HomeMy WebLinkAbout09-05-13 i
' J 1505610143
REV-1500 °`�°,_,°, 1�
PA Departrnent of Revenue OFFICIAL USE ONLY
pennsylvania ca.ny code v�r File Nunber
Bureau of Individual Taxes ���*���
Po Box.2soso� INHERITANCE TAX RETURN 21 13 r
Harrisburg,PA 1712&0601 RESIDENT DECEDENT � ��3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
213 12 7592 05 14 2013 12 16 1921
DecedenYs Last Name Suffa DecedenYs First Name M�
?�E I STER DOROTHY C
(If Applicable)Enter Survnring Spouse's Ir�formation Below
Spouse's Last Name Suffa Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X� 1. Original Retum � 2. Supplemental Retum � 3. Remainde►Retum(date of death
prror to 12-13-82)
� 4. Limited Estate � qa Future Interest Compramise 5. Federal Estate Tau Retum R uired
(date of death after 12-12�) � Eq
� g, Decedent Died Testate � Decedent Maintained a Living Trust O
(Attad,Copy of wlp � (Attach Capy af Tn,s�) S. Total Number of Safe Deposit Boxes
� 9. Li�gation Proceeds Received � 10.�Pz�1 a�ndrt�-i��f death � 11.Election to tax under Sec.8113(A)
(Attach Sch.O)
> � CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORYATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
RICHARD L WEBBER JR ESQIII 717 532 7�$8
n �� � �
RE T�R OF WIEI�US�°OL'�11kY
�_ ..
� `: �-.� � � :..,
First line of address � �, �-•-
r-- ., ` , ,_��
126 EAST KING STREET �° U� = '
r��.7 �., l ., ..
Second line of address
�-, ¢_ .�::�
�:.; .
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City or Post Office State ZIP Code "`� .::�DATE F L�D �;, :.:<
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SBIPPENSBURG PA 17257
comespondent�s e-maii aadress: �ebber@weigleassociates.com
��������m.��a�I�n�examined this retum,induding aocompanying schedules and statemerds,and to 1he best pf my knaNedye and belief,
P� Prepa►e�other tfian the personal rep25eMative is based on all information of which preparer has any Imowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RE7URN
DATE
�'�'��� . �� Clayton M Leister,Jr � I�v'�
ADDRE
17409 N.37th Avenue Glendale AZ 85308-d334
SIGNATURE OF PREPARER OTHER THAN REp(tESENTATNE
DATE
�� �/�, —� / Richard L Webber,Jr,Esquire �����
ADDRESS
126 East King Street,Shippensburg,PA 17257
Side 1
L 1505610143 1505610143 J
' � 1505610243
REV-1500 IX
DeoedenYs Social Security Number
°��^''S"� Leister, Dorothy C. 213 12 7592
�caPiTUwnoN
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages 8 Notes Receivable(Schedule D)........................................................ 4.
5• Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)............... 5. 1,132. 72
6. Jointly Owned Property(Schedule� � Separate Billing Requested............ 6. 5Z,32 6. 61
7. Inter-V'roos Transfers&Miscellaneous I�oq Probate Properly
(Schedule G) �� Separate Billiny Requested............ 7. 443,034.49
s. 7otal cross�►ssets(tota��ines�-�..................................................................... s- 4 96,4 93. 82
9. Funeral Expenses 8 Administrative Costs(Schedule H)....................................... 9. 21,3 7�. 6'�
10. Debts of Decedent,MoRgage Liabilities,�Liens(Schedule I).............................. 10. 3]_. 1 .rJ
11. Total Deductions(total Lines 9�10)................................................................... 11. 21,4 O 1. 82
12. Net Value of Estate(Line 8 minus Line 11).................... ............................ 12. 4 7 5,0 92. �0
..........
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13. 2,�0 0. 0 0
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... �4. 4 73,0 92. 0 0
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15• 0 . 0 0
i 6. Amount of Line 14 taxable
atlinea�rateX .oa5 473,092. 00 76. 21,289. 14
17. Amount of Line 14 taxable
at sibling rate X.12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0. 0 0 1 S. 0. 0 0
19. Tax Due.................................................................................•••••••-••••••••••.......•••••••• 19. 21,289. 14
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 150561U243 150561�243 �
REV-1500 EX Page 3 File Number 21-13
Decedent's Complete Address:
DECEDENT'S NAME
Leister, Dorothy C.
STREETADDRESS
Elmcroft Nursing Home
129 Walnut Bottom Road
CIIY
STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 21,289.14
2. Credits/Payments
A. Prior Payments 20,224.68
B. Discount 1,064.46
Total Credits(A +g� (2) 21,289.14
3. Interest �3�
4. If Line 2 is greater than Line 1+Line 3,eMer the difference. This is the OVERPAYMENT. �4�
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enterthe difference. This is the TAX DUE. (5) O.oO
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............... � �
. .......................••••••••••••••......•••••••••••••••••••-
b. retain the right to designate who shall use the property transferred or its income:.................................. � �
c. retain a reversionary interest;or............................. X
. . ................................................................................
d. receive the promise for life of either paymerns,benefits or care?........... , � �
.....................•••••••••••••...........••-
. f death ocxurred aiter December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................... � �
.................................................................................
3. Did decedent ovm an°in trust for or payable upon death bank account or security at his or her death?.._.... � �
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate properly which
contains a benefiaary designation?.................... � �
....................................
IF THE ANSYVER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU IIAUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent p2 P.S.§9116(a)(1.1)()].
For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
p2 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse irom tax,and the statutory requirements for disGosure of
assets and filing a tax retum are still applicable even if the surviving spouse is the only benefiaary.
For dates of death on or after Ju ly 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
.The tax rate imposed on the net value of transfers to or for the use of the deoedenYs lineal benefiaaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)1-
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
�� ..M
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R�,-�soe oc.�see�
� SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
�o�n�ni aF voa+sr�vnNw
IMERfTANCE TAX RETURN
RESIDEPIT DECEUEMT
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
a���auae u,e proceeds w�itigau«�ar,a u�e clate n,e pro�s wrre r�ived ny u,e esta�a
Prol►�Y Ia�Y-0wned wifh the ri�rt of suvirash(p must be diaclosed on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Blue Cross -Refund
217.63
2 CenturyLink-Refund 15.89
3 Sr.Care Operations Holding LLC(Elmcroft) 899.20
TOTAL(Also enter on Line 5,Recapitulation) 1,132.72
(If more space is needed,addi6onal pages of ihe same size)
Copyright(c)2002 form soflware only The Ladcner Group,Inc. Form PA-1500 Schedule E(Rev.6-98)
Rev-150B DC+(�)
' SCHEDULE F
co�orrv�a�niaF�snviww JOINTLY-OWNED PROPERTY
INHERfTANCE TAX RER1PtM
RESIDEM DECEDENT
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
H an asset was made jaM Mntlin one year d the decedeaPs date d death,it must be reported an schedule G.
SURVMNG JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Clayton M.Leister,Jr. 17409 N.37th Avenue Son
Glendale,AZ 85308-4334
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY
��M FOR JOIN MADE �NCLUDE NAME OF FINANCULL INSTiTUT10N AND BANK ACCOUNT pq-�OF DEATH %OF °A�u oF TM
NUMBER TENANT ���� NUMBER OR SIMILAR IDENTIFYING NUMBER ATfACH DEED FOR ALUE OF ASS DECD'S DECEDENTS INTEREST
JOINTLY-HELD REAL ESTATE. INTEREST
1 A 07/28/2010 Orrstown Bank Certificate of Deposit 16,663.30 0.500� 8,331.65
#4000038516
2 A► Orrstown Bank Certificate of Deposit 25.56 0.500•k 12.78
#4000038516-Accrued Interest to DOD
3 A 08/09/2010 Orrstown Bank Certificate of Deposit 58,703.63 0.500•� 29,351.82
#4000038647
4 A 06/29H998 Orrstown Bank Checldng Account 11,190.30 50.000% 5,595.15
#103210105
5 Orrstown Bank Checldng Account 0.89 50.000% p,45
#103210105-Accrued Interest to DOD
6 A 08/14h 990 Orrstown Bank Checking Account#647829 18,068.79 0.500� 9,034.40
7 A Orrstown Bank Checking Account#647829- 0.72 0.500% 0.36
Accrued interest to DOD
TOTAL(Also enter on Line 6,Recapitulation) 5Z,326.61
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Ladcner Group,Inc. Form PA-1500 Schedule F(Rev.�98)
Rev-7510'�X+(5�gg)
SCHEDULE G
INTER-VIVOS TRANSFERS �
MISC. NON-PROBATE PROPERTY
�a+�w�n+oFPOa+sv�vnww
INERfTANCE TAX RE7URN
RESIDEIdT DECEDENT
ESTATE OF FILE NUMBER
Leister, Doroth C. 21-13
This sdiedule must be cornp�eted ar�d filed'rf the answer to arry d questiqis 1 ryvaugh q�p���side d the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH '�6 OF DECD'S
NUMBER �NCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND INTEREST �CLUSION TAXABLE
THE DATE OF TRANSFER ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET QF APPLICABLE) VALUE
1 Edward Jones Investrnent Account#377-09364-1-1 336,994.00 100.000% 3,000.00 333.994.00
2 Mortgage receivable relating to 727 Fireside Drive, 89,250.00 100.00OX 89,250.00
Shippensburg, PA
3 Proceeds from sale of real estate located at 727 19,790.49 700.000% 19,790.49
Fire.side Drive
TOTAL(Also enter on Line 7,Recapitulation) 443,034.49
(if more space is needed,additional pages of the same size)
Copyright(c)2002 form soflware only The Ladcner Group,Inc. Form PA-1500 Schedule G(Rev.E98)
REV-1151�DC+(70-06)
� scHEOU�E H
co������oE����a FUNERAL EXPENSES 8�
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
Debts of decedent must be neported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 11,074.48
B. ADMINISTRATIVE COSTS:
7. Personal Representative's Commissions
Name of Personal Representative(s)
SUeet Address
C� State Zio
Yearfsl Commission uaid
2. AttomeYs Fees Weigle&Associates,P.C. 5,000.00
3. Family 6cemption: (If decedenYs address is not the same as daimanYs,attach explanation)
Claimant
Street Address
C� State Zin
Relationshio of Claimant to Decedent
4. Probate Fees
5• Accountant's Fees
6. Tax Retum Preparers Fees
7. OtherAdministrative Costs 5,296.19
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 21,370.67
Copyright(c)2009 form software only The Ladcner Group,Inc. Form PA-1500 Schedule H(Rev.10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Bullock's Famity Resturent 263.49
2 John Runshaw,Minister at Funeral 200.00
3 Little's Funeral Home 9,289.28
4 Little's Funeral Home-Engraving fee 160.00
5 St Mary's Cemetery-Grave opening 900.00
6 The Flower Shop 232.09
7 Walmart-Artificial Graveside Flowers 29.62
H-A► 11,074.48
Other Administrative Costs
s ,�u�re a�.�o
9 AirFare to BWI and back to Phoenix 1.153.60
10 Cumberland County Register of�Ils-Filing fee for inheritance tax retum 15.00
11 Gas for rental car 73.50
12 Lodging 1,451.10
13 Meals 1.105.67
14 Meals 28.06
Copyright(c)2002 form software oniy The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
ITEM
NUMBER DESCRIPTION AMOUNT
15 Parking Fees-Airport 2.20
16 Postage and Thank You cards 14.86
17 Rental Car
739.38
18 Super Shuttle from Airport to Home 41.00
19 Super Shut�fe to Airport
41.00
20 UPS Fees
176.72
H-B7 5,296.19
Copyright(c)2002 form soflware only The Ladcner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
_ _ __
r�as��oc���s-os�
� SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
�o�a�a�Tr+oF Poa+sr�viww
INQiRANCE TAX RERIRN
RE&DEM DECEDENT
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21 13
Repat da1Ns incurrcd by the decedent prior to deafh thaR remained uipaid at the date of
deaUS indwing unreimhursnd medical e�,
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 CenturyLink 26.15
2 Pharmacy Bill 5.00
TOTAL(Also enter on Line 10,Recapitulation) 31.15
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form soflware only The Ladcner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
r�v�sti�oc+���-oe�
�
SCHEDULE J
co�u,�,rR �r��F�ep�s,n�v�,v�w BENEFICIARIES
"'�ESIDE DE ED�Ir�F
ESTATE OF FILE NUMBER
Leister, Dorothy C. 21-13
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE OUHT OF ESTATE
NUMBER PERSON(Sl RECEMNG PROPERTY DECEDENT
0o Na usc Tn,st s M�ords) �a$$)
I� TAXABLE DISTRIBUTIONS [indude outright spousal
disUibutions,and transfers
under Sec.9116 a 1.2
Clayton M.Leister,Jr. Son One-Hundr+ed 475,092.00
17409 N.37th Avenue Percent
Glendale,AZ 85308�334
Total 475,092.00
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II• A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
� Maranatha Baptist Church 2,000.00
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 2,000.00
Copyright(c)2009 form software only The Ladcner Group,Inc. Form PA-1500 Schedule J(Rev. 11-08)
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Z�AST wILL AND TEST�IMENT
I, DOROTHY C. LEISTER, presendy residing at 727 Fireside Drive, Shippensburg
Borough,Franklin County,pennsylvania 17257,being of sound mind,memory and disposition,do
hereby make,publish and declare this my Last Will and Testament, hereby revoking and making
void all Wills by me at any time heretofore made.
FIRST: PAYMENT OF EXPENSES - I order and direct my personai representa.tive
hereinafter named to pay all of my just debts, funerai expenses and e�enses involved or
connected with the administration of my estate as soon after my death as is reasonably possible.
SECOND: MONETARY GIFI'—I give and bequeath the sum of TEN THOUSAND
DOLLARS (S10,000.00) to the MARANATgA BAPTIST CgORCg, of Shippensburg,
Pennsylvania
T�D: RESIDIJE OF ESTATE -I give, devise and bequeath all the remainder of
mY �e, �, Peisonal and mixed, whatsoever and wheresoever situate equally to my son,
CLAYTON 1VL LEISTER, JR. and my daughter-in law, JEANETTE � LEISTER, or the
s�rvivor thereof.
FO_ CONTINGENT BENEFICIARIES — Should my son and daughter-in-law,
CLAYTON M.LEISTER,JR,, and JEANEII'E$T,Fr�TER,predecease me then I direct that
any portion of my estate which would otherwise be distributable to them be given, devised,
bequeathed and distributed to my nieces and nephews in shares of equal value, shaze and share
ali.ke.
FI�'I��: PERSONAL REPRESENTATiVE — I nominate, constitute and appoint my
son, CLAYTON M. LEISTER, JR. and JEAIVETTE H. LEISTER to be the Co-Executors of
WElGLE & ASSOCIATES. P.C. - qTTORNEYS AT LAW - 126 EAST KIPJG STREET - SH9PPENSBURG, pA 77Z57_�3g7
this my I,ast Will and Testament. In the further event that my Co-Executors are u.nable to serve, I
nominate,constit�te and appoint my niece, CHRiSTIlVE E.BOIVN�R as Executor.
SIX1'H: WAIVER OF BOND - I direct that my executors and substitutes shall not
be required to give bond for the faithful performance of their duties in any jurisdiction.
SEVENTH: TAXES -I hereby direct tha#all federal, state and other dea.th taxes payable
because of my death, with respect to the property forming my gross estate for tax purposes,
whether or not passing under this Will, including any interest or penalty imposed in connection
with such taxes, sha11 be considered a part of the expense of administration of my estate and that
such be paid out of the rest and residue of my estate.
IN WITNESS WHEREOF, I, DOROTHY C. LEISTER have hereunto set my hand and
seal to t.h�s my Last Will and Testament, the first page signed for identification only, this
S '���
day of J v� � ,2012
. �
,�",` p ��
, {
: �" �,�.-j�� ,. L � .;,-
(SEAL)
DOROTHY C�LEISTER
WEIGLE & ASSOCIATES, P.C_ - ATTORNEYS AT LAW - 126 EAST KIIVG STREET - SHIPPENSBURG, PA 17257-1397
4
This instrUment was by the Testalr�, on the date hereof, si�ed, published and declared by
��i3�ta i Ti`��. L�IS'TE�to be her Last Will and Testament, in our presence, who at her request
and in the presence of each other, we believing her to be of sound and disposing mind and
memory,have hereunto subscribed our names as witnesses.
" �� s�
✓.
�
�-�� �-� .
WE[GLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 1Z6 EAST KING STREET - SHIPPENSBURG, Pq 17257-i397
r
COMMONWEALTH OF PENNSYLVANIA :
: SS
COIJNTY OF CUMBERLAND •
We, �c�S�� �y �, ����C�.r and �5 r��i'7 i �I S�n
. �
the witnesses whose names aze signed to the foregoing instrument,being duly qualified according
to law, do depose and say that we were present and saw BOROTHY C.LEISTER,the Testatri��,
sign and execute the inshument as her Last Will;that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein e�ressed; that each of us in the hearing and
sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge"the � -
Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
,
s �
�� ' Qsa�
Sworn or affirmed to and subscribed before me
by ���56-��e�y .� '7/I61 co/�
and ����� ��56�
witnesses,this ��day of���_,2012.
- 'Ll � � � ,
Notary Public
�wOTARIAL SEAL
41CriRRi�.��'V�BBER JR.,NGTARY PUBLIC
SH!PPEhS�u�G hC�G,��Uf�BERLAND COUNTY
�tYCQn����S;,i�P�ti(?iRES NUGUST27,2014
WEIGLE & ASSOGIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPEI�[SBURG. PA 77Z5?-7397
. ,
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND -
I, DOROTHY C. LEISTER, the person whose name is signed to the foregoing instrument,
�� �n dulY qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; t]�at I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
. �
� r� ��� �
r- �,. . '?
��."�-t�
DOROTHY C.LEISTER
Sworn or affirmed to and acknowledged before
me by DOROTHY C.LELSTER,the Testatrix,
this �'�day of_ -�c � ,y 2012.
,
��� f�
Notary Public
� NOTARIAL SEAL
RICHARD L WEBBER JR.,NOTARY PUBLIC
SHIAPENSBURG BORO,ClJt�f�ERLAf�D COUfVTY
MYCO�IMISSIQN IXPIRES:�UGUST27,2014
WEIGLE S� ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SEiIPPENSBURG, Pq 17Z57-1397
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JUL-02-2013(TUE) 12: 05 ORRSTOIJN BANK OPERRTIONS ���J��� �f �
(FAX)7177093093 P. 001/003
aRRSTOwIv
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A Tradition of Excellence
J�ane 05,20I3
Wei�e&Associates,P.C.
Attorneys-at-Law CORRLCTED COPY
126 Ea,�t Kin�Street
Shipparsburg,PA 17257 �
Fax: 532-6552
Re: Estatc of Dorothy C, Leister
Soci.al Security Number 213-12-7592
Datc ofDeath 5/14/2013
�.T IS 11ERCBY CERTIFIED TllAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNTS WT1'H ORRSTOWN BANK;
CHF.CKlNG ACCOIIIVT
Account No- 647829
Account Type- Rclation Interest Checkin�
Date Opened- 8/14/1990
Joint Account(nFUne/date)- Ycs/Clayton M Leister Jr/06/14/2010
Balance- $18,068.79
Accrucd Interes�t- $0.72
CHECKING ACCDUNT
Account No.- 1032 a 0105 Sorry for the mistake. i
Account Type- Hometown inv��me�t vAVe made the corrcction.
Date Opcned- 07/06/1998 i also enclosed.a copy af
Joint Account(name/date)- Ye�/C1Ayton M Leister Jr /06/29/1998 thc signaturc card to
Balance at Deatli- $11,190.30 show both are on the
Accrucd Interesl $0.89 account as of 6/29/98.
CERTIFICATE OF DFPOS/7'
Account No.- . 4000038516
Account Typc- Cp
Date Opened- 07/28/2010
_ Joint Account�name/date .. yes/Claytan M Lcister Jr
$��an�- $16,663.30 ---•
Accrucd Interest- $25.SG
2695 Plilladeiphia Avenue •Chambenburg, PA 17201
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JUL-02-2013(TUE) 12: 05 ORRSTOIJN BANK OPERRTIONS �
(FRX)7177093093 P. 002/003
Tltese accoun[s have closed within one ear o her date o death.
CERTIFICATE OF/a�pOSIT
Accourit No.- 4000028008
Account Type- CD
Date Opencd- 08/25/08
Joint Account(nam�/date)_ yea/Clayton M Leister Jr
Balancc- $11,202.30
Date Closcd- OS/31./12
CFRTl'CICATE nFDLPOSIT
Account No.- 4000035493
Account Type- CD
Date Opcnccl- l 0/28/09
Joint Account(nameJdate)- Ycs/Clayton M Leister Jr
Balance- $12,967.32
Datc Closed- 10/30/2012
CF,2TIFICATE pFpEPOSIT
Accounl No: 4000038647
Account T�pe- CD
Dat�Opened- 08/09/10
Joint Account(namc/date)- Yes/Clayton M Leister Tr
Balance- $58,703.63
Date Closed- 02/21/2013
Best Resard,s�
�� � �
Lisa R Kline
lleposit Proc�,gin�Clerk III
JUL-02-2013(TUE) 12: 07 ORRSTOWN BHNK OPERHTIONS (FRX)7177093093 P. 003/003
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Printmail Group
Date 6/15/12 Page 1
Primary Aocount 647829
Endosures
Dorothy C Leister
Clayton M Leister Jr
727 Fireside Drive
Shippensburg PA 17257-1633
ACCOUNT SUMMARY
Account Number Account TitJe Current Balance Enciosures
103210105 Hometown Inve.strnent Account 55,897.04
647829 Relationship Interest Checldng 10,493.90
4000028008 12-17 Month CD .00
4000035493 18-23 Month CD 12,9Q4.95
4000038516 60-119 Month CD 16,195.81
4000038647 60-119 Month CD 59,283.33
CHECKINGACCOUNTS
Account Title Dorothy C Leister
Gayton M Leister Jr
Relationship Interest Chedcing Check Safekeeping
Account Number 647829 Statement Dates 5/16/12 thru 6/17/12
Previous Balance 151.49 Days In The Statement Period 33
4 Deposits/Gedits 11,783.30 Average Ledger 6,400.87
8 Checks/Debits 1,441.17 Average Coilected 6,388.62
Service Fee .00 Inter�t Eamed .28
Interesf Paid .28 �d�!!S.!�I P��C?!1�C,��Yi21d EsC7l�� 0.�5°!
Current Balance 10,493.90 2012 Interest Paid .29
I I I I
� � Total For� Total�
I I This Period� Year-to-Date�
I I I I
I I I I
�Total Overdraft Fees � $.00� $74.00�
I I I i
I I I I
�Total Retum Item Fees � �.00� �.00�
I I I i
Printed 6/15/2012 Printrnail Group-Page 1 of 5
Date 6/15/12 Page 2
Primary Account 647829
Enclosures
Dorothy C Leister
Gayton M Leister Jr
727 Fireside Drive
Shippensburg PA 17257
Relationship Interest Checking 647829 (Continued)
Deposits and Additions
Date Descrip�ion Amount
5J17 Deposit 470.00
5/18 Deposit 7.00
5J30 Deposit 11,202.30
6/04 Qeposit 104.00
6/ll Interest Depasit .28
Electronic Deb�ts and Withdrawals
Date DesQiption Amount
5/22 BILL PYMT PENELEC 120.20-
CHECK# 1015
5/22 BILL PYMT CenturyLink 30.08-
CHEQC# 1014
S/23 PURCHASE WAL-MART STORES 36.21-
CHKK#1019 SNIP PA
—CHECK SUMMARY---
Date Chedc No Arrzount Date Check No Amount
5/22 1014 -See above- 5/23 1019* -See above-
5/22 1015 -See above- 6/04 1d20 1,080.00
5/23 1016 35.00 6/01 1021 29.95
5/30 1017 90.00 6/14 1023* 19.73
* Denotes missing check numbers
Daily Balance Information
Date Balance Date Balance Date Balance
5/16 151.49 5/23 407.00 6/14 10,493.62
5/17 621.49 S/30 11,519.30 6/17 10,493.90
5/18 628.49 6/Ol 11,489.35
5/22 478.21 6/04 10,513.35
__
Date 6/15/12 Page 3
Primary Account 647829
Enctosures
Dorothy C Leister
qayton M Leister Jr
727 Fireside Drive
Shippensburg PA 17257
Relationship Interest Checking 647829 (Continued)
Interest Rate Summary
5/18 0.010000%
5/22 0.000000%
5/30 0.050000%
************�x******************************************�*�**************�******
Account Title Qorothy C Leister
Gayton M Leister Jr
Hometown Investrnent Account Chedc Safekeeping
Acwunt Number 103210105 Statement Dates 5/16/12 thru 6/17/12
Previous Balance 55,142.82 Days In The Statement Period 33
1 Deposits/Credits 744.20 Average Ledger 55,526.19
Checks/Debits .00 Average Collected 55,526.19
Service Fee .00 Interest Eamed 10.02
Interest Paid 10.02 Annual Percentage Yeld Eamed 0.20%
Current Balance 55,897.04 2012 Inter�t Paid 57.l3
Deposits and Additions
Date Description Amount
6/01 XXSOC SEC US TREASURY 303 744.20
PPD
6/17 Interest Deposit 10.02
Daily Balance Information
Date Balance Date Balance Date Balance
5/16 55,142.82 6/d1 55,887.02 6/17 55,897.04
Date 6/15/12 Page 4
Primary Account 647829
Enclosures
Qorothy C Leister
C(ayton M Leister Jr
727 Fireside Drive
Shippensburg PA 17257
Hometown Investrnent Account 103210105 (Continued)
Interest Rate Summary
5/15 0.200000%
�********************�*�***x***�**:�*�****�***********************�*****�******
CERTIFICATES OF DEPOSIT
Account Title: Dorothy C Leister
Ctayton M Leister Jr
12-17 Month CD
Account Number Current Balance Interest Rate Maturity Date 2012 Interest
4000028008 .00 0.600000% 8/25/13 47.33
**********�***************************************�**********�**********�******
Account Titie: Dorothy C Leister
CJayton M Leister Jr
18-23 Month CD
Account Number Current Balance Interest Rate Maturity Date 2012 Interest
4000035493 12,904.95 1.150000% 10/28/12 61.46
*****************************�**********�***********************�*************�
Account Trde: Dorothy C Leister
Clayton M Leister Jr
60-119 Month CD
Account Number Current Balance Interest Rate Maturity Date 20i2 Interest
4000038516 16,195.81 3.11d000% 7/28/15 207.59
************************************************�*********************�*�******
Account Trtie: Dorothy C Leister
Clayton M Leister Jr
�
Date 6/15/12 Page 5
Primary Account 647829
Endosures
Dorothy C Leister
Ciayton M Leister]r
727 Freside Drive
Shippensburg PA 17257
60-ii9 Month CD
Aaaunt Number Current Balance Interest Rate Maturity Date 2012 Interest
4000038647 59,283.33 3.11Q000% 8/09/15 913.86
THANK YOU FOR BANIQNG WITH ORRSTOWN BANK
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Bus Da.te: 05/30/2012
Branch/Teller Q002/0031
05J30/2012 09:54:56
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_ _ _ _
Printmail Group
Date 11/15/12 Page 1
Primary Account 647829
Endosures
Dorothy C Leister
dayton M Leister Jr
17409 N 37th Ave
Glendale AZ 85308-4334
ACCOUNT SUMMARY
Account Number Account Title Current Balance Enclosures
103210105 Hometown Investrnent Account 62,042.78
647829 Relationship Interest Checking 3,228.06
4000035493 18-23 Month CD .00
4000038516 60-119 Month CD 16,407.46
4000038647 60-119 Month CD 60,058.08
CHECKING ACCOUNTS
Aocount Title Dorothy C Leister
Clayton M Leister Jr
Relationship Interest Chedcing Check Safekeeping
Account Number 647829 Statement Dates 10/16/12 thru 11/15/12
Previous Balance 2,03035 Days In The Statement Period 31
3 Deposits/Credits 4,700.00 Average Ledger 3,596.69
3 ChecksJDebits 3,502.32 Average Collected 3,596.69
�rn�� .00 Interest Eamed .03
Interest Paid .03 Annual Percentage Yeld Eamed 0.01%
Current Balance 3,228.06 2012 Interest Paid .4i
� � � �
� � Total For� Total�
� � This Period� Year-to-Date�
� � �
� � � � �
iTotal Overdraft Fees � $.00� $74.00�
� I I I � � �
iTotal Retum Item Fees � $.00� $.00�
� � I
Printed 11/15/2012 Printmail Group-Page 1 of 4
1
Date 11/15/12 Page 2
Primary Account 647829
Endosures
Dorothy C Leister
Clayton M Leister]r
17409 N 37th Ave
Glendale AZ 85308-4434
Relationship Interest Checking 647829 (Continued)
Deposits and Additions
Date Description Amount
10/26 9044 CCD EDWARD JONES 1,100.00
PPD
10/31 9044 CCD EDWARD JONES 1,100.00
PPD
li/01 Transfer from DDA 2,500.00
Acct No. 103210105
li/15 Interest Deposit .03
Electronic Debits and wthdrawals
Date Description Amount
11/08 EASY PAY SENIOR CARE OPER 3,294.00-
PPD
--CHECK SUMMARY--
Date Cfiedc No Amount Date Check No Amount
10/24 1043 108.3211/08 1045�` lOC�.00
*Denotes missing check numbers
Daily Balance Information
Date Balanoe Date Balance Date Balance
10/16 2,030.35 10/31 4,122.03 11/15 3,228.06
10/24 1,922.03 11/01 6,622.03
10/26 3,022.03 11/08 3,228.03
Interest Rate Summary
10/15 0.010000%
..
Date 11/15/12 Page 3
Primary Acoount 647829
Endosures
Dorothy C Leister
Clayton M Leister Jr
17409 N 37th Ave
Glendale AZ 85308-4434
***********************�*******************************************************
Account Title Dorothy C Leister
Clayton M Leister]r
Hometown Investrnent Account Chedc Safekeeping
Account Number 103210105 Statement Dates 10/16/12 thru 11/15/12
Previous Balance 50,719.96 Days In The Statement Period 31
3 Deposits/Credits 13,815.52 Average Ledger 57,422.75
1 Checks/Debits 2,500.00 Average Collected 57,422J5
�mce� .00 Interest Eamed 7.30
Interest Paid 7.30 Annual Percentage Yield Eamed 0.15%
Current Balance 62,042.78 2012 Interest Paid 98.55
Deposits and Additions
Date Description Amount
10/29 Deposit 12,967.32
11/02 XXSOC SEC US TREASURY 303 744.2p
PPD
11/02 PENSION-CK NATIONAL REfIREM 104.00
PPD
11/15 Interest Deposit 7.30
Electronic Debits and Withdrawals
Date Description Amount
11/01 Transfer to DDA 2,500.00-
Acct No. 647829
Daily Balance Information
Date Balance Date Balance Date Balance
10/16 50,719.96 11/01 61,187.28 11/15 62,042.78
10/29 63,687.28 11/02 62,035.48
�
Date 11/15/12 Page 4
Primary Account 647829
Enclosures
Dorothy C Leister
Clayton M Leister Jr
17409 N 37th Ave
Glendale AZ 85308-4434
Hometown Investment Account 103210105 (Continued)
Interest Rate Summary
10/15 0.150000%
*******************************************************************************
CERTIFICATES OF DEPOSIT
Account Title: Dorothy C Leister
Clayton M Leister Jr
]eanette H Leister POA
18-23 Month CD
Account Number Current Balance Interest Rate Maturity Date 2012 Interest
4000035493 .00 0.600000% 4/28/14 123.83
*******************************************************************************
Aocount Title: Dorothy C Leister
dayton M Leister Jr
Jeanette H Le€ster POA
60-119 Monii�CD
Account Number Current Balance Interest Rate Maturity Date 2012 Interest
4000038516 16,407.46 3.110000% 7/28/15 419.24
*******************************************************************************
Account Title: Dorothy C Leister
Clayton M Leister)r
Jeanette H Leister POA
60-119 Month CD
Account Number Current Balance Interest Rate Maturity Date 2012 Interest
4000038647 60,058.08 3.110000% 8/09/15 1,688.61
THANK YOU FOR BANIQNG WITH ORRSTOWN BANK
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bb/'Lb/1b1:i by:27 8668730540 EDWARD JDNES � ; . �W ���� xGH������R�
, • - • PAGE 04/11
. - "• ���
�, 709 Uni�ed States Gift(and Generation-Skipping Transfer) Tax Retum oMS r,�.,so�-oo�o
►Inforn�on about Form 7Q9 and its separate instructions is at www.irs.gov/form7Q9.
IrRrinat Ftevenue Serv� (�r gifis made during calendar year 2012) LS O��
►See itssbructions.
1 Donors first nama middle initial 2 Donor's last name 3 Don�s sxial secvity number
DOROTIiY LEISTER 213-12-7592
4 Address(number, cet,and apazhnerrt nunbe� ' S Le9a1 residence(domicQe)
17409 N 37TH AV PENIIISLVANIA
s city,scate,and ZIP poscal cxde 7 C�rip(see instn,c6ons)
GLENDALE AZ 8 USA
0 8 If the donor ied during the year,check here► ❑ and enter date of death Y� �
❑ __...._----------- ' .
� 9 IE you exter► ed the 6me to file this Fa�m 709,chedc here► ;;;;;•;� �-�
10 Enter the to number of donees listed on Schedule A Count each person on�y once,► -'':�;=�`�`4--
E 17a Have ou dono y � ""`�`���
,o� Y ►j previousi filed a Fortn 70.9(or 709-/�for any other yeart If'No.'skip Cu�e 7 y b . �/
t b Has your ress changecl since you last fifed Form 709(or 709-A)7 • • - . . .
i 12 GiRs by h band or wite to third parties.Do you coruent to have the gifts(indudirig generation..siapp��g tr�fe���e
c bY Y��d by your spouse to third parties during the cale�dar year�ons��as made one-haff by each of you? (see
� instructions (If the artsnrer 15•yes,'the folbwing infonnation must be ftm�ished and your spouse must sign the consent
� shown beto .If tfie answer is°No,'sldp Cmes 13-18.) . . . . . . . . . . . . . . . ✓
*� 13 Name of c ting spouse 14 SSN . . x;. -
��'... :?��s:;
a 1 S Were you to one another during the entire calendar year?(see Instruc6o�es) , -
16 If 15 is"IVo,' whether�married ❑divorced� �widowed/dec;eased,and give date(see mstructions)► -�=;;ti�?�?:4�
17 Will a gift rehan for this year be filed spouse (!f �;"'""°�"�'T
bY Your ? "Yes,"mail both retums in the same enveiope.) .
18 Co�errt of .I consent to have the gitts(and generatiorF�ppin9 transfers)cnade by me ar�d bY mY spouse to thi►d pxti�d�aing the calendar year
eonsidered Rmde o�ha1F by each of us.We are both aware of the joint and sevaai iab�'ity for tax created by the exealtion of Uiis consent
��n8� si�acure►
Date►
19 Have you ied a DSUE amount received from a predeceased spouse to a gift or giHs reported on{fifs or a previous Form
709?If"Y 'complete Schedule C . _ . . . . . . . . . , . �
1 Errter amount from Schedule A,Part 4,fine 11 . . . . . . . . . . . . . . . 1 433034
2 Enter amount from Schedule B.line 3 . . . . . . . . . . . . . 2 0
3 Total gifts.Add li�s 1 and 2 . . . . . . . . . . . . . . 3 433034
4 Tax co puted on amou�t on line 3(see Tab/e for CompWng Gift Tax in instruc6ons) . . - - 4 133032
5 Tau puted on amount cn line 2(see Table for Computing Gitt Tax in instructions) . . . . 5 0
0 6 Balanc .Subtract fine 5 from 6ne 4 . 6 733032
7 App e credit amount tf donor has DSUE amount from pr+edeceased spouse(s� errter amourrt
� from edule C,fine 5;otherwise,see mstructions 7
Q 8 Enter e applicabie credit against t�c allowable for all rior . . . . . . . . . . 133032
P Pe�ods(from Sch,B,line 1,col.C) . 8 �
� 9 Balan .Subtract Gne B from 6ne 7.Do not errter less than zero . . 9 733032
�j 10 Fster %(20)of fhe amount aUowed as a
specifc exemption for gifts macle after Septemyer 8,
x 1976, d betore January 1,1977(sae instructions) 10
iy 7 .Subtract line 10 from line 9.Do rtot enter less than zero . . . . . . . _ . . �
N 72 Appli e cr�t Enter the smaller of tine 6 or iine 1'I . _ 11 133032
- • - - • - - - . . . . �2 133032
a 13 Credit foreign gift taxes(see ir�structions) . . . . . . . . . . . . . . . . �g p
14 Total edPts.Add lines 12 and y3. . . _ . . . . . . _ . . f 4 133032
15 .Subtract line 14 from Gne 6.Oo not enter less than zero , , , , , . . 15 0
� 16 Gen -skipping transfer taxes(from SchedWe D,Part 3,col.H,Total�. . . _ . . . . 16 p
m 17 Total Add lines 15 and 16 . . . . . . 1� o
L 18 Gift generation-sldpping transf�taxes prepaid with extension of Ume to file . . . . Z8
� 19 If Gne 1 is less than line'17,enter batance due(see instruct(ons) . . . . ' . . . �
o � If Cne f is greater than Gne 17,enter�nount to be retunded . " ' - . . . . 19 p
�
C Un penakies ofp ry 1 declare that I have exami�ed 8ris retum�indudng arry a�xompanyi schedules and statements,and to the bes!of
p � �e be6ef�k ta true.oorrect.�d cort►plete.�eclaration of prepar+ar(oU�er than donor�is based on atl infammtion of which preparer ha
� Sign
° Here n�r,►�iRS a�,�u,��c�„
� with the Preperer s�wwn befow
L ' (�e'^struc�ons)?�Yes�No
V ' nature of donor
t Date
V P'dIC� F'^ YPe P►aPa►�s narne ?►ePare►'s signahre Date P11N
RU SELL D NELSON �� � fi
a Preparer �-��� P01387512
U�Qnty s neme ► RUSSELL D AIELSON
Frm's E1N► 536-46.571
s address► 2425 W DESERT COVE AV PHOENIX AZ 85029 Phone no_ 602-625-0844 �
For Disdosure, ' Act,and Paperwork Reductio�n Act Notice,sce yie ins6vctions for this forta, Cat No.16783M Form 709(2012)
�� ��
,, ., ,< .
.��� �� � ,
t'Jb/LF71 ZF71d by:Y/ tibbtil�'F9b4b > ' < .
, EDWARD JONES PAGE 05/11
Fonn�os(20�1�
� • omputation of Taxable GiRs pncludin transfers in trust) see instructions �se2
A Does the value of an item listed on Schedule A reflect any valuation discounY/ff`Yes.°attach ex
B ❑ � Check here if you elect under section 52 c P��tion . . _ . - • Yes ❑ No❑
9(?CZ)(B)to treat any transfers made U�is year to a quatified tuiGon program as made ratabty ov�a
5-Year Period iming this year.See fi�,structions.Attach explanadon.
P�t 1—GiRs Sub' to Gift Tax.Gifts less liticai o anizatfon,medical,and educational exclusions. see irtstructions
A •Donee's e and address G H
Item •Relatior�shi to dorar(rf any) C � E F For split Net transfer
number '�Ption f 9ift Dorror's adjusted Date Value at 9IRs.eMer (subtraet
•H the gHt of securities,give CUSIP rro. b�is of gift of 9� date of gift '/z of
•If closely h entkY.9ive QN column F col.G frum
col.�
9 CLAY LEISTE see addendum ;�-;:��=
2 CLAY!EI "�''`"''�;�� �6994 10/29/12 �
,,�,��- �y 336994 336994
see addendum �";�' 89250 i0129/12 89250
�'T*yn� 0 89250
3 CLAY LEISTE see addendum �-z��;�i
:�-�'*zY 19790 70V29N2 19790 0 79790
Gifts made b s use ciom /efe only if �are split�ing itls with � r s ouse and he/she also made iRs.
=a4:�.
�;��">°
.��
n��.�
�:•..,..
�;?�',.��
i�;',fi'iY-,
{j'r'';:'t'��.
Totaf of Part 1.Add from Part 1,column H . -
Part 2—Direct Sidps ifts that are direct skips and are subject to both giR tax and . . . . . . . . . . ► 446034
chronological order. 9e�tion-sldppin9 transfer tax.You must Ifst the gifts in
A •Donee's e and address G
{2em ��O � to dorror(ff any) C p E F H
number '� f gift 2632(b) Donors acfiusted Date Value at ���tt �tra�xfer
•If She gift of secisities.9ive CUSlP no. election b�is of gift of 9� date of 9��errt� (subdact
•If dosely d elrtity,g'ive pN out 9� /z of coL G from
eolumn F wl.�
1
GiRs made by spouse—comp/efe only if you are splitting gifts wi�YourSPouse arrd he/she also made giRs
TO���f Part 2.Add unts irom Part 2,column H . .
Part 3—Indirect S ' Gifts to trusts that are curr . . . . . . . . . - - • - • . . . . . . ►
must list these gifts in ronologica!order. ���b�tO g���d�y later be subject to generation-s{tipping trany-f�{�.You
B
A •Donee's ar►d address
•RelaL'anshi to donor�a�M C p E a H
� � trar�er
num� ���PbO of gift 2632(c) Donor's adjusted Date Value at �R �
•tt Uie giR of sacurities�9ive CUSIP no. ��+0� basis of gift of 9ift date of giit 9�iRjZ�t� ���
'If dose�y entity.give EIN oolurtut F �,�
i
GifLs made by sPou —comp/ete on/y if you are spfitting gifts with your spouse and he/she a/so made
9�-
Total of part 3.Add unts from part 3,column H . .
(If mor�space is n ,attach addiL�onal stafements.) �
Form 709(201�
UO1LU/LG13 G7:�r �ob���e5qe EDWARD JONES PAGE� 06/11 �
r-o��os�20�z� P�3
Part 4—Taxable Gift nciliation
1 Total value of g' of dona.Add totals from cofumn H of Parts 1,2,and 3 . . . , . . . . . . 1 4q6pgq
2 Total annual ex usions fa gifts listed on fma 1 (see instructions) . . . . . . . . . . . . . 2 1300p
3 Total inciuded a ount of gifts.Subtract line 2 f►om tine 1 . . . . . . . . . . . . . . . 3 433034
Deductions see in 'ons ��
) :kx:_:�r�
4 Gifts of interes to '`�I'�
spouse for which a marital deduction will be claimed,based h_:�;:
on item numbe �-----------------------• of SchedWe A . _ 4 ^-
5 Exdusions attri utabte to gifts on line 4 . . . . . . . . . _ . . 5 -:'�'�,
6 Marit�al dedu .Subtract fine 5 from line 4 . . . . . _ . . . . . 6 _
7 Charitable dedu tion,based on item nos.--- M-`-- less exclusior� . ? 'k:��`:
8 Total deduction _Add lines 6 and 7 . . . . . . . . . . . . . . . . . • - • • g 0
9 Subtract line 8 om line 3 . . . . . . . . . . . . . . . . . . . . . . . . 8 433034
10 Generatiorrsidp ing transfer taxes payable wRh this Form 7�(from Schedule D,Part 3,col.H,Total) . . 10 p
11 Taxabte giits. dd lines 9 and 10.Enter here and on page 1,Part 2—Tax Computation,line 1 . �1 4��
Terminable IMe�t(Q Merital Deduatlon.(see instructions tor Schedule A,Part 4,Ane 4)
If a frust(or other meets the requirements of qualified terminable ir►terest property under section 2523(fl,and-
a.The trust(or other roperty)is qsted on Sdiedule a and
b.The value of the t(or other property)ts entered in wtiole or in part as a deduction on Schedule A,Part 4,fine 4,
then the donor shall be eemed to have made an elecGon to have such tnist(or otfier property)treated as qualified terminabte interest property under
section 2523(t)-
If less tfian the entire ue of the U�ust(or other property)that the donor has inGuded in Parts 1 and 3 of Schedule A is entered as a deduction on Gne
4,the donor shap be dered to have made an eiection only as to a fraction of the trust(or other property).The numerator of this fracdon[s squaf to
the amount of the trust or other property)deducted on Schedule A,Part 4,Gne 6.The denominator is equal to the total value of the Uust(or other
properi�Gsted in Parls and 3 of Schedule A.
ff you make the QTIP "oe,the terminab[e iniaest prope�ty invoived wli be included in yau spouse's gross estate upon tris or her death(section
2044).See ir�tructions or fine 4 of Schedule A if your spouse disposes(Iry glft or otherwise)of all or part of the qualitying life income intsrest,he or
she will be cons�dened have made a transfer of the entire propeHy that Is subject to the gift tax.See Transter of Cerlain Life Estates Recelved From
SpoUSe in the insUuctio
12 FJection Out of TIP Treatment of Annuities
❑ �Chedc here if y elect under secbon 2523(t)(6y not to treat as qualified terminable intarest prop�ty any joint and sunrivor amuities that are
reported on !e A and would otherwise be treated as qualified terminable interest property�der section 2523(Q.See instructions.Enter the
ftem numbers irom edule A for the annuities for which you are malcing this election►
� G'ifts From Prior Periods
If you answered°1( "on Gne 11a of page i,Part 7,see the irtstructions far campleting Schedule B.if you answered°No,"skip to the
Tax Computation page 7(or Schedules C or D,if applicable).Comp3ete Schedale A before beginning Schedule B.See instructions
for recaiculation of e cotumn C amourrts.Attach calculations.
C
A B Artaur�of appGcable D
Calendar year or IMemal Heverwa office �edit(unfied cred� Amouet of specific E
calendar quarter where prior retum was fiied agairat 9ift tax exemption for P� /4nouni of
(see instructioru) ior periods after P��ds enduig before t�caWe g'ifts
Decertiber 31,7976 �����1977
1 Totals for prior periods . . . . _ . . . . . . . 1
2 AmouM,tf any by which toffiI specific exemption,line 1,cdumn D is more than$30,OOp _ . . . . . 2
3 Totsl amount f taxable giffs for prior periods Add amount on line 1,column E and amouni,if any�on fine p,
Fnter here and on page 1,Part 2—Tax Computation,Gne 2. . _ .
3 p
pf more space is n ed,aitach additional statements.) p�7���
nb/Ln/Lbl� n�:�r tlbb�(�b54b EDWARD JONES PAGE 07/11
Form 709(201� �4
� D sed Spousat Unused Exciusion(DSUE)Arnount
Provide the fotlowing i rtnation to determine the DSUE amotmt and applicable credit rece.ived from prior spouses.Complete Schedule A
before inn' Sc ule C.
A B C D E p R;��.�1",{���,, ...� �,.,,.
5�.4��"R'f`^:..y�.'j�y'T�',? �''3
Name of Dec�ed Date of Death Portability Bection If`Yes;DSUE DSUEMiamtApp6ed Date of Gift(� •y�..�- .r,-.��..�:-�ec... ''��s,�
�. �E��'�3�"��ti
(dates of death after Made? Amount Reoeived by Donato Ltfetlme (errter as yy-t "` •,�� '�;,:��,."•
Oecember 31.2010 on �SP�� Gifts(Gst artent and f�PaR 1 and as �;.:;��'�:��=�i'r"��=°s�_��#_
'���-i�;';7.''%c�+"-,��i
Yes No P►�9�) YYYY far Part 2) �at g�� �.�„���(;�;•
.?���=��:�:�*t.�1
� f '• � � � � ••
°'."�$�' ,-- F
) � ' • � . '.fri�y�.�.�r:
� '•
N��t .�r r�e>
�;Y.'s3�:i.�=is�i:.C..i.�'�•",::k��-,S.i�r�_�
��•�=.5-.�,,.'5�•�:a:C?-}•trR?F�:7.f'��'k�^6�.'b:�
'•r=s�.,�.1.^�-5�`fr'rF r�"„X'.����
-•s., fc' r'fr3:ni r.:..�.:z�,-i��•-
oi:�= '-'° z'^pf �yy'",�9
z�:�+s��^..r.��.��-�:5
�ti�"��`i��`..r*'Y���C.�"'��;��
}7e3�.�-r•�,�s�:.,�.�� 1F�
��?dTt..:i.`�cN-_.,"~i$'�=:Y.^ __c]
TOTAL or all DSUE amounts ied for Part 1 and Part 2 ''�x"~�""��`'*" =�.' '`�'""::�� �'��-�:
w..r,•=,o:ti.:�a.£L}=.iv:.ri�4•o `�s:'.`•i�i-`..'%�"..�''=�;.��„=f+^-.•-..,�i
i Donor's basic clusion arnount(see irtstructions) . . . . _ . . . . - • - - . . . . 1
2 Total fiom colu n E,Parts 1 and 2. . . . . . . . . . . . . . . . . . . . . . 2
3 Reserved . . . . . . : ,._ .- � . ,
• - • • • . . . . . . . . . . . . . . . . . 3 ��=�`i�=�;�;r=j��� �-= '�;��i
.a-� i>.� :a.. •:f
4 Add lines 1 and . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Applicabie cred t on amount in Gna 4(See Tab/e tor Compuffng Gitt Tax in the instructioris). Enter here and
on line 7,Part 2 Tax Computation - - - . . . - - - • - - - - - - . . . - - 5
..y;...�.,..y4'+ `'�s=�Y^_
2S2rN@d . . . . . . . - • . . . . . . . . . . . . . . . . . 6
:`�`���-�'z�,s�'�.''�.'� �.�::f
7 Reserved . . . . . . . . . . . �.;,;r�r�
. . . . . . . . . . . . . . . . • 7 ;� i`:���n i� �r�
-fi:s�:3k�.s:�G:��::zt.. ^r'.+���K#-.''�s:i
8 ReS6rVed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 �xi,sv��'�-s-��,u_�+;,i "tf:,�,-,-.
- »A..�'�'<.__::;'v::•t�:?`c,:.+`, •;r� %�;
9 Reserved . . . . . . f�"
:3`y �,� :�._:_s:
. . . . . . . . . . . . . . . . . . . . . . 9 -����'��•.�i'��
10 Fieserved . . . �•w��.� x.
10 �.¢•�-:.,�.�;:�:<`-.�'�,. �"'t�;��
� � omputation of Generation-Ski i Transfer Tax
Nate.itrter vivos dire sidps that are completey excluded by the G5T exemption must stiU be futly reported(mduding value and
exemptions daimed) Scheduie D.
Part i—Generation- kipping Transfers
A
ttem No. B C D
(from Sched�de A. Value(from Sd�edule/� Nontaxable Net Tcansfer(subtract
Part 2.wL� P���.M Portion of Transfer coL C{rom eoi.g�
1
Gifts made by (for gift splitting only)
(If more space is n ,attach addrtiorral siatemerKs.) Farm 709(2012)
bb/'Lb/'Lbl� ey:1� �bb8730540 EDWARD JONES PAGE 08/11
Form 7os�zoi2�
aa�e 5
Part 2—G5F Exempti n Reconcil'iation(Section 2631 and Section�52(a 3)Election
Ct�Ck here► ❑ if y are maldng a seclion 2652(ax3)(special QT1P)eiection(see instrvctioru)
Errter the item numbers m Schedule A of the gifts for whic6 you are matdrg this efection►
1 Ma�dmum all fe exemption(see'Instructions) . . . . . . . . . -.---- _ �.-Y 1
2 Total exemption used for periods before filing this retum . . . . . . . . . . . . . . . . . 2
3 Exemption avai le for this ret�m.Subtract Ifne 2 from line 1 . . . . . . . . . . . . . . . . g
4 Exemption ' ed on this retum from Part 3,coiumn C total,below . . . . . . . . . . . . . . 4
5 Automatic al tion of exemption to transfers reported on Schedule A,Part 3(see instructions), , . , . . 5
6 Exemption all ted to transfers not shown on line 4 or 5,above.You must attach a `Notice of Allocation.°
(see instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g
7 Add lines 4,5. 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Ex�n tion avaii e for iuture transfers.Subtract line 7 from Gne 3 _ 8
Part 3—Tax Comp on
A g
E H
item No. �om edule D, GST Exem tbn Divide cd.C �nclusion Ratio F Appiicable Rate Generation
(from Schedule Mocated y (SLbtract col.D Ma�num Estata �AP�9
0,Part 1) PaR .coL D) Y col'B from 1_000) Tatt Rate ���'ool.E l'ransfer?au
bN�1•�] (muFtiply Cd.B by col.(�
1
35% .3
35% .3
359'0 .3
35°.G .3
35% .35
359'0 .3
Gifts made by spoase(for gift splitting oNy)
35% .3
35% .3
3596 .3
35% .35
35% .35
35°.G .35
Total exemption claim . Enter
her+e and on Part 2,bna , above. Total generation-skipping transfer tax. Fster h�e: on Pa9e 3,
May not exceed Part , line 3, Schedute A, Part 4, �ne 10; and on page 1, Part 2—Tax
�e Computation,Bne 16 _
pf more space is nee attaah add'rtional statements.) r-orm 709�207�
bb/Lb/Lbl� ny:1r �bb�(�b54b EDWARD JONES PAGE � 09I11���
ADDEMDU TO FORM 709—2012
SCHEDULE A
1. Ctay eister
17 9 N 37"'Ave,Glendale,AZ 85308
Son
Cash
2. Clay eister
174 9 N 37�'Ave,Glendale,AZ 85308
San
Mo gage Note
3. 3_CI y Leister
174 N 37�'Ave,Glendale,AZ 85308
Son
Cash
� ,,, _ . ,
CJO/LCJ/LCJ1J e��:�r �sbb�s r,�n�4n tllWARD JONES PAGE 10111
- 03/19/2013 5:18:29 PM Page 1
Emest Hoffman
Compound Period ........ : Monthly
Nominal Annuai R te.... : 2.443 %
CASH FLOW DAT
Event Date Amount Num6er Period End Date
1 Loan 10/29/2012 89,250.00 1
2 Payment 11/29/2012 350.00 360 Monthly 10/29/2042
AMORTIZAT(ON S HEDULE- Normal Amortizafion
Date Payment Interest Principal Balance
Loan 10/29/201 89,250.00
1 11/29/201 350.00 184.69 168.31 89,081.69
2 12/29/20'! 350.00 181.35 168.65 88,913.04
2012 Totats 700.00 363.U4 33g,gg
3 01/29/204 350.00 181.00 169.00 gg,744,04
4 02J28/201 350.00 180.66 169.34 88,574.70
5 03/29/201 350.00 180.31 169.69 88,405.01
6 04/29/201 350_00 179.97 170.03 8g,234.98
7 05/29/201 350.00 979.62 170.38 88,064.60
8 06/29/20'f 350.00 179.28 170.72 87,893.88
9 07/29/201 350.00 178.93 171.07 87,722.81
90 08/29/201 350.00 178.58 971.42 87,559.39
11 09/29/201 350.00 178.23 171.77 87,379.62
12 10/29/201 350.00 177.88 172.12 87,207.50
13 19/29/201 350.00 177.53 172.47 87,035.03
14 12J29/201 350.00 177.18 172.82 86,862.21
2013 Totals 4,200.00 2,149.17 2,050.83
15 09/29/201 350.00 176.83 173.17 86,689.04
16 02/28/201 350.00 176.47 173.53 86,515.51
17 03/29/201 350.00 176.12 173.88 86,341.63
18 04/29/201 350_00 9 75.77 174.23 86,167.40
19 05/29/201 350.00 175.41 174.59 85,992.81
20 06/29/20'I 350.00 175.06 174.94 85,817.87
21 07/29/201 350.00 174.70 175.30 85,642.57
22 08/29/201 350.00 174.34 175.66 85,466.91
23 09/29/201 350.00 173.99 176.01 85,290.90
24 10/29/201 350.00 173.63 176.37 85,19 4.53
25 11/29/201 350.00 173.27 176.73 84,937.80
26 12/29/201 350.00 172.91 177.09 84,760.71
2014 Totals 4,200.00 2,098.50 2,101.50
27 01/29/201 350.00 172.55 177.45 84,583.26
28 02/28/201 350.00 172.19 177.81 84,405.45
29 03/29/201 350.00 171.83 178.17 g4,227.2g
�bILGILnl� n�:�r �bb�l�bb4b EDWARD JONES PAGE 11/11
. . ----------•------------------- - --
�. . . - 5�91
. . � OnRS�axg
.1'ortde. .�'o�rr��utlPine�9'�
Real EscrowAcct/Con ��,� - _.
1 6 East�Street� d�Q.15p3-313
� Shi sburg,l�A 17257.� Check#_ 5912 . �
717-532•7387 � - 10/30/12
PAYTOTHE �... Clay a•M. Leister, .Jr:, Agent and. Assignea.. ��**$1 79 49 *
OROER OF . . 9; 0: * .
L�TINSTSffi�T T80II � SgVSN HUNDRRD DTINSTY� DOLLARS and 49/100 -
�. . .: .: : .. . . . . . : . . . . � 0
,. .. :.• .
_ . . . -. . . . Ot.1�4R:
: . . Claytoa ._ Leister, Jr., Ageat.:aad.Assigaee . . ....::. . �
727 .P`ir ide Drive . . . .
... . ... .. ...... . .. -
.-- SouU�Central Nome Setdements,tnc..
� - . �. . � � �. . . . - �
��
` � . ShiPP�$ ��J. PA 17257 ° �� : �" .
� `... .
. � " � . � . . . �.� - - � � � . ' .. . � : . '�ty �, . .
��3LEIST�'727 'reside Drive, -Shippansburg, PA 17257. �'�
.e.r:-��•�.E! � .. . .. �.
O��.�.—'�'...�
� 0059LZ��` �:03 � 3i5036�: iO3 00639Li�'
LIT'T`LE'S �ERAj, $Ql1'I�i Richard A.Little,Jr.,F.D.,necrz4ed
L.ee Ana{Little)Smdy,F.D.,Owner 34 MAPLE AVINUE Shirie H.Little,RD.
John D.Study,F.D. LITTLESTOWN,PA 17340 y
(717}359�224
STATEMENT pF FUNERAI, GOODS Ai�'D SERVICES SELECTED
Charga ue oaly for chose items�6at you seiecced or tLat ue requirecl.If we uc required by law or by a cemetery•or aemuory•[o uu�ng items,we will
eapLtin in wridng below.
If you sclected a fuoeral thac may require emb�lming,suc6 u a funenl with viewing.You mzy h�ve ro pay for embxlming.You do not have to psy!or embalming
you did uot approve if you selecred amngemcnrs such u a direct cremuion or immedia[e burisl.If wc ckarged for emb�Lning,we w-i11 expltin why below.
For the Seraice of Mrc_ Tlnrnth��(' T ai�tor Ihte of Death Ma� 1 4� 2��.3
ctiugew: Mr_C1aYton M. Leister, Jr. 17409 N. 37th Ave Glendale, AZ 85308
Aadz�ss ��S' sure
A.C1fARGE FOR SERVICES SELECIBD: Other cloihing
1_ PR�FESSIO�IALSER�'ICES '
Services of Funecal pirectodSta�.... & 1 R 9 5.QQ a .
Emb�iming...................... 3 79 5.�� Cremuion uro................... 8
Ot6er prcpan[ion of body (DescrlpUon)
OTHER �
............................... E�-5�.00 E
3UB-TOTAL OF PROFESSIOAIAL 3ERYICES.,,,,,,., p� E�-0�0{� s
2.FACILITIES AAiD SERVICFS �'1'OTAL AfHBCHANDISH SELECfID.................9 B E-1F�0.(
Use of 6cilitiet and servias[or C.SPECfAL CHARGES:
viewi�(VisitatioMV�e)......... f--1�Q.00 Forwarding of remains to
Use of facilities and swlces ;
for funenl aremoa (Funeni Home)
y............ 5--�9.00 Recciving of mmaira hom
[Dse of f�aliCia and services for $
Manori�l Servitt ............... E - (Funenl Ho�e)
Usc of equipmeot and scrvices lmmcdiuc Buriat................. f
for graveside urvice............. i • Direct Crcmation................. $
Other use of fadEities s
StD&TO?AL OP SPECIAL CNAItGES ................ C S
D.CAS$ADYANC6D
............................... t Opcning Gnve .................. E�3II111}r
SIDB-TOTAL OF FACILlTIESlEQUIPMENT...........A2 F��.OO CemNay Equipmrnt.............. i
3.AIPCOM01'[VE EQUJPENPSDT Lot and Dccd.................... f
Vehicle ro trtnsfec rtma;ns�p Fuoenl Home. ��sp�Pv Noticea—Lop� ......... 6 120.00 E. Sun
�...........:...............s 275.00 ��PUNotias--Ont-of-town.... f 119.88 CC Times
Heuse(Casket Coach) Tclephone&TdeB� ........... i
Local........................... S.�.Q.Q..DO 'tirfare......................... i
Limousine C�nBF/Mass Offering.............. S--.f�tAily
Pallbtu'ecs...................... 3
Loc�i........................... S Cenified Copics of[he Deuh
Fmw7y ru Cttti&nte .-..�..@..�6........ S��/.��
Loc�i........................... 8 Police Fscort.................... L
Elower car or flord disposition Flowers ........................ J �
�........................... 3 Y�ult Secvitt Chuge........ t
Lead cu/cl�xBY� �ubl i c O�i n;on...... f�40
L°°i........................... E��00 s •
Car for pallbearcw
i
Lorrl........................... s a
Out of town trmsportaGon......... i g
i ;
sus-rorni.oF nnv�►a�c�s....................... D s 4b4.28
a 650.nn
3TDB-TOTAL OF!113TOE1fOTIYE EQ[BIP31F1�T........ A3 S "We chuge you for our sen�ias in obqining:
TOTAL OF PEOEESSIONAL SEItYICES, �S��ilY��o�ncea�bat arn marked-up)
FACILiTIES AApD AUTOMOTIVE NONE
EQUIPll[E!V'P ................................... A a--4�.�p,
B.C[iAkGB FOR 16fERC�fIqApD1SE SELECI'ED: ��A�$Y OF CHAItGfiS
A. Professional Suriccs,Faci9itfa and
Gsket......................••.. f�i(1�.�� Equipment,uid Automotive
(Descripnon}�� 6. "�4s-1�,3�t�"—Ash w/ Equipment...................... s 4170.00
. . rners B. Much�ndise.................:... f�ZD.00
Othtr Rcttp[acle................. i C.S �I C
..... i PAID AT 1711�SECTIO.......... E
OO OF OR P.......... i--�r+.ZH
(Dcscripdon)
D. Cuh Advwca.........NS........................ t--���F.2$
Outcr buriat cont�inet. . '
••-•• RIOSTO
(DtSC[Ip[IOd� Wilhart r�nnfincnt8l V3lllt !II�RA�'GEh1F11T$......................
.......... f
B.U.AlVCE DUE.................................. S—�ZQ�t.2 H
Acknowiedgement cards ........... t—ISw.DO REASOY FOR ENBALAlING
Registcrbook(s).................. S�AD _ ViPwing af ar 4 h G
Memory foldccs ..................E��-00 If any hw,amctery,or cremuory rcquiremears tuvc rcquired the purcl�sse
P�y���..................... i of�ny of the it�ms lis�ed above the&w ot requirement is ezpltined below.
TemPo�Y Bnve muker........... f ,
Buri�l clodiing................... S , ���S—a--�&1���
I agree ihu I Inve enmined r6e items ofgoods and srnices seJected above�od found t6em to be mcrec[�nd ucording to the amngcmeuts I haac rcquatcd.I aclaowledge
recript of�mpy of this St�crmcot of Funenl Goods u�d Savices SeJetted,I represmt that[have sufficien[funds a��ilable for p2yment of the cuh pria for the goods
and sm�iccs seleaed.I�lso zgrec co mal• mt of f within
sigos beiow.A hte ctu of� d�Fs.1�gra[o be ioin�p�nd uvnally liable with aogoa�e�ise�ho
� � per month�mounting to �will be npplied w the uaptid b�hnce beginning da}s
hom the da[e of dtis agreement i wi�n!w pay[o the Fuuee�l Dircttor xtl reuo�ble rnsts pud by the Fuaenl Direcror to colEcct�mounts I owe undu tha a�rnt.
Those costs maq include attomeys'Fea,wurt tosts�nd oihet costs.Atty addition�!scrvicts or merchandise ordaed or rcquested�ftu 16e dau of ttiis:
be coasidered part of this agretment and the mst thaeof will be refiecced on�he fuul bill oc sntement �tD����
(snq May 21, 201�
(Purchuer� �ie
�,�� s.-y,-� �_��
iP°«�r� (lice�esed Funen[Direc�or)
66A20/2013 �9:27 866873�54� EDWARD JONES PAGE 02111
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Southwes Airlines- Purchase Confirmation Page 1 of 2
t
. a�.;��
�xrrt�w�:+��nn�
Thank you for your purchase!
Phoenix,AZ-PHX to Baltimore/Washington,MD-BWI
New Purchases in Trip
Air
G�nfismation#a�4�'?1�05
Phoenix,AZ-PHX to
Baltimore/Washington,MD-BWI
Friday,May 17,2013-Friday,]une 7,
2013
, EarlyBird Check-In Purchased
Air Total: $1153.60
Amount Paid
$1153.60
Trip Total
$1153.60
_rv�ar a�_'.
F�� 05/17/13 - Baltimore
New purchases added to your trip.
AIR
Phoenix,AZ-PHX to Baltimore/Washington,MD-BWI Confirmation#.��'=�'9?��;��
OS/17/2013 - 06/07/2013
Senior Passenger(s) Rapid Rewards#
JEANETTE LEISTER 00020169345442
CLAYTON LEISTER JR
Subscribe to Flight Status Messaging
DEPnRT 06:00 AM Depart Phoenix,AZ(PHX)on Fi�qnc ,:
. ___
! :�,av v Southwest Airlines #�49 '•�T��"'�f Friday,May 17,2013
. —FRI� .
01:25 PM Arrive in Travel Time 4 h 25 m
Baltimore/Washington,MD (Nonstop)
�BWI� Senior
RETURN 09:15 AM Depart Fiiqnt .,;,;� Friday,June 7,2013
��,a� Baltimore/Washington,MD #331 �T„',v�.T
F92a (BWI)on Southwest Airlines Travel Time�}h 50 m
31:05 AM Arrive in Phoenix,AZ(PHX) (Nonstop)
Senior
What you need to know to travel:
Don't forget to check in for your flight(s)24 hours before your trip on southwest.com or your mobile device.
Southwest Airlines does not have assigned seats,so you can choose your seat when you board the plane.You will
be assigned a boarding position based on your checkin time.The earlier you check in,within 24 hours of your
flight,the earlier you get to board.
https://www.southwest.com/reservations/confirm-reservation,s.html?disc=pdc%3A1368643927.970000%3Atg-14qDH R... 5/15/2013
Airlines- Purchase Confirmation Page 2 of 2
PRICE:SENIOR
Trip Routing Fare Type�View Fare Rules Fare Detaits Quantity Total
6: IJo Gh2ny°Fees
(applicetle rare differance zpplies)
Depart PHX-BWI ���� � Fcus��ie��:'uras 2 $551.80
��� (,r.ontr�nsfersble-no name c`engss allov�ed)
�'� Refundable
_... .._..,...:.,_,.,...�..�.,. �..,._:....-.. ., :._.:_... ,_.s..,_ ..,. ._..�.,,..., .... .......... ...:.-_.
0 No Chana2 Fees
���� (applicable fare differenr.e zpplie;)
Retum BWI-PHX �� �� R=usableFuntls 2 $551.80
� (nontransferable-no name chang=s�alloweA)
�r Refvndabfe
Earn at least 3180 Rapid Rewards Points per person when you take this SubtOtal $1103.60
trip. Fare
ereakdown
Carty-on Items:1 bag+1 small personai item are free,see full details.
�Checked Items:First and second bags are free,size and weight limits appty. 80g ChdfgE $0.00
EARLYBIRD CHECK-IN PRICING
Option Passenger Price Quantity Details Reeeipt# ToWI
EarlyBird Check-In JEANETTE LEISTER $12.50 1 PHX-BWI 5260629039041 $12,50
EarlyBiM Check-In CLAYTON LEISTER lR $12.50 1 PHX-BWI 5260629039040 $12.50
EarlyBird Check-In JEANETTE LEISTER $12.50 1 BWI-PHX 5260629039039 $12.50
EarlyBird Check-In CLAYTON LEISTER]R $12.50 1 BWI-PHX 526D6Z9039042 $12.50
Subtotal ;50.00
Air Total:
$1153.60
Gov't taxes&fees now included
PufChaser Name Jeanette Leister Billing Address 17ao9 N 37Th Ave
Glendale,AZ US 85308
Form of Payment Amount Applied
Visa-XXxxxXxxxxxx-3367 $1153.60
Amount Paid
$1153.60
Trip Total
� $1153.60
https://www.southwest.com/reservations/confirm-reser�ations.html?disc=pdc%3A1368643927.970000%3Atg-14qDH R... 5/15/2013
• -
�� 1^i`�er��'"IS�
Rental agre��:�t Sumiary
R�# �344460�2 ,
RENTER: JEA;tE�`� IEISTER
Non-Loyalt;
"' Date�: ,•' •�� Q Location
iil33i
Friday, P•tay ;. , -- 7426 NEW RIDGE RD PO
14:26 Pht BOX 347 HANOVER hID,
21076-3101
(41�)68��-3295
fridny, June 07, �013 74?6 NEW RIDGE RD PO ;
13:3� PI'•I BOX 347 HANOVER P•ID,
� 21076-3101
(�1��684-3295
QVehicle
---_----------
hlake/Mode1:NISN/ALTI
Color:BLP.CK
. i�lileage:6&
Fuel:8
License#:4BC8�81 „
Vehicle#:DCZ58820 -- _-__--_—- •
_ .__ _--------
Vehicle Co�dition '
OCharges Price/Unit You
TID1E & DISTANCE: $�5.63%� �-� •
TIPIE & DISTANCE: $128.15/L�*3 $256.30
EXTftA - TIb1E & $18.31.%D*C� $1'8.11
DISTuNCF:
Eii�fRa1 - f!�'' ���
�,3.CiG/H $0.00
pi`�fAlv�-t
� �;, �;�:,,�, 6�, ,,�!ra �''.�`'' .
CUSTUP�1Eh $=.75iu'C1 �fO."
FACILITY CHRG '
3.75/DAY:
TRANSPORTATION $1.60/D*21 $33.60
� FAC CHG
1.6�/DAY:
CONCESSION $0.�0/C*21 ��•38
RECOVERY FEE
11.11
' PCT(11.11%�:
VEHICLE LICENSE $0.40/D*21 $$��
FEE .�40/DAY:
SALES $0.00/C*?1 $63.55
TAX(11.5%)� --------------- .
7otal Estimated Charge:
$616.15 .
flPnos itS:
. ,._ , _ : _. . .
� � ___ �
�_
CUS`OIIER $=.75iii*C1 ���.,�
FACILITY CHRG
3.75/GAY:
� TRANSPORTATION $1.60.'D*21 $33.60
' FAC CHG
1.6�/DAY:
CONCESSION $0.�0iC*21 $47.38
� RECOVERY FEE
11.11
PCT(,11.11%):
VEHICLE LICENSE $0.40/D*21 $8-40
FEE .�40/DAY:
SALES $0.00/C#21 $63.55
TAX�11.596):
—--------_--------
Total Estimated Charge: $616.15
Deposits:
VISA *;�if33387 $739.38
Additional Drive�s
` Except as provided in a separate corporate sales
� oi� tuur agreement or as required by law, no
additional drivers are authorized to drive the
vehicle with the exception of the driver�s listed
betow.
(Additional driver names listed here if
. applicable)
OProtection Products
COLLISION DAhIAGE WAIVER FULL declined 05;17/2013
COLLISION DAh1AGE WAIVER $1000 declined
05/17/2013
PAI/PEC declined 05/17/2013
SUPPLEkIENTAL LIABILITY PROTECTION declined
05/17�`2013
ROADSTDE ASSISTANCE PROTECTION declined
05/17%2013
OWNER: ENTERPRISE RAC COIdPANY OF BALTIMORE, LLC
' Please keep this Rental Agreement Sumnary with
. you in the vehicle.during the rental.
�local Addenda
�is cantract offers, for an additional charge,
a callision dcmage waiver to cover your
responsibility far the damage ta the autanobile.
Before deci�ing whether to purchase the
. collision danage waiver, yau may wish ta
detern�ine whether your dwn autanobile insuranc�
aff�rds you coverag� far danag� to th� rental
autanobile and the anaunt of the deductibl�
under your own insurance coverage, The purchase
�� +h;c r�,l l i c i nn rlr�mna wni var i C nn� mf]Mf���(11'�
�� � r __
.
. � � ` �S� . . . . ..._.
JERRYA.wE�GLE WEIGLE & ASSOCIATES, P.C.
Attorneys-at-Law
Associates 126 EAST IQNG STREET
JOSEPH P.RUANE SHIPPENSBURG,PENNSYLVANIA 17257-1397
RICHARD L.WEBBER,JR.
TELEPHONE(71'�532-7388
Of Counsel FAX(71�532-5289
THOMAS L.BRIGIiT www.weigleassociates.com
MARK W.ALLSHOUSE
September 4,2013
Pennsylvania Department of Revenue
Bureau of Individual Taxes
Inheritance TaY Division
Department 280601
Harrisburg,PA 17128-0601
Re: Dorothy C. Leister,deceased
S.S.#x�x-�-7592
DOD: May 14,2013
Dear Ladies and Gentlemen:
I represent Clayton M. Leister.He is the son of Dorothy C.Leister,deceased. In addition,he is
named as the Executor in the Last Will and Testament.
I have enclosed Rev-1 S00 Inheritance Tax Return Resident Decedent.
T'he following two accounts are listed in the letter from Lisa R.Kline of Orrstown Bank dated
June 5, 2013: ,
1. Certificate of Deposit#4000028008 in the amount of$11,20230; and
2. Certificate of Deposit#4000035493 in the amount of$12,967.32.
We did not list those Certificates of Deposit on the inheritance tax return. Mr. Leister indicated
that Certificate of Deposit 400028008 was closed and liquidated on May 30, 2012. The entire
proceeds of that Certificate were placed into checking account#647829. Certificate of Deposit
4000035493 was closed and liquidated on or about October 30,2012. He further stated that the
entire proceeds of this Certificate were deposited into Orrstown Hometown Investment Bank
Checking Account#103210105. Each of these two checking accounts are listed on schedule F,
items 6 and 4,of the Inheritance Tatc Return. I have enclosed supporting documentation.
Please feel free to contact me if you have any questions or if you need additional information.
Respectfully submitted,
WEIGLE&ASSOCIATES,P.C.
/ C_� �
Richard L. Webber,Jr.,Esquire
RLW/paf
Enclosure
Cc: Clayton M. Leister,Jr.
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