddends.
A true aM camplete wpy M ihis mpoR ca�ins 14 paAes,ircluEinp aWbAS which am co�idered an irtepral part of ihe mport This apP�aisal repotl may not be
properly unAerstoad witlnu[raferenca Oo Ne iMarmatian ca�ined in�he complete raport
Attached Ediibi6',
❑ScopeofWoAC �LimitingCoitl/CeNfica6o� �NartativeAddendum �PMhpraphAEdmda ❑SlmtchAAAendum
�MapAddeMa ❑AEEPoOreISales ❑CastA00eMUm ❑FbodAddeMUm ❑Manuf.HouseAdEendum
e5cal ConOitlans E�eordire Assum Aons ❑
ClieiRCOMacC CliamName: HedyDiSimoni
E-Mail: Address: 501 Evri Street Pnnceton NJ 08540
APPRAISER SUPERVISORV APPRAISER(If ropulred)
or CO-APPRAISER(If applleable)
�,
�{.z.;.1u✓'�_ Supervisary ar
AbprvsarName. SuaanB.Burkholtler Co-pppraiserName�.
ComDercy'. Diwnifrod Aporei+al SeMCes Comparty:
PMne'. 777-249-2758 Fex'. )77-258-4701 PMM: Faz'.
E-Mail', sue.burkhdder�pmeil.com E-MaiC
Oate of Feport(SgnaWre): 01/01/2013 Deh at flepo�(SqnaNre):
" LicenseorCerfificafionN: RL000859L Stah'. PA LicemearCertificrtbnY', Sb�e:
� Oesiprelion: StaHAporauer �esipnation:
E�iratian�ak af License ar Cetldice6on: OB/30/2073 E�iretion Oste of Liceree or CetlAicatian:
Inspxtlon of Su61�� �InNrio�6 E#erior ❑Exterior Onl� ❑None IrcpxGOn af Su61�'� ❑InMior 6 Erterior ;�Exterbr Ony �None
Oaboflisxtion: 01/09/2012 Oakoflaecfion:
����^A Copyny�10200]byahmade.iu.ThisbimmrybereqoducMwmo9fltlxilhwimAMOeimiesion.howerer.elemo6,'mc.muNbee�bpMeEpetlenEareEiled.
W Form GPCONDO—"WinTOTAL"appraisal soitware by a le mode,inc.—1-806ALAMO�E fl�ZO��
Supplemental Addendum FileNa.020412M
Bormwer/Cfem n.a.
Ro Addmss 33 Camhrid e Ct M 33
C' CarNek Cau Cumberland Shd PA L Cade 17013
LeMer Hed DiSimoni
Atlditlonal Cammenfs:
The aubjeq is older than(ve yeen old. All mechenical aystems inUuding heating,eleclrical end plumbing systema appear to
6e working atlequetaly. No wartenties ere implied in this statemant.
One or more of t�a wmpereCle selea ero olderihen siz months old.Atthough there are compareble propenies in tha subject's
area,nona heve sold recently, thereTOre,seles in ezceas of six monMa old heve to ba usetl. All three comparebles used were
lhe best aveileble.
ANhough Mere are other similer home in tha subjecfs neigh6orhood,none have sold recently.Therefore is wea necessery to
use seles/urther then one mile from the subjecl property. The salea uaed ere the beat aveileble.
This report has bean electronicelly prepered and transmitteA in compliance vrilh USPAP guidelines which inclu0es wri(icetion of
the complete trensfer and delivery,digitally protected signatures antl eAequete sacunty measurea in place to proted tlete
trensmitted by eppraiser.
The Intended Uaer Mthis appreisal report is the Lender/Client. Tha Intendad Uee ia to evaluate the proparty that is Me subjed
of this appraisel Tor e martgage(nance trensaction,aubjecl ta the rtatad Swpe of Wark,puryose o/the eppraiaal.ieporting
requiremants of this eppreicel repotl Porm,and Defindion of Market Value. No additional Intentlatl Uaers ero idmtified by the
appreiser.
Tha appraiaer hes not hes any involvement in the property in the past three yeers.
Tharc is an eHediva numbar of competing properties in the merket in thie erea.this indiceted that supply end 0amand ere in
belence.Reasonable e�oaure pano0 is eatimated to 6e under 6 months.Typicel holding period is 5-7 years.
Prlwry Notice
Pursuant to the Gramm-Leach-Billey Acl oT 1999,e/lective July 1,2001,appreisera,elong with all provitlera of pereonel finandel
sarvicea ara now required by federel lawto infoim their clienta of the policiea of lhe firm wkh regerd to tha privacy of t�e client
nonpublic peraonal infoimetion. As professionals,we undarstand ihet your privacy is very impohant to you end are pleesetl to
pmtide you vrith this informetion.
In ihe wurse of perlorming eppreisel,wa mey collect what is knovm as"nonpublic personal inTOrtnation"about you.Thia
in/ortnation is usad to(adlitate the services thet wa provide to you entl mey include the informedon provided to ua by you
tlirectly or received by us fram othere with your authonretion.
We do not tlisclose any nonpublic penonel infoimation obtainetl in the coune of our engegament with our Uienta to
non�liated third peniea,ezcept as necessary or as roquired by lew. By wey of e�mple,a neceasary tlisclosure would ba to
our intlapendent mntredon,and in certein situetions,ro unrelated ihird perty mnaultante who need to know that info�metion to
assiat us in provi0ing appraisel servi�ea to you. All indepentlent contradon and any thiN peAy mneultanta we engege ere
informed t�at any inb�metion they see ea part of en eppraisel is to be maintained in strict confldence within tha firtn. A
tliadosure iaquirod by lewwould be a disclosure by us that ia ordered by a court of competent junadiction wRh ragerd to a legal
action to which you ere pehy.
We will ratain recortls releting to profeasional services thet we heva provided to you(or a reeaonable time ao t�at we aro better
able to assiat you with your needa. In order to protecl yow nonpublic personal in/ormetion for unauthonzatl eccasa hy Ihird
perties,we meintein physical,Nedronic antl procedurel sefeguerds thet camply vrith our profesaionel atanderda insuro ihe
sacunry and integnty of your in/ortnation.
SiA�eWm !' SiA�aNre
Name Sua . u er Name
DahSipned 0?/Od/20'13 UataSipned
SgqCeNficafioni RL-000859-L State S�akCe�9fiafianB Sqte
Or 59te Lke�e A S�a�e_ Or State Lkense k yyak
Foim iA0U2—'�nTOTAB'app�isal sailwem 6y a la made,inc.—1-804ALAMODE
Location Map
Bormwer/Cfem n.a.
Pro Address 33 Cambrid e Ct k 33
C' Cadiab Cau Cum6erlentl Spd pq L CoOe 770�3
LeMer Hed DiSimani
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Form MAP LOC—'�nTOIAL"appraisal saflware 6y a la made,inc.—1-B00.ALAMOOE
Sub�ect Photos
BortowedCimi n.a.
Pro e Address 33 Cam6nd e Ct #33
C Carisb Cou Cumbenantl Shm Pq li Cade 17073
teMer H DiSimoni
Sub�ect Front
33 Cambridge Ct,lt 33
Suh�sct Rear
8uh�ect Strsst
Form PICPIX.TN—"WinTOTAL"sppraisal software hy a la maAe,inc,—1-BOPAlAM00E
Photograph Addendum
eormwer cfam n.a.
Pro Addmss 33 Cambrid Ct p 33
C' Cadiak Cou CumbedarM STate Pq L CaOe 77073
Lender Hed DiSimoni
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Form G%CPIX—'�nTOTqL"appraisal soflware hy e la made,inc.—1-800.ALAIAOUE
Photograph Addendum
Bartawer/GfeM n.a.
Pra Address 33 Cam6nd e q N 39
C' Carfsb Cau CumbeAentl Shh PA li Code 17013
Lentler Hed DiSimoni
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Foim GPICPIX—"WnT07P1"appraisal software by a la moAe,irc.—i-800.ALAMOOE
Photograph Addendum
BormweqCfem n.a.
Pro e Address 33 Cembrid e Ct R 33
C� Catliab Cau Cumbedend Stad pA L Code 17013
Lender Hetl DiSimoni
;�
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krm G%CPIX—'WinTOTAL"appreisal soNwam by a Ia made,iic.—1-800.ALAMOOE
Comparable Photo Page
a�rz�rc� �.8. _
Ro e Atltlress 33Cambrfd Ct p33„_ .._. _.
C Cedble Cou CumbetlaM State PA L Code 17013
Lmder Hed DlSimoni
Compars6le 1
29 CambriEge Cuur1
I�"i ' I 'I' "'II Comparahla 2
23 Cambridge Court
�
`"�"" Comparabla 8
^,�.* - i5 Wdpirite WsM
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foim PIGP6Y BR—��WmTOTAI"sPR��asl safiware h7 a la mode,u�c_—7�89aNAMl70E
FAeNO.020472M
OEFlXIIION OF IMpI�T VFWE: The mast pmhable prica wMch a pmDetly sMUN brinp in a campefifive aM oDen market uMx all coMNOns
requisde la a fair sale, the buyer and seAer, each ac6np pmtleMy, kmwledpeaby and assuminp Ihe O�ice is mt attected 6y uMue stlmulus. Implicit in Mis
definRion is ihe consummatbn of a sile as of a specAied date antl the D�sinp N tAk tmm sellar ta buyer uMx candi6o�s whereby: (1)�uyer and aeller are
ypkaHy mofivad0�, (2)hath pa�tin ue weN iMormed or wel a0nsed,aM each actlnp in what he wnsiders Ns own best iiAemst, (3)a reasarehle fime is albwe0
for uposure in ihe apen madel;(4�DaymeM is maAe in Mrms af cash in LL5. dollars or in terms oi financial arrangemams camDarabk Mere[o; and(5)�he Drica
represeMS Ne normal consiAention far iM pmperty sak unaflected hy s0�ial or creafive firencing or sales cantessions• g2Med by eiryone assaciatad wAh
Me sala (Source', F�IC IMeregency Appraisil and Evaluatlan GuiAelines, Octo6er 27, 1994.)
'Adjus6nwrts N th compara6ks must be made far spxiil ar cmafive finencinp or sales coreessio�u. Na aAjustmerrts are necessary
for tlwse costs which are normalty paid by sellers as a resutt N tradNon or law in a market area; these casis am maAiy idemdia6le
since the sdler Days these cos6 in virNaNy all sales hensacfians. Speciil or creative finencinp eej��msm: can Oe me0e ta the
comparable O�oOerty by camparisons m financing terms otteretl by a ihiN party ins6N6orel lender ihat is not already irnoNetl in ihe
pmpMy m transaction. Arty aJlusMeM sMuq mt be cakukted on a mxhenical daYar tor doWr cost af Ne financinp ar cancession
but Me doller amoum oi am/ a0lusMeM shouN appmumate tl�e markefs reacfian to ihe firencinp or concessians 6ased on ihe
appraiser's IudpemeM.
STATEMENT OF LIMITING CONDITIONS AND CENTIFICATION
CONIINOEMANO WIING CONOf�ONB: The appaiser's certfiwfianthat appesrs in ihe aDP�aisal�eport is subject ta the fobwinp wntlNOns'.
1. The aDPraisar wil iwt be responsi6le kr metlas of a lepal reWre that aflect ahher tha pmperty 6einp appnised ar the title to d, The appraiser assumes tlqt
tM title is goo0 anA marketable sM, Nnefore, wil mt reMer eM oDina�s ahaut Me title. The pmperty is valueA an tM besis nf it beinp unAU mspa�ihle
awnership.
2. Am/sketcA prmqe0 in tM appreisal repon may show appmumate Uimensions M tAe impmvemmts and is includeA any ta assist the reader of Ne report in risustring
the pmperty, The aDP�aiser hes maEe no survry of Me pmperty.
3. The epP�aiser will not give hstimo�ry or appear in cautl�acause he or she made an ap0�aisal oi tl�e pmpetly in quas9an, unless specific anangemems fo do
so have been matle hefarehan0,ar as aMerxise raquired by law.
4. Airy distribufian W valuafion between IaM aM imprwemm6 in Me mport applies ony uMer Me mus4ny pmgram M utllization.These separek vaMUtions of the
IanA anA impmvemeMS must ml 6a usetl in conjunction wM any atlw appnisal aM am invek A tl�ry are so usad.
5. The aDProisx Aas m knowledga N airy hidden ar urepDarerA coMNans of the prapeM1y ar advarse emiranmeMel condiGOns(reluding ihe presence of hezardous waste,
muc su6stlnces,eh J Net wauld make Ne propdry more or less valuabk,aM hes assumeE tlnt there a�e iw such eontlNOna and mekes no AuaaMees ar wuraiNes,
c�ress or implied, repardiig the caMNOn of the pmperty.TM appraser witl not he respamihk Far aM such coMNans that Ea eusi or kr arcy enpineenng or
testiny tlpt mqM 6e required to Oiacover whetler suchcoMNOns eust. THS aDP�+isal rtportmust mt 6e cort�ideretl an anvimnmeMal assessmaR af Na su6ject pmperty.
fi. The appraiser o6hined Ne iMormatlon, esfimahs, antl opirvo� Nat wxe mmresseA in tM apprtisal mport imm sources Ihat he or she wnsiders ta be
mlia6le and beliares tMm fu be ima aM canect. TM apD�iser daes not assume asponsi6iYty far tAe accurary ot such Aems that were Wmshed by o�her
parAes.
7. The apProiser wid wt discbse iha coNems af iM appraisal repoh �ept as Orovided for in Ne Uniform StaMards o1 Professional Appnisal PraeGro,
aM a�ry app&aWe federal, state or bwl laws.
8. The appraiser has based Ms a her aOU�aisal report aM valua6an canclusan for an appreisal that is subla� m safisfactory complatwq repairs, or
atlmstlons on Ma assump6on Nat completlan N the impmvemmR will he perfo�metl In a vroAOnaHiNe mamer.
9. The aDP�aiser must pmvide Ns ar her prior written conse�d before tM IeMer/cAeM specified in be apprtisal report can dis4ibNe ihe apprzisal repotl
(incPodinp concWSwns abaut the propedy value, iha apprvser's i0enfiry and pmfesswnal desi0�ha�. aM relerences to airy pralessioml appnisal
argatlntians or the firm wiM wtich the appniser is associehA)to a�ryom ather Man iha borrower, ihe martpagee or hs successors aN essipns;the martpage
insumr, consuttents', professbnal appaisal orgama6ons; em/ steh or federely sppmved financial instiWfian', ar aRy depaNneM, aAency, ar inshummqliy
oi ihe IlnAed States or any stah or Ne Dis6ict af Calumbia�, except tAat the Imder�clieM may distribNe Ne pmperty dascri0hon secfion af tM repotl onty ta data
wlectlon or reporting servke(s) witlput havinp ta ablain tl�e appraiser's prior writlan ca�errt. The appraiser's wrilten eamem aM appraval murt also
be ahmined 6efare ihe appraisal cen he comeyed hy anyoiro W Ne Dublic through adrerfisinp, Dubic relefions, nexs, sales, or aNer metlia.
10. The appraiser is not an emp6yee af Me compart/or iMividuel(s)aUerinp tliia repoR aM compensafion is not cominpeM upon Ihe repaNrp M a predNermined
value or dimqion of value or upan en aetion or eveM raaultinp imm ihe aneysis, apirvans, wrclusions, ar ihe use oi this report. This asaipnmem is rwt
based an a requiad minimum,specRic vilmfian,or ihe appmral N a laan.
Page 7 of 2
Farm ACH2—"WinTOTAL"apD�isal saflware by a k made,inc.—1-B�0.NlAM00E
FlNNo.020412M
LEP11FlL11710N: The appraiser ca�ifies and agrees ihat.
1. The statdneMS of fact caMaineA in tlus report aa true aM cortect.
2. The reparted anayses, apiniore, aM conclusuns aa imited anly hy Ne repohed assump5ons aM IimNng con0itlans aM are my persanal, imDartal
dlld IIII�IdSEd pN�l56101121 31GNS95, OpIIlORS, 211A COIIC�1151016.
3. Udess oNe�wise intlicated, I heve no preseM or prospective imeast in the propetly that is Ne subl� � 1Ns repart and m personal imerest
iMe�est wAh aspect ta iM paNes imaNeO.
4. Ildess atlniwise iMicated, I heve DertarmeA no smices, as an appmisn or in eny atMr capacity, reqardinp �he Omperry Iha� is the suhject
of mis mporl wiNin Ne thea�year pmbd immediatey D��eAing accep4rce of tl�is assipnndR,
5. I have m bias wAh respect N Ne pmpetly tl�at is ihe su6jxt ai ihis repaR ar Me paNes imroNed wAh Nis assignmmt.
6. My engagemeM in Mis assqnmeM was not caiNngeM upan dauehping ar repoNrp pre0etermine0 resutts.
7. My compensatlan for cample6np tlis assqimeM is not caiNnpeM upon me OnelopmeM or repoNnp o1 a predehrmined value or direction in value
Nat fevars Ne cause N the clieK, iM amoum af Ne velue apinion, �he atlaiimert of a sfipulated msutt, or me oaurrmce of a suhseQUem eveM
directl� related to Me iMeMed use of ihis apPraisal.
8. My anayses, oDinans, aM cancPoSiarts were deve6ped, aM tNs mport has 6een prepareA, in coMaimdy wM ihe Ilritorm StaMards af Pmfessiowl
Appraisal Pracfice Mat were in efleM a� �he 6me tlis raport was papared.
9. IlNess otle�wise in0icateA, I have maAe a persorel inspecfion of ihe iMerior and mAeriar veas N the pmperty ihat is ihe subject of tNs repoq
aM the n�leriors of all pmDerties listetl aa compaabks.
10. Wless aMeiwisa indkated, ro one pmvided siA��kaM real praperty apprzisal assistance to ihe person(s) sigMnp ihis cetlAicafion �if tAere ara
eiwe06ons, the name af each iMividuel pmvidinp significaM mal pmperty apOrusal assishnce is sqtad dsewhere in tMS report�.
ADDIIESE OF PROPERTY ANALYZED: 33 Cambnaae Ct #33 Cedisk PA 17013
APPMISER: SUPERVISORY or CO-�PPRAIEER (I}applicabls�:
Sqnature'." SiB�dre'.
Name: uaan B. uAc�olEer �ma:
Ttle: StaRAppraiwr TNe'.
Stlh C&fifitafion Y: Rl-OOOfi59-L SptO CertAica6on M'.
or State License M'. or State Licaiae Y:
State'. PA FMpireSon Oah af Ce�iticafion or License: OB/30/2013 Shte: Fxpiration Oah of CerNiwfion or Lkense:
Date SIgnBA: 02/04/P013 �ete SiO�ed'
.,] Oid [� Oid Not I�peet Prapary
Pape 2 af 2
Farm NCH2—"WinTOTAL"apprzisal soflware by a la mode,inc.—1-B06A1AM00E
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Form SCA—"WmTOTAL"appraisal mflware by a la made,inc.—1-806ALAMODE
REV-�5a;EX+(8-u)
�pennsylvania SCi1EpNLE B
DEPARTMEMOFNEVENUE
INHERITANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THERESA G. MUNSON
All property Jolntty owned with ApM of wrvivonhip must ba dimdosed on Sahedule F.
REM VALUE AT DATE
NUMBER DESCRIPfION OF DEATH
1� Allergan Inc.,44 shares common stock,$86 per share
3,784.00
TOTAL(Also enter on Line 2, Recapitulation) ; 3,784.00
If more space is needed,insert additlonal sheets of the same size
Page 1 of 2
NewUSeRk?oglster Signln 4ap PreviewMallw(YlTOOlbar Mai MyY'� Vabool
_._.._ ..'_"__._.. ...._.._ ._ . ..__"'__
— ,... .___"
Searc;h SearohWeb ��'�,
HOME INVESTING NEWS PERSONALFINANCE MYPORTFOLIOS EXCLUSIVES
.... .__._. �.
GBt QUOtBS Flnance Seamh ?ua,May 2A.Yil13,t0�.C2AM EUT�US Ma4 �s cwae In F Fisand 68 mins �.
Uow 1L31/Nasdaq iO.Ot% . .. .... .. .. . .. . . . .. .. .. . ... . ... . .. .... .... .. . . . .. . .. . . . .
� A�` . �
I Ailergan Inc.(AGN)��vvs naa io Pomoiw��� �� ��ke zi'�.
��0.�4 t2.03(2.07%) io:oznMeor-NesaaaReeirmePa�
__ _____�
HistoricalPrices cNxi.�aic.irno..ro.: '�.,;;�yp;,
Set Date Range
. . .___ _.. ._ ..._.. .. .
'�i Daily
Sbn Datr.�'...Sep� 2 � 2012 Eg.Jan 1,2010 .?+;.Wcekly
ena wta Sep� 2 2012 �� � �'a MoMhly
?��DiNdends Only
♦
� r
First�Previous�Next�Wst
__ _ __ __ . . .
Prices
Date Open High Low Close Vdume Atlj Close'
Aug 31,2012 86.01 8@50 85.43 86.13 1,650,000 88.00
'Clax pnca aCjusteE tor tlivitlentls antl splib.
First�Previous�Ne#��asi
!�DOwnload to Spreadsheet
Currency in USD.
.. �„;..;�.
�
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REV-i5a8 EX+(o8-a2)
j� pennsylvania SCIIEp11LE E
�y� DEPARTMENTOFREVENUE CASH� BANK DEPOSITS &MISC.
INHERITqNCETA%RETURN PERSONAL PROPERTY
RESIOEPfr DECEDENT
ESTATE OF: FILE NUMBER:
THERESA G. MUNSON
Include the proceeds of lidgatlon and the date the proceeds were received by the estate.
All Property jolMly owned with riqM M survivonhip must be disdosed on ScAfldule F.
ITEM VALUE AT DATE
NUMBER DESCRIP'fION OF DEATH
�. Sovereign Bank Checking account#1671011074 3,567.38
2 Sovereign Bank Savings account#2894019096
2,769.66
3 Piano,spinet
500.00
q Diningroomfumiture 1,000.00
5 Livingroomiumiture 1,000.00
g Bedraom fumiture 500.00
� Morgan Stanley Smith Bamey IRA account#341-907022-550
22,925.51
TOTAL(Also enter on line 5, Recapitulation) � 32,262.55
If more space is needed,use additional sheets of paper of the same size.
� - � � �
�Sov�`reigri
5t�ement Period 08/U7ti2 Td 09fO6t12
PREFERRED CHECKING
For your convenience our Customer ContaaC Center
is availabie irom 7 am-8 pm EST,7 days a week.
CaH u&at t-877-SOV-6ANK{1-877-7fi$-22fi5}.
Nearing impaired may ca�l 1-800�28-9'I27 (TTVJTDD).
www.save reignbank.com
OD000586 MSBT3778096 Oi 0006
TMERESA G MUNS4N q 6 6 0
10460
33 CAMBRiDGE CT
CARLISLE PA 17013-2733 n0003t187
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��E �{� .��� w �t the Maney Yau Need
j`x`�`��� � '= t �� �at Rates and More Flexibility
�
s �: �. �%e.,� � � ...�
3 � � � fi
O T 4�
o � ' ' �� ' �1�� *+���." Get grea#er financial flexibility and control aver your
� �:�� " ;a �" ' ' borrowing needs with a Sovereign Personai line af
�
o ,��� � �-"< <. � Credit ot Laani
o h,,�d ey M�l n�'w i 'f . .
� '�"� "�5 "�'�'' Features & Benefits:
b ;�� ` � �,.
a �,�,� � � • Interest rates are tompetitive and Iawer than n�ar7y
" "� " �°� ' credit cards
o �" ��,�} � ����
� . � � �. ,���`` ' � �' : • No collaterai required
m ��,s >�` �� �4 �` ` • Use your line or loan for just abaut anything: travel,
� a�(.sd�`x r`.' ���' n �'Y� r�� �, ��' C�2bt COIl50�IC�dYlq11, Ill@(jICB� 2Xpe1152S, IT1dJOf pUfCf12525
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� �� �: �� �� ��� like appliances or furniture, a�d moee.
� ` � * xe�� ���"
� '" ' �� �+: � '�"�����" 1 To apply, stop by any Sovereign Branch,
� , ta1) 1.877.4.50V.lClAN,or visit sovereignbank.com.
>> .
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;s�,:,= r �*; ,r�- .. . ��a�
Try Sovereign IdentityPratectarSM
far 3(} days for just $1
�, This powerful suite of services warks to deted, intercept, resolve,and help prevent identity e
�� theft. Get the identity fraud protection you need with Sovereign IdentiiyPratector`". �:
�'-� A monihly fee of $14.99 will begin after your 30-day trial is complete, unless you call `
to tancel at 1.866.999.p427.
peace af mind in 4 easy steps!To find out more,stop by a Saxe�n Branch,v�sit us at '
sovereignbank.com/idenfttyprotector or call 1.866.999.0634. ���«� � ,:�;
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sovrtcm ea�k,u.n Is z Memtel Fn�c ana a vmo�ly ovmee.�bsie>y o�6anw saMa�acw,s n.o x�l smxrvp�
9ank.N R I��erclgn a�tl Sanlaitler a�tl Ils lago ae reOMeretl Iratlemak6 M Swnspn 8aik,N A aid
PR�C. lO.f3 �� a�.+ws�r eecsn.��r.�r.«ureo-arcuae:aswsw���mme�maaas�ae:saaner��,�nas 167L1)t1074
THERESA G MUNSON
Deposit Accounts Account Number Averege Daily Balance Current Balance
STATEMENT SAVINGS 2894079096 $2,769.48 $2,769.66
Total Deposits 56,337.04
THERESA G MUNSON Acco�nt#167f01f074
Balances
De sits/Credits +$2587.87 Avera eDail Balance $2,34728
Interest
Eamed this Period $0.02 Paid last Year $0.78
'The interest earned and the interest paid may differ depending on when interest is credited to yow accoun[.
Checks Posted
Check# Date Paid Amount Refemnce Chxk N Dale Paid Amount Refercnce
798 08/17 $37.50 982867610
3 Check�s)Posted=5704.60
An asterisk(')indirates a skip in sequential check numbers. An(E)indicates check was converted to an elechonic item.
Account Activity
Date Description Additions Subtractions Balance
OB-07 B inning Balance $2,775.94
08-07 DELTA DENTAL AUG 12 EFT080612 $30.62 $2,66778
0004 619
OB-09 DEBBIE JOHNSON ONLINE PMT720809� $300.00 $2,323.68
F 8728074P S
OS-77 CHECK000000000798000000000798 $31.50 $1,992.18
OB-23 DEBBIE JOHNSON ONLINE PMT120823 $300.00 i $1,657.18
C 8787 P S
0830 DEBBIE JOHNSON ONLINE PMT120830 $300.00 $1 47125
C F 87 80 4POS
0837 US TREASURY 303 XXSOC SEC 083N2 $572A0 � $3,13Z25
..A
09-04 CARL�SLE CORPORA PENS PMTS SEP 12 $5072 / $3,944.97
004440
09-06 INTEREST CREDIT LESS FED TAX WITHHELD $092 $3,892.38
��Zofj 16 71 01/0 74
_
�Sovereigri �
Account Activity (Cont.for Acct# 1671011074)
Dffie Description Additions Subtractions Balance
0.00
09-06 Ending Balance $3,567.38
THERESA G MUNSON Account#2894019096
Balances
De osits/Credits +$0.19 Avera eDail Balance $2,769.48
Interest
Eamed this Period $0.19 Paid Last Year $4.18
'The interest eamed and the interest paid may diHer depending on when interest is credited to your account.
0
o Account Activity
�°, Date Description Additions Subtractions Balance
b08-07 Beginning Balance $2.769.47
0
0
0
� 09-06 Ending Balance $2,769.66
b
0
0
u
o IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR F.LNCTRONIC TRANSFERS
°w CAI,L YOUR CU57'OMF,R SERVICF,CENTER AT'!HG NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRIIE TO THE BANK
3
� FOR DF;Ri"I CARD ISSUES: FOR ALL OTHER ELF.CTROMC TRANSFER ISSUES:
� Sovereip�Bank Sovemig�Bank
� Atrn:Card Disputes Team Avn:Client Relations
� MAI MB3 02 OS 10-421-CRI
� P.O.Box 831002 P.O.Box 12646
o Roston,MA 02283J002 Reading,PA 19612-2646
0
r. Pleau contact us if you think information about an olectronic trens&r on your statement or receipt is wrong or if you need addi[ional into�mation about
n an elecVOnic transfer on�he statement or mceipG We must hea[from you no latee[han 60 days aIler we sent you[he FIRST stamment on which the
� error appeared.
W • Tell us your name and account number. •Describe the clect�onic tmnsfer ertor or the elect�onic vansfer that you are unsuro about and
• Tell us the dollar amoun[of[he suspected er�or. txplain as cleady as you can why you btlieve�hem is an c�mr o�why you need turthec
miormation.
If you iell us orally,we may require you to send your complaint oc question in writing within 10 business days.
We will promptly investigate the matter and cell or write[o you with an enswer wi[hin 10 business days.If we necd mom time,we may[ake up ro 45
days to imeshKate your complaint or question.If we do,we wdl cmdit your accoun[within this 10-day pcnod fo�the amoun[you ihink is in error�so
you wdl have the use of the money dueing the time it takes us to comple[e ouc investigatioa If wc ask you to put your complamt or question in wuting
and we Ao not reccive if wi�hin 10 busincss days,we may choose no�to cmdit your accounl.
Fo�eerors involving new accounts,point otselep�chases oe foreign t�ansections,we may take up to 90 days to investigete your complaint oc
questiort For new accounts,we may take up m 20 business days ro cadit your account for the amount you ihmk is in ermr.
We will tell you the msults of our imes[igation within 3 busicess days after compieting our investigation.If we decide them was no error,we will
� senA you a wnuen explannriort You may ask for copies of Ihe dowments we used m our�mesnganon.
IN CASF,OF F,RRORS OR QUESTIONS ABOUT OTHER'CRANSACTIONS ON YOUR STATEMENT
You must contaa us within thirty(30)days alter you receive your statement if you think a transaction,oNe�[han an ekctmnic transfer,shown on
your statement is wmng o�i(you need mo�e info�ma�ion abou[ihe iransection.
You may contact your neaas[branch or ou�Customcr Con[act Cen4r at 877-SOV-BANK Customers with hearing impai�menls may call
500-428-91 L (TTY/TDD). We will invesligate you�dispu[e and lell you�he rosul[s of Iha�imesligation.
paRe3 oj3 1677011074
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� pennsylvania SCREpULE F
DEPAPTMENT OF PEVENUE
INMERITANCETRXRETURN ]OINTLY-OWNED PROPERTY
RESIDEM�ECEDEM
ESTATE OF: FILE NUMBER:
THERESA G. MUNSON
If an asee[became ioiMly owned witldn one year of the deceden!'s date of death,It mus[be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Charies D. Munson 4400 Cactus Hills Place, NW Son
Albuquerque, NM 07114-5386
e•Hedy M. DiSimoni ' S01 Ewing Street Daughter
� Princeton, NJ 08540-2705
G
]OINTLY OWNED PROPERTY:
tEnet Dn7E DESCRIFfION OF PROPERTY %or DAre OF DFAn�
IiEM FOR]OINT MADE INCLU�E fUME OF FINRNNL QISiIMION AND&JIK ACWUM NUMB9l OR SIMIWI �AIE OF�FA7H DECEDEMS VFLUE OF
fiUMBER TENFNf ]OIM IDENrtFl7NG XUMBER.qTTqp7�EED FOR JOINRY HEID RFAL 2�TAlE. VFLUE OF qSSEf INTEREST DKEDBlfS INiE0.ESf
1. A. 02/02/99 �MorganStanleySmithBarneyaccount#341-902685-550 153,124.93 33%� 50,531.23
B. 02/02/99 same as above
TOTAL(Also enter on Line 6, Rerapitulation) � 50,531.23
If more space is needed,use addiNonal sheets of paper of the same size.
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REV-1510 E%+(98-09)
� pennsylvania SCHEDULE G
oevnr+.Me�roFReveHUe INTER-VIVOSTRANSFERSAND
INHERITANCETAXRETURN MISC. NON—PROBATE PROPERTY
RESIDENrOECEDENT
ESTATE OF FILE NUMBER
THERESA G. MUNSON
This schedule must be completed and Flled if the answer to any af questions 1 thraugh 4 on page three of the REV-I500 is yes.
DESCRIPTION OF PROPER7Y DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
REM �NQUOETHENhMEOFiXE1MN5FEREE,iHE1RAHR10N5HIP10U��EMPX�
NUMBER iNEDAlEOfiRANSFER. ATTROIPCO%OFiHEDEEDPoRRFALESTATE. VALUEOFASSET INTEREST �r�rww� VALUE
i. Sun Life Insurance Company oi America Mnuity Contract#A0089105801 � 30,000.00'� 100 30,000.00 � 0.00
TOTAL(Also enter on Line 7, Recapitulation) $ � 0.00 �
If more space is needed,use additional sheets of paper of Me same size.
SUN LIFE INSURANCE COMPANY OF AMERICA
(Hereinafter called Th@ Company)
260 Peachtree Street, N.W.
Atlanta, Georgia 30303
�
This is a SINGLE PREMIUM DEFERRED ANNUITY POLICY.It is issued in consideration of the application and the payment
of a Single Premium.
10 DAY RIGHT TO EXAMINE POLICY—This Policy may, at any time within 10 days after its receipt by the Owner, be
returned by delivering or mailing it to the Company or to the agent through whom it was purchased.Immediately upon such
delivery or mailing,the Policy will be deemed void from the beginning, and any premium paid will be refunded.
Signed for the Company on the Issue Date of the Policy.
!� �J � „ �rt�ln.✓l / <(��
Secretary President
PC-301P Page 1 62892-PP10
TABLE OF CONTENTS
PROVISIUN PAGE PROVISION PAGE
Annuity Option Provisions 9 Definitions 3
Annuity Provisions 4 General Provisions 4
Cash Surrender Provisions 6 Table of Guaranteed Values 7
Death Benefit Provisions 8 Partial Withdrawal Provisions 6
I
,
PG301 P Page 2 62892-PP10
ANNUITANT: THERESA G MUNSQN CUN7RACT NUMBER: A0089i05�01
SiNGLE PREMIIIM : #2C,CCO,OC ISSUE DAT€ OF TNE
CdNTRAGTs MAY 03• 1989
KET SIkG1E FRE�IUM: S20,OOO.OQ
SEX ARG ISSUE AGE DF GUARANTEFQ MINI!!UN
ANN�ITANT: FEMAIE — b4 IN7ERES7 RATES:
ANNUIT� CGMNENCEMENT ALL AGLI£Y YEAAS 4.OQ$
CATE: 12117I194k
10 YEAR CERTAIN AN� LIFE MONTHIY iNtOMf A7 ANNUITY CUMNfNCEM€NT
GATE. PER 3isD0U QF NET SIN6lE PREMIU�s 8A5ED GM GUARANT€EU
MINIMUM INTEREST RATES: t8.83.
tC+t�' ��_ . . ,�xa� � � ,
f�: E „ . . h !_ . . :� _ � = t ; ��� .
. �. • �� . V� � . . - .
� . � _ . .. . . . -i � . , . .
tin�jwij .H� `°. a � 3ttM1 • ` '.. 'J�.; . . _ . � iC � . . . ..
. ! { � ,.:a , � i . . _ . .. . ' .. . . . .,
. .. , .. -L � . . . . . . , � t�' , . � � . 'i;a
� i l : i ,. . . ' . �. .
' �"� ) � ! , ..,a ✓ L i )i Q A. � i'�fi : )A f '( .f': ' 1 . . _ ��d- ' � ; - . � . � _
. . " l. .. - . _ . n �F r ` A � !:it i i,: !. . ,. � . . , . � � .
, . . � . � � -� .. . . i _ .. , :
___
ENDQRSEMENT
The foilowing Provision is added to the policy:
GUARANTEE 4F PRINCiPAI
if you elect to surrender this Palicy,the Rroceeds payabia on surrender wili be at ieast equal to the Cash Surzender Value,less
the amount of any partial withdrawals and partial annuity elections.This amount will be at least equal to the Single Premium
you paid tess any previaus partiai withdrawats and amounts applied ta a partiai annuity eiectian,where,for ihe purposes of
this provision, no interest will have been considered credited to the Single Premium,nor added to any partial withdrawal.
This endorsement is attached to and made a part pf the policy as pf the Issue Date af the policy.
SUN LtFE INSURANCE COMPANY OF AMERICA
,��'�>�`^"t ,�
President
E-328 62945-Et
, , ENDORSEMENT TO POLICY
The following provision is added to the policy:
SURRENDER CHARGE WAIVER PROVISION
The Surrender Charge specified in the policy will be waived for a period of 30 days commencing on the Policy Anniversary when
and if the declared interest rate for the upcoming policy year is below the lesser of:
A) 1 1/4% less than the initial interest rate credited to the policy, or
B) 1 1l4% less than the interest rate credited to the policy in the previous policy year.
During such 30 day period,the Cash Surrender Value will equal the Annuity Value.
This endorsement is attached to and made a part of the policy as of the Issue Date of the policy.
SUN LIFE INSURANCE COMPANY OF AMERICA
�r<%(n✓/ � �'ay�
President
E-331 62754-E-1
� ENDORSEMENT
Any reference to PREMIUM TAX in this Policy is hereby deleted in its entirety.
This Endorsement is attached to and made a part of the Policy as of the Issue Date of the Policy.
SUN LIFE INSURANCE COMPANY OF AMERICA
��f�� � .." � � ��C�
President
E-353
DEFINITIONS
AGE is age as of the last birthday.
ANNUITAN7 is a natural person shown on the Policy Schedule whose life determines the annuity benefits underthis Policy.
ANNUITY COMMENCEMENT DATE is stated in the application and is shown on the Policy Schedule.This is the day we
will start annuity payments if the Policy is still in force.
ANNUITY OPTION PROVISIONS are the choices offered by us under which,upon written request,we will pay any proceeds
due under this Policy in periodic payments.
BENEFICIARY shall be as named in the application or as changed by written request signed while the Annuitant is living.
Any change will take effect on the date it is signed,subject to any action taken or payment made by us before the request
for change was recorded at our Administrative Office.
CASH SURRENDER is the process by which the Owner terminates the Policy and receives the Cash Surrender Value from
us.
CONTINGENT BENEFICIARY is the person named in the application or as changed by written request signed while the
Annuitant is living who becomes the beneficiary upon the death of the Beneficiary.Any change will take effecton the date
it is signed, subject to any action taken or payment made by us before the request for change was recorded at our
Administrative Office.
GENDER used in this Policy will be masculine, unless the reference is to a female.
ISSUE DATE is the date of receipt of the Single Premium for this Policy at our Administrative Office.This date is stated on
the Policy Schedule. It is the date from which Policy Years and Anniversaries are measured. In measuring any time period,
the first day will be included and the first day of the foilowing period will be excluded.
NET SINGLE PREMIUM is the Single Premium received less any premium tax.
NON-PARTICIPATING means a Policy under which no dividends from surplus are paid.
OWNER means the Annuitant unless otherwise specified in the application or as changed by written request.The Owner
may,subject to the rights of any Irrevocable Beneficiary or Assignee,exercise every right and option provided in this Policy.
Unless otherwise designated in the application or in a later written request,the Beneficiary will become the Owner of this
Policy upon the death of the Owner.
PARTIAL ANNUITY ELECTION is the process by which the Owner may apply a portion of the Annuity Value to an Annuity
Option prior to the Annuity Commencement Date.
PARTIAI WITHDRAWAL is the process by which the Owner may withdraw a portion of the Cash Surrender Value. The
written request for a partial withdrawal must be received:(a)during the lifetime of the Annuitant,and(b)before the Annuity
Commencement Date in effect, subject to Poiicy Provisions.
PREMIUM TAX is the amount of state premium tax, if any, imposed on this Policy.
PROCEEDS means any amounts paid by us because of death, Surrender,or the Commencement of an Annuity.
RESTRICTED OWNERSHIP means this Policy may not be transferred,sold,assigned,discounted,or pledged as security
for the performance of an obligation, or for any other purpose,to anyone other than us, if:
1. This Policy is issued to qualify under Section 403(b)or 408 of the Internal Revenue Code;
2. This Policy is issued to qualify under the Self-Employed Persons Retirement Act of t962;
3. The Annuitant becomes the Owner upon termination of his employment under a plan defined in Section 401 of the
Internal Revenue Code, unless the Owner requests otherwise at the time of transfer;or
4. Restricted Ownership is requested in the application.
SINGLE PREMIUM is the sum of money in United States currency paid for this Policy. It shall become part of our general
funds.If checks,drafts or money orders are used in remitting such payments,they must be currently dated and made payable
to the Sun Lite Insurance Company of America.
PC301 P Page 3 62892-PP10
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DETERMINATION OF ANNUITY VALUES.The Annuity Value wiil bethe Net Single Premium received pius accrued interest
and adjusted for Partial Withdrawals and Partial Annuity elections.Interest will accrue from the date the premium is received
at our Administrative Office to the earlier of:(1)the Annuity Commencement Date,(2)the date of Cash Surrender,or(3)the
date of death of the Annuitant or Owner,whoever dies first. On any date that a Partial Withdrawal is made or a portion of
the Annuity Value is apptied under a Partial Annuity Election,the Annuity Value will be adjusted as defined in the appropriate
provisions.
PREMIUM TAX. In the event that a premium tax is imposed on the Single Premium as of the Issue Date, such tax will be
deducted from the Single Premium to calculate the Net Single Premium.
In the event that a premium tax is imposed after the Issue Date,such tax will be deducted trom the Annuity Value at the earlier
of:
1. the date such premium tax is due;or
2. the date that the Annuity Value is used to determine the value of annuiry payments,any proceeds payable upon death,
or the Cash Surrender Value.
AUTOMATIC ANNUITY COMMENCEMENT DATE.The Annuity Commencement Date is the date stated in the application
when annuity benefits are to commence. In the event no Annuity Commencement Date is specified,the automatic Annuity
Commencement Date will be the Policy Anniversary immediately following the Annuitant's 65th birthday.
ANNUITY PAYMENT. Annuity payments are payable to the Annuitant unless otherwise designated. The first annuity
payment is payable on the Annuity Commencement Date.The amount of each annuity payment will be determined on the
basis of:
1. the Annuitant's sex and age on such date;
2. the Annuity Vaiue on such date;and
3. the Annuity Option selected by the Annuitant.
Except for minimum guaranteed payments under an Annuity Option, it is a condition precedent to the payment of each
annuity payment that the Annuitant is alive on the date that such payment is due.We may refuse to make an annuity payment
until we receive satisfactory proof that the Annuitant is alive.
Annuity payments will be computed using the 1971 Individual Annuity Mortality Table and interest at the guaranteed rate
of 4% per annum.
Prior to the payment of any annuity benefit under Annuity Options 2 or 3, we will calculate an alternative annuity benefit
amount using our then current Single Premium Immediate Annuity Purchase Rates. This procedure is set forth in the
Alternative Annuity Option Provision of this Policy.
Annuity payments will be withheld until we receive evidence satisfactory to us of the Annuitant's sex and birthday. If the
sex or age of any person receiving benefits,or any other fact determining benefits has been misstated,the annuity benefits
payable shall be such as the actual Annuity Value would have purchased, determined by the correct sex, age, or fact,
according to our rates in effect on the date that annuity payments were determined.Any overpayment or underpayment by
us,with interest at the guaranteed rate of 4%per annum,compounded annually,shall be charged against,or added to,the
payments to be made after such adjustment.
CHANGE OF ELECTION OF ANNUITY OPTION. At any time during the AnnuitanYs lifetime and before the Annuity
Commencement Date,the Owner may elect,revoke,or change the Annuity Option underwhich the annuity payments are
to be made.The Owner must send a written request of such election, revocation,or change.We must receive your request
at least 31 days prior to the Annuity Commencement Date.When such written request has been recorded by us,it will take
effect as of the date the request was signed. We will not be liable for any action taken before recording such request.
The present value of the total annuity payments to be made to the Annuitan[under the Annuity Option selected must be at
least 51%of the present value of the total annuity payments to be made to the Annuitant and Beneficiary.We will determine
such 51%requirement as of the Annuity Commencement Date.It will be based upon the mortality table and interest rates
set forth in the ANNUITY OPTIONS PROVISIONS.
PC301P Page 5 62892-PP10
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If the Annuitant or the Owner dies before the Annuity Commencement Date and the Beneficiary is the surviving spouse of the
decedent,the spouse has the same rights as any other Beneficiary and in addition may elect to continue this Policy in force
on a deferred basis with the spouse becoming the Annuitant.
In any case,any remaining amounts payable under a Partial Annuity Election will be paid to the Beneficiary.
DEATH BENEFITS AFTER THE ANNUITY COMMENCEMENT DATE.If the death of the Annuitant occurs after the Annuity
Commencement Date,then the Proceeds,if any,payable upon death will be as provided in the Annuity Option then in effect.
ANNUITY OPTION PROVISIONS
GENERAL ANNUITY PROVISIONS
The Proceeds used to calculate the Annuity Option benefit will be the Annuity Value.
If any annuity payment is less than$20,we may make payments less often in order to make each annuity payment at least$20.
If the annual annuity payment would be less than$20,we may discharge our entire liability by payment of a single sum to the
person entitled to such payment.The first payment under any Annuity Option will be payable on the Annuity Commencement
Date.
Additional interest, if any,will be paid in the amount and by the method determined by us.
The values for Annuity Options 2 and 3 are based on the 1971 Individual Annuity Mortality Table with 4o/o interest.The values
for Option 1 are based on 4% interest.
PARTIAL ANNUITY ELECTION
At any time during the lifetime of the Annuitant and prior to the Annuity Commencement Date in effect,the Owner may elect
to have part of the Annuity Value made payable under the Annuity Options.Any amount applied to a Partial Annuity Election
will be deducted from the Annuity Value as of the date such amount is applied.The Policy must be returned to us in order to
exercise this option.
The right to a Partial Annuity Election is subject to the following restrictions:
1. Any amount applied to Annuity Option 1 must be at least$3,000.
2. Any amount applied to Annuity Options 2 or 3 must be at least$10,000.
3. The amount of the remaining Annuity Value must be at least$3,000.
ANNUITY OPTION 1—ANNUITY PAYMENTS FOR A SPECIFIED PERIOD. We will pay the Proceeds in equal annuity
payments for a specified number of years.These payments may be on an annual,semi-annual,quarterly,or monthly basis.
The Annuitant may specify any yearly period of not less than 5 years and not more than 30 years.The amount of each annuity
payment is shown in Table 1.
If the Annuitant dies while receiving annuity payments under this Annuity Option,we will pay to the Beneficiary the remaining
payments, if any, in continuing instal�ments for the balance of the period specified.
PC-301 P Page 9 62892-PP10
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NO GUARANTEED PERIOD. We wili pay the Proceeds in equal annuity payments continuing only during the life of the
Annuitant. These payments may be on an annual, semi-annual, quarterly, or monthly basis. The amount of each annuity
payment is shown in Table 2.
TABLE 2
MONTHLY PAYMENTS PER 51,000 OF
ANNUITY VALUE FOR LIFE UNDER OPTION 2
� __ _ _ MONTHLV ANNUITV PAYMENT FOR UFE --
Age of No Guaranteed 10 Years 7 5 Vears 20 VearS ��staliment
Annurtant Period INo Fefund Certain Certain Certain Refund
on Annuiry Upo��eathi
Commencement
Date Male Female Male Female Ma1e Femele Male Female Male Female
50 55.13 54 69 55.05 54.65 54.94 54.61 54.81 54.55 54.89 54.57
51 5.22 4J6 5.12 4.72 5.01 4.67 4.86 <.60 4.96 4.63
52 5-31 4.83 52� dJ9 5.08 4J4 4.92 4.66 5.04 4.70
53 5.41 4.92 5.29 4.87 5.76 4.80 4.98 4.�2 5.11 4J6
Sa 5.52 5.00 5.38 4.94 5.23 4.87 5.03 4.78 5.19 4.83
55 5.63 5.09 5.48 5.03 5.31 4.95 5.09 4.84 5.28 4.91
56 5J4 5.79 5.58 5.17 5.39 5A2 5.15 4.90 5.37 4.99
57 5.87 5.29 5.68 5.20 5.4� 5.10 5.21 4.97 5.a6 5.07
58 5.99 5.39 5.79 5.30 5.56 5.19 5.27 5.03 5.56 5.16
59 6.13 5.50 5.90 5.40 5.64 5.28 5.33 5.70 5.66 5.25
60 6.28 5.62 6.02 5.51 5.73 5.37 5.39 5.17 5.77 5.35
61 6.43 5.75 6.14 5.62 5.83 5.46 5.45 5.24 5.88 5.45
62 6.60 5.88 6.27 5.74 5.92 5.56 5.50 5.31 6.01 5.56
63 6J9 6.03 6.a1 5.86 6.01 5.66 5.58 5.39 5.13 5.68
6d 6.97 6.19 6.55 6.00 6.11 5.77 5.61 5.44 6.27 5.80
65 7.17 6.36 6.70 6.14 6.21 5.87 5.66 5.51 6.42 5.93
66 7.39 6.54 6.85 6.29 6.30 5.98 5J1 5.57 6.57 6.07
67 7.63 6J4 7.01 6.45 6.40 6.10 5.75 5.63 6J3 6.22
68 7.88 6.96 7.17 6.62 6.49 R.21 5.79 5.69 6.90 6.39
69 8.15 7.20 7.34 6.80 6.58 6.32 5.83 5.74 7.08 6.56
7G 8.44 7.46 7.51 6.98 6.67 6.43 5.87 5.78 7.27 6.74
71 8J6 7J4 7.69 J.1B 6J6 6.54 5.89 5.82 7.48 �6.94
72 9.10 8.05 7.87 7.37 6.84 6.64 5.92 5.86 7.70 7.15
73 9.47 8.39 8.05 7.58 6.91 6.74 5.94 5.89 7.93 7.37
74 9.97 8.75 8.23 7.78 6.98 6.83 5.96 5.91 8.18 7.61
75 10.30 9.15 8.41 7.99 7.05 6.97 5.97 5.93 8.44 �.86
The amount of each quarterly, semi-annuel end annual ennuity Dayment may be determined by multiplying the amount of
the mon�hly annuity payment by 2.99. 5.95 and 11.79, respectively.
PC-301 P Page 11 62892-PPt 0
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REV-1511 EX+(10-09)
� pennsylvania SCHEDULE H
� DEPRXTMENT OF NEVENUE FUNERAL EXPENSES AND
[NHERITANCETA%REN2N ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THERESA G. MUNSON
Decedent's debtc must be reported on Schedule I.
ITEM
NUMBER DESCR[PTION AMOUNT
a. FUNERAL EXPENSES:
1' Hoffman Roth Funeral Home 2,216.02
2. Royer's Flowers 58.29
3. Luncheon at Comfort Inn&Suites 801.33 -
4. Lodging at Fairfield Inn 8 Suites 156.96
5. Priest(Fr. Schlaline) 250.00
e. Organist 150.00
�. Lector and altar servers 115.00
B. ADMINISTRATIVE COSTS:
1. Personal RepresenWtive Commissions:
Name(s)of Personal Representative(s)
Street Address _ ._
City State Z[P____.__
Year(s)Commission Paid:_
2. Attorney Fees. . .
3. Family&emptian: pf decedenPs address is not the same as claimant's,attach explanatianJ . .
Claimant
Street Address
City State ZIP_
Relatiunship of Claimant to Decedent __ .___.
4. Probate Fees: 323.50
5. AccounWnt Fees:
6. Taz Retum Preparer Fees: $5.58
�. PropertyMaintenance 8,124.03
Propedy Appraisal 350.00
TOTAL(Alsa enter an Line 9, Recapitulatian) ; 12,630.71
If mare space is needed,use additional sheets af paper af the same size.
� --. rt
PROM:
Divers�ed Appraisal Services
35 E. High Street, Suite 101 INVOICE DAiE REhERENCE
Cadisle, PA 17013 020472M 0?J04/2013
Phone: (717)249-2758
Fax (717)258-4701
TaxID Number206-36-6731
T0:
Hedy DiSimoni
DESCRiPT10N pMOUNT
30 Cambridge Court '�, 350.00
Cadisle,PA 17013 I
i
(Estate of Theresa Munson) I, .. .
S� hlL
���� l ,� ',
� F�� �� � ��� � �
SUBTOTAL I 350.00
Rate % ADJUSTMENT I
SUBTOTAL �I 350.00
Rate % ADJUSTMENT �I
SUBTOTAL I 350.00
TOTAL = 350,00
Diversified Appraisal Services
Farm D2NIN—"WinTOiAL"apPraisal saflware by a la made,inc.—1-BOGALAMODE
__ _
REV-3532 EX+(12-32)
j'�jpennsylvania SCHEDULE I
� DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
[NHERITANCETA%0.ETURN MORTGAGE LIABILITIES &LIENS
0.ESIDEPfr DECEOENT
ESTATE OF FILE NUMBER
THERESA G. MUNSON
Report debts incurred by tha decadent prlor to daath thM remalned unpeid at the dah of deeth,includinq unrcimbuned medicel e�enus.
]7EM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Property Taxes payable on 33 Cambridge Court,#33,Carlisle,PA 17013 2,354.80
2. 2012 PA State Income Taxes payable for Theresa G.Munson 128.00
TOTAL(Alsa enter on Line S0,Recapitulatian) ; 2,482.80
If mare space is needed,insert addftional sheets of the same size.
REV-7513 E%+(01-19)
. pennsyl�ania SCHEDULE 7
INHERITANCE TA%RENRN BEN E FICIARIES
0.ESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
THERESA G. MUNSON
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRE55 OF PERSON(S)RECEIVING PROPERTY Do Not Llct Truatee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• Chades D.Munson,4400 Caclus Hills PI.NW,Nbuquerque,NM 87114 Son 50%
2. Hedy M.DiSimoni,501 Ewing St.,Princeton,NJ 08540 Daughter 50%
ENTER DOLIAR AMOUNTS FOR D15TRIBUf10N5 SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
� NON-TAXABLE DISTRIBUTIONS
A. SPOUSA�DISTRIBUTIONS UNDER SECf10N 9113 FOR WHICH AN ELECf10N TO TAX[S NOT TAKEN:
1. . . . . . . .. . .
B. CHARITABLE AND 60VERNMENTAL DISTRIBUTIONS:
1. . . . . . .. . . . . . . . . . .
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SFIEEf. #
If more space is needed,use additional sheets of paper of the same size.