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HomeMy WebLinkAbout11-15-13 s` i • 1505610105 REV-1500°``02-11'(FT) OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual Taxes County Code Year — File Number — — PO BOX28o6oi INHERITANCE TAX RETURN 1 i i Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ' ; 105/20/2013 07/28/1949 I , Decedent's Last Name Suffix Decedent's First Name MI _------------------------------....—.— — -----------...--- ----...-__------.._—.-.._..- ---- Horner j r Randall (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 'Rhoades ;Sandy K i Spouse's Social Security Number —-'� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 210-44-6577 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C@D 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) CMD 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 BE DIRECTED TO: Name _ Daytimejelephone Nutx r - Ronald E. Johnson, Esq I !(717400123 r �—sue.-�--- R1GfSTE )OF W E S USIYONJ�,F rn First Line of Address C/) M U 1 78 West Pomfret Street --------.._..-------.-.._....__... ---___ - -- -------- CD - t Second Line of Address — ------------------------. _.._I —1 r " City or Post Office- — State ZIP Code DATED Carlisle — —----_ --_- I PA 117013 — — Correspondent's e-mail address:rejohnson @pa.net 1 Under penalties 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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA E OF PER ON RESPONSI L FOR FILING RETURN DATE ADDRESS C/o 78 WqspPomfret Street, C sl , PA 17013 6 ER T E ENTATIVE DAT D E S c/ 78 West Pomfret St t, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 1. 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Randalle E. Horner RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. ' 71,250.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 i 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. I 0.00 i 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 1 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. I 7,900.77 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property - (Schedule G) O Separate Billing Requested........ 7.``' 0.00 8. Total Gross Assets(total Lines 1 through 7)............................. 8. I 79,150.77 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 11,286.06 i 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 2,429.75 11. Total Deductions(total Lines 9 and 10)................................. 11. { 13,715.81 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 65,434.96 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 65,434.96 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 _ -- --- - -_-- ---------....... (a)(1.2)X.0 0 65,434.96 ? 15.? 0.00 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 0.00 17. Amount of Line 14 taxable at sibling rate X.12 I 17.s 0.00 18. Amount of Line 14 taxable at collateral rate X.15 18.1 0.00 19. TAX DUE..............:.......................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Randall E. Horner STREETADDRESS 532 North Bedford Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 15.42 B.Discount 0.00 3. Interest Total Credits(A+B) (2) 15.42 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2,Line 20 to request a refund. (4) 15.42 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income............................................ ❑ c. retain a reversionary interest.............................................................................................................................. ❑ E d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N 2. If 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?.............. ❑ N 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a 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)(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 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 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. Autom,ated Last Will and Testament by Page 1 of 8 Last Will and Testament of Randall E Horner I, Randall E Horner,presently of Carlisle, Pennsylvania, declare that this is my Last Will and Testament. PRELIMINARY DECLARATIONS 1. Prior Wills and Codicils c � o ca z rn = � c/ I revoke all prior Wills and Codicils. z ,rn f~-► n Cn 2. Marital Status ° ° `T► � I am not married. --4 ►-- ;— �� y, c� C) U. 3. Children I do not have any living children. PERSONAL REPRESENTATIVE The expression'my Personal Representative'used throughout this Will includes either the singular or plural number, or the masculine or feminine gender as appropriate wherever the fact or context so requires. The term'personal representative'in this Will is synonymous with and includes the terms 'executor' and'executrix'. 4. Appointment I appoint Sandy K Rhoades of Carlisle, Pennsylvania, as my Personal Representative of this my Will. My Personal Representative is not required to post bond. 5. Powers Of My Personal Representative I give and appoint to my Personal Representative the following duties and powers with respect to my estate: a. To pay my legally enforceable debts, funeral expenses and all expenses in connection with the administration of my estate and the trusts created by my Will as soon as convenient after my death, except for any debt secured by real and/or personal property which is to be assumed by the recipient of such property. b. To take all legal actions to have the probate of my Will completed as quickly and simply as possible, and as free as possible from any court supervision,under the laws of the http://www.lawdepot.com/contracts/Willus/Preview.php 1/20/2006 Automated Last Will and Testament by Page 2 of 8 Commonwealth of Pennsylvania. c. To retain, exchange or dispose of any personal property without liability for loss or depreciation. d. To purchase, maintain, convert and liquidate investments or securities, and to vote stock, or exercise any option concerning any investments or securities. e. To open or close bank accounts. f. To maintain, continue, dissolve, change or sell any business which is part of my estate, or to purchase any business if deemed necessary or beneficial to my estate by my Personal Representative. g. To lease any real property in my estate. h. To maintain, settle, abandon, sue or defend, or otherwise deal with any lawsuits against my estate. i. To employ any lawyer, accountant or other professional. j. Except as otherwise provided, to act as my Trustee by holding in trust the share of any minor beneficiary, and to keep such share invested,pay the income or capital or as much of either or both as my Personal Representative considers advisable for the maintenance, education, advancement or benefit of such minor beneficiary and to pay or transfer the capital of such share or the amount remaining to such beneficiary when he or she reaches the age of majority or, during the minority of such beneficiary, to pay or transfer such share to any parent or guardian of such beneficiary subject to like conditions and the receipt of any such parent or guardian discharges my Personal Representative. The above authority and powers granted to my Personal Representative are in addition to any powers and elective rights conferred by statute or federal law or by other provision of this Will and may be exercised as often as required, and without application to or approval by any court. DISPOSITION OF ESTATE 6. Distribution of Residue To receive property under this Will a beneficiary must survive me for thirty(3 0) days. Beneficiaries of my estate residue will receive and share all of my property and assets not specifically bequeathed or otherwise required for the payment of any debts owed, including but not limited to, expenses associated with the probate of my Will,the payment of taxes, funeral expenses or any other expense resulting from the administration of my Will. The entire estate residue is to be divided between my designated beneficiaries with the beneficiaries receiving a percentage of the entire estate residue. A one hundred percent(100%) share of the estate residue is equal to the entire estate residue. All property given under this Will is subject to any encumbrances or liens attached to the property. http://www.lawdepot.com/contracts/willus/preview.php 1/20/2006 Automated Last Will and Testament by Page 3 of 8 I leave the residuary of my estate as follows: a. Sandy K Rhoades of 532 North Bedford St. Carlisle Pa. 17013, USA, will receive a 100 percent share of my residuary estate. 7. Individuals Omitted From Bequests If I have omitted to leave property in this Will to one or more of my heirs as named above the failure to do so is intentional. GENERAL PROVISIONS 8. No Contest Provision If any beneficiary under this Will contests in any court any of the provisions of this Will, then each and all such persons shall not be entitled to any devises, legacies,bequests, or benefits under this Will or any codicil hereto, and such interest or share in my estate shall be disposed of as if that contesting beneficiary had not survived me. 9. Severability If any provisions of this Will are deemed unenforceable, the remaining provisions will remain in full force and effect. 10. Signature I, Randall E Horner, the within named Testator,have to this my last Will contained on this and the preceding pages, set my hand at the City of Carlisle, in the Commonwealth of Pennsylvania, this 20th day of January, 2006. I declare that this instrument is my last Will, that I am of the legal age in this jurisdiction to make a Will,that I am under no constraint or undue influence, and that I sign this Will freely and voluntarily. Randall E Horner WITNESSES This instrument was signed on the above written date by Randall E Homer, and in our presence he declared this instrument to be his last Will. At his request and in his presence and in the presence of each other, we subscribe our names as witnesses hereto. Each of us observed the signing of this Will by Randall E Homer and by each other subscribing witness and affirm that each signature is the true signature of the person whose name was signed. Each of us is now the age of majority and a competent witness and resides at the address set forth after their name. To the best of our knowledge, the Testator is of the age of majority or otherwise legally empowered to make a Will, is mentally competent and under no constraint or undue influence. http://www.lawdepot.com/contracts/willus/preview.php 1/20/2006 Automated Last Will and Testament by Page 4 of 8 We declare under penalty of perjury under the laws of the Commonwealth of Pennsylvania that the foregoing is true and correct this 20th day of January, 2006, at Carlisle, Pennsylvania. hilod 1 (2 Uje t Signature Signature Q-�s�)gmypj_. Name 3 it u�� trrd� ��, Name �cflASz0 GU, Address I4 b Pa Address City/State City/State -jAf ESO-cJAJ l Z4M Signature J Name i` ,�'' re ye Address f y City/States http://www.lawdepot.com/contracts/willus/preview.php 1/20/2006 Automated Last Will and Testament by Page 5 of 8 AFFIDAVIT State of. County of I, Randall E Homer, the Testator, sign my name to the attached or foregoing instrument this an-G day of 20 O G.;.and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this instrument as my last will and testament and that I sign it willingly(or willingly direct another to sign'for me), that I execute it as my free and voluntary act for the purposes therein expressed,.and that I am eighteen(18)years of age or older, of sound mind, and under no constraint or undue influence. G/,rJ- ee Randall E Homer We, -T)C,t'y)i-e W0— -J(n e,5 f l C��l��C�(,c� S?" Er�f , C' 6,(-/4 the witnesses, sign our names to this instrument,being first duly sworn, and do hereby declare to the undersigned authority that the Testator signs and executes this instrument as his last will and that he signs it willingly(or willingly directs another to sign on his behalf), and that each of us, in the presence and hearing of the Testator,hereby signs this will as witness to the Testator's signing, and that to the best of our knowledge the Testator is eighteen(18)years of age or older, of sound mind, and under no constraint or undue influence. Witness Signature U Witness Signature Witness Name OI C D(Vh )jb- t Witness Name Witness Signature Witness Name F?c�,4 fz 1) t)- E �! 4 kl� W http://www.lawdepot.com/contracts/willus/preview.php 1/20/2006 Automated Last Will and Testament by Page 6 of 8 e Subscribed, sworn to and acknowledged before me by Randall E Horner, the Testator and subscribed and sworn to before me bygW and witnesses, this/P—t y of 1� , 20,0�O / T (Signed) r-� t Sandra G otarial Seal Fa1n'ieweiler,Notary Public MY Commission 'YOB County (Official capacity of officer Member,Penns VExpires February 18 2007 YI ania Association of Notaries http://www.lawdepot.com/contracts/willus/preview.php 1/20/2006 REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Randall E. Horner 21-13-0065 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. VALUE AT DATE NUMBER OF DEATH DESCRIPTION _.... .........._- i. ALL THAT CERTAIN tract of land with the improvements thereon erected situate in the r,4...... .. r. _,.. x.x........x. x - m. , < s, :Borough of Carlisle,Cumberland County,PA;being known and numbered as 532 North Bedford Street,Carlisle,PA 17013 .w„",..... ,ww,•...w.w,.,...x,..w>,.�.�„«wwwww,.M.,.ws,u..-...w.-.•.,.-,�.,xw,•.ww..owwwn�+,...,.r..>�.�..-.w..w.row.w.w.•,..e...•,.�w..,w«+w.�,.nw.n•...w.w..w.�w '�v' , ._..,.....4�rJ:...::C+:C.v.iw:5.+,.�"w': X. , ,See Deed Book L Volume 36 Page 1124 see appraisal attached 71,250.00, x:._.. ,.,....xxx.. ...........x.....xx..•,. .. ... x-....,..,, .-_,. --� <x, x x,.: - ....-, -.-__ _,.:��._.- a, � � Y i ::::- r_- ...: .......... ...r..._ ,..... >x_<: <x , , < < y i,:n �' i,ww�;>,w..�..<.w...-.�.:wn-.wmxw�w:»mw.,n. vn nno:,.•.,v..nn~_.,w•n.ww:.wwnnwrr.�.-.:�rwn.��,.«w.wrrvm�w,nw:wr:.www.nvevwn•�r,vw�...v..•in-.w�,vvw. - � X ',j :.� ' Z ....,...>. .,.,>,.......,....«».,n,....�.......,.t. ,H.,...n...-.•......,,.•,w.w�...,..,.......,n...-...}_.,,,..,...,.......,.....,..,.,,.,v, .-...,....,,,.....:.,....n.,...,.,..w.,,..:.,,n•, ,,....,.«n,.:..,.,. ,�,.a..�.w.'"xx`...�:.r-.. .. ...... M M- , a w ..... ry ,n"..-,. n,.-,.•n,,,.,n,,.,n-,.....•..,rvN,.•nw�.,,..,,�,....,,�...w....,..ww...,u,,.,.,.rv,.wn,.w•n,rv,..,,,..�.�,, :,� ��:.. _.... _....,x_ . x F' -.: .x•:x, ::-�_.:..:x..>.x::.....:.<,.:xr��.:,x...x_,.,,...,....x_.............._x:xerx�.x:x ...«., x u.x -x .x .,,xx ..x vx,: x�-:r - ...u. :... :i w , - _.x.....xrx-x.-: ::.y._.y:�.x:+x..:<.�.:..... ................ .... .,:....x::,. .. ,..>..s•_.x:xxx..x..:x._. _x.. ., sx. u..4t..^ , F x >.<�..•n.,..,..,..,x„ �.•....w,�.,.,,,.,,.,,>...�...,,.�,.•,,,.M:,•,.....,.,<....•.w..,.,rv:.,,..-„<,.<.,n,.n.�,;..v.n-..v.w...,.:,.•.,.-.,.,.,..�,..n...:..n-,�n.:n.................>U,..:•rv.:.n...n.,..,.,r•n,,,-n.,..-,.,v..•....,,•n... �_ .. . :::i __:,..._z;ti: ....>.:''•:. i i.,, 5wv.-,,:,•.,v.»......, r.,,,.w..,,v,n..,,.+,-n.,-.,,.,n,-,.-..•..,..v,•n,...,,,...,,.nv,.w.n>.,�„v.-,.,...,_.,,,...:.�.v.,....,.vw,w..+.,,w..rv.,..::n..w...w..,,n„>.,r.............:.•n,.�.w,v,+rw,v..nw:.uwv,..xw.n,.v,,,,v.,»wx,v_.x,w.; :� , r .._a._.. i_ k • < fi > ' , � Y , row..w-,++v,v,•nv Yn.v.�wrnn.vw.•n.,.v'.r..::.,wn,vow,v.nv.rn,vnnw�+�mmv+,w..•`x.,vw+w.•�r.�.ro'.w+�.,�ww.w„+wvn-�.n,nw,w«,v,rvwwwwvw„v.,v.^,vvwwr,nwv.-m:,nvwaur:.+n,wwnnnvx` x.�X3'..h.el �:.ui..e.z': .. t....::-'"-x X_ i.,..v,,,,.•,.^..,�..-...,..,.,,,,,..,,++.w.,.,..-..n,..,.,,.,.n...H.,...,.,..,.•,,,.,,.,n.,�.,n-,.,....,.•n•.w,,.,.,.•..,,..•„+•.-....,.:.,"...,..,,,.,....,,,•.....,,..,,...-..•....-.,.,--,......•..-......:w„,n ..>..x .,...7.x...�..�i4H 5 ' , , ' , , .:x_...x:.x......, .,_ ..............-........—x......_.:. ., x -.-......._. ...x.x..>...... ... r '..............<........,-.: u.nwr..,,..,,:....-.�..•.....,,...-.....n,.n.....,,......,......,...,.,.�..,..,..-.....,,--•....«,,,•,...�..•n...«.....x.«..:.n.«.......:.....,.,....,w.,�..�..n...rh•...�..-...n�nw,.�.s......„.v..,w..,.,.�......w�, x.,c:....:�.. ,_...'�:::. .....,!!.' , i F _,x.:.nw...-n•,wr .'v..•,........�•.vw,w.•..nw.v.�+.ww.v.�.w.v:.•m-..n•....:.w+.,w:v:.vnvrvn-wwrm„w,w.:.v.:.•.w:rv•.,vr.v.wr,�,wwwenvw...rn..v-n,.w.•>w:w.n.,w.v,vw.wa.�nn+.w.:mw:,= �- , < 9 .... ......... ^.....,................,......,.....,......................,.......,..............................,.......................................................,.........................«....,...........a x , TOTAL(Also enter on Line 1, Recapitulation.) $ 71 250.00,x If more space is needed,use additional sheets of paper of the same size. File No.532 NORTH BEDFOF SANDY K RHOADES 532 N BEDFORD ST CARLISLE PA 17013 File Number: 532 NORTH BEDFORD In accordance with your request, I have appraised the real property at: 532 NORTH BEDFORD STREET CARLISLE,PA 17013 The purpose of this appraisal is to develop an opinion of the market value of the subject property,as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion,the market value of the property as of is: $71,250 Seventy-One Thousand Two Hundred Fifty Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. DOUGLAS R HEINEMAN Pro perty Description UNIFORM RESIDENTIAL APPRAISAL REPORT FileNo. 532 NORTH BEDFORI PropertyAddress 532 NORTH BEDFORD STREET City CARLISLE State PA L Code 17013 Legal Description DB 20133 DEED PG 662 County CUMBERLAND Assessor's Parcel No.02-20-1800-034 Tax Year 2013 R.E.Taxes$17 47.36 S edal Assessments$ 0.00 Borrower NA Current Owner SANDY K RHOADES Occu ant: X Owner Tenant I I Vacant „ Property rights appraised X Fee Simple Leasehold Pro ect Type I I PUD I I Condominium UDNA on HOA$ /Mo. Neighborhood or Project Name Map Reference 2001800-034 Census Tract Sale Price$1 Date of Sale 25 SEPT 2013 Description and$amount of loan charges/concessions to be paid by seller NA Lender/Client SANDY K RHOADES Address 532 N BEDFORD ST CARLISLE PA 17013 Appraiser DOUGLAS R HEINEMAN_ Address 163 N HANOVER ST CARLISLE PA Location X Urban Suburban Rural Predominant Single family housing Presentlanduse% Land use change Built up X Over 75% 25-75% Under 25% occupancy PRICE AGE P s(mil ty,si One fatuity X Not likely ❑Likely Growth rate Rapid IX Stable Slow I X❑Owner Low 2 4 family In process Property values Increasing Stable Declining ❑Tenant High Multi-famy To: Demand/supply Shortage In balance Oversupply X❑Va=(45%) Predominant Commercial Marketin time Under 3 mos 3-6 mos. Over 6 mos. vacm raw,9% Note:Race and the racial composition of the neighborhood are not appraisal factors. Neighborhood boundaries and characteristics: THIS PROPERTY IS BOUNDED BY N HANOVER ST TO E HIGH ST TO THE EAST BY SPRING GARDEN TO N HANOVER Factors that affect the marketability of the properties in the neighborhood(proximity to employment and amenities,employment stability,appeal to market,etc.): tHIS NEIGHBORHOOD IS WITHIN A FEW MINUTES OF SHOPPING SCHOOLS EMPLOYMENT AND ENTERTAINMENT. THE APPROXIMATE AGE OF THE HOMES ARE 50-125 YEARS. Market conditions in the subject neighborhood(including support for the above conclusions related to the trend of property values,demand/supply,and marketing time --such as data on competitive properties for sale in the neighborhood,description of the prevalence of sales and financing concessions,etc.): Marketing time at this juncture is 38-45 days. There has been a small percentage increase in values over the last 6 months. The demand and supply appears to be average with no seller or buyer advantage This is from a very large supply over the last several ears due to foreclosurers etc. Typically,there are sales consessions in this price range;such a seller help and repair dollars. Project Information for PUDs(If applicable)--Is the developer/builder in control of the Home Owners'Association(HOA)? LJ YES X NO Approximate total number of units in the subject project _ Approximate total number of units for sale In the subject project Describe common elements and recreational facilities: Dimensions 14'8'•X 122 Topography Basically Level Site area .04 acres Comer Lot LJ Yes X No Size Typical for area Specific zoning classification and description Shape Rectan ular Zoning compliance X❑Legal ❑Legal nonconforming(Grandfathered use) LJ Illegal LJ No zoning Drainage Appears adequate Highest&best use as improved: RI Present use f I Other use(explain) View Average Utilities Public Other Off-site improvements Type Public Private Landscaping Typical Electricity X❑ Street Asphalt X❑ Driveway Surface Asphalt Gas XQ Curb/gutter CEMENT X Apparent easements None apparent Water X Sidewalk CEMENT X FEMA Special Rood Hazard Area X Yes No Sanitary sewer Xg Street rights ELECTRIC X FEMAZone Map Date Storm sewer X Alley ASPHALT X FEMA Map No. Comments(apparent adverse easements,encroachments,special assessments,slide areas,illegal or legal nonconforming zoning,use,etc.): Upon observation only,there appears to be no adverse easements or encoachments etc. GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION No.of Units One Foundation Concrete Slab No Area Sq.RL Roof Cncld X No.of Stories One ExteriorWalLs Brick Ca lSpace %Finished Ceiling Cncicl X Type(DeL/AtL) Detached Roof Surface As h.Sh. Basement Ceiling Waits Cncld X Design(Style) Ranch Gutters&Dwnspts. Aluminium Sump Pump Walls Floor Cncid X❑ Existing/Proposed Existing Window Type . Wood D.H. Dampness None noted Floor None Age(Yrs.) Storm/Screens Thermo/Yes Settlement None noted Outside Entry urkn ❑ Effective Age(Yrs.) Manufactured House No Infestation None noted ROOMS Foyer I Livina Dininci Kitchen I Den Family Rm. Rec.Rm. Bedrooms I #Baths Laundry Other Areas .FL Basement Level 1 1 1 1 .5 580 Leve12 3 1 550 0 Finished area above grade contains: 6 Rooms: 3 Bedrooms• 1.5 Baths• 1 130 S are Feet of Gross Living Area • INTERIOR Materials/Condidon HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE: Floors LAMINATEIGOOD Type FWA Refrigerator X None Fireplace(s)# ❑ None ❑ Walls Painted/AVERAGE Fuel Gas Range/Oven X Stairs X Patio Garage #of cars Trim�nish PAINTED/AVE ConditionAv . Disposal Drop Stair Deck Attached Bath Floor VINYUAVE COOLING Dishwasher X❑ Scuttle ❑ Porch COVERED Detached 1 Bath Wainscot CERAMIC/AVE Central Yes Fan/Hood X Floor X❑ Fence SIDES Built-In Doors Other None Microwave Heated Pool Carport ConditionAv . Washer/Dryer X Finished Driveway Additional features(special energy efficient items,etc.): None observes Condition of the Improvements,depreciation(physical,functional,and external),repairs needed,quality of construction remodeling/additions,etc.: There is some functional utility problems;such as walking through one bedroom to another. This is typical for this age and location of the property. Adverse environmental conditions(such as,but not limited to,hazardous wastes,toxic substances,etc.)present in the improvements,on the site,or in the immediate vicinity of the subject property: NONE OBSERVED Freddie Met Fan 70 693 PAGE 1 OF 2 Famk Mae Fam 1004 693 P.6-0.*g Al)WW..8MZX97V WwwadNihmm valuation Section UNIFORM RESIDENTIAL APPRAISAL REPORT Fite No. 532 NORTH BEDFOF ESTIMATED SITE VALUE,,, ,=$ 25,000 Comments on Cost Approach(such as,source of cost estimate, ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS: site value,square foot calculation and for HUD,VA and FmHA,the Dwelling 1,130 Sq.FL @$ _$ 0 estimated remaining economic life of the property): Sq.Ft. @$ = THE COST APPROACH TO VALUE WAS NOT USED IN THIS EVALUATION DUE TO THE AGE OF THE SUBJECT Garage/Carport Sq.FL @$ = PROPERTY. Total Estimated Cost New ,,-,,,,,,,,•,,,, =$ 0 Less Physical Functional External Est.Remaining Econ.Life: Depreciation I =$ 0 Depreciated Value of Improvements ,,,,,,,,,,,,,,,,,,, =$ p "As-is"Value of Site Improvements,,,,,,,,,,,,,,,,,,, =$ INDICATED VALUE BY COST APPROACH =$ 25000 ITEM SUBJECT COMPARABLE NO..1 COMPARABLE NO.2 COMPARABLE NO.3 532 NORTH BEDFORD STREET 530 NORTH BEDFORD ST 528 NORTH BEDFORD ST 318 N BEDFORD ST Address CARLISLE CARLISLE PA 17013 CARLISLE PA 17013 CARLISLE PA 17013 Pmximfty to Subject NEXT DOOR 2 DOORS 2 BLOCKS Sales Price Is 1 $ 69,000 $ 72 000 $ 84,900 Price/Gross Llv.Area $ 0.00 0 $ 62.56 0 $ 65.45 O $ J 59.45 m i Data and/or CPML CCCH CPML CCCH CPML CCCH CPML CCCH Verification Sources INSPECTIO VALUEADJUSTMENTS DESCRIPTION DESCRIPTION +•sA m DESCRIPTION +•EA mtmen DESCRIPTION +•Sad em Sales or Financing ammeNONE Concessions NONE 2000 -2,000 Date of Sale/Time 6 SEPT 2013 13 NOV 2012 3 JULY 2013 Location Urban SIMILAR SIMILAR SIMILAR LeasehokYFeeSimple, Fee Simple FEE SIMPLE FEE SIMPLE FEE SIMPLE Site TYPICAL SIMILAR SIMILAR SIMILAR View Average SIMILAP, SIMILAR SIMILAR Design and A eal 2 STORY TOWN SIMILAR SIMILAR END UNIT -5000 Qually,ofConstruction AVERAGE SIMILAR SIMILAR SIMILAR A e 100+ SIMILAR SIMILAR SIMILAR Condition AVERAGE SIMILAR SIMILAR SIMILAR Above Grade Tmel'B&M' BeIRS TOW'Bdrms' emrtfi Tae ma'so ' Beus TOW',edme hs ' 9e Room Count 6; 3: 1.50 5; 3 1.00' 1,500 6j 31 1.50' 6: 3: 1.50' Gross Living Area 1 130 S .FL 1,103 S .Ft. l 1 100 S .Ft. 1,428 S .Ft. -6,200 Basement&Finished FULL UNFINISH FULL UNFINISH I FULL UNFINIS FULL UNFIN Rooms Below Grade Functional Utility TYPICAL TYPICAL TYPICAL TYPICAL Heatin/Coolin Gas FWA C/Air SIMILAR SIMILAR OIL/NO CA 3,500 Energy Efficient items Garage/Carport 1 Det.Garaq a SIMILAR SIMILAR OFF STREET 3,500 Porch,Patio,Deck, Fireplace(s),etc. CVRED PORCH SIMILAR SIMILAR SIMILAR Fence,Pool,etc. FENCH SIMILAR SIMILAR SIMILAR Net Ad'.(total) _ X + $ 1 500 X + $ 0 + 1x1- ;$ 6,200 - M'a Adjusted Sales Price � • .�l. -0:� ±Gms�23� of Com arable e_; ° $ 70 500 t2 3 Q p'. $ 72,000 ., $ 78,700 Comments on Sales Comparison(Including the subject property's compatibility to the neighborhood,etc.): ALL THREE COMPARABLES ARE SIMILAR IN NATURE AND AN ADJUST MENT OF 21 PER SQUARE FOOT WAS USED TO NUMBER.THREE. BECAUSE OF THE PROXIMITY OF ONE AND TWO COMPARABLES AND NO ADJUSTMENTS IT IS MY OPINION THAT ONE AND TWO CARRY THE MOST WEIGHT.I DID CHECK WITHTHE SELLING AGENT AS TO CONDITION ETC. ITEM SUBJECT COMPARABLE N0.1 COMPARABLE N0.2 COMPARABLE NO.3 Date,Price and Data Source for prior sales NONE NONE NONE NONE within arof Analysis of any current agreement of sale,option,or lisfing of the subject property and analysis of any pdorsales of subject and comparables within one year of the date of appraisal: NONE APPARENT INDICATEDVALUEBY SALES COMPARISON APPROACH ,,,,,,,,,,,,,,,,,,,,,,,„ ,,,•...,,•,,,...,,,....,.,,,$ INDICATED VALUE BYINCOME APPROACH of Applicable) Estimated Market Rent$ N/A /Mo.x Gros Rent Multiplier N/A =$ 0 This appraisal is made XO "as is” LJ subject to the repairs,atterations,inspections or conditions fisted below LJ subject to completion per plans and specifications. ConditionsufAppraL* THERE WERE NO REPAIRS OBSERVED WHICH NEEDED ATTENTION. THIS APPRAISAL IS AS IS.THIS APPRAISAL IS NOT INTENDED OR CAN BE USED FOR ANYTHING OTHER THE ESTATE VALUATION. Final Reconciliation:IN THIS APPRAISERS OPINION THE MARKET APPROACH IS THE ONLY VALID APPROACH TO VALUE. THE 1&2 COMPARABLES HAVE THE MOST WEIGHT IN THIS EVALUATION. • The purpose of this appraisal is to estimate die market value of the real property that is the subject of this report,based on the above conditions and the certification,contingent and limiting conditions,and market value definition that are stated in the attached Freddie Mac Form 439/Fannie Mae Form 1004B(Revised ). I ME)ESTIMA ET ETVALUE,ASDEFINED,OFTHEREALPROPERTYTHATISTHESUBJECTOFT HSREPCRI-,ASOF (WHICHISTHEDATEOFINS ONANDTHEEFFECiNEDATEOFTHSREPORT)TOBE$ 71,250 APPRAISER: - SUPERVISORYAPPRAISER(ONLYIFREQUIRED): Signature Signature F]Did E]Did Not Name DOUGLAS R H al.WkMAN Name Inspect Property Date Report Signed 24 OCTOBER 2013 Date Report Signed State Certification# RL-000569-L State PA State Certification# State Or State License# State Or State License# State Fredde Mat Form 79 6-93 PAGE 2 OF 2 Farhe Mae Fm 1000 6.93 Pmdmad aeeo AD raen.,e.eouuetn­dWeb.mm Heineman Appraisals REV-i5o9 EX+(oi-io) I pennsy[vania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Randall E. Hor 21-13-0065 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 ,.,.,...,,.,.,,,:..........,.,,,.,,,,_..,,..,,,,,......_._.,,..,,_,...,,,,..,..._, ...,,,........,.,,.,,,,._,,,,,,,,,,,,,,....... ,.... AJSandy K. Rhoades :532 North Bedford Street,Carlisle, PA 17013 :wife(common law) .._....._... _.. .,.................-,..-............... .... .................... .... .............. w�.........,.......,..:....... ...,......... B. C _ .,, , ..._.... ....................... .... M..,.,_,,,,,, ._...,..,..__..,. ....,,..._,,...,,,,,, ,_,,,,,,,.,,.._.,,.,._.. ,,,---..-----...,,_,,,,,,.,,,,.. i JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST ........ .. _. ...............................- .... ..... ......... ..... ................. ........................ _ ..... .. ..: ...; 1. A. 10/19/92 `Savings account no:129287-00-Members 1st FCU(see'attached letter) 1,301.54 50 650.77 F., 2. ; A ' 201 0 `2010 Honda CVR autmobile(proceeds from sale) 14,500 00 50 7,250.00' x z x ,. .. W . y..... ._,.. ,,....,.,._.,,.,, .................................................,,,,.......,,,...,,.,,.,,_,,,,,,,....,,,..,....»,,..,.., ,..,,,..,.,,_..,,,,,... .;,;,:,'w�wW...aTv:"..mow ..,...... xxc.:..:,w..... .X:,t`,CSx.Ku: c......... ,.....r.....: :.................... ... .......... t............... ,,.,............,...,u,,,.........,._,.,,..,..,.,,,...y,.,__..__,,.,......,,,._,,,__....,......,....,.._,,.,,,,,_.,,.,._, .xccsxxcx;ma;:•r-.,:;s., ,.,......, ,: < < < < L.........a _ _ < R 7 ' < < < < < < ;..,.,.,.. 5... .,.......<: ................................................., .......,..........-,........................................,....._...,, vo.., - -v;,w>:,, :.. :an �.y •.ti_'> < < < h L <........... .............. <..,......,............. .—..._...._........_..._......._.__.__......._._.._.._..____...._.............._...__.._..__....�_..._..........__...................._ < ` < < < < s < < < < < y h � � h i� < < E , = r < 3 <�.....,-.., :..... _... ..........,........,.' :,...............,...................,.,«_...........................................,...,............,.........,................,.,... ...... S.:.is L n ,•b...>.row...,v.,. TOTAL(Also enter on Line 6, Recapitulation) 7,900.77 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 129287-00 D-ate Account Established 10/19/1992 Principal Balance at Date of Death $1301.43 Accrued Interest to Date of Death $0.11 Total Principal and Accrued Interest $1301.54 Name of Joint Owner Sandy Rhoades CHECKING ACCOUNT: Account Number/Suffix 129287-11 D-ate Account Established 10/19/1992 Principal Balance at Date of Death $0 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $0 Name of Joint Owner Sandy Rhoades LOAN ACCOUNT: Account Number/Suffix 129287-09* Date Opened 07/07/2011 Principal Balance at Date of Death $1621.37 Loan Type Unsecured/Contractual Pledge of Shares Collateral Secured None Interest Rate 10.39% Name of Co-Borrower None *Loan has life coverage. MEMBERS 1"FEDERAL CREDIT UNION Anderson Lending Insurance Support Specialist June 17, 2013 Estate of: Randall Horner Date of Death: 5/20/2013 Social Security Number: 208-38-6781 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org �i 1 REV-1511 EX+(08-13) ispennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Randall E. Horner 21-13-0065 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES--------------------------------- ,,,.,«,_.,_.«,,, .-«.,...-..,,_.,.«.,,,,.,,,,......».,.,-,....,,...,.....,....,.,.,...,..........« 1' Ewing Brothers Funeral Home k 2,125 00 i y S' < _ , < > B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: k: a i Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: s 3,000.00 2, Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00 k 'd2+;guy'��53x�3iwc:vE°r. Claimant Sandy Rhoades Street Address 532 North Bedford Street city Carlisle State PA zip 17013 Relationship of Claimant to Decedent wife r 4. Probate Fees: 223.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. €Howard Hanna Real Estate-appraisal 350.00.x B PP&L Electric 73.64 K s Comcast 76.25 1 o Shipley Oil-furnance and a/c insurance 49 00 t. ;Nationwide-homeowners insurance 45.31 F. 12. Centurylink 40.38 .: TOTAL(Also enter on Line 9 Recapitulation) If more space is needed,use additional sheets of paper of the same size. w SCHEDULE H- continued Funeral Expenses,Administration Costs and Miscellaneous Expenses ESTATE OF FILE NUMBER Randall E. Horner 21-13-00653 13. Borough of Carlisle—school real estate taxes $1,107.39 14. PP&L Electric—final bill $150.28 16. Nationwide—homeowners insurance $45.31 17. Reserve for closing and accounting $500.00 TOTAL(also enter on be 9,Recapitulation) $11,286.06 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Randall E. Horner 21-13-0065 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 --------- ------««-,«----«--«_,.«.-«--.««««-.«-,.-..«,.«------ _.....,........................««.....«......,..., ....-_----------.«.-------------------------_««« ri 1 Unsecured loan no:129287-09-Members 1st FCU(see letter attached to Schedule F) 1,621.37 2. PP&L Electric R 86.93^,: , 3.i 'Comcast 76.34 l; r 4. Fumance and a/c insurance-Shipley Oil x49.00 5. ;Nationwide-homeowners insurance 45.31 6. ;Nationwide-car insurance 59.00'5 7. 'Centurylink 30.80 f 8. `Carlisle Hospital-medical 150.00 9 :Anesthesiologist medical � 136.00 k 10 'Carlisle Hospital-medical 125.00 r , 1 1A Masland Assoc-medical bil 50.00 ---,«.--- ,...---._--«.................... ... .... .««......--_.w....w««.....«.«.«..--.-....-..........,.-...«............ ......,...................«...........«- 1 > r e.: , , Y; s K k' > > 3 t, h , , > > , 7 k w:. > > ! ' z c^::. .... ................... ....«..«,. .......:,««..-.....cwcc..,,...,.,.....«..........,roc:c,.,-_««..««-.«..«............c.-«.,....«.«_«..-._.-:oo c ..«.. ...«, �,.-�.nX�.w�..._,.. ..,-:. 4'. r , ........ ...... .............«..................................... --, .........,...... ... TOTAL(Also enter on Line 10, Recapitulation) $^ 2,429.75 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Randall E. Horner 21-13-0065 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• Sandy K.Rhoades,532 North Bedford Street,Carlisle,PA 17013 common law wife 100% «.........................«,,.«..... ,..,. .....-......._...........,......«..-....-..-..,_..«......,, _..,,...... ,......_,.._,.,,.. .(see supporting documents attached hereto) < 1.......................^..,..,,.......,.,.,,..-.,.«^x •:9S qr�:x.; :;�c;.NY �.�....�„x 7: :.......,.... ..........,".............,..,.,..........................",..,,....^..,.,.................,....,,.„.,,.... ..^..,.._.,...— z..,,.,...._.....,.----- Fi .......-...•.«..,.,-..--«.........-,,.,.,,. ......«...,.,,«..,..«...,..«.................«.-,«...,.- .......,....,..........:....._,.,............,......,....,,..^ F.......:.,:<::..x x...xxxx�M-.::....:_�..,::ix...__:..:x..xX::..:.:.. ..,,......:: ......_..................,.....:,.._..a..,.,..,.....,._..........,.....,.,.,.,.,-,.M.,.,.,...,.,...._.. ,.,._—__,......, --.,,..._......:.,....--_............ _.,.......,..,.M .x .:..r , .....,..... ,,..,._.............,....,..... .................,...,,,,,.........,......,,,..,,..,..:...,.,".... .,..., ,,,,......, «..-«..............«...,.«.,.«„«..,.... .................... ... .. ..... . _.,,, ......,........... ' F F i.......,^..x .....,_..._.....,.,"....,..__....,.,...,....,.,,...,,,,.,,,,,,.,".................."........,.....,,..,.,,.,,.....,,,.._.,.,,.,"........................_..,„i :,,««««..., .,----.......«.,,,.«..,..,,, s F . > • F y i..,,,...,,t ,„.........,..,....................",......,.........,.,.....,,....,..,.......,,.,,.,..,.,,.,,...,....,..,....„...........,,...",..,,,,,,..,,".,...,..._ ..-.,.,,—"..,.,......-...,..,—,-, .._,„,,...5 ."....... .....................,,...,......•...,„....,....,..,.,^.> ,,...,,..,...,,....:............."............,..,.,....,.•., ,....,.......,.«._..-.-.«.,,-„--.....,__-,-..-_ c'�.....:a'..c.:., ...,c.".... ...r«a...«. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: wz ,,,,,,. .CC.,..'::.;. "..,Y.: _:._, ,",. __•---_ «.."-.,�,.....,:��::�"..C:^.C...,tC::".0^.".::.^.:,.:C�::4"���C. , "4:^.: ....:..... ". ...,..,...,.i".C-.:05".:.`^.':::v:'C:^.^..C'.C�� , > , ... .. :::,:.`::.^r`.,".°.::::',";,^..:,::.•.".".::,-.".:•.".'::.:'::::.:::::.':::� .:.::':`�.::..^,."x'.::.:..`.;::.::'.:':.:.:":..�'.:`.:'::^_-.":::.::.".:•.:.:..:::";.:.•::.'.'.•:""::`..«..:.�'"_.-x,^..^n-.w,::.:.,•.^.^'..•:.:,:`:...":�::.^':::::°:- '.x"S':..::-9',:-.x_ x:x:_..:� .n..... -::.x:xx , , k B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 ..........._........_......-....-...............................- ---.....---------.....— ------------------__.........._.._.............._..._...._............._............__._..._.__. x; r , ...<,....,,,,,,,,,,,,,,^,,.... .,.,«..... .,.. ..—"_. — .._. ........,..,.........._ .......... ,"_...---...M........ ,,,._.,__...,,.,,..,_ s:�.....,- -.,,: 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. it t. PROOF OF COMMON LAW MARRIAGE Common law marriages have long been held to be valid under Pennsylvania law. This involves a civil contract between the parties with the capacity so to contract. In this case both parties were unmarried as of the date of the contract of their marriage. To create a common law marriage there must be an exchange with the specific purpose or intent that a legal relationship of husband and wife be created. All that is essential is proof of an agreement to enter into the legal relationship of marriage at the present time. Often this consists only as an oral declaration. Cohabitation and representation are relevant factors to consider in determining whether the parties have entered into a common law marriage. In this case there is a written declaration attached as Exhibit "A"which is a legal contract between the parties declaring themselves to be husband and wife and establishing a common law marriage. This document is not only witnessed it is notarized and dated April 2, 2010. It is submitted that this document alone should satisfy the requirements of a common law marriage in the state of Pennsylvania. Exhibits`B"and"C"are designation of beneficiary forms executed by the decedent Randall E.Horner. On both of these forms,which are dated January 26,2006,actually prior to the previous statement, Mr. Horner names Sandy K. Rhoades as the beneficiary of his civil service retirement insurance and his Thrift Savings Plan designating her as his common law wife. Page 1 of 2 a Exhibits"D"and`B"attached are affidavits;one executed by the common law spouse's son and the other executed by a friend of both of the parties. Both establish that they recognize the parties as common law husband and wife,and also that they held themselves out to their friends in the community as husband and wife and were recognized as husband and wife in their community of their friends. Exhibits"F"and"G"are copies of the 2011 and 2012 US individual income tax returns filed by the parties. Each return indicates that they were married filing jointly. Finally, the parties lived together at the same residence since 2001 as evidenced and acknowledged in Exhibit"A". Page 2 of 2 n. VIS 0- 10 C)-/44 4 s ALL Gls EXHIBIT a NOTARIAL SEAL CAMELA J MARGE*S Notary Public (1 t+ Form approved OMB No.3206-0142 Designation of Beneficiary Civil Service Important: Retirement System" Civil Service Retirement System Read all instructions (� p t° .�'-+r�•A•��,,r+r-�a_•�^-•r .:,�y,-„-�,^s.,.,,r, .,-;,, be or�ou use the orm. f;,,. ,��1,,.3�7�Y)8�3��1.1,.yf}s,.,;{,:+;:•r_.!�.is.s�:� ,its” -:i�� ..�u-. <;t�f 1 _f.,� 1�it t.. j.i� tr•.-•Gn y a ' s�� 'r s.".i' is ,, }v, �.•�,ri; Name(last,�rs4 mid`le) Date of birth(mm/dd/yyyy) Social Security Number Place an'X"in the '' An employee If you are retired,give your claim block that applies Retired or an applicant for retirement number. to you. Former employee eligible for retirement in the future CSA Department or agency in which presently employed(or former department oragency): Department or agency Bureau Division Location(city,state and ZIP code) -/0-1 U I, the person identified above, designate the beneficiary or beneficiaries I direct, unless otherwise indicated below, that if more than one beneficiary named below to receive any lump-sum benefit which may become payable is named,the share of any beneficiary who may predecease me or who may under the Civil Service Retirement System (CSRS) after my death. I be disqualified for any other-reason shall be distributed equally among the understand that this designation of beneficiary will not affect the rights of stated beneficiaries or entirely to the survivor.If none of the beneficiaries are any survivors who may qualify for annuity benefits after my death, canceis alive and eligible to receive payment when a lump sum becomes payable, any previous designation of beneficiary,and remains in effect until I cancel it this designation is void and payment will be made according to the order of in writing'or I receive payment before retirement of all the monies to my precedence set by law. credit in the Civil Service Retirement and Disability Fund. �,r'r•.',"'*'�^�*''"'S'� ''�,.,57,i'^�'•" �.-rp�,.�...�m,m..�,.•.,7y.,.•••,m�i�-rc•-•-^, ..•etc?'} u�r'i• 1, S r- r--• ^i'�-".',.-� .-r-•.•...-_-•,a.-_""r �-•=c^•. '�'* •t'""*;�.+-a Sorrr3afiort CQncernYrgfier�eneic�arres(See'Eararnples nri�tl�e're�erse'o2'art �' T e or rrzi ceariy rY i First name,middle initial,and Address(including ZIP code)of each beneficiary © Relationship Share to be last name of each beneficiary O to you O paid to each beneficiary ` � ; l 761( j f C1 l �5, i% Date of designation(mm/dd/yyyy)p Y 'i nature Shares desig- nated 46 C.� equal . at 1 0�t f o y,, •re s. 0,40:cCs H.5 'fir '. '7u-. r z* -sr:��•. S ic'' '.:.1.F ?�r'' a._ ;,t:mr� •^s••"c-rir•-,"��:.t':' tx'�c'""."r:•, a•'r t .. �h"-'`y:i.'T7.t"'-'_Tp?xt�7 Ci!It}iesSes�j".4 rtrtes 2s t3O ibieo treceryev: in en,t a St beI1;0I8T J :u"'w. '-_euaifTirrt.'Y�fiu 'Y.5 -"_+�w°—e Y,• ,'•Tai'I^�'yNf_ ..]r1��,=%�C.y3. Y SL 11 Vrr '-' 5 5 x w✓^f^�' .+1'. O_.,iF'9S�i '4y Ev? ��Y .w'll We,the undersigned, certify that the person identified in A.above signed in our presence. S, nature of witness Address(including ZIP code) 3, AJI�40�cu; fJr�s� op I ;-76:10 Mg ture f it e Address(including ZIP code) � L-sa,'\ , ^L_0,k O We will pay to the person you designate,even If that person's name or relationship to you changes after you file this designation.For example,suppose you designate your spouse and then you two divorce and you marry someone else.We will pay any lump sum to your former spouse unless you submit another designation to cancel prior designations or to designate who we are to pay. © We will write to the address you provide here to contact the person you designate.However,that person is obligated to get in touch with us after your death to ask us to make payment. Type or print your return address so that we can return a copy for your file. Your designation is not effective until OPM receives and certifies it.Mail both copies of your designation of beneficiary to: 'I, let , ,•err.! �, (+ , •.- =rr=�%��v U.S.Office of Personnel Management FSIG. �j,i��;4 Retirement Operations Center , P.O.Box 45 ���,���iiv�s, s�t)',✓o t`� i1�7�-���� � Boyers, PA 16017-0045 EXHIBIT U.S.Office of Personnel Management 5 CFR 831 Part 2-Duplicate NSN 7540-00-634-4260 2808-109 D r. ** * THRIFT SAVINGS PLAN TSP-3 * * A61 DESIGNATION OF BENEFICIARY * Use this form to designate a beneficiary or beneficiaries to receive your civilian Thrift Savings Plan (TSP) account after your death. Read the instructions on the back to assist you in completing this form. Type or print the information requested. Do not alter this form or the information you enter; if you need to make a correction or change your entries, start over on a new form. If you have a uniformed services TSP account, you will need to make a separate TSP beneficiary designation for that account on Form TSP-U-3. I. INFORMATION 1. Name 'b�/l(�.62. ABOUT YOU Last` First Middle 2. og - - 3. a7 1a 8'/ /q41 4. (7( 7 ) 770 - c?0,5 7 Social Security Number Date of Birth (mm/dd/yyyy) Daytime Phone (Area Code and Number) 5. Address 532 A O/Z-74 6Lf;6MP-1L S' Street address or box number 6. 04-P_4.iS1_E 7. 74- 8. /-10 3 X9/3 City State/Country Zip Code II. Indicate in whole percentages or fractions the share of your TSP account to be paid to each beneficiary. DESIGNATING - 5 .S&J. L/ YOUR 1' Beneficiary Name(Last) (First) (Middle) Share: BENEFICIARIES -5-3_--� 1.4(z�L C)-tom/1 y� S et address or box number City I State/Country Zip Code alb ` 6,572 !�9' 1,R6'1/953 cm -e �.0 r G )'14 . Social Security Number/EIN Date of Birth (mm/dd/yyyy) Relationship 2• Share: Beneficiary Name(Last) (First) (Middle) Street address or box number City State/Country Zip Code Social Security Number/EIN Date.of Birth (mm/dd/yyyy) Relationship 3• Share: Beneficiary Name(Last) (First) (Middle) Street address or box number City State/Country Zip Code Social Security Number/EIN Date of Birth (mrrVdd/yyyy) Relationship U�9' ❑ Check here if additional pages are used. Number of additional pages (See back of form.) III. Sign and date this sectionaYou si gnature must be witnessed in Section IV. YOUR SIGNATURE Participant's Signature7 Date Signed IV. This form is valid only if it is witnessed by two persons. The witnesses must be age 21 or older. (A witness WITNESSES TO cannot be a beneficiary of any portion of this TSP account.) By signing below, the witnesses affirm that the SIGNATURE participant: (a) signed Section III in their presence, or (b) informed them that the signature in Section III is the participant's own signature. // Witness 1�>r 4. �Y� Typed�o`r,P,rinte Name eooftFirst Witnalss "ofSecond EXHIBIT Witness 2 Typed or Printed Name of Second Witness x COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) I, Christopher J. Calaman,being duly sworn according to law does hereby depose and say: 1. That I am an adult individual residing at 118 Hogstown Road, Mechanicsburg, PA 17055; 2. That I am the second of three sons born to Sandy K. Rhoades; 3. That I was a witness to Randy Horner and mother signing and having a document notarized stating that they were in fact common law husband and wife; 4. That I have accepted and considered my mother and Randy Horner as husband and wife for at least the last 14 years; 5. That I have accepted and considered Randy Horner as my step-father and he had acknowledged me and my two brothers as his step-sons. Christ h . Calaman Sworn and subscribed to before me this COMMONWEALTH OF PENNSYLVANIA Notarial Seal day of Ajat, es 2013. Daniel James Morton Jr.,Notary Public Silver Spring Twp.,Cumberland County My CDMM&Jon E)ires March 30,2014 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES r No ubli EXHIBIT a 3 i� �w i. COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) I, Denise Morrison, being duly sworn according to law does hereby depose and say: 1. I am an adult individual and residing at 131 Wheatfield Lane, Shermans Dale,PA 17090; 2. That I have known Randy Horner and Sandy Rhoades for at least 10-12 years; 3. That I was a friend to both of them and not in any way related to them; 4. That I recall a day now many years ago when Randy and Sandy came into the Sportsman's Inn and told everyone present that they were married and considered legally married through paperwork from the government; 5. That I and everyone in the community of our friends considered them to be husband and wife; 6. That Randy and Sandy held themselves out to the public as husband and wife. Denise Morris n Sworn and subscribed to bef re me this _MMMONWEALTH of PENNlt;__ b f Notarial Seal day of 2013. 1 rues=D.Nut N0taFy P015 w I Silver SPrlrys rwP.,`Cumberland Gvungt f c I nay CommW-ion F:plre5 Oct.za,zo14 i Member.P-nns Wnla Gssnrlakion of Notaries Not Public t EXHIBIT Department of the Treasury-Intemal Revenue Service (99) € 1040 U.S.Individual Income Tax Return 2011 OMB No.1545-0074 IRS Use Only-Do not write or staple In this space. For the year Jan.1-Dec.31,2011,or other tax year beginning 2011,ending 20 See separate instructions. Your first name and Initial Last name Your social security number RANDALL E HORNER If a joint return,spouse's first name and initial Last name Spouse's social security no. SANDY K RHOADES Home address(number and street).If you have a P.O.box,see instructions. Apt.no. - Make sure the SSN(s)above 532 NORTH BEDFORD STREET and on line 6c are correct. City,town or post office,state,and ZIP code.If you have a foreign address,also complete spaces below(see Instructions). Presidential Election Campaign CARLISLE PA 17 013 Check here If you,or your spouse if filing jointly,want$3 to go to this fund.Check- Foreign country name Foreign province/county Foreign postal code Ing a box below will not change your tax or refund. You Spouse 1 Single 4 LJ Head of household(with qualifying person). (See instructions.) Filing Status 2 Married filing jointly(even if only one had income) If the qualifying person is a child but not your dependent,enter Check only 3 Married filing separately.Enter spouse's SSN above this child's name here.► one box. and full name here. ► 5 n Qualifying widower)with dependent child Exemptions 6a Yourself. If someone can claim you as a dependent,do not check box 6a ................ Boxes checked on bSpouse ............................................. ................ ............. 6a and 6b 2 If more than c Dependents: (2) Dependent's (3) Dependent's (4ll if child under No.of children relationship to n e9rfogr 1 `�aa"- on 6c who: four depen- (1) First name Last name social security no. you credit see Instr •lived with you 0 dents,see •did not live with you due to divorce instr.and or separation 0 (see mstr.) check Dependents on 6' 0 not entered above here ► 0 d Total number of exemptions claimed Add numbers ............................................................................ on lines above► 2 Income 7 Wages,salaries,tips,etc.Attach Form(s)W-2 7 Attach 8a Taxable interest. Attach Schedule B if required .......................................... 8a Form(s)W-2 here. b Tax-exempt interest. Do not include on line 8a 8b 1 2. Also attach Forms 9a Ordinary dividends. Attach Schedule B if required W-2G and :...... 9a 1099-R if tax b Qualified dividends ......................................I 9b y ' was withheld. 10 Taxable refunds,credits,or offsets of state and local income taxes ........................ 10 11 Alimony received .......................................................................... 11 12 Business income or(loss). Attach Schedule C or C-EZ .................................... 12 If you did not 13 Capital gain or(loss). Attach Schedule D if required. If not required,.check here ► a 13 get a W-2, 14 Other gains or(losses). Attach Form 4797 ................................................ 14 see instructions. 15a IRA distributions ..........15 I b Taxable amount .......... 15b 16a Pensions and annuities ....1164 4 3 ,4 6 4 1 b Taxable amount .......... 16b 40, 846 . 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc. Attach Schedule E .... 17 18 Farm income or(loss). Attach Schedule F ................................................ 18 Enclose,but do 19 Unemployment compensation not attach,any .,...,,,,*.- ........................................ 19 payment. Also, 20a Social security benefits -,I204 8 5 2 . b Taxable amount .......... 20b 426 . please use 21 Other income. List type and amount(see instr.) 21 Form 1040-V. 22 Combine the amounts in the far right column for lines 7 through 21.This is your total incom! 22 41, 272 . "Y`a 23 Educator expenses ........................................ 23 Adjusted 24 Certain business expenses of reservists,performing artists, Gross and fee-basis ov.officials. Attach Form 2106 or 2106-EZ.. 24 "fir 9 Income 25 Health savings account deduction. Attach Form 8889 ...... 25 26 Moving expenses. Attach Form 3903 26 ," 27 Deductible part of self-employment tax.Attach Schedule SE 27 Self-employed q P 29 Self-employed health Insurance deduction 29 30 Penalty withdrawal of tans ........ 28 tY Y 9 ........... 30 31a Alimony paid b Reelpienrs ssN 00, 31 a 32 IRA deduction ........................................ 32W` 4 .ta 33 Student loan interest deduction 33 ;= 34 Tuition and fees.Attach Form 8917 34 IAN 35 Domestic production activities deduction.Attach Form 8903 35 36 Add lines 23 through 35 .................................................................. 36 EXHIBIT 37 Subtract line 36 from line 22. This is your adjusted gross Income IN- 37 b BCA For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate Instructions. US1040$1 o 1040 Odp�71entjifthe Treasury.I ntemal Revenue Service (99) V. n vidual Income Tax Return 120121 OMB No.1545-0074 IRS Use Only-Do notwriteorstapieInthisspace. For the year Jan.I-Dec.31,2012,or other tax year beginning 2012,ending 20 See separate instructions. Your first name and initial Last name If a joint return,spouse's first name and initial Last name Spouse's social security no. SANDY K RHOADES Home address(number and street).If you have a P.O.box,see instructions. Apt.no. Make sure the SSN(s)above 532 NORTH BEDFORD STREET and on line 6c are correct. City,town or post office,state,and ZIP code,If you have a foreign address,also complete spaces below(see Instructions), Presidential Election Campaign CARLISLE PA 17013 Check here if you,or your spouse if filing jointly,want$3 to go to this fund.Check- Foreign country name Foreign provincelcounly Foreign postal code Ing a box below will not change your tax or refund. I I n You n Spouse I Single 4 _J Head of household(with qualifying person). (See instructions.) Filing Status 2 Married filing jointly(even If only one had income) if the qualifying person is a child but not your dependent,enter Check only 3 Married filing separately.Enter spouse's SSN above this child's name here.► one box and full name here. lo- 6 F1 Qualifying widower)with dependent child Exemptions 6a � Yourself. If someone can claim you as a dependent,do not check box 6a ............ Bo:es chocked on bSpouse ................. ............................ .............................. �Z nd 6b 2 If more than c Dependents: (2) Dependent's (3) Dependent's (,4J,Vf1f child unde children relationship to Lin er age 17 quali- on 6c who: four depen- (1) First name Last name social security no. you lying for child ax 0 credit(see instr.) -lived with you -did not live with dents,see you due to divorce or separation 0 instr.and (see mstr.) ependents on so 0 Check not entered above here Do- Q Add numbers d Total number of exemptions claimed ........... ................................................................. on lines above► 2 Income 7 Wages,salaries,tips,etc.Attach Form(s)W-2 7 Attach 8a Taxable interest, Attach Schedule B If required .......................................... 8a -2 here. ..........I 8b b Tax-exempt Interest. Do not include on line 8a Form(s)W Also attach Forms 9a Ordinary dividends. Attach Schedule B if required ........................................ 9a W.2G and 1099-R If tax b Qualified dividends ......................................I 9b - , ,lz- was withheld. 10 Taxable refunds,credits,or offsets of state and local income taxes ........................ 10 11 Alimony received .... ................................................ .................... 11 12 Business income or(loss). Attach Schedule C or C-EZ .................................... 12 If you did not 13 Capital gain or(loss). Attach Schedule D If required. If not required,check here Do- D 13 get a W-2, 14 Other gains or(losses), Attach Form 4797 ................................................ 14 see instructions. 16a IRA distributions ..........16 b Taxable amount ..�....... 16b 16a Pensions and 11 —5,_02_17_, b Taxable amount .......... 16b 42—, 406. 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc. Attach Schedule E .... 17 18 Farm Income or(loss). Attach Schedule F ................................................ 18 Enclose,but do 19 Unemployment compensation ............................................................ 19 - not attach,any payment. Also, 20a Social security benefits J204 17, 6 6 4 b Taxable amount .......... 20b 12, 152 . please use 21 Other income. List type and amount(see instr.) 21 - Form 1040-V. 22 Combine the amounts In the far right column for lines 7 through 21. is Is your total!neon* 22 54, 558 . 23 Educator expenses ......................... .............. 23 4, 4. Adjusted 24 Certain business expenses of reservists,performing artists, Gross and fee-basis gov.officials. Attach Form 2106 or 2106-EZ.. 24 Income 26 Health savings account deduction. Attach Form 8889 ...... 26 26 Moving expenses. Attach Form 3903 ...................... 26 27 Deductible part of self-employment tax,Attach Schedule SE 27 28 Self-employed SEP,SIMPLE,and qualified plans ­1.... 28 29 Self-employed health Insurance deduction ................ 29 30 Penalty on early withdrawal of savings .................... 30 31a Alimony paid Id Recipients SSN 10- 31a 32 IRA deduction . ................................ 12 33 Student loan interest deduction ................ 33 34 34 Tuition and fees.Attach Form 8917 .................. 36 36 Domestic production activities deduction.Attach Form 8903 9 36 Add lines 23 through 35 .................................................................. EXHIBIT 37 Subtract line 36 from line 22. This is your adjusted Income ► 3T BCA For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate Instructions. US1040$1 F b G�