Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
12-23-13 (2)
1 J REV-1500 EX(D2-1 150561D143 11) y OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county Code Year File Number Bureau of Individual Taxes DEP"RTWNTOP Re'EN°E PO BOx.280601 INHERITANCE TAX RETURN 21 13 0293 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 02 13 2013 11 21 1925 Decedent's Last Name Suffix Decedent's First Name MI MUSSELMAN JO ANN (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 12-13-82) Limited Estate 4a Future Interest Compromise 5. Federal Estate Tax Return Required 4. ❑ ❑ (data of death after 12-12-82) 6 Decedent Died Testate T Decedent t Maintained finea Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wil) ( Copy C Trust) 9. Litigation Proceeds Received ❑ 10.Spousal troy� endit(D%of Death 11.Electiion to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 1� EDMUND G MYERS g717) T61 514 0 O M m r 7 EtsI�JER OF /VILg U?�E ONLY x rn First Line of Address _; C) 7: 301 MARKET STREET ;? Second Line of Address — c7 PO BOX 109 —I r > r- m D� City or Post Office State ZIP Code RATE FIL� LEMOYNE PA 17043 Correspondent's e-mail address: epm(Mclsw com 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. NATURE OF PERSON RESPONSIBLE FOR FILING RETURN ' QA7E Brian C Musselman RESS 1915 Lincoln Street Camp Hill PA 11 SIGNgZRE OF PREPER OTHER THAN REPRESENTATIVE DATE Edmund G. Myers ADDRESS 301 MARKET STREET Lemoyne PA L 1505610143 Side 1 1505610143 �(� 1505610243 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 170 , 000 . 00 2. Stocks and Bonds(Schedule B).........................................................................,. 2. 547 , 404 . 06 3. 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. 51 , 524 . 32 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property (Schedule G) a Separate Billing Requested..,......... 7, 621 , 665 . 15 8. Total Gross Assets(total Lines 1 through 7)....................... .... 8, 1 , 390 , 593 . 53 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 45 , 234 . 18 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)............................ 10. 110 , 265 . 54 11. Total Deductions(total Lines 9 and 10),..,......... ...................... —....I................... 11. 155 , 499 . 72 12, Net Value of Estate(Line 8 minus Line 11).......................................................... 12, 1 , 235 , 093 . 81 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)......................I....1.1..1....I......... 14. 1 , 235 , 093 . 81 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 at lineal rate X .045 1 , 235 , 093 . 81 ts. 55 , 579 . 22 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 55 , 579 . 22 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0293 Decedent's Complete Address: DECEDENT'S NAME Musselman,Jo Ann STREETADDRESS 1954 Chestnust Street CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 55,579.22 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 168.63 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 55,747.85 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;..._._....................... ._............................................ ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;....... ........... ❑x 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?.................................................................................................................... 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 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. ... ... ,..r.... . ... ... . _ ..... 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 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)3. • 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. Jo Ann Musselman #Days to Add Amt on which interest based 55,579.22 for Holiday Filing Deadline Decedent Date of Death Wed,Feb 13,2013 O Wed,Nov 13,2013-1 9 Months After DOD Wed, Nov 13,2013 Final Payment Date Fri, Dec 20, 2013 Suggested Interest 168.63 Daily Interest Amount PrincipalTaxDue r 55,579,22 Year Rate #Days for Year Credits 0.00 1990 .000301 Interest 168.63 1991 .000301 Tax Due 55,747.85 1992 .000247 1993 .000192 1994 .000192 1995 .000247 1996 .000247 1997 .000247 1998 .000247 1999 .000192 2000 .000219 2001 .000247 2002 .000164 2003 .000137 2004 .000110 2005 .000137 2006 .000192 2007 .000219 2008 .000192 2009 .000137 2010 .000110 2011 .000062 2012 .000082 2013 .000082 37 168.627353 2014 Suggested Interest 168.627353 Note: does not include interest for dates before 1990, Rev-1502 ERi(01-10) SCHEDULE A pennsylval REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman Jo Ann 21-13-0293 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 decedent's interest If owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate- 1954 Chestnut Street,Camp Hill, Cumberland County,PA-Contracted Sales 170,000.00 Price. Real Estate sold on October 18,2013. A copy of the HUD-1 Settlement Sheet is Attached TOTAL(Also enter on Line 1, Recapitulation) 170,000.00 (1f 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) d Rev-1503 E%r(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman, Jo Ann 21-13-0293 All property jointly-owned with right of survivorship must bedisclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 MML Investment Services Brokerage Account No. BMA 543,904.79 -495140 -Date of Death Value of Account. Date of death account statement is attached to this Return 2 744320102 61 shares of Prudential Financial Inc-Com.Valued using 57.365 3,499.27 EstateVal.A copy is attached to this Return TOTAL(Also enter on Line 2, Recapitulation) 547,404.06 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-1508 l(11.10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman Jo Ann 21-13-0293 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash 959.41 2 M&T Checking Account No. 10642420 43,134.41 3 2002 Nissan Maxima-Sales Price 4,024.40 4 Personal Property -Sold at Auction by Cordier Auctions &Appraisals. A copy of the listing 517.50 of multi-item auction is attached 5 CitiMortgage/CitiBank Mortgage Account No.0008414005-2-Escrow Refund 803.72 6 Real Estate-1954 Chestnut Street, Camp Hill, Cumberland County,PA- 2,084.88 Reimbursements/Refund for County and School real estate taxes; Homeowners Association Fees and Sewer. A copy of the HUD-1 Settlement Sheet is attached TOTAL(Also enter on Line 5, Recapitulation) 51,524.32 (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) Rev-1510 EX.(08-09) SCHEDULE G pennsylval INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman Jo Ann 21-13-0293 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three ofthe REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECDS EXCLUSION TAXABLE NUMBER INCLUDE AE OF TRANSFERSA TAckA THEIR RELATIONSHIP THHE DEED FOR ESTATE. VALUE OF ASSET INTEREST (�F APPLICABLE) VALUE 1 American Funds IRA Account No. 64495516- 40,168.76 40.168.76 Beneficiaries: Brian C. Musselman,San- Lesley Jo Vereen, Daughter and Dave C. Musselman,Son 2 Mass Mutual Annuity Contract No. RE501072170 03 - 459,653.51 459,653.51 Beneficiaries: Brian C. Musselman -Son- Lesley Jo Vereen -Daughter-Dane C. Musselman-Son 3 Mass Mutual Annuity Contract No. SPA8510552- 17,079.98 17,079.98 Beneficiaries: Brian C. Musselman -Son- Lesley Jo Vereen-Daughter- Dane C. Musselman -Son 4 Mass Mutual Financial Group -Annuity Contract No. 104,762.90 104,762.90 EXP9000633; Beneficiary-Brian C. Musselman TOTAL(Also enter on Line 7, Recapitulation) 621,665.15 (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) REV-1511 Ex-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman Jo Ann 21-13-0293 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 16,213.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees JOHNSON DUFFIE 15,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 603.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 250.00 7. Other Administrative Costs 13,167.10 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 45,234.18 Copyright(c)2009 form software only The Lackner Group. Inc. Form PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Musselman, Jo Ann 21-13-0293 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Bricker House-Funeral Reception 952.43 2 Musselman Funeral Home-Funeral Expenses 15,261.15 H-A 16,213.58 Other Administrative Costs 3 1-800 Got-Junk-Removal of Miscellaneous Personal Items from Residence 228.00 4 AT&T 519.39 5 Barb Musselman-Reimbursement for estate expenses and preparing real estate to be sold 200.00 6 Brian C. Musselman -Reimbursement for Estate Administrative Expenses 683.50 7 Camp Hill Sewer&Refuse 498.89 8 Christian Companion --Medical expenses 100.41 9 Comcast 144.86 10 Cordier Auctions -Commission for sale of personal property 169.13 11 Donegal Insurance 161.00 12 Expenses to Prepare Real Estate for Sale 317.94 13 F.M. Berkheimer-Furnace/Heat Pump Repair 899.05 14 F.M. Berkheimer-Heating and Air Conditioning to Furnace 7,285.00 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 Musselman, Jo Ann 21-13-0293 ITEM NUMBER DESCRIPTION AMOUNT 15 PMI Property Management--Resale Certificate 150.00 16 PP&L-Utility 29.26 17 Repairs to Automobile 1,056.93 18 Reserves: Additional Miscellaneous Estate Expenses 500.00 19 The Cumberland Law Journal - Notice of Estate Administration 75.00 20 The Patriot News Company-Notice of Estate Administration 148.74 H-B7 13.167.10 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX.(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Musselman Jo Ann 21-13-0293 Report debts Incurred by the decadent prior to death that remained unpaid at the date of death,including unraimbursed medical asperses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Camp Hill Fire Co. -Ambulance Care 200.00 2 Check Clearing After Date of Death 218.00 3 CitiMortgage/CitiBank Mortgage Account No.0008414005.2 -Principal Balance on Account 98,013.07 4 C iti Mortgage/Citi Bank Mortgage Account No. 0008414005-2-Escrow Shortage Amount 48.81 5 Conforti-- Medical Services 164.17 6 Holy Spirit Hospital 15.33 7 Jan Miller, Tax Collector-Municipal Tax 6.50 8 Life Alert 300.00 9 M&T Credit Card Account 500.00 10 Penn Credit-Payment of Delinquent County/Per Capita Taxes 30.00 11 PMI Property Management-Homeowner's Association Fees 3,604.81 12 Ray Grandon -- Insurance Services 19.85 13 Real Estate-1954 Chestnut Street,Camp Hill, Cumberland County,PA -Settlement Charges. 7,145.00 A copy of the HUD-1 Settlement Sheet is attached. TOTAL(Also enter on Line 10, Recapitulation) 110,265.54 (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 Musselman,Jo Ann 21-13-0293 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSONS)RECEIVING PROPERTY oDECEDEN as (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Brian C Musselman Son 1/3rd of Tangible 1915 Lincoln Street Personal Camp Hill, PA 17011 Property; 1/3rd of Residue 2 Dane C Musselman Son 1/3rd of Tangible 585 Fairview Drive Personal Paducah, KY 42001 Property; 113rd of Residue 3 Lesley Jo Vereen Son 1/3rd of Tangible 12956 Eagle Run Personal Omaha, NE 68164 Property; 1/3rd of Residue Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) J ESTATE OF JO ANN MUSSELMAN SCHEDULE OF EXHIBITS EXHIBITA Last Will and Testament for Jo Ann Musselman signed and dated August 2, 2001 EXHIBIT B Request for Extension on Filing PA Inheritance Tax Return dated November 12, 2013 EXHIBIT C HUD-1 Settlement Sheet for sale of Real Estate located at 1954 Chestnut Street, Camp Hill, PA 17011. Property sold on October 18, 2013 EXHIBIT D UFinancial Group — Date of Death Letter for Decedent's MAIL Investment Services Brokerage Account No. BMA 495140 EXHIBIT E Estate Val Valuation on Prudential Stock EXHIBIT F M&T Bank Date of Death Letter on Decedent's Checking Account No. 10642420 EXHIBIT G Cordier Auction & Appraisals listing of Multi-Auction Items on July 27, 2013 EXHIBIT H UFinancial Group — Date of Death Letter for Decedent's American Funds IRA Account No. 64495516 Beneficiaries were decedent's 3 children EXHIBIT I UFinancial Group — Date of Death Letter for Decedent's Mass Mutual Annuities -Account No. RE50107217-0 and SPA8510552. Beneficiaries were decedent's 3 children EXHIBIT J Mass Mutual Financial Group Date of Death Letter for Annuity Contract No. EXP9000633 Brian C. Musselman was named beneficiary :597643 005104-00002/07.24.01/EGM/KLT/130321.3 loot ME aub TEotament OF JO ANN MUSSELMAN I, JO ANN MUSSELMAN, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II I give and bequeath my motor vehicles, household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto those of my children, BRIAN C. MUSSELMAN, DANE C. MUSSELMAN, and LESLEY JO VEREEN, who survive me, to be divided among them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. ARTICLE III I give and bequeath the sum of ONE HUNDRED THIRTY FIVE THOUSAND ($135,000.00) DOLLARS unto my daughter, LESLEY JO VEREEN, provided that should she predecease me, I give and bequeath the same unto her then-living issue per stirpes. I� EXHIBIT A 005104-00002/07.24.01/EGM/t{LT/130321.3 ARTICLE IV I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate unto my children, BRIAN C. MUSSELMAN, DANE C. MUSSLEMAN, and LESLEY JO VEREEN, in equal shares, the then-living issue of any of said beneficiaries who predeceases me to receive the share of the deceased beneficiary per stirpes. ARTICLE V In the event that any beneficiary of my Will shall not have reached the age of twenty five (25) years at the time of my death, I give, devise and bequeath such beneficiary's share unto ALLFIRST TRUST COMPANY OF PENNSYLVANIA,NA, and in separate TRUST to hold, manage, invest and reinvest the share(s) so received, and the accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee's discretion, may be necessary or appropriate for such beneficiary's support and education (including college education, both graduate and undergraduate, and vocational training) without regard to his or her ability to provide for such support or education or to make payment for these purposes without further responsibility, to such beneficiary or to any person taking care of such beneficiary. After the beneficiary shall attain the age of twenty one (21) years the Trustee shall pay and distribute to him or to her the net income of such Trust periodically, but not less frequently than quarterly. When such beneficiary shall attain the age of twenty five (25) years, Trustee shall distribute the then remaining principal and any income accumulated thereon on to such beneficiary absolutely, and the Trust as to that beneficiary shall terminate. In the event any beneficiary dies before receiving his or her final distribution hereunder, the Trust as to that beneficiary shall terminate and the balance of principal and any net undistributed income shall be paid over to such beneficiary's personal representative. 2 005 1 04-0 00 02/07.24.01/EGM/KLT/130321.3 ARTICLE VI During the time any portion of my Estate remains in Trust, the same shall not be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt thereof. The Trustee shall pay over income and principal as herembefore determined to the parties designated, as their interest may appear, without regard to any attempted anticipation, pledge or assignment by any beneficiary, and without regard to any claims thereto or attempted levy, attachment, seizure or other process, shall be authorized by law or specific order of any Court having jurisdiction, Trustee shall not be liable to any beneficiary for violation hereof by reason of the same. ARTICLE VII If at any time during the continuance of any Trust created hereunder, the Trustee in its sole and absolute discretion determines that the size of any individual Trust account has become so small as to be impractical to continue to hold in Trust and uneconomical to continue to administer as a Trust, then in such circumstances, the Trustee may without further authorization distribute the balance of the principal and income in such Trust account to the beneficiary then- entitled to the income therefrom, and upon such distribution the Trustee shall be released from further obligation with respect to that account and shall not be subject to any claim from any person who may have had a future interest in such Trust account had it been continued in Trust. ARTICLE VIII I name, constitute and appoint my son, BRIAN C. MUSSLEMAN, Executor of this my Last Will and Testament. Should my son, BRIAN C. MUSSELAIAN, fail to qualify or cease to so act, I name, constitute and appoint my daughter, LESLEY JO VEREEN, Alternate Executrix 3 0 05 1 04-0 0 002/07.24.01/EGM/KLT/13 0321.3 to complete the administration of my estate. I direct that neither shall be required to post bond for the faithful administration of the duties required in any jurisdiction. ARTICLE IX In addition to the powers granted by law, my Executor(s) and Trustee shall have the following discretionary powers, applicable to principal and income, which shall be exercisable without leave of court and shall continue until distribution is actually made: A. To accept and retain any or all property, including stock or other securities of the Trustee or of a holding company controlling the Trustee; B. To buy investments at a premium or discount; C. To give proxies, both ministerial and discretionary; D. To compromise claims; E. To join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders, and to delegate discretionary duties with respect thereto; F. To sell, to exchange, to improve, or to lease for any period of time, any real or personal property; and to give options for sales, exchanges, or leases; G. To allocate any property received or charge incurred to principal or income or partly to each,without being obliged to apply the usual rules of trust accounting. 4 005104-00002/07.24.01 BGM/KLT/130321.3 H. To distribute in cash or in kind or partly in each. ARTICLE X I direct that all estate, inheritance, legacy, succession or transfer taxes (including any interest and penalties thereon) imposed by the laws of any state or the federal government now or hereafter enforced with respect to all property taxable under such laws by reason of my death, whether such taxes be payable by my estate or by any recipient of such property, shall be paid by my Personal Representative out of my residuary Estate as part of the expense of administration thereof, without apportionment and with no right to reimbursement from any recipient of any such property. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this,my Last Will and Testament,this �?k day of� k 12001. (SEAL) J' ANN MUSSEL MAN Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament,in the presence of us,who at her request,in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 5 005104-00602/07.24'.01/EGM/KLT/]30321.3 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND We, JO ANN MUSSELMAN, and 'N"K,a � -`V , the Testatrix and the witnesses, resp ctively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. OJO ANN MtJSSELMAN id'm '%� Witness Widiess Subscribed, sworn to and acknowledged before me by JO ANN MUSSLEMAN, Testatrix, and subscribed and sworn to before me by and witnesses,this Q n1 aday of 2001. Notary Public 6 NOTARIAL SEAL DIANNE LENIG, Notary Public Lemoyne Borough Cumberland Co. My Commission Expires Dec.21,2001 JERRY R.DUFFLE ( BARRIE B.GEHRLEIN RICHARD W STEWART ANTHONY T.LUCIDO EDMUND G.MYERS L A W O F F I C E S CAROLYN B.MCCLAIN DAVID A.S AFFER J O7 7 A 7("�OA 7 JOHN A.Lucy SON C.DUFFLE JOHN A.STATLER �`v'J Il\vl ULYSSES S.WILSON JEFFREY B. RETTIG JULIA A.MORRISON JOHN R.NINOSKY DUFFIE MATTHEW RIDLEY MICHAEL.J. CASSIDY OF COUNSEL MELISSA P.GREEVY HORACE A.JOHNSON WADE D.MANLEY C.ROY WEIDNER,JR. November 12, 2013 VIA EMAIL RA-InheritanceTaxExt@state.pa.us Department of Revenue Bureau of Individual Taxes Inheritance Tax Division P.O. Box 280601 Harrisburg, PA 17128-0601 RE: Estate of Jo Ann Musselman Date of Death: February 13, 2013 Cumberland Co. File No. 21-13-2-13 Our File No. 5104-2 Ladies and Gentlemen: This firm represents Brian C. Musselman, Executor of the Will of Jo Ann Musselman. Ms. Musselman died February 13, 2013. The inheritance tax return is due to be filed on November 13, 2013. The Executor is completing information necessary for the Return. We request a 6 month extension to file the Inheritance Tax Return. We thank you in advance. Very truly yours, JOHNSON, DUFFIE, STEWART& WEIDNER Edmund G. Myers c: Brian C. Musselman,Executor EGM:dlw:591349 301 MARKET STREET P.O.BOX 109 LEMOYP 4 WWWJDSWCOM 717.761.4540 FAX: 717.1 EXHIBIT B JOHNSON, DUFFIE, STEWARD—,.. .,- o.ixux.n° OMB Approval No.25020265 t a�IG�� ? A. Settlement Statement(HUD-1) B. Type of Loan 1.[]FHA 2.Q RHS 3.(@ Cone Unlns. 6. FR.Number: 7. Loan Number: 8. Mortgage Insurance Case Number 4.Q VA S.C]Con,Ins. 07-100.004 1367377 C. Note: 7tvs tom+is furnishedbgiva youa statement of actual seitl amen{gas{s, pmouMa pektto antl hytlre settlement agent are shown. Items marked"(p.a a)"were paid outside the closing,they ere shown here for Informalkenel purposes and are not included in the Wells D. Name and Address of Borrower E. Nameand Addreasof Seller: F. Name and Address of Lender: Dome H.Bish and Estate of won C.Mumdman PENNSYLVANIA STATE EMPLOYEES Jeanette Danis Bish CREDIT UNION 1654 Chestnut Street 1 CREDIT UNION PLACE Camp Hill,PA 17011 HARRISBURG,PA 17110-209D G. Propenyt-otamm: H.SatAemermAgerir I. Settlement Date: 1954 Chestnut Btroad MkistateAbstract Company Camp Hill,PA 17011 2331 Markel Street October 18,2013 Cumberland County,Pennsylvania Camp Hill,PA 17011 Ph. (717)763.1383 ' PWce of Settlement. 23$1 Market Street Camp HU,PA 17011 J. Summary of Borrowers transaction K. Summary of Seller's transaction 100. Gross Amount Due from Berrower 400, Groas Amount Due to Seller: _ 101. Contract sales price 17000600 401. COrmrWsalesp W.,__prl �' 170.000.00 102. Femoral property 402 Pers�gei ro err __ 103. Settlement Chances to Borrower line 1400 6,437.65 403. 104. _� 404. .� 1D5. 405. Ad�pstments or items paid by Balfe(In advance Adjustments foritams sold by Sailer In advance t08. C4 frown Those to 406.Ci G-=,Tarns to 107. County Tams 10118/13 to 01101114 194.90 407.County Taxes iGN11113 to 0IMI114 194.90 108. School tame 10116113 to 07/01114 1,574.82 408.School taxes 10/78/13 to Wf01/14 1,5]4.82 109. HOADues 10118/13 to 11/01)13 180.65 409.HOA Due$10/18/13 to 11101/13 i8G.65 110. 4th Qt,Sewer 10/18/1310 01101/14 134.51 410,4th Lrd.Sewer 1011&13[p Ot/01Ii4 13 .51 711. 411. 112. 412. 120. Gross Amount Due from Borrower 176.522.53 420.Gross Amount Due to Seller 172,084.88 200. Amounts Paid by or In Behalf of Borrower 000. Reductions In Amount Due Seller: _ 201. Deposit oraarnest men 1 501. Emess deposit see instructions 202. principal anwurd of near loan 5 136,M 00 502. SattkmanF rime ee to Se6ar One 1400 2,045.00 203. Exists bar 5 taken sub" ol to 503. Eemkrof ban s taken sowed to 204. Lender Credit For Fees 37722 504.PsyoRFlrsl Mortga9eto CIUMwtgage,lnc/000841 98,613.07 205. 505.Payoff Second Morl a e 21)6. 506. 207. 507. 208. 50B. 209. Seller Assist 5,100.00 509.Seller ASSlst 5 100.00 Ad ustments for Items unpaid by Seller Ad ustmenta for Items unpaid by Seller 210. Cit Crown Texas to 510. Cil rrown Tams to 211. County Taxes l0 511. County Taxes to _ 212. Sdooitwore b 512.Sdwei taxes to 213. 1 513, 214, 514. rr 215. 515. 216, 516, 217, 517. 218, 518.Esaow irlheseroe Taxes to Midstme Abstract ESV 4,860.0 219, 519. 220. Total Paid b /for Borrower 141,477.22 520.Total product Ion Am a unt Due Seller 110,018.7 100. Casty at Settlement tremolo Borrower 600. Cash at settlement folfrorn Sailer 301. Grass amount due from earrowar t2G 178,522.53 601. Gross ameult due to Buyer hinve 420 T]2.G64.88 302, less amount paid b/for Borrower Ill 220 ( 141,47722) 602. Less reductions due your line 520 ( ' 11GpiB07 303, Cash 0 From ❑ To Bonowor 37,045.31 603. Cash ❑X To From Seller 62,066.81 Thad The underalagrr eel •wwele).aAhe(5i.�oiEa(4,a mrarelrlT) haeatsy aa:wwiad9a recegt at a oompieted copy o(U's statamerA 8 any attadtments rataned W herein Borrower SeBar Esteteof JOann C.MU55olntan Curia H. BY Jeanette Davis am iMPGieRWaa4&ntlq+N 0zcEheNndkL 4'ttte6mumGmpNgH9SmYetm:mts{vee!v AiaG -�••"• �„_.,e..-.�. MtldM1tuYRfiie>fiq;9Weaih+84eH8wYCOnds.NaweCatiergla eiNIXtalaeacipfoaif�rtWN[ay_]k3a � ��-v.�.-.d tl 1168. Page 1 of 3 EXHIBIT C L.Settlement Charges 700.Total Real Estate Broker Fees DMSOn of oommksSon Nhe]00 as follows: Pad From Patl Fran ( ) Bwmwers senors to Fads FUds al 702. to SaltlemerM1 Settlement 703.Commladon paid at settlement 704. 705. 000.Items Pa able In Connection with Loan 801.Our or' oration dinar e $ 550.00 from GFE#1 802.Your credit or charge(points)(or the spedfic merest rate diosen $ (rpm GFE#2 803.Your ac lusted origination dinar es from GFE#A 55000 :- 804.Appreleal fee to PEN NSYLUANIA STATE EMPLOYEES CRED from GFE#3) 349.05 :-5',I' 805.Credit Report to CBC InroAs ham GFE il3 21.17 806.Tax N. to from GFE#3 807.Flood certification to LPS National Flood from GFE#3 7.00 808. (from GFE#3 809. from GFE#3 810. hom GFE#3 811. (from GFE#3) 900.Items Required by Lenderto Be Paid in Advance 901.Daily Interest shares from 10/18/13 to 11101/13 14 $13.972600/da from GFE#10 195.62 .::. 902,Mortgage Insurance premium for months to from GFE#3 903.Homeowner's tneurance for era to from GFE#11 904. from GFE#11 905. from GFE#11) 1000.Reserves Deposited with Lender 1001.Inillal deposit far your escrow aaount from GFE#9) 1,330.81 Y, T. Homeowners Insurance months U $ per month $ 1003.Mod a einsurance months r more 1004.Property taxes $ 1,646.91 Count Taxes 9,000 months 79.04 per month School taxes 5.000 months 187.11 par month 1005. 1006. months $ per month 10117, months 0 $ per month $ 1008, E 1009.Aggregate E3ao Adjustment $ -316.10 1100.Title Charges 1101. Title seMces and lender's lice Insurance (hum GFE#4 1,445.00 30.00 1102, Sehame t or dosinq fee 1103. Owner's title Insurance to Midslale Abstract Company wrance ACd. (from GFE#53 170.00 1104. Lenders title lnsuranoe to Midstme Abstract Company Insurance Acd. 1280.00 1105. Lender's title M11W limit 136000.00 TO& Owner's title g2Lq imit $ 170000.00 1107. a is croon of the total the Insurance premium to Mdstete Abstract Company 130000 1108. Underwriter's portion of the total title Phslrance premium to Mdstate Abstract Company Insurance ACC. $ 15000 1109. S 1110. E 1111. $ 1112. $ 1113. $ 1200.Government Record Ing and Transfer Charges 1201.G.,emment,.coming charges to Cumberland CourityReourder of Daeds from GFE#] 169.00 1202.Deed 68.00 mortgage $ 101.00 Releases Other $ 1203,Transfer tales to Cumberland County Remrder of Deeds from GFE#13) 1700,00 ' 1204.City/County City/County tax/stamps Deed 1,700.00 Mortgage 1205.Slate taw'siam s Deed $ 1,700.00 Mortgage$ 1,700.00 1206. 1207. 1300.Additional Settlement Charges 1301.Required servloss that you mn shop for from GFE#6) 1302. $ 1303.4th Qtr,Serer to Camp Hill Borough Aar.1994-0 165.00 1304. Initiation Fee HOA to Chestnut Court Condo.ASaop $ 500.00 1305.Resale Ced. to PMI $ 150.00 1400,Total Settlement Charges(enter on lines 103,$action J and 502,Section K) 6,437.65 2,045.00 vaaomrmadmiry W exiwxle).caialst,iaavly.v aeawMiT) eysielNMP h auxeewianae,n:euaeurimeww.aexpiaagda cangH�uVi a 0^3ar a 9auciu.mwweabnaa. Midstate Abstad Company,Settlement Agent Certified to be a true copy. Page 2 of 3 HUD-1 (BISH CURTIS.PFD/07-100.004/12) Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our originator charge # 601 550.00 550.00 Your adjusted orginateen olarges # 803 550.00 550.00 Transfer taxes #1203 3,400.00 1,700.00 Charges That in Total Cannot Increase More than 10% 'Good Faith Estimate HUD-1 Government recording charges #1201 430.00 169.00 Appraisal fee # 804 349.05 349.05 Credit report If 805 21.17 21.17 Food certification # 807 7.00 7.00 Total 807.22 546.22 Increase between GFE and HUD-1 Charges s .261.00 or -$2.33% Charges That Can Change Good Faith Estimate HUD-1 WWI depost for your escrow account #1001 2,71670 1,330.61 Daily Interest charges # 901 $ 13.972600/day 237.53 195.52 Homeowner's insurance # 903 300:00 0.00 Title services and lender's title Insurance 41101 1,805.00 1.445.00 Owner's title Insurano to Waists,Abstract Company Insurance Ac #1103 170.00 170.00 Loan Terms Your Initial loan amount Is $136.000.00 Your loan term is 15.00 years Your Imillet Interest rate is 3,7600% Your Initial monthly amount owed for principal,Interest and $989.02 Includes any mortgage Insurance to Q Principal Q Interest ❑ Mortgage Insurance Co.your Interest rate rise? - ❑X No ❑ Yes,it can rise to a maximum of %. The first change witi be on__and can change again every_months after . Every change date,your Interest rate can increase or decrease by__%. Over the life of the(can,your interest rate is guaranteed to never be lower than %or higher than %. Even if you make payments on time,can your loan balance Aso? ❑X No ❑ Yes,it can rise to a maumum of$ Even If you make payments on lime,can your monthly ❑Q No ❑ Yes,the first Increase can be onand the monthly amount owed for principal,interest,and mortgage Insurance Has? amount owed can rise to$ The maximum It can ever Had to is$ Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty is$ Does your loan have a balloon payment? ❑X 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. ❑X You have an additional monthly escrow payment of$266.15 that results in a total Initial monthly amount owed of$1,255.17. This Includes principal,Interest,any mortgage Insurance and any items checked below: [g) Property taxes ❑ Homeowner's insurance [] Food Insurance ❑ ❑ ❑ Note: It you have any questions about the Settlement Charges and Loan Terms Ilsted on this form,please contact your fender Page 3 of 3 HUD-1 (BISH.CURT IS.PFO/07-100.004/12) HUD-1 Attachment Borrower(s):Curtis H. Bish and Jeanette Davis Bish Selle(s): Estate of Joann C.Musselman 1954 Chestnut Street Camp Hill, PA 17011 Lender:PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Settlement Agent:Midslate Abstract Company (717)71 Place of Settlement:2331 Market Street Camp Hill,PA 17011 Settlement Date:October 18,2013 Property Location:1954 Chestnut Street Camp Hill,PA 17011 Cumberland County, Pennsylvania Additional Adjustments For Items Paid By Seller In Advance(Borrower Debit) Description Amount From/Through Prorated Amount HOADues 400.00 10101113 through 10/31/13 180.65 Total Line 1091409 180.65 4th Qtr. Sewer 165.00 10/01/13 through 12/31/13 134.51 Total Line 110/410 134.51 Adjustments For Items Unpaid By Seller(Seller Debit) Descriptlon Amount Fmmfrhrough Prorated Amount Seller Loan Payoff Details Payoff First Mortgage to CitiMortgage,Inc. Re:0008414005 Loan Payoff 98,013.07 As of 10/01/13 Total Additional Interest 17 days @ Per Diem Total Loan Payoff 98,013.07 Adjusted Origination Charge Details Origination Charge Origination charge 550.00 to PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Total $ 550,00 Origination Credit/Charge(points)for the specific Interest rate chosen Total $ Adjusted Origination Charges $ 550.00 Reserves Deposited with Lender County Taxes 711.36 9.000 at 79.04 per month School taxes 935.55 5.000 at 187.11 per month Aggregate Escrow Adjustment -316.10 Total $ 1,330.81 WARNING: It Is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can inolude a fine and Imprisonment. For details see:Title 18 U.S.Coda Section 1001 and Section 1010. (BISH.CURTI$.PFI)/07-100.004/12) HUD-1 Attachment- Continued Title Services and Lender's Title Insurance Details BORROWER SELLER Closing Service Letter 75.00 to Midstate Abstract Company Electronic Doc,Preparation 50.00 to Midstate Abstract Company Wire Fee 15.00 to Midstate Abstract Company Notary Fee 10.00 5.00 to Midstate Abstract Company Overnight Fees 15.00 15.00 to Midstate Abstract Company Tax Cent. 10.00 to Janet Miller Lender's title Insurance 1,280.00 to Midstate Abstract Company Insurance Acct Total $ 1,445.00 $ 30.00 Owner's Title insurance BORROWER SELLER Owner's Policy Premium 170.00 to Midstate Abstract Company Insurance Acct. Total $ 170.00 $ 0.00 Lender's Title Insurance BORROWER SELLER `feesalso shown above In Title Services and Lendoes Title Insurance Details Lender's Policy Premium 1,080.00 to Midstate Abstract Company Insurance Acct. Lender's Endorsement Charges 200.00 Endorsement Endorsement Charge ALTA Endorsement Form 4.1 (Condominium) 50.00 ALTA Endorsement Form 8.1 100 300 150.00 Total $ 1,280.00 $ 0.00 WARNING: It Is a crime to knowingly make false statements to the United Slates on this or any similar form. Penalties upon conviction can Include a fine and Imprisonment. For details$ee:Title 18 U.S.Code Section 1001 and Section 1010. DISH.CURTIS.PFD107400.004/121 FINANCIAL GROUP Brian R. Logan, MBA, AAMS 5001 Louise Drive nr+newaw.wainc-ixwaance-iervrs�Mems.zxce esv Director of Investments and Financial Planning Suite 300 Mechanicsburg, PA 17055 Tel: 717.7913300 www.uFinancialGroup.com Fax: 717-790.9151 800.278.8053 blogan@financiaiguide.com October 11,2013 Johnson, Duffie, Stewart&Weidner 301 Market Street—P.O. Box 109 Lemoyne, PA 17043-0109 . RE:Jo Ann Musselman MML/NFS Brokerage Individual Non-qualified Account#BMA495140 To Whom it May Concern, As of the date of Jo Ann Musselman's death,February 13,2013, her Non-qualified individual Brokerage account held through MML Investor Services, account# BMA495140, had a total market value of $543,904.83. Sincerely, Jeremy Boehm Assistant to Brian R.Logan EXHIBIT D Brian R.Logan is a registered principal of and offers se and financial planning services through A4rbfL lnvestorsi CA Insurance License#OF$aszu MIN I M 'Estate Valuation Date of Death: 02/13/2013 Estate of: Jo Ann Musselman Estate Valuation Date: 02/13/2013 Account: 5104-2 Processing Date: 11/12/2013 Report Type: Date of Death Number of Securities: 1 File ID: musselman Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 61 PRUDENTIAL FINL INC (744320102) COM New York Stock Exchange 02/13/2013 57.66000 57.07000 H/L 57.365000 3,999.27 Total Value: $3,499.21 Total Accrual: $0.00 Total: $3,499.27 Page 1 This report was produced with EstateVal, a product of Estate Valuation. - please contact EVP Systems at (818) 313-6300 or www� �• EXHIBIT E 1 © M&TBank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 September 30,2013 . Law Offices John Duffie 301 Market Street P.O. Box 109 Lemoyne,PA 17043-0109 Re: Estate of Jo Ann Musselman Social Security: 182-22-7533 Date of Death: February 13, 2013 Dear Sir or Madam: Per your inquiry on September 23, 2013,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 10642420 Ownership(Names of) Brian C Musselman(POA) Jo Ann Musselman Opening Date 1212911994 Balance on Date of Death $43,134.35 Accruedlnterest $ .06 - .. .._._....._.------...-_........ ..........---------------.......-- --- Total $43,134.41 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the West Shore Plana at 717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement. Sincerely, RECEIVED — - _.nrzn_i,,)ni - Valarie Mercer Adjustment Services EXHIBIT F Consignor Settlement Cordier Auctions &Appraisals 1500 Paxton Street CO#: 7040 Harrisburg, PA 17104 Date: 7/27/2013 Phone: 717-731-8662 Fax: 717-731-9830 Page: 1 Consignor: 2979 Estate of JoAnn Musselman c/o Br1an Musselman 1915 Lincoln Street Camp Hill, PA 17011 Phone:717-329-371 0(Barb) uction: Multi-Estate Auction 7/27/13 Lot# Description Unit Price EXt.Pdco Comm7BuyBack Expenses 4 BL--4 PC ART 5.00 5.00 -1.75 0.00 Bid Card#144 -------------- ---------------------------------------------------------- °-------------------------- 9 BL-WHITE WICKER CHAIR 2.50 2.50 -0.88 0.00 Bid Card#157 ------------------------------------ - ...- ----- ------- -------------------------------------------------------------- - ---------------- ------ - 37 BL-LGLQTARTWORKISERVINGTRAY 15.00 15.00 -5.25 0.00 Bid Card#153 ------------------------------------------------------------------------------- - --------------------- ----------..... ------------------------ - ° --- - ---------- 33 BL-CHINESE RUG ROOM SIZE 25.00 .-25.00 -8.75 0:00 Bid Card#163 225 2 ANTIQUE FASHION PRINTS 20.00 20.00 -7.00 0.00 ---- ..._ - -= ------ -----Bitl-Card-#175 --- ?58 2 BRASS CANDLE STICKS 40.00 40.00 14.00 0.00 Bid Card#117 -------------- ------------------ -- ------------- ------- -------------------------- - - --------------------------- .... -------------- - - !60 BRASS CANDLEABRA 40.00 40.00 -14.00 0.00 Bid Card#117 ------------- ------------------------------------------------------------------------------------------- ------------------------------------------------------- !62 ANTIQUE CANDLE STANDS-PAIR OF 2 70.00 70.00 -24.50 0.00 Bid Card#172 ----------------- ----------- -- - - - - - ----------------- --- -- ----------------------------------------------- ------------------------ -- - 165 MIX LOT, 5.00 5.00 -1.75 0.00 - Bid Card#143 --------------------------------- ------- ---------------------- ----- -------------------------------------------:---------------------- 67 MARBLE BOOKENDS, MUSICBOX,BASKET 5.00 5.00 -1.75 0.00 SET Bid Card#135 - ------------------ -------L--------------------------- - 69 MUSICBOX 120.00 120.00 -30.00 0.00 Bid Card#172 - ----------------------------------------------------------- ------ - -------------------- --------------------------------------------- ---------------- 70 FIGURAL LAMP 5.00 5.00 -1.75 0.00 Bid Card#144 --------- ------------------------------------------------------------------------------------------------- ----------------------------------------------------------- 73 TRAY LOT,LENNOX,WEDGEWOOD 5.00 5.00 1.75 0.00 Bid Card#175 - ------------------------------------ - -- --------------------------- 77 TRAY LOT,ART GLASS,MUSIC BOX MORE 5.00 5.00 -1.75 0.00 Bid Card#143 - --------------------------- -----. .I—--------- --- - - --- ----------------------------- ------------------------- 30 TRAY LOT,GLASSWARE,CAKE PLATE 5.00 5.00 -1.75 0.00 Bid Card#147 ---------------------------- ------------------------ - ------- -------------- --------------------- ------------------------- --------------------- 12 2 FASHION PRINTS 10.00 10.00 -3.50 0.00 - - -- - -° ^ard#175 13 MIXED TRAY LOT,FIGURINES MORE EXHIBIT G 0.00 - - laid#127 Consignor Settlement Cordier Auctions &Appraisals CO#: 7040 1500 Paxton Street Harrisburg, PA 17104 Date;- 7/2712013 Phone: 717-731-8662 Fax: 717-731-9830 Page: 2 Lot# Description Unit Price EXt.PrIce Comm/BuyBack Expenses 287 GLASS VASE, RUBY BOWL 15.00 15.00 -5.25 0.00 Bid Card#109 ----------------------------------------------------------------- -------------------------------------------------- -------------------------------------- 289 DELFT PLANTER 20.00 20.00 -7.00 0.00 Bid Card#140 290 2 TABLE LAMPS 5.00 5.00 -1.75 0.00 Bid Card#117 292- 17 PIECE WEDGEWOOD TEA AND COFFEE - - 30.00 30.00 -10.50 0.00 SET Bid Card#140 ----------------------=--------------- --------------------------------------------------------------°------------------------------------ ---------- ------------- 295 2 PORC PIECES, FIGURINES 15.00 15.00 -5.25 0.00 Bid Card#172 ----------------------------------------------------,-----------------------------------•-------------------------------------------------------------------------- 344 HERITAGE FRENCH STYLE END TABLE 15.00 15.00 5.25 0.00 Bid Card#185 ------------------------ --------------'-------------------------------------------------- -------- ----------------------------------_----------- ------ ------------ 380 FOOTSTOOL- 5.00 5.00 1.75 0.00 Bid Card#139 ------ -------------------------------------------- --------------------------------------------------------------------------------------------------------------- 423 PR VICTORIAN UPHOLSTERED SEAT CHAIRS 10.00 ' 10.00 3.50 0.00 Bid Card#101 ---------------------------------------------------------------- ------------ --------------------------__--_--------------------- --------- - -- -- - - --5�0--5.60- 1-7r,----x.00- -- B - id Card#124 ----------------------- --------------------------------------- ----------------------------------------------------------- --------------------- 435 NIGHTSTAND 5.00 5.00 -1.75 0.00 ------------------------------------- -- --=--------- ----------------------------------------B--id--C-a-r-d-#---1-3--2-- --- 167 LUGGAGE RACK 5.00 5.00 -1.75 0.00 Bid Card#186 °- - ------------ ------------------------------------------ --------------------------------------------------------------------------------- - ----------------- 983 VICTORIAN NEEDLEPOINT CHAIR 5.00 5.00 -1.75 0.00 Bid Card#117 Total Quantity: 29.00 Total Invoice Sale Price: 517.50 Total Commission '( 169.13) Total Due to C'onsigno?: 348.37 Total Payments: 0.00 Balance: $348,37 Positive Balance, Monies Owed to Consignor COMMISSION SETTINGS Calculate Commission By: Each Commission Structure Type: Sliding Scale Up to $100 35% $100.01 - $1,000 25% $1,000.01 - $10,000 20% over $10,000 15% NO+�1,�,uiYrzi3�7'i nF?�:�1. �i�"�,.-Ttr_`+�7�1 i c- i•••fi�Sci-.+ m O o � OK O 1 M0 T om = 0 a�Na O n OS D (AN m o �ti>O 5 ma- -1 4 m 3 warn-$. _v :3 Yn Q a�T Ofk Rim O 77 m � ° Y a 3 w N W ♦i r k . V RI tlM a s w m ui 'r r tL w ti n • � n (gam �IW Z m `"7i-W Hi l _ � co co co N CJ O O v W O r s. � w T� o .�. FINANCIAL GROUP Brian R: Logari,`MBA,`AAMS 5 of Y'Ise Drive" FINANCIAL Director of Investments and Financial Planning Suite 300' Mechanicsburg, PA 17055 Tel: 717-791-3300 www.uF!nancialGroup.com Fax: 717-790-9151 800-278.8053 bloga n @f 1n a nci alg u id e.com October 11,2013 Johnson, Duffie,Stewart&Weidner 301 Market Street—P.O. Box 109 Lemoyne, PA 17043-0109 RE:Jo Ann Musselman American Funds IRA Account#64495516 To Whom It May Concern, As of the date of Jo Ann Musselman's death,February 13,2013,the account value of her American Funds IRA account#64495516 was as follows: Fund Cusi # Market Value Income Fund of America 453320103 $13,329.61 Capital Income Builder 140193103 $14,221.52 Capital World Growth&Income 140543109 $12,617.43 Total Market Value: $40,168.76 Sincerely, X---- Jeremy Boehm Assistant to Brian R. Logan EXHIBIT H Brian R.Logan is a registered principal of and offers set and financial planning services through MML Investors CA Insurance License#0F84928 ------ FINANCIAL GROUP Brian R. Logan, MBA, ARMS 5001 Louisa Drive U Director of Investments and Financial Planning Suite 300 Mechanicsburg, PA 17055 r Tel: 717-781.3300 www.uFlnancialGroup.com Fax: 717-790-9151 800.278-8053 blogan@7financialguide.com October 11,2013 Johnson, Duffle,Stewart&Weidner 301 Market Street—P.O. Box 109 Lemoyne, PA 17043-0109 RE:Jo Ann Musselman Single Premium Annuities contract#RE50107217-0 and SPA8510552 To Whom it May Concern, Jo Ann Musselman held two Mass Mutual Annuity contracts with Life Installment Refund features.As of the date her death, February 13, 2013: - Contract#RES0107217-0 had paid approximately$46;547.93 of the original$506,201.44 premium, leaving$459,653.51 to be paid out to the beneficiaries. - Contract#SPA8510552 had paid approximately$99,167.20 out of the original 116,247.18 premium, leaving$17,079.98 to be paid out to the beneficiaries. S' cerely, Jeremy Boehm Assistant to Brian R. Logan Brian R.Logan is a ragistareci ptincipai otandofle s i EXH781 t I and financial planning services through MML Investor, j CA Insurance License#Of., ___ �� Massachusetts Mutual Life Insurance Company and aff hates Springfield MA 01111-000 1 wvW riassmututtl can ire MassMutual May 13, 2013 `F210`"` BRIAN C MUSSELMAN 1915 LINCOLN ST CAMP HILL PA 17011 Dear Mr. Musselman: Re: Contract No(s). HXP9000633;Annuitant-Joann Musselman; Issuing Company-CM Life Insurance Co (referred to herein as"MassMutual") Enclosed please find a check,representing your full settlement for the above referenced contract. Transaction Date: May 13, 2013 Valuation Date: May 8, 2013 Total of Proceeds: $104,762.90 Contract Interest* $52.38 Federal Income Tax Withheld $16,428.87 Total Amount Payable $88,386.41 . *Interest calculated at 3% from the valuation date to May 14, 2413. If you have any questions,please contact your claim examiner Karen.Borawski at(800) 272- 2216 ext. 21960 or contact me directly at ext. 48858. Sincerely, z"Im Laura Ritchie Operations Support Analyst USIG Policyholders Services and Claims Enclosure: 1 cc: Pat McEvoy (037) 02013 Massachusetts Mutual Life hisurance Company,Springfield,MA 01111-0001.All rights reserved.w winassmutual.com.MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insuranoe Company tMassMutuall mid its aftliated companies and sales representatives. —` EXHIBIT J 3