HomeMy WebLinkAbout08-28-13 (3) J '� penosylvania 1505610143
xru��ror�rcreHUe E%106-73)
REV-7 g00 OFFICIAL USE ONLY
County Cotle Vear Fib Number
Bureau of Individual Taxes
ao sox.zaoso� INHERITANCE TAX RETURN Z1 13 0479
Harrisburp PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociel Security Number Data of Death Date of BiAh
O1 28 2013 11 12 1919
DecadenPs Last Nama Suffix DecedenPS First Name MI
OCKER HAROLD E
(If Applicable)Enter Surviving Spouse'e Infortnatio�Below
Spouse's Last Name Suffix Spouse's Firat Name MI
Spousa'e Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
PILL IN APPROPRIATE OVALS BELOW
� 1, Original Retum � 2. Supplemantal Return � 3. Remelnder Retum(Date of Deat�
Prior�o 12-13-82)
� 4. Llmitetl Eslate � 48 FuWre Intereat Compmmise � 5, Federel EStete Tax ReNfn Requiretl
'(tlele ol tleath etler 12-1P-B2)
� 8 oec.aomoreare.��a � �, OA���er�oPYlM�jn��LivirpTruet � e. TotelNUmDarofSafeDepoailBOxes
' (Atte�hCOpyofV�lp ( °�
� 9. LitigationProceedsReceivetl � ���pg°�9enP2���i�erid��oa��aDeatn � ��,ElecliontotaxunderSeC.9713(A)
(Attech 5chetlule 0)
CORRESPONDENT-TMIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAI TAX INFORMATION SMOULD 8E DIRECTED TO:
Name Daytlms Telephone Numbsr
JERRY R DUFFIE c�(717) `7,61��40
� o '"� c�
Fint Line of Address � ' ""'' �-�
p7 - -- -
3 O 1 MARKE T 3 T m �- '�'' i �'`
� i r�
r' �- o� -,
Seeond Line of Address 3> U� - ����
- , , r, •:r
a''
PO BOX 109 '� c� �' " � -':
,,, =a
City or Post OHice gtate ZIP Cotle ;� .`,,r, �, �... `
;"r7
T.FMOYNE PA 170430].-Q<J'� �, c,
REGI9TER9P WILIS US ONIV
REOIBTER OF VALLS U6E ONLY
� �...-_.....""
DATE FlLED
� � � � y � � �
Corcespondsflt'S B-mail eddP6ss: DATE FILED STAMP
Untler penaltias of perjury,I tleclare that I have examinetl tAia retum,indutlirw eccompanying scheOules anE staUmenb,and to the Oest of my knowletlge antl belief,
it is true,cortec�end Compbte.OeGaration of preperer other Men Me personel representativ8 ia baseE on all intormation of which preparor has any knowletlpe.
SIGNA OFPE 5 N ESPONSIBL FILIN RETURN r� I �ATE
Peter D Kirk y (,2..�[!(�
ADDRESS
5155 K lock Road Meehanicsbur PA 17055
SIG RE OF PREPAR R THAN ftEPRESENTATIVE �ATE
JERRY R DUFFIE ,�
a s
01 Market Street, Lemo ne, PA 17043
L Side 1 �
1505610143 1505610143
�y
� 1505610243
REV-1500 EX
DecedenYs Social SacurRy Number
DeceEanYeNeme�. OCIC@�� Harold E
RECAPITULATION
t. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(SChedule 8)............................................................................. 2. L 1 B ,23 6. 32
3. Closely Held Corparation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedute E)............... 5. 246, 361 . 51
8. Jointly Owned Property(Schedule F) ❑ Separate Billing Requeated............ 6.
7. Inter-Vivos Transfero&Miscelleneous -Probate Proparty
(SChedule G) � Separete Billing Requeated............ 7, 3Z5 , 480 . 91
8. Total Groas Asaeb(total�ines 1 through 7)........................................................ 8. 790 � 078 . 74
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 7 , 32 9. 8 9
10. Debts ot Decedent,Mortgage Liabilities end Liens(Schedule I)............................ 10. 5 , 915 . 91
11. Total Deductlons(total Linas 9 and 101................................................................ 11. 33 ,245 . 80
12. Net Value of Ettate(Line B minus Line 11).......................................................... 12. 756, 832 . 94
13. Charitabla and Governmental BequeatslSec 9113 Trusts for which
an eledion to tex has nol been made(Schedule J)............................................... 13.
14. Net Value Subjectto Tax(Line 12 minus Line 13)............................................... 14. 756, 832 . 94
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
trensfers under Sec.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable 756� 832 . 94 ts. 34 � 057 . 4B
at lineel rete X .045
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rete X.75 0 . 00 18. 0 . 00
19. TAXDUE................................................................................................................ 19. 3Q � �S7 . 4e
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
$Ide 2
� 1505610243 1505610243 J
REV-7500 EX Pege 3 File Number 21-13-0478
Decedent's Complete Address:
DECEDENT'S NAME
Ocker, Harold E
STREETADDRESS
473 Bethany Drive
CITY STATE ZIP
Camp Hill PA �7071
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 34,087.48
2. CredkalPeyments
A. Prior Payments 25,000.00
B. Discount 1,315.79
Total Credits(A +g) (2) 26,315.79
3. Interest (3)
q. If Line 2 is greater than Line 1 +Line 3,entar the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund
g, If Line 1 +Lina 3 is greater than�ine 2,enter the differance. This is tha TAX DUE. (5) ],741.69
Make Check Pa able to: REGISTER OF WILLS AGENT.
� � � �
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make e trensfer and: Yes No
a. retain the uae or income of the ptoperty transfarred:............................................................................... ❑ ❑x
b. retain the right to designata who ahall use the property trensterrad or ita income;......._._...................... ❑ �
c. retain a reversionary interest;or............................................................................................................... ❑ :
d. raceive the promise for life of either payments,benefits or cera9............................................................ ❑ �
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one yeer of death without
receiving adequate eonsideration9.................................................................................................................... ❑ ❑X
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ �
4. Did decedenl own an individual retirement account,annuity,or other non-probete property which
contains e benaficiary designetion7.................................................................................................................. ❑X ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE 6 AND PILE IT AS PART OF THE RETURN.
For detes of death on or eftar Juty 1, 1994 end before Jan. 1, 1995,the tex rate imposed on the net value of trensfers to or for the use otthe surviving spousa
is 3 pereent P2 P.S.§9116(a)(1.1)(i11.
For tlates of death on or aflar January 1,1995,the tax rate imposad on the net value af transfers to or for the use of the surviving spouse is 0 percent
�72 P,S.§9N6(a)(1.1)(ii)]. The statute does not exempt a trensfer to a surviving spouse irom Wz,and the statutory requiremants for disclosure ot asseta and
filing e tex retum are still appliceble avan if the surviving apouse is the onry 6eneTdery,
For dates of tleath on or aRer July t,2000:
• The Wx rate imposed on the net value of transfara from a tleceased child 21 years of age or younger at death to orfor the use of a natural parent,an
adoptiva perent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)],
• The tez rate imposed on the net value of transfero to orfor the use of the decedenPs lineal benefidaries is 4.5 percent,except as noted in�72 P,S.§9176(a)(1)],
. The tax reta imposed on the nel value of trensfera io or for the uae of tha decodenYs aiblings is 12 percent[72 P.S.§9176(a)(1.3)]. A sibling is defined,
under Sedion 910Y,as an individual who has at least one parant in common with the decedent,whether by blood or adoption.
Nsv-7607 E%��8-BB)
� scH�ou�� s
STOCKS & BONDS
COMMONNFALTHOFPENNSVWRNIA
INHEFR�NCETA%RETURN
HE810ENTDECEDENT
ESTATE OF FILE NUMBER
Ocker, Harold E 21-13-0479
All property jolnHyrownatlwlM rlpM o/�univonhlp mu�t D�Claelo�M on M�sAUIS F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRiPTION UNIT VALUE OF DEATH
Wella Fawo Inveatmant Account No.126�.7274
7 38142Y825 5,632.873 shares of Goldman Sachs TR High Yfeld Municlpal 9.54 53,737.98
FdCIA
Accrued divide�d on Item 7 through date of death 179.18
2 92119R309 12,218.481 sharea oflnvesco High Yleld MunlclpalFund CI C 10.16 124,149.93
Accrued dividend on Item 2 through date of death 445.89
3 3,348.606 shares of Wells Fargo Advantage Tax Free Fd 11.84 39,647.50
Class C
Accrued dividend on Item 3 through date ot death 11.84 75.83
TOTAL(Also enter on Line 2, Recapitulationl 218,238.32
(If more spece ie needetl,atlditionel pepes of tha sema siza)
Copyright(c)2002 form soRwara only The Lackner Group, Inc. Form PA-7600 Schedule B(Rev.6-98)
Rsr�i60B E%��17-70)
scN�ou�e e
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INMERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ocker, Harold E 21-13-0478
i�u�ma Pro�aed.a in�pation eM ttre tlate tha procaeE�were receivW by tM eelale.
All prop�rty Jolntlyovmetlwlth ths tlp�t ohurvlvonhip mu��M tlpclwW on tc�s0ule F.
ITEM � VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
7 M�T Bank Power Checking Account No.85104722 29,700.88
2 M6T Bank Power Money Market Account No. 15004218038718 84,887.86
3 Metro Bank CeRiflcate of Deposit-1.50°k-38 Month CD 102,331.81
4 Orrstown Bank Certificate of Deposit Account No.4000042470-Date of Death Lettsr is 44,887.58
attached to this Retum
Accrued income on Item 4 through date of death 71.00
5 7999 Ford MuaWnd Lx ConveRible-Contrected Sales Price 4,500.00
6 Peroonal Property 200.00
7 2012 Faderel Individual Income Tax Refu�d 77B.00
8 HighmaHc Blue Rx-Refund on Account 2.78
TOTAL(Also enter on Lina 8,Recapitulation) 246,361.51
(If more apace ia noedetl,atltlttional pa9ea of t�e sartre size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rav-7610 EX+�OB-09)
SCNEDULE 6
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPqRTMENTOFREVENVE
INHERI7ANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ocker, Harold E 21-13-0479
This schetlule muet be compbtetl entl flatl if the anawer to eny of queelione 1 Ihrough 4 on pepe threa ol tM REV-1500 ia yoa.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S E%CLUSION TAXABLE
NUMBER HE DATE 0 TF RANSFERgATTACHTA COPVEOF THE OEEO�OR REAL ES�E. VALUE OF ASSET INTEREST (�F PPPUCABLE) VAI.UE
1 Md�T Bank IRA Account No. 683855-Beneflciariea: 121,087.77 127,087.11
Carol Kirk, Daughter and Nancy Hoffman, Daughter
2 The Hartford Annulty ConVact No. 710784955- 19,719,75 18.118.15
Beneflciariea: Carol Kirk, Daughter and Nancy
HoHman, Daughter
3 Western National Annuity Contrect No. AN201080- 183,274.65 183,274.83
Boneflciarles: Carol Kirk, Daughter and Nancy
Hoffman, Daughter
4 Lauri Becker-Cash Gift 5,000.00 3,000.00 2,000.00
TOTAL(Also enter on Lina 7, Recapitulation) 325,480.87
(If more spece ie needetl,atlCilionel pegea ot the same eize)
Copyright(c)2009 form software only Tha lacknar Group,Inc. Form PA-7600 Schedule G(Rev. 08-09)
REV�1577 EXi(10-08)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETA%RETURN ADMINISTRATIVE COSTS
RESIDENT DECE�ENT
ESTATE OF FILE NUMBER
Ocker, Harold E 27-13-0479
DecedenYa debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
See continuation schedule�s) attached 7a,e74.77
B. ADMINISTRATIVE COSTS:
1, Personal Rapreaentative's Commissions
Name of Personal Representativa(s)
Street Address
City State Zio
Year(s)Commission Paid
2 Attornev's Fees JOHNSON, DUFFIE, STEWART&WEIDNER 70,000.00
. 3. Family Exemption: Qf decedenfs address is not the same es claimanYS, attach explanation)
Claimant
Street Address
Cily StBte ZiD
Reletionshio of Ctaiment to Decedent
4. Probate Fees 500.00
5. AcwuntanPs Fees
6. Tax Return PraDarer's Fees
7. Other Administrative Costs 2,015.12
See continuation achedule(a)attached
TOTAI(Also enter on Ilne 9, RecapitulaHon) 27,329.89
Copyright(c)2009 form soitware only The LaCkner Group, Inc. Form PA-7600 Schedule H(Rev. 10-09)
.. _- -_ . .. .
SCHEDULE H
FUNERAL EXPENSES AND ADMtNISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ocker Harold E 27-13-0479
ITEtn
NUMBER DESCi21PTtON AMOUNT
Funaral E:penses
1 Camp Hili United Methodist Church Hospitality Ministry-Funaral luncheon d00.00
2 Church Services for Funeral f,000.00
3 P�rthemore funeral Home&Cremation Servicea,inc. 11,919.77
4 Rolling Green Cemetery-Grave Qpentng 1,495.4Q
H-A 74,814.77
er A���piatnX�v_�Coa#s
5 Bethany Vlllage-Final medical Expenses 937.14
B Erie inaurance Group•Automobile Insurance 126.00
7 Erie Insurance Group-Automabile fnaurance 128.06
8 MB,T Eatate Checking Account•Expenaes for EsGate Checke 18.74
8 Ressrves: Additional Miscellaneous Estate E�cpenses 1,000.00
14 The Cumberland Law Journal•Notfce of Estate Administratfon 75A0
11 The Patriot News Ca, -Notiee of Eatata Administratfon 147.24
t�-�7 z.a�s.�2
�I
Copyright(c)2p02 form sokware only The Lackner Group,Ina Form PA-1500 Schetlule H(Rev.6•98)
_
Rsvd67t E%�(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OFREVENUE
INMERITANCE7A%RETURN MORTGAGE LIABILITIES AND LIENS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Ocker, Harold E 21-13-0478
RspoN Wbb IncumE by the McMmt qior to tls�lh M�t nmelnstl unpNd�tpi�Gte of Eaath,Includln9��nlm�unW m�Elc�l axpamx.
� ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Alpha Diagnostics 6.11
2 Bethany Village-Final Resident(al invoice-Skilled Nuraing 4,080.05
3 Bonnie K. Mlller, Treasurer-2073 Per Capita 4.80
4 Camp Hfll Emergancy Physiciana Account No. HYP44132124 29.57
5 CCRX of Bethany Village 778.96
6 Clem A.Ciccarelli, MD 58.89
7 Commonwealth of PA-Ragistretion for Automobile 38.00
8 Hampden Physiclan Aasoc. 202.28
9 Hampden Phyaician Assoc. yp,��
10 Nephrology Assoc. of Central PA Inc. 39.44
71 Nephrology Assoc. Of Central PA 38.44
12 PA American Water-Finai Invoice on Personal Account 20.38
73 PA Depardnent of Revenue-2072 Individual Income Taxes Due 105.00
14 Philhaven y�,y�
15 PlnnacieHealth Cardivascular �y,gq
16 PP&L Electric -Pinal Invoice on Penonal Account ypq,q�
17 Quantum Imaging and Therapeutic Associates 39.31
Total of ConGnuation Schedule gee anaehed pape
TOTAL(Aleo enter on Llne 10, Recapitulatfon) 5,815.87
(If more space ia neetled,edditionel pages of t�e same aize)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1600 Schedule I(Rav. 12-OB)
Rw�167P E%+�1RA8�
acNEOU�� �
pennsylvania pEBTS 4F DECEDENT,
DEPARTMENT OF REVENUE
INNERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT OECEDENT'
COtl�itlU6t�
ESTATE OF FILE NUMBER
Ocker,Harold E 21-13-0479
ITEM VAIUE AT DATE
NUMBER DESCRIPTION OF DEATN
18 Gluantum Imaging and Thorap�utic Assocfates 9.82
19 Razar Replacsment-Cheek Glea�ing After Date af Death 2T.40
20 Rumbelgen's Servfae-Service on Autamokile 40.23
21 Shippenaburg Univenity-Check Clearing After date of Death 15p.00
22 3pirit Phyaician Servlces-Physician Invoiae 4t4.22
23 Tom Willard-Check Clearing After Date of Death 1SU.00
2A Urology of Centra) PA-Account#2747 7.48
2S Weis Market-Cheek Clearing Atter Date of Death tTB.34
28 West Shore EMS 193.88
�
�
TOTAL(Also enter on Line 10.Recapftulation) 5,915.81
Copyright(c)200$form soTtwere only Thd Lackner Group, Ina Form PA-1600 Schedule I(Rev. 12-OB)
.
REV•7677 EX�(Oi-0p)
pennsylvania SCNlDU1.E J
DEPRRTMEMT4FREVENUE
INHERITpNCE 7A%NETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE 4f FILE NUMBER
Ocket,H�rold E 21-13-0479
RELATIQNSHIP TO
NAME AND ADpRESS OF SHARE OF ESTAT� AMOUN7 OF ESTATE
NUMBER pERSONtS1RECEiViNGPROPERTY OECEDENT
(YYords) {g$g)
i TAXABLE piSTRi$UTlQNS jinciude outripht spousat
distribu4ona,and transfers
under Sea 9118 e 1.2
1 Lau�ie Becker Granddaughtar ;,5,004 Speclfic
5412 Flrothom tane Bequest
Mechanicsburg, PA 17055
2 Eatate of Caroi A.iCirk DaugFt�r 112 af Tangibie
5155 Kytack Rosd Pena�ai
Mechanfcaburg, PA 77055 Property; 7/2 af
Residue
3 Nancy J.Hoffman Daughter 1J2 Tangible
A2 October Giory Orive Peraonal
Ocean View, DE 19870 PropeHy; 7/2 pf
Rssldue
d Todd Hoffmao Grand�an �5,OQ0 3pecifie
2628 Sputh Fern Street Bequest
Arlingtan,VA 222q2
5 Tyle�Haffman Grandsan �i3OQQ Specific
744 SoutM Martin Street Bequest
Philadelphia, PA 19146
See continuation schedule attached Cantinustion
Total
Enter doAar amounts fqr distri6utions ahown above o�lines 15 thro h Y 8 an Rev 154Q covar sheet as a ro riate.
NOPI-TAXABIE DISTRIBUTI4NS:
II• A. SPOUSAL DISTRiBUTIONS UN4ER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT tAKEN
B.CtiP�RITABIE ANQ G4VERNM€NTAl6ISTRI8UTI0NS
�
�
TOTA OP PART 0-ENTER TOTAL NON-TA7(A81.£6ISTRIBUTI4NS 4N I.INE 13 OP REV-'f 560 COVER SHEE
Copyright(c)2010 form aoftware only The Lackner Group,Ina. Fortn PA•1600 Schedule J(Rev.01-10)
SCHEDULE J
BENEF{CIARIES
(Part I, Taxable Dfstributione�
ESTATE OF:
Harold E Ocker 4112812013 204-Q3-5172
Item Name and Address of Peraon(s) Share of Estate Amount of Estate
Number Recsiving Proparty Ralationship tWorcls} {�;}
6 Bredtey Kirk Grandson 58,000 Spaciflc Bequsat
8 8eeehwood Lane
Hershey,PA 1T033
7 Wendy Kirk Grenddaughter $5,000 Speciflc Bequeat
5165 Kylock Road
Mechanicaburg, PA 17666
(
i
ESTATE OFHAROLD E. OCKER
SCHEDULE OFEJf�HIBITS
EXHIBITA Last Will and Testament for Harold E. Ocker signed and dated
August 19, 2011.
EXHIBIT B Copy of Receipt of Pre-Payment of Inheritance Taxes on April 29,
2013.
EXHIBIT C EstateVal Date of Death Yaluation of Wells Fargo Investment
Account
EXHIBIT D M&T Bank Date of Death Letter for Decedent's Cash Accounts.
EXHIBIT E Metro Bank Date of Death Letter for Decedent's Certificate of
Deposit Account.
EXHIBIT F Orrstown Bank Date of Death Letter for Decedent's Certif cate of
Deposit Account.
EXHIBIT G M&T Bank Date of Death Letter for Decedent's IRA Account.
EXHIBIT H The Hartford Date of Death Letter for Annuiry Account No.
710794955.
EXHIBIT I Western National Date of Death Letter for Annuiry Account No.
AN201090
576820
��
Last Wiii and Testament
OF
MAROlD E. OCKER
I, HAROLD E. dCKER, of Lower Allen 7ownship, Cumberland County, Pennsylvania,
declare this to be my last Witl and revoke any Will previously made by me.
1.
1 direct that alI my tegal debts and furtr�ra! expenses, induding my gravemarker and aii
expenses of my last illness tha# the Co-Executrixes are oblfgated ta pay, shai! i,� paid from my
residuary estate as soon as practicable after my decease as a paR of the e�ense of the
administration of my estate.
II.
I bequeath rny automobile, household gaads and personal effects and other tangibie
persanatty of a like nature {not inciuding cash or securinties}, tagetfier witfi any e�sting insurance
thereon, to my daughters, GARO� A. Klf2K and hlANCY J. HC}FFMAN, ta be divided behaeen
them with due regard for their personal preferences in as nearly equal shares as practicaL Shauld
either of my daughters, CARQL A. KIRK or NANCY J. HOFFMAN, predecease me, I bequeath
her share such tangible personalty and insurance thereon to said deceased daughter's then living
issue, per stirpes.
1lI.
i direet tha# the fo0owing �cuniary bequests shall be made to eact� of my named
grandchildren as foltows:
A. Five Thousand ($5,000.00) Dollars to my granddaughter, LAURI A.
BECKER. If my granddaughter, LAURi A. BECKER, shall predeceaee me, I bequeath
said pecuniary bequesf, in equai shares, to her then living issue, per stirpes, and in defauif
i of said issue said bequest shall be distributed, in equal shares, befi+veen her surviving
ExHtatrA
_.
.—_ _ .._ . I
�
siblings, WENDY K. KIRK and BRADLEY D. KfRK, or, 'rf applicable, his or her then tiving
issue, per stirpes.
B. Five Thousand ($5,000.00) doilars ta my granddaughter, WENDY L. KIRK.
tf my granddaugMer, WEiVDY C. KiRK, shall predecease me, I bequeath said pecuniary
bequest, in equal shares, ta her then living issue, per stirpes, and in default of said issue
said I�quest shail be dlstribufed, in equal shares, beEween her surviving si6lings,
L.AURI A. BECKER and BRADLEY Q. KlRK, or, if appficable, his ar her then living issue,
per stirpes.
C. Five Thousand ($5,000.00} Doilars to my grandson, BRADLEY D. KIRK. if
my grandson, BRADLEY D. K(F2K, shall predecease me, I bequeath said pecuniary
t�quest, in equa( sfiares, #o fiis #hen living issue, per stirpes, and in defauit of said issue
said bequest shaii k�dlstributed, in equai shares, between his surviving siblings, LAIJRI A.
BECKER and WENDY L. KIRK, or, if applicable, her#hen living issue, per stir�s.
D. Five Thousand ($5,000.00) Dollars to my grandson, TYLER B. HOFFMAN.
if my grandson, TYLEFt B, HOFFMAN, shall predecease me, I bequeath said pecuniary
bequesf, in equal shares, to his then living issue, per stirpes, and in default of said issue
said b�uest sfiall be distributed to his brother, TODD C. HOFFMAN, or, if appiicable, his
then fiving issue, per stirpes.
E. Five Thousand {$5,000.04) Daltars to my grandson, TOQD C. H4FFMAN.
If my grandson, TODD C. HOFFMAN, shal! predecease me, ! bequeath said pecuniary
bequest, in equai shares, to his then living issue, per stirpes, and in default of said issus
said bequest shaii be distributed to his brother, TYLER B. HOFFMAN, or, if applicable, his
then (iving issue, per sti�ses. ,
Further, ! direct that in the event that eny of my named grandchildrert shail predecease me
and said share shall be distributed to said deceased grandchild's then Iiving issue, per stirpes,that
if the pecuniary bequest is payable to a minor or minors, that said pecuniary bequest !ae
distributed to the issue's parent and not subject to the provisions of Paragraph V of this Will.
-z-
!V.
I devise and bequeath the residue of my estate of every nature and wherever situate, in
equai shares, to my daughters, CAROL A. KIRK end NANCY J. HdFFMAN. Should either of my
daughters, CAROL A. KIRK ar NANCY J. HOFFMAN, predecease me, I devise and bequeath her
share of#fie residue af my estata of every nature and wherever situate to her then tiv'ing issue, per
stitpes.
Y.
Except as provided in Paragraph III, should any of my issue entitled to a share of my
estate nat have attained the age af twenty-one (27) years at the time of distribution to him or her, I
devise his or her share to ORRSTOWN BANK, iN SEPARATE TRUST, to hold, manage, invest
and reinvest the share or shares so received and the accumulation of income thereon, and to use
and appiy the incgme and pri�cipal, or so much thereof as, in Trustee's sole and absolute
discretion, may be necessary and appropriate far such issue's support and educafian {inctuding
#rade schoo! and co!lege education, bath graduate and undergraduate) without regard to his or
her parent's abillty to provide for such support and education and to make payments for these
purposes, without further responsibility, to such person or such issue's parent or to any person
taking care pf such issue, Any such principal or incame not so applied shall be distributed to such
issue absolute(y when hs or she atfains the age of twen#y-one (21). If the issue dies befare
attaining tfie age of fiverrty-ane {21}, the Trust shail terminafe and such sfiare shall 6e distributed
to his ar her persana! representative.
Vi.
I direct that the interest of the beneficiaries hereunder sha!! not be subject ta anticipation
or voluntary or involuntary alienation.
VII.
i direct that ati ta�ces tFrat may be assessed in consequence af my dea#h af whatever
nature and by whatever jurisdic�ian imposed shafl be paid fram my residuaryr estate as a part of
the e�ense of the administration of my estafe.
-3-
VIII.
f appoint my daughters, CAROL A. KIRK and NANCY J. HQFFMAN, Co-Executrixes of
#�is, my Iast Wi(1. Shauki either nf my daughters, CAROL A. KIRK or NANCY J. FfOFFMAN,faii to
qualify ar cease to act as CaExecutrix, then I appoint the other as Executrix of this, my last Will.
IX.
I direct that my Co-Executrixes or their successor or successors shall not be required to
past bond for the faith#uI perfarmance af tfieir duties in any jurisdiccfion.
IN WITNESS WHEREdF, I have hereunto set my hand and seal this 1 "1�� day of
���5� 241'I.
�"��`� ���2�t�(SEAL)
HARdLD E. OCKER
Slgned, sealed, published and declared by the abave-named Tes#ator, as and for his t�ast
Will and Testament, in the presence of us, wha, at his request, in his presence and in the
presence ot each other have hereunto subscrit�cl our names as witnesses.
�
f �--�—
� �
-4-
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
. ss:
COUNTY OFCUMBERLAND ,
I, HAROLD E. OCKER, Testator, whose name is signed to the foregoing instrument,
having been duly qual�ed according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed.
%�+ ` "'-�„r � .. �-� �,d� �
�
HAROLD E. OCKER
Sworn or affirtned to and acknowledged before me, by HAROLD E. OCKER, the Testator,
this��ay of�, 2011.
Not Public `�
COMMONWAALTH OF PENNSYLVANL4
NOTARIAL SpAT,
Gail J.�viahoney,Notary Public
Lemoyne Borougly Cumberland County
oommiuion ex ' Feb 19,2014
-5-
AFFIDAVIT
COMMONWEAITH OF P�NNSYlVANIA :
. ss:
COUN7X OF CUMBERI.AND .
we, JG°/'�"�l �.��iT7"t L° and f f�{�.�� VYtL°-°v��f1 > the
witnesses whose names are signed to the foregoing instrument, being duly qual�ed according to
law, do depose and say that wa were present and saw the Teetator sign and execute tFre
faregoing instrumerrt as fiis last WiI!and Testametrt; that fie signed wiliingly and that he executed
it as his free and voluntary act for the purposes therein expressed; that eaoh of us in the hearing
and sight of the Testatar signed the WiCI as writnesses; and thaf to the best of our knowledge, the
Testator was that time at least 18 years of age, of sound mind and under na constraint or undue
influence.
Swom ar affirmed to and subscribed to befnre me by_J(..°/Y'Y ��l T �i'�- �pd
p�_ —t--
���I��,��dC,�, r�r 4�S i% >witnesses, this_L�day a# f.�-te t_S�"' , 2011.
No ublic
���M,
:453470 COb1MikIWF.ALTHOFPENNSYLVANLI (",�'p�iIv10NWHAI.TfiOFPENNSYf.UANSA
NOTAFtTAL SEAL ' NOTARIAL SBA7-
Ciail7.Mahoncy,Notmy Public �°Eail l.Ivfahone�l.NMa�'Y�'ablic
Z�}me 8aoagfy Cumbe�land Camty t,�moyr�e Haou$�y Cumbalan3£auntX
twuomieaion' ' Feb 19 2014 i �yoounoissitmexp'vesFabrnkcy t9,20i4
COMi�iQPIWEALTH�r;
NOTARIAI.SF:
Gait7.Mahoae}�.Nota�=
Ztmapno Bo:ang6,.C�m6aiatin Couaty
��y��¢ ' peb 19 2Q14
-6-
COMM4NWEALTN 6F PENNSY�VANIA REV-A T62 EX{��-9S}
�EPARTMENT OFflEVENUE
BUflEAU OF INDIVIOUAL TAXES
DEP7.280601
HAflRi58URG,PA i7i28-OSOt
PENNSYLVANIA
RECEIVEp FROM: INHERITANCE AND ESTATE TAX
OFFICIA! RECEIPT
NC}. CD 017518
DU�FIE JERRY R
3Q1 MARKET STREET
PO BOX 109
�EMOYNE, PA 17043
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------- �� --....--- --.�.--
101 � $25,OQ0.00
ESTATE INFORMATION: ssN: 244-as-�»2 C
FILE NUMBER: 2113-0479 �
DECEDENT tvAME: OGKER HARO�D E �
DATE OF PAYMEfVT: 04/3CTJ2013 f
POSTMARK DATE: 04/29/201 3 �
CoUNTY: Ct1MBERLAND (
DATE OF DEATH: 01/2$/201 � �
(
TOTAL AMOUNT PAID: 525,0OO.OQ
REMARKS: RECEIPT TO ATTY
CHECK# 200351 1 15 0
INITIALS: HEA
sEa� RECEIVED BY: GLENDA FARNER STRASBAUGH
R�CEIV�'b REGISTER OF WILLS
M�'r' 0 i 2013
JOHNSON DUFFIE TAXPAYER
EXHIBIT B
Betate vaivatioa
Harolfl & Ocker
Date of Death: O1/28/2013 Betate o[� Haro18 8 Ocker
Valuatioa Date: O1/2B/3013 Aceovat: 1259-1474 - Individual
Proceeeiag Date� 08/O1/2013 He ort
H Type� Date oP DeatL
Numbar of Securittee� 3
� File ID: Ocker, Harolfl 1254-1274
eharee Security Meaa and/or security Div aafl Iat
Identifier or Par Deecription High/Aek Loa/Bifl Adjuetmenta Valua Accruala
1) 9Y113R309 12219.481 AIDC TA7C-S7L�T FD8 INV8SC0 (ACTPX)
INV HIYLD MONI C
lSUtual Pund (ae quoted by NASDAQ)
oi/ze/aois io.ie000 euct
10.160000 124,149.93
Dally Div. Accrual ae oY O1/28/3013 945.89
2) 38142Y625 5632.913 GOLDMAN SACHB TR (GBYAIC)
HI YLD ldONI A
Mutuel Pund (ae quoted by NASDAQ)
O1/28/2013 9.54000 Mlct
9.590000 53,737.99
Daily Div. Aceruel ae o! O1/28/2013 179.18
3) BRVCX 3398.606 ➢PSLLS PARGO AIIVANTA68 PDS
WFA PN TYPF PD C
tdutual 8und (ae quoted by NA9DAp)
oi/se/zoi3 ii.e9000 nae
11.840000 39,647.50
Daily Div. Accrual ae of O1/28/2013 75.83
Total Valuei $217,535.42
Totel Accrual: 5700.90
Total: $218,236.32
Page 1
Thie report wae yroduceA with BetateVal. a nroQUCt of Hetate Valuatioae 6 Pricing Syateme, Iae. IL you have queetione,
pleaea contact SVe "---'-•-- �.3.1)
ExHieir C
� ��
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502�349
F ax (302)934-2955
- May 16,2013
Law Offices
Johnson Duffie
301 Market Street
P.O. Box 109
Lemoyne, PA 17043-0109
Re: Estate of Hazold E.Ocker
Social SecuriTy: 204-03-5172
Date of Death: Januarv 28.2013
Dear Sir or Madam:
Per your inquny on May 9,2013,please be advised that at the time of death,the above-named decederrt had on
deposit with this bank ihe following:
1. TypeofAccount CheckirrgAccount
AccmartNumber 65104722
Ownershrp(Names o,/J Lauri A.Becker(POA)
C�vol A.Kirk(POA)
Harold E. Ocker
OpenirrgDate 11/28/1968
Balance on Date ofDeath $29,100.80
Accrued Iraerest $ .09
----._---------------------------
Total $29,100.89
2. 7�pe ofAccount Savi�s Account
AccourrtNumber 15004218038716
Ownership(Names on Lmvi A.Becker(POA)
Ccmol A.Kirk(PO.�
Hmold E. Ocker
OpeningDate oa�z�i2oos �EGEIVE[3
Balurrce on Date ofDeath $64,679.28 MAY 2 1 2013
JOHNSON QUFFIE
Accruedlraerest $ z,3g
Total ---�------------_---------..,----...-
$64,681.66
ExH�BIT D
06/04/2013 14:59 717-920-4666 DEPOSIT SERVICES PAGE 02/02
METRO
BAN K ��i Paxton Street 888,937.0004
Harrisburg, pA 17111 mymetrobank.com
6/4/13
Dana Wieseman
Law Offices of Johnson buffie
301 Market St,
Lemoyne, PA 17043
RE: Estate of: Harold E. Ocker
Tax Identification Number: 204-03-5172
Date of Death: January 28, 2013
To Whom It May Concem:
This letter is in reference to decedent account information you requested for the
individuaf listed above.
We are able to provide the following:
Account Type:CD
Account Number: 7700178080
Date Opened: 07/13/2011
Primary Owner: Harold
Principal Balance: $1U2,264,84
Accrued Interest: $66.77
pate of Deat11 Balance: $102,331.61
Please feel free to contact us at 1-888-937-0004 (f we may be of further assistance.
Sincerel
- �.._� �..._.... . , .
JenniferJacobs
Research Associate
Metro Bank
ExH16IT E
O�sTOwlv
B�
A Traditaon of Excellence
May 10, 2013
Law Offices Johnson Duffie
Dana L. Wieseman, Estate Administration Paralegat
301 Mazket Street
PO Box 109
Lemoyne, PA 17043
Fax: 761-3015
Re: Estate of Hazold E. Ocker
Social 5ecurity Numher 20403-5172
Date ofDeath 1/28/2013
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT IiAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CERTIFICATE OFDEPOSIT
Account No.- 40000424'70
Account Type- 60-119 Month Growth CD
Date Opened- 8/2/2011
7oint-�4cco�nt(namafdate)—I�Io
Balance- $44,697.59
Accrued Interest- $71.00
Best Regards,
�, R.�w�
J' R. Worthington
Deposit Processing Clerk
EXH/e�r F
2695 Philade.y�.,a n�e.,u� - �.,a..,��.,,,,,,b, �„ �,"„
3. Type ofAccound Individual Retirement Account
AccouraNumber 35004200893855
Ownership(Names on Harold E. Ocker
Opening Date 10/02/2006
BalanceonDateofDeath $121,026.75
Accrued Interest $ 60.36
------.._..._..........--.._.......----_..__...__...___._.....
Total $121,087.11
For any addi8onal loformation on the above accounb,including owne�ship and any cha�gcs,ciosurea and/or reimbnrsement of funds,
plesse eall the Mechanicsbmg et 717597-1515.
We were uneble ro locate any sate deposit box tor t6e above-menNoned decedent �
1'6is ktter does not indude eny acaunb in which Ne deceased may heve bcen listed as Powv of Attorney,Custodfan of Udform Trens[ers,
Reprmenfative Payee,or Truatee under e Written Agreement
$li1CCIE1}�,
Valarie Mercer
Adjustrnent Services
ExHiB�r G
_
May 22, 2013
THE
HARTFORD
Johnson, Duffie, Steward & Weidner
Ol Market Street
P.O.Box 109
Lemoyne, PA 17043
REFERENCE: Account# 710794955
Decedent: Hazold E Ocker
Deaz : Johnson, Duffie, Stewazd& Weidner
As you requested,the Date of Death Value as of 01/28/2013 was $19,119.15.
Please be advised this figure is for the date of date value purpose only, it does not
represent the death benefit amount. Mazket and surrender values change daily.
If you have any other questions or concerns, please feel free to contact your investment
professional, or an AnnuiTy Service Specialist by calling 1-500-862-6668, Monday
through Thursday from 8 a.m. to 7 p.m., and Friday 9:15 a.m. to 6 p.m. Eastern time. We
will be happy to assist you.
Sincerely,
Annuity Payout Services
The Hartford
The Harlford Wealth Management
Global Annultlea
745 West New Clrcle Road
Building 200,7°Floor
Lexington,KY 40611
Malling Address:
PO Box 14293
Lexington,KY 405124293
ExH�e�r H
°� WESTERN
NATIONAL
May 13, 2013
LAW OFFICES OF JOHNSON DUFFIE
DANA I, WIESEMAN
PO BOX 109
LEMOYNE PA 17043-0109
Re: Contract#: AN201090
Deceased: Hazold E. Ocker
Deaz Ms. Wieseman:
Thank you for your recent inquiry regazding the referenced annuity contract. It is our pleasure to
be of service to you.
The value of the above referenced contract on January 28, 2013 was $183,274.65.
Should you have any questions or require further assistance, please contact our Client Caze
Center by using our toll free number of 1-800-424-4990.
Sir.cerely,
C�sa.�t�4�'n ��,i�
Carolyn Smith
Annuity Claims Dept.
` fAAY 2 1 2013
JOHNSON DUFFIE
. � � American General Life Insurance Company
Annuity:
The Western National series of annuitie EXH/BITI >tates Life Insurance
Company in the City of New York and ir npany.
LH�WNNGL
�
:
_ �.
= t
- R•
o =-
= t
� c
>
C� OC'� � E
Am � c"'i
w C� m y � . , O� t.
m � S A F�.i.r�^ r .
D = o � .�:V, _ .
� � c� � F„y �
WNZ � � . . �" . �
0 � 0 "
A C n �
�
ti
� �. w �
c w � ° �'
ooa �
o � x �
�ob .. �
a om
� �
.
» � �
�. �.
� �k.
l��F
�� rn'�
`.17 S 6? C
� n � N �
$► r N � � fl1
� 2 r'" � �r. ,;..
y ;e;
. >c p : >
f� p � '�''� � '
C: ^-� -3 _..',".
- i�
.T� � m
Ca� U? O
a] � 7$ �
■ � � �
� �
Y
W
� .� T
.V
�� N �
�
��
v //� >y
. . ..�.Q_ _. y/._ tll.. ..
�
1
f
;
,E
;� :
>�,
'�'
''�
(�,
i
�:f
�
;<:a'.
�
t'
�