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HomeMy WebLinkAbout10-11-13 I 1505610105 J REV-1500 EX(ozn)(FI) !}; PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual,Taxes County Code Year File Number PO BOX 28o6o1 a INHERITANCE TAX RETURN Harrisburg,PA 17128-o6O1 RESIDENT DECEDENT a d 7G f ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06109/2013 11/04/1925 Decedent's Last Name Suffix Decedent's First Name MI Deardorff Gloria M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW m 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death ' Prior to 12-13-82) O 4.Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) CID 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C=:) 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death (=D 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BEDIRECTED T% Name Daytime CTTT Iephone Number M rrl Andrew C. Sheely, Esquire 717-6t7-7.350 C' o m -a 1 —a N � REGISTER OF WILL-S�USEiONLn Sul i f_1 ;.1'd d First Line of Address n �-� 'tT 'rt -n 127 South Market Street I`__ r m Second Line of Address -•,T r o P.O. Box 95 City or Post Office State ZIP Code DATE FILED Mechanicsburg PA 17055 Correspondent's e-mail address:andrewc.sheely @verizon.net ' Under penalfies of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,coned and complete.Declaration of pmparer other than the personal representative is based on all information of preparer has any knowledge. SIGNATURE OF PERS ESPONSI E F ILING RETURN _ /O///�Q AnnRFR Jerry L. Deardorff, 707 W. Keller St.,Mechanicsburg, PA 17055/J. R hard Deardorff,9004 Ken emer Cirle NW, AlOr-FhC4"0 SIGNAT OF PREyARE T Ida RF SENTATIVE DATF - on`G)44' .4 (mot LX A111112,01.3 nn o cc Andrew C. Sheely, Esquire 127 Soul, Market St, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J ' REV-1500 EX(FI) - 1505610205 Decedent's Social Security Number Decedent's Name: Deardorff, Gloria M. RECAPITULATION 1. Real Estate(Schedule A)- ..... ... ........ $95,000M i 2. Stocks and Bonds(Schedule B) .. . . ... ... .. ... ... . .. . . . . . . ... . 2 ., 1 Closely Held Corporation,Partnership or Sale-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable Schedule D 4, : • I i 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E),,..... 5. .. $57,50146 6. Jointly Owned Property(Schedule F) C'D Separate Billing Requested .. . , . 6 I $46,800.13 �. 7. inter•Vivos Transfers&Miscellaneous Non-Probate Property - (Schedule G) O Separate Billing Requested........ 7. , S. Total Gross Assets(total Lines 1 through 7). .. . . . . . ... . . .. . ..... . . .. 8 ! $199,303.59, 9. Funeral Expenses and Administrative Costs(Schedule H). 9. $3,439.501 - 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. . ..... . ... . . . 10. , $1,436.01 j 11. Total Deductions(total Lines 9 and 10).................................. 11. $4,875.511 r..,..._.____._.._._.__..,_.,__,....,,.____.,_,_._._..,_.__.i 12. Net Value of Estate(Line 8 minus Line 11) . ..... . . . .... . . . . . ...... . . . ... 12. $194,428.081 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . ..... .. .............. 13. , 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .... ....... .. . . ..... 14. _ $194,428.081 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Rec.9116 --" .._..... _..... ._..._... (a)(12)X.0 15.`- i 16. Amount of Line 14 r-able .._.,-.._..,„,,,....._.._......,... _...,... .,„..__.,_...__.._..,,._......__,.,....:_.__..,.,._..»,...____..,: at lineal rate X.045 _ $194,428M 16 $8,749.26; 17. Amount of Line 14 taxable .,......,..... .,_..�....-._�...m_.....,_..., .,..._._....: ........._._.._.........»..._.__. ....:...___....-...... ..._i at sibling rate X.12 17, j 18. Amount of Line 14 taxable W__.... ,.„_...,.._..._-..,,....,..._ _.....,_,..,.„,-_._.,_..,....,., ..,,_.,....,...._,._....-,.._..__ _..,..._..._...�.,...__....`_,z at collateral rate X .15 18. 19. TAX DUE . ......... .... ...... ...... .......... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 REV-1500 EX(F) Page 3 File Number Decedent's Complete Address: c�21 " 13 ` 70/ DECEDENT'S NAME Gloria M. Deafdorff fiTRFFTAnnRF&S -- 707 West Keifer Street Mechanicsburg I srATE Z'P 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) {1) $8,749.26 2. Credits/Payments A.Prior Payments $9,350.00 B. Discount 492.09 Total Credits(A+B) (2) $9,8+12.09 3. Interest (3} 4, if Line 2 is greater than tine 1 +Line 3,enter the difference. This is the OVERPAYMENT. - Fill in oval on Page 2,Lane 20 to request a refund. (4) $1,092.83 5_ If Line 1 +Line 3 is cheater than Line 2,enter the difference.This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred-.............._..................................-.............._........_.......... ❑ E b. retain the right to designate who shall use the property transferred or its income ................ ........................... ❑ c. retain a reversionary interest...._.....__........................................._......................................................_........... ❑ d. receive the promise for life of either payments,benefits or care?............................................................ .......... ❑ 2. I€death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................-........ ❑ E 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ...........-............................-............................................................................. ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S. §9116(a) (1.1)(i)). For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(11)(ii)].The statute does not example transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 F.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(i 1-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TMES DEPT.280801 HARRISBURG,PA 17128.O8Mi PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018031 DEARDORFF JERRY L 707 WEST KELLER STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $9,350.00 ESTATE INFORMATION: SSN: 174-20-6091 FILE NUMBER: 2113-0701 DECEDENT NAME: DEARDORFF GLORIA M DATE OF PAYMENT: 08/16/2013 POSTMARK DATE: 08/16/2013 COUNTY: CUMBERLAND DATE OF DEATH: 06/09/2013 TOTAL AMOUNT PAID: $9,350.00 REMARKS: RECEIPT TO ATTY CHECK#4 INITIALS: CJ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+(11-08) 17pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT - ESTATE OF Gloria M. Deardorff FILE NUMBER 21-13-0701 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. NUMBER VALUE AT DATE DESCRIPTION OF DEATH t. Decedent's residence located at 707 West Keller Street, Mechanicsburg,Cumberland County,PA 17055. Tax Parcel#20-24-0785-006.Deed Book 14-R-356. 15-P-244.Der aooraisal of Sue A.Matrese. $95,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 95,000.00 If more space is needed,insert additional sheets of the same size. rs' SUMMARY Of Slit aft FFATOES Y SL Suoisc Addrs 707 W Keller St Legal Description Cumberland County Deed Book 14R; Page 356 City Mechanicsburg County Cumberland state PA Zip Code 17055 Census Tract 0115.00 Map Reference Franklin 2846 F-8 Sale Price s Date of Sale Client The Estate of Gloria Deardorff Lender/Client The Estate of Gloria Deardorff Size(Square Feet) 1,833 Price per Square Foot s Location Suburban Age 62 Condition Poor Total Rooms 9 Bedrooms 4 Baths 2.0 Appraiser Sue A Matrese Date of Appraised Value 08/19/2013 Rnal Estimate of Value S95,000 REV-i5o8 EX.(ii-io) �: pennsylvania SCHEDULE E V DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: - Gloria M. Deardorff 21-13-0701 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. FrEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC Bank CD Acct.#21001012823-balance of$16,000.00,accrued interest$5.09 $16,005.09 2. PNC Bank Checking Acct.#5070078172-balance of$2,311.06,accrued interest$0.00 $2,311.06 3. PNC Bank Savings Acct.#5030121279-balance of$37,936.65,accrued interest$.66 $37,937.31 4. Decedent's personal property $ 750.00 5, Decedent's 1995 Chevy Lumina, 137,000 miles,poor condition $500.00 TOTAL(Also enter on Line 5, Recapitulation) $ 57,503.46 If more space is needed,use additional sheets of paper of the same size. ,06/27/2013 12:47 7177834447 PA DEPT-OF REVENUE PAGE 03/04 _J 48500041046 REV-485 EX(DS-04) SAFE DEPOSIT SOXINVENTORY _ PA Deperonent of Revenue , PLEASE USE ORIGINAL FORM ONLY Social Security or Death Ceri fieale Number Dste o`Death County Code Year File Number � ._.7. .y Decedent's LAW N_ame Suffix Flrst Name MI ADDRESS OF DELEDENT STREET: CITY: S ATE: ZIP CODE: '70-7 &V . Kt//e r St. .f /l'I f /� � s� 4- i 70 T.f ©NAME AND��7ADDRESS OF PERSOO�N REQUESTING THE OPENING OP THE SAFE DEPOSIT BOX /G / NAME: e GJ (' ST ET ADDRESS: CITY: l STATE: ZIP CODE / 7 .S. rr/r1T 6i D u 3 xfj' nl 11&11. rL: /moo i '70S NAME,ADDRESS AND RELATIONSHIP OF ANY) ECEDEKT,OF PERSON(S)PRESENT AT THE BOX OPENI e. NAME: RELATIONSHIP: STREET ADDRE S: • -✓+ -- CITY: STATE: ZIP CODE: 2 0- t lnrs A//i/Sir Mme%,. -- 7u3�s- b. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZIP COOS: c. NAME: m - RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME ANb ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: Pr ` ` 6 �/ --- STREETADDRESS: /_ ` C k3A7E: ZIP coop: Y Q NAA"F PERSO MAKNO ST ENTRY DATE N T%E OF LAST ENTRY �. ��t l 23 2a1'Z yy�� DATE OF DNTRACT TO REM BOX • NUMBER OF BOX L TITLE UNDER WHICH BOX IS E ESTED J. Q/G Fin d Stinc. /3 D 1 17 Sa M./ l��rzrvr+0. NAME AND ADDRESS OF PERSOJN(S)HAVING ACCESS TO SOX A NAMEir L T��G7Ul/La' /.- b. 7E�ADOR 93y�ICf S/17�L�1 �JG�RE W_ - STATE: ZIP COVE' CITy:� STATE: ZIP CODE: /' /J✓} 17 / KL�ln(Iq /c slyer v NAME At4ATtTLr OF EMP EE TAM G THE INVENTORY A r`2 I— •' WASAWILLINTHEBOX? ❑ YES NO Nyes, e.Date of wlll: A b. Namn and addmss of personal representative,N named In tha will NAME: STREET 0.0oRE55: CT': STATE: 71P CODE; C. Nams and addr -of ittarnry,It any --- NAME: STREETADDRESS: -- _. - - CRY: STATE: ZIP CODE: L 48500041046 48500041046 J .06/27/2013 12:47 7177834447 PA DEPT-OF REVE"LE PACE .04/04 REV-495 EX SAFE DEPOSIT BOX INVENTORY Page---Of- HNSTRUCTIONS (1) Cash:Report fatal only. (2) Stocks:List In detail every common or preferred certficate,warrant or other rights found In box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government..Number of items,date of Issue,face value,names In which registered and type of ownership, i_o.,jointly held,payable on death,etc. . (4) Bonds:Dasignoie by name,amount,sar`Ie[number,or other designation"(Hearer Ponds) (S) Rank and Savings and Loan Passbooks:Stole name of depositor,number of book,last date appearing In book.name Of bank and branch,and balance. - (9) Joweiry,Coins,Stamps,Manuscripts,etc:List and descrbe as fully as possible. (7) Beads,Mortgages,Currant insurame Policies or other evidences of indebtedness:List and describe as fully as possible. (8) All other contents, (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEFT.290601 HARRISBURG,PA 1 71 29-06 01 nhiff NO. REM DESCRIPTION I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RESC& NG COPY OF CORRECTANO COMPLETE TO THE 91797 OF MY KNOMEDGE AND BELIEF SAFE OEPOS OX INVENTORY- 2 Is NAP a PRINT NAME t HINT NAME ANp CN APPROPRIATE BOX BELOW, P,R�`7tTtE c DATE CH'cR1ATE 60X: J'/YfC(/C'L✓ �'- r>fIEEI(�r h�f"f��"j IC/!IJ/.� ,QaM,I ©Anml�h+raronlrol q,,. G J q G. +��/ ,e vgen noGroaBnIRM�mr [�JMnk..r of mte d11...1t b. tdOT :Attach addittona( !�"x it"sheetjs}if necessary or use duplicates of this page Of form. iheDepartrmxtt Is mIx rted by law.42 U.S.C.1409(c)(2nC}p},to faTve dk.Sbwm of Soda)5emnity numbers in emnzCJcn v,an odmirdste".aide tax aws.7he Daparanert ices tits Social Saadty number b Identify the doosdent and pwrc i reprttantatim of us astale.The Commo 1th may also use the Infama6on in exChange of tex kromtaaon agreerren6 wNh Federal end local tMn2 8401111m.The slaty law pKibbt the Commomaealtll's Pasnanal Ban disdosimp confidential tax Information ocw for offal purposes, Jun. 21. 2013 10:39AM PNC Bank No- 8042 P. 1 .PNC, L �14E WkY. June 27,2013 Andrew Sheely . Attorney at Law 127 S Market St Mechanicsburg,PA 17055 RE: Gloria M Deardorff SS\t: 174-20-6091 DOD: 06-09-2013 Dear Mr. Sheely: In response to your request for Date of Death.(DOD)balances for the customer noted above,our records show the following: Certificate of Deposit Account 4.31800196696 Established: 08-02-2000 GLORIA M DEARDORFF JERRY L DEARDORFF DOD balance: $30,000.00+2.60 accrued interest Interest paid 01-01-2013 thru 06-09-2013 S 67.59 YTD Account#31100198211 Established: 06-06-2000 GLORIA M DEARDORFF JERRY L DEARDORFF DOD balance: $ 10,000.00+0.33 accrued interest Interest paid 01-01-2013 thru 06-09-2013 $ 19.99 YTD Account#31900312450 Established: 04-12-2007 GLORIA M DEARDORFF JERRY L DEARDORFF DOD balance: $ 10,000.00+0.77 accrued interest Interest paid 01-01-2013 thru 06-09-2013 S 4.18 YTD Account#21001012823 Established: 0311-1993 GLORIA M DEARDORFF DOD balance: $ 16,000.00+5.09 accrued interest Interest paid 01-01-2013 thru 06-09-2013 $26.54 YTD Page 1 of 3 Jun. 27, 2013 10:39AM PNC Bank No. 8042 P. 2 Account#31800263786 Established: 06-07-2005 GLORIA M DEARDORFF I RICHARD DEARDORFF JERRY L DEARDORFF DOD balance: $5,000.00+0.08 accrued interest Interest paid 01-01-2013 thru 06-09-2013 $ 9.17 YTD Checking Account Account#5070078172 Established: 11-20-1961 GLORIA M DEARDORFF DOD balance: $2,311.06+0.00 accrued interest Interest paid 01-0 1-2013 ttuu 06-09-2013 $0.25 YID Savings Account Account#5030121279 Established 04-07-1983 GLORIA M DEARDORFF DOD balance: $ 37,936.65 +0.66 accrued interest Interest paid 01-01-2013 dun 06-09-2013 $2.64 YTD Safe Deposit Box The decedent maintained safe deposit box#01817 JERRY L DEARDORFF GLORIA M DEARDORFF RICHARD 1 DEARDORFF Located at: Mechanicsburg Branch 2 E Main St Mechanicsburg, PA 17055 (717)691-4011 Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762.2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC Page 2 of 3 REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: Gloria M. Deardorff FILE NUMBER! - 21-13-0701 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.Jerry L. Deardorff 707 West Keller Street, Mechanicsburg, PA 17055 Son 8•Ji Richard Deardorff 9004 Kennemer Circle NW, North Canton, OH 44720 Son C. JOINTLY OWNED PROPERTY: IETJEIt. DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH, ITEM FOR IOIM MADE INCLUDE NAME OF FINANCIAL INSTRUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE EA NUMBER TEN AM' JOINT IDEMIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VA T E OF ASSET INTEREST DECEDENTS INTEREST OF 1. A. 08!02/2000 PNC Bank CD Acct.#31800196696-principal balance of$30,000.00, $30,002.60 50% $15,001.30 $2.60 accrued interest 2. A. 6/06/2000 PNC Bank CD Acct.#31100198211 -principal balance of$10,000.00,$.33 $10,000.33 50% $5,000.16 accrued interest 3. A 4/1212007 PNC Bank CD Accl.#31900312450-principal balance of$10,000.00,$77 $10,000.77 50% $5,000.38 accrued interest 4. A, B 6/0712005 PNC Bank CDAcct.#31800263786-principal balanceof$5,000.00,$.08 $5,000.08 331/3 $1,666.69 accrued interest 5. ; B 4/1/1995 Members 1st Savings Acct.#16649-00,balance of$9,415.04,$31 - accrued interest $9,415.35 50% $4,707.67 6. B 10/1212 0 0 6 Members 1st CD Acct.#16649-40,balance of$20,000.00,$1.97 accrued $20,001.97 50% $10.000.98 interest 7. B 6/2611995 Members 1st Savings Aoct.#16649-01,balance of$10,844.84,$1.07 $10,845.91 50% $5,422.95 accrued interest TOTAL (Also enter on Line 6, Recapitulation) $ 46,800.013 If more space is needed,use additional sheets of paper of the same size. St MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 1664940 Date Account Established 1011011974 Principal Balance at Date of Death $9,415.04 Accrued Interest to Date of Death $.31 Total Principal and Accrued Interest $9,415.35 Name of Joint Owner J.Richard Deardorff Date Joint Ownership Established'- 04/0111995 CERTIFICATE OF DEPOSIT: Account Number/Suffix 16649-40 16649.41 Date Account Established 03/1612009' 0626/1995 Principal Balance at Date of Death $20,000.00 $10,844.84 Accrued Interest to Date of Death $1.97 $1.07 Total Principal and Accrued Interest $20,001.97 $10,845.91 Name of Joint Owner J. Richard Deardorff J.Richard Deardorff Date Joint Ownership Established 10112/2006 0626 11995 'Rollover from certificate 1664942,originally established 10/122006. VISA ACCOUNT: Account Number/Suffer 4672090000459578 Date Account Established 05/31/1991 Principal Balance at Date of Death $.00 Name of Joint Owner Cardholder - None ian,elle RS�V11��Fn!E�DERAC CREDIT A.Kline ✓ �� Lending Insurance Support Specialist June 25,2013 Estate of:GLORIA DEARDORFF Date of Death:0 610 912 01 3 Social Security Number: 174-20-6091 - . 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 • wwwmemberslstorg REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT ED RETURN ADMINISTRATIVE COSTS RESIDEYT DECEDENT ESTATE OF Gloria M. Deardorff FILE NUMBER 21-13-0701 ITEM Decedent's debts must be reported on Schedule I. NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT - 1' Funeral Luncheon $300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $00.00 Name(s)of Personal Representative(s).Jerry L. Deardorff 1 J. Richard Deardorff Street Address 707 W. Keller Street/9004 Kennemer Circle NW city Mechanicsburg /North Canton GN —State PA/Zlp 17055/4472D Year(s)Commission Paid: Z• Attorney Fees: r4V&Uj ', SheC(1 $1,500.00 3. Family Exemption:(if decedent's address is not the same as clalmant's,attach explanation.) ....... Claimant.. Street Address - - City_ State ZIP Relationship of Claimant to Decedent 4• Probate Fees: $403.50 5. Accountant Fees: 6. Tax Return Preparer Fees: Z Reimbursement to Executors for travel and related administrative expenses/costs B $625.00 Misc.Postage $11.00 9. Reserves to conclude Estate administration,final accountings $600.00 TOTAL(Also enter on Line 9, Recapitulation) g 3,439.50 If more space is needed,use additional sheets of paper of the same size. RECEIPT FOR PAYMENT ,GLENDA FARNER STRASBAUGH Receipt Date : 6/24/2013 Cumberland County - Register Of Wills e : 10 :47 :2 Time :Receipt T8 One Courthouse Square 1074608 Carlisle, PA 17013 Receipt Tim DEARDORFF GLORIA M Estate File No. : 2013-00701 --- Paid By Remarks : JERRY L DEARDORFF DMB ------------------------ Receipt Distribution ----------_-_-_------_-- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 : 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INS TAE RETURN JCS FEE 15 . 00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D --- ----5_00 CUMBERLAND COUNTY GENERAL FUN Check# 635 ---- Total Received. . . . . . . . ., 403 . 50 REV-1512 EX+(12-08) ' pennsylvania SCHEDULE I DEPARTMENT Of REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gloria M. Deardorff 21-13-0701 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH 1. PPL-final{rill $453.13 2. Verizon-final bill $171.67 3. Comcast-final bill $230.87 4. United Water-final bill $76.84 5. Misc.fees to review deeds,verify parcel numbers $72.50 6. Sue A.Matrese-appraisal of real estate $300.00 7. sewer and trash-final bill $131.00 TOTAL(Also enter on Line 10, Recapitulation) $ 11436.01 If more space is needed,insert additional sheets of the same size. -* rrIDM: INVOICE e.' Sue Matrese '- :ti�:4?���.•.•<1PtY0ll� �,..,nfM.-�> `s 6900 Blue Ridge Ave 0$131151$ Harrisburg,PA 17712 •. 0$11912073 TelephtmeNumher.7t7.802-2600 Far .Number: ';:i.Fsr.' 5?w�"r,.1'��"'YFr�'bii' ?ri�iT�:�r.'t1"r'."ra'!=,:s;:".•.' TO: Internal Order#: 08131151$ The Estate of Gloria Deardorff Lender Cam It. Client Fk#: Main Fife#mn tome: 081311518 Other File#ontorm: Deardorff .TekpAoneNumber. Far Number: Feder TWO: AttemuftNumber: E-f✓laii: Emidayer10.' Order your appraisals online at www.accu-fast.net to save time and receive updates. Lender The Estate of Gloria Deardorff Giettk The Estate of Gloria Deardorff Purchaw/Boffower: Property Address: 707 W Keller St r- City: Mechanicsburg County: Cumberland State: PA Tip: 17055 Legal Description: Cumberland County Deed Boots taR:Page 356 se." 5'�j qa av s�`*. ,43 "vc'4; "r,vTC .9�"� 4•° �v,.r 'fir` n , ' rY- Six,.• �f"'fi'.c��aa+xT{ vv�'tu 1�_•w�r�� ks, .; v:`',�S GPRES 300.00 INVOICE IS DUE UPON RECEIPT SUBTOTAL 300.00 +REV-1513 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Gloria M. Deardorff 21-13-0701 10 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RtDo Not LAHUNSHIP Trust e(s)N I nmuOF TESTATE Z.MAKt I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. Jerry L.Deardorff,707 West Keller Street,Mechanicsburg,PA 17055 Son 50% Rest, Residue & RPmninrlar of Fntata 2. J.Richard Deardorff,9004 Kennemer Circle NW,North Canton,OH 44720 Son 50% Rest, Residue & Remainder of Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. Ii NON-1AXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II —ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. last Vill aub 19e.4tament OF GLORIA M.DEARDORF BE IT REMEMBERED,that 1,GLORIA M.DEARDORF,of 707 W.Keller Street,Mechanicsburg,Cumberland County,Pennsylvania,being of sound mind,memory and understanding, do make, publish and declare this as and for my Last Will and Testament,hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. UEM I: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. BEM2:All the rest,residue and remainder ofmy estate,ofwhatsoevernature and - wheresoever situate,whether it be real,personal or mixed,including property over which I have a power of appointment,I give,devise and bequeath unto my sons,J.RICHARD DEARDORF and JERRY L.DEARDORF,absolutely,provided they survive me for a period of thirty(30)days,in equal shares,or if pre-deceased to their issue in equal shares, per stirpes. ITEM 3: 1 direct my hereinafter named Executor to pay all inheritance,estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate,it being my intention that none of the aforesaid taxes,either federal or state,on any property required to be _ included in my gross estate,under the provisions of any state or federal law now in force or hereafter enacted,shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. i ITEM 4: 1 appoint my sons, J. RICHARD DEARDORF and JERRY L. DEARDORF,as Co-Executors of this my Last Will and Testament. ITEM 5: I direct my hereinafter named Executor to pay all inheritance,estate, succession and legacy taxes of whatsoever nature and kind,to which my estate or the , transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate,it being my intention that none of the aforesaid taxes,either federal or state, on any property required to be included in my gross estate,under the provisions of any state or federal law now in force or heteafier enacted,shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues, TI'EM b;, I direct that my Executors,Guardian,Trustees,or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. M 7. MyPersonal Representatives shall have the following powers in addition to those vested in them by Law and by otherprovisions ofthis,my Last Will and Testament, exercisable without court approval,and effective until distribution of all property: 1. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania ' fiduciaries,as they from time to time may deem proper, without regard to any principal of diversification or risk. 2. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries,as they from time to time may deem proper,without regard to any principal of diversification ! or risk. t 3. To sell at public or private sale,to exchange, or to lease for any period of time,any real or personal property and to give options for sales,exchanges or leases,for such prices and upon such terms or conditions as they from time to time may deem proper. 4. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. ' S. To borrow money from persons or institutions,themselves included, and to mortgage or pledge any or all real or personal property as they in their sole discretion shall choose, without regard to the dispositive provisions of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7. To make distribution in cash or in kind or partly in cash and partly in kind,and in such manner as theymay determine,and atvaluations finally to be fixed by them. IN WITNESS WHEREOF,I have hereunto set my hand and seal this 13° day of March, 2013. WITNESS: ✓ C'J GLORIA M.DEARDORF COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK :SS We,GLORIA M.DEARDORF,JAN M.WILEY,ES 6 KUHN,the Testator and the witnesses QUIRE and DERRICK or foregoing respectively,whose names are signed to the attached feS g mmument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly(or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed,and that each of the witnesses,in the presence and hearing of the Testator,signed this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen(18)years of age or older,of sound mind and under no constraint or undue influence. GLORIA M.DEARDORF m s s S WITNESS Swom to and subscribed before me this 13"day of Match,2013. _ CTOMNWEALTH OF PEIMMAt1[A - (1nr1 I J SNOTARY PUBLIC �,oencnvuw�soamrou a xm�c MY COMMISSION EXPIRES;