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07-16-13 (2)
J i C EX(00-11)(FT) 1505610105 REV-1500 OO OFFICIAL USE ONLY PA Department of Revenue Pennsylvania P CouW Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN "- " - PO BOX 28o6o1 Harrisburg,PA 17128-0601 RESIDENT DECEDENT I �`,.� ENTER DECEDENT INFORMATION BELOW 104/2 /2 --- -- -- -- - - - Decedent's Last Name Suffix Decedent's First Name MI Ky Sophia nosk J ------ -- - ------1 �- (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name _ Suffix Spouse's First Name MI --- - ---- -- --1 L- - - --_- -- ----- - - �� Spouse's Social Security N-umber- _ - -- --- -- - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE L _ - _.-I REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ODD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) DID 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number James A Miller, Esquire 1 (717) 737-6400 REWTER OF WILLUSE ONLY.Z7 a O rTT rn IA 7J r n First Line of Address r'n ?3 c O 4 South 17th Street n r rn R1 Second Line of Address ___—_.__.—_—,_,__ D 71 O O _..—- o n n o c ]] DATEF D n City or Post Office _Statt e ZIP P Code rTl Camp HIII ( PA 17011 GO O ---- -- - --- - -- L---I Correspondent's e-mail address:james@paatlaw.COm Under penalties of ry,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,wrrect a Complete,Declaraj4dh of Pleader other than the personal representative is based on all information of which preparer has any knowledge. SlGNATU!:aI270N RE IBLE F FILING RETURN DATE 07/15/2013 ADDRESS 4 Lucie Street, Mechanic g P 17050 SIGNATURE OF PREPARE HER H REP SENTATIV REE DATE ( �' 07/15/2013 ADDRESS 4 South 1 Street C p Hill PA 17011 L� PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 15135610205 REV-1500 EX(FI) RECAPITULATION - ---- 1. Real Estate(Schedule A). .. . .... . .. . ... 178.1000.00 2. Stocks and Bonds(Schedule B) ... .... ... . .. . 2. !8700.400 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. 1,207.02 6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested . . .. ... 6. 3,880.16 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C=:) Separate Billing Requested.... ... . 7. & Total Gross Assets(total Lines I through 7). ... ... ... ... .. . 8. 187,957.578 9. Funeral Expenses and Administrative Costs(Schedule H). ... ... ... .. ... .... 9. 35,120.42 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. .. . .. ........ 10 9,168.93 11. Total Deductions(total Lines 9 and 10).. ...... ... ... . . . ... . 11 44,289.36 11 Net Value of Estate(Line 8 minus Line 11) . ... ... .. . . .. . 12. 143,668.23 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. 143,668.231 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 16. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sao.9116 (a)(1.2)X.0- 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 16, Yi 6,465.07 17. Amount of Line 14 taxable at sibling rate X.12 17, 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE . .. .... . ... . .... . . ... 19. 6,466.07 t 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=) Side 2 1505610205 1505610205 REV-1500 EX(F7) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Sophia J Knosky STREETADDRESS 4 Lucie Street CITY - - -- - -- STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,465.07 2. Credits/Payments A.Prior Payments — B.Discount Total Credits(A+B) (2) 3. Interest (3) 94,89 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on page 2,Line 20 to request a refund. (4) 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 6,559.96 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. retain the right to designate who shall use the property transferred or its income .............---...._-................. [ c. retain a reversionary interest...............................................................................................................-............. d. receive the promise for life of either payments,benefits or care?...................................................................... El 2. if death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. El 0 1 Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. [j N 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary desgnation? ...............--........-_................--................---............................,,.,.......... ... ❑ 1� IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, I 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 172 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 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 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)1. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. I LAST WILL AND TESTAMENT OF SOPHIA JEAN KNOSKY I, SOPHIA JEAN KNOSKY of the Township of Lower Allen, Cumberland County, Pennsylvania,declare this to be my Last Will and revoke any will or codicil previously made by me. ITEM 1: Upon my demise, I direct that my body be interred in Resurrection Cemetery, 1116 Oak Grove Road,Harrisburg,Pennsylvania. ITEM 2: I direct that all my funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from each beneficiary's share at the O rate then assigned to that beneficiary and in no event shall the taxes owed by reason of my death be paid in a collective manner from the gross residue of my estate since the beneficiaries of this estate are taxed at ti different rates. i d aITEM 4: I give, devise and bequeath all the rest, residue and remainder of my estate of o� O every nature and wheresoever situate, together with insurance thereon, to my son, THOMAS D. i KNOSKY,of 4 Lucie Street,Mechanicsburg, Pennsylvania,provided he survives my death by thirty (30) i days. I Page 1 of 8 ITEM 5: Should my son, THOMAS D. KNOSKY, predecease me or fail to survive my death by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate,together with insurance thereon,to be divided as follows: A. One Third(1/3)to my grandson,TROY J. KNOSKY of 100 Iroquois Trail, York Haven, Pennsylvania,per stirpes; B. One Third (1/3) to my grandson, RICK K. KNOSKY of 952 Cloverleaf Road, York, Pennsylvania,per stirpes; and C. One Third (1/3) to my great grandson, HUNTER A. KNOSKY of 100 Iroquois Trail, York Haven, Pennsylvania, provided he survives my death by thirty (30) days. Should my great grandson,Hunter A.Knosky predecease me or fail to survive my death by thirty (30) days, I give, devise and bequeath his share to my son, TROY J. KNOSKY, per stirpes. ITEM 6: Should my great grandson, HUNTER A. KNOSKY be entitled to a share of my 4zestate not have attained the age of twenty-five (25) years at the time of distribution to him, I devise and bequeath the share of such beneficiary to my son, Thomas D.Knosky's wife, ELAINE M. KNOSKY of 4 O zzz Lucie Street, Mechanicsburg,Pennsylvania,provided she is married to my son, Thomas D. Knosky at the W time of my death, as Trustee, to be held in trust, to hold, manage, invest and reinvest the share so received, in accumulation of income thereon, and to use and apply the income and principal, or so much a W thereof as, in trustee's discretion, may be necessary or appropriate for such beneficiary's maintenance, i support, and education (including college education,both graduate and undergraduate) without regard to his parents' ability to provide for such maintenance, support or education, or to make payment for these } I purposes, without further responsibility, to such beneficiary's parents or to any person taking care of such j Cj E Page 2 of 8 beneficiary. Any principal or income not so applied shall be distributed to such beneficiary absolutely when he attains the age of twenty-five (25) years. If the beneficiary of this trust dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be distributed to his or her personal representative. Should the principal of any trust herein provided for be or become too small in the trustee's discretion so as to make establishment or continuance of the trust inadvisable,the trustee's or my personal representative may, without court approval, make immediate distribution of the then-remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportions they are then entitled to income. Upon such termination,the rights of all persons who might otherwise have an I interest as succeeding income beneficiary or in remainder shall cease. In the event Elaine M. Knosky predeceases me or fails to qualify or ceases to act as Trustee or is not married to my son, Thomas D. Knosky at the time of my death, I appoint my grandson, TROY J. KNOSKY,as alternate Trustee herein per the terms and conditions of the Trust established herein. ITEM 7: 1 hereby acknowledge the existence of my granddaughter, TAMMY L. S KNOSKY of Dillsburg, Pennsylvania, and I intentionally, with full knowledge,hereby choose to exclude s � her and all of descendants from any benefit under the terms of this Last Will. zO x ITEM 8: My Executor, trustee or their successors shall have the following powers in z � waddition to those given by law to be exercised by them in their absolute discretion, which powers shall be Q x applicable to all property held by them, effective without the order of any court and until the actual a {S distribution of all such property: a. To retain any investments at discretion including stock of any corporate fiduciary hereunder or of a holding company controlling it; p 9 Page 3 of 8 s b. To invest and reinvest in the executor's or trustee's discretion as permitted under Act 28 of 1999, as amended, the"Prudent Investor Act,"with the specific right to invest in stocks, bonds and real estate, including non-income producing residential real estate for the occupancy of any present income beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executor and trustee deem appropriate; C. To sell,to grant options for the sale of, or otherwise convert any real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof, e. To compromise claims by or against my estate or any trust created hereunder; f. To allocate and distribute different kinds or disproportionate shares of property or x ! O undivided interests in property among beneficiaries or trusts,in cash or in kind,or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such w All 6 form that they will pass by delivery; A a h. To join in any recapitalization, merger, reorganization or voting trust plan affecting O , � 4 investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and i generally to exercise all rights of security holders; Page 4 of 8 i. To manage,operate,repair,alter or improve real estate or other property,and to lease real estate and other property upon such terms and for such period as my executor and trustee deem advisable even for more than five(5)years and beyond the duration of any trust; J. To deduct administration expenses upon either the federal estate tax return or fiduciary income tax return with or without adjustment as between principal and income, as my corporate or disinterested executor shall determine; k. To associate with them in the absence of a corporate fiduciary,an accountant,custodian and investment advisor,and other agents and to compensate them from principal or income or both, as my j executor or trustee shall determine, such compensation to be a reduction of the compensation of my executor or trustee; 1. To associate with them at any time, in their absolute discretion and of their choice, a corporate fiduciary which shall have the same powers as my executor or trustee, such designation by my i executor or trustees and acceptance by a corporate fiduciary to be in writing; m. To combine, without prior court approval, any trust herein with any other trust with substantially similar provisions, although such other trust may have been created by separate instruments and by different persons, and, if necessary to protect different future interests, to value the assets at the ptime of such combination and to record the proportionate interest of each separate trust in the combined z fund; provided however, that no such combination shall be permitted if the effect of such combination Qwould be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or z 0. more of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or (3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the generation-skipping tax; i k� Page 5 of 8 M1 � i n. To exercise any stock options which they may receive; to borrow such funds from any source as my executor or trustees may deem necessary for the exercise of such options; and to pledge assets as my executor or trustee deems appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court(and failure to account alone shall not be considered such a breach); nor shall trustee be required to obtain the order or approval of any court in the exercise of any power or i f decision granted hereunder; P. To allocate any generation-skipping transfer tax exemption from the federal generation- skipping transfer tax to any property to which I am deemed the transferor under the provisions of Section I 2652(a)of the Internal Revenue Code of 1986 and its successors,including any property transferred under my will and any property not in my probate estate and any property transferred by me during life as to 3 which no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios i I applicable to such transfers to be zero; q. To disclaim any interest in property without court approval; and 1 A r. To do all other acts and things necessary or appropriate in the management, administration and distribution of my estate or trust. j QITEM 9: In the event any legatee or devisee named in this will dies under such Q circumstances that there is not sufficient evidence to determine absolutely whether such legatee or devisee x 0 survived me, I direct such legatee or devisee shall be presumed to have predeceased me and devise and Cn bequeath the gift in favor of that legatee or devisee to such persons and in such manner and in such proportions as set forth in this will for distribution if the legatee or devisee predeceased me. g� Page 6 of 8 4 ITEM 10: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 11: I appoint my son, THOMAS D. KNOSKY, as Executor of this my Last Will. i Should my son, THOMAS D. KNOSKY,predecease me, fail to qualify or cease to act for any reason as my Executor,I appoint my son,Thomas D. Knosky's wife,ELAINE M.KNOSKY, as alternate Executrix of this my Last Will, provided she is married to my son, Thomas D. Knosky at the time of my death. Should Elaine M. Knosky predecease me or fail to qualify or cease to act for any reason as my alternate Executrix,then I appoint my grandson,TROY J.KNOSKY, as my second alternate Executor. i ITEM 12: I direct that my personal representative, trustee or their successors shall not be I required to give bond for the faithful performance of their duties in any jurisdiction. s i IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and E Testament,this day of /eQ_ 2011. k SOPHIA JEAN KNOSKY ' Signed, sealed,published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. n l .1/br+-� , ll�l`I<,`i'`''� residing at �dd deli rr 17��19 residing at nl e cG/.LCµv 'l''s f'94— 17✓S--r i Page 7 of 8 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, SOPHIA JEAN KNOSKY, / r/P/? 2 - ��6✓ewy and CE (o�l O, the Testatrix and the 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 Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the will as witness and that to the best of his or her knowledge, the Testatrix was at the time eighteen (18) years of older, of sound mind and under no constraint or undue influence. SOPHIA JEAN KNIOSKY'n Wi ss With ss Subscribed, sworn and acknowledged before me by SOPHIA JEAN KNOSKY, the Testatrix, and subscribed and sworn to before me by NX/."..P �f. „�d✓FI��.rF�y and L e Sa 11Av 1``2(e yr" , the witnesses, this 2 day of �+ ,rr f 2011. d I Notary Public SEAL) COMMONWEAL.H Oi.►ENNSVLVAN111 NS,ITARIALSEAL " '-Henry F.Coyne, Notary PYttlie' -. Page 8 of 8 Hampden Township. Cumberleno County . ` My Commission Expires June 17,2QtQ' REV-1502 EX♦ (12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Estate of Sophia Jean Knosky 2112-0688 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. REM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 16 Citadel Drive,Camp Hill,Lower Allen Township,Cumberland County,Pennsylvania 178,000.00 7-7 1 1 _ I i i 178,000.00 TOTAL(Also enter on Line 1, Recapitulation.) •_�• If more space Is needed,use additional sheets of paper of the same size. .. ,r' l,f�t � , _ j: ;,�.,. . . 0 m9"..0 ' �y t . + w m in y O� C5 LP W .tp1 KlH t 1 mr, hK a �.z �' aoama N ♦? ycq - \� �'hv C m Lnd . •� l y Li y� \ att\ tj v 'ZL l 4r t .: vtM nJ S h �h S. is Y d 9 k I y �t't - t ' 1 _ i VA-1 pl y yN' Y2^b� i�J'�Yi.• .03 t �v i Y y ,f r .aC `1 Dlp `hlti „1 n .r7"rlC7nctk. iQz h.'\7 MI _ 14 pi't ` rYS ,Z .�i xAn lt_ ri(h" � • Wa [ u his htn+ Y 4 C + htit�1 L �ZC ♦ :f � IP.' t a..0 > > r 3 ' �n' IvW h 0 Tl t t t in t aj N: t t•�`r��� �, 'ly ft �{4 n }2 hY ti I.kkir y:< rt OMB Approval No.2502-0285 A. Settlement Statement {HUD-'t} FINAL S.Type of Loan 1,Q PHA 2.❑RHS 3.[X Conv.Unins, 6,File Number: 7.Loan Number: 8.Mortgage Insurance Case Number CS12504 OODD354250 4.❑VA 5.❑Conv.Ins. C.Note:This form is furnished to give you a statement of actual settlement vests.Amounts paid to and by the settlement agents are show,Items marked -(p.o.cy-ware paid outside the during;they are shown here for informational purposes and am not Included In the totals. D.Name&Address of Borrower: E,Name&Address of Seller: F.Name&Address of Lender: Tiny J.Knosky,Cherie J.Knosky Estate of Sophia Jean Knosky Stonegate Mortgage Corporation 16 Citadel Drive,Camp Hit,PA 17011 4 Lucie Street,Mechanicsburg,PA 17050 9190 Priority Way West Drive,Su0e 300, Indianapolis,IN 46240 G.Property Location: H.Settlement Agent: I.Settlement Date:012812013 16 Citadel Drive Charter Settlement Services,LLC Disbursement Date:OV282013 Camp Hilt PA 17011 4705 E.Trmdis Road,Mechanicsburg,PA 17050 tower Allen Township 717-730-9664 Place of Settlement ImmExpress 3805 Market Street,Camp Kid,PA 17011 Printed 012812013 at 12:50 pm by VS 100. Gross Amount Due train Bortuver 11400. GroaaAmount Onto Seller 101. Contract sales price 178,1 .00 11401. Contract sales once pr ice -'��- 178,000.0) 102. Persoo ...nal y "" 402. Personal Property..... ��. property 103. Settlement charges to borrower(line 1400) . 7,824,091 1 401 13C 404. 105. 405. Ad ushnents for Rema std b seller in advance Adjustments for Items aid b seller in advance 106. Cityllown taxes to 406. City0own taxes to 107, Camty taxes to 407. County Wes 10 - 108. Assessments to 408. Assessments to 109. School Taxes 01/282013 to 061302013 743,63 409, 012812013 to 06/30/2013 743.63 110. SeeierlRefuse 01262013 to 031312013 82.39 410 SmerlRefuse 012812013100313112013 82.39 111. 411, 12, 1 1412, 120. Gross Amount Due fmm Borrower 188,650.11 420. Gross Amount Due to Seller 178,826.02 200. Amaunk Pofdb or in Behalf of Borrower 1500. Reductions In Amount Duets Seller r r earnest money 501. Excess dooms(s�Instructions)l a, unf of new ioan(s) 133,500.00 502. Settlement charges to seller(line 1400) 12,170.00 loa s taken sub'ed to 503. Existing loo s taken Subset to 504. Payoff of first mortgage loan - 505. Payoff of second mortgage kran 508. 507, 508, 509. Adjustments for Items unpaid by seller Adustmente for Items unparill by seller M. Cityn wn taxes 011012013 to 11282013 60.01 510. Cityllown taxes 01/010.013 to 0128 13 1 60,01 P219. y taxes to 51L County taxes to sments to 512. Assessments to l Taxes to 513. to f Equity 44,500.0 0 514. Gift of Equity 44,500.00 r credit for dosing costs 8,590.10 515. Seiler credit for dosing costs 8,590.10 516, 517, 518. 519. 220. Total Paid b Hoc Borrower 188,850.11 520. Total Reduction Amount Due Seller 65,320.11 301). Cash atSNtlememfmmRo Borrower 000. Cash MSaBtemsMtoHrom Sege - 301. Grossamounidue fromborrower(line120) 186,650.11 601, Gross amount due to seller fine 420) 178,826.02 302. Less amounts paid by/for borrower(line 220) 18600,11 602, Less reductions in amount due seller(line 520) 65,320.11 303- Cash 0% From 0 To Borrower Orm 603. Cash © To from Seller 113,595.91 wwmwn.naam.�®r.wuam�ww.:x.,rm�.ea,m.wss.+w,.¢w:aim..awmuw-�weena�ava,«.a.wee..w;vsmxb-�wwM.me,+auao•.�.uo„away eenamwpnva Previous editions are obsolete Page 1 of 4 HUD-1 Settlement Statement - 16 Citadel Dr Camp Hill PA L.Settlement Charges 700. Total Real Estate Broker Fees Paid From Paid From Division of commission tine 7110 as follows: Borrower's Seller's 701. $0,00 to Funds at Funds at 702. $0,00 to I Settlement Settlement 703. Commission paid at settlement 800. hems Payable in Connection wdh Loan 801. Our origination charge (Includes Origination Point 0.000%or$0.00) $5,123.75 (from GFE#1) 802. Your credit or charge(points)for the speck interest rate chosen $-1,236.21 (from GFE#2) 803. Your adjusted origination charges (from GFE A) 3,887.54 804. Appraisal fee to Slreetlinks $410.00 P.O.C.B•(from GFE#3) 805. Credit report to Credit Plus(Cody Fin Mtg Svc (from GFE 43) 35.83 806. Tax service to Corel is Ston ate Mt (from GFE#3) 70.00 807. Flood certification to Corei is Ston ate Mt (from GFE#3) 19.00 808. to 900. Items Required by Lender to be Paid in Advance 901. Daily interest charges from from 012812013 to 0210112013 @$12.8014/day (from GFE#10) 51.21 902. Mortgage Ins.Premium for months to (from GFE#3) 903. Homeowners insurance Pori yearstoEneInsurance (from GFE#it) I 460.00 904. months to from GFE#11 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrm account (from GFE#9) 1 1,562.51 1002.Homeowners insurance 3 months A,$ 38.33/month $114.99 1003.Mortgage insurance months $ 0.001month $ 1004.City Property Tax months @$ 67.601month $ 1005.County Property Tax 12 months 0$ 67.60 1month $811.20 1006.School Property Tax 8 months $ 146.871month $1,174.96 1007.Aggregate Adjustment $-538.64 1100.TiBe Charges 1101.Title services and lenders title insurance from GFE#4 1 1,360.00 1102. Settlement or closing fee to $ 1103.Owners title insurance-Old Republic National Title Insurance Co. from GFE#5) 220.00 1104. Lenders title insurance-Old Republic National Title Insurance Co. $1,295.00 1105. Lenders We policy limit$133,500.00 Lenders Policy 1106.Owners bile policy limit$178,000.00 Owners Policy 1107.Agent's portion of the total rrtle insurance premium $1,224.00 1108. Underwriters potion of the total title insurance premium $291.0D 1109. Edoc Delivery Fee to Comerstone Land Transfer $25.00 1110. Courier/Wire Fee to Charter Settlement Svcs.ac$15.DO 1111. Notary Fee to Valerie Priest $25.00 A255.00 1112. Reimburse for Tax Certification to Charter Settlement Svcs.ac$1113. Deed preparation fee to Charter Settlement Service:$ 1200.Gmemment Rftording and Transfer Charges 1201.Government recording charges $ (from GFE#7) 158.00 1202. Deed$62.00 Mortgage$96.00 Release$ 1203.Transfer taxes $ (from GFE#8) 1204.CitylCounty taxlstamps Deed$ Mortgage$ 1205. Stale Tax/slamps Deed$ Mortgage$ 1206. Deed$ Mortgage$ 1207. $ 1300.Additional Settlement Cha n - - 1301.Required services that you can shop for (from GFE#6) 1302.Survey to $ 1303. to 1304. Escrow for Inheritance Tax to $ 12,01550 1305. to 400 Total Settlement Charges (enter on lines 103,Section J and 502, 7,824.09 12,170.00 *Paid outside of closing by(B)onower,(S)eller,(L)ender,(gnvestor,Bro(IQer."Credit by lender shown on page 1.-Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 Settlement Statement - 16 Citadel Drive Camp Hill PA page 2 Comparison of Cood Faith Estimate GFE)and HUM Charges Good faith Estimate HUM Charges That Cannot increase 1,11.1O.1 Line Number Our odgination charge # 801 5,123.75 5,123.75 Your credit a charge(points)for the specific interest rate drossn # 802 -1,236.21 4,236.21 Your adjusted origination charges # 803 3,887.54 3,887.54 Transfer tam # 1203 0.00 0.00 Cherries That In Total Cannot Increase More Than 10% Good Faith Estimate HUD1 Government recording Charges # 1201 190.00 158.00 Appraisal fee # 804 400.00 410.00 Credit report # 805 50.00 35.83 Tan service # 806 70.00 70.00 Flood certification #807 19.00 19.00 Title services and lender's lithe Insurance # 1101 1,445.00 1,360.00 Ownees Bge inwrence-Old Republic Nafiona Tige Insumnoe Co. It 1103 220.00 220.00 le 2,394.00 2,272.83 - Increase behveen GFE and HUD-I S 421.17 a 5.0614% Charges That Can Change - Good Faith Estimate HUD-1 Initial deposit for your escrow amount - # 1001 2,490.00 1,562.51 Daly interest charges from - #901 $12.80141d 192.02 51.21 Homeomrefs insurance # 903.. 540.00 460.00 # # # Loan Terms Your Initial loan amount is $133,500.00 Your loan term is - 30.years Your initial Interest rate is 3.500D% Your initial monthly amount owed for principal,interest,and anymorlgage $599.47 includes insurance Is Nndpa ❑X Interest ❑Mortgage Insurance Can your Interest rate rise? ❑X No. ❑Yes,It can rlse to a matdmum of %. The first Change vAl be m I I and can change again every years after l I . Every change date,your Interest rate can Increase or decrease by %. Over the life of the ban,your interest rate is guaranteed to never be lower than %a higher than %. Even if you make payments on time,can your loan balance rise? ❑X No. ❑Yes,it mn dse to a madmum of S Even if you make payments on lime,can your monthly amount owed for [g]NO. ❑Yes,the first increase can be on I I and the monthly principal,Interest,and mortgage insurance rise? - amount owed can rise to S The madmum it can ever rise to is$ Does your ban have a prepayment penalty? ❑X No. ❑Yes,your marlmum prepayment penally Is$ Does your ban have a balloon payment? ©No. ❑Yes,you have a baboon payment of$ due In years on I I Total monthly amount awed including escrow account payments ❑You do not have a monthly escrow payment for Iterts,such as pmpeny,taxes and hon eow ergs Insu once. You must pay these hems directly yourself. - %❑You have an additional monthly,escrow payment of$252.80 that results In a total Initial monthly amount awed of$852.27. This includes principal interest,any mortgage Insurance and any items checked below. ❑X Property taxes ❑X Homeowner's insurance ❑Flood insurance ❑ ❑ ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Settlemen PMVI ys editlons are ybsolete ge 3 of 4 a emenL - 16 Citadel Dr ivpd HUD-1 Camp Hill PA Page 3 Signature Page HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction I further certify that 1 have received a copy of the HUD-1 Settlement Statement. Troy J.Knosky Cne J.Knosky Estate of Sophia Jean Knos y int The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction I have caused or will cause the funds to be disbursed In accordance with this statement. 11d1 SI/3 SETTLEMENTAGENT DATE WARNING:IT IS CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 Settlement STatement - 16 Citadel Drive Camp Hill PA page 4 REV-ip3 a'(6-12) pennsylvania SCHEDULE B ` DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sophia Jean Knosky 2112-0688 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER - DESCRIPTION OF DEATH 1' Computershare,Prudential Finanical,Inc. 4,870.40 I -hall 80 shares,common TOTAL(Also enter on Line 2, Recapitulation) $ 4,870.40 If more space Is needed,Insert additional sheets of the same size Prudential Computershare NEW Computershare PO Box 43033 Providence,R102940-3033 Within USA, US territories 8 Canada 800 305 9404 Outside USA, US territories 8 Canada 732 512 3782 000448 www.computershare.com/investor S JEAN KNOSKY C/O THOMAS KNOSKY CEDAR CLIFF MNR 16 CITADEL DR CAMP HILL PA UNITED STATES 17011-7617 Date 01 May 2012 Re: S JEAN KNOSKY Company Name: Prudential Financial,Inc. Account Number:******8248 *DRS book-entry shares:80 Closing Price per Share as of 01 May 2012:-$60.88 **Certificated Shares:0 Dear Sir or Madam: Thank you for notifying us that the owner of the Prudential Financial stock account noted above has passed away.On behalf of Prudential and myself, I would like to express my sincerest condolences for your loss. I understand that this is a difficult time and the process of transferring the assets of a loved one who has passed away can seem overwhelming at times.We want to help in any way possible and have enclosed the forms you will need to transfer the Prudential shares to a new owner.We have also included detailed instructions,as well as a set of Frequently Asked Questions,to guide you through the process. I hope this information will be helpful as you make decisions regarding this account. Most of Prudential's registered shareholders received their shares as a result of Prudential's demutualization in December 2001.Although some individuals were given shares as a result of their policy ownership,the shares are completely separate from the policy and they must be transferred to a new owner,even if you have already claimed the policy benefits. We understand that,in some situations, the new owner may wish to sell the shares as soon as the transfer is completed. If the new owner wishes to sell through Computershare,it offers a voluntary sales facility for eligible shareholders to conveniently liquidate their shares.A copy of the terms of this sales facility will be enclosed with the new account statement that will be mailed once the transfer is completed. Once the transfer is complete and the new account materials are received,shareholders wishing to sell their shares may do so by contacting Computershare directly at the number contained within those materials. Please do not hesitate to contact us if we can be of any help to you during this difficult time. If you have any questions regarding the transfer process, please call 800-305-9404 and select menu option 4.After the automated message,you may then press 2 to reach a Computershare representative for assistance. Again, please accept our sincere condolences. Sincerely, I AA Margaret M. Foran Chief Governance Officer, Vice President and Corporate Secretary 'DRS book-entry shares-a recordkeeping option for you to record your ownership electronically on the books of the company. Shares for which a physical stock certificate has been issued. Account value subject to market fluctuation. " n1DAVA REV-i5o8 EX+(08-13) pennsylvania If SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Sophia J Knosky 2112-0668 Induce 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. Prorated real estate taxes(Sch A above-HUD line 409)reimbursed to Estate-value at settlement 743.63 2 Prorated sewer/refuse(Sch A-HUD line 410)reimbursed to Estate-value at settlement 82,3'9 3 ;Prorated homeowners insurance reimbursement-value at settlement(check copy attached-Exhibit E1) 239.00 4 2012 income tax refund(check copy attached-Exhibit E1)(IRS form 1310 copy attached Exhibit E2- 142.00 Statement of Person Claiming Refund Due a Deceased Person) i r TOTAL(Also enter on Line 5, Recapitulation) $ 1,207.02 If more space is needed,use additional sheets of paper of the same size. i ry >d, ✓ ?y '. 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Sequence No. 87 Tax year decedent was due a refund: Calendar year 2012 ,or other tax year beginning 20 ,and ending 20 Name of decedent Date of death Decedent's social security number S Jean Knosky 04/26/2012 154-01-1890 Please Name of person claiming refund Your social security number print Thomas D Knosky 164-32-8528 or Home address(number and street).If you have a P.O.box,see Instructions. Apt.no. type 4 Lucie Street City,town or post office,state,and ZIP code.If you have a foreign address,see instructions. Mechanicsburg PA 17050 Check the box that applies to you. Check only one box. Be sure to complete Part III below. A ❑ Surviving spouse requesting reissuance of a refund check (see instructions). B ❑ Court-appointed or certified personal representative (defined below).Attach a court certificate showing your appointment, unless previously filed (see instructions). C ® Person, other than A or B, claiming refund for the decedent's estate (see instructions). Also, complete Part II. CM Complete this part only if you checked the box on line C above. Yes No 1 Did the decedent leave a will? . . . . . . . . . . . . . . . . . . . . . . . X 2a Has a court appointed a personal representative for the estate of the decedent? . . . . . . . . . . X b If you answered "No"to 2a, will one be appointed?. . . . . . . . . . . . . . . . . . . X If you answered "Yes"to 2a or 2b,the personal representative must file for the refund. 3 As the person claiming the refund for the decedent's estate, will you pay out the refund according to the laws of the state where the decedent was a legal resident? . . . . . . . . . . . . . . . X If you answered"No"to 3,a refund cannot be made until you submit a court certificate showing your appointment as personal representative or other evidence that you are entitled under state law to receive the refund. Signature and verification.All filers must complete this part. I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief,it is true, correct,and complete. Signature of person claiming refund► Date P. Valid Proof of Death is in my Possession General Instructions tax return. However, you must attach to his return a copy of the court certificate showing your appointment. Purpose of Form Where To File Use Form 1310 to claim a refund on behalf of a deceased If you checked the box on line A, you can return the taxpayer. joint-name check with Form 1310 to your local IRS office or Who Must File the Internal Revenue Service Center where you filed your If you are claiming a refund on behalf of a deceased return. If you checked the box on line B or line C, then: taxpayer,you must file Form 1310 unless either of the • Follow the instructions for the form to which you are following applies: attaching Form-1310, or • You are a surviving spouse filing an original or amended • Send it to the same Internal Revenue Service Center where joint return with the decedent, or the original return was filed if you are filing Form 1310 • fined on this page) separately. If the original return was filed electronically, mail You are a personal representative(de Form 1310 to the Internal Revenue Service Center filing an original Form 1040, Form 1040A, Form 1040EZ,or Form 1040NR for the decedent and a court certificate designated for the address shown Form 1310 above. See the instructions for the original return for the address. showing your appointment is attached to the return. Example. Assume Mr.Green died on January 4 before Personal Representative filing his tax return. On April 3 of the same year,you were For purposes of this form, a personal representative is the appointed by the court as the personal representative for Mr. executor or administrator of the decedent's estate, as Green's estate and you file Form 1040 for Mr. Green.You do appointed or certified by the court A copy of the decedent's not need to file Form 1310 to claim the refund on Mr. Green's For Privacy Act and Paperwork Reduction Act Notice,sae page 2. aAA REV o711en2 rrw Form 1310 (Rev.11-2oo5) EXHIBIT E2, Pagel DECEASED S Jean Knosky 04/26/2012 Form Department of the Treasury—Internal Revenue Service 1040A U.S. Individual Income Tax Return(99) 2012 IRS Use Only—DO not write or staple in this space. Your first name and initial Last name OMB No.1545-0074 Your social security number S Jean Knosky 154-01-1890 If a joint return,spouse's first name and initial Last name Spouse's social security number Home address(number and street).If you have a P.O.box,see instructions. no. & Make sure the SSN(s)above Apl. 16 Citadel Drive and on line 6c are correct. City,town or post office,state,and 21P coda.If you have a foreign address,also corroetespecas below(see insuuctlora). Presidential section Campaign Camp Hill PA 17011 Check here g you,or your spouse K Ting Foreign country name Foreign province/state/county, Foregn postal mda IoMty,want S3 to go to this W.Checking e box helow will not change your tax or refund. ❑You ❑Spouse Filing 1 ❑x Single 4 ❑ Head of household(with qualifying person).(see instructions.) status 2 ❑ Married filing jointly(even if only one had income) If the qualifying person is a child but not your dependent, Check only 3 ❑ Married filing separately.Enter spouse's SSN above and enter this child's name here. ► one box. full name here.► 5 ❑ Qualifying widow(er)with dependent child(see instructions) Exemptions 6a ©Yourself. If someone can claim you as a dependent, do not check Boxes box 6a. checked on Us and eb 1 b El Spouse No.of children c Dependents: (4) itch urn on so who: (2)Dependent's social (3)Dependent's a e 17 qualifying for 'lived with If more than six security number relationship to you child tax credit yOu dependents,sae (1)First name Last name instructions) .did not live Instructions. ❑ with you due to divorce or ❑ separation(see ❑ instructions) _ Dependents on so not L1 entered above Atltl numbers ❑ on lines 1 of Total number of exemptions claimed. above. Income 7 Wages, salaries, tips,etc.Attach Forml W-2. 7 Attach Form(s)W-2 8a Taxable interest.Attach Schedule B if required. 8a here.Also b Tax-exempt interest. Do not include on line 8a. 8b attach 9a Ordinary dividends.Attach Schedule B if required. 9a Forms) N eU 1099-R if tax b Qualified dividends(see instructions). gb was 10 Capital gain distributions(see instructions). 10 withheld. 11a IRA 11b Taxable amount If you dm not distributions. 11a (see instructions). 11b gala W-2,see Instructions. 12a Pensions and 12b Taxable amount annuities. 12a (see instructions). 12b 3,752. Enclose,but do not attach,any 13 Unemployment compensation and Alaska Permanent Fund dividends. 13 payment.Also, please use Form 14a Social security 14b Taxable amount t0404. benefits. 14a 4,843. (see instructions). 14b o.- 15 Add lines 7 through 14b(far right column).This is your total income. ► 15 3,752._ Adjusted gross 16 Educator expenses (see instructions). 16 income 17 IRA deduction (see instructions). 17 18 Student loan interest deduction(see instructions). 18 19 Tuition and fees.Attach Form 8917. 19 20 Add lines 16 through 19.These are your total adjustments. 20 21 Subtract line 20 from line 15.This is your adjusted gross income. ► 21 3,752. For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. BAA Form 1040A(2012) REV 01/28/19 Tf W EXHIBIT E2, Page 2 Form 1040A(2012) Page 2 Tax,credits, 22 Enter the amount from line 21 (adjusted gross income). 22 3,752. and 23a Check(( ❑X You were born before January 2, 1948, ❑Blind Total boxes payments if: t F1 Spouse was born before January 2, 1948, ❑Blind )checked ► 23a El b If you are married filing separately and your spouse itemizes Standard deductions,check here ►23b El foeduaion 24 Enter your standard deduction. 24 7,400. •People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter-0-. 25 - o. check any box on line 26 Exemptions. Multiply$3,800 by the number on line 6d. 26 3,800. 23a or 23b or 27 Subtract line 26 from line 25. If line 26 is more than line 25,enter-0-. who can be claimed as a This is your taxable income. ► 27 0 dependent, see 28 Tax including any alternative minimum tax(see instructions). 28 0. instructions. P9 Credit for child and dependent care expenses.Attach •All others: Form 2441. 29 Single'filing filing 30 Credit for the elderly or the disabled.Attach s separately' Schedule R. 30 0. Married filing 31 Education credits from Form 8863,line 19. 31 joint)y or oualifyin 32 Retirement savings contributions credit.Attach widow(erj, Form 8880. 32 $11,900 Head of 33 Child tax credit.Attach Schedule 8812, if required. 33 $8,700 s old' 34 Add lines 29 through 33.These are your total credits. 34 0. 35 Subtract line 34 from line 28. If line 34 is more than line 28, enter-0-. This is your total tax. 35 0. 36 Federal income tax withheld from Forms W-2 and 1099. 36 142. If you have 37 2012 estimated tax payments and amount applied a qualifying from 2011 return. 37 child,attach 38a Earned income credit(EIC). 38a Schedule Elc. b Nontaxable combat pay election. 38b 39 Additional child tax credit.Attach Schedule 8812. 39 40 American opportunity credit from Form 8863, line 8. 40 41 Add lines 36 37 38a 39 and 40.These are your total payments. ► 41 142. Refund 42 If line 41 is more than line 35, subtract line 35 from line 41. This is the amount you overpaid. 42 142. Direct 43a Amount of line 42 you want refunded to you.If Form 8888 is attached,check here►❑43a 142. deposit? Routing ►c Type: Checking Savings See ► b number xxXxXxxxx yp ❑ g ❑ 9 instructions and fill in d Account and 433d d or ► number xxxxxxxxxxxxxxxxx and Form 8888. 44 Amount of line 42 you want applied to your 2013 estimated tax. 44 Amount 45 Amount you owe. Subtract line 41 from line 35. For details on how to pay, you owe see instructions. ► 45 46 Estimated tax penalty(see instructions). 46 Third party Do you want to allow another person to discuss this return with the IRS(see instructions)?❑Yes.Complete the following. M No designee Designee's Phone Personal identification name ► M. ► number(PIN) ► under penaft es of Perjury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge Sign and belief,they are true,correct.and accurate N list all amounts and sources of intone Precelved during the tax year.Declaration of prewar(other here than the taxpayer)is based on all information o which the preparer has any knowledge. Your signature Date Youroccupstion Daytime phone number Joint return? Retired (717)763-0755 Sea Instructions. Keep a copy Spouse's signature.If a joint return,both must sign. Date Spouse's occupation If the ISsalyur an idadityPrdwtim for N e4cett Y records. Pi Paid Print/type preparer's name Preparer's signature Date Chack►❑tf PTIN sell-employed preparer Firm's EIN► Firm's name SELF PREPARED use only Frm's address► Phone no. MV01/28113"W Form 1040A (2012) EXHIBIT E2, Page 3 REV-J5u9 EX+(o3-1o) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Sophia Jean Knosky 2112-0688 If an asset became Jointly owned within one year of the decedent's date of death,It must be reported on Schedule G. SURVIVING)DINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.Thomas D Knosky 4 Lucie Street, Mechanicsburg PA son i I 6. ---' —� i I C. -- JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH REM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTTTUT10N AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENnFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. r f M8T Checking account number 42705975 - 1760.32 50% 3,880.16 r� _ LnJ L—� __..._.,._ � E C1 H I V El F-1 El _� F-1 of TOTAL(Also enter on Line 6, Recapitulation) $ WT 3,680.16�� If more space is needed,use additional sheets of paper of the same size. ••� LM M&T Bank ACCOUNT NO:, ACCOUNT TYPE - - STATEMENT PERIOD -PAGE 42705975 MBT SELECT WITH INTEREST APR.24-MAY.23,2012 1 OF 2 00 0 06113M NM I17 3769 _ S JEAN KNOSKY OR TOM KNOSKY 16 CITADEL DR CAMP HILL PA 17011-7617 INTEREST EARNED FOR STATEMENT PERIOD 0.06 HIGHLAND PARK INTEREST PAID YEAR TO DATE 0.33 ACCOUNT SUMMARY BEGINNING DEPOSITS'8 : .... .. - OTHER: . ....CURRENT ENDING BALANCE - OTHER ADDITIONS CHECKS PAID S BTRACTIONS I INTEREST.PD BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT 7,760.32 3 1,810.10 11 200.00 1 1 1 697.30 0.07 1 8,673.19 ACCOUNT ACTIVITY 'POSTING - . -. DEPOSITS,INTEREST ::,:LHELK5: 8 ,OTHER DAILY -;-DATE ' ' " TRANSACTION DESCRIPTION -: B-OTHER ADDITIONS SUBTRACTIONS < -BALANCE 04-24-12 BEGINNING BALANCE 07,760.32 04-24-12 CHECK NUMBER 5734 200.00 7,560.32 05-01-12 FIDELITY INVESTM PENSION 697.30 8,257.62 05-03-12 US TREASURY 303 KKSOC SEC AUjjrGS& 1,111.00 9,368.62 05-04-12 FIDELITY INVESTM REVERSAL 697.30 8,671.32 05-23-12 VERIZON VERIZON Re 1.80 OS-23-12 INTEREST PAYMENT 0.07 8,673:19 ENDING BALANCE 08,673.19 CHECKS PAID SUMMARY 5734 04-24-12 200.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 EFFECTIVE JULY 30, 2012, THE FEE FOR EACH DAY THAT THERE IS A TRANSFER FROM YOUR SAVINGS, MONEY MARKET, OR CHECKING ACCOUNT TO COVER ONE OR MORE OVERDRAFTS IN YOUR CHECKING ACCOUNT WILL BE 012.50. THIS FEE WILL BE CHARGED TO THE ACCOUNT FROM WHICH THE FUNDS WERE TRANSFERRED. THIS FEE DOES NOT APPLY TO A POWER CHECKING OR MYCHOICE PREMIUM CHECKING ACCOUNT. LOMA(M7) A A . P.O. Box 4650 ACH/EDI Services Buffalo,NY 14240-9975 *** This is an Advice *** (800)724-2240 Date: Friday,June 15,2012 S JEAN KNOSKY TOM KNOSKY 16 CITADEL DR CAMP HILL PA 17011-7617 Subject:Notification of Death/Reclamation -- -_ ._Case Number:-1299-I-----.-- ------ -_..— ----- -- ----------- --- Funds Deposited to Account: ******5975 Funds Deducted from Account(s): ******5975 $2,222.00 This is to advise you that on 6/15/2012 we deducted from the account(s)shown above the amount of$2222,for the SSA Direct Deposit of 6/1/2012. Due to the fact that S JEAN KNOSKY has passed away prior to the issuance of the credit,the Treasury of the United States is requesting reimbursement. In accordance with Federal Regulations,any subsequent post-death benefit payments should be returned immediatly,by ACH,to the Government Disbursing Office. If the number of the'account deducted from'is different from the account into which the funds were originally deposited,the deduction is authorized under the bank's rules for right of offset because one or more of the owners on both accounts are the same. Should you have any further questions-about-this charge,-please-call and refer to the case number above. This advice is provided to facilitate the reconcilement of your monthly account statement. Respectfully, ACH/EDI Services M&T REV-1511 Ex+(1009) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAY RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sophia J Knosky 2112-0688 Decedent's debts must be reported on Schedule I. REM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1. [Myers Funeral Home, 8,421.00 QlRessurection Cemetery check 4345,copy attached,paid 5/4112 EJ B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: _ _ 6,678.00 Name(s)of Personal Representative(s) Thomas D Knosky r`�-'•f~- Street address 4 Lucie Street City Mechanicsburg State PA Zip 17050 Year(s)Commission Paid: 2013 2. Attorney Fees: Miller Lipsitt LLC - 4 S 17th St Camp Hill PA 17011- 3,000.00 3. Family Exemption:(If decedent's address is not the same as clalmant's,attach explanation.) Claimant Street Address city State_ZIP Relationship of Claimant to Decedent 4. Probate Fees: Cumberland County Register of Wills 323.50 5. AEEownhw+Fees+- Cumberland County Law Journal-advertising 75.00 6. Tax-ReWF Preparers The Sentinel-advertising 168.30 7. Bonnie K Miller,2012-13 School Real Estate Tax-check 4414 paid 7112/12 ^_� 1,727.24 ❑ 16 Citadel Drive,Camp Hill,PA Utilities-see next line itemization: ❑& PPL_$249.86;PA American Water$71.77;Comcasl$12.84;Lower Allen Twp$217.90 Flo Donegal Insurance-check 4403 paid 6127/12 11 16 Citadel Drive Camp Hill,PA repair for sale: AAA Renovations$12300;Lowes$321.01 12,621.01 TOTAL(Also enter on Line 9, Recapitulation) $� 3, 5_12 42 If more space is needed,use additional sheets of paper of the same size. / RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 6/18/2012 Cumberland County - Register Of Wills Receipt Time : 13 :27 : 12 One Courthouse Square Receipt No. : 1070316 Carlisle, PA 17613 KNOSKY SOPHIA JEAN Estate File No. : 2012-00688 Paid By Remarks : THOMAS D KNOSKY CJ ------ --------- --------- Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 4396 $323 . 50 Total Received. . . . . . . . . $323 . 50 f. D CpG2 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tale: (717)249-3166 Fax:(717)249-2663 March 8, 2013 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T0: James A. Miller, Esquire RE: Sophia J. Knosky Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. ------------------------------------------------------------------ ------------------------------------------------------------------ Advertisement inserted on the following dates: February 22, March_ 1, and March 8, 2013 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by The Sentinel MILLER LIPSITT LLC AD NUMBER PAGE NO. www.c e m b e r l l n k,c o m 4 SOUTH 17TH STREET 418312 1Of1 CAMP HILL,PA 17011 Pi BILL DATE SALESPERSON 717-7376400 CW11i.0 3 PHNMLRF pozwcwu 02/27/13 wolfc . START DATE STOP DATE 02/13/13 02/27113 '. AD NUMBER AD DESCRIPTION CLASS 'LINES 418312 NOTICE NOTICE IS HEREBY GIVEN THAT 10 PUBLIC NOTICES 30 ` 2 cols Publication Insertions Rate Net Amount Gross Amount 3 THE SENTINEL-LEGAL 3 LGL $159.30 TOTAL AD CHARGE $159.30 3 MOBILE SITE MOB2 $2.00 3 PROOF OF PUBLICATION 01 PRF $7.00 Purchase Order Est. S.J.Knosky PAY THIS AMOUNT $168.30 $201.96` *AFTER 03/24/13 THE SENTINEL Thank you for advertising with The Sentinel! Deadline.for c/o LEE NEWSPAPERS in-column legal ads is 4:00 p.m. two business days prior to PO BOX 540 date of insertion. For questions, call(717)240-7130. WATERLOO IA 50704.0540 Return this portion with yourpayment Legal THE SENTINEL .. ❑ Check# ❑Credit Card Ad Number 418312 c/o LEE NEWSPAPERS Billing Date 02/27/13 PO BOX 540 WATERLOO IA 50704-0540 Acct#: Amount Due $ 168.30 E>p.Dater m . Name on credit card rr-11 $ 1 Signature . Please make checks payable to: THE SENTINEL - . } ,• - 000167 THE SENTINEL MILLER LIPSITT LLC _ c/o LEE NEWSPAPERS 4 SOUTH 17TH STREET - PO BOX 742548 CAMP HILL, PA 17011 CINCINNATI OH 45274.2548 21540200000.0041831200000000000000020196000..0016.8307 REV•1512 EX4(12.12) Y.tiY pennsytvania SCHEDULE I T-y DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER . Sophia J Knosky 2112-0688 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 I Closing costs pursuant to the sale of real estate(see attached HUD-1 settlement statement'} 8,745.10 lines 515($8590.10), 1111 ($20),1112($10), 1113($125) . 9r2 Quantum Imaging 21.38 3 Intemists of Central PA 151.65 4 Cardiology Diagnostic —-- -- 35.00 5 Cardiology Practice—�— .14.46 6 W.S.Pathology — 8.00 [:7] Pinnacle Health 8 �Spirit Physician- —_ TOTAL(Also enter on Line 10,Recapitulation) $E . 8,168.93 If more space is needed,insert additional sheets of the same size. n7 =m 87m5KY 9.. 441-4 - _ - _ •0019386334 �'ns4naen, T > / >031301846< ' 'mow, ,>lm ���g—t L• R 9»tle Bank 0,ib #02 s 2012-07-11 a 019386333 EMO PoeaflnandDt 2� 00 3 130 29 5 5+: 3856654907.4 L4 Check 44414 Pald :07/1212012 $1727.24 check #4414- Paid .07/12/2012 $1727.24 THOMAS 0.7040SKY ,m iM. 4413 A ... M117 ,m 00+9336332 i 44M]65T. ^•} 1T03l3 81EOlC<Sch #01 1 ,4s>wxs. Wmm w1 ,eae,>m �S7=(2.- -t , 2012-07-11 r- 019386332 ' L;MMMff$ABt C Pawn Ha ISOIOOams f IDWk$3029550 3856L549s•443 i � S Check #4413 Paid :07/12/2012 $9.80 - (hock #4413 Paid :07/12/2012 $9.80 -?r ners,..sm°.ww9kr - - sue., A 4441 "� �v 9 f ankh 6>. Q,�7 Iy f i,N g !+60wac�ln4ra ?ja0• W�� : � {. �1�•�~c�'� flop tiw wat� y Stott�� fp �MdTTBC R bus Pt TtD � ] s 00333029550 3856 L54 .'4441 Check $4441 Paid x08/10/2012 $391.01 Cheek #4441 Paid :08/10/2012 $321.01 17707#.80.KNO3W "�,•y.> A 4345 1-x nra:am X00.it yaw:,= ��q^'tY�•r. _ .. " �•7 L611i "Bvmk �Pb„eriTumt97 1404 °.040 ,t�1, - ! t ,:0313029550 3656154 1*4845 ♦0000102500X - tea_ Paid :05/04/2012 $1025.00 check #4345 Paid :05/04/2012 $1025.00 r�4n0, �'�`m w. A 4442 L1831391=4 a lt.� 819514BBB812= c88�flB28A + &T B= s _ i 7:0333029550 385635491-44:62 Check #4442 Paid x08/09/2012 16100.00 7 '� 2 - 1. ._. - _ Check #4442 Paid :08/09/2012 $6300.01 n,olhiso luwsx, glow A► 4428-1 �N ygpyuM�B1e1D,9a nie„im QC c k �� :y��•+!?'•w� ; 0 z FULTON >83i3$UMC 61651489873MM 97IM'M WM&TSatilc -� �.. 1 4013&302455r 3859&549r;;28 Check 84428 Paid :07/20/7012 86000.00 Check 8+428 Paid A7/20/2012 16000.00 UXMMS a XNOSKV 4478 4e m e,s A1. , m mass,m 4e fiw, .. mmovna WaM8WBu1Yk • Fin:ndat'..'.-w d+ - �S �t'.�`iV t 031 rTarC 861{ , L p•-(� OZL- is?1 1:0313029550 3$561549e'44?8 3r- +'000II 1Cl Q895,� Check 44478- - _ _ Paid :10/16/2012 1108.95 Check 14478 Paid :10/16/2012 1108.95 440$ , MriTal4pm •' .: ,k�Ts ,iy{��..; i/ ? ^ � s $ lP • WM rB`an �8- Seem�-»---1SYSR'SS6Ca"�S d MME • ?•Y 'Otl�&302455C 3856&549r44tl3 -.;S • (aleck 84403 Paid :06/27/3012 8529.00 Check 84409 Paid :06/27/2012 1529.00 A6 4343 - .. . MBCKWe:5W414,6. ,74A„m !wOR •-e��' .. . i - 1 $1 LgM&TBmk vawerFlnamiat urom y srF nt4" MAU ' +:03&3029551; 385$1 44e•;31.3 .. - 8 sz Check 84343 Paid :05/01/2012 112.84 Cheek 84343 Paid :05101/2012 a 112.84 Pns�OSKY �ei AL 4412 - �$ 4YIGK ST. 4- 40806 vA „e9o.lmz �'—/==:L'�•� �jyf'°', - e WM&TSank 1 _ �Nnanvacsokerms--- < A 3�f z{n 1:03 1 30 295 5x: 3856i549r4412 r'00 0010845/ Check 14412 Paid :07/16/2012 8101.95- Cheek 84412 Paid 107/16/2013 ;108.95 yTHOMAS D.KNOSKT n J& 4357 - T � er 'St__O LM 7L3029SSC R dal Iufims it 1:03 385fi 1549x4357 ." 000 24 2 3001 Check 04357 Paid :05/17/4032 $2421.004 Cheek #4357 Paid :05/17/2012 $2421.00 THOMAS D.KNOSKY H o AL 4344 °• RM&TBank Pee- c ISduKOns F0100005 � ,:0333029554 385635,. W1.344 10000500000x' Check 04344 Paid :05/04/2012 ;5000.00 Check #4344 Pad :e5104/2012 •-• - - . $5000.00 THOMAS 0.mosKY y. .y'r -•- -- - 1-�- 1v._ - -- - - ---- -- --- -'— . PA auO68r. �ryy�� '^ MBNT P - kFlnan clarions $ w 6 - tu t 3856 iSt.9o4358 Check 043$8 Paid :05/15/2034 548.69 Chad[ 09358 Paid :05/15/1014 $18.69 - - THOMAS aknOS" .. A% 4388 4 ucE ar. nEaw.aseuna w rnsorice ., 86?w"�T--`2' •t . __ -_ m LRM&TBanlc t:03i3029554 38561 p4388 _• Check 04398 Paid :06/15/3012 $17.56 Check 64388 ' Paid :06/15/1014 117.56 A3. 4425 wk ma9raD _ r i t-7— _. i1MNAS 0.8NOS" or {'/ ♦u�8r.' °°��tmu�rnz - 't''d Jt —' sI�3 M&TBank - r ,�t�kDa Jcsal ...�... A rp33302955t: 38 56 3 5496'4425 � '. e - g Y lol Check 84415 Paid :07/18/1011 $16.11 Check 84415' Paid :07/18/1011 _ $16.11 A — InO D atom - � iA:: 4446'.e�gn( irow.iroi It 30 29 5 5R -38.56151.99.6446 - L .. __---_- Cheek 84446 Paid 08/1512011 $69.63 - Check 04446 Paid t08/15/1011 $69.63 78OW1$o.lOosC7 a�: 4463 _ ' s{� $ 11777 .i W 1 ank • 5Yk16A14 •4 _ rn Z p C MGM/rY.//�J qA 3•! [ :.� �y Y t:0 3 130 29 385635 F. ..,,re . �.-•rr. Check 04463 Paid :09/37/1011 $117.77 Cheek 04463 Paid :09/17/1011 $117.77 7xo6tASD.uxosuY A. 4359 1x 7nsa:aela - /\ - 'smux�wuv,. 111BT1TD Bww- 't��.' r .7 S� ;0000111090517120084 SNYMELLON 11\I'-R 11r1 l (fit 8 E� -000t>4-60 PAYEE 0=71412 ABS ND GUAR _ i M WBank Pus Flnandal50t hnD .051712 IC3412 110 220 CO3i3D 2955:: 3856$5494'4.359 Check 8/359 Paid :05/17/2012- $24.75 Check 04359 Paid :05/17/2012 $24.75 4392 ' 'i A } ;J.; t` g 0.10106KY - .yf� j 1 �..�-j j $ �S•� . ^e�4 240 051812 00¢4 }_ f f7/ �--- 406273595 PIT CRED TO PAYEE ks-•E—^ �, .71(A¢S Tt — °�° - ~.� 1$46008147/412 ABS ND GUAR j3• � SphOpm6 ti' yy 71812178586 24 V 48.2 _ p ...r.r 3856i549d•439Z raai3oz95s1: Check 04392 --- Paid :06/18/2012 013.79 Check 04392 Paid :06/18/2012 $13.79 THOMAS 061010SfY - •!mom m 4424--- -°---- - . 41®N14We1N8 kkka. #2 1 $ OP0023 111071912 0694 SNYMELLON . , .h.t{�) ����� ® 0002408274595 PR CRED TO PAYEE .. 184-MOW371412 ABS ND GUAR � �k - •wr SoYtlI01a 071912 262708111 222 - CD33302955:: 3856 i549L, - - Cheek 04424 Paid :07/19/2012 $13.86 Cheek 04424 Paid :07/19/2012 $13.86 $1OUAS D.WMMKY AL 4448 _ 'r®« :w(a�-M ::w�o+loz.. . -- - "- - -� '(G-L'�-If ._- 4rz s 1 � 171820a2I112 0094 7 L k 't406273x95 ?tr _ CRED TOPAYEE} 1•8""4-6008071412 -ABS ND'OUAR - I� - u8on4 a= r:i.• ty9ey12341904'1843(M Mff 1:0 3 130 29 5 51: 3856$549 4448 '- `''e i.s_c_:.;_�_- _' .:_::=: __. a-. _ • ChOOk 04448 Paid :08/20/2012 $19.37 Chock 84448 Paid :08/20/2012 ^$19.37 ' w V344w 4n�oiu4s R KNC&cv - � � ��aw Ji 0370 dp ss"i z3aa50 xpitivfze is:oxv 4 LWuiac%awa r'a,7kBo-+xe ` t. � fi• ' o Ss nKi*fSP C6 t 70,1 lim ig WbwBank Pawerfi0eadjl { Y O3i�S•: 3856194^µ 0 4 '_- •y :n Check #4370 Paid :05/30/9012 $70.18 Check 44370 Paid :05130/2032 $70.18 4430 THOMAS KNOWY f.+^} _ -_.._.. ... . . �. ' 40# ST. y100?Air@ £. { ..: t'--•t- I/ [ N cy . YEUe � .eat -+ ms $ turbo Td�iMtBantc Zle Check $4430 Paid z07/25/9012 $114.60 Cheek 04430- Paid :07/95/2032 $115.60 mm. ill 4447 FPM.C� FW . 7m� m - fish t2^� • i$ W .—" .T�:!'OT C'. -__j a mz- Ra1M4<TBank mw44ddmwcpu c' 40 3 i 30 29 5 SO. 38 56 i S49$4444 4 Check #4447 Paid <08/23/2032 48.00 Check 04447 Paid e08/2312012 $8.00 i � C .-T X. 1c-3 `'11 � i �. THOf1a$0.KNOSI[Y' .•4R� ry v g��'' .o •'71�' d3&�... '` - _ IF ►at+1M&TBank FlM1X1h19e1Wmn = _ p : _ '1:0333029551: 3856i54911'4393 -,�4. •,_,_. _, m Check #6391 Paid :06/22/2012 ' $12.64 Cheek #4391 ' Paid :06/22/2012 $12.64 T ROM"0.KNOSKY 1w. "AL 4380'0' ------- � — . M ,re1019nL aeoa 4,4,4 - i —sr S�S2$T PIFV L1 AJJ J $ I M&TBan1C 4MVFlnandal59uNon4 i�o�oc 3� ' f is-6u�c::s�`r1'G�SB 1:03&3029551: 3856&549p4380 FO 00000582/' Cheek #4380 Paid :06/14/2012 $5.82 Check $4380 Paid :06/1412012 $5.82 k. y YNOMAS 0.KNOSKY {> T y p . ?11`• . 4378 .,aCE6Y l?r Scwe1 P.•rn6o-11e1 - i . t 8tffd- _ _ { '- lb'�1 a 1 /aS�M&TBank . Pe Flea luuow = N -1:0313029551: 38 56 151.90-16 3 7a Cheek #4378 Paid :06/1312012 $25.90. Cheek #4378 Paid :06/13/2012 $25.90 �.n. .AL 4379 `� ' S TNOMAS O.KNOSKY _ i Tt Tlb,ye', / py 1 .E — I N[GW1YLmJe3.PA r]K+i1-Y�]n2 z $ IT 70 HITH Ngt1E0 Ppi EE " O C 19 X4` 4 Powcr FlnanQal Intlans a 18f1 t!3 861'X83 , a / �9H63< �H52H00113< 7-2 7 F<.! 1:03&3029551: 38563549n`4379 FOO 00t7ROF - - - Cheek #4379 Paid :06/11/2012 $17.90 Check #4379 Paid :06/11/2012 517.90 PhYlroiraS KNOSKY , AL 4371 A .. fiRFTOIT TO p41THIN nRjjeU PR7EE RJI� R a�ma M&TBank — flnantl kOons Bch-8529c^01� r,C•5� 1, + 0_- wr - f a1lr� y 'R 16 i< a052000113< i . t :$YI7a7g401�{RR80 Y 1:03&3029551: 38S61549r1,371 000000&?4F 53-,:ri '=R2 Check #4371 Paid :05/29/2012 --.• - 11.76 Check #4371 Paid :05/29/2012 __.... — $1.74 t i e .. � ti.. ; z „ .�. �mwmmD..KNOB" 4407` X31 Balk 04f3ieiar'°-..• a ILC1E m. #2012A17103 jam x VRAPA I.MeIM asrl^2—iL• . 1ST 9A� ClJ S !Sl.GS �' c x CJ►ti�� �.. roomed LM&TB=k ftI RnW]CN15011dmIS N as9� ��K g9 . 003 N02955C 38 56 4 549049.07 a F Cheek 84407 Paid :07/0512012 $251.65 Check 84407 Paid :07/0512012 - -.. $151.65 � TIONAS�I�IQIOBKY - m° M 4472 MBCfYYaCSmMq,'PA 1MSetAY ' e EM&Z• - vexes .SaBrtkms �. - i x:0313029550 3856A Check 84472 Paid :09/2812012 $35.00 melds $4472 Paid :09/28/2012 $35.00 7110 D�1.KN08104 + ''..•: ' ax A 4435 v . 4 >x> ' -7 wi.�i$mlTae :` Bank llC0 3 130 295 5x: 3856i549r1.1.35 Cheek 84435 Paid x08/09/2012 $14.46 Check 84435 Paid x08/09/2012 $14.46 �IpwMasaw+osxcr "�1e Ad 4479 . Px n»xeaa - ; I6dWtlC59V(G.PA x?On)IIOP ��L� l Klyl! _ _ _ 998 Ifl112H1 x" 02 $iHItEO PflYEE _. WM&TBantc �MpF an al -c aH52HHO113c _ ,....a, ''xu1Vj•�i. n me_ - r0 31 30 Z955,: 38 5f1549N 1,4 79�r000000 (Reek 84479 Paid :10111/2012 $1.74 Check 84479 Paid :10/11/2012 $1.74 n OMAS 0.101O8KY .�mn AL• 4373 `M.SSf ffi? 'T a-ra :I TO.YG-tY�=RYBE FBSSu OF E`IT -GTI"nF•K META PP 1MSylTm ]CCCC'"?C(in-531es-LPJ-0-l6'A-$e - �n 1 i $33 WM&TnanIY PaecrR cda�SoWUms --Y x:0343029551: 3856154 x'1.37 Check 04313 Paid :06/0512012 $33.38 Cheek 84373 Paid :06/05/2012 /$33.39 lOn 1. REV-1513 EX+(0110) i pennsytvania SCHEDULE a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Estate of Sophia Jean Knosk 2112-0688 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).) Rnrw•m�nurnx I. Thomas D Knosky-4 Lucie Street Mechanicsburg PA 1750 son, 1000/0 El I El L- Ej F1 I 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 TAXIS NOT TAKEN: #g 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: El I iswFRnw�N..�.wr 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. & �- Y - ,. -- i.. ...-v... . . .. ONNEWNR STATEMENT OF ACCOUNT ESTATE OF SOPHIA J KNOSKY 2112-0688 A Real Estate: 16 Citadel Drive, Camp Hill, Lower Allen Township, Cumberland County PA $ 178,000.00 B Personal Property: $8,750.56 1 Stocks $4,870.40 2 Bank Account-M&T $3,88016 C REIMBURSEMENTS: $1,207.02 1 Prorated school real estate taxes (A above- HUD line 409) $743.63 2 Prorated sewer/refuse(A above-HUD line 410) $82.39 3 Prorated homeowner's insurance reimbursement $239.00 4 2012 income tax refund $142.00 TOTAL ASSETS $ 187,957.58 II DEBTS/DISBURSEMENTS: 1 Register of Wills, Cumberland County-Probate Fees(SCH H, 134) $ (323.50) 2 16 Citadel Drive Camp Hill PA closing costs(Sch i, 61) $ (8,74510) 3 16 Citadel Drive Camp Hill PA 2012-13 School real estate (SCH H, B7) $ (1,727.24) 4 16 Citadel Drive Camp Hill PA utilities (SCH H, B8) $ (552.37) 5 16 Citadel Drive Camp Hill PA insurance(SCH H, B10) $ (529.00) 6 16 Citadel Drive Camp Hill PA repairs(SCH H, B11) $ (12,621.01) 7 Medical charges/payments (Sch I, B2 -8)) $ (423.83) 8 Myers Funeral Home/Ressurection (Sch H, A) $ (9,446.00) 9 Legal Advertising reimburse Miller Lipsitt LLC(SCH H, 65/6) $ (243.30) 10 Thomas D Knosky-Executor Fee (SCH H, 61) $ (6,678.00) 11 Miller Lipsitt LLC -Attorney Fees (SCH H, 62) $ (3,000.00) TOTAL DEBTSIDISBURSEMENTS $ (44,289.35) III DISTRIBUTION: $ 143,668.23 A Payments: 1 PA Dept of Revenue- Inheritance Tax $ (6,465.07) Interest from 1/18113 to 7/16/13 $ (94.89) Total Due PA Department of Revenue $ (6,559.96) TOTAL PAYMENTS: $ (6,559.96) D Net Proceeds to Beneficiary-son $ 137,108.27 Thomas D Knosky 4 Lucie Street Mechanicsburg PA 17050 Total Beneficiary Distribution $ 137,108.27 Account Balance $ Receipts/Disbursements - Pa No 21-12-0688