HomeMy WebLinkAbout10-30-13 Pennsylvania 1505610143
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EX(06-13)
REV-1500 OFFICIAL USE ONLY
Canty COda Year Fib Number
Bureau of Individual Taxes
PO BOx.260601 INHERITANCE TAX RETURN 21 13 0178
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 30 2013 01 15 1944
Decedent's Last Name Suffix Decedent's First Name MI
GANNON KATHLEEN 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
1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12.13.62)
4. Limited Estate 48. Future Interest Comproi 111 5. Federal Estate Tax Return Required
(date of death after 12A 82)
® 6, Decedunl Died Toslale 7 pecodenpt Ma nlyinadaLNirgl Tnrel B. Tole Number of Sala Deposit Boxes
(Attach Copy of Willi (Attach GJM rot prust) t t°yt
9. Litigation Proceeds Received 10.bo waon 1y1��1-�1 er�tTpae6) Doalh 11,Election to tax under Sec.9113(A)
(Attach Schedule 0)
CORRESPONDENT•THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SEAN M SHULTZ 717 243 6222
First Line of Address
26 W HIGH STREET
Second Line of Address
City or Post Office State ZIP Code rn crn7
CARLISLE PA 17013 u G":
1 1505610243
_I REV-1500 EX
Decedent's Social Security Number
Decedent's Name Gannon, Kathleen M.
RECAPITULATION
1. Real Estate(Schedule A)................._. ........................ 1. 165 , 000 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2.
1 Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 35 , 403 . 07
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 870 . 69
7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property
(Schedule G) a Separate Billing Requested............ 7. 109, 602 . 69
8. Total Gross Assets (total Lines 1 through 7)........................................................ 8. 310 , 876 . 45
9. Funeral Expenses and Administrative Costs(Schedule H)............................I.....1. 9. 34 , 595 . 79
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 115 , 174 . 47
11. Total Deductions(total Lines 9 and 10)................................................................ 11, 149, 770 . 26
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 161 , 106 . 19
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. 161 , 106 . 19
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec. 9116 15 0 . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 161 , 106 . 19 16. 7 , 249 . 78
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17, 0 . 00
18. Amount of Line 14 taxable 0 . 00
at collateral rate X.15 0 . 00 18.
19. TAX DUE................................................................................................................ 19. 7 , 249. 78
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0178
Decedent's Complete Address:
DECEDENT'S NAME
Gannon, Kathleen M.
STREETADDRESS
2024 Lincoln Street
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 7,249.78
2, Credits/Payments
A. Prior Payments 7,500.00
B. Discount 362.49
Total Credits(A +B) (2) 7,862.49
1 Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 612.71
Check box on Page 2,Line 20 to request a refund
5, If Line 1 +Line 3 is greater 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 "V IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;...........................___..........................-................. ❑ III--I
b. retain the right to designate who shall use the property transferred or its income;................ ........ ❑
c. retain a reversionary interest;or............................................................................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.............................................................................-..................................... ❑ ❑x
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
contains a beneficiary designation?.................................................................................................................. ❑x ❑
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 January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
fling 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 P S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1502 EX-(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
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
Include a copy of the deed showing decedenra interest g owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate situate at 2024 Lincoln Street,Camp Hill, PA-sales price-See attached HUD-1 165,000.00
TOTAL(Also enter on Line 1, Recapitulation) 165,000.00
(If more space Is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev. 01-10)
OMB Approval No.2502-0265
A.Settlement Statement(HUD-1)
-Gr)Il�slik
;f Loan
FHA 2.Q RHS 3. 6,File Number. 7.Loan Number 6 Menage Immmnce Case Number
1 H Cony.Dome. 2013-051-Fidelity
4.(�VA 5.Q Cony-ins-
GNote: Thisform is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are sham.Items marked
"(p o.c)"were paid outside the closing:they are shown here for infowwwal purposes and are not included in the totals,
O.Name 4 Atltlas of Sorrows, E.Name 8 Atlumae of seller F.Name k Address of Lander'.
Daniel R.Miller Estate of Kath/ee0 M.Gannon,Marl:S. Centre;Bankk,,
72 Wiliobv Cannot Gannon,Fxe;uior 4320 LingtesMwn Read
Bunk"flit;WV 25413 2024 thrcofn Street Harrlsborg,PA 17112
Jennifer A,Miller Camp Hill,PA 17011
72 Wylob Court
Bunker H It,WV 25413
G.Property Location: H.Samemenl Agent t.Settlement Date:
2024 Lincoln Street DETHLEFS-PYXOSH LAW GROUP,LLC, 0711WZ013
Camp Hill,PA 17011 Dorsey C.Dethle is,EspWre
Phone Number:(717)975-9446
Cumberland County 2132 Market Street
Co. Hill PA 17011
Place of Settlement.
2132 Market Smash,Camp Hiy,PA 17011 Disbursement Date:0711612013
J. Summary of Borrowers Transaction K.Summary of Sellers Transaction
100.Ones.Amount Due From Borrower 400. Gross Amount Due To Seller
101.Contract sates 3 000.00 401.Contract ones wood 265 000.00
102,Personal propeartV 402.1dersamorlprop e the
103.Settlement charges to borrower line 1400 $4,864.00 403.
104,
105, 405.
Adjustments for Items Paid by seller in advance Ad'usimerds for items paid by seller in advance
106.Cityleam taxes to 406.Cityllown taxes is
107.County taxes 07 16 2013 to 12 31 2013 $488.47 407.County taxes 07 16 2013 to 12 31 2013 $488.47
108.Assessments 0711512013 to 06 30 2014 $2,463.89 408.Assessments 07 15 2013 to 06 .90 2014 $2,463.89
t09. 138.10 409. 138.I0
110. 410.
111. 411,
112, 412.
120.Gross Amount Due From Borrower $172,954.46 420,Gross Amount Due To Seller $168,090,46
200.Amounts Paid By Or in Behaff Of Borrower 600.Reductions in Amount Due To Seiler
201.Deposit or earnest money $1,000.00 501.Excess deposit(see instructions)
202.Principal amount of new loan S $156,750.00 502.Settlement charges to seller line 1400 $15,214.48
203.Exsl lowto taken subject to 503.txishn loans taken sW'eer W
204, 504.Payoff of test mortgage loan
205. 505.Payoff of second mortgage loan
206. 506,
207, 507.
200, 506,
209. 509,
Adjustments for items uses id b seller Adjustments for items unpaid b seller
2t0.CI itoven taxes m 510.CieVinown taxes so
211 County taxes to 511.County taxes to
212.Assessments ro 512.Assessments to
213. 513,
214. 514,
215. $15.
216. 516.
217, 517,
218 518.
219. 519.
220,Total Paid SylFor Borrower $157,750.00 520,Total Reduction Amount Due Seller $25,214.48
300.Cash At Settlement FmnmTQ Borrower 600.Cash At Settlement TolFrom Seller
301.Gross a mount due from borrower(line 120) $$172.954.46 1601.Gross amount due to seller Tine 420) $168,090.45
302.Less amounts paid bytfor burrower(line 220) 1 7 750.00 602.Less reductions in amt,due seller line 520) ( $15,214.48 1
303,Cash El From CI To Borrower 1 $15,204.46 603.Cash RI To CI From Seller $152,875.98
The public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and
reporting the data.This agency may not bailout this information,and you are not required to complete this form,unless,it displays a
currently valid OMB control number.No Confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to
a RESPA covered transaction with information during the settlement process.
Previous editions are obsolete Page 1 of 3 HUD4
L. Settlement Charges
700.Total Real Estate Broker Fees $10,195.00 peitl Prom pals Pmm
Division of Commission tare 700 as follows: earowers 5eaars
70IJ 5,245.00 i0 century 21 Realty Sarviaes fS295i
Funds at Funds at
702. 4,950.00 19, Re/tees let Advanta a, Inc. Sa0emenl Seakmanf
703.Commission paid at Settlement $10,195.00
704. Re/Max tat Ad(8rokerFee-8)1C-21 (Daad-B) 1 ROC ey ) $250.00 $150.00
800.items Payable in Connection With Loan
801.Our origination charge $720.00 (from GTE#1)
802.Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2
803.Your adjusted eh ination char eS from GFE A $920.00
804,Appirwaid fee W Ca for S Axnhibald v o c by }(from GFE#3) $400,00
845,Credit re on to ® far MrcAntsC t I p'OC ty y from GFE#3 $55.00
806.Tax service to ( p o c by I from GFE#3
807.Flood certification ® for asrs I p.oc.e y (from GFE#3) $19.00
808.
M.
614.
811,
812.
900.items Required By Lender To Be Paid in Advance
901,DaRy interest charges fmm 0 711 612 013 10 0810112013 $ /da y (from GFE#10)
902.Mortgage Insurance Premium for months. (from GFE#3)
to
903.Homeowners insurance for years, (hom GFE#11)
to
904, years
to
905.
1000,Reserves Deposited With Lander
1001.indee deposit for your escrow account (from GFE#9}
100$,Homeowners insurance months per month $
1003,Mortgage insurance months @$ per month $
1004,Property taxes months @$ per month
1005. months @$ per month S
1006, months @$ per month $
1007,Aggregate Adjustment -$ 0.00
1100,Tithe Charges
1101.Title services and lendets title insurance (from GFE#4) 4121630.00
1102,Settlement or closing fee S
1103.Owners title insurance (from GFE#5) $40.00
1104,Lenders title insurance isaved thre Fidelity National Title $1,42$.00
1105,Lenders title 011 limit$156,750.04
1106.Owners the policy limit 165,000.00
1107,Agents portion of the total title insurance premium Dethlafs-Pykosh Law croup $1,111.25
1108,Underwriters portion of the total title insurance premium Fidelity National Title $213.75
1109. (Hale Rate - 4 End.)
1110, Fidelity National Title (CPL Fee) $75.00
1111, Darnall C. Dethle£a (Notary Fie) $25.00
1112, Dethlefs-Pykosh Law Group (Tax Cart Reimbursement) $10.00
1113, Commie Elliman (Notary Fee) $15.00
1114.
1115.
1200,Govenment Recording and Transfer Charges
1201. Cumberland Covn ay Recorder Government recording char es, (from GFE#7) $200.00
1202 Deed$67.00 ;Mortgage$133.00 Releases$
1203.Transfer taros Crmbarland County Recorder (from GFF#8) $1,650.00 $1,650.00
1204.CRY/Co.my CRY/Co. taxista s; Deed$ 1,650,00 Mangano $
1205.State tax)stam s: Deed$ 1,6M00 Mortgage $
1206, $
1207. $
1208. $
1209. $
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE 0
1302. $
1303, $
1304,
1305.
1306. Janat ruler, Treasurer (2013-14 School Tax) $2,569.48
1307. American R. Shield (H. Vernon ) $460.00
1308. casit, Hill Borough (3rd quartez - July-Sept 2013) $165.00
1309,
1400,Total Settlement Charges tenter on fines 103,Section J and 502,Section K) $4,864.00 7$11,.14 41
Previous editions are obsolete Page 2 013 HUD-1
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD4 Line Number
Our origination charge #801 $0.00 $120.00
Your credit or charge(points)for the specific interest rate chosen #802 $0.00 $0.00
Your adjusted origination charges #B03 $0.00 $720.00
Transfer taxes #1203 $0.00 $1,650.00
Charges That In Total Cannot Increase More Than 10% Good Faith Estimate HUD-1
Government recording charges #1201 $0.00 $200.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
Total $0.00 $200.00
Increase between GFE and HUD-1 Charges $ 200.00 or 100.00 %
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001 $0.00 $0.00
Daily interest charges #901 $0.00 /day $0.00 $0.00
Homeowners insurance #903 $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
# $0.00 $0.00
Loan Terms
Your initial loan amount is $156,)50.00
Your loan term is years
Your initial interest rate is 0.00 %
Your initial monthly amount owed for principal,interest,and $ 0.00 includes
and any mortgage insurance is
❑Principal
❑Interest
❑Mortgage Insurance
Can your interest rate nse? ®No ❑Yes,it can rise to a maximum of %.The first change will be
on and can change again every afier
.Every change date,your interest rate can increase or
decrease by %.Over the life of the loan.your interest rate is
guaranteed to never be lower than %or higher than %.
Even 9 you make payments on time,can your loan balance rise? ®No.❑Yes,it can rise to a maximum of$
Even d you make payments on time,win your monthly ®No ❑Yes,the first increase can be on
amount owed for principal,interest,and mortgage insurance rise? and the monthly amount owed can rise to$
The maximum it can ever Has to is$
Does your loan have a prepayment penalty? ®No ❑Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? ®No.❑Yes,you have a balloon payment of$ due in
years on
Total monthly amount owed including escrow account payments ®you do not have a monthly escrow payment for items,such as property
taxes and homeowners insurance.You must pay these items directly yourself.
❑You have an additional monthly escrow payment of IS
that results in a total initial monthly amount owed of$ .This include.
,2nncipal,interest,any mortgage insurance and any items chocked below.
u Property taxes ❑Homeowners insurance
❑Flood insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this forth,please contact your lender.
Previous editions are obsolete Page 3 of 3 HUD-1
Rev-0508 EX.t11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jomtlyo ned with the right of survivomhip must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2012 Honda Accord-See attached Trade-In invoice 16,000.00
2 Ocean Beach Club,Virginia Beach Timeshare-Valued at 50%of purchase price($19,755.00) 9,877.50
-See attached Deed
3 Refund for 2013 County/Township taxes 488.47
4 Refund for Honda warranty 1,075.51
5 Refund from Comcast Cable 11.59
6 Williamsburg Plantation Timeshare-Valued at 50%of purchase price($15,900.00)-See 7,950.00
attached Deed
TOTAL(Also enter on Line 5, Recapitulation) 35,403.07
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
I
Bobby Raba]Honda Bobby Raba]Acura Bobby Rahal Toyota-Scion Bobby Rahal Lezus
6696 Carlisle%ke 6694 Carlisle Pike 6711 Carlisle Pike 6715 Carlisle Plke
Mecb.wcsburg,PA 17050 Mechanitsburg PA 170M Mechanicsburg,PA 17050 M.M.We.burg,PA 17050
717-766-4300 717-790-6000 717*91 4500 717-691-5600
I
AUTOMOTIVE GROUP Bobby Radial Toyota-Scion Bobby Radial Lezus Bobby Rahal Used Car Outlet
of Lewistown of Lewistown 66%Carlisle Pike
425 Elea ile Awnue 425 Electric Assume Meehanlesburg,PA 17050
Lrwbtoaa,PA 17044 Lea'Irtawn,PA 17044 717-790.6000
717-24&0119 717-246-0119
PLEASE ENTER MY ORDER FOR THE FOLLOWING DEAL N . - Cu Ni o. OCCUPATION
El ❑USED ❑DEMO ❑CAR ❑TRUCK ❑LOANER
YEAR MAKE MODEL TYPE DATE 1 SALESPERSON
COLOR TRIM ❑Nnv PURCHASER
❑NN•LL
17110 17
VIN CO-PURCHASER
STOCK NO. MILES CODE COgRESPONOENCE76 _ .-
ESTIMATED DELIVERY DATE TIME ❑AM ADDRESS - -
11 PM ]
CASH❑ FINANCED❑ LEASE❑ crry STATE ZIP / COUNrV
DESCRIPTION OFTRADEAN
TYPE
MOD
F-
.,1Ab .," d w
YEAR MAKE
RES.PHONE BUS PHONE
K O. MILES C040
TITLED TO -
L Qh PURCHASERS SOC,SEC NO -PURCHASERS SOC.SEC.NO
VIN
PURCHASER'S DRIVERS LICENSE NO. CO-PURCHASER'S DRIVERS LICENSE NO. !
VEHICLE BEING TRADED-IN: ❑LEASE [3 OWNED BYYOU ❑PAYOFF
PRICE OF VEHICLE
DOES ANY OF THE FOLLOWING PERTAIN TO YOUR TRADE-IN:
R-Titled, Branded Title,True Miles Unknown(TMU)&Grey Market ACCESSORIES -
❑YES ❑NO
Customer's
S' nature X
LICENSE PLATE NO. VALID EXPIRES h
LIEN HOLDER J 14
ADDRE 2 �o Z� S /, 4 11174-
G
ACCT# TfTL 0
I
PHONE I PAYOFF AMOUN"r - e00DTILL VERIREDBY
COLLISION COVERAGE
NAME OF AGENT PHONE
ADDRESS - -
POLICY NUMBER VERIFIED BY DATES
TO: FROM:
INSURANCE CO. COMP COLL SUBTOTAL �M
WARRANTY INFORMATION SERVICE PLAN
❑FACTORY WARRANTY-T,e keloryassmoty eoretltuara NI of Oro assereas'a,,oarpaetro ft sale TYPE
a Mle Iarmaarme TI,erears n.reby espresso,dlemlma.1 awmrtes,aIM•rex reseal or mules McNd, j
very Implied wanerm,M mom onvio try or III for a particular purpose,mod Me Wier Wther assumes MONTHS MILES VMEn nor aN rsa s.rry other person to amume W a am II�NIiry In pannedlon,.IM Me sear of INS IlatWems. I
CAN WARRANTY TA EhPo wenn VV HtCLE lwoC IIsmVON on KEEVowiR RIM u 1. TOTAL SALE PRICE OF VEHICLE VOU
CONTMRY OROeIISpN6INTNE CONTRACT OFBALE
❑AS IS Tea motor eeblW Is said-AS IS--amwt ary werear,ty ever«pressed or Imph.d.Toe 2 ALLOWANCE ON TRADE-IN
wnB Mew Ncir M..mire awaaeaarepalnnpor waaautp.r,y axeatMm presently Ndab orMn veer
PURCHASER'S 3. TAXABLE BALANCE TUNE I-LNE 21
SIGNATURE DATE
CO-PURCHASER'S
4. STATE SALES TAX
' _
SIGNATURE DAtE 5. LUXURY TAX
11
v^ .ntA1N
A TIME-SHARE
DEFERRED PURCHASE DEED OF TRUST NOTE
DATE: March 11,2008
FOR VALUE RECEIVED, each of the ullkisl ned (hereinafter collectively called "Buyer")
jointly and severally promises to pay to the order of /�/�lr Club,LLC, a Virginia limited liability
company, the sum of Nineteen Thousand Seven HufiAeYf! Five And 00/100 DOLLARS
($19,955.00) plus interest, at the office of Ocean Beach Club, L 3 Road, Virginia Beach,
Virginia 23451 or its assignee as directed thereby, Such amount shall be p 0 equal consecutive i
monthly installments of Three Hundred Twenty-Nine And 69/100($329.69).
The first payment shall be paid on May 5, 2008 and one like installment on the same dale of each
following month until paid in full. If not sooner paid, the entire outstanding principal balance hereof,
with all accrued and unpaid interest thereon, shall become due and payable on April 5,2018.
Interest will accrue on the unpaid principal amount commencing thirty(30) days prior to the first
payment date and continue, until paid in full, at a rate of (15.90%) per year. If such payments are j
authorized to be paid by electronic funds transfer (EFT), a reduction of 1% in the annual percentage rate
charged has been included herein. If the authority to make the monthly payments directly by EFT is
either revoked or dishonored, the annual percentage rate will automatically increase to the greater of: (a)
the annual percentage rate being charged by Ocean Beach Club, LLC as of the date of revocation or
dishonor to new purchasers who did not authorize such direct transfers; or(b) the annual percentage rate
being charged by Ocean Beach Club, LLC as of the date B /9 gW Qbt��ru b#ew p%YtiK�t*s who
it rn d liability company,
did not authorize such direct transfers and will remain at the said rate or any period or mods the rFT
authorization is not in effect. Any increase will take the fon�ftWGIenn �f ffd1R�S2yment
i get
of an installment continues for more than ten (10) days, a late five (5%) percent
of such payment shall be charged, By: W 42
mella
The full ri ght of anticipation, in whole or in part, al artyititttt[arui w¢tditolkpMtait gi"werved. In
the event Buyer pays off this Note in full within thirty (30) days of Its date, all interest charged and
collected from Buyer will be returned in full.
Ocean Beach Club, LLC reserves the option to sell or assign this note to another entity,
whether or not such entity is affiliated with Ocean Beach Club,LLC
i In the event Buyer fails to pay any installment due hereunder,Noteholder may, at its option, upon
thirty (30) days written notice to Buyer, declare immediately due and payable all amounts due and to
become due hereunder, less unearned Finance Charges. The waiver by Noteholdcr of any default shall
not constitute a waiver of that or any subsequent default. Each Buyer and endorser hereof severally waive
presentment, demand, protest, and notice of dishonor. In the event of default hereunder, Buyer also
agrees to pay all cost of collection, including reasonable attorney fees.
Each buyer who Is a signatory hereto has read and acknowledges receipt of the truth-in-
leading disclosures statement a d a duly executed copy of this deferred purchase deed of trust note.
�� (SEAL)
Buyer sign here Kathleen M. Gannon
Grantor Tax Pd - $21,60 vk..,mAIN Dr"ft�,.n ".LU D,
Slate Tax Pd - $63.76
A TIME-SHARE
DEED OF CONVEYANCE
THIS DEED made this I Ith day of March, 2008, by and between OCEAN BEACH CLUB,
LLC, a Virginia limited liability company, hereinafter referred to as the "Grantor" and Kathleen M.
Gannon, a single woman, hereinafter referred to as the "Grantee", whose current address is c/o Ocean
Beach Club Owners Association, 1081 191h Street,Virginia Beach, Virginia 23451,
WITNESSETH:
For and in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the
receipt of which is hereby acknowledged, Grantor does hereby grant and convey, with General Warranty
and, except as set forth below, English Covenants of Title unto Grantee
Individually,
a Time-share Estate (the "Time-Share")at that certain real estate time-share project known as "Ocean
Beach Club, a Time-Share", located at 3401 Atlantic Avenue, Virginia Beach, Virginia 23451 all as
more fully described in that certain Time-Share Instrument for Ocean Beach Club, a Time-Sbare,dated
May 14, 2004, recorded July 8, 2004, in the Clerk's Office of the Circuit Court of Virginia Beach,
Virginia (the "Clerk's Office"), as Instrument Number 2004070800104883, as heretofore or hereafter
amended and/or supplemented (the "Time-Share Instrument").
Capitalized terms used herein have those meanings given to them in the Time-Share Instrument
or the Virginia Real Estate Time-Share Act.
This conveyance is made subject to (a) covenants, restrictions and easements of record applicable
to and legally binding upon the Time-Share hereby conveyed and especially those contained in the Time-
Share Instrument and (b) the terms and conditions of a certain Purchase Agreement of even date between
Grantor and Grantee(the Purchase Agreement) the subject of which is the Time-Share as such terms and
conditions relate to the Assigned Unit Week, Assigned Time-Share Unit, the Time-Share Unit Type, and
whether the Time-Share is a Fixed/Fixed,Fixed/Floating or Floating/Floating.
The Assigned Time-Share Unit and Assigned Time-Share Unit Week, as specified in the
Purchase Agreement, and designated solely for Developer inventory control purposes, is Unit 0609, Week
28.
IN WITNESS WHEREOF,Grantor has caused its name to be signed by its solo Manager.
Ocean Beach Club,LLC
A Virginia limited liability company
By: BQTS Associates, Inc.,
A Vlrgtttta czrrporattar �rrd tale Mantrger ..___._ -.
By:
Atithorized.Signatory
STATE OF: Virginia
CITY OF: Virginia Beach
This Deed of Conveyance was acknowledged before me 4nq oresaid this I I th
day of March,2008, by John L. Houser Jr., Authorized Signatates, Inc., sole
Manager of Ocean Beac hC`uLc''',ns...Nw No P elrcY 9 0''r�4$»o iJ z NOT PUBWCOMMIS :x apEs, ; My commissio
T141S DEED made this I Ith day of March, 2008, by and between OCEAN BEACH CLUB,
LLC, a Virginia limited liability company, hereinafter referred to as the "Grantor" and Kathleen M.
Gannon, a single woman, hereinafter referred to as the "Grantee", whose current address is c/o Ocean
Beach Club Owners Association, 1081 19i°Street, Virginia Beach,Virginia 23451.
WITNESSETH:
For and in consideration of Ten Dollars ($10,00) and other good and valuable consideration, the
receipt of which is hereby acknowledged, Grantor does hereby grant and convey, with General Warranty
and, except as set forth below, English Covenants of Title unto Grantee
Individually,
a Time-share Estate (the "Time-Share") at that certain real estate time-share project known as "Ocean
Beach Club, a Time-Share", located at 3401 Atlantic Avenue, Virginia Beach, Virginia 23451 all as
more fully described in that certain Time-Share Instrument for Ocean Beach Club, a Time-Share,dated j
May 14, 2004, recorded July 8, 2004, in the Clerk's Office of the Circuit Court of Virginia Beach,
Virginia (the "Clerk's Office"), as Instrument Number 2004070800104883, as heretofore or hereafter
amended and/or supplemented(the"Time-Share Instrument").
I
Capitalized Corms used herein have those meanings given to them in the Time-Share Instrument
or the Virginia Real Estate Time-Share Act.
i
This conveyance is made subject to (a) covenants, restrictions and easements of record applicable
to and legally binding upon the Time-Share hereby conveyed and especially those contained in the Time-
Share Instrument and (b) the terns and conditions of a certain Purchase Agreement of even date between
Grantor and Grantee (the Purchase Agreement) the subject of which is the Time-Share as such terms and
conditions relate to the Assigned Unit Week, Assigned Time-Share Unit, the Time-Share Unit Type, and
whether the Time-Share is a Fixed/Fixed,Fixed/Floating or Floating/Floating.
The Assigned Time-Share Unit and Assigned Time-Share Unit Week, as specified in the
Purchase Agreement, and designated solely for Developer inventory control purposes, is Unit 0609, Week
28,
IN WITNESS WHEREOF,Grantor has caused its name to be signed by its sole Manager.
Ocean Beach Club,LLC
A Virginia limited liability company
By: BQTS Associates,Inc.,
.^A" aria o orativaaad aoicivl
By;
thorized Signatory
STATE OF: Virginia
i CrFY OF: Virginia Beach
This Deed of Conveyance was acknowledged before me in the juris ' tion aforesaid this 11 th
day of March,2008, by John L.Houser Jr., Authorized Signatory of B S Associates,Inc., sole
Manager of Ocean Beach Club, LLC.
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Contract No.:352997
VA Code Section 17.1-223.13,Disclosure: First American Title Insurance Company
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Rev-1509 EX+(01.10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
H an asset was made joint within one year of the decedent's date of death,it must lae reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Mark S. Gannon PO Box 458 Son
San Quentin, CA 94964
B. Brian J. Gannon 1956 South Hamlin Avenue, #2 Son
Chicago, IL 60623
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOIN MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR VALUE OF ASSE INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 AB 10126/1978 PNC Checking Account No. 5140161167-See 1,241.87 33.330% 413.92
attached letter from PNC dated February 8,
2013
2 AB 03/2611997 PNC Savings Account No. 5000986589 -See 424.07 33.330% 141.34
attached letter from PNC dated February 8,
2013
3 AB 05/30/2003 PSECU Christmas Account No. 6.97 33.330% 2.32
5307531692970-See attached letter from
PSECU dated April 8, 2013
4 AB 05/30/2003 PSECU Money Handler Account No. 924.29 33.330% 308.07
530753692970-See attached letter from
PSECU dated April 8,2013
5 AB 05/3012003 PSECU Savings Account No. 530753692970- 5.00 33.330% 1.67
See attached letter from PSECU dated April 8,
2013
6 AB 05130/2003 PSECU Vacation Account No. 530753692970 10.12 33.330% 3.37
-See attached letter from PSECU dated April
8, 2013
TOTAL(Also enter on Line 6, Recapitulation) 870.69
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
FEB 1 3 2013
t N
February 8, 2013
Sean Shultz
Attorney At Law
Attn Dolly Hockenberry
26 W High St
Carlisle PA 17013
RE: Kathleen M Gannon
SSN: 192-34-6789
DOD: 01/30/2013
Dear Sir/Madam:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account# 5140161167 Established: 10/26/1978
KATHLEEN M GANNON
BRIAN J GANNON
MARK S GANNON
DOD balance: $ 1,241.87 + 0.00 accrued interest
Savings Account
Account# 5000986589 Established: 03/26/1997
KATHLEEN M GANNON
BRIAN J GANNON
MARK S GANNON
DOD balance: $ 424.07 + 0.00 accrued interest
Loan Account
The decedent maintained Loan Account 4003048012680333. For further information and assistance,
please contact 1-888-762-2265. This is a voice activated system,please state the word 'operator"
and follow the prompts to speak to a Loan Financial Service Consultant.
Page 1 of 2
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
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable
law. If the reader of this message is not the intended recipient or the employee or agent
responsible for delivering this message to the intended recipient,you are hereby notified that any
dissemination, distribution or copying of this communications is strictly prohibited. If you have
received this communication in error,please notify me immediately by reply or by telephone at
800 762-1775 and immediately destroy this faxed document
Page 2 of 2
® APR 1 i 2013
PSECU 04/08/2013
Saidis, Sullivan&Rogers
Sean M. Shultz,Attorney
26 W. High St.
Carlisle, PA 17013
Re: KATHLEEN M GANNON,Deceased.
PSECU Reference#5307531692970
Dear Attorney Shultz:
The above referenced person has an account with PSECU which was opened on
April 15, 1970. The Share accounts were jointly held by Kathleen M Gannon,Mark S
Gannon and Brian J Gannon. The joint owners,Mark and Brian, were added to the account
on May 30,2003. The Personal Service Loan(PSL) loan was individually held.
The following are the Date of Death Balances for KATHLEEN M GANNON's account with
PSECU:
Account Date of Death Balances Interest—January 1-30
Shares:
(Sl) Savings $5.00 $0.00
(S2)Vacation $10.12 $0.00
(S3) Christmas $6.97 $0.00
(S4)Money Handler $924.15 $0.14
Loans:
(LI)PSL $203.44
The PSL currently has a balance due of$371.72. If the Estate has sufficient funds to pay off
the decedent's PSL,please remit a check, made payable to PSECU. If there are not sufficient
funds to pay off this loan,please submit a letter of insolvency along with supporting
documentation such as a final inheritance tax return and financial accounting.
If you have any questions,please contact me at (717)234-8484 or toll-free at (800)237-
7328, press 6, extension 3120.
Sincerely, p
�y
andy Fa ' ey
Member Service Representative
PSECU
Pennsylvania State Employees Credit Union
1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • »psecu.com
THIS CREDIT UNION 15 FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER.
Rev-1510 EX.(0609)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DEWS EXCLUSION TAXABLE
NUMBER THE DATE OFdTRAANSFER SATfACH THEIR COPY OF THE DEIED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Ameriprise Financial Annuity No.93008400753 1 004- 21,890.03 21,890.03
Beneficiaries-Decedent's children-See attached
letter from Ameriprise Financial dated April 11, 2013
2 Ameriprise Financial IRA Annuity No. 93108133770 7 30,173.00 30,173.00
004-Beneficiaries-Decedent's children-See
attached letter from Ameriprise Financial dated April
11,2013
3 Ameriprise Financial IRA Basic Brokerage Account 26,505.94 26,505.94
No.00020428770 0 133-Beneficaries-Decedent's
children -See attached letter from Ameriprise
Financial dated April 11, 2013
4 Ameriprise Financial IRA Certificate No.00504579233 1,873.78 1,873.78
9 001 -Beneficiaries -Decedent's children-See
attached letter from Ameriprise Financial dated April
11, 2013
5 Ameriprise Financial IRA Certificate No.03304741528 10,990.27 10,990.27
7 001 -Beneficiaries -Decedent's children-See
attached letter from Ameriprise Financial dated April
11,2013
6 Ameriprise Financial IRA Certificate No. 03304791535 7,143.62 7,143.62
1 001 -Beneficiaries-Decedent's children-See
attached letter from Ameriprise Financial dated April
11, 2013
7 Ameriprise Financial IRA Mutual Fund Account No. 11,026.05 11,026.05
02014837367 1 002-Beneficiaries-Decedent's
children-See attached letter from Ameriprise
Financial dated April 11, 2013
TOTAL(Also enter on Line 7, Recapitulation) 109,602.69
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
APR 15 2013
Ameriprise
RiverSource Life Insurance Company
Financial Ameriprise Financial Company
70100 Ameriprise Financial Center
Minneapolis,MN 55474
April 11, 2013
SAIDIS,SULLIVAN&ROGERS
26 WEST HIGH ST
CARLISLE,PA 17013
Dear SAIDIS,SULLIVAN&ROGERS: 18128066 1 001
Thank you for your recent inquiry regarding KATHLEEN M GANNON's accounts. These are the
values of the accounts as of 01/30/2013.
Account Information
Mutual Funds
Account Number Ownership
02014837367 1 002 IRA-beneficiary designated
Certificates
Account Number Ownership
00504579233 9 001 IRA-beneficiary designated
03304741528 7 001 IRA-beneficiary designated
03304791535 1 001 IRA -beneficiary designated
Annuities-Post 1985
Account Number Ownership
93008400753 1 004 Individual
93108133770 7 004 IRA-beneficiary designated
Basic Brokerage
Account Number Ownership
00020428770 0 133 Beneficial IRA-beneficiary designated
Insurance and annuities
are issued by RiverSourc
Life Insurance Company,
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services, Inc.Ameriprise
Financial Services, Inc.
Member FlNRA and SIPC.
Ameriprise
Financial
Beneficiary Information
We have the following beneficiaries on record for the deceased's accounts.
All claims settled in full
Account Number: 00504579233 9 001
Designation:
PRIMARY BENEFICIARY
LARRY J GANNON predeceased SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED, HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES
Account Number: 03304741528 7 001
Designation:
PRIMARY BENEFICIARY
LARRY J GANNON SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES
Account Number: 03304791535 1 001
Designation:
PRIMARY BENEFICIARY
LARRY J GANNON SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING,LAWFUL CHILDREN IN EQUAL SHARES
Account Number: 02014837367 1 002
Designation:
PRIMARY BENEFICIARY
LARRY J GANNON SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES Insurance and annuities
are issued by RiverSoun
Life Insurance Company
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services,Inc.Ameriprisr
Financial Services, Inc.
Member BNRA and SIPC.
Ameriprise Q
Financial
Account Number: 93008400753 1 004
Designation:
PRIMARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES
Account Number: 93108133770 7 004
Designation:
PRIMARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES
Account Number: 00020428770 0 133
Designation:
PRIMARY BENEFICIARY
LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00%
IF A CHILD IS DECEASED,HIS OR HER SHARE TO BE PAID TO HIS OR HER
LIVING, LAWFUL CHILDREN IN EQUAL SHARES
Mutual Funds
Account Number Total Value #of shares Asset Value Per Share
020148373671002 $11026.05 1100.404 10.020
Certificates
Account Number Total Value #of shares Asset Value Per Share
00504579233 9 001 $1873.78
03304741528 7 001 $10990.27
03304791535 1 001 $7143.62
Annuities - Post 1985
Account Number Total Value #of shares Asset Value Per Share
93008400753 1 004 $21890.03
93108133770 7 004 $30173.00 Insurance and annuities
are issued by RiverSoun
Life Insurance Company
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services, Inc.Ameriprisr
Financial Services, Inc.
Member FlNRA and SIPC.
Ameriprise e.
Financial
Basic Brokerage
Account Number Total Value #of shares Asset Value Per Share
00020428770 0133 $26505.94
Acct Name:Am uprise Brokerage Accoovl., AMERIPRISE TRUST COMPANY COO KATHLEEN M GANNON ACF KATHLEEN
M GANNON INH IRA AS GENE OF SHIRLEY GANNON
Acct N0:00,32D428770133 Accf Type:SENEFICiAL IRA
r_
Asset Nagrer
Ink d-
^Bioad Name., t 'quatdity :-Ear�e¢(j). VaNe{ .
CASH - CASH EQUIVALENTS - 4,197.41 1.00 4.127.41
WELLS FAR GO ADVANTAGE ESAAX SHORT-TERM FIXED WE'I S FARGO 880.24 9.18 8.080.58
ADJUSTABLE RATE GOVT CL A INCOME ADVANTAGE
FONDS
WELLS FFJ2GOADVANTAGE HIGH EKHAX HIGH-YIELD FIXED WELLS FARGO 4,298.47 3.31 14227.84
YIELD BOND rL A INCOME ADVANTAGE
FONDS
A. Tatat $28,50524
The date of death values provided are for estate tax purposes and are not a value to be paid.
Accounts may be subject to market fluctuation as governed by each product. Please note that the
values indicated for any Life Insurance product(s)with the insured deceased reflect the gross death
benefit at date of death and not the cash value. Values indicated for Life Insurance Products with
only the owner deceased reflect the cash value as of the date of death. Values for any proprietary
mutual funds include accrued dividends as applicable. Values provided for brokerage products are
manually calculated,and should be used as estimates only. The prices used to provide values are
estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides
these values as a service to its clients. Actual values used in preparation of tax returns or for
planning purposes should be verified by your legal and accounting advisors.
We appreciate the opportunity to be of service to you. Please contact us if you have any questions.
Sincerely,
Christine Meath
Death Settlements Processing Team
70100 Ameriprise Financial Center
Minneapolis,MN 55474
1-800-862-7919,Option 2,ask for Estate Settlements
Insurance and annuities
are issued by RiverSourc
Life Insurance Company,
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services, Inc.Ameriprisc
Financial Services, Inc.
Member FINRA and SIPC.
REV-1511 EX.(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 10,009.66
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attornev's Fees 3,500.00
See continuation schedule(s) attached
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 408.50
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 20,677.63
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 34,595.79
Copyright(c)2009 form software only The Lackner Group,Inc. Forth PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Camp Hill United Methodist Church Hospitality Ministry-Funeral Luncheon 450.00
2 Musselman Funeral Home-Funeral 9,559.66
H-A 10,009.66
Attorney Fees
3 Attorneys fees to Saidis, Sullivan&Rogers (estimated) 31500.00
H-B2 3,500.00
Probate Fees
4 Probate Fees to Register of Wills 408.50
H-B4 408.50
Other Administrative Costs
5 1%transfer tax on real estate 1,650.00
6 American Home Shield-Home Warranty 460.00
7 Bowers Pest Control-Termite Bill 137.00
8 Broker Fee for real estate settlement 150.00
9 Budget-rental of van on June 29, 2013 to move personal property of Decedent 2,772.38
10 Budget-truck rental on July 9, 2013 92.20
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
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-----------------------------------
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
ITEM
NUMBER DESCRIPTION AMOUNT
11 Comfort Inn stay for Executor on July 3, 2013 117.72
12 Connie Zigman-Notary Fee for real estate settlement 15.00
13 Countryside Suites-hotel room for Executor on July 2, 2013 77.35
14 Cumberland Law Journal -Advertise Letters 75.00
15 Dan Klick-lawn care-April through July, 2013 425.00
16 Dethlefs-Pykosh Law Group-Tax Certification 10.00
17 Enterprise-car rental -February 17, 2013 415.33
18 Forneys Remodeling-repair mortar in basement 75.00
19 Gas on July 1, 2013 for trip of Executor to handle estate matters-Richfield,Ohio 58.14
20 Gas on July 1,2013 for trip of Executor to handle estate matters-Howe, Indiana 54.41
21 Gas on July 2,2013 for trip of Executor to handle estate matters-Omaha, Nebraska 60.95
22 Gas on July 2, 2013 for trip of Executor to handle estate matters -Minooka, Illinois 51.24
23 Gas on July 2, 2013 for trip of Executor to handle estate matters-Williamsburg, Iowa 49.71
24 Gas on July 3, 2013 for trip of Executor to handle estate matters-Bartlesville, Oklahoma 69.93
25 Gas on July 3, 2013 for trip of Executor to handle estate matters-Lexington, Nebraska 66.22
26 Gas on July 3, 2013 for trip of Executor to handle estate matters -Sidney, Nebraska 48.68
27 Gas on July 4, 2013 for trip of Executor to handle estate matters -South Wells, Nevada 47.80
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
ITEM
NUMBER DESCRIPTION AMOUNT
28 Gas on July 4, 2013 for trip of Executor to handle estate matters-Rock Springs,Wyoming 35.18
29 Gas on July 4, 2013 for trip of Executor to handle estate matters -Valmy, Nevada 30.00
30 Gas on July 4, 2013 for trip of Executor to handle estate matters-Salt Lake City, Utah 53.07
31 Gas on July 5,2013 for trip of Executor to handle estate matters -Reno, Nevada 82.36
32 Gas on June 30, 2013 for trip of Executor to handle estate matters-Waterfall, Pennsylvania 34.60
33 Hudson &Bondurant, PC -attorneys fees for titling timeshares 443.75
34 HV Mechanical Services, LLC -home inspection repair 109.85
35 Motel 6 stay for Executor on June 30, 2013 51.73
36 Paula Kraber-Hunter-house repairs 1,484.16
37 Paula Kraber-Hunter-house repairs 490.00
38 PSECU -fee for overdraft 17.75
39 Realtors Commission 10,195.00
40 Register of Wills -fee for exemplified copies of Will 30.00
41 Register of Wills -Short Certificate 10.00
42 Storage Depot-storage for house contents -February through July, 2013 321.26
43 The Sentinel-Advertise Letters 189.54
44 Turnpike Tolls-See attached receipts 57.05
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1600 Schedule H(Rev.6-98)
ITRCC
OHIO TURNPIKE Toll Indiana Toll Road
COMMISSION
30-Jun.13 NNM.,Ii IP I111'9, 1 il'q
Receipt: 1031
Entry 239 LANE: Lane 1OX
Time 20:45 From: Eastpoint
Exit 173 To: Portage
Lane 05 CATEGORY: 2 Axles
Time 21 :59 Total : $ 7.90
Class 02 Axles 02 Paymeri. r.:athod: CASH
Collector# 117322 Toll icQe•ator: 45385
Payment: Date: 7/1/2013 '':32:18 PM
Cash All time Central
loll Due $ 8.00 ----------------- --------------
BaldDue $ 0.00 iIIIIIII�IIIIIIIIIII�I;�II��II�IIII�II'II!II�I�I�I
05334379371249730626
---------------------------
Ca•s Pay your Old rates with i-Zoom
visit: www,getizoom,com today
Questions or comments call 1-668-496-6690
ITRCC
52551 Ash Road
Granger, 1. 46530
THANK YOU
Drive safely
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Entry 173
Time 10:23
z Exit 002
p Lane 07
p a Time 13:04
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Collector# 100246
Payment:
Cash
Toll Due $ 20.00
Paid $ 20.00
Bal Due S 0.00
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
ITEM
NUMBER DESCRIPTION AMOUNT
45 U-haul-move house contents to storage-February 15, 2013 63.27
H-B7 20,677.63
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule If(Rev. 6-98)
Rev-1512 EX.(12-05)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
Report debts incurred by the decedent Pifer to death that remained unpaid at the date of death,Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Borough of Camp Hill Sewer 165.00
2 Borough of Camp Hill Sewer 165.00
3 Borough of Camp Hill Sewer 26.90
4 Discover Card ending in 5299 85.68
5 Janet L. Miller,Tax Collector-per capital tax 14.70
6 Janet Miller,Tax Collector-2013/2014 School Taxes 105.59
7 Janet Miller,Tax Collector-County/Township Tax 1,054.97
8 Loan on Honda Accord 16,800.00
9 Nester and Mathias Dental Associates, PC 50.00
10 Ocean Beach Club Owners'Association- Maintenance fee for timeshare 667.00
11 Pennsylvania American Water-February through July, 2013 132.56
12 PNC Line of Credit 94,712.50
13 PPL Electric -February through July, 2013 958.48
14 PSECU Personal Service Loan -See attached letter from PSECU dated April 8,2013 203.44
15 Verizon 32.65
TOTAL(Also enter on Line 10, Recapitulation) 115,174.47
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV 1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gannon, Kathleen M. 21-13-0178
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
Do PERSON(S)RECEIVING PROPERTY Not .s sag (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.91 16 a 1.2
1 Brian J.Gannon Son 50%residue
1956 South Hamlin Ave.,#2
Chicago, IL 60623
2 Mark S. Gannon Son 50%residue
PO Box 458
San Quentin, CA 94964
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as approp riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS,that I, KATHLEEN M. GANNON,
currently residing in Camp Hill, Cumberland County, Commonwealth of Pennsylvania, being in
good health and of sound and disposing memory do hereby make, declare and publish this as my
Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me.
FIRST: I direct that all of my debts not barred by the statute of limitations,
expenses of my last illness, funeral expenses, costs of administration and claims allowed in the
administration of my estate shall be paid by my Executor hereinafter named, from my estate as
soon after my decease as shall be found convenient.
SECOND: I bequeath my automobiles,household and personal effects and other
tangible personalty of like nature (not including cash or securities),together with any existing
insurance thereon,to my sons MARK S. GANNON and BRIAN J. GANNON,in equal shares. If
they are unable to agree,then by making alternate selections of items in turn until each has
selected an equal dollar amount, provided that the share of anyone who predeceases me or dies
before the complete distribution of his share shall be distributed to his issue per stirpes.
THIRD: I give, devise and bequeath the rest, residue and remainder of my estate,
whether real, personal or mixed, and of any nature whatsoever and wherever situate, to my sons
MARK S. GANNON and BRIAN J. GANNON, in equal shares, per stirpes.
FOURTH: I hereby nominate, constitute, and appoint MARK S. GANNON as
Executor of this, my Last Will and Testament. In the event that MARK S. GANNON shall
predecease me, or be unwilling or unable to act as my Executor, as aforesaid,then I nominate,
constitute and appoint BRIAN J. GANNON without necessity for posting security regardless of
state of residence, as Executor of this, my Last Will and Testament. All references to the
Executor herein shall be applicable to said substitute Executor.
1
1 J f
FIFTH: My Executor shall have, in addition to the powers and authority conferred
upon him by law,the following additional powers and authority:
1. To sell at public or private sale, exchange, transfer, partition, give options upon,
lease,mortgage,pledge or otherwise dispose of any property, real or personal, at any time
constituting a portion of my estate, and upon such terms and conditions as the Executor shall
deem wise.
2. To invest any money at any time in such bonds, stocks,notes, real estate,
mortgages, life insurance, annuities or other securities, or such property, real or personal, as the
Executor shall deem wise, without being limited by any statutes or rule of law regarding
investments by the Executor.
3. To retain, without incurring any liability, as investments, any property owned by
me at the time of my death, as long as my Executor may deem it wise, and even though such
property is not the kind of property an Executor would purchase as an investment; and even
though to retain such property might violate sound diversification principles.
4. To cause any security or other property which may constitute a portion of my
estate to be issued,held or registered in the Executor's own name, or in the name of a nominee,
or in such form that title will pass by delivery.
5. To consent to the reorganization, consolidation, readjustment of the financial
structure, or sale of the assets of any corporation or other organization, the securities of which
constitute a portion of my estate, and to take any action with reference to such securities which,
in the opinion of the Executor is necessary to obtain the benefit of any such reorganization,
consolidation, readjustment or sale; to exercise any conversion privilege or subscription right
given to my Executor as owner of any securities constituting a portion of my estate resulting
from any reorganization, consolidation,readjustment, sale, conversion or subscription.
6. To pay all costs,taxes, charges and expenses in connection with the
administration of my estate, including such compensation to the Executor which shall.be in
accordance with established fees throughout the period of administration of my estate.
4 2
7. To determine what is"income" and what is "principal"hereunder, and my
Executor's decision thereon shall be final; and to purchase securities at a premium or discount,
and to apply or charge said premium or discount against income or principal as the Executor may
determine.
8. The Executor may make payments to or on behalf of any person who is the
beneficiary hereunder but in no event, however, shall payments be made to any creditor or other
such person because of anticipation of payment by the beneficiary, and any such claim made by
way of anticipation by the beneficiary shall be of no validity or legal effect.
9. To borrow money from any person, firm or corporation, including any
corporation acting as an Executor hereunder, for the purpose of protecting and preserving or
improving my estate hereunder; to execute promissory notes or other obligations for amounts so
borrowed.
10. To employ legal counsel, accountants, brokers, investment advisors, custodians,
managers and other agents and employees and to pay reasonable compensation out of my estate
or any funds held hereunder to which said compensation is attributable.
11. To carry on any business owned or controlled by me at my death for whatever
period of time my Executor shall think proper, and my Executor shall have the power to do any
and all things my Executor deems necessary or appropriate, including the power to close out,
liquidate or sell the business at such time and upon such terms as my Executor shall deem best.
12. To do all other acts in my Executor's judgment necessary or desirable for the
proper and advantageous management, investment and distribution of my estate.
SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed
because of my death, whether the funds, property or insurance proceeds to which such taxes are
attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor
pay, or provide for payment of all such taxes at such time, or times, and in such manner as my
Executor deems best.
=AP4 3
IN WITNESS WHEREOF, I, KATHLEEN M. GANNON,the Testator to this,my Last
Will and Testament, typewritten on four sheets of paper which I have identified at the bottom of
e h page by my initials, hereunto set my hand and seal the day of
2003.
KATHLEEN M. GANNON
The preceding instrument consisting of this and three other typewritten pages, each identified by
the signature of the Testator,KATHLEEN M. GANNON, this day and date thereof signed,
publishe&,and declared by KATHLEEN M. GANNON, the Testator therein named, as and for
her Last Will, in the presence of us who, at her request, in her presence, and in the presence of
each other have subscribed our names as witnesses.
4
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
1,KATHLEEN M. GANNON, Testator,whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will;that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
THLEEN M. GANNON
Sworn or affirmed two and acknowledged before me by KATHLEEN M. GANNON, Testator,
the Oday of 2003.
(SEAL) Notary Public
NOTARIAL SEAL
Roberta L.Radcliff, Notary Public
Wormleysburg Borough,County of Cumberland
My Commission Expires Jan.20,2005
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND \
We Jo.V^neS Q �o�Ole and JAS /( . /�'I 3�cA , Fi- , the
witnesses whose names are signed to the attached or foregoing instrument,being duly qualified according
to law, do depose and say that we were present and saw Testator sign and execute the instrument as her
Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes
therein expressed;that each of us in the hearing and sight of the Testator signed the Will as witnesses; and
that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound
mind and under no constraint or undue influence.
Sworn or ffir/me/d to and subscribed to before me by L M/r 5 X and
4 �� /nL�l,I r F l� witnesses,this 1�day of�/'7lc f�c� 2 12003.
(SEAL) � z
Notary Public
NOTARIAL SEAL
Roberta L. Radcliff,Notary Public
5 Wormleysburg Borough,County of Cumberland
My Commission Expires Jan.20,2005