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HomeMy WebLinkAbout08-29-13 � 1505611184 REV-1500 fx{ar_,,,tFi,r� PA Department pf Revenue PM�h� OFFICiAI USE QNLY Bureau of IndiWdual Taxes """"Ytln""rw County Code Year File Numher PO BOX z8o641 INHERITANCE TAX RETURN �� !� �� j�� ttamsbury,RR s�izs-o6ai RfSIDENT DECEDENT J ENTER DECEDENTINFORMATIpN BELOW Social Securiry Number Date af DeSth MMDDYYYY pate of Birlh MMDDYYYY 10182d22 01341934 DecedenPs Last Namd Su�x Decedenfs First N2me MI JUZBASIC SfiEPIiEN A {if Appiicabte}Enter Surviving 8pouse'a intormation Below Spouse's Last Name Su�x Spouse's Pirst Name MI Spouse's Social Secunty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WI�LS FILI IN APPROPRiATE 4VALS BEIOW ($� 1. Odginal Retum (� 2.SupplemaMal Retum Q 3. Remainder Retum(dste ot tleath priorto 12-t3-82} Q 4, �imited Estete Q 4a.Future Intareat Cam�mise(dste af Q 5. Federat Estsie Ta�c Retum Raquirsd desih after 12-12-82) p 8. DaceAant Died Testate Q 7. DecedeM Mainlalned a LiWng Trust _ 8, Total Number of Safe Dapoait Boxea (Attech Copy pf 4VIII} {Atlach Copy pf Truat) C� 9.�ltigation Praceeds RecBived � '10.Spouasi PovBtty Credit(date of tleath � tt. EleGian to t�unCer Sec.9113(A} behvAen 12-31-97 and 1•1-85} (Attach Solredula O) CORRESPtlNDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPQNpENCE ANQ CONFIDENiIAI TAX INFORMATION SHpULD BE DIRECTED T0: Name Daytlme�Tyiaphane NurtOer G - -,. , FRANK H KELLY EA 717 �7�'. 7536,_� � �'� �F bF W(iL$USH ftt�1( I i^- ,_ -�,� I A M::_ : � --� C•� .. First line ot address � - . ' � '���� 400 BRIGDE STREET. SUTTE #4 v �� --� Sacond line oi addrese ,� � �=? .� : f�? � 7 CJ ,i Gl V ,� City or Posf Office StaiB ZIP Code DA'FE FiLED ' NEW CUMBERLAND PA 17070 CorrsspandenPa a�mail addross:FRANKKELLY@KELLYTAX.CpM Untler penattba ot perjury,I deUara thet I hava ezaminetl thin retum,InGutlinp accomparrying acfredules antl s�temenb,en0 to the beat of my knowleOpe anC belbf, it is Uva,cortecf anA compie4e.DeGaradtm ot Pre¢arer�er than the P��ai repreaeniaiive is Oased ort aH infamatbn W which preparer has etry knowietlga. SIGNATURE pF ON�'2F.iPqN5161�.i9R'FILING RETUHN DATE � ADDRES� 142 SZXTEENTI3 ST , CLiMBERLANI7, PA 17070 OF PR R ER THAN REPRESENTATIVE DATE 0 S 4 0 E STREET, SUITE #4 NEW CUMBERLANZ}, PA 1707Q PLEA88 UsE ORIOiNAL FQRM ONLY Side 1 L 1505611184 1505611184 � ��� J 1505611284 REV-1500 EX(FI) Decedenfs Social Securily Number oecedenrsName:STEPHEN A JUZBASIC RECAPITULATION t. Real Estate(Schedule A). . . . . .. . . . . . . . . . . . . .. . .. . .. . . . . . . .. . . . . . . .. . . 1. 1 O H , 812.�� 2. Stocks and Bonds(Schedule B) .. . . . . . . . . . . . . .. . . . . . . . . . .. . . . . .. . . . . . . 2. 211, 3 7 8.0 0 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . .. 3. . 4. Mortgagea and Noles Receivable(Schedule D) . .. . .. . .. . . . . . . .. . . . . .. . . . . 4. . 5. Cash, Bank Deposds and Miacellaneous Personal Property(Schedule E). . . . . . . 5. 11, 71�.�� 6. Jointty Owned Propetly(Schedule F) O Saparate Billing Requested . . . . . . . 6. 9 , 319.00 7. Inter-Vivos TransTen&Miscellaneous Non-Probate Proparty �scneauie c� O Separate Billing Requestad.. .. . . . . 7. 2$5, 449.00 B. Tohl Groas Asseb(total Lines 1 through 7). . . . . . . .. . .. . . . .. . . . . .. . .. . .. 8. 62 6, 6 6 8.0 0 9. Funeral Expenses and Administretive Costa(Schedub H). .. . . . . .. . . . . . . .. . . 9. 53 , 23 7.00 10. Debts of Decedent, Mortgage LiabilHies, and Liens(Schedule I) .. . .. . . . . .. . .. 10. , 11. Tofal Deductlons(total Lines 9 and 10). .. . .. . .. . .. . . . .. . . . . . . . . . .. . . . . . 11. 53 , 237.00 12. Net Valua of Estats(Line B minus Line 11) . . .. . .. . .. . .. . . . .. . .. . .. . . . . .. 12. 573 , 431.00 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an eleclion to tax has not bean made(Schedule J) . . . . . . .. . . . . .. .. . .. . .. . . 13. , 14. Net Value SubJeet to Tu(Line 12 minus Line 13) . . .. . . . .. . .. . .. . . . .. . . .. 14. 5 7 3 , 4 31.0 0 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount oi Line 14 taxable at the spousal tax rate,or transfers undar Sec.9116 �a>��.z>x .o45 537 , 050. �e. 24, 167 .25 16. Amount of Line 14 Wxable at lineal rate X.0_ , �6. � 17. Amount of Lina 14 taxable at sibling rate X.12 , �7. , 18. Amount of Line 14 taxable at wllateral rate X.15 . �g, , 19. TAXDUE . . . . . .. .. . .. . . . .. . . . . .. . .. . .. . . . . . . .. . .. . . . . . . . . . .. . .. . .. 19. 24, 167.25 20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505611284 1505611284 � REV-1500 EX(FI) Page 3 Flla Numbsr �p 12 .01179 Deeedent's Campfete Address: DECEOENTSNAME Stephen A Suzbasic ____ _..__---- _.------...---- — STREETMDRESS __ . _-- -- _...---- 142 Sixteenth Street -- --- ___---- - -- — ---- --- ---------- -- . — -- -_ CI7Y i STATE ZIP New Cumberland .PA �17070 Tax Payments and C�edlts: t. Ta�cDue{Page2,Une19j (i) 24,167.25 2. CreditslPayments — A.PnorPaymente _. _3�,494 $.Discwunt 1,2 68 TotalCredits{A+g) {2) _ 31,7D2.00 3. Interest {3J 4. If Gne 2 is greater than Line 1+li�3,errtet the dil�tence. Tl�s is the OYERPAYt�NT. � FIIt in oval on Page 2,tina 20 W request s relund. (4) 7,53 4.7 5 5. It line 1+Line 3 is greater than Line 2,eMer the diNerenca.This ia the TAX DUE. (5) Make check payable to: REGISTER OF WII.�S,AGENT. PIEASE ANSWER THE FOLLQWING QUESTlONS BY PLAClNG AM "X"IN THE APPRQPRIA7E BLdCKB T. Did decedent maka a transferaM: Yes No a. retain Ihe use or inwme of the properry vansferced:......................................................................................_.. ❑ � b. retain the right to designate who shall use the prupeAy transtertsd or its income;.._......._....._................._..... ❑ � e. rehain a reversionary interest_........._......................._.............._...........:................................._..................... ❑ � d. receive the promise Por life of either paymen45,benefits or care7...................................................................... � �,] 2. If deaM occurred after Dec.12,1982,did decedent t2nsfer properry wfthin one year of death withflut recei»ng a�equate cansideratbn?.............................................................................................................. ❑ � 3. Did decedent own an"in trust fof'or peyabie-upon-death bank eccount or sewrity at his or her deatlr?.............. ❑ (� 4, pid decedent own an individual ratirement account,annuily nr other non-probate property,which contains a beneficiary designetion? ..................................._........_........................................ � � ...................._........... IF THE ANSWER TO ANY 4�THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE7URN. Fa dates of tleath on w aRer Juiy 1, 1994,and befae Jan. 1, 1995,the faz rate impa�d on the net ve�e of tran&fers to or foe the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(i.i)(i)1• For dates of death on or after Jan. 1, 1995, tha tax rata imposed on the net value of hansfer� tu or for the use of the surviving spouse is 0 percent (72 P.S.§9118{a){1.1){ii}].The sta#ute daes oot exem�a transfer to a surviving spouse ftan Iaac,and the statutay requirem�ts fa diselosure of asseGs and filing a t�retum are stiH applicabie even if the surviving spouse is the onty beneficiary. For daRes of death on or after July 1,2000: • The taac tate imposed on Uie net value of transfets from a deceased sfii�! 21 years of� or young�at death fa flr kx fhe use of a natural parent, an adc�a6ve pareM or a steppareM of the child is D percsnt[72 P.S.§91i8(a}{1.2)]. • The tax rate imposed on the net value of transfers ta or for the use oi the decedenYs lineal benefiaaries is 4.5 percent,except as noted in[72 P.S.§9118(a)(1)J. • The tax rate imposed on the net value of transfars to or for the osa of the decedenYs siblings is 12 percent(72 P.S.§9116{a}{1.3}].A sibling is defined, under Sectian 9102,as an individuaE who has at Ieast one parent in common witti the decedent,whether by 6lood or adoptio�. REV-1502 EX+(01-10) �pennsylvania SCHEDULE A OEVANTMENT OF NEVENUE INHERITANCE TAX REfURN REAL ESTATE RESIDEM OECEDENT ESTATE OF FILE NUMBER Stephen a Juzbasic 2012.01179 All real proparty owned solaly or ss a hnant In common must be reported at hlr markat valua.Fair market value is defined as the price at which property would be ezchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Raal properly that Is Jointly-owned with right of survivonhip must ba disclo�ed on Schedule F. Attach a copy af the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1, House and Land - 142 16th Street, New Cumberland, PA 108, 812 Based on appraisal dated 4.29.13 by Gina DiStafano The appraisal dated 4.29.13 is low - we used a blended rate between the value as established through zillo and the appriasal. The Zillo estiamted FMV is $150, 624 while the appriasal is $67, 000. The property has been valued a the average of the two figures - for a FMV of $108, 812 . TOTAL(Also enter on Line 1, Recapitulation.) ; 108, 812.00 If more space is needed,insert additional sheets of the same size. REV-1503 E%+(&12) �pennsylvania SCHEDULE B DEVANTMENT Of XEVFNIIE INHERITANCETAXRETURN STOCKS & BONDS RESIDENT DECEOENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 All property jol�y owned wRh�Ipht of aurvlvonhlp muet 6e dlselaed on Schadub f. ITEM VALUEATDATE NUMBER DESCRIPTION OF DEATH �� U S ^aavings Bonds 211,378 TOTAL(PJsoenteronline2,Recapitulafion) S 211,378.00 If more s0ace is needed,inseA addRional sheeb of the sama sae REV-1504EX+(8-98) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR IN RE8 DAE TEDEC DENTRN SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 Schadule C4 or C-2(including all suppotling information)must ba atlached tor each clasely-heW coryorotionlpertnership interast of tha Aecedent,otherthan a sob-proprietorship.See instrucliona for the suppoRing inPormatian to be submitted far sole•propriatoBhipa. ITEM VALUEAT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL(Also enteron line 3,Recapitulatan) E (If more spaca is needed,inuM1 adddional sheeb of tha same s¢e) REV-1505 EX+ (11-11) �pennsylvania SCHEDULE C-1 j�� DEP�RTMENTOFXEVENUE CLOSELY-HELD CORPORATE INNERITANCETA%RENRN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OP FILE NUMBER Stephen A Juzbasic 2012 .01179 t. Name of Corporation None State of Incorporetion Address Date of Incorporation City SWte_ ZIP Code Total Number of Shareholders 2. Federal Employer ID Number Business Reporting Year 3. Type of Business ProducUService 4 ��i,;t E�E�:� :a� ��, 3�� �;5���� ;.'¢ �fi �i. !¢i'�3 i�S !E j � � Sd�� � I �� �!. � 1(F, ����� F� � �i � r���a � ..�'� �i ��I�,"F��I�°� ���1�5�9� Common j Prakmd j Provide all rights and restrictions pertaining M each Gass of stodc. 5. Was the decedent employed by the corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, Position_ Mnual Salary $ Time Devoted to Business 6. Was the corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, provide amount of indebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedenY7 . . . . . ❑Yes ❑No If yes, Cash Sunender Value$ Net proceeds payable$ Owner of the policy_ 8. Did the decedent sell or transfer stock in this company within one year prior to death or within lwo years if the date of death was prior to 12-31-82? ❑Yes ❑No If yes, ❑Transfer ❑Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was thera a wrilmn shaieholders agreement in eRect at the time of the decedenYs death7 ... . ❑Yes ❑No If yes, provide a copy of the agreement. 10.Wasthe decedenPs stodcsold9 . .... . . . . .... .. . . ..... . . .... .... . . . . ........ . . ....... ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 11. Was the coryoration dissolved or liquidated after ihe decedeM's death? .. .... .. . . ......... . ❑Yes ❑No If yes,provide a breakdown of distributions received by the estate,inGuding dates and amounts received. 12. Did the corporation have an interest in other corporations or paRnerships9 . . . . . . . . . . . . . ❑Yes ❑No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each intarest. • • •' • � � A. Detailed ralculations used in the valuation of the decedenYs stock. B. Complete copies of financial sfatements or federal corporate income tax retums(Fortn 1120)for the year of death and four preceding years. C. If Me corporation owned real estate,submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured,attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationships to the decedeM. E. List of officers,their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those deGared and unpaid. G. Any other infortnation relating to the valuation of the decedenYs stock. (If more space is needed,inaert additional aheets of the same size.) REV-1506 EX+ (12-11) ' il �pennsylvania SCHEDULE C-2 ' OEPAFTMENT OFNEVENUE PARTNERSHIP INHERITANCETAI(REfURN INFORMATION REPORT RESIDENT DKEDENT ESTATE OF FILE NUMBER Stephen A Juzbaslc 2012 .01179 1. Name of Partnership None Date Business Commenced Address Business Reporting Year City State ZIP Code 2. Federal Employer ID Number 3. Type of Business ProducUService 4. Decedent was a ❑General ❑Limited partner. If decedent was a limited partner, provide indial invea4nent$ .. .m. , . � . . ,. . 5 .. : ^ � � ' ���t , ' � ; ` � ' i ,,, , �III }� ,.:` ` . _ . ., . t, .s . �� ="�Ii t �- .r ,t �� i i " . . ....'r ... ... .�.. {, ,: .,. .:�..N!R' -: A. B. C. D. 6. Value of the decedenYs interest$ 7. Was the partnership indebted to the decedent9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p Yes ❑No If yes, provide amount of indebtedness$ 8. Was there life insurance payable to the partnership upon the death of the decedenY� . .. ... ❑Yes 0 No If yes, Cash Surrender Value$ Net proceeda payable$ Owner of the policy_ 9. Did the decedent sell or transfer an interest in thia partnership within one year prior to death or within lwo years if the date of death was prior to 12-31-829 ❑Yes ❑No If yes, ❑Transfer ❑Sale Percentage trensferred/sold Transferee or Purohaser Consideretion$ Date Attach a separete sheet for additional trensfers and/or sales. 10. Was there a wrilten partnership agreement in efied at the time of the decedenYs death? . . .... ❑Ves ❑No If yes, provide a copy of the agreement. 11. Was the decedenPs partnership interest sold7 ........ . . . . .... . . . . . . . . .. .. . . . . .... . . .. . ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 12. Was the partnership dissolved or liquidated after the decedeM's death9 ... .. . . . ..... . . . . ... ❑Yes ❑No If yes,provide a breakdown of distributions raceived by the estate, induding dates and amounb received. 13.Was the decedent related M any of the partners9 . . . ........ . . . ...... ... ......... . . . . .. ❑Yes ❑No If yes, explain 14. Did the partnership have an interest in other corporetions or partnerships9...... . ....... . ❑Yes ❑No If yes, report the necessary infortnation on a separete sheet, including a Schedule C-1 or C-2 for each interest. •' • � � A. Detailed calculatlons used in the valuation of the decedanPs partnership interast. 8. Complete copies of finandal statements or federal partnership income tax retums(Fortn 1065)for the year of death and four preoeding years. C. If the partnership owned real estate,submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other infirmation relating to the valuation of the decedenYs partnership intereat. REV-1507 EX*(e-98) SCHEDULE D COMMONWEALTH OF PENNSYWANIA MORTGAGES 8 NOTES INHERITANCE TAX REfURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 All property Jointly-0wned with rlght of aunivonhip mwt be dleelaed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH None TOTAL(Also eMer on line 4,Recap@ulation) f (If mare space is needed,insert addkbnal sheets ot the same srze) REV-1508 EX+(08-12) � pennsylvania / SCIIEDULE E �i� DEPAFTMENTOFPEVENUE y/�SH� BANK DEPOSITS & MISC� INHERRANCE TA%RETURN PERSONAL PROPERTY 0.ESI�ENT DECEDENT ESTATE OF: FILE NUMBER: Stephen A Juzbasic 2012 .01179 Include the proceeds of litigation and[he date[he praeeds were received by the estate. All property�ointty owned wkh rlght ot survivanhip must be disclosed on Schedule F. ��M VALUE AT DATE NUMBER DESCRIPT[ON OF DEATH 1. ri & T aank 49942107 B, 935 2. M & T Bank 031003913917993 - closed 10.12 .12 0.00 3. 1998 Pontiac Sdn 1G2wJ52KXWF303462 1, 500 4. Personal Property - living room furniture, household goods, Television, bedding, bedroom furniture - bed, dresser, nightstands clothing - value determined by using the IRS/Salvation Army Tab].es 1,275 TO7AL(Also enter on Line 5, Recapitulation) ; 11,710.00 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) �pennsylvania SCHEDULE F V� OEV�RTMENTOFXEVENUE �OINTLY-OWNED PROPERTY INHERIiANCE THX REfURN RESIDEM DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.011'79 If an asfst was msde JoiM wilhin ons year of the deeedanPe deb of death,it muet be reported on Schedule G SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIPTO DECEDENT A� Stephen A. Juzbasic 142 16th Street Son New Cumberland, PA 17070 B. C. JOINTLY-0WNED PROPERTY: LEfiER DATE �ESCFIPTION OF PFOPERTY %OF DATE OF DEA7H ITEM FORJOIM IMOE INCLUDEWIMEOFFIWINCIAINSTRUIIONANDBANKACCOUMNUMBERORSIMIUR �ATEOFOEAM OECEOENTS VAWEOF NUMBER TENAfJT JOINi IOENTIFYINGNIIMBER.ATfACH�EE�FOftJ01N1lYAELDREALESTATE VALUEOFA65Ef INTEREST UECEDENTSINiEPEST 1. A. 12222000 Fulton Bank Account 052 .0133827 7,634 50 3,817.00 2• A 08312004 Sovereign Bank 0775514953 11,004 50 5,502.00 TOTAL(Also enter an line 8,Recapduladon) S 9,319.00 pf more s0ace is needed,insetl addNional sheets of the same siu) REV-1510 EX+(OB-09) �pennsylvania SCHEDULE G ��� DEP�PTMENTOFXEVENUE INTER-VIVOS TRANSFERS 8 INHE0.RANCE TAX REfURN MISC. NON-PROBATE PROPERTY RESIDEPLr DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012 .01179 This schedub must be completed and filed Htha answer to any of queations 1 through 4 on the reverse sida al the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCW�ETIEN4MEOFT1EiNAN6FEREE,IHEIFRElATI0N5HIPT0�ECEDENTAND DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE NUMBER T1E]AlEOFTRAN&FEF.ATACHACOWOF7MEPFE�FORRFALESTATE. VALUEOFASSET INTEREST (IFAPPUCABLE) VAWE 1. Western National Life Insurance Company 256, 889 100 256,889.00 2 • Fulton Bank NA IRA Account 390.1971350 13, 649 100 13,649.00 3 . Sovereign Bank NA 2RA Account 0778116822 3,298 100 3,298.00 4. Sovereign Hank NA IRA Account 0778118067 4,265 100 4,265.00 5. Sovereign Hank NA IRA Account 0778118109 3, 759 100 3,759.00 6. Sovereign Hank NA IRA Account 0778118158 3, 589 100 3, 589.00 TOiAL(AlsoeMeronline7,Recapftulation) S 285,449.00 pf more space is needed,inseA adddbnal sheats of the sama siza) REV-1511 EX+(10-09) �pennsylvania SCHEDULE H �y� DEPAFTMENTOFNEVENUE FUNERAL EXPENSES 8 MHERITANCE TAX 0.EfURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasi.c 2012. 01179 Debb of decedeM mwt be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUM n. FUNERALEXPENSES: �� Wiedman Funeral Home, Steelton, PA 3, 826 2 . B. ADMINISTRATIVE COSTS: 1. PersonalRapreserAetive'sCommissions 29,242 NameofPersonelReprexrdatNe(s�Stephen Juzbasic SYreetAddress142 16th Street CiryNew Cumberland SlatePA ZIP17070 Year(s)Commissbn Paid:2 013 2. Attomey Feae 3. FamiyExemption:(IfdecedenPseddressisnMthasamaesclaimanPs,attechexplanation) 3,500 CWimant Stephen A Juzbasic SlreatAddreas142 16th Street CiryNew Cumberland SatePA ZIP17070 RelatbnahipafClaimandoDecadent Son 4. Probate Feea q 2$ 5. Accountant'sFeas 6. Tax Retum Preparer's Fees 16,2 41 7. TOTAL(PJso enter on line 9,Recapituladon) S 53,2 37.00 (If mae space is needad,inseA addkbnal sheeta o(the same sae) REV-1512 EX*(12-OB) '�i� pennsylvania SCHEDULE I � DEP�RTMENTOFNEVENUE DEBTS OF DECEDENT, INHERRANCETA%0.ETURN MORTGAGE LIABILITIES & LIENS NESIDENT DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 Report debts incurred by the decedent prior to death lhat remained unpald at the date oi dealh,Including unrelmbursed mediwl expense�. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 70TAL(Also enter on Line 10, Recapitulation) ; If more sDace is nee0ed,insert a0ditional sheets of the same size. REV-1513 EX+(01-10) � pennsylvania SCHEDULE ) INHE0.RANCETAI(0.EfURN BENEFICIARIES 0.ESIDENT DECEDENT ESTATE OF: FILE NUMBER: Stephen A Juzbasic 2012.01179 RELATIONSHIP TO DECEDENT AMOUNT OR SNARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Truatee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal dis[ributions and transfers under Sec. 9116(a) (1.2).) 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUiI0N5 SHOWN ABOVE ON LINES IS TNROUGH IB Of REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABIE DISTRIBUT10N5 A. SPOUSAL DISTRIBUTIONS UNDER SECRON 9113 fOR WHICH AN ELECRON TO TAX IS NOT TAKEN: 1. B. CHARIfABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV•1500 COVER SHEFf. ; If mare space is needed, use additional sheets of paper of the same size. REV4514 E%*(4-09) �pennsylvania SCMEpYLE K DE>�RTMENTOFPEVENUF LIFE ESTATE, ANNUITY Bureau of IndlNduat Taxes &TERM CERTAIN PD BO%380601 Hartisburg PA t9u8o6ot (CFiECK BOX q ON REV•1500 COVER SHEEn ESTATE OF FILE NUMBER Stephen A Juzbasic 2012 .01179 This schedule should be used for all single-life,joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publicatlan 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume far dates of death from 5-1-99 and thereaRer. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax retum. ❑ Will ❑ Intervivos Dced of Trust ❑ Other . !,k, � :hL i; '� �i; , ❑ Life or ❑Tertn of Years ❑Life or ❑Tertn af Years ❑Life or p Tertn of Years ❑ Life or p Tertn of Years ❑Life or ❑Tertn of Years 1. Value of fund from which life esWte is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Actuarial fac[or per appropriate Wble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest table rate -❑3.5% ❑6% ❑ 10% ❑Variable Rate % 3. Value of Iite estate(L1ne 1 multiplied by Llne 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ � ;j€, ❑ Life or p Tertn of Years ❑Life or ❑Tertn of Years ❑Life or ❑Tertn of Years ❑Life ar ❑Tertn of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . . Frequenq of payout--p Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12) ❑ Quarterly(4) ❑ Semi-annually (2) ❑ Annually(1) ❑Other( ) 3. Amountofpayoutperperiod . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor(see instructions) Interest table rate-❑3.5% ❑6% ❑ 10% ❑Variable Rate % 6. Adjustment Fador(See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value o(annuity-If using 3.5, 6,or 10%,ar if variable 2te and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax retum.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the retum. If more space is needed, use additional sheets of Me same size. REV-1&04 EX+(0140) �pennsylvania lNHERITANCE TAX Ril OEMRTMENtOFPEVENUE SCHEDULE L INHEHITANCETAXNEfUHN REMAINDER PREPAYMENT HESIDEFf�DECEDENT OR INVASION OF TRUST CORPUS I. ESTATE OF FILE NUMBER Ste hen A Juzbasic 2012.01179 This schedule Is appropriate only for estates of decedents dytng on or before Dec. 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inherltance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) of Eledion or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real EsWte . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . .$ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . .$ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . .$ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . .$ 3. Value of Non Includable Assets . . . . . . . . . . . . .$ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ E. Total Value of Trust Assets (Line C-6 minus Line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . .$ F. RemainderFactor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. 7axable Remainder Value (Multiply Line E by Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of Corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. CorpusConsumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. RemainderFactor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Taxable Value of Corpus Consumed (Multiply Line C by Line D) . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) REV-1845 EX+(11-09) �pennsylvania lNHERITANCE TAX ��� OEP�NTMENTOFREVENVE SCHEDULE L-1 INHERITANLETA7(pETURN REMAINDER PREPAYMENT ELECTION flESIDENT DECEOENT -ASSETS' I. ESTATE OF FILE NUMBER Stephen A Juzbasic 2012 .01179 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) Total Value of Real Estate $ (Include on Section II, Line C-1 on Schedule L.) B. Stocks and Bonds (Please list.) Total Value of Stocks and Bonds $ (Include on Section II, Line C-2 on Schedule L.) C. Closely Held Stock/Partnership - Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnerehip $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ (Include on Settion II, Line C-5 on Schedule L.) III. TOTAL (Also enter on Sedion II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. REV-1848 EX+(11-09) ,�i pennsylvania lNHERITANCE TAX �,�� OEP�PIMENTOFREVENIIE SCHEDULE L-2 INHERIiANCETAXREfURN REMAINDER PREPAYMENT ELECTION qESIDEM DECEDENT -CREDITS- I. ESTATE OP FILE NUMBER Stephen A Juzbasic 2012.01179 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Liabilities $ (include on Sedion II, Line D-1 on Schedule L) B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (otherthan unpaid bequestslisted under"B"above) that are Not Included for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include on Sedion II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ If more space is needed, attach additional sheets of paper of the same size. REV-164] EX+ (02-30) �pennsylvania SCHEDULE M Lv �EPAFTMENT OF PEYENUE FUTURE INTEREST COMPROMISE INHERIfANCE TN(RERIRN RESIDENT DECEDENT (Check Box;a on REV-s5oo) ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 This schedule is appropriate only tor estatea of decedants who died after Dec. 12, 1982. This schedule is to be used for all future interestr where the rate of tax that will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax retum. ❑ Will ❑ Trust ❑ Other I. Beneficlarles NAME OF BENEFICIARY RELAlIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spause exercises such withdrawal right. ❑ Unlimited rfght of withdrawal ❑ Limited right of withdrowal III. Explanatlon of Compromise Offer: IV. � Summary of Compromise Offer: 1. Amount of future interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. � (Also include as part of total shown on Line 13 of REV-1500.) . . . . . . . . $ � 3. Value of Line 1 passing to spouse at appropriate tax 2te Check one. O 6%, O 3%, O 0% . . . . . . . . . . . . . . . . . . . . $ (Alsa include as part of toWl shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. O 6%, O 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate(12%) (Also include as part of total shown on Line 17 of REV-1500.) . . . . . . . . $ 6. Value of Line 1 Wxable at collateral rate(15%) (Also include as part of total shown on Line 18 of REV-1500.) . . . . . . . . $ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . $ If more space is needed, use addi[ional sheets of paper af the same size. REV-164B EX(02-09) �pennsylvania SCHEDULE N ��M�TM����F�E�E��E SPOUSAL POVERTY CREDIT eureau of IMiNdualTams PO Bma8o6ot FOR DATES OF DEATIi Ol/OS/92 TO 12/31/9� Hartlsbu PA i u8 ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 This schedule must be completed and filed if you checked the spousal poverty credit boz on the cover sheet. � � • � 1 . Taxable assets total from Line 8(cover sheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . 2. Insurance proceeds on life of decedent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Retirement beneFlt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 3. 4. Jointassetr withspouse . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 4. 5. PA Lottery winnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 6a. Other nontaxable assets: List and attach schedule if necessary . . 6a. 6b. 6t. 6d. 6. SUB707AL(Lines6a,b,c,d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 6. 7. Total gross assetr(Add IJnes 1 thru 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 7. 8. ToWI adual liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 9. Net value of estate(Subtract Line 8 from Line 7) . . . . . . . . . . . . . . . . .. . . . . . . . .. . . .. . . . . . . .. . . . . . 9. ff Line 9 is grealer than 5200,000•S70P. Tire esfate is not dlglble to daim dre credtt.If nM,contlnue M Part 7I. • • • • � � � � . Income: , 1. TAl(YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse . . . . . . . . . . . . . Sa. 2a. 3a. b. Decedent . . . . . . . . . . . lb. 2b. 3b. c. Joint . . . . . . . . . . . . . . ic. 2c. 3ci d. Tax-exempt income . . . . ld. 2d. 3d. e Other income not listed above . . . . . , . . . le. 2e. 3e. f. Total . . . . . . . . . . . . . . lf. 2f. 3f. 4. Ave2ge joint exemption income calculation 4a. Add joint exemption income from above: (lf) +(2f) + (3f) - (+3) 4b. Averagejointexemptionincome . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . _ If line 4 6 is rea[er than$40,000•STOP. The estate B rrot d lble lo daim the nedlt If not continue to Part 111. • • • � • • � � � � � • � 1. Insert amount of taxable trensfers to spouse or SI00,000,whichever is less . . . .. . . . . . . . . . . . . . . . . . . . 1 2. Multiply by credit percenWge(see instructions) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . z 3. This is the amount of the Resident Spousal Poverty Credit.Include this figure in the calculation of toWl credits on Line 18 of the cover sheet. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 4. For nonresi0entr,enter Me ratio of the decedent's gross estate in PA M Me value of the decedent's gross esWte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Multiply Line 3 by Line 4 and enter the total here.This is the amount of the Nonresident Spousal 5 Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . . . . . . . . REV-1849 EX+(8-g8) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESI�ENT DECEDENT ESTATE OF FILE NUMBER Stephen A Juzbasic 2012.01179 Do not compleb thla schaduk unlau the ahta b makinp Me slactlon W hx aeaed unde�Sectlon 917J�A)of the Inherihnce 8 Eshb Tax Aet. If the elaction appliea lo more than ane trust or similar arrangement,a separete kmi must be fibd far each tmst. This eledion appliea to Iha Trust(merilal,residualA,B,By-peaa,Unifrod Credd,atc J. If a trust or similar arcangement meeb the requiremenb af Seclbn 9113(A),and: a. ThetrustorsimilarartangementislistedonSchedub0,and b. The value of the tmst ar similar arcangemenl is antered in whole o�in pad as an asset on Schedule 0, then the tranaferor's personal raprosentetive may specificaly identify Ihe trust(all or a fradianal poAion or percentage)to be included in the electian to have such trust or similar properry trealed as a fazabk tranafer in Ihis esfate.If less than the entire val�of the huat orsinilar propery is inGuded as a tazabb transferon Schedub O,Ihe personal representatNe shall he comidered ta have made the electbn only as ta e hadion of the trust or similar artangement.The numeretor o(thia hadion is equal lo the amounl af the trusl or similar arrangement included as a tazabb asset an Schedub 0.The denominalar is equal to the tolal value af the truat or similar anangement. Part A: Enter the description and value of all interests, both taxable and non-taxable,regardless of location,which pass to the decedenPs surviving spouse under a Section 9113(A)trust or similar arrangement. DeacriDd� Velue PaRATotal $ Part B: Enter the descnption and value of all interests induded in Part A for which the Section 9113(A)election to ta�c is being made. oexnvnm vaWe Part B Total $ Qf mora space is needed,inaeR aCdAional sheeb W tha same s¢e) REGESTER OF WlLLS CERTtFICATE OF CUMBERLAND COUNTY GRANT QF LETTERS PENNSYLVANlA .. � L �f�C�' No. 2017- 01179 "� PA No. 21- >2- 1178 ? Estate Qf: STEPNENAJUZBASlC 1F%nr,.a/dtl�r,turl La te pf: N£W CUMBERLAND BORQUGH Gt1MB'ERL.4N1} COUNTY Dec�ased Social Security No: i74-20-1237 WHEREAS, on the 8th day of November 2022 an instrument dated IJecember 27th 2008 was admiCted ta probate as the Zast wi1Z of STEPHEN A JUZBASIC (Hrer,M.d1N,GsU Zate of NEW CUMBERtANO BOROUGH, CUMBERLAND County, who died on the 16th day of C7ctober 2012 and, WHEREAS, a true copy af the wiZl as prabated is annexed hexeto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wi11s in and for CUMBERLAND County, in the Commanwea.tth of Fenns,y2vania, hereby certify thet I heve this day granted Letters TESTAMENTARYto: STEPXEAt ANDREW JUZBASIG who has duly qualified as EXECUTOR/RIX) and has agreed to ariminister the estate according to Iaw, a12 of which fu12y appears af record in my offiae at CUMBERLAND COUNTY CQURT NOUSE, CARUSLE, PENNSYLVANIA. IN TESTIMONY WXEREOF, I have hezeunta set rny hand and affixed the sea3 of my office on the 8ih day of Novembe� 201'2. I ��P nrkx� `�rn���-fi��" �l�.tpp �'���,+��, eputy **NOTE** ALL NAMES ABQVE APPEAR (FI123T, MIl7DLE, L}iST) This is co ctrtiCy chat this is a true copy of the record whsch is on file in the Pennsylvania Deparzmenx of Healch, in accordance with che Vital Scadstics Law of 1953, as amended. WARNING: tt 6s lllegai ta duplfcate thls capy by photostat or phatograph. ��AItNOfpf�,�, �4�w+�. ��1��`"4b�a�#a..� '! � .�::--�._.--. .. �`r Marina IJ'Reilly Matthew �p ���� -:; � S[are ftegistrar � # x * 7Q$6968 �, ° - _ - ',a� DEC 1 12012 q�ENS�F� . Na. � I�ate �'yp�/Yrint In CpMMON WfAITN OF�[NMSYLVPN4�O[�AI�TMflR Oi NMIrX�V ITAL IIQC01105 Pe�.�ri�` CERTIFICATE C?F DEATN si«�a+ w.�,w.: �.e.w.e w.n.texu,rwwe�..�.n.w'n:) x s.� a. i s.=..nv�«a�,e.. wa w a.sn on +v .t sa.��rv.ei wn 57'E:'P[�2Q A. JUZSASiIC Mele 174-20—i237 i�/�� ..y�-i.ao nnne.v Ivr.) se.ona�. . s.o.e. �rtn Ime Mv uq Isw r.�amb v..urt pau(eM.mf aw.e,se� rv ner�l �g2 r.w�m. o.v. Ho� 1 rwin«e�. Januery 3d y 1930 "10.MYIM1pNC�IcwMyl IWnc�ISe�saaeaa���nCeun�ry) M.R�l1 n �s �ndNUmWr.InvuMAplrro.) �e.OtlOeaeJ�mtl���n� pwn�e�IP� ' � PA 142 Sixteen[i'� St. p..„,M.,;.y.,,.��,� Q _ eeo�,.rzr x..w. Cun(aerl8 a.we�m......mec�.� o.a.mt«��m..e.oxn��n�.w 9.[ti�11r yi Mm rc��> 30.M�rlt�St�l�� � ��k M� 1l. MNN N Spd�x�N�m��l,w n� m IbR m C��p �[Iv� pn O�+nk.e.+. OoHO.�w O� wrraen.a Ou � �..n o. ...d�.� va.F�< +rc.r�a�.w I��.n. aai..i..�. u . m .H.mw�nw m n�ne rn�.N.�. �irn.p�i Ivg'��n�q.Juzbaalc Mte e g aa�ytszyn��A. Juzbasics Jr. vn. aw�,.n�omo.oa.... a m •. w..�aee....�x...i..a��nna..,cM.u..M.zro�Da.1 S ...._......... ........_......._.................. ........................_............................e:...+,............ �l.4e:.5�actcent ..... Cunb�rl .�. .�e o..,. " ka 5 t. Ne�w axad Pa 170? � iid..viv«��l..em.nwon.0 CY��v.u.�� no..mo���...asem.. .._..........._......_ .... ' ..........,_..........._........ ........._................... ... � � .wrr'n�an..rx���rio.wne C]'R . F.rnM �T° d �.n � em� mwo ..i.m w.aonwm.i n�m ne.., w �.....u..r.xu cnnn., oi m sse. i nm i�.<n�swn,�w..�..... �ume..; v�.cnv a. ssn.. � ie cee� •a e.c w .m 14�2 ixt@�entk) St. Nev C:imberla[d PA 27070 �Cum�eY and � 16�R�rnar��£mm SGttn ",��Oen�pdt C��matlon 1 .D�f� �VO�liien SCC 01�s bn iN�m�M f+m�t��Y.mmate�'I.w W�u} � . �s K ^,:`n.. Oct 25� 2012 SndianCOwn Gap National Cen�tery 1°1�'�3"1°�.��m t .�a aw ..sy..w.�m v,..,.ti s�...q u�.w c.v...o.��cn�qr er� a�n�����mw. 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S� t� t y o��.�o o.m�Ha. 0747052 . nvns-�+a .._, _ �cvmnoss I This is to cettify [hac this is a true copy of che rtcord which is nn filt in che Pennsylvania Department of�Healch, in accordance with thrt Vixal Scaciscics Law nf 1953� aa amended. WARNING: ft Is lllegal ta duplicate tfils copy by photoatat or photagraph. ��ZN UF P,�,� �a".�"..` 0'i'��''"��..., ��` - . 'rJ's. Mazina (�'Reilly Matth�v -� � Scate flegisaar f � ♦ t 7125267 ,9��- .�`�.,'� JAN042013 �re�s� No. Dare xiaswrtvivma COME104JWEALTHOFPENNSYLVAWA�DEPl�RtLENTOFHEALTH•YRAl.RECOFlOS 018519 m�rewrzx �� CERTIFlCATE OF DEATH jSNIMW6tl011t/MlLIIIPWdIIlVN'M) SATEflLEMMIBBi i.ilwd4aMi�eRwlY.Y/.Yr7 . 281It iSedYSn14'MNw 4GYqWIAl�1d1'.7�1 ANNETTE M. JUZBASIC Femat 210 — 26 — 654i Febn�a 20 2069 a�aars+rn wri uw.i doraan r. � rr. t�aao..n 74 � �•• � �•• �••� Aug. 15, 1434 Harris6tirg, PA p�w pa�asrM Oaa ❑ru+v�.E]w.u� Oa+r�mwr •a�taa�r, aary,mat�.aor ecas7ir.�ea�P•r,sasm�9 a�ranrr.a�uto�ynt 9xo [�r. iahze.+m►anse�x�r.wc C�mberland New C�miberland 142 Sixteenth Street n""'0M�0°` {� w+=.vu.e�nts ' e � n.od.nwr a.nr. .�a wmrrr urrmau«.�na uoe�.r�m mr m�r4 um+a�camax�uwaC x�++as�ewg�++tiu+�,�.mn �QI!lEQIfl�C2L �T �� uaMreraan Bnrrr�wnW�'iutt Ca�qn�a6.1 rrmw4olaualS!�il . ❑,r �9� 2"arriecl Stephen A. Juzbssic NGaltl�f�IlwlbH��tlMlbn�lr.�ym6� O�elYfs � WO�eYqt 142 $ixt2enth St. �+� �n� �A 1i°' ��*+���� rR iVer QIDberlaztd, PA 27Q�0 rroc�,r Ct1t�FRT1+ND �'""� �m��,,,y�;�*■+� I3ew Ctmberland r,��m�. 1{.fMNrR4+�tl4KW ' 16BbYIY�i�4�.�/1a) �2�. 1NI1Q j7� 18TTj. 6Ybnr011�mplMb9 10Y. IY�IYr /bR !4 � St A. 3uzbasic 1�k�2 Sixteent�i �t.,�ew�( aaberland, PA 1�070 ' m.Wqe�enw+cn par. ❑owd zaa.auo�mM�t+nn.1 ms`aacrer.l�+urwa�.wr.m.o�ed aamm�inwar,�ma � ❑�.°iYyy,� �"°""A' ��„�❑.�,p�, Feb. 25, 240�3 Itdisnt�m Gap National Gemetery Mnville, PA 270d3 � 1i dNd 40�a4a.W �} ffi31sMa0r aIY�M+Wf�tlFl� ► �i!/ dlD(eQ/-L r,,�pggpN �, (�E 357 S 2nd St, Steelton, PA 17113 CqW�flee�pvinaitpq E7L1Mh�1�IM�uMtlFYl�mPntlMl`MYY11tlIwFY6 �WiolYF4 �e01Y91p�d4mMrbiM q wr�aw'�raa.u� ,tl �I� a"]a L a o-0� �UO ! 1�X#�uYw�WM1� :4.TSd6M ALY/wsslptlM�iF AYbO�M1Y�1bYMaIFMr/Camnb�tMm01irM0aMeia0atin7 www.�«r. f�w 'U a-.OD`1" pu. �(w c�avoumler►rwue..rmryr� �+�mrwr.� ercrerarr am�m.xourasrreors PaRF6NrYYif��S�114MMR¢m�-Mf6d/a�dbbM.➢DlOfrtt w�YafiYalew�l t pWbdr` hIM io6� � �MiM1w4a�slMyrYYleMIniI�sBVh�bpFWWwarnrANa � �qFh�nl�MysO�bMl ❑'h QFSOM' � �,M Q Ui� �e����` . .k�hflrarS.nord k�emarr� c� � �(7rnrn si P1b�m��C�PiMIaaQ � � � �M9r�XkpM1� YwiMt1+A� 0. v�-i'{f�,.d MASS i �IYMn dA9N�MilM 1YI��WM qwI�1�1 �FyI��M41��yy�1Aw�/CyYyE�� 0'lb�ptY!lI�PMna$ i ���AK����� MrlMryp`lllN[ ° � nqbM v DU�tpraam�ymaa � Ll�Mlp(e'Itldp�biMr .> 1 i ❑tYiriwi���sofMMMPaIr , �AIbnA �lnWPtllrb�dnpfn r�lYStlG+I �L4MtlIpyWL�FIMf ffiOWY1�11wt}ry91a1w1 sOM�i��e�tf+m4 tlQ>M7�b} �� �� � �� ��, �w �w ❑�mr� O�aM+rre aarn.a� awr■wm a�t.�.r.Mn�ei ramr�aMn�a�enw 6 ps�as Ocwwror.w�a � �a� Dw Qm.ra.+.�++.wr(�� �•� Z . ��I�d7aq asprw.airac.r .. Lk • d.�+�a+w.�wv.d��.�.o�.�...�a+.�aa.e,.� , rn�o33� Febr,�.:.i m�.a+ree.r�rrw�w.�a►w�(ea�.w+�w�'"'"'.""'"'",_..__.._.."""...� �� nar+�r.nqyprp�ewe�a�Mar�ea cara � --' xrra�S�ocmp.uoo.aor�#e�na��m; , � � asrrw`+Mw+r.�rarr.r4ro4.wria.wy9r.....rt-' - --. . ❑ Z�J`1 u,..�rm. moreweaam+Y. • OriiE~e1�YMa���d/�M�Ipie�bN4��bMaMftl�Ytr.bRMIM�NMbM • �IrrnrYl.❑ ZJ�. a :o. E1ix., m:�G;-� � ��� 3 �a\oo� SF. S4�te ZOS l.e.-.,o w_ Ah tZC3�l3 t �„�,,,,�„� 0309796 Y .. ( • i::�s�' i1#G� .�,yu �'�s F.�#1tEV?` ae STEE'HEV .��iBit{3S£ 3UZ6�►S1C I,S1'EPHEN AMBROSE JUZBASIC,of ihe t 42 Sixteenth Street in the Bureau of New Cumberland. Cumberland County,Pennsylvania, do make,publish and declare this ta 6e my Last Will and Testament, haeby revokiag ali Wills am1 Codiciis by me at any time made. FTEM Is I d'vect that all my just debts and funaat expenses inciuding my grave marker and all oxpenses of my last illness, and any and all taxea assessmaats imposai by any governmenta!body as a result of my death,whether an property passing under thss Will a�otherwist, shalt be paid from my residuary estate as saon as practicabla after my decease as a part of the e�cpense of the adminrstration of my estate. TTEM IIc i give derisc and bequrath my estate, whatsoever the same may be and wheresaever the same may be situated to my wifc, ANNE1'fE M. .itIZHASIC, praviding she shall survivo me by thirty (30)days. ITCM Bi: I alsa bequ�th to my son, STEPHEN ANDREW JUZBASIC,all shans ar rights ta future rayalties ramed by the Scrcen Actors Guild which was beyueathed to me by my sista, Barbara Aheam. ITEM YL In the event rny wiFe,ANNETTE M.JUZBASTC, predeceases me or dies on ar before the thirtieth{30'"}day fallowing my death, i give, devise and bequeath all of my estat�, whatscevc the samt may be and wherescever the same mey be situated as follows: �: ,a� � �� -r_,��� � � � 'y��D :ip m i.� . . -p �j �,,iC`� t. Six-tenihs{d110 or 64°!0)ta rny son, 5TII'HEN A. NLBASIC;and ��f ° -.r_ ��-: i:`; I �;_�.- � �=�-�r;� I 2. dne-fifth(2/i0 or 20%)to my son,THdMAS G. JUZBASIC and «�-�-'�,-, =" o -, ::.:c; 3. One-fifth(2/10 or 20%)to my son,KEVIN A. JVLBASIC. t�c> • � � -« r.� �.z; i'_rri v "" -' ;:n t� ITEM Y: I appctini STEYHEN ANDREW JUZBASIC,my son, Exxutor ofthis�Last Wit y, In the evcnt STEPHEN t�NI)REW ILJ'LBASIC fails to qualify or ceases to act as Exxutor, [appoint my Stephen A.Juzbesic: �� ` Witness Nl initials: Witness#2 initiais: Witness#3initial5: �a• Page 1 aF 4 sons,THOMAS G. .RJZBAStC and KEVIN A. 7LJZBASIC,as Co-�xecutors of this, rny Last W'rll. tieither my Executor no Co-��ccYrutar;:shall k�ti rec�uirec�ze git-e any band or tiunds. iT£N YT: f dirert(h�t aay pc�son c�ntesting this 1Va11 or attempting to defeatits dispi3sid�e pravisions, if they are unsuccessful in their efforts, shall forfeit any distributive share of my estate to which they are encitlCd uuder this W ill and direct that their distribniive share go, instead to the other person taking under this my Last Witl. TTEM VII: Ali of the intcrest af the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall thty be snbjxt to any ex�ution ar attachmeat. I1'EM YBI: in a�iition to the other powers and autharities granted ta my persanat representative by Pennsylvania law aad by the other ternu and provieions of this Will, I hereby g'rve ta my persocia!representative the following powas and autharitirs tffcetive without caurt approvat and untit actuai distribution of a12 property; to oompromisa any claim or controversy; to make distribution in cash or in kind,or partly in cash and partly in kind,and in such manner as my gersonal representative may ddamine and at vatuarioas fina22y to be fixed by them; to inv�si in atT forms of prope�ty, including any stock or other securities in any corporate 6duciary or its suacessor without restriction tn investmcnts authorized far Pennsylvania fiduciaries,as my pusonal represtntativo daems ptaper, without regard to any pricxiple of risk or divasification, to se2l at pubiio or privau sale, to exchange, or to lease for any period af time, any real or personal propaty and to give options for sales,exchanges,or leases, for such priccs and upon such terms or conditians as my pasonai representative deems proper;a�to ailacated ' recaipts and e�cpenses ta principal or income or paRiy to each as my personal representatives dam praper in their sole discretion. nJ E � i snbscribe rny iname to this W ill this�siay of ��• ,240$at G_u �-t(►�t:R{+��) Commonweatth af Pennsylvania, and declare it is my last Will, that I s'rgn it williagly, that I eacecute it as my free and voluntary act far the purpases e�cpressed, and that I am of tht aga of majority or otherwise iegaliy empawaed ta make a Wil1 and under no constraint or undue in#tuence. 4?i ,�+-cr. Ca�'�G"x'v "� : Err na�sxo�.rtrt�nsic Stephen A.Juzbasic:.7_,�._ VJitness q1 initials:.�� WEtness#2 initiais: Wltness#3 initiais: Page 2 af d WITNESS STA"TEMEIVT C7n this ''�''`� �ny is'F� " �,v�:'c " . zpqg. thr"festator S'CEPHEN tL4IBRUSE JUZBAS(C. dcY'larec: to us, the undersigned, tliat this instru�ent uas�er ia�t i�'i!i and requested us to act as witnesses io ic �he Testator signed this Will in our presence, all of us being present at the same time. We now, at the Tcstator's rcquest, in the Testator's presence and in the presence of each oiher, suhscribe our names as witnesses and each declare that we undetstand this to be tha Testator's Wiit, and that to the best of our knawledge the Testator is of tho age of tnajority, or is otherwise legally empowered ta make a Will, and appears to tre of sound mind and under no consiraint ar undue influenee. �Wo declare under penalty of p ury t the forogoing is true and cortxt, this�day of _3 3E;��_,,,2W&,at��,yj��_,Commonwealth of Pennsyivania. �/d�i.t���t� .�"nJm c,t2ra ti'�al� {witness signature} {priated ctame} residing at _„_c��'"] �/L�L��/ , �/n �(� (stred address) —����y� - ��i''.rG��lh , �, (countY) (sta�) ��,% {w�tness ignature} � �LI r �',�.. �_____�� {grinted name} rrsiding at � /� �{����,j�� {strset address) {cttY) ������ , �� � , (county} {state} � ��, Li'�L.�_ r(�/G2�t�fi �/'J,{`CO �( {witness signature) {ptinted name� residingat �.S.�D ,Ql'Rns�� /7R • , �/Poa�+ C.v:s�e�l�Q�'ta� (stre�t a+idzess} {ciry} l.tiln��-�4nGQ /'• /9 . (county} {siate} Stephen A.luxbasic: � WiMess ql initials: WitneSS N2 initials: Witness#3 initiats: Page 3 of 4 i SELF-PROVING A�FiDAVIT Ct7t�t�iONW'Er\LTH OF PENNSYL�'ANIA COUNTY C7E CLJMBERLAND I, the undasigned,an offictt authorized to administc oaths, c:cstify that ST "PFIEN AM S " JCJZB C, the TesGator,and N TN , and �,�`!rf Q.c r�Yca/ ,tha wifiesses, whose�mes• ,signed th a ched and foregoing instrumcnt and wh�e signatw�es appear 6elaw,having appeared before me and ving fust becn duly swom, each of them declared to me that(1)tht attached and foregoing instrument is the last Wil!of the kestator; (2)the testator willingly and voluntarily doctared, signed and eacrented the W ill in the pcesonce af the witncsses; (3}the wikiesses signed the Wi11 upen ffie request af the testator and in the presence of each other; (4)ro the best knowledge of each witness, the testator was,at the time of signing, of the age of majority{ar othcrw'rse lagally compttent to make a Will},of saund mind and memary,and under no canstraint or nndue influence; arxi{3)each wimrss was and is compctent snd af proper age to witness a WiNI. .:����a�� , �_{Testator) _, (Wimess) (1Yitness) ( [1 �u7 � i{� {Witness) � Subscribed end sworn before mc by that STEPHEN AMBRCISE JUZEiASIC, the testator, who is persttnally knpwn to be or who has pradttced a iY�Q, i CflJS�ss Mientificatiott,and by � �i�P� ,,,�i8t17`A ,a witaess who is ptrsonally known me or who has a �t(�G� .�iy p.'� ,as identification, and bY c� , a wimess who is personally�°wn to me ar who has P� , as identificati�this �� �'�' as identifieaqpn,a�bp y0 "q Gfiia, .�r�Sto/ / a wwmess wha �s sanall known to me or G wha has produced a r �`�✓' %� �y pp dGGef�Yt�?C' ,2�8. COMMONWEALTH OF PENNSYLVANIA . r�, q,�, Nala�Nl Sad 1E iy�h � "�� ��Y Notary Publir LT p,yC�m�ebnEqrkw,wy0.Zq�o (4{tlflWf.{MMtyMlfd9 A3lCGkltbll W NOfil1N Stephen A luzbasic: Witness lt1 initlals: witness N2 initials: Witness#3 initials:` ' Page 4 of 4 142 16th St, New Cumberland, PA 17070 - Zillow Page 2 of 5 74216th St, New Cumberland, PA 17070 Contact a local agent �_ � DBmBtri Map Blrtl's E.ya Street View Koutsokoetes Nol for Sai9 .,,,.,_,,. '�� ZestNnele:5750.634 G��:O+D�i�+»�� . �x �,�f� ghts� 3pp � � RentZea�imete:37,144/mo �- � MatthewGrocno ¢ w.. row� -...+'� Eat Mortgage:5530/mo ' c.rc pn�ea[.omx .�v`''� Sc . Sxe moxinvooL'.urvi r � TammyFromm °µ f nirl..r�s] �^6�" ABaa(runilSGa6t8 '08, B.'loUrSlor50 Y1�� . GaIA P1]1�64Y4W . � 9edroomc Contactfordetails ;.�;i�.��,,,,1z . . . .. BHhroomc Cont2tl tor details . -.. rtgrn 91np1f Famlly: 1,748 eq X P'norie � Lot: 31.3639qfl :�n.i3�IFG::ress VsarBulR: 19Y0 I woultl like e proPoSSbnal estimate of my 9i Parkinp: Contac[(or A�taiia pome et 142 16th St,New CumOerlenQ PA � Cooling: Cantad fa AMails 17070. �;r :3� �.. p �� � � � ContactAgenl�l sr'� I.eari�how In appear in Ihis list Corretl home iatls Sevv t0is nome Get updetes Email more• Descrlptlon Every company says theirinternetisfasfest. rn�s�s a nae��e�a roa.,��gia ramaY noma.u�s m�m,e�iaz ism sc Now ameeeeoe,PaoosYi�e�;e. But who's telling the truth? HeaLngTYPe BasemantTYPa Fireplacs PC�.4g�zhrhastMarsxacTheyrmapwtlMn IJnknown Unknown Un)mown otaOtMma rl�ttxnR �0 R p(Wi�Yry060HA111YfKi. FIOOICovaring Attit Roo/Typ9 F�"�����Ya'medaHqrlghtchWCa,nifyovn ovarpayingia secoM ba�t aervko, Unkno�m Jnkn�m�n UnM�>wn EztBhorMaterlal VIeW pSbrlea � Unimewn ��nkoown Linknowi� Deck �'�"�"1Y° Slmilar Homea for Sale .I._ __—_.— �4tore . �+i�':�;.�i�_, Y77 Bailev St Ne Cum... . `'�"""' Fw Sab:b189,900 .unmemn�,n. . '^��`-'» Beds 3 SqR:1470 Zestimatas � Batha:l.o La:8534 Vaiw Ranp� 30-0q chan0� Shaft Last upE�tatl � tS446"tln St NB C .. Zsetlmab 5160,634 E125K- " ��a"i9�" 3173K +§933 .588 Ot/08/2013 . *� ��<"� ForSalr.S99,900 RentZeatlm�b St,14a/mo � cumbe�i�rrci. 3915-SLSK/mo ia16 E0.85 01/07/2013 I `m����' Betls:1 Sqft:1336 Baths:iD Lot:7105 OwnvE�Amab Posiyourownestlrn&te I��x, i .��,�� � 73098randtAVO NewC... for Salr.5148,900 2astimata RenlZesOmaie more 7yoar 5years 10yean � �� ��"�� , 8eda:3 Sqfl:1415 � Balhs:t0 Lal:6534 8uo listings near 142 t6ih St Nearby Similar Sales Loading chaR... 116 Waefnv D N C b I nd PA tl... Soltl on 7/81tO7S:f220,000 Beda:4 SqN:2088 Belhs:t.5 Lot:313fi3 7705 Kafhrvn Sf New Cumde I tl PA 170... http://www.zillow.com/homedetails/142-16th-St-New-Cumberland-PA-17070/9269443 z... 1/11/2013 142 16th St, New Cumberland, PA 17070 - Zillow Page 3 of 5 Vlow yoor 3 Oure�au CREDIT RGFORT Neighborhood for 142 t6th Street � Hom�V�luw � LietlnBa View laraer mau Nearby Schools in New Cumbedantl 6n0et Dlapnu GroatSChoob R�dnp New Cum6arlantl Midtlla iassignetl� 68 0.5 mi Hilisitle Elamentery(assigned) K-5 OJ mi CetlarCliRHlghiassigncai 9-12 1.3mi $e Thvresa Elementary PK-8 09 mi Highlentl Elementary K-5 1.3 mi Sylvan Heights Science Charter K-4 1.3 mi Foose K-7 1.3 mi View more schools in Naw Cumberlantl http://www.zillow.com/homedetails/142-16th-St-New-Cumberland-PA-17070/9269443 z... 1/11/2013 Mark Heckman Real Estate Appraisers ' ' 7309 Brldpe Street, New Cumberfand, PA 17070 File No. 142SIx� Bn�h APPRAISAL OF .�+ �A f . , t "+ ' , .� ' Sinple Femlly ReslAentlel ProDerty LOCATED AT: 142 18ih Street New Cumberlend, PA 17070 CLIENT: Stephen A. Juzbealc 142 181h Street New Cumberlend, PA 17070 AS OF: Ap�ll 29, 2013 BY: Glna Distefeno, Stete Certifled Reaitlentlal ADP�alaer RL138B81 PH (717) 774-7202 FAX (717) 774-0383 EMAIL heckmanapPraiaere8 Comcest.net Mark Heckman Real Estate Appraisers 1309&Itlqe StreaL New CumbeAand,PA 17070 _ FieNO. td2Slztlpnth � I APPRAISAL OF ' ; 1 I Sinple Family ReslOerrtial PropeM I LOCATED AT: i 142 18M Sireet New Cumberland,PA 17070 CLIENT: SteP�n A.Ju:besic 142 16M SVeM I New Cumbedand,PA 17070 AS OF: Aprll 29,2073 BV: Gina DlStefarq,PA State Cert.ReslE.Appr i RL138981 I I I PH(717)77d-7202 FAX(717)7740383 EMAI�heckmanaPP�isers�wmcast.net MpYk MxMmBn RpW Eefan Appnurs ResidertiaiAppraisaiRepnrt r�r+a �ass�xmenu, T�pupne a mn e�nsn�ream isroamamme nrer+cwun a neaeiea��mme aermauvawcdue�.+vwn+Y��me imer�e�se dmea�amsai. CHemNemminbrkeUwStehenA.JiubpSiO E�meiiNOne CxaM Aetlrns 14218th S � New Cumberland Sie�e PA Z 17070 nmwrei inierrxo Ste hen.luzbasic and fils asst na �maam use Fair market vaiue for tuture enni u 66s R Naaasn i42 i8�h StlEtlt C New Cunl6eAand S�e PA I' 17070 OawwvndakxurtS AdAnnefleM.,ltabasic C Cum68ttand � OaadBOOk 0421Y P Numbar 01003 Rssessu'sP I 28-23-0541-098 TaxYex201 R,E.Texesf 25p3.00 Ns Nana New C Aand Bom h Reiaencs 28-23-0547-098 Census nen OipT.pO R +iseG fx5' a Laeserop Gler aesrnCe refeaech @tl dd�tewN ' ttbsarsan9ttsIXUfe taAe9vtt eas � rorieeifectiveEetIXUes �. SaidlrenStG�. 6Me Pr<e s Melysisdprws&eatra�sirMStpyWMewqenptoyery(aMmmperebksaies,itappi[eble� A lO�Spl'SBI181 I&showsrwVansfarsforthesub'ect ro In tM ast thrae rs. cmar�.o�SUm+mam:asHtreKrectieeaateamcepprma� NoruK�rown Lp:etian Utben S�eWn Ruai W Yalues Mo ' SmEk Dec" PRICE AGE +JncUrM 7B% BuYFU Qrer7S% z5�1i% umct2546 NBeiarce Over 5000 2�1UM 5'k C+m�Ui Ra tl SIaOk Slvri Nerketl Tpne UMer3mN5 J�6mNS Orxr6mtlis 30�ow 20 Muti�Gani $% Nrgnnvnooa Oa�Manes Sx AttUChed AddBrWum 375 N h 120 Commerci& 78% 132 Nea. 80 omer VacaM 5% Nc�9���snW� ThIS Stlt}W6i� hGOtfi00d hBS RNSt IG UG�Ii85 eYePObNS �818i! QA eCCESu t0 eiii M 2(id 5!(VkQ$ aM is com " a wiM otlrar�xi s in the dr�rai area. Mrrst heve simiiar amenitfae. ManercmauareUrcnaings��pWnrormeam.ernrcuniw�s� Whibhous ieeaonanatlonalbeslsare tobeOSCiini theCentralPAmetkmt in ha rqt 5Nn� � tlotf. }�urever Up market in thb aree has sioxed in Nst resldentiei dveai are matkatsC for bn et s af tltnm ksii Mesa than 186 d s. A raiss have aiw er�counfered more saileB ssWn isfaxe n In recent rs. cwne�ms See FMat Ma aea.72 sna RxL ular uew Avera e t � cros.4�cetion Rt Ra10erNai Zotie t - AUowa far cuemnt uso u a ' farn resWentld z � � e � � c�mim«e�iu aot � i i IS�IC�IgMS�eMireAUSedtMSUb�.YqopenyesimpmyeE�naspopo5eqperplansantlspecilirmqris�1hepeseMUSe? Ves No IINo,Eeunbe. __ WIIMa PUblk Otlw IMK'elh Vuq% 01Fw O�z�IM PR-fbM1n u—T PuWlc Mv�N Ekcc 240 AMPS wasa Saece Cass Staar NOn! Siie cmimmms Stte hes avera e stte im rpvemeirts awbra tanE i arM ical maintenance.The sita im rovemerrt5 and xrvicas to the stte arc ad wb and acca bN3 in Mis market.There are no a arent adversa easemerns encroachments or nther aEVarse wrMRbns on this site. Unns one qewlQ.ut Cunneresmo aa.�sre fauneaaonWmis B�ICWConc/Falr Fiaors C tlNINFaIr Imsares 2 fw�easemem rarne�eesemant EttmvwaXS BriCklFalr Waus PlastedPanlFair t on- nn. s�hmu�a eesare�rvm 99s a. �s�rtae s k1Far r�� wo�tFair E�isn sea untlercamt Pesnnm�Finrsn Ox cunns[bwn sAluminuMFair aMFloor Vln UFair bev e 2$Cq I.hM1SNeE vn Su Pum WiMOwT DOUbkHU Fel! B4NWemscq �.'BfTIIB/Filf Yaraun1920 sarmsasNim�aua Sbmi9/Falr Cers�aa Nom rs Sutens 8ir rdCars 2 .iPlc Nare Fre FWA +tW NaqieiK Amme� V�bo� s(6 Si�lacc C Aair S�an IMie FwiOil Fre ac s 10 FmceNOne Gam Ia1Gars 0 Fbu Sci�lb C GeMelAiCOMAbni PetltlUttkNOf1G Pnch 2 Car /olCars 0 Finslxd Hwietl I�NrvWwl Uhe Pool tllltl OVfe�Non! qv. �¢C BuNbin .. Wces ReR mr Mvoweve ONr aew�e FNesneaareawws mecwazim�. 8aw� 36ec�aoms t s 206A efaadcrosstrci AreaneoreGane q�dnami�eee.es pil(umace ro lacetl 5 ars o. Beamed ce111 s In fo r. BuiN in tlresser in 6etlroom#1,pouble oil tank. Decorative 11ro �ace. comme�an m,e The 6eme tausa ic�aver uai antl t+mf fa�t mainiensrme.l'Mre is rw ' �ttw kitcFmn w dsn. iHe entine o is 1n rmetl a( such as renavai of tom antl 8aki wa eoo .Thero Is a detached ara that is in extreme disre ir. It is reisers inlon Nat d cen mt be ro Iretl and shou be Wm down and romoved.RA R7 rrrow�m.���,.=.em.zx.m....m.m.� rmmmrarm°zmsm�ancio�aima..eswP.u. w�aw.n wye�a� �ywx-�cr.�ww��m"Y'w�a%�°i°n ��^..__,,.,:. l _ MaM HecWnen Ral Esten Appnlaen ResidemialAppraisaiReport ru��. �a2s�menm FEANftE SUBi£CT Gp&'ARABtf SALE NQ.i CONWAAABLE 54I.E N0,2 COMPApABLE SALE fl0.3 142 181h St�eet 3850000980Q57900321 i6th St 924 76�h Street 818 71th Strent aness New CumbertaM New Cum rlaM New C mbeAand N Cumherland a�ovi � �o �c 0.13 mfbs WSW o.n mues sw 0.64 miks SSE smf� s s 55oon s aeow s ��000 SYe�sw.am s 0.66 .rt. 3�.84 ,rt s 84.07 .n s 73.70 .rt. Dan Sar s 4MLSlTax FteCOrds MLSR Records MLS/Tax ReCOrds Vslkmbn Swce s Tsx Recofd8 Tax RECOrds T9JC RecorEs 4AtUEAlUUSTMENTS OESCR�TION �ESCRIPT�lt ,=s OESCPIPTWN .�.s OESCPoPTION .t s SffieaFeranem@ C88hEtpdvB�eM ' FHA FHA Cpcessions ' Nons Knovm Cb Costv -5 000 CI In Costs -3 600 De�easaidtima /01/2012 O7/OB/2013 10/26/2012 ormon Subu rt Subwben Suburb4n 5ubur6an LasSdaaEee � Fee Si ie Fea S Fee Fee Si k 5ne .t2ACre .tOAae 4 0 29ACro 2150 .tOAcre 4960 view Avera e Ave e Ave e A r pesi 5 2 Sto 2 Sro 2 S 2 SW dcomnu.wn Avera A e Avxa Good -8q00 acva 93+6Years 102+t-Years 73+t-Years 87N-Years commm Fatr Fah Goatl -12 b00 Gaotl -72 000 PAow Grade iwi Bmns es�: Yrm eams ame rou� e�n taw 9emi: esm kmm twn 8 3 1 8 3 2 -4 p00 4 2 7 6 2 $ .t 0pp cmss �� qm14.00 206a n- t 485 e. 8800 t 3tt rt 75W t 368 .rt. t400 amememaFaavcea F�Basertient Fu8 6asement FuN Baaemant Rdi Beserr�eM awmsBaw.Graa�ee u�lN6hed UMInisMtl urfini&hed U�nisMd ru�n�orei Avero a Avera A Aver nee� odm OIIFIW1NoGA OIINW/NOGA OIIFWA/NOC/A OIIHW/NOC/A E Frcaiw nnra T 1,0.reet F i RreatA T i Rrast T ' i AreN 2 Car 2 Cu Drivcwa 2 Gar p�adied -8 000 2 Car tMvew Palio'peck 2 PplC�I03 7 POfthpS 2?OICIMB �a Ppftly$ CMher None Npne Norie 2 F/P -4 Oi)0 OTher None NOrro None None plMr Nan6r No�e t+bt�e PX1ne +ke � asi S 8 T$0 S 15 350 s t9 04d PAjusreasekPoCe xelpq. 12$% NdPq. -18.3% NetAq. -79.0% Can mms . 28.8% 61 7 0 Cams 1.3% f fi8 850 . 43.0% 8 aseiesG A oecn SeeAttecfKKtllddetlUum SM VBM Cwnme�Ms E5TIM4TED REPROWCTIONOR REPUCEMENTCpSTNEW OPINIp10F51TEVALUE..__.. .._. _. S Saucedmsane D.eili 2064 .it�i __ .. .•i p � ¢axcmcsmar.c ErtecamdeYacottma Bsmt9� .Ft. .Ft�i ... .....,i 0 C.pMMRa11G05t OM#1 SIhS 81PdC8kid9�AI15. - 8S. In view M tlW a e M Mese i rova Cost roach Ger 5.iY.af .=5 Gdnfq�b!CAI'181deleE 2n BCCUf3te indM.etM Of velUe. 7otal E9mek d Cos�New ..{ p Len P aa! FuncHpql Extenzi man •S O ' eaGm�IXlm . . S 0 'Asis'ValueWSAelm mremems .5 M101CAFE�Y YCQST ....... . EstimetWMoM IbpketAertf xGossRem =S �MkateEValue Ircome h Smmeryoiircamepppoacn�1ncwingwwmramenenrnnzmcaMl Thelncoma achisi�e abbecausethe icalbu rota ro 9lmller to ihC sub� ct In s e conditlon a a al woulE be an M�rtWr occu M, ��wv=nwvw. : sr.. s caacA a 0 ircon» n x s Attached Addendum � TNSnppraluirsmetle "asis,' wb,�ztmtnmpkpvnperpiarrsenqspxficatiq�sonNeaasisNeM1ypalMeVCaicon6Wn9ie�NeimporemniXSNeehe¢n[omqafeE, �suqm�omefolbvnngreparsaaleraoomanmeavsiaNa�rypmnetiwlcmatiantnetmerepersuenenlonsherxbeenwmpa�e9 ❑wly>7m�rela�a�.+rq�. 8�i+tlmMeKGW ofwrk,ase�enpUOna•IImtU�g4wtlNla�ssMtPMtlaer'sCNtKfuiloM1mYi�W�Ma+aflMbo-MeEVaitN W NerW pYOpwty . ms�+.mes�e,�ormiareporc�ss S�.OW esor04/29/7A73 .wnmhlsmaertecnvetlNaoiMissppre�sei. rw���.m.eimu�..uo.xrnn.....m,... rm��rm,.q.°mos.mie�xirv�aaocw.s.�.+.i.. Maa�..w .eu Vy�1d! (pPAR"If Yh�Ynv��� ��.,.,..n..-,.F Atark HACkt�Rtal Eslate Appfai9erS M&k HxkmeuY RMI EsdU Aqlmiaers ResidentialAppraisalReport v!krm. iazscxuenm Sc�e at Woric.AssumptioM and limiting CaMitions Scope W work Is EeflnW In SM Unllam SY�N4rES o/PreMfxbrul Nppsisrl AMka�s"IM rype ena mrten[al researcharMenalyses In en lSS19MMM,"In 511Of1.5C0�1X O�WOf�IE 51111�MIII�{Vlp�%if�ISN QW MI}{N{�IIM Ib Il1IIfl�(�1�CWRIO�I�M SSS1011TlM.M IIICIWlS,441[1511M IlmlteElo:tlteeYtenttowhlcf�iMpropwtylaidm[MeGSiElnspecmA,metypeaMernrNp/defarcseerr.l�etl.NetypeerMaxteritofeixlyauseppl(M *a artire M uP�i�m c4ncXn W ns. 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A�ORESS OF 7HE PROVERTV APPRp6ED: 142 16N$troel �New Cumbsrlantl PA 1'7070 EFFECTIYE Dd.TC�F TXE RPPttRiSAt:04129121'113 APPRAtSEp VA{i/f pFiHE StlB1ECT PR6PERTY S 67.400 RPVMISER SIIPERVI50RYAPPRAISER 519^e�u'e. Sigrense: Name�. Gina�3tefe��'�te Cert. sitl.AOOr xame�. su�eGenmcatlonx RL738991 , su�ecroACaiunr a L�.eense Y a taerse f a0me{tlesnitr{: Seaet S�e: bate:PA ExpiretimpbeuiCeRfia�lona4kmse: EKprca�imomeafr,woro-aumaLi�eme�. 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PLAT MAP ClienC SteoMe A.J�nDaak File No� 1425Lheenth Pmoertv Address 14218M Sueet Case No� C� :Nnv CumOSAaM State: PA Zi :17070 i 14� ��h �r�et' .. ;: ..�,.....w . � � � ; � � PH(717)7747202 FAX(717)774-0383 EMAIL fackmanaDWeisen�wmcast.net FLOORPLANSKETCH ClienC SroWim A JiaWsic File No� 1a25t�ctaernh PropeRV AGCress:142 18N Street Case No� C� . New CumCadand $tate: PA Zi :17070 i 40' Bath � A Second Fk�o�r Bedroom N I [Area: 96t}ft'] Bedroom eedroom 40' i � ,—"° � � s.wnasra enrar�row . . ��e��. - ... $ Y MY UEB� Np PH(717)7747202 FN((717)7740383 EMAIL heckmanaPP�aisars�comcaslnet FLOORPLANSKETCH ClienC Slaohen A.J�ahssk File No� 742SIzteeMh Pmperty Adtlrew:t4Y 18th SVeat Case No� Ci :Nsw Cumbedand Sla[e: PA Zi : 17070 � i V p I f Den � �0 p Kilei�en Fir F}a ',� �•uw ��� p_�Q �rer � {Mw:11GM} „ „ „ v�tibwe �, v Q t�—i Fwwrm. rw.rr« ..r.w� �z�r, ' s. ... o�a- . . is 9�1! �St . .. . .. . . . . . 1(k NF OW� tY 3la J� . QfO.. �� N2 . FM FYar a IOO.t! . , .... � - ��I � I L va � � 12a Dfe. W �. c^ I - — PH(717)7747202 FAX(717)7740383 EMAIL heckmanappnisers�comcast.net COMPARABLEPROPERTYPHOTOADDENDUM ClienC Slaohen A.J�ak File No.: 142SIZteenM Praoertv Address 142 i8th St�eet Case No.: Ci :Ns,v CumbeAand State: PA Zi : 17070 � I � COMPARABLESALENI , �;, , � ;�� �'':�"• � 3850000990Q5790032118MSVeet Y' .,��'�� New CumbeAand 1���� Sale Date:OB/01/2012 Sale Price:f 55.000 I � � \ � COMPARABLESALEN2 92416ih Sireet �� New CumberlarW Sale Date:02/(I6/2013 Sale Price:f 84,000 COMPARABLESALEM3 31811 th Stree� New Cumberlan0 �,�� Sale Date: 10/28I2012 � Sale Price:f 100.000 �r:�: Client Steohen A.J�¢basic File Na� 142SIxteenN Propertv Address:142 18t�Street Case No.: CI :New CumbedanE State: PA Zi : nW0 Bedroom ,w Bedroom 1� � � i � J nama�w�nar..aiv�m....o.s� nmmmm� . I I���� Ilent Sroohan A.JusDasia FAe No' 142S�Cteenth Ro�etty ACdress:ta2 i8th Str�t Case No� . Ci : Nsw CumderlaM State: PA � Zi :tt070 � r�f,e. s�p�y ^� Kitchen �'� � »u..—. t: ;C 9etlrtom Bethropm e ,. � PwW uyl.[IyAM�.�1,]Al.pitl��p.mn Mi]NPA11 .��. Cllenl Staohen A.Juzbaak File No.: 142S�COee'rth Procem A�ess:u2 t�h Streea Case No.: Ci : NewCumlrsrlanrJ 51ate: PA Zi : 17070 � Livinp Room � � Qining Room Ni—1 Kitc�en ��� �I� L II�} ns.r�src.�r...serN.em....vi.e.� nnammm� SU8JEC7PROFERTYFH4T6 AODENDUM ClienL Staohen 0.J�abasic File No� 14251zteenfh Arosert,y Rddress:tA2 tBU�S4eet Case No� CI :NewCumbeAend State: PA Zi : r7070 _ FRONT VIEW 6F SUBJEC7PROPER7Y � ;� Appraisesl�ate:N�++�2s.2a�a Appraised Vaiue:S 87.00p `5`.. . � � " •� . `�� ��r, i I � i REAR VIEW 6F SUBJECTPROpERTY �� STREETSCENE i DIMENSION LIST ADDENDUM ClienC Stsohen A.J�Galc File No� 742SbRaenth Prooertv Address 142 18M Sveat Case No� C .NewCu M State: PA Zi ; 77070 GROSSBUILDINGAREA(GBA) 3.i50 GROSS LIVING AREA(GLA) 2,084 Nea�s) Nea %dGIA %oIGBA Lnmg 2,084 65.52 Leveii 1.104 53.49 35.05 Lew11 960 48.51 30.48 Leve�3 0 0.00 0.00 rnner 90 4.36 2.88 G Basm�em ❑ 998 Gara9e Q ❑ Area Measuremems Area Type Musuremsnls Faclor Totel Lewll Lave12 Leval3 OUis BsmL Geroge 998.W � �„QQ y �,QQ - 998.00 998.00 � �.4Q � �.QQ . 998.00 � ❑ ❑ ❑ ❑ ❑ x _ x _ • 109.00 a �.Q4 x .S.QQ - 109.00 ❑ ❑ ❑ 96°.� . �.Qn . � . �o.00 °a o a° °o o° o° � R � 11 _ • � O � O % _ Y _ d _ M _ s O O O O � O — . — . - - o 0 0 0 0 0 — . . - - o 0 0 ❑ o 0 K — . - - o a ❑ o 0 0 — � — � — . o ❑ o 0 0 0 . — . - - o 0 0 0 0 0 — . — . — • D O O O O O K e _ - ❑ ❑ � ❑ ❑ ❑ — � — x — . O D O O O O — K x — . o o a o a o x . — o 0 0 0 o a — . — . — = o 0 0 ❑ o 0 — . — . — . ❑ o 0 0 0 0 — . — � - - o 0 0 ❑ o 0 M M _ . O O O O O O � . - - o 0 0 0 0 0 — . — . — . ❑ o 0 0 0 0 . . — • O D O O O O . . — o a o 0 0 0 _ X _ M _ - ❑ O ❑ ❑ O D _ R _ F _ - O O O O O O _ A _ M _ - O O O O O O � x — . o 0 0 0 0 0 � � — • o 0 0 0 0 0 — . — . — . O D O O D O M Y _ • ❑ O O O O O — . — . — ' O O O O O O _ . _ R _ - O O O O O O _ F _ A _ • O O O O O � — . — � — . o 0 0 0 0 0 — � — . - - O O O D D D _ M _ . _ . O O O O O O M _ . _ . O O O ❑ O O � . — . o a o o a o M Y _ • O O O O O O . . - - O O D O O O . , — . o o ❑ o 0 0 x x — . ❑ ❑ ❑ ❑ ❑ 0 . . — . ❑ o 0 0 ❑ o . . — . o 0 0 o a a M Y _ . ❑ p O O O O � . — . o 0 0 0 0 0 . . — o o ❑ a o a . � — . ❑ O O O D O M � _ . O D O O O O A 1 _ O O O O O O »�W,K„�..�,ma„�,_a,,� a.o�, � CINnC SiaahMAJuiLUic FNeNU' 1425I�Rnrtllf Proc�MMdns' 1L2t89tStr�at CaseFb_� . Ctty WwCumtwWM Slab: P� Lp: 17PT0 80Yndvbs 7he subJect propeM�s located in New Cumberimntl eorough. New Cumberiantl Borough is bountl by ihe Borough at Lemoyna M Me north;7he Swquahanne River tp Me easp Fefrview Townahip to the wuth antl Lower Alkn iownshlp to ihe wB6l. �`.O!lltti�iib MI$i�M ti`011ip��{f01f � Conditbn ad�ustmeM6 to wmpereWes num6er two and ihrae are basatl on iM foibwinp:Comparabie#2 was on the markat for 0 deye wIM a full price oRer. It aolA FHA which has cerlHin requlremente regertling candi0on o/the property. Compareble N3 conditbn antl quelity of consWCtbn edjuatmenb ara based on MLS daecrlp0on which atatas'upAatetl kltc�en,2 heaufHWIY uptletetl baWf.vautteC celflnga,repiecbd wirWews.hencn doors,tankleas Mt waterlreater. A ttrorough aearch for ccmparabie eaies has 6een made M flntl salas which bracke[Me 8irei vaWe e6Nmate.After s thorough search of all evellable market data,tM1e three ealas used ere conaMeretl to be Me 6est indlcetore of value.All three comperable salas are located In the seme markb�area as the eub�ed woultl 4a considered by the same prospecUve purchaeer'rf all wera on Me marlcst at t�e sams tlme as ihe subJect Appropriate atljustmants heve baen mada tot gll �Ytfererwes.Campgra�e ssies usbd are aiofletl sai8x in ottler to HM competabk saVee N was necessar}to we leas recant salsa.it is noted that ttw groas ad}uatment{ar aii Comparabb 3sies exceecl 25%. This adJustrnent is iarge�than npmrai,but salea choaen are wnsiderad Me beat avalla6le.OMer comparebba analyzetl would havs requlred less deatrable ad�uatmenta and were not ueeE Po�that reaeon.COmparebla Shce No.1 ia considereA ihe hest Intliratur ot valua antl is weighMd more heaWly then Compe261e No.2 or No.3. Fkfd tlKOnclRaiipll APPRAISER HEREBY CERTIFIES THAT THIS REPORT HAS BEEN PHEPARED IN COMPLIANCE WITHIN THE UNIFpRM STANOARDS OF PROFESSIONAL APPRAISAL PRACTICE(USPAP),7HAT 7HE APPRAI$ER IS A DISINTERESTED PARTV AND TNAT THE VALUE STATED IN THIS REPORT IS ACCURATE TO THE BEST OF THE APPR415ER'S ABlUN.ANO7HIS VALUE HAS NOT BEEN PREDETfRMiNE�. In ihe viqw of Me ape of fhesa impmvemeMa,the CoM Approech cannot be conaidared an accurate indicaior af value.Sae attachetl appraleefs certlflcetlon e�W Statement of Limitlng CondNlons.The upprelxr wneideretl onty thoae Items thst were permanentty atlached to the pro{prry as realry. Any Itams not eo afflxeE auch as refrlgeraMrs,washara,dryars,above ground awlmming poo1S,etu,were not inUuOed in the esUmate at market value. This appraisai asxtrtres a reasanaMs marketing periotl forthe dubject pmperty of'!80 dsys antl a reasonsbie szpasure time a(180 days.This appraiml Is ba�atl nn readlly obeenable condWons and Is not W ba coneltlered as a Momugh home inspectlon to anelyee pr warrant the aub�ect property and/or Its mechanicsl systems.This appralsal report has been prepared wkh the propBrty in'as i9"conANio�. ee�m nqe i ai Calculated Value of Your Paper Savings Bond(s} Page 1 of 5 Calculated Value of Yaur Paper Savings Bond(s) Caleulator Results for Redemptlon Date O1/2013 Totai Price Total Yalue Tatal 2nterest XTD Intaresf 58 331.25 211 378.40 153 p47.15 752,34 (-1 k ?rOM)S 8,UCC�,Ot� (o!/G�. 7/� Bonds: i-244 of 244 Serial # Series Danom Issue Next Final Igsue Price InteresC Interest yalue Nota Date Accrual Meturity Rate r42208A39ee EE $2p0 ifJ19$7 OS(2813 IiJ2017 $200.08 $240.24 4.00% ;34D.24 r42188229ee EE $2p0 07/19$7 07/2q19 07/2017 $1p0.00 $247,04 4.00Mn j347.04 r4219i510ee EE $200 07/1988 Q7/2013 07l2019 $100.00 $233.60 4.00Mo #333.60 r422$9073ee EE $200 14ji987 04�2013 IOJZ017 $100.40 $240.24 4.00°l0 #34Q.24 r42208897ee EE $200 22/i9$7 46(2013 12J2017 $100.40 $240.24 4.00% #348.24 r42189757ee EE $200 04/1488 04/20i3 04/2018 $1p0.00 $233,60 4.00% ;333.60 m457698l8ee EE $S,OOU 09/1992 03/2023 �9(2U22 $SOOAO $895.60 4.009b f1,345.60 r324678i3ee �E $200 Q6jf4$? 66j2013 Q612617 $140.60 $247.44 4.4pMo #347.04 r29545612ee EE $200 OS/1986 OSj2013 USJ2016 $i00.00 $301.60 4.00% $401.60 r29545478ee EE $200 04/1986 04/2013 04/20iB $i40.00 $301.60 4.00°k ;401.60 r29545759ee EE $204 OSJ1486 OS/2019 OS/2016 $ip0.00 $301.60 4.00% f40X.66 r248697fi2ee EE $20Q 48j1986 Q2j2013 OSJ2p26 $100A0 $293.58 4.40°l0 ;393.65 r29869658ee EE $2q0 08/1986 02(2013 08/2016 $Sd0.00 $293.48 4.00% ;393.68 r29869593ee EE $20p 08/1986 02/20i3 08/2piB $100.00 $293.68 4.00°/a ;393.68 r29546983ee EE $20Q li/198b QS(2423 11/2416 $lOq.00 $254.qQ 4.00°l0 ;3S4A0 r24546834ee EE $206 SiJi986 OSJ2013 SSJ241fi $500.00 $254.00 a.00°la #354.66 r29548655ee EE $240 SOJ1986 04/2013 lOJ2pi6 $100.00 $293.68 4.00% ;393.68 r26869141ee EE $200 07/1986 07/2013 07/2016 $iQ0.00 $301.60 4.00°h ;401.60 r24546249ee EE $200 07fi98$ 07J2413 Q7J2016 $100.00 $30f.60 4.OQ% ;401.60 r24547259ee EE $2Q0 12j1986 Obj2413 12j2016 $id0.60 $25a.4Q 4.00% jSS4.40 m012666918ee EE $1,Op0 02/i986 02J2p13 02/2016 $540.00 $1,508.Op 4.00Ma ;2,008.00 29546p76ee E6 $20p 06/1986 O6/2013 06/2016 $100.00 $301.60 4.00�/o s401.60 r245459i4ee EE $Z00 Ofi/1986 O6/2023 05J2018 $200.00 $301.60 4.00% �401.60 ri4944624ee EE $200 OJ/19&5 47j2013 6712015 $i00.00 $317,76 4A0°!a ;417.T6 r19999462ee EE $200 06/1465 06/2013 06/2015 $i00.00 $317.76 4.00% ;417.76 r19994804ee EE $200 06/1985 06/2013 06/2015 $100.00 $317.76 4.00°k ;417.�6 r24494223ee EE $240 03/1985 03f2013 03j2015 $100.04 $317.?5 4.Q0% ;427.76 r19990507ee EE $204 03j29$5 43j2013 63J2015 $100.00 $327.76 4.00% ;417.76 r22338462ee EE $200 07J1985 07/2013 07/2015 $106.00� $317.76 4.00% ;41�J6 r19994627ee EE $200 05/1985 OS/2013 OS/2015 $lOp.00 $317J6 4.00% ;417J6 199444S6ee EE $200 04f29$5 04J2013 U4J2015 $iQQ.00 $317.J6 4.40°/a $417.78 ri9944322ee EE $204 04j1485 Q4J2013 04j2Q15 $100.60 $317.76 4.00°!0 #41?.76 r19743635ee EE $200 02/1485 02/2013 02/20i5 $100.00 $317J6 4.00Mo ;417J6 r19790801ee EE $200 01/1985 07/2013 O1(2015 $30Q.00 $326.16 4.00% ;426.16 r14740684ee EE $200 Oij1985 07J2023 OIJ201S $140Ad $325.16 4A6°k $428.18 ri9786394ee EE $200 22j29$R 06J2d13 iZ12024 $lOd.00 $326.18 4.08% $�{26.18 r19940335ee EE $2p0 03/1985 03/2p13 03/2015 $i00.00 $317.76 4.00% ;417.76 r1999qi53ee EE $200 02/1985 02/2013.02/2015 $1p0.00 $31�J6 4.00% ;417.T6 r17512289ee EE $200 14j1984 04(2413 10J2014 $SOO.OU $326.16 4A0% ;426.26 r2978602free EE $200 li/1484 OSJ2023 11(2014 $100.00 $326.16 4.00% ;42b.16 r19786217 EF $2p0 12/1984 06/2013 12/20i4 $100.00 $326.i6 4.00% ;426.16 r17502849ee EE $200 OB/1984 02(2019 OS/20i4 $10tl.00 $326.16 4.00°Po 5426.16 R 75026SSee EE $200 QSJ1484 62J2Q13 68/2014 $100.Q4 $326.16 4.00% #426.16 r175F2474ee EE $200 11(19&4 OSj2013 i1J2014 $100.00 $326.16 4.00°k ;426.1fi r1750S163ee EE $2p0 10/1984 04/2013 10/20i4 $ipp,00 $326.SB 4.00% ;426.16 r17505015ee EE $20� 09/1984 03/2013 09/2014 $100.00 $326.16 4.00% �428.16 r17503�51ee EE $2Q0 04J19$5 03J2013 09j2015 $SOOAO $304.64 4.40°la ¢404.6d r22341140ee EE $2Q0 09/1985 03j2013 49J2025 $IQ0.00 $3d9.64 4.00°h ;4p9.68 http://www.treasurydirect.gavBC/S$CPrioe U11I2U 13 Calcutatad Value of Your Paper Savings Bpnd{s} Page 2 of 5 r223409S3ee EE $200 08j1985 42(2013 0812015 $100.60 $309.60 4.Od% #409.60 r22336691ee EE $200 08/1985 02/2013 08/2015 $1p0.00 $309.60 4.00% ;4p9.60 r22343031ee 8E $200 11/1985 OS/2013 11/2015 $1pp.00 $309.60 4.00% �409.60 ri9994241ee EE $200 45j1485 OS/2413 QS/Z015 $idd.6Q $317.�6 4.04% �417.78 r22341297ee EE $200 09119$5 Q31Za13 09j2015 $140.60 $309.6p 4.00°k �404.6Q r22341998ee EE $200 11/19$5 OS/20i3 11/2015 $1p0.00 $309.60 4.00°k ;449.60 r22336633ee E� ¢200 OS/1985 02/2013 08/2015 #100.00 $309.60 4.00% ;404.60 r19543453ee EE $200 I2J1985 O6j2413 12J2415 �1oa.oa $344.68 4.00°k #409.80 r424027541ee EE $200 42j1986 02J2013 0212016 $108.00 $3D1.60 4.00% ;401.60 r2234i460ee EE $200 10/1985 04/2013 10/2015 $100.00 $309.60 4.00% ;404.60 r17514451ee EE $200 10(1985 04(2013 10(2015 $100.00 $309.60 4.00°h ;409.60 r22342466ee EE $204 03/298b Q3/2013 03j2416 $100.40 $341.64 4.40Mo ;4q1.84 r22342314ee EE $200 03ji496 03J2013 03j2016 $100.00 $30i.6Q 4 AOMa #401.50 r029027S42ee EE $20p 02/1986 02/2013 02/2016 $100.00 $301.60 4.00% ;401.60 r029025161ee EE $20Q 02(1988 02(2013 02(2016 $100.00 $301.60 4.00°k ;401.60 r22342233ee EE $244 02j1986 62J2013 02J2016 $100.40 $341.60 4.00% ;401.60 r29545323ee EE $204 04/1986 64JZ013 04)20i6 $100.00 $301.60 4.00% ;401.60 r029027540ee EE $200 02/1984 02/2013 02/2016 sioo.00 $301.60 4.00°/n 5401.60 r029027539ee EE $200 02J1986 02(2013 Q2/2016 $100.00 $301.66 4.00% ;403.60 r029025162ee EE $240 02/1986 Q2J2013 0212018 $100.00 $341.60 4.OQ% ;401.SG r22343947ee EE $200 Oij1986 0712013 OiJ20i6 $500.00 $309.b0 4.00% ;4p4.60 r22344p29ee EE $2p0 O1/1986 07/2013 01/2016 $100.00 $309.6p 4.00% ;409.60 r22344029ee EE $200 Ol(1986 07J2013 OSJ2016 $100.00 $309.6d 4.00% ;409.58 r195035biee EE $240 iZj1485 O6J2423 12J2615 $140.D0 $349.b4 4.40% #409.6d r22344232ee EE $200 01/19$6 07J2013 01/2p16 $ip0.00 $309.60 4.00% ;409.60 r49894363ee EE $200 OS/1969 OS/2013 OS/20i9 $500,00 $220.64 4.00% �320.64 r498991i9ee EE $200 Q4J19$9 Q�R013 04(2019 $100.00 $220.64 4.00% �320.64 r17494$17ee EE $200 0$J19$4 021z013 D$j2614 $106A0 $326.16 4.6QMo ;428.16 r49900246ee EE $Z00 06/1989 06J2013 061z019 $1p0.00 $220.64 4.00% ;320.64 r49900026ee EE $200 06/1984 O6/20i3 06/2019 $100.00 $220.64 4.00°k #320.64 r44899642ee EE $204 OSji989 OS/2033 45/2019 $100.00 $220.64 4.00% ;320.64 r49&97a45ee EE $244 02J2989 02J2Q13 02j2019 $100.04 $220.6A 4.fl0°lo- ;320.54 r498972147ee EE $200 O1/1489 07/2013 O1/2019 $iq0.00 $227.04 4.00Mo #32�.04 r80230672ee EE $200 0�/1992 07/20i3 07/2022 $140.00 $184.72 4.00°k ;284J2 r448482A8ee EE $240 03j1989 Q3j2Q13 03J2Q19 $10Q.00 $220.64 4.60% f3�0.54 r49$4?9$3ee EE $206 03j1489 83j2013 03j2419 $100.60 $220.64 4A0°lo $320.64 r49697718ee EE $200 02/1494 02/2013 02/2014 $100.00 $220.64 4.00% ;320.64 r47542745ee EE $200 11/1988 OS/2013 11/2018 $30Q.00 $227.04 4.00% ;327.04 r49898822ee EE $200 04J14$9 4412Q23 04J2419 $SOO.OQ $224.64 4.04% #320.64 r44898524ee EE $20Q 04j1984 d4J2013 64J2019 $SOOA4 $220.b4 4.Q0% #320.64 r49896195ee EE $200 11/1988 OS/2019 11/2p1$ $30p,00 $227.04 4,00% ;527.04 r49896433ee EE $200 12/19$8 06/2019 12/20i8 $1p0.00 $227.p4 4.00% ;32>.04 r49896704ee EE $246 SZJ1988 06t2413 Y21z418 $100.OQ $227.44 4.04% #327.04 r47541SS7ee EF $200'44J19$8 03j2013 09j201$ $100.06 $227.04 4.00% #327.04 r47541364ee EE $200 09/1488 03/2013 09/20i8 $100.00 $227.04 4.00°k ;327.04 r49896955ee EF. $200 01/1989 07(2013 O1/2019 $100.00 $227.04 4.00% ;327.04 r47542518ee EE $20Q 16J2988 04j2413 fOf2018 $lOp.00 $227.04 4.04% #32T.04 r47542122ee EF $200 SOJ1988�04j2813 14j201$ $rao.00 $227.OR 4.00% �32�.04 r47541$03ee EF $20p 10/1988 04/2013 10/2018 $300.00 $227.04 4.00°/a ;327.04 r42191997ee EE $200 08/14$8 02/2013 08/2018 $100.00 $227.p4 4.00% ;31'7.04 r42141767ee EE $246 0?J1988 071zffi3 67)Z018 �ioa.oa $233.60 4.44°fo 5333.60 r42191265ee EE $200 05J1988 06j2013 D6j2018 $100.04 $233.60 4AOg'o �333.60 1526401i79ee EE $50 02/1995 02/2013, 02/2025 $25.00 $25.84 4.00% #BQ.84 1543732692ee EE $SO 02(1996 02(2013 02(2026 $25.OQ $18.78 0.76Ma ;43.78 kfi94328i1ee EE $?5 64114$7 Q3I2013 04l2417 $37.54 $90A9 4.OQ�/a $12T.58 q1957440002e E $25 0811982 d8j2002 $16.75 $194.06 ;212.81 MA k69432810ee EE $75 09/1987 03/2013 09/2017 $37,50 $90.09 4.00% ;127.59 k41206369ee EE $75 07/1984 07(2013 07/2014 $37.SU $125.49 4.00% ;162.99 r3$882765ee EE $200 47l1987 07JZ413 071241? $f00.00 $247.04 4.84% f34�.04 r3888llb4ee EE $200 07(1987 07J2013 07/2017 $100.00 $247.04 4.00% ;34�A4 r42188322ee EE $20q 07/19$7�07/2013 07/2017 $300,00� $247.04 4.00% ;347.04 r32467i49ee EE $200 OS/1987 OS/2013 OS(2017 $100,Q0 $247.04 4.00°/n ;34T.04 � r3$$81767ee EE $200 4711987 Q7J24f3 07J2017 $Y00.00 $247.Q4 A.04% $34TA4 r3881�6bee EEI $206 07ji9$7 07J2013 07j201� $100.04 $247.04 4.00°l0 #347.04 I http:/lwww.treasurydirect.govBClSBCPrice 1/11/2013 Calculated Value of Your Paper Savings Bond(s) Page 3 of 5 r32467642ee EE $200 06/1987 06/2013 06/2017 $100.00 $247.04 4.00% ;347.04 r32467459ee EE $200 06/1987 06/2013 06/2017 $100.00 $247.04 4.00% ;347.04 r32467350ee EE $200 OS/1987 OS/2013 OS/2017 $300.00 $247.04 4.00�a ;347.04 r47541100ee EE $200 08/1988 02/2013 08/2018 $100.00 $227.04 4.00% ;327.04 r17493949ee EE $200 06/1984 06/2013 06/2014 $100.00 $334.64 4.00% ;434.64 r17499473ee EE $200 07/1984 07/2013 07/2014 $100.00 $334.64 4.00% ;434.64 r42168732ee EE $200 08/1987 02/2013 08/2017 $100.00 $240.24 4.00% ;340.24 r42188560ee EE $200 08/1987 02/2013 08/2017 $300.00 $240.24 4.00% ;340.24 r42189952ee EE $200 04/1986 04/2013 04/2018 $100.00 $233.60 4.00% ;333.60 r42190778ee EE $200�05/1988 OS/2013 OS/2018 ¢100.00 $233.60 4.00% #333.60 r42190569ee EE $200 OS/1988 OS/2013 OS/2018 $100.00 $233.60 4.00Mo ;333.60 r42190224ee EE $200 OS/1986 OS/2013 OS/2018 $100.00 $233.60 4.00% ;333.60 r42206566ee EE $200 02/1988 02/2013 02/2018 $100.00 $233.60 4.00Mo ;333.60 2209378ee EE $200 01/1986 07/2013 01/2018 $300.00 $240.24 4.00% ;340.24 r42191009ee EE $200 06/1988 06/2013 06/2018 $100.00 $233.60 4.00% ;333.60 r42189554ee EE $200 03/1988 03/2013 03/2018 $100.00 $233.60 4.00Mo ;333.60 r42209677ee EE $200 02/1988 02/2013 02/2018 $100.00 $233.60 4.00% ;333.60 r42189363ee EE $200 03/1988 03/2013 03/2018 $500.00 $233.60 4.00% ;333.60 r42209186ee EE $200 O1/1988 07/2013 O1/2018 $300.00 $240.24 4.00% ;340.24 r42209003ee EE $200 12/1987 O6/2013 12/2017 $100.00 $240.24 4.00% 5340.24 r42208620ee EE $200 12/1987 06/2013 12/2017 $100.00 $240.24 4.00% ;340.24 r42208056ee EE $200 10/1987 04/2013 10/2017 $100.00 $240.24 4.00% ;340.24 r42207826ee EE $200 09/1987 03/2013 09/2017 $100.00 $240.24 4.00°h �340Z4 r42188880ee EE $200 09/1987 03/2013 09/2017 $100.00 $240Z4 4.00% ¢340.24 r38881769ee EE $200 07/1987 07/2013 07/2017 $100.00 $247.04 4.00% ;347.04 r38881768ee EE $200 07/1987 07/2013 07/2017 $100.00 $247.04 4.00°k ;347.04 r42208260ee EE $200 11/1987 OS/2013 11/2017 $300.00 $240.24 4.00% ;340.24 m012666915ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% f2,008.00 m012666916ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ¢2,008.00 r38881770ee EE $200 07/1987 07/2013 07/2017 $100.00 $247.04 4.00% ;347.04 m012666912ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m012666913ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m012666914ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956060ee EE $1,000 02/19B6 02/2013 02/2016 $500.00 $1,508.00 4.00% �2,008.00 m13956061ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m012666911ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956057ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956058ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% f2,008.00 m13956059ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956054ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956055ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956056ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956051ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% �2,008.00 m13956052ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956053ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00°h ;2,008.00 m13956048ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956049ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956050ee EE $1,000 02/1986 02/2013 02/2016 $500.00� $1,508.00 4.00% ;2,008.00 m13956045ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956046ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% #2,008.00 m143956047ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956042ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956043ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956044ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4,00% �2,008.00 m13956037ee EE $1,000 02/1966 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m13956040ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00°h ;2,008.00 m13956041ee EF. $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m24735451ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m13956039ee EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 m135956038ee EE $1,000 02/1984 02/2013 02/2014 $500.00 $1,673.20 4.00% ;2,173.20 m24735448ee EE. $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735449ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00°h f1,735.20 m24723450ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00Mo ;1,735.20 m24735445ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00Mo ;1,735.20 http://www.treasurydirect.govBGSBCPrice I/1 U2013 Calculated Value of Your Paper Savings Bond(s) Page 4 of 5 m24735446ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735447ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735442ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% �1,734.20 m24735443ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% #1,735.20 m24735444ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735439ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735440ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 m24735441ee EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% 51,735.20 M13956062EE EE $1,000 02/1987 02/2013 02/2017 $500.00 $1,235.20 4.00% ;1,734.20 M24735489EE EE $1,000 08/1967 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735438EE EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 M24735492EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735491EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% �1,701.20 M24735490EE EE $1,000 08/1987 02/2013 08/201J $500.00 $1,201.20 4.00% ¢1,701.20 M24735488EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735437EE EE $1,000 07/1987 07/2013 07/2017 $500.00 $1,235.20 4.00% ;1,735.20 M24735493EE EE $1,000 08/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735486EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735485EE EE $1,000 08/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735487EE EE $1,000 OB/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735482EE EE $1,000 08/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735481EE EE $1,000 OB/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735480EE EE $1,000 OB/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00°k ;1�701.20 M24735479EE EE $1,000 OB/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735484EE EE $1,000 OB/1987 02/2013 08/2017 $500.00 $1,201.20 4.00Mo ;1,701.20 M24735483EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735476EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735477EE EE $1,000 OS/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% 51,701.20 M24735478EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00Mo �1,701.20 M50685973EE EE $1,000 12/1987 06/2013 12/2017 $500.00 $1,201.20 4.00% ;1,701.20 M50685971EE EE $1,000 12/1987 06/2013 12/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735475EE EE $1,000 OS/1987 02/2013 08/2017 $500.00 $1,201.20 4.00°h ;1,701.20 M45660793EE EE $1,000 06/1992 O6/2013 06/2022 $500.00 $923.60 4.00°h ;1,423.60 M43960618EE EE $1�000 OS/1992 OS/2013 OS/2022 $500.00 $923.60 4.00% ;1�423.60 M43920852EE EE $1,000 04/1992 04/2013 04/2022 $500.00 $923.60 4.00% ;1,423.60 R32900642EE EE $200 03/1967 03/2013 03/2017 $100.00 $247.04 4.00% �347.04 R32900102EE EE $200 03/1967 03/2013 03/2017 $100.00 $247.04 4.00% ;347.04 R29870918EE EE $200 02/1987 02/2013 02/2017 $100.00 $247.04 4.00% ;347.04 R32467024EE EE $200 04/1987 04/2013 04/2017 $100.00 $247.04 4.00% ;347.04 R29870017EE EE $200 12/1986 06/2013 12/2016 $100.00 $254.00 4.00Mo ;354.00 R32900837EE EE $200 04/1987 04/2013 04/2017 $100.00 $247.04 4.00% ;347.04 R29870579EE EE $200 O1/1987 07/2013 O1/2017 $100.00 $254.00 4.00% ;354.00 R29870269EE EE $200 12/1986 06/2013 12/2016 $100.00 $254.00 4.00% ¢354.00 R29870424EE EE $200 O1/1987 07/2013 O1/2017 $100.00 $254.00 4.00% �354.00 R29546339EE EE $200 09/1986 03/2013 09/2016 $500.00 $293.68 4.00°h ;393.68 R29869913EE EE $200 09/1986 03/2013 09/2016 $100.00 $293.68 4.00°h ;393.68 A29870745EE EE ¢200 02/1987 02/2013 02/2017 $100.00 $247.04 4.00% ;347.04 A29546502EE EE $200 10/1986 04/2013 10/2016 $100.00 $293.68 4.00% ;393.68 M45691018EE EE $1,000 07/1992 07/2013 07/2022 $500.00 $923.60 4.00% ;1,423.60 M012666917EE EE $1,000 02/1986 02/2013 02/2016 $500.00 $1,508.00 4.00% ;2,008.00 M45894312EE EE $1,000 11/1992 OS/2013 il/2022 $500.00 $895.60 4.00% ;1,395.60 M45819289EE EE $1,000 10/1992 04/2013 10/2022 $500.00 $895.60 4.00% f1,395.60 M45732323EE EE $1,000 OB/1992 02/2013 08/2022 $500.00 $895.60 4.00% ;1,395.60 M24735472EE EE $1,000 OB/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735473EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% �1,701.20 M24735474EE EE $1,000 OS/1987 02/2013 OS/2017 $500.00 $1,201.20 4.00% 51,701.20 M24735469EE EE $1,000 08/1987 02/2013 OS/2017 $500.00 $1,201.20 4.00°k ;1,701.20 M24735470EE EE $1,000 OS/1987 02/2013 OB/2017 $500.00 $1,201.20 4.00% �1,701.20 M24735471EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00°h ;1,701.20 M24735466EE EE $1,000 OS/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735467EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% ;1,701.20 M24735468EE EE $1,000 08/1987 02/2013 08/2017 $500.00 $1,201.20 4.00% �1,701.20 C669370782EE EE $50 OS/1999 02/2013 08/2029 $25.00 $13.74 0.81% ;38.74 6579686338EE EIE $50 10/1999 02/2013 10/2029 $25.00 $13.68 0.81% ;38.68 . http://www.treasurydirect.gov/BGSBCPrice 1/I 1/2013 Calculated Value of Yow Paper Savings Bond(s) Page 5 of 5 M050685972EE EE $50 12/1987 06/2013 12/2017 $25.00 $60.06 4.00% ;85.06 C345984526EE EE $50 07/1992 07/2013 07/2022 $25.00 $46.18 4.00% 571.18 D29878728EE EE $50 08/1992 02/2013 OS/2022 $25.00 $44.78 4.00% ;69.78 L477797346EE EE $50 10/1994 02/2013 30/2024 $25.00 $26.52 4.00% ;51.52 Totala for 244 Bonds 558,331.25 5153,047.15 ;211,378.40 Notes NI NotISSUed 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'� � .: _ i � -'" �- R29 990151 EE -�.--� �..�- .. .. .. , . . . . ; I i � -- -- -- _. _ _ __ 1 I ..�...�r�.��..,s. " �o�r� I . . �.. � � ...� 11�1�147�M�or I7+r'��Y�I#'� _" , *:e,L`..�. - �' 1+� STEPHEI� R .�SI,C AlfP GKrKS p�"' � 142 i6� 5'�R�� • ^r $.,,; nE1t G##Ia�tLI�N�`r �� f't4� , � O(t MR� �11M�ifiTE �f' .14t��31G fl�"�"""'' i � � 3�t ;�,.' � �, . .�«., " ;,.,' 5' !, M 1 �TMZ ' � . _ . � �� ,,,. t� � �" . R19 99Q 335 EE _ � �..- �� . . . . . , 1 I ����� I I ; �s�uc ow�rc I ..rw H asaw.c.�a 17#-24-1 ' f•MR STEPi4�eit A �BASIL ' A+�' �4�i45 uE�1�4,.�--' } 142 IbfiE� STAE�T. ,.. -- NEM LUMB€Ri.I►MDf PA 17�70 4�� `. OR 1�5 AI1d�TTE N• .WZff�[SSt �%���* '� 1"Lf21/� ;, MtiS1..',.vA. � _ �-�'- -=== R19 786 394 EE � 4 3EY�I� � .�._,.r �k�, r- c ii � �� ii � M l�t Y11qRYy�{111�y1�N issvc a�T wMtl�n�qF�YSf o�r or 174-2�-123T T•Ma STEPHfN A JUZH�ISIG AMP 04445 '�F __ 142 16TH STREEt" �-=--"''r'�'-° NEM CUJ�EftIAND► PR 170T4 ti�'gp OR MRS ANNEiT� 14 JUZifASIC pp�`{' ,�,�,,, '; ' 1/Il�l�� ,• H6fi«`�PA. ' g��„g � ��� ° R19 790 684 EE =��`�' .�.�- . . . . .. ( II � 1� I ar,�rmr..i..e..�.... �:s�ic GA�tc I „p�cw�s qrtpwr o�s os I 174-20-1�l7 I w r•MR STEPMBI A 3URiASIC Al4Y o4445 JA�,,,,�tS�_;,,�o„-- 142 16Tli S►Ti1E�E1` �� ,'• NEiI GUl�ERUfD• ►� 170T8 0P0��Y'�"` �, I �t 111tS R#MIEttE M i1iZiRSIC ��� ; � •, � liBiFs'�Ar_-,'", � '�� -�_ �=''� R19 790 801 EE �! 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I I I � � �� � w11N[�uluwt�rflfor wu rwr �� ��� ISSUE DATE 174-20-1237 wmcM is rx�rmsr o�.ov ToMR STEPHEN A JUZbAS1G AMP 04445 AP @$____,____ 142 16TH STREET �''�'�--' �""'"' NEM CUMBERLANOs PA 1T0T0 4,150 Oft MRS ANNETTE M JUIBASIG tH�qT �i�.�•�� �' 4/�26/fi5� rW(..'-PA. � — SERIFS EE r'°" ��y�4 R19 994 456 EE . i i i --.- ....,.. i 1 I ' ' ' ���"'�""r�0���� 165U[ DATE �� wwcx is rw n�s*o�r ar 174-20-1237 T°MR S7EPHEN A JUZEASIG AMP 04�M►5 MAY��85___�,�;�-- lh2 16TH STREET -'� NEM GUMBERLANU� YA 1?070 4150 OR NRS ANNETT't M JUZBASIG �dT '��'°`"" ' 5✓'�,iu!,�.,.r tui6.� PA. . �a —•� �' R19 994 627 EE sEx�.s EE _p �."��`�-�y��-,�.: . � . � �� �sry ii � � ii � ��tw wtu�rn K�[or wu r�r ��� It�UE OAT[ 1T��2ai «�icw is nrc rMSt o�r or TaM11 STEPNEN A ,IUZ6ASIC AMY 04445 .rill 1985 142 167H iTREET -'"°""',-_�___""",-- NEM Wl6ERlAND• PA 17070 ♦Y50 OR /Yl5 ANtiETTE M JU2BA5IG W8T ,�Q,,.,Mr '�, 7y19l95 d.»»....� F1f►6:. 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STATEMENT PERI04 �� PACE � OCT.05-lIOV.02�2012 1 OF 5 00 0 06443M fM I17 000003879 FIDS1541G70177021211 02 000000 s097 STEPHEN A JU2BASIC STEPHEN JU2BASIC 142 16TH ST NEW CUMBERLAND PA 17070-1109 SELECTED �tCCRWfiT SUN!#�tRY ACCOUN7 ACCOUlIT INTERES? EARNED MATURITV ENDINC TYPE MIMBER _ YEAR-TO-DATE DATE BALANLE MiT SELECT MITH INTEREST 000000049942107 2.19 9�920.14 MiT SELECT 12 MONTH CD 031003913917993 22.18 04-25-13 0.00� TOTAL DEPOSITS 9�920.14 � ■ INTEREST EARNED IS INCIUDED IN YOUR TIME DEPOSIT ENDINC BALANCE � ONI.Y IF 2T HAS BEEN PAID TO YOUR ACCOUNT. � � � ° ECT T T TIT If 4 STEPHEN JUZdA3 i 5 Att01MT N0. 49942307 BALTIMORE MAIN p INTERE3T EARIED FOR STATEMENT PERIOD 0.13 n � ACCOUNT SUMMARY A � 4 EALANCE �1 :OTMfR -���TlOM3 D -���. ��- INI'ER t P :'. 3AEilt�� N0. AlIOIMT � N0. AMOUpi N0. 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T �.Tk 'fI�� tlESCkrMTYGN ■i' . . .Y'r ��.Y� 30-26-12 PAMC PAVMENT 61.02 8�520.16 10-29-12 CHECK tM�ER 2052 110.00 8�430.16 11-01-12 6ENEFIT PAVIEIfTS DEPOSIT 529.26 11-01-12 FREEDO!lLUE FREEOOMEFT 167.00 11-03-12 LIlERTY MIfTUA� PAYMENT 40.25 11-01-12 COlICAST CENTRAL CENTRAL PA 14.18 8�71a.01 � 11-02-12 US TREASURY 303 XXSOC SEC 1,202.00 11-02-12 INTEREST PAYMENT 0.13 9i920.14 & � EImINC BA�ANCE �9 920.14 � u a CXECKE �AxD SiMR41RY N O y 1966 10-05-12 477.00 1966� 10-16-12 367.50 1989 30-15-12 120.00 g 1990 10-23-12 130.00 2051■ 10-24-12 17�362.00 2052 30-29-12 110.00 2053 10-26-12 120.00 Y n Ag i � A1M1AL PERCENTACE YIELD EARlIED = 0.00 % �p 8 M06ILE TEI(T BAIKINC- IT•3 AS EASY AS TE%TINC THE LETTER "8^ 70 IWtmT (6263l7 TO RETRIEVE YWR ACC011lIf BALANCE. NITH lIOBILE TE%T BAIKINC YOU.CAN CET ACC011lIT INFOMUITION AT YOUR FINCERTIPS AND RETRIEVE YOUR BALANCES A1m RECENf TRAlL4ACTIONS. NOM YW CAN ALSO ENROLL TO RECEIVE TEI(T ALERTS ON IMPORTANT ACCOIMT ACT2VITIE4. lIOBILE TEXT BANCINC NORKS ON VIRTUALLY EVERY 1106ILE PHONE. VIEM OUR DEMO AND LEARN lIORE TODAY AT lfT6.Cq1/IqBIIE. MElOER FDIC. LWfl?CS(Nt21 STATEMENT PERIOD� PACF. � . 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Air Conditioner 520.00 fqp pp Children's Cloth'n¢Donaz;on Pumitwe Donation nry� 545.00 590.00 � Houuhold Goods Donaz� Electric Stove 575.00 5150.00 ' Men's CIoN'n¢Donai oq � GasStove 550.00 f125.00 Miscellanwus Donazion Heater 5750 f2200 �y ' CI th� Do ion Microwave SI0.00 550.00 Refngeralor(working) 575.00 S2S0.00 � T.V.(color,working) 575 00 5225.00 / Washing Machine 540.00 5150.00 ___'_'_"__'_____'___"__'____ "___.._._.'_-- _"__"_'__'-__'_ � CHILDREN'S CLOTHWG DONATION � � --�-- ------ -._._-- ------ - -------- ---- ...._.._.__._. Childron'S<InOiinglhmanon I.ow ryigL � � BI e 52.00 5800 � Boots 53 00 520.00 � 1 i Coat f4.50 520.00 Drcss E3.50 512.00 � Jacket 53.00 525.00 ileans 53.50 f12.00 Pants 52.50 512.00 ; Shfn 52.00 56.00 II Shoes f2.50 S8J5 '�., Skirt SI.50 56.00 � � Slacks 52.0 58.00 i Snowsuil 54.00 519.00 � Socks 50.50 �SO ( � Sweala f2.50 58.00 Undmvesr J_- SL00 53.50 I_-_-_"__"__' -_-___"' _-___'_'-______ FURNITURE DONATION I�"'---'-'---" FivniNrc[kmation _--I.ow Hieh .._. __..... .__._.. � Bed(PoI1.9ueen.kin8) T5000 SI']000 Bed(single) 53500 SI0000 iBedroom Sa(complete) 5250.00 51,000.00 Caniage 55.00 5100.00 �� � S � Chair(upM1olslered) I 525.00 5100.00 � Chest I 525.00 E93.00 http://satruck.org/donation-value-guide 7/30/2013 The Salvation Army Family Stores: Donation Value Guide Page 2 of 4 _ I'umiturc IM�mtion I.uw Hi�h � ChinaCebina f85.00 5300.00 � Clo�hesClose� I f1500 550.00 Coffee Table 515,00 i 565.00 i J Cnb(w/memess) 523.00 f100.00 Desk S15.00 5140.00 � Dining Room Sel(complet<) SI50.00 5900.00 2 Uesserw/Mirtor 520.00 5100.00 EndTable SI0.00 550.00 � Polding Bed f20.00 T60.00 Hi Riser 535.00 575.00 High CM1a�r 510.00 i 550.00 Kimhm Cabinet 525.00 575.00 KitchenCheir 52.50 $10.00 Kilchen Sel 535.00 SI70.00 Mattrese(double) f12.50 575,00 Mattrcss(9ingle) SI5,00 535.00 Playpen 53J5 530.00 Rugs 520.00 590.00 Secrelary 550.00 A40.00 Sleeper Sofa(wi�M1 mettress) 585.00 5300.00 Bofa 53500 5200.00 Tnmk ( 5500 57000 ! Werdmbe I 52000 SI0000 ....._ ........ ._._._ . 1 ........ ...... _..._..... HOUSEHOLD GOODS DONATION }IOivselxilA(wod�Ll�nabon Low High - __-"_ '___--_-"_""'_"__" Bekeware SI00 53.00 iBedsproad/Quill f3.00 $24.00 IBlankel f3.00 515.00 I Chair/Sofe Cover 515.00 S35 00 i � � Cof&emaker 54.00 SI5.00 Curtains SI.50 512.00 I; Drapes 56.50 $40.00 ' Fireplace5et f2000 580.00 FloorLemp 56.00 55000 / I ci�c�v soso s,so 1 �'� Gnddle 54.00 512.00 I IKirohen Utensils 50.50 57.50 i �� Lamp 55.00 575.00 IMixer/Blender 5500 520.00 � Picture/Painting 55.00 5200.00 i ( Pillow 52.00 58.00 II Pla�e i T0.50 53.00 http://satruck.org/donation-value-guide 7/30/2013 The Salvation Army Family Stores: Donation Value Guide Page 3 of 4 _Hnu>elinlU(i�od9[hmxfinn Luw 4{�g�i PoI/Pen -� SI.00 53.00 i Sheete I f2.00 T8.00 ThrowRug SI.50 S1200 Towels 50.50 '___ f4_00_'_"'___... MEN'S CLOTHING DONATION bleiisClnthingDonation Low Fliqh __... .......... _._ .... ......... .......... . ....._......... Jackel f7.50 525 00 Overcoai SI5.00 560.00 Pajemav 5200 58.00 Raincoa� � $5.00 520.00 � Shirt 52.50 512.00 Shces 53.50 525.00 Shons 53.50 SI000 Slecks 55.00 512.00 Suit SI5.00 560.00 i Sweater 52.50 512.00 I Swim Trunks 52.50 58.00 Tuzedo 570.00 560.00 UndersM1irt � SI.00 53.00 Undershort I $1.00 $J.00 I._-'_____"'____'__-__-...___J-__-_'__'_._'_ '__' MISCELLANEOUS ITEM DONATION r..__ ....____--_.�-----. --------T ._ .........---. -___-_- IMi�cellnnu�ac ittm Donannn I Lox iLgh I -� swenng Machine I 510.00 530 00 B��Y I 55.00 580.00 BoerdG T1.00 53.00 I � �ook(hardbeck SI.00 S3 00 Baok(paperback) 5075 SI.50 CD 52.00 55.00 CamputttManiror f5.00 550.00 CompumrPrinmr 55.00 SI50.00 Compumr Syslem 5100.00 f400.00 Copier 540.00 5200.00 DVD SI.00 55.00 DVDPIayttNCR 58.00 SI5.00 I Edger 5.00 525.00 I GolfClubs S2. f25.00 I IceSkales 53.00 515.00 � i �u68a6e 55.00 SI5.00 � Mower 525.00 5100 00 I i Mower(ndinB) SI00.00 S .pp i , Radio SZ50 I 550. http://satruck.org/donation-value-guide 7/30/2013 . The Salvation Army Family Stores: Donation Value Guide Page 4 of 4 Miscellanuws I�cm Do��alinn I uw High Roller Bledee §3.00 515.00 SewingMechim I SI5.00 E65.00 Srcreo f15.00 575.00 StuffedAnimal 50.50 SI.00 TrnnisRacket 52.00 55.00 Typewriter 55.00 525.00 Umbrclla � 52.00 56.00 _ Vacuum Cleaner__ _ __ I 515.00 f65.00 WOMEN'S CLOTHWG DONATION - - - - T' -- _..._.. E ._ Wnmen'sClMhmgUnwt�ou , Lnw. r .._. Ihgh _. �NmgSutl ...... 54.00 { SB.00 B� � 52.50 511.00 Bloux 52.50 f12.00 Boots 52.00 E5.00 B� 51.00 53.00 C�� 510.00 540.00 - i ��ss 54.00 520.00 Evenmglhess SI0.00 56000 Fowdarian Ga�ment $3.00 SB.00 Fur Coet 525.00 5400.00 FurHa� f7.00 515.00 Handba8 52.00 f20.00 Het EL00 58.00 Jacket 54.00 512.00 Nightgown 54.00 512.00 Pan�s Suit .50 � T25 00 Shoes 52. 525.00 Skin S3 00 58.00 � Slacks f3.50 SI2.00 Slip SI.00 f6.00 i Socks 50.50 .25 i iSuit 56.00 � 525.0 , Sweattt S3J5 SI500 All donalionn af eppliancea,electronics end equipment assum<d to be working,and ell clothing and fumiture donations in good condition. . . . . �� . . . .. �. .,.�z i _��.,����, �nx i e.�.:�_.�. http://satruck.org/donation-value-guide 7/30/2013 _ _ _ . ��J�il� LISTENING IS JUST THE BEGINNING.°° January 18, 2013 Steven Andrew Juzbasic 142 16`h Street New Cumberland, PA 17070 Deaz Mr. Juzbasic, RE: Stephen A. Juzbasic, deceased October 18, 2012 In response to your recent inquiry concerning the accounts maintained in the ntune of the decedent, please be advised that the following accounts were open at the date of death: DATE OF DEATH ACC CDN BALANCE INT RATE OPEN ROLL OVER MATURITY 052-0133827 $7,633.82 $123.14 1.98°/a 12/28/00 12/28/09 12/28/12 ']oint wi[h Annette M.Juzbasic with Steven Andrew Juzbasic as Power oFAttomey �390-1971350 $13,649.48 $10.29 0.25% 6/17/03 2/IS/12 5/l5/13 • IRA-Titled in his name alone with Annette M. Juzbasic listed as the beneficiary and the Estate of Stephen A. Juzbasic listed as the contingent beneficiary If you have any other questions, please feel free to contact me at (717) 327-2497. Sincerely, �Q'l Joshua A. Groff C ON F I D E NT i AL Credit Confirmation Processor This Irtfamaiion is furnished as a matter oi business courtesy in answ�r to your inquiry,and is ior yrour cor.fidenfial use o�ry. The bank tumishiny :his information does not represent or euarantf:ee ,ne accur:c:y: ecmoCetaness or roliability of the ir,'torma;ir,;, FrroviG��. r.;o 'esnonsitlliry is assu^ed by the trank o;ary eF i�>��iiCai::, 2r�,p!nfaea or agents. Wny opinian herein expia:�ec i, sub;>ct to change wilnout noticP 1.800.FULTON.4 • fultonbank.com Folmn Bank,N A.Membo FDIC. Member of the FWion Financial family Sovereign � Court Ordered Processing\Decedents- MA1-MB3-02-]0 - P. O. Box 4 5 - Boston, MA 02284 i � jJanuary 28, 2013 � � e � Mr. Stephen A. Juzabasic Jr. 6 142 Sixteenth St. � New Cumberland, PA 17070 � e � RE: Estate of Stephen A. Juzbasic N Date of Death: October 18, 2012 � � Dear Mr. Juzabasic: � � Per your request, enclosed please find the account information as of the date of death � for the above-named decedent. For your information, accrued interest is not included in � the date of death balance. � riea�e feel free to contact me if I can be of any further assistance. g Very truly yours, i � ���v� _ _ �� Lmda Spavento Team Leader � 617-514-5189 � � R 0 1 � � � � � � � � � � < � � s Sovereign Bank ESTATE OF Stephen A Juzbasic SOCIAL SECURITY #: 174-20-1237 DATE OF DEATH: October 18, 2012 Account #: 0775514953 Type: CD Open date: 8/31/2004 In t6e name of: Stephen A Juzbasic or Stephen A Juzbasic Date of Death Balance: $11,003.05 Int.(YTD) from 1/1/2012 to 9/30/2012 $138.70 Accrued interest to date of death: $9.68 Other Info: Account#: 0778116822 Type: IRA Open date: 3/24/1998 In the name of: Stephen A Juzbasic Date of Death Balance: $3,297.50 Int.(YTD) from 1/1/2012 to 9/24/2012 $1.09 Accrued interest to date of death: $0.02 Other Info: Beneficiary: Annette Juzbasic, wife Contingents: Sepehn A Juzbasic & Kevin Juzbasic, sons Account#: 0778 1 1 8067 Type: IRA Open date: 10/7/1997 In the name of: Stephen A Juzbasic Date of Death Balance: $4,265.02 Int.(YTD) from 1/1/2012 to 9/30/2012 $8.21 Accrued interest to date of death: $0.14 Other Info: Beneficiary: Annette Juzbasic, wife Contingents: Sepehn A Juzbasic & Kevin Juzbasic, sons Account#: 0778 1 1 8 1 09 Type: IRA Open date: 7/19/1997 In the name of: Stephen A Juzbasic Date of Death Balance: $3,758.91 Int.(YTD) from 1/1/2012 to 9/19/2012 $5.91 Accrued interest to date of deat6: $031 Other Info: Beneficiary: Annette Juzbasic, wife Contingents: Sepehn A Juzbasic & Kevin Juzbasic, sons Account#: 0778118158 Type: IRA Open date: 1/8/1993 In the name of: Stephen A Juzbasic Date of Death Balance: $3,58934 Int.(YTD) from 1/1/2012 to 10/17/2012 $1.06 Accrued interest to date of death: $0.00 Other Info: Beneficiary: Annette Juzbasic, wife Contingents: Sepehn A Juzbasic & Kevin Juzbasic, sons Page 1 of 1 � WESTERN J NAT[ONAL L i f e I n s u r a n c e C o m p o n y PO.Box 871 Amarillq Texas 79I05-08?1 1 BUU 424 4990 Januazy 18, 2013 Steve Juzbasic 142 16`h st New Cumberland Pa 17070 Re: Annuity Contract AN211167 Deceased Stephen Juzbasic Dear Mr. Juzbasic: Thank you for your recent inquiry regarding the above referenced annuity contract. We would like to take this opportunity to respond to your request. The accumulated value of this contract as of October 18, 2012, the date of death, is $256,888.92. Mr. Juzbasic, we appreciate the opportunity to assist you. Should you have any qu�stions,please contact our Client Care Center at 1-800-424-4990. Sincerely, C�.l�a. (�10.�-� Celia Martinez Annuity Claims Department WIEDEMAN � FACKLER- WIEDEMAN FUNERAL HOME, INC. FUNERAL HOMI 357 Souih Second Street W IEDEMAN 23rd and Derry Street stee�ton, PA 1711&2524 FACKLER-WIEDEMAN Hcarrisburg, PA 17104272t Phone: 717.939.2344 Phone: 717.939.234� Fax: 717.939.1999 -�RT'� Fax: 717.939.1995 Dennis L.Wedemon,FD,President,Supenisor-SteelTOn � lames W.ialian,FD,Supervisor-Harrisburg �Iliam A.Siberf,FO � Liw M Wtedemar�Krosnar, FD,Marketing Coadinata Emalt wiademaMh�comcad.net I M�sbsMr.www.wMd�maMunrrolhoms.com Mr.Stephen A.Juzbasic,Jr. November 08, 2D12 142 Sixteenth Street New Cumberland,PA 17070 For the Funeral Services of: Stephen A.Juzbasic CLIENT NUMBER: 2012-W-101 PROFESS�ONAL SERVICES Immediate Burial with alternative container $ 2,395.00 OTHER STAFF AND RELATED FACILITIES Use of Equipment and Services for Graveside Service $ 325.00 TRANSPORTATION Limousine $ 180.00 MERCHANDISE Refrigeration (5 days @ $45.00 per day) $ 225.00 Harmony Deluxe-Blue Cloth Covered, as selected $ 375.00 CASH ADVANCES Newspaper Notices - Local $ 165.52 Clergy Honorarium $ 125.00 Certified Copies of Death Certificate $ 36.00 TOTAL AMOUNT DUE: S 3,826.sz family awncd and operated . . . wc care Kelly Financial Services, ��. Invoice 400 Bridge Street, Su 4 New Cumberland, PA 17070 Date Invo�ce x 717.774.7536l717.774.4802 (faz) ananois 10296 EIN 23.2874776 Bill To 8state of Stephen Jusbasic do S[ep6m]uzbaaic,Executor l42 16th Shut New Clrmberland,PA 17070 DeecripHon AmouM Preparazion of U S Individuel Income Tax Return for tax year-2012 287.50 Preparation of U S EstatdFiduciary Income Tau Retum for tax year 2012.2013 575.50 Preparatioe of PA Department of Revrnue Inheritana Tax Retum-PA REV I500 15,666.00 T�tB� 516.529.00 -� RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date : 11/OS/2012 Cumberland County - Register Of Wills Receipt Time : 11 : 33 : 39 One Courthouse S uare Receipt No. : 1071999 Carlisle, PA 17�13 JUZBASIC STEPHEN A Estate File No. : 2012-01179 Paid By Remarks : STEPHEN JUZABSIC DMB -- - -- - - ---- --- - Receipt Distribution --- - — --- - - ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 360 . 00 CUMSERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 24 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN Check# 2059 $427 . 50 Total Received. . . . . . . . . $427 . 50 � _