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� 1505610101
REV-1500 °`�°,-'°> � -
PA DepaRment of Revenue pennrylva�a _ oFFiGnL uSE ON�r -
` Bureau af IndiNdual Taxes °""""° Counry Code Year Fle Number
POBOXZ8o6oi INHERITANCE TAX RETURN
� Harrtsburg PA 17u8-o601 RESIDENT DECEDENT �' t � d � 7 �{ .3
ENTER DECEDENT INFORMATION BELOW �,;. � � .�-�_ ti -
Social Security Number �ate of Oeath MMDDYYYY Date of BfAh MMDDYYYY . .
� � O6f3Zolz pSo � / 4 / 9
� DecedenYs Last Name Suffix DecedenPS First Name MI
� lCEfo2i✓ � � ARREc � /�
� QfApplicable)Enter§urvWfrig Spouse's Informatton Below �
Spouse's Last Name SuRx . Spouse's First Name MI '
� T � ❑
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPL{CATE WITH TNE
' ` REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW �
� 7.Onginal Retum r p 2.Supplemental Retum O 3. Remainder Retum(Oate of death
�� � '��. � .. t� C- � • � . .q . � .. pno�to 12-13-02)
p 4. Limited Estate p 4a.Futura Interest Compromise(tlate of O 5. Federal Estate Tax Retum Required
� �: \ � `[ � �. death aRer 12-12-82) .
� 6. Decedant Died Testate O 7.Decedant Maintained a Livirg T`ust � 8.Total Number oi Saie Deposit Boxes
� `� (Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigalion Proceeds Received O 10.Spousal Povedy Credit(date of tleath O 11. Elec[ion to tax under Sec.9173(A) '��
,'� J p � r � 1 between 1231-91 and 1-1-95) (Attach Sch.O)
,CORRESPONDENT- THIS SECTIOri MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TA%INFORMATION SHOULD BE DIRECTED T0:
� Name � -L „ � T � Daylime Telephone Number
CI� � Q � E's �' SN / FLDS � � � 7 � 7_ 7�GG oz04
� � � � 1- �� � F� REGISTER OF W3CLS USE O�}Y
C� w �y m
c � m � • -
First line of address � .^.�o c� � �
�
� C �. ou �' E � k.OA- a � n � ,�, -, °
m rn
- r Z � -C%i �f o
Second line of address b N � O O
/ %4'L � '� ' . , _ } . o C,,,� � -n -n
� . .: . c� o°�i - -^
City or Post Office State ZIP Code O C .DATE FILED= C>
. /!1 E C rY� J 1 C s _�, //��2,G N �4- . 1 D s' r °
- - - 7 5�9,� �� S�; �' �,
. _ . , � . .. .,
Correspo�ndenYs e-mail address: C�-°$n�elds 3Q ComCasf ne1'
U�tler penaNies of perjury,I tledare thaf I have examinetl Ihis retum,inGUding accompanying schedu�es antl stetements,and to the best of my knowledga antl belief,
it is true,correq and complete.DeGaration of p2pa2r other than Ihe personal rep2sentative�s based on all infoRnation of which pr¢parer has any knovAetlge.
SIGNATURE OF PERSON RESPONSfBLE FOR FILING RETURN D TE
� x "�✓u�S, Y��.�e�.. �� �3�/3
ADDRESS 9 F S. 117ENLER , �308 HarvQ�d Dr%vt, ctnrQJ Hi/l, P.4 /7o/i
SI�G�NATURE EP ER OytiER T ��TA� DATE �/�3�3
G l
ADDRESS • ,
, Ch'fl-2�E5 E SN/EL.vs� / U' nusu- QoQC+�, //je�tia��s ur�,P/f I7oss-
PLEASE USE ORIGINAL FORM ONLY
Side 1 •
� 1505610101 15�561Q1�1 �
����
J 1505610105
REV-1500 EX
�
RECAPITULATION `
1. Real Eslate(Schedule A). .................... ........... ....... ...... t. A •�O O
. . . . . � -1--��� - --- ,,� � --
2. Stocks an0 Bontls(Schedule B) ............ .................. ......... 2. " �J-I�S � � �1� D �
� . --i.-'.-v--.-.-..-ti
3. Closety Held Corporation,Partnership or SolrProprietorship(Schedule C) . .... 3. � � �,
4. Mortgages and Notes Receivable(Schedule D) .... .... ....... ........... . 4. .�����•�0 O
5. Cash,Bank Deposits and Miscellaneous Personal Property(SChedule E)... .... 5. � � �D � ��•,j'g�0
--
6. JoinUy Owned Property(Schedule F) O Separale Billing Requested ... .... 6. ��_��]�• Q �
7. IntervVivos T2nsfers 8 Miscellaneous Non-Probate PropeAy - - t-[ p
(Schedule G) . O Separate Billing Requested.... .... 7. I 7 T 6 8 I •�7 �
� . �_ ._
8. ToWI Gross Assets(total�ines 1 through 7).... ....... .... .
.... e. 39 .(2 I 37 •�77
9. Funeral Expenses and Administrative CosGS(Schedule H)... ....... ... .... .. 9. � s,�j8� 7 •LO' p
10. Debts of�ecedent,Mortgage Liabilities,and Liens(Schedule I) .. .... ....... . 10. 1n1.YA��y1•��
�a-��.�r '`�
11, Total Detluctfons(total Lines 9 and 10).... ....... .... .... .............. 11. � 6 � 3��f•f�p � �
12. Net Value of Estate(Line 8 minus Line 11) .. .... .... .... ... .......... ... 12. �3���� 2 �•��
13. Charitable and Govemmental 8equests/Sec 9113 Trusts for which - - --- -" �-,.-+r--- -
an election to tax has not been made(Schedule J)�...... ... .... ......'..... 13. ,5 $� S (p ♦.3 �i
14. Net Value Subjeet to Taz(Line 12 minus Line 13) . ....... ....... ... .... .. 14, 1�'�A�(��•'7� q
L
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount o�Line 14 taxable
at the spousal tax rate,or �
transfers under Sec.9116
(a)(1.2)X.OL .{Q,O 15. . O �
16. Amount ot Line 14�tp�xable - n r•-• --L-i.-.+� _�
at�inea�ratex .oY,� ��3 .'� ,6 /o'.S �!• 7' 9 ,s. - ��.�.�6 9 9 33
17. Amount of Line 14 taxable � �'
at siblin9 rate X.12 � . � � 17. �+�� Q
. . �. . ...�:r
18. Amount of line 14 taxabte -- n�
at collateral rate X.15 or,�� 3 �� 1 ± � � 18. -� ; � 7 �!
19. TAX DUE ....... ... ....... .... ... .... .....:. ....... .... ... ......... 19. ' . . - � 0 �l /i .� g.8`
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUND OF AN OVERPAVMENT �
Side 2
� 1505610105 1505610105 J
:.
,
�REV-7500 EX Page 3 Flle Numher 2� ��.?— ��3
DecedenYs Complete Address:
DECEDENPS NAME
Darroll I►1. k��'�,orn
� SiREETADDRESS L
98 �IZQ/`QQtGT Dti ✓G
�"� �Ie�ianjcs6u sTA� P� ��P i�os�
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) ��r 0 �f�� 8�
2. CreditslPaymenGs �p
A.Prior Payments 1� ��s�
B.oiscount '/q S, 00 }�
—� Total Credits A+g 2 / � /OD. �
3. Interest .�j .Z DD,00 ( ) ( ) —.-�
(3! �` S3, i2
4. It Line 2 is greater than Line 1 +Line 3,enter fhe difierence. This is the OVERPAYMENT.
Fitl in oval on Page 2,Line 20 to request a refund. (4) fl
5. If Line 1 +Line 3 is greater than Line 2,enter the diBerence.This is the TAX DUE. (5) �
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIDNS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of ihe property trens(erted:.......................................................................................... � ❑
b. retain the right to designate who shall use the pmQerty transterted or its income:............................................ ❑ �
c. retain a reversionary iMerest;or.......................................................................................................................... ❑ �
d. receive fhe promise for tife of eflher payments,benefiis or rare?...................................................................... ❑ �
2. If death occurted aRer Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent ovm an"in trusl toP or payable-upon-death bank account or securiry at his a her death?.............. ❑ �
4. Did decedenl own an individual retirement account,annuity or other non•probate property,which
containsa benefidary designa6on? ..........................................................:............................................................. � ❑
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 t, 1994,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or(or the use of the surviving spouse is
3 percent[72 P.S.§9tt6(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) (7.1) (ii)J. The statute does not exempt a Vansfer to a surviving spouse from tax,and the statutory requirements for disctosure of assets and
filing a tax retum are sfill applicable even if the surviving spouse is the nnly beneficiary.
For dates of death on or after July 1,2000:
. The tax rate imposed on ihe 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)(12�].
• The taz rate imposed an the net value of transfers to or for the use of the decedenPs iineal beneficiaries is 4.5 percent, except as noted in
�z P.s.§s��s��.z���2 a.s.§s»s!a)(�)l.
. The tax rate imposed on the net value of transters to or for the use of the decedenPS 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 wiih the decedent,whether by biood or adoption.
COMMONWE4LTH OF PENNSYLVANIA � - -
DEPARTMENT OF REVENUE REV-i l fi2 EX(i 1-96)
BUREAU OF INDIVIDUAL TAXES
OEPT.280601
HARRISBUNG,PA 1112g-0601
PENNSYLVANIA
RECENED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 016495
MEHLER JOYCE S
2308 HARVARD AVENUE
CAMP HILL, PA 1701 �
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
__'_""_ roio .
__'___"_ ___'__
101 � 59,405.00
ESTATE INFORMATION: ssN: I
FILE NUMBER: 2112-0743 �
DECEDErvT NAME: EICHORN DARRELL M �
DATEOFPAYMENT: 09/12/2012 I
POSTMARK DATE: 09/11/2012 (
CoUNTY: CUMBERLAND �
DATE OF DEATH: 06/13/2012 I
�
TOTAL AMOUNT PAID: 59,405.00
REMARKS: RECEIPT TO ATTY
CHECK# 1013
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
. _ _ . . _ . . _ _ . .. _ _. . . _
COMMONWEALTH OF PENNSYLVANIA FEV-1162 EX�71-96)
OEPARTMENT OF REVENUE
BUREAU OF INONIDUAL TA%ES -
DEPT.280601
HARRiSBURG,VA 1�128-D&01
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. C� 017732
MEHLER ,iOYCE S
2308 HARVARD AVENUE
CAMP HILt, PA 17011
ACiV
ASSESSMENT AMOUNT
CONTR�L
NUMBER
"'_'__ tme
10l � 55,200.00
ESTATE INFORMATION: ssrv: �
FILE NUMBER: 2112-0743 �
DECE�ENT NAME: EICHORN DARRELL M �
DATE OFPAYMENT: O6/12/2013 �
POSTMARK DATE: 06/11/2013 i
CouNTY: CUMBERLAND �
DATE OFDEATH: 06/13j2012 �
�
TOTAL AMOUNT PAID: 55,200.00
REMARKS: RECEIPT TO ATTY
CHECK# 1018
INIT{ALS: WZ
SEAI RECEiVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WIL�S
TAXPAYER
�
�y� ��?iP�LL E�CHOR/� �'3� Z l -I2 -7 f�3
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_�--.--- - !.Cl�,?�__.SY.¢2ES' _ OF_rQ�s'�PlCE
._�_�— ,�.! _._.,__ �..____ - �-
--_____ ' �e� 39/ /37.77
__ ' -' cfo,l� f e�_, s_��l, 3 r�.GZ .r..__ �_
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va� �,�s ~�.� 1P89. 7�
-- ;-,�--- ��t9-?f �'/6.37 -�r;dacancoaa� et'�a.lc,.,�.� /�o
_._._.. - . . _. __ �._ __-.. __ ._..._.._ ._....____ _ - ..__.___ .______�'�s �`�"� _ � =.eara�u.
_ ' i � o � 2, 9a8_ �8 ---
___.-- -_------,----_____ ____.
-_---- —. 190 = .z.�za�. �a -
._ �r � �01�,�c��.�� s,'Ss6. 3�
i;
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� mnunt to / /� / �
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- �-;�s'�on-��.of- � 3/T. od x���o = 35�7 ss
` I 3 (5/.7 y � _/� 6 99.33
; �� T = D 6. 8�
f
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� REV9503 EX+(6-98j
scNE�u�E �
GOMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERIT0.NCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
�Qarre,�� m. r-� Gknrn ,2�- �y -7rf�
- All propeAy jointly-owned with rfght ot survivorship must be disclosed on Schetlule F.
ITEM - VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
' A66o�f/� Lcbora�rrias (/}�3T} tfp Shares a�` Common
h% Gt.90 /0 6/, s3 ave, f6/,bz x�o = �Z, y�6 y, 80
(Sec ✓r��ua�,'en a/hichei/} '
a, C;seo Systel�s, �rc. �s�o) aaT �'3.�d sl�ar�s ��
'Lolstnu�n hi I6.SS /a /6.56 �. '�/�,7/ — �3, s� 7z. 43
t5ee i'isluahan af1�z��/)
�, �eclr^r�f4� p�/�A/"c itPlrJ�!"S �Yi C B 5 [.d.
/�. L,�crf !f S Gor%t /�sp� /J9kt Tasf — �3l0, 398,Z�
�. C/o ver l'rc/u� �..,�' ¢Y, �!Y��79
jS�e YQ�irQ�an /��e�'' dfJ`ac�i¢a�}
ff. �los�ira, �ac. � �� ax.s o,� �otun�n
h� 3z,6F fa 3a.o9 ave. %3a, 3� x �f = ����,3�
�sze �/�{IuaiS�� d�c%��
�',� /Y1e�r» l�trtecrP. �c . �/i4ETi2� ao0 Stidrr.s � Cnrttnun,
h: /�. 9,z /o fi, 2 s' a�e_ �/�,S9 X z no = �
/ / �� �/7 00
i 52G' ll!(�u a/70l1 ¢�c�d.."4�1
b. 7'a�u.s Globa{ �esearch �,ma� � (3`�NwX �
h; �{o,�� la yo, o� �Ue, �`�}o,pb x6s9. 6rsh= af�, Y2`f.38
CSCL YA�Lt4�i'o� Qf�A(.�cq�)
7, hl�CrOSa�'�' �r�_ CMSFi�
HQ.�63 sb. s�- t't>vn}nen
h; o't,Y. y�f !d a9.os rure = ��,2s x Y4.oGasl�= ¢i. 5�3s,oq
�See {ra/uGfion afl'achcd�
(see Cen�nua6oh d�ieet�
TOTAL(Also enter on line 2,Recapitulation) $ � �s p�D. OI
. QS more space is needetl,insert additional s�eets of the same size)
� REV4503EX+(6-98) -
SCHEDULE �
COMMONWEALTH OF PENNSVLVANIA STOCKS & BONDS
INHEflITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
�arrc�� �11. �ic�orn -Z�- /� -75�3
- All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM � � VALUEATDATE
NUMBER DESCRIPTION OF DEATH
' /�660�/' �.abo/a/tne5 (/}�3T� �f0 SharYS o� C'o/hmon
�i (0%90 /0 6/. 33 ave. f6/,62 X�b ' �.7, 5�6 �/. 80
(Sec ✓t/ua�Sen qI�'RLl7CN�)
�. �>'seo �ysfe�ns, .��. �scol aoz �3a6 st�u�s �� �
CYDItt�Y1 {�i /b,$S �d /b.S(o ccve. g/b,7/ — 3; �f �z.93
�see /�u/r�d/5an a�i4c�er/)
�, F�deru ed o3/rarc�r��r%'S �rYi c e s �o.
/�. �,,6�rfi lf s Gdvt /LtDpe� //�,�'t Tast — �36, 398.1" �
,G. C/ove�' !/�c/uE: �cnd �'f,. yy�,79
�Sce /�Qfira�icn /��er' R�}ac�i¢a��
h� �los�ira, 1r�c. �fF �k a re_s a,� C�l1lixo�l
ti� 3z.6/ l0 3a.o� a,re. �3a. 3�1 x �f = ���q,31�
�s�e �a/ua�Sdn ,c�aclu�)
.f, /1'le/ra (�nCcr�. 3m- �1t?ET2� �� Sharcs e� Ct1lr�rnccn
h; i�. 9� /a t/, zs ave_ �//,S9 k 2no = ��, 3/7, o0
�seL' vtf/u a�iorJ ¢�a c/aec��
(. Sa�us Global �+,esearch �'uma� � �T/�NWK�
h� �o,o(o lo y0, ob q�, ��0,06 X 6s9. d z sl,= al,, Y25� 38
(see ralu4f,'o„ at%nchu+'�
�, �'I:croSaFf �Orp. (MsFT�
H9.U63 sh: s�- C'owimen
h; a.9. y�{ 1� a9.oS av� = a9,ZSx `fl�.O�3sti= ¢/. �3s,oq
�See l�k�uG/�on a�'ackcd�
�see Cen�i�xm�i'oq d�ieet)
TOTAL(Also e�ter on line 2,Recapitulationj $ ( �5 p�0.O 1
Qf more space is needed,inserl addilional sheets of the same size)
�_ 2 scN� �3 . s T c�s � �oti�s
_--- - �S%__ oF_�ar/el � .. F•'c�r:�... _.._ _.
/ _ _ _ ___.._._ _ .__. --�7c.E � �/-�z-7Y..?.
---_ _.
__ ...__$. _ D�a e/. __L'OrP,__�Q2e�) do0_c9'taKS_sf _Co1lyiJten_ ..---_
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--- -� a7 36_.. /o .2e,_�9 tcYi 27._0 9 X_.ZOo. sti ,. _ �S y�g� e�
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69.� � r Q.84(1.22°l01 4:OOPM EDi�After Hours:66.98 i0.53(0.19%)4:10PM EDT-Nasdaq Real Time Price
HistoricalPriees ceewseo�+�siaa�aro.:LL_!-_T,-�(c0:
Set Date Range
�Daily
r�_...- (.-n:__._. Weekl
SfartDate: �Jun 13 . .2012 jEg.Jan1,2010 ,r^� '
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EnAData: �.-Jun _� 13 9 ��012 i M����
C�"-; "°' ��ivitle�s Only
cGMdPrlces-.j
First I Previous�NeM�Las[
r
1 Pnces ,
�
Date Open H�gh Low Close Volume Adj Close`
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�i�t`�.t�Vr'I �� �� �/^'i"l% �
Federated Shareholder � � �����'`'�� � .���E'� �Z,� ���� �
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Fedr�a�ed'°°r=�°r=.�°°� Federated
WORLD-CLASS INVESTMF.IYl MANAGEIG
�
August 29, 2012
Charles E Shields III
Attorney at Law
6 Clouser Road
Mechanicsburg PA 17055
Reference: 00608679
Darrell M Eichorn
Dear Mr. Shields:
Thank you for contacting Federated.
We received your request to redeem the referenced accounts. Checks and confirmation will each be sent to you
under separate cover.
On Ju�e 13,2012,the value of the Federated Liberty U. S.Government Money Market Trust, account number
XXX7308,was$36,39824, based on 36,398.2400 shares at the constant price of$1.00 per share.
°'°"" .---- ,-,. _ .._.<.
On June 13,2012,the value of the Federated Clover Value Fund,account number XXX7411,was$4,443.79,
based on 305.4150 shaazes at the net asset value of$14.55 per shaze on that date. °""""^°`
Account transcripts wil] be mailed under separate cover.
Please call us ifyou have questions. Client Service Representatives aze available to help you from 8:00 a.m.to
6:00 p.m.,Eastern time. The number is 1-800-245-4770.
Sincerely,
�—'r.s��i���
Steve Perry
Vice President
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�N4Sl c�od.r.tiG�>
����ii, OppenheimerFunds
August 28, 2012 v� OppenheimerFunds Services
A Division of OppenheimerFunds,Inc.
P.O.Box 5270
�ii����ii�����������n�������u���������n������in���u���i�� Denver,CO 802V-5270
www.oppenhei merfunds.com
Charles E. Shields III
6 Clouser Road
Mechanicsburg,PA 17055-9751
Re: 003303300239888 Oppenheimer Global Fund -Class A Shares
DARRELL M EICHORN &
LUCILLE EICHORN
JT TEN WROS NOT TC
Dear Mr. Shields:
We received the request to redeem the assets of the above-referenced account due to the passing
of both owners. I am able to confirm that we processed the redemption request effective August
27,2012. We have no record of any other accounu registered to Danell Eichom or Darrell M.
Eichom Revocable Living Trust.
You requested the date-of-death account value. As of June 13,2012,the value of the account
was $32,506.42,based on 598.645 shares, and a share price of$5430 at Net Asset Value.
Additionally, enclosed please find the original death certificates that you submitted.
lf you�eed anything further with regard to this account,please do not hesitate to call us at 1-
800-228-7774. We are available Monday through Friday from 8:00 a.m. to 7:00 p.m. Eastem
Time. If you would like to speak with Colleen Sanders,her extension is 7022 and she is
available Monday through Friday from ]0:30 a.m. to 7:00 p.m.Eastem Time. She will be glad
to assist you.
Sincerely,
Alisa Sharff
OppenheimerFunds, Inc.
The Right Way to Invest
Encl: Original Death Certificates (2)
IDOC#205678771,E05]25582
REV-r'ABEx.(t�9�
SCHEDULE E
CAMMONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS� � MISC.
iNHaESioEr�rrEOE EDENTpN PERSONAL P�6PERTY
ESTATE OF �a rr�ll h?. �;ch o rn £S�'afi FILE NUMBER �� _�
� � Z'i 3
Indude Ne proceeds of litigafion and Ne date Ne proceeds we2 received by�he est2te.All property pintlyovmed with Me right of surv'rvorebip must be disclosed on Schedule F.
. ITEM VALUE AT DA7E
NUMBER DESCRIPTION OF DEATH
�' Salc oF pe.-sona!y ,by ay,clionear, C'hu.ck Br�'oKor, on
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�r °/i�/iL ur�rWN'V
Q M&TBank
499 Mitchell Road,Millsboro,DE]9966 Adjusttnent Services �
Phone 888-502-4349
F az (302)934-2955
August 13,2012
Charles E. Shields,III
6 Clouser Road
Comer of Trindle and Clouser Roads
Mechanicsburg,PA 17055
Re: Estate of Darrell M.Eichom
Social Security•
Date of Death:June 13 2012
Dear Sir or Madam:
Per your inquiry o�August 7,2012,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1. Type ofAccowu Checking Account
AccountNumber 52333339/
� Ownership(Names ofl Darrell M.Eichom(Grantor)
Joyce S Mehle�(POA)
Opening Date OR/l7/]997
Balance on Date ofDeath $6S,971.72
Accrued fnteresi g ,pp
Tota1 -------------------------------
. $65,977J2
For any edditional information on the above attrounis,induding ownership and any cAanges�closures and/or reimbursement of funds,
please call Ne ITigL Shae((',ailisle at 717-210-0536.
We were unaAle lo Iomte any sa1'e deposit box for iLe above-mentioned decedenL
This letter dces not mdude eity a000unts m which the deceased may have been tisled as power of Attornry,(.ti.ctodian of iLtiform 7Y�and'ers,
xearecenmbve rayee,or7Yu.aee m,aec a wrinen ngixw,nenc
$I(1CCiC�}�,
Valarie Mercer
Adjustrnent Services
,. ._ _ ,/ .-F ,s�.—
� I � i � I � 1 � ��� �,omputershare +
_ � ' � /+O q Computershare Trust Comparry,N.A.
� �r POBox43078
= R'ovidence,RI029qU-3078 �
� - wthin USA,US tertitories&Canada 80p 2Sq 57gq
� � . Outside USA,US territones&Canada 781 575 3120
� 0 U 0 010 �^+'�''0Df"P�ersn°:z.�°minvestw
= �IIi�qI��II�u����qhh�����Ir���r��h�IrPihl��hlln���r
= DARRELL M EICHORN
= GO CHARLES E SHIELDS III
— 6 ClOUSER RD
= MECHANICSBURG PA 17055
— � HolderAccountNumber �
= c000000ao�s IND
I IIIIIII IIII(IIII IIIII IIIII I�III Ilul IIIII IIII)IIIII(IIII IIII(III
Tickx Symboi �p
CUSIP 77275R102
�Gisco Syste�as,i�c I�efund.Cl�eck . ' '
,
The check below is being refunded to you for one of the following reasons:
—Your cash conMbution is under the Plan minimum.
—Your cash contribution is over the Plan maximum.
—Your cash contribution was received 30 days pnor to the investment date.
—A refund was requested prior to the investment of funds.
—A withdrawal/terminabon was requested. This check represents your recent dividend payment.
Please refer to Ne Plan brochure/prospectus for details.
� 1 L T R C S C S +
OO1CD70003
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n•DOD5208041n• �:07i9i5580�: 04��� 226��� 536��� iu•
� REV-1510 EX+(08-09) '
�pennsylvania SCHEDULE G
DEOARIMEN10FflEVENUE INTER-VIV6S TRANSFERS AND
INHERRANCETA%RETURN MISC. NQN-PROBATE PROPERTY '
RESiDENT DECE9ENT
ESTATE OF FILE NUMBER
�Ctrreil 1YI. �� ckorn o�l-/�-7//v�
This schedule must be fnmpleted and filed i/the answer to any of questions t through 4 on page three of the REV-1500 is yes.
�M DESCRIP110N OF PROPERT!' DATE OF DEATH 90 OF DECD'S IXQUSION TAXABLE
�xawe ixe xnne v na r�xs�e+ce,r�ma aennoxsruv ro ocancxr uro
NUMBER n�eahaixu+se�.nm,a�mrro��o�oraauucsr�rt. VAlUEOFlSSEf INTERESi avw VALUE
'' t",es�denf%dl (t'e,l Esfa.f'a Io�,ted a.f 98 Ma�r+j
aro�' 7�!-i✓e� A1eehan�csburg � S��✓G- SPr'rt9
Towns/>�p, C�unberlaxd Pcwnt, ��^ns 1rn.xia,
./�;-�-1� {teld bf, 17arrc,11 �It. E'�ahorn �eil��.
i�ust �old o.�' PubliG Glu-ri�'on �a N.I.
Sol�..4�ons Groc�, �l.C. f3S,om' �oo?c -o- f35oe0-`
��ee Cepy e{� se�f(emenf Sheaf� T�st
f�rcamenf;• r9��po,'ntmenf aF �u�assar
T¢ste� � �+m� Tru3ftes Deed � Cnn�eyav.�
cetfa�h ad�
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O
LM C f►t lRtl u,e Trust C� C
i H6 . 35(� Sha�re.s p "3s.y8 = 5,631.�8 IooX� --o - �s`3►,�g
�Ste {/¢lu.ad�'o.� 5hee{' ¢�ached�
�cnt,�'tiaries � �3 y. «A� /�/q �i 9�`�,�d o�
3. Charlcs Selrw�b 9Acc� yo. a�ab -89�, �R�t
CortfaFn�a�:
�a,nkf�n l�7�'dG+.p--Sm/1 Gro�1��4 �FRs�xJ �
368. 9y8 ,S/ran: � 3Y.`f6 � /a.7�3.95 /no�o -o - ¢iz,7r3, 9S
.lanus kror�/c�w,i�e (Thtur.»c)
ay3. `M70 �harrs �s'i fS�o.oz = �97�1_� /oo9n -o -- ¢?, 7�f/. iS
��t�a[e+r! ��i �`.Tsieo�tte �VQnJOX)
Ho� 7P6 0 �baks � fafr.i2^ %/ ST.�/8' /DO� --o - ii, s�3.i8
�o9if /{yC�
�5� {Ti/!�[Hhen slttus a7i�ac�irdJ A79.71 �oof —o — fi79.?z
�-u1fRCi a/'tG5 l Kr�3f T/L�a /Z�la�tr.��49�
���J����G�n, Y,2 q+'o�d�
,t
TOTAL(Also enter on Line 7, Recapitulation) $ �7�,6 �9. 7�
�IF more space Is needeA, use addltional sheets of paper of the same slze.
APPOINTMENT OF SUCCESSOR TRUSTEE FOR
THE DARRELL M. �.ICHORN REVOCABLE TRUST
WHEREAS,on the 10`"day of luly 1997, DARRELL M. EICHORN,of 98 Mazgare:
Drive, MecOanicsburg, Cumberland County, Pennsylvania,executed a Trust Agreement as
Settlor and as Trustee; and
WHEREAS,the said DARRELL M. EICHORN hes departed this earthly life as of the
13`�day of June 2012;and
WFiEREAS, the said Trust Agreement in Article 8.03 provides for the appointrnent o4a
Successor Trustee, in pcctinent pari as follows,to wit:
"Upon the death,resignation,removal or incapacity of the Tnistee[DARRELL
M. EICHORN],then my daughter,PEGGY M. APPELHOLM, is hereby
appointed as Successor Trustee;'and
WHEREAS, the said PEGGY M. APPELHOLM,predeceased the said DARRELL M.
EICHORN, having departed this earthly life on the l4N day of May 2005;and
WFIEREAS, there is no further Successor Trustee appointed in said Tnut Agreement;
end
WHEREAS. [n such event,said Article 8.03 further provides in pertinent part for the
appointment of a Successor Trustee in such circumstences es fotlows, [o wii:
"Upon the death,resignation,removet or incapaciry of PEGGY M.
APPELHOLM, then a Successor Tnutee may be eppointed ... after Settlor's
death [DARRELL M. EfCHORN],by a majority of the cuRent beneficiaries;"
and
WHEREAS, thc current beneficiaries as namcd and provided for in Article 4.03 of said
Tnut Agmement,aze DARRELL M. EICHORN'S grandson, RODGER D.APPELHOLM,
also known as ROGER D. APPELHOLM,and granddaughter, KRISTA MARIE THOLE,
formerly known as KRISTA M. APPELHOLM;and
WHEREAS, the said DARRELL M. EICHORN, in his Last Will and Testament made
on the 9N day of May 2012,appointed his vusted friend and companion,JOYCE S.MEHLER,
as his Executrix;and
WHEREAS, the said RODGER D.APPELHOLM,also known as ROGER D.
APPELHOLM,end the said, KRISTA MARIE THOLE, formedy known as KRISTA M.
APPELHOLM,are both desirous of exercising their aforementioned powers to appoint a
Successor Tnistee of said'frust to appoint thc snid JOYCE S. MEHI.ER; and
Page 1
WAEREAS,the said JOYCE S. MEHLER is agreeable to scrve as such Successor
Trustee of said Trust.
IN WIINES5 WHEREOF,we,the said RODGER D. APPELHOLM,also known as
ROGER D.APPELHOLM,and KRISTA MARIE THOLE, formerly known as KRISTA M.
APPELHOLM,acting in our capacities as the curcent beneficiaries of said Trust, do hereby
nominate, constitute and appoint our said grandfather's trusted friend and companion,the said
JOYCE S. MEHLER, to be the Successor Trustee for the said DARRELL M.EICHORN
REVOCABLE TRUST.
[N FURTHER WITNESS WHEREOF,intending to be legally bound hereby and to
bind our respectivc heirs, executors,administrators and assigns, we have�xed our respective
hands and seals to the respective signature pages attached hereto.
Page 2
f
;
SIGI�ATtTIt;E pAGE F012
APPOIIVTiI�IEN3'OT+ SU�GGESSOI2 TR�STEE �+'t?IL`
T.I�E DAR12�liI�:1VI-:�IGHO�2.N REi�OCABL`� 'T`I2T7ST
1, T20DGET2,D.fS,EPEI:HALMr also•kno�vn as"RO:GLrR Dt AI'P�LHOLM, do f�ei�Fiy
nbrriiriate,cbnstitu[e nnd nrpoiht my saic7 grandfather's husted friand�nd.COrrspanion,J"OS'G�S:
MEFILEft, ns Suceessor`I'ri�stee:
_�� ?nl2 — ���,��+%�G�_ r�x�Ll
Date RODG�R D.,A1'1'ELH�QLNI
G`"� �/�;��i" EAL;)
4Uitness e.k,a.ROG�R'D.APP�1:$OI:iVT
STA`f'C OF 11!ITNNESiQTA ).
_ �S:
COUI\TY OF ` r" r,ti,. . ')
Onthis, tha��_.,dayqf, ,�qfU, . . „2012,b�foteineathe .
undGrsigned officer,persona7ly-appeared RODG., D. A}'PELHbLiVI; also knoXVh as ROG�i2
p,.A'P.PGLHOLM, who is:either personally known to iiie Qr has"pr"avid�d to tiae stifticierit pio�f
of id�ntity", and being duly sworn accoid�ng to iaw;deposes and says,ttlat d�e fore�oin�
Appqinhnen;t of Sucotssoi Triiscee For Ihe Darrall:M. Eichorii:Rzvoaattle'I`rust i's lii8 act:rincl
dee8;unt1 that he'ilesires the same2obe:aeknowl'edged antl;r.ecbrded;�s sucli::
!N 1'VI1'N�SS,N.'tTER�OI',T.have hereunto set my'hand an�.notarial;se�7 thc i�ay an�
year aforesaid..
�
s:
�:
�
N otary.---��
My cqmm�ssion ezpires: 01��{��at5,,.
(�EAI,)
JENNIF�fY�.:NELSON
t�ot'�v r��uc-t��sora
btY G�M�ISSYDN EXPtR�S of1�r 1i�;.
_... . . . ,;i
P-agc 3
.�� ,:.��:�.: . . ... . -_- � �: .
. � . .., v.�,.�z.�s... . . ... . . .. .
SIGNATURE PAGE FGi2
APPOINTMENT OF SUCCESSOR TRUSTEE FOR
THE DARRELL M. EICA�RN REVOCABLE TRUST
1. KR[STA MARIE THOLE,fortnerly known as KRISTA M.APPELHOLM,do
hcreby nominate,constitutc and appoint my said gandfather's trustcd friend and companion,
JOYCE S. MEHLER, as Successor Trustee.
� : �n Pni.
�-a - I� � a Noessa�•ema�sora
Date �A HOLE �: MY O�IfStAtpe
� —a -(�-- I�Z ' c �1 .l _ TEA PALr�,SOrA
H'�a� .k.a. KRISTA M. ELft rarCOYMISSIOnEx�EBtA�ne
STATE OF MINNESOTA )
. SS:
COUNTY OF S )
n �
On �his, the oC day of �1�� ,2012,before me,the
undersigncd officcr,personally appeared KRISTA MARIE THOLE, formerly known az
KRISTA M.APPELHOLM,who is either personally known to me or has providcd to me
sufficicnt proof of identity,and bcing duly swom according to law,deposes and says that the
forcgoing Appointment of Successor Tnutee for the Darretl M. Eichom Rcvocablc Trust is his
act and dccd and that hc dcsires the seme to be acknowledged and recorded as such.
QV WITNESS WAEREOF, 1 have hcreunto sct my hand and notarial scal thc day and
year aforesaid.
No Pub ic
co mission expires: l-3) —{!p
SEAL
NOTANYPIt�_MHN7�TA
�n'cae+�aaoa�si�+ne
Page 4
SIGNATURE PAGE FOR ACCEPTANCE OF
APPC�IiYTMENT OF SUCCESSOR TRi1STEE FOR
TNE DARRELL M. EICHORN REVOCABLE TRUST
I,JOYCE S. MEHLER, do hereby accept the apgointment as Successor Trustee of the
DARRELL M. EICHORN REVOCABLE TRUST,as nominated,constituted end appointed
by the current beneficiaries thereof,the said RODGER D.APPELHOLM,also known as
ROGER D.APPELHOLM,and KRISTA MAI2IE THOLE, formerly known as KItISTA M.
APPELHOLM.
�J— a, Y— J a. �M�t,c S . � �,tit, (SEALI
Date J CE .MEHLER
�J �"^-��t '
Witness .
COMMONWEALTH OF PENNSYLVANfA j
. SS:
COUNTY OF CUMBERLAND )
Ort this, the o?f�day of� , 2012, before mc, the
undersigned officer,personally appe��ed YCE S. MEHLER, who is either personally known
to me or hes provided to me sufficient proof of idendty,and being duly sworn according to law,
deposes and says that the foregoing Acceptance of Appoindnent of Succes9or Trustee for the
Darrell M.Eichom Revocable Tnut is her act and deed and that she desires the same to be
acknowledged and recorded as such.
IN WITNFSS WHEREOF, I have hereunto set my hand and notazial seal the day and
year aforesaid.
(,����C r✓C������� .�
Notary Pabtic
_ My commission expires:
. - - . (SEAI.)
� -:'ti'•_�'., . �� ap MONWFJ1lT1 OF PENttSYLVANTA �.
� '�.r :•.:� . . � . . tlatmlll SBd
' _ .� ' ''.s:.:..�`��,�- .:� OiaAes&SbtldsiII.NOm1'PuDtk
k .7:1:.. �� � ��' pwnpefendCamW
:. - �,
..�'�:...�:,. ..., .. Mm+ceM�. Nne1DM16
.:. ...,. .
• �'� `. pgB��s..!:-. r. ccrosnvu�utita�wtta�acnmu�
. . `'�1>f�>�..Yy�/�. .
` ��b4:"��X'}Y'�.J:. , �•
. ..� �:C.+:a
THIS INDENTURE,made the��j,�day of ���Q� ,2012 A.D.
Between JOYCE S.MEHI,ER,in her cepacity fls the Successor Trustee of the DARRELL M.
EICHORN REVOCABLE TRUST,dated the 10'�day of July, 1997,of the first part,
hereinafter called the Granror.
and
H.I.SOLiTTIONS GROUP,LLC,a duly registered LLC with the Commonwealth of
Pennsylvania, having a business eddressed of 6059 Allentown Boulevard,Suite 242,Harsisburg,
Dauphin County,Pennsylvania,of the second part hereinafter of celled the Grantee.
WHEREAS,the said DARRELL M.EICHORN,then of the Township of Sitver
Spring,Cumberland County,Pennsylvania,executed end delivered unto 6imself the same said
DARRELL M.EICHORN,the aforesaid wrttten REVOCABLE TRUST,dated the ]0'"day of
July, 1997,which was originally left unrecorded for purposes of privacy,wherein and whereby
he appointed himself,the same said DARRELL M.EICHORN,Trustee of the said TRUST as
per the opening Peragraph of the seid TRUST;and
WHEREAS,the said DARRELL M.EICHORN,subsequenUy also depar[ed this
earthly life on the 13th day of June 2012,es eppears more fiilly ai large in his Fstate file in the
Office of the Register of Wills in and for Cumberland County,Pennsylvania,docketed to Estate
File No.21-12-0743;end
WfLEREAS,the said TRUST in Article 8.03 provides for the appointrnent of a
Successor Trustee,in pertincn[part es follows,to wi[:
"Upon the death,resignation,removal,or incapacity af the Trustee[DARRELL M.
EICHORNj,then my daughter,PEGGY M.APPELHOLM,is hereby appoin[ed es
Successor Trusted;"end
WHEREAS,the said PEGGY M.APPELHOLM,predeceased the said DARRELL M.
EICHOILN,having departed this carthly life on the 14'"day of May 2005;and
WHEREAS,there is no further Successor Trustee appointed in said TRUST;and .
Wf3EREAS,in such event,said Article 8.03 further provides in per[inent pazt for the
appointrnent of a Successor Trustee in such ciroumstances as follows,to wit:
. "Upon the death,resignetion,removal or incapacity of PEGGY M.APPELHOLM,
then a Successor Tcustee may be eppointed ... after Settlor's death[DARRELL M.
EICHORN],by a majority of the cucrent beneficiaries;'and
WHEREAS,the current beneficiaries es named and provided for in Article 4.03 of said
TRUST,are DARRELL M.EICHORN'S grandson,RODGER D.APPELHOLM,also
known as ROGER D.APPELHOLM,end granddaughter,KRISTA MARIE THOLE,
fonnedy Imown es KRISTA M.APPELHOLM;and
WHEREAS,the aforesaid cucrent beneficieries have taken ell necessary steps to
fonnally appoint the said JOYCE S.MEHLER,as Successor Trustee,a true and correct copy of
her foanal appointrnent and her ecceptence of[he appointment is attached hereto es"Exhibit A"
and incoiporated herein by reference;and
WHEREAS,the said JOYCE S.MEHLER,es Successor Tmstee is specifically clothed
with all the power end authorities necessary to grant and convey the premises hereinbelow
described end to sign,seal and deliver ttus IndenNre,es more specifically set forth in said
TRUST,es follows in pertinent part,to wit:
Page I
"Section S.OI(A)(1)—General Powcrs: In eddition to such other powers and
duties as may have been granted elsewhere in Uus Tmst... the Trustee shal!have
the following poweis and duties:
A. Management,Care and DisposiHon OCT'his Trust.
In the management,care,and disposition of this Trust,the Trustee shall
have the power to do all things and to execute such deeds,inshuments,or
other documents,as may be deemed necessary and proper,incfuding the
following powers,all of which may be exercised without order of or mport
to eny court:
(1) To sell,exchange,or otherwise dispose of any property,
real,personal or mixed,at any time held or acquired hereunder,at public
or private sele,for cash or on tenns without advertisement...:'
WI�REAS,the said premises were not specifically devised.
NOW,1'HIS INDENTURE VF'ITNESSETH,that the said Grantcr,for and in
consideration of the sum of ONE HUNDRED THIR1'Y-FIVE THOUSAND and No/100ths
($135,000.00)DOLLARS,to her in hand paid by the said Grentee,a[and before the ensealing
end delivery hereof,the receipt whereof is hereby acknowledged,has gran[ed,bargained,sold,
aliened,released,and confirmed,and by these presents,does grant,bargain,sell,alien,release,
and confirtn unro the said Gran[ee,its successors and assigns:
ALL that certain trflct of land situate in Silver Spring Township,Cumberland County,
Pennsylvania,bounded and described as follows: � -
BEGINNING a[a point on the northern side of Margaret Drive on[he dividing line
bctween Lots Nos.28 and 29 on Ihe hereinafter men[ioned Pian of L.ots;thence by said dividing
line,North 39 degrees 32 minutes?A seconds West,a disrance of I50.00 feet to a poinr,thence
South 60 degrees 27 minutes 40 seconds West,a disiance of 273.61 feet to e point;thence by the
dividing line between Lqts Nos.30 and 31 on�said Plan of Lots,Sauth 52 degrees 51 minutes 35
seconds East,a distance of 17224 feet to a poin[on[he nor[hem side of Margaret Drive;thence
by the northem side of Margaret Drive by a curve to the right having a radius of 100 feet,an erc
distance of 40.70 fcet to a point;thence continuing by the northem side of Margare[Drive,North
60 degrees 27 minutes 40 seconds East,a distance of 165.84 feet to the place of BEGINNING.
BEING Lou Nos.29 and 30 of Plan"C"of Ridge Hills as rewrded in the Office of the
Recorder of Deeds in and for Cumberland County in Pian Book 18,Page 76.
BEING THE SAME premises which Darrell M.Eichom,by his quit claim deed dated
July 10,1997 and recorded Augus[25, 1997 in Ihe Office of the Recorder of Deeds in and for
Cumbedand County,Pennsylvania,in Deed Book 163,Page 300,quit cleimed a�l of his right,
title,and interest in and to the said premises unto the DARRELL M.EICHORN
REVOCABLE TRUST,afaresaid dated July 10,1947.
UNDER AND SUBJECT to prior restric[ions and declerations of record. Sa
Miscellaneous Book 142,Page 343 and Miscellaneous Book 143,Page 391.
TO FIAVE AND TO HOLD the said messuage or tenemen[and tract of land,
hereditaments and premises hemby gran[ed and released,or men0oned and intended so ro be,
with the appurtenances,unto the said Grantee,its successors and assigns,to end for the only
proper use and behoof of the said Grantee,its successors and assigns,forover.
AND THE SAID GRANTOR,as Successor Trustee,as aforesaid,her successors end
sssigns do covenant,promise and agree to and with the said Grantee,its successors and assigns,
by these presents,thet the Grantor has not done,committed any act,matter or thing whatsoever
Pege 2
whereby the premises hereby granted,or any part thereof,is,are,shall or may be impeached,
charged or encumbered in title,or otherwise howsoever.
IN WITNESS WHEREOF,the said JOYCE S.MEFILER,Successor Trustee of
`OfHE DARRELL M.EICHORN REVOCABLE TRUST,"Grantor herein,has hereunto set
her hand and seal[he day and year firs[above written.
Signed,Sealed and Delivered
in the Presence of: .
C���"wrn� �i.��� C�'J . Y�IR�H.�.�C. (SEAL)
Witness JO E S �HLER,Successor Trus[ee of
`°T E DARRELL M.EICHORN REVOCABLE
TRUS7"'
� �
itness ,
Page 3
COMMONWEALTH OF PENNSYLVAMA )
. SS:
COUNTY OFCUMBERLAND )
On[his,tte � day of 0����-- ,A.D.2012,before me a notary
public,in and for the Commonweal[h of Pennsylvania,personally appeared JOYCE S.
MEHLER,known[o me(or satisfactorily proven)to be the person whose name is subscribed as
Successor Tmstee of"THE DARI2ELL M.EICHORN REVOCABLE TRUST"and
acknowledged that she executed the same in such capacity.
IN WITNESS WHEREOF,I hereun[o set my hand an o�cia(seal.
/
No ary Public �
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL My commission expires:
KANDI L.LENKER,Notary Public
HAMPDENTWP.,CUMBERLANDCOUNTY (SEAL)
MY COMMISSION EXPIRES AUGUST 24,2013
CERTIFICATE OF RESIDENCE
I do hereby certify[ha[the precise and exac[post office address of the within Grantee is:
Atto ey or Gra
Page 4
x✓^4 OMB Appmvel No.YSOI-0265
�`����`�� A. Settlement Statement (HUD-1)
`��.
B. TypeofLOen
6. F0e Number: 7. Laen Number: 8. MwigaBe Insuran�Cese NumOer.
1,�FHA 2�RM5 3.QCom.UnW. 20120659
4.�VA 5.�Conv,Ins.
C. Note: TMS1amblumLsAeOtoyAepuestafementolecfuelsettkmenlmsis ArtrouMSpe/dfoerMbyNesettfementaga�rtereanorm.
Ifems mertmd'(O.ac1'were peltl ouhMe Ne cb.ri�g;Neyara shown herelmtrdorms0onalpurposes erM ore mflnCUdetl h Uro fofek
D. Nemee�MAtlOressofBuyer. E NemeaMAdOressol5ekr. ' F. Nameen0A0dressolLentler.
H.t.SoMbns Group.LLC
DarteP M.Ekhom Rew�Ele TnM
G. ProperyLOCetbn: H. Sett�mentPgem: I. SellkmeMDate:
98 Mergaret Drt+e lew Offims M Peter J.Russo PC
Med�encd0urg.PA170W SOWFastTrlMkRd. pqoE¢ra.2(N2
CumDerleMCouny.PennsyNenla Med�eni¢Wrg,7A17050 PI�. (71�591-1755
adw m sememem:
5W8 Easl TrNtl�Rd.
MedienleCUr ,PA 77050
J. Summary of Bu ers Imnsactlon K. Summary of Seliefs transactlon
700. GrossAmwnt Due frwn B r. d00. GrossAmouM Dua to Seller.
101. COntreduks rke 735000.00 901. COntredaaks rl� 135000.0
'102 Penonel ro e 602. Personel ro c
103. SeltlementC�ar esto L1ne7400 2507.00 a03.
10d. 40a.
105. 405.
' Adustments/oritems aitl Selterinativence Adustmenta/orltems eltlb Sellerinativence
706. C v.mTexes 10/OE/t2 lo O7/O7H3 57.89 40fi.C /famTeaea 70Po4M2 to OV07H3 E
107. Coun Tmms 70NCH2 to Ot107/13 N6.72 4W.Cwn Taxes 1NOM72 l0 01IOiN3 t18.i
708. &MOOtTems 7LLNd112 to 07Po7H3 7609.82 408.SdioolTema 10/OIH2 to 07N1H3 1608.P
tos. aoe.
no. aio.
rn. an.
172 Grent of Fatemion Fee 7,0OO.OU 472 GraM of Exlrnsbn Fee 1.000.0
7t0. GrossAmount Duefmm B er 140,280.93 420.Gmss Amount Due to Seller 137,783.E
200. AmountsPaidb orineehalfofB er 600. RaductlonslnAmountDuoSellar.
207. Sfl or eama5l rtron 10 000.00 501. Emess Ee bee 615tNCbrt4
202. Prin el amounl of�rew ben s 502 Setlkment Mer s to SeRr LNe ta00 1 380.(
203. F�Qifh ben s teken su l0 503. E�st ben s teken w to
209. GreM ol Eaensbn 1 000.00 500. FYSt MMga
205, Held PelerJ.RUUO 5. Sem M
208. 505.De rtelneE 684f 70000.(
207. 507.
208. 508.
209. 509.
Ad ustmenb for Items un ald Sollor AE ustmants/or Items un aitl C Scller
270. C awnTmms l0 610. ownTm�es to
27t. Coun TexES ta 517. Coun Tmws lo
212 SNOOITm�es to 512.Stl�odTezas to
213. 573.
2ta. sta.
zis. sis.
218. 518.
217. 517.
278. 578.
218. 518.
710. TotnlValO MorBu er 11,000.00 620. TotolReAUCtlonAmountDueSelier 11,38D1
I00. CeshotSetllementfmmROBU or 600. CesAetsettlementto/tmm5ellar
301 Gross ertauM Ave hom B r Ene 720 140 280.83 fi07. Grosa amount due to SeYe� Y�e 420 1J7 783,
302 Less amamt eM or B r Me 220 ( H.000.00) 602. Le�s reOVtlbns Cue SeAer Me 520 ( 17.380.
303. Cesh ��% From � To Buyer 128,290.93 60.t. Ces� ❑X To � Fmm Selier 126,403: .
The uiMars��d here0y atlmwAeOge rece�t o1 B oomDkteE wpy of pages 1,2&3 01 tAb¢tatement 8 aM ettedime�HS relerted lo AerNn
�` �<� �' O.oM�.t S•�'1'� .u�+�
, �n oMbl Group,LLC 1 Elq�orn R bb
TN�t
n em�i�n pm��a�M'��a%m�vn����mavRem+uy�•I °�.v.a�e.aV1 �.�a.�nm�m.i,��pee�b aaisMebiHEW1���i�mm�ro�nnvve�i
o-�a
Pe9e 1 a!3 MU4'
(HI.SOLUTIONS.MAiiG4REf DRPFD20720a59/1C
L Settlemant Charges � '
700.Total Real Estate Bnker Feas �F� �Fr�
p mmm Lne 00 as aAbwr ' � �
' FvW• ivT•
Z. D bGOnuY 9tl�TOY
C m n N et settk n
7(14.
705.
BOO.Items aEle In Canntttion with Loan
BD7.Our Ire7br,tlie e Indudes Inetbn PoM %.or E tran GFEA1 1!si�ASl'.7�"'ik�?S�t'5to"te'?aWi4Y'...�•i
802.Yaur aedd or charga(poFts)tor Ihe specd�c Interest rete tliosen Y (Irom GFE xq 3!�.�.*.�'i",��i&�'ttm'�,�?5�
i�"1'��_ .�t 04�^n'�i;ti.�'}i5`'S
803.VOUr steC Inetonchargeslo franGFERA >4S'tG4:�SrG.iiJ7
806. rakelfee to homGFEA3 .d,.�'%�6S�f73
80.5.Credt Re rt to Irom GFE 713 ',YF(EeftY!^ii�.
806. e:sa lo fromG Etf3 rr�il:D^e'k:�±.
� 807.FbaC ceM t lo an GFEil3 f'h,4�R?:d'�
808. hom GFE 7!3 '�'eYSM:f�a�:�
809.
ffan FEp3 sY1F.�C '4iGi?
870. Irom GFE iq FS&3'6�°.FiFP�
871. /rom Etl3 :fi� ..6:;i?J
800.items Re ulmA b Lender to Be Paitl In Advance
801.Da Interest tlie es fran to 5/O (from GFE k70 �?�G.'(�7��
.MIPT xtmLNeafLOa onih o � � �T����
903.HOmavxnefelnsuren�br rsto homGFE7lt1 .4!Y� `Etf1L7U
gpp. frqn GFE 6N :�'�m'�'�
BOS. (from CFE M111) ��;-,€$.$Pij�i
t000.Reserves De ositeE wIN Lander
7007.Intllai tle R fa ur eaaow eaounl hom GFE �'�i
1002.HOmewmefslnwrena months � S r month S i�ai�AF:ta`�AA���(F7;.1.'b'vi
1 3.Mmt a suran�e mont�s f r month S c9Pit�"r�4'.'8,�d2R�e7 SS�YY.N3F:lFS51
t00a.Pro Iaxes S 7it�`In`�$t�.�FS+'a�i°
Coun axes mont�s � f per mont� �?;;t1�FSf2F1: ':�.,'�°„i�$
Ciyrtownie�s montrts � S per momn ' ��'S„ '-�`�q.,r�,t,ur���,x,g
' Assessmenis monVU � 5 r montn $.�'�q,?g�Pf..Sx3;���fi
tODS. monlM Q E r monih S dF`3�1�`iP,,�@:4�t�Y6�'.�'ii't�:fi
tooc, montns � s month s y;".�a�fk7'.APF`.��(�t%PA�E
�oo�. momns s ��m s ��"�:��a��'��i2:�
� �ooa. s ���sct�x��'i��
, s �:���s:v,�i r�rt��;us
1100.TItIeCha es
N01. TRIeseMCesand@ndef�tdkhsura� (franGFE44) pp,pp
t702. Setlkmenladwtri tea S hldx..'H�7�.1'�t,t:fd1
t103. OwnefafAlebsurenmtoFtrslPmerkanTAlelnwranwCom a fromCaFE t.075.OD
N04. LeMefsule sura�loF riPme n A InsurarrcaCO S �gf,?I:�1tFjA5Fi�g?EXLy;S�a'�
i�as. �emersi�� o �„n s �r��3 a��i sr�y��,�
1106. OnmeY6lAb fm9 E 135000.00 NIL.7; �° �'�A'4��. _'SE'li
11PI. enYa rtbn of Ne totel l&le Inaurenm remNm lo Lew Otfices of Peter J.Russo PC S 813.75 EM:E0.00 .� o;.. �f, � � �`�
NOe. UiMem�rkefs rlbn of Ihe totel tdb disurenm remNm to FhatAmerkan Tdk Insurence C@npa 16125 EM:50.00 y"�Ty'�M+�H$�;$"t%J�r,"�j,�'�a,.�y
t709. Nota Fee to Lew Ofl'ms ol P¢ter J.Russo PC Pp.�
1110. ex tl to elch eAbstradN ,Inc 70.�
1717. a Fees �e C�a S�kps,
t112.
1113.
tP00.Govemmont ReeoNing and Trans/orC�arges
t201.GovemmeM re che es ro CumberlanO Remroer otDeedf from GFE 8200�C$;���
t2M.0eeO 5 6200 Mon e S Rekases 5 01her S 15A.P�1S5n�mf(«��,
1203.Trenslertmma lo SeetthQroAbAted .I� GamGFERB 7,350.00����nui
72D0.C Imdrie Deed S 7,350.00 Mort e S Nai�.�ii�.z�( 1,350.
7205.State tar/stem s DaeO S 7 350.00 Mor1 a a S "'u-�'N'9;�.-..°"^�,'�
7206.
tt07.
t300.AddltionalSaltlamantChe as
_ 7307.R treC cervlces t�et u wn aho far /rmn GFE � ,`+{�e;,?.
7302.
7303.
730a.
7305.
1400.7otat SetUement Cha es enteron Ilnes 70J Section J an0 607 Section K 5p7,pp 7 ygp
A'M�R PP t u W a Mnv4 n�NV�e qvaxNP rrJq e�mM4e m%tl l4 t d ON Mo PP
lew OI! Pottt J PC.SetlkKnentAgeM
CertYkd l0 6e e trua mpy.
Pa9e 2 013 ry�0.1
(HI.SOLUTIONS.MARGaRE7 DR.PFD20120459H�
Com arlson otGOOd Felth Estlmata(GFE�an0 MUD•7 Cha'ga Good Fe1N Estimate HUp•1
Cha as That Cennot Inerease XUD•1 llna NumOar
Out o atbn c�e e R 807 �
Your aetl@ or charga(pofnls for I�e d!k Nlerest refe chosen S 802
Your ed steE o h�atbn Ner s R 803 -
Trensfer faxes D1203 1,350.OD
Cha eaTAat ln Tofal Cannot�ncrease More then 10% GooO Falth Estlmata HUD-1
Govemment recortlb�aerges _ 91207 62.00 i
Tllh aervkes end k'Nere We Insuranoe #1101 � 20.OU '
�QmefatRkhsurenmloFdalAmeflmnTAklmurenmComPe�ry #11U3 -- ---( 1075.OU
Total 7.757.00
L _ I�eax beNreen GFE eM HUP7 Charges I 5 � 1,157.00 or 0.00%
Cherges Thet Can ChanBe � �pad Fai[�Estimeta HUD-1
In0.61 OeposR for your escow ecmuM 7t1007
DaPylnterendiar0� a901 S /tlay
�Homeowners Imurenm IX 803 � . ..
Loan Terms
Your fn(tlal foan amount fs
Your lonn term Is yeare
Your Initlai interest rete is %
�ourinitlal monNy umount owetl for principal,lnterest end � hWdes
any mortBaBe insu2nce Is O P���a�
a Intetest
. ❑ MatBegelnaurenm �
Con your Intemst rate dsel a � No � Yes,A mn rlsa to e mmmnum of %.Tha fvst
chenpe v�De on_eM�n tliange aBH�every_monttu efier
Ewry die�ga Oete,your Intermt rete wn tive¢ae or deaeese
by %. O.erfhefi(eofNeban,your�tarestrstekguerenhed
to navar be bwer than X or hgher lhan %.
Even If you make peymants on tlme,wn your loan belence rlso4 � No � Yes.Atan r5e lo e madmum o1 S
Evenlfyoumekepeymantaontfine,canyourmonthly � No [] YeAUe6sfNaeasecanDeon enQNartpn(hy
amountoweEforptlnelpal,intereat,andmortBeBeinsumncodse9 emountwreJmnrhetoE
' TAe mmdmum A pn a.er Ase to k 5 .
Doesyourloanheveaprepaymentpenalty7 Q No � Yea,yourmmRnumprapsym¢n�p¢n¢py�E
Doesyourloanhaveabelloonpayment4 QX No � Yea,youhseeba0oonpaymentolE
Oue b_years on
TotelmonNyemountowedlncluAingescrowettountpayments �X VouEOnothevaemontt�yemowpeymemtwrtems,wchaspropery
taus eM Mmeowne(a hsure�rc¢, Vou must pey Nau Eema dFatly
yourseE.
� lbuhseaneCdAbnelrtaMhyewowpaymenlolS Ihatresu2v
Y�e lotel h0.bl moMhy ammmt oured o1 t _7ryg by�qay
P�dPa4 hrterest,eM mortgege h�svre�roe e�E a�ty Aems rneWaO p¢low;
❑ 7roPertYlexes � Homeawnefaiuvrence
OFboE Nsurene O
Note: Ilyou hew erry Questbns eboul t�e Settkment Charges eM Loen Tertns ined on Ihb fortn,pkaae mntap your kMer.
�
Pege 3 of 3 �,�
, (HI.SOLVfIONS,MARGARET DR.PFDf20120459M0)
HUD-1, Page 4
euyer(s):H.I.Solutfons Group, LlC Sener(s): Darrell M. Eichorn Revocable.Trust
Settiement Agerrt:Law Offices of Peter J. Russo PC
� (717)591-1755 ,
Piace oFSettlement:5006 East Trindle Rd.
Mechanicsburg,PA 17050
Settlement Date:Octobe�4,2012 �
PropertyLOCation:g6 Marga�et Drive
Mechancisburg, PA17050 �
Cumberland Counry,Pennsylvania
Title Services and Lender's Title Insurance Details
BORROWER SELLER
Notary Fee 20.00
Law Offices of Peter J. Russo PC
Total . $ 20.00 $
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowletlge and belief,k is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transactlon. �further
certify that I have received a wpy of the HUD-1 Settlement Statement.
� /
. ol Bons Gr p, LLC Da II Eichorn Rev cable
Trust
WARNING It is a cdmato knowingy make faise statements to tha Unftetl States on this oreny simllarfortn, PenalNes upon comfction ean
IncludeaflneandlmpdaonmenLFordatailssea: TitIe18U.S.CotleSecUon1001andSectlon1010. '
(HI.SOLUTIONS.MARG4REf DR.PFD/20720459/70)
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Jun 13,2012 34.46 34,46 3q.46 34.46 0 3t.19
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, fl�V4571 EX�(70�OG) ��
SCIIEDULE N
COMMONWEALT/i OF PENNSYLVANIA FUNERAL EXPENSES�8 . .
. INHEflITANCETAXRETURN ADMINISTRATIVE CO5T5
� RESIDEN7 DECEDEM '
ESTATE OF �arre�/ /1�, �.c{yo!/I ESl• , FILE NUMBER ,
oY/-/.z-7S��3
' Oebts of decedent must be reported on Schedute L � �
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: $ ,
/YluSSe�/y�ans �unera� Hbma. s'. .595. °O
a. /reimb. � .Tyee f19Gti/tr �r /�u�incnf �' Lrkod/ucd� �1��%✓ �/, 3zz .00
3. �1r:c�cr Housc (�csfuHrant, Fu�r.�l Lu.n�l�en fS3.2;/�/
'f, /�e:n,6. �a' �mf. �/ti�.�r �- od.i4�a,. Cos�s '`�BB.�° .
e. ADMINISTRATIVE COSTS:
t. Personal RepresentaGve's Commissions � �
NameofPersonalRepreseniative(s) f°yCG .5. i/ie�i�Cr �/�� �QQ '�
Sveetaadress _a3p� /y,�trt�_pye. � '
ciry� y%/ state�zip /yo!/
Year(s)Commission Paid: �
L C� / �•
2. Attomeyfees �//QC�CS � �/���ps �� . ���� �0O'o0
� 3. FamTy Exemption:(If decedenfs address is not the same as GaimanCs,attach exD�nalion) '
qa�maot /UO ON.E �G/G/G3LF NdN�
Sireet Address
Ciry State Zip
Relationship of Gaimant to Decedent
4• ProbateFees [y�,� O/'i�li/1� /SSNC eF .S/rorJ�L'erf���'��S !/�,�
i
5. AccountanfsFees �Rpb�; M• Park of �.erk Fi�ant.a/, 1.�eludes
� <o�o c%seo�, /�.f. Yo �-�a/ /o�s /'�Fy/s
6. Taz Retum PreDarefs Fees �d ¢
/�eCOnslru��i%!�q r9CarsL� �tx �furns w�/� an� CE. Sti�e%� �i��•oo
�. , P �'
/�d✓e�hs:n9 .n �'k,,,�u'/.axd Law,Tot�/�n'a/ ��,5; o0
$• ,4dre�h's;.�f %� C'Qr/:s/� .Sa�iSne/ /Ye�sO�a/��r �/,36, y�
9. �;/:�� Fee y!m GPe�:.�kr e�' 6v.j/s {/S� �
/0. �c�a�i�ionm/ �oMr�ii� �Be � � ' . tz80.00
ii. 8reff GeC�flm/er, �PP�.'sa/ e� Gl�/ �'stmt �3�.00
�Stc ('0i/f:n. S�eefJ
TOTAL(Also enter on line 9, Recapitulation) $ ,�v� p/,, p O
(If more space is needed,inserl adGifronal s�eets oi t�e same size) . �
�e� 2 SChed. N.
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_ .. _
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----°_._
_ _ _ _ ___.---------�/�S2�C--��_.�l_C/_Snil4/�_. a�rd_/2'R.��_..-------...-- - ---------�-------f--------
/
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---�---- ---�---- -- ---------
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' 72
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,; . _. ... .
-� Buy & 3eU on Cc:nmEssfon - Complete Sa(e Service .
_. � g3 Texaco Rd.,.Mechanicsburg, PA 17055 766,5785
� �� �w�b � A E�c�Po 5 E
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FPOM: INVOICE
Brenletl4naler . �."INYOCENUMBEH.., .
16 Sen Juan Dr - �Z'��Of^
' Mec�anic.^,hur9�PA 1']055 �:
7/19/4012
TekphoneNumber:71A697-0828 faxNUmber:�1�$9�-0220
pE
' T0: � InlmialONerp:
. . 4Me�CUefi.
. Tha Es;a�e ol Darzetl M Eichom ' ' C�M�p.. �
, MalnFlkdonidm: �2_Eichom �
. OlherFlleNOnfam:
TekphoneNUndr: FaxNumEec . FederelTal�:
- AAemahNUmbv: ' E-NaA: Fmpb1'al�: '
� . S �
L¢nOeY.The Estate o(Dartell M Eirhom � , CIimC The Estale ot DarteA M Eichom � -
- Purcheser/BOrtower:NA . ,
� PropedyAddRS5:98Maryare[Dr , � . , •
C51y:Mecharccsb�rg �
Counry:CumEerlaM . State:PA Lp: 77050
Le9al De§MpHOn:Deetl Book 163 Page 300 . �
Fam 1004 � 300.00
� � SUBTOTAL i 300.00
Chxk//: Dale: Deaalp0on: . .
Cneck#: Date: UesalpHOn:
C�eck#: Date: DesWptbn: .
� SUBTOTAL i
TOTAL DUE S aoo.00 -
� Fnrm NNS—M1YmTOTFL'apprelsal softwart Gy a W mode,iic.—i-BOPAlAMO�E '
fppraisal5dulions p17�697-1828 �
�/(� �,-
From: Roger Appelholm<rogerappelholm@gmail.com>
Subject: Fwd:inspection REport-98 Margare[Drive
Date: July 27,2012 2:24:06 PM EDT
70: ceshields3@comcasLnet --
► 2 Attachments,2.4 MB
. ......__... . . __._.....__ __. ___._._.
. ___...._.. .______ _ _...._._.._ ..... ._'__....__ .._.__._.__.. ..
.._.__....._____.
------ Forwarded message ----
Fmm:"ROger Appe!holm"<roqeraooelholm@amail corru
Date:Jul 23,2012 10:34 AM
Subjec�: Fwd:Inspeclion REport-98 Margaret Drive
To:"Krista Appelholm Thole"<kristathole@hotmail.com>
--------Forwarded message------
From:<hfes007 @comcasGne�
Date:Jun 22,2012 3:35 PM
Subject:Inspection REport-98 Margaret Drive
To:ao4eraooelhoim@gmail com>
Roger-attached is the inspection report antl a copy of my invoice which includes the fee for the radon and water test. I should have the water test
results back about mid-neM week and will forward them to you when they come in. I tagged some of the items as defects where normally in a
house this age,they would normally be"observations". 1 did this because you might want to consider addressing Ihem instead of letting them go
"as-is". Keep in mind that you can put a few dollars in atldressing minor issues tha[will pay back significantly with a higher sale price.
Blue text inlhe report is informational only and requires no immediate action. Red tex[indicates a defect that you may or may not want to address
but will surely be something that a potential buyer will look at as an item that will affect the final price. In this area,houses in the$�30K to$220K
are moving nicely. I believe this house would go for[he mid to upper$200 range if there were not so many issues so you might want to consider
having some of the issues adtlressed. Up to you of course.
Unfortunately,there is little you can do abou[ihe water odor ii shocking the well doesnY work. Here are some web-sites ihat explains what it is antl
how to shock ihe well.
htto://www.water-research.neUsulfu r.htm#sou rces
http:/lohioline.osu.edu/aex-factl0319 hVnl
htto:!/www.water-research.neVshockweildisinfection htm
I otter service after the inspection for all my clients so ii you have any questions conceming the inspection or report itself,please feel free to contact
me.
Fred Stoner-BIS Home Inspeciion Services.
Invoice
� BIS. . . ' ` CRI � Date �mo�wa
R , � NOh1�:IHSp�CT10N'
SEBYICE �°�°,� '�
�r,ir
706 Somerset Drive
Mechanicsburg,PA 17055 -
Realty Firm �
Mn��i�
. �+::i?�i''ti��,e ,,A� .
Clienl Name
Estmc ofD.Eichmn
Desvip4on Amounl
WholeHOUael�pection
98 Hour RaEOn M J00.00
°ty'�5 1J000
SmiderdMicm Semple SS 00
For inspecuon servica providM ai 98 Margvc�Drivq Mcchenicsbueg,PA on Junc 20,2U12
Total �,as.�
�
Insoection R t odF(1.9 MB3
REV-1512 EX+(72-03) ,
SCHEDULE i �
coMMOriw�un{oF PeNNSnvnrnn DEBT$ OF DECEDENT,
iNHERITANCETA%RENRN MORTGAGE LIABILITIES, & LIENS
RESIDEM DECEDENT
ESTATE OF FiLE NUMBER
�a,rrol( ir]. �'.'ct-,mrr, a./-1� - 7`f3
Report deb[s incurred by the decedent prior to death which remained unpaid as ot the date of death,including unreimbursed medlcal expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
' Cha.lcs �. rSh;elds % �'vr I��F�'me esl-a�z �lann� ,
t'CVi Sron oT G✓i�l� tte.eJ �owu-s o� a.-�orne�, �,-i�S� 1�
� 90�.ao
hos�;f�.l, rc"�,bursameri1's . �.
�. Pp� �`�?�sz
3 (�'l.fa/ B�ut (�rnss ��tmiam �/o7.5lU
/f, �a�2hta c�ttG � hlaspnic �/i%�a9e �r �en� Yfin� �
�Prrices X�';by3. 66
.S; �E1'iLO�'J X�ol.�/o
F. �a.n�asfrs- �'u,. Nea.lf�i �6Y zz
�. 1�bra �7S2�roie �+/;es� Twwc L�' //,, Per � 7"�x '"io,r�
8, /{�soni� �%/aye, fla.�a�ra sf�¢//�i eare essl's �35/.97
9. �axcasl-'cr Gen. d�[ns�o;f�� f t�s, 79
TOTAL(Also enter on line 70,Recapitulation) $ t f l�l� ��
Qf more sDace is needed,insed addilional sheets of the same size)
_ ._
B PNCBANC
�5�30�ZQ12 ' ' AmemberofThePNCFinar.cial5erviceSGronp
DARRELL EICHORN
98 MARGARET DR
MECHANICSBURG, PA 17050-1734 _ �
Dear DARRELL EICHORN,
Effective OS/3o/2012 , our records have been updated to ref]ect a change in your mai]ing address,
as shown below. For your security, this change of address confirmation has been sent to your
previous address. Please verify that the following is correct:
New Address Previous Address
DARRELL EICHORN DARRELL EICHORN
2308 HARVARD AVE 98 MARGARET DR
CAMP HILL, PA 17011-5331 MECHANICSBURG, PA 17050-1734
If the information above is correct, there is nothing you need to do. All future correspondence
from PNC Bank will be sent to your new address.
If the information above is incorrect, or if this change of address was not authorized by you,
please call us iininediately at 1-888-PNC-BANK.
PNC Aank appreciates your business and looks forward to continuing to provide the exceptional
level of service you expect From us.
Sincerely,
��u.� Q..���
Michelle A. Neidhardt
Senior Vice President
PNC Bank - National Financial Services Center
FRDOl
� REV-1513EX+(9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
�arrc�( m� C �'chorn Zl-/2- 7�f3
RELATIONSNIPTODECEDENT AMOUNTORSHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERN Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS[include ouVight spousal tlisiributions,and iranslers under
Sec.9776(a)(12)j
' ,1-oyce s_ I►?�bicr �1-rxsfed F�-�w,d RUsfv� %h bank:�
a3o8 Narra.�d !/�Ye. +�'nwnc�m) insl-os.
Cr�mp N;ll, ��4 iaon
�_ Kras�'a Mar�� Tkole �amclda�i�' �.Z, l2?Si`dua
�/
IIS$ }7oinf�o��a5 �odr� Sou}�i
vSf'. �mw�� /Yl/l� SS�/4
3. �y'e� .�PFe/ho%t ��+sa� yz res:c�ue
dsZo �ilrer Lane NE, /�pf. aoG
sf. /fi�,t�ny, �in/ �ss�ai
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TNROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SNEEf
ll NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9173 FOfl WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
' �ur�ka �ad9e /Yo. 302 F' �AM one�/�lF�^Gb"f'
A��: !+J/!]. /llC4aa�lc,�ore�'Rry , /yl4sanic Tampl� ��ie/im. �esida�
9i0 eS /ltar/(�" -�
/19ectian�cs6�rHg , PA �3oss
a. Zembo %tan�o% --�i/vi�crs -�u�/,J'�ir�nars ylespif.�l op� �,���r�nf
for Ch:ldren aFp�in. �s.due
a9oo �eky ro:nf Dr;r� �Po �ou 3� 356>
%.n a F'/e r.da 3.31�o �
TOTAL OF PART 1[—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed,insert additional sheels ot the same size)
LAST WILL AND TESTAMENT OF DARRELL M. EICHORN
1,DARRELL M.EICHORN,currently of 98 Margarct Drive,Mechanicsburg,Silva
Spring Township,�mbcrland County,Pcnnsylvania,bcing of sound and disposing mind,
memory and undcrstanding,do make,publish and declare ihis my i,ut Will and Testament,
hereby revoking and making void any snd all prior Wills and Codicils by me at any timc
heretofore madc.
I.
" [dircct thc payment of all my just dcbts and funcral expenses as soon after my dcccase as
the same can convenienUy be done.
2.
- To my wsted fricnd and companion,JOYCE S.MEHLER,of Camp Hill,any stock
which I may own at thc timc of my death in any banking or financial institution. The eslate and
inheritancc�axes on this giR to be paid from the residue of my Eslate. In the cvcnt she has
� predeceased me,ihis gifl shall lapse and shall become part of the residue of my Estate.
3.
All the rest,residue and remainder of my Fstate,after the payment of all estate and
inheritance taxes,fees and thc like to be divided and distributed as follows:
a) One(1%)percent to EUREKA LODGE NO.302 F.&A.M.
bJ One(1%)percent to 7.F.MBO TEMPLE SHRIIVER'S FUND for crippled
children.
Thc romaining balance to bc distributed as follows:
c.) Onc-half(%)to my granddaughter,IQ2ISTA MARIE THOLE.
d.) Ooo-half(%)to my grar�dsoq ROGER APPELHOLM.
In the event eithcr of my grandchildren predeceases me,then his or 2ier share to be
distributed to his or her issuc,as the case may bc,per stirpes. In thc cvent ei�her of my
, grandchildren predeccases me without surviving issue,then his or her sharq as[he case'may
be,shall go to the other gandchild,or that gandchild's issues,per s�irnes.as the case may be.
4.
It is my intention ihat beneficiaries named beforc or afier the datc of ihis Will on my
life insurance,annuities,individual retirement accounts(iRAs),in Trust for or joint bank
�/�// /'\ ' �G+��( � a,�I Z Pagc 1
�C� _J ' J
� aocounts end any other assets for which I may designate benciiciaries will rcccivc such
invcs[menis and iha[my Will provisions shall not control such investrnents.
5.
1 nominatc,consti[ute and appoint my trusted friend and companioq JOYCE S.
MEHLER,to bc thc Execuvix of this my Last Will and Testamcnt. In the event that shc is
unable or unwilling to act as Executrix,I appoint my Wsled fricnd and companion's daughtcr,
AMY E.MOYER,to bc Executrix in hcr place and stead. In thc evcnt that shc is unablc or �
unwilting to act as Executrix,I appoint PNC AAIVFC,IVA7'IONAL ASSOCIA770N,to bc
Execulor in her plece and stead. I further d'vect that they shall not be requ'ved to file bond or
other security in thc O�ce of the Registcr oC Wilis for t6e purposc of administering my
Estate.
. . IN WI7'NESS WFIEREOF,I have hercunm set my hnnd and seal ihis I day,
of A.D.2012.
V1�1I/I ���// ��//7�.-,� (SEni.)
DARRELL . O ' ° ��—
Signcd,scalcd,published and declared by the above-named DARRELL M.
• EICHORN,as and for his Last Will and Testament,in the presence of�s,who at his requcst
and in his prescnce,and in the presence of each other,havc hcreunto subscribed our names as
witr�esus.
9�Q/C.e�.L �{• ����
Witn sSignahue
�(o..xenl Ch�SbRo
Printcd Narne
I rrJ��m �c �,�;��
Address
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City,State, ip
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WiN Si�a[ure
5�2��C �C 1�7�a r
. Printed�e��— '
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Address
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Page 2
DARRELL M.EICHORN,the testato;whose name is signed to the attached or
foregoing insWnent,having been duly qualified according to law,do hereby acimowledge that I
� sig�ed and executed the instrument as my Last Will;and that I signed it willingly and as my free
and voluntaty act for the pu�wses therein e�cpressed.
Swom to or�rmed and acknowtedged before me by DARRELL M.EICHORN,the
testamr,this `_day of�A.D.2012.
"tfA�L . O ' �7'�vr 1 (Sea1)
�1'La�io�v�� � -
Notary Public
ccir�twanw€��
NofaMlSed
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Wat 6w�a�TW�.Ie���^N
ryy�ymnYSqpn 6q�a feD.31,1D35
MF1�PEll,RN16YLVNQ/./�4N/.ltpl OF NOIARR9
We, �'1('�-f{Q..R� ��IJI�O aad�e�� T Re�G�e� ,the
wimesses whose names are signed to the attached or fore ing inshnment,being duly qualified
according to law,do depose and say that we were present and saw ihe testator sign and exccu[e
the iastmment as his Last Will;that[he tes[ator signed willingly and executed it as his free and
voluntary act for the parposes therein expressed;that each subscribing wimess in the hearing and
sight of the testator signed the Will as a wimess;and tha[to the bes[of ovr knowledge the
testator was at that time 18 or more years of age,of sound mind and under no constraint or mdue
inllue�ce. -
. Swom to or��med and subscribed to before me by
KO-VQ(� �12�'Jl�n and ��e.��4 S Ra��.e/ ,witnesses,dated this
�day of�p.D.2072.
�i-VC1!./�, l��wdr�'_O (Seal)
� Q J`� (Seat)
�h�w,, �. �.c�,
Notary Public
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CHARLES E. SHIELDS, H]
A7?()8NEY-67�L3W
6Cu}CSExROAD
^v7�,nvY/and(3x^,rRoads
R% 17055
WIX'(:L M. },)U[o T7.|IMioXE (7|)} 70o420v
6`X [,|7> 7yj��7�
(1912-1(1912-1991))2Yv|)
July 26, 201
Inheritance TuxDivision
Couonuonxcuk1l of'Ile mis}(ruoix
Depxumu/8o|'Auvrnue
Bureau v(hndiviJuu| ?locs
U,pL2806O|
Hunrisiv/rg, Pi
l |7l28'O60}
De: Estate uf Darrell 0Y. Eichorn
No. 21-12-0743
SSN: 485'0-5^7475
DOD: 6/13/2012
[>cur �ir/ Madam:
Please I-ioJ attached the Inheritance Tax Return for Darrell M. Eichorn, deceased. /\sper
MV several phone conversations, \vo had u number 0f complex issues ko deal with which led io
(i`cdul^}/.
There were some unresolved issues regarding thoTzus\ sold (o Mr. Eichorn and his true
an(I ultimate distribUtiVC in(Crit. This has now been resolved and agreed to in conjunction with
John Downing oftht Attorney Clcocrxys ()[fico oil bchul[o[tile two charities.
/\|su, |'orin[noo:/ivuul purposes,Mr. Eichorn had uchariiuhlc annuity with the Masonic
Homes which was not u8�icct |oInhtrta o
uccTuz�odo�ichnuuuo\ iuc�u�c� nSthtduk: G.
/\ny additional information oil it, should you desire any, can buprovided through Alvin Blitz.
[cu. in the ?-\lus0oic [{0nucc
|fyou need any additional infounution. Please advise. Thank you.
Vcn7 truly yours,
Charles F. Shields, III
.nocncy'/\t^[un'
[|-S/| j
Fnc\usu/c
cc )0vccS. K1eb1o,. l�uocu1riV1