HomeMy WebLinkAbout12-16-13 REV-1500 EX(02-11) 1 1505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania county code Year File Number
Bureau of Individual Taxes °EP°R�Me^TM RsE^vE
Po 80x.280601 INHERITANCE TAX RETURN 21 13 0029
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
12 09 2012 9/17/1939
Decedent's Last Name Suffix Decedent's First Name MI
PEET THERESA A
(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 1 Supplemental Return 3, Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate - 4a.Future Interest Compromise
(date of death after 12-12-82) F 5. Federal Estate Tax Return Required
g Decedent Died Testate T Decetlent Main#arned a Living Trust S. Total Number of Safe Deposit Boxes
(Attach Copy of V i (Attach Copy o rust)
9. Litigation Proceeds Received 10,Spousal PovertV Credit rDate of Death 11.Election to tax under Sec.9113(A)
between 12-31. 1 and f-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL T INFORMATION3HOULD BE�11RECTED TO:
Name - Dayi"me Telephone-Numb m -
JOEL O SECHRIST ESQ 7k77c938 3 96? o
rn n cn u-c Cn
-,- r-- F-+
REGISTERTOF WILLS USE FO-NLY
Cn
7 C? C-3
First Line of Address n j 7i 1 -r
1
568 OLD YORK ROAD
CD c::
Second Line of Address
TI
DATE FILED
City or Post Office State ZIP Code
ETTERS PA 17319
Correspondent's e-mail address: Sechristlaw @gmail.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.Declara eparer other than the personal representative is based on all information of which preparer has any knowled e.
SIGN TURF 05OPERS N RE ONSI E FO IN RETURN / p E
Lonny /
L Gohn Jr t 3 Z Q
ADDRESS
823 Wudermilch Road Hummelstown PA 17036
SIGN U OF PREPAR OTHE REPRESENT NE DA E '\
Joel 0. Sechrist Esq. (J O Z U �3
ADD
8 Old York Road, Etters, PA
Side 1
1505610143 1505610143
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Peet,Theresa Ann 21-13-0029
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 an owledge.
Signature#2 1 117L
Name J e h M Gohn
Addressl 5 Old York Road
Addressl
City, State,Zip Etteni,PA 17319
Date �� I3
J 1505610243
REV-1500 EX
Decedent's Social Security Number
DewdeM's Name: Peet, Theresa Ann
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 151 , 755 . 75
2. Stocks and Bonds(Schedule B)............................................................................. 2. 17 , 498 . 85
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. 86, 613 . 11
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous I(oq-Probate Property
(Schedule G) a Separate Billing Requested............ 7, 163, 460 . 70
8. Total Gross Assets.(total-Lines.l through7)......................_................................. 8. 419, 328 . 41
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 27 , 684 . 36
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. - 13 , 460 . 69
11. Total Deductions(total Lines 9 and 10)................................................................ 11, 41 , 145 . 05
12. Net Value of Estate(Line 8 minus Line 11)... - ....... 12. 378 , 183 . 36
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J).......!.........I....I........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 378 , 183 . 36
TAX COMPUTATION-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.00
15. 0 . 00
16. Amount of Line 14 taxable
0 . 00 16. 0 . 00
at lineal rate X .045
17. Amount of Line 14 taxable
w
at sibling rate x.12 37 ,268 . 25 17. 4 , 472 . 19
18. Amount of Line 14 taxable
at collateral rate X.15' 340 , 915 . 11 1&. 51 , 137 . 27
19. TAX DUE................................................................................................................ 19. 55 , 609. 46
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21-13-0029
Decedent's Complete Address:
DECEDENT'S NAME
Peet, Theresa Ann
STREET ADDRESS
6363 Stephens Crossing
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 55,609.46
2. Credits/Payments
A. Prior Payments 10,000.00
B. Discount 526.32
Total Credits(A +B) (2) 10,526.32
3. Interest (3)
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) 455,083.14
Make Check Pa able 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;or............................................................................................................... ❑ ❑
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.:............. ................... .......................... .............................................. ❑ ❑x
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑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.
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)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-0502 EX+(01-10)
SCHEDULE A
pennsylvall REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
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 properly would be
exchanged between a willing buyer and a willing sailer,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 Pro-rations on sale of real estate 1,755.75
2 Real estate at 6363 Stephens Crossing, Mechanicsburg, PA as sold 150,000.00
TOTAL(Also enter on Line 1, Recapitulation) 151,755.75
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form Software only The Lackner Group, Inc. Form PA-7500 Schedule A(Rev.01-10)
Rev-1503 EX.(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSriVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
All property jointly,oWned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Sun Life Financial 645 shares @$27.131share 17,498.85
TOTAL(Also enter on Line 2, Recapitulation) 17,498.85
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Fonn PA-1500 Schedule B(Rev.6-98)
Rev-15D8 EX+(11-00)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
Include the proceeds of litigation and the date the proceeds were received by the estate.
Jul property jointly-owned with Me right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Aetna Insurance refund 111.82
2 Allstate Insurance refund 17.82
3 Capitol One refund 40.62
4 Comcast refund 42.47
5 Federal income tax refund 4,612.00
6 Members First FCU checking account - 6,425.97
7 Members First FCU investment savings account 43,834.59
8 Members First FCU savings account 16.93
9 Personal property sale gross proceeds 692.50
10 Personal property retained by John Kupres 835.00
11 Personal property retained by Lonny Gohn and Joseph Gohn 940.00
12 MetLife IRA 28,843.39
TOTAL(Also enter on Line 5, Recapitulation) 86,613.11
(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+(99-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Peet,Theresa Ann 21-13-0029
This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REVA 500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %oF DECD'S EXCLUSION TAXABLE
NUMBER THE DA E OF TRANSFER SATTACHTA COPYEOF TIHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Met Life annuity-Zachary Gohn and Nicholas Gohn, 163,460.70 100.000% 0.00 163,460.70
grandnephews,are the beneficiaries
TOTAL(Also enter on Line 7, Recapitulation) 163,460.70
(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
INHERITANCE ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,497.86
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Lonny L Gohn Jr Joseph M Gohn
Street Address 668 Old York Road
City Etters State PA Zlo 17319
Year(s)Commission Paid 12,234.00
2. Attornev's Fees Joel O. Sechrist Esq. 12,234.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
,. Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 718.50
See continuation schedule(s)attached
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs
TOTAL(Also enter on line 9, Recapitulation) 27,684.36
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
Peet,Theresa Ann 21-13-0029
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expense s
1 Codori Memorials 1,114.00
2 Funeral meal 175.65
3 Hoss' Restaurant funeral gathering 390.06
4 Malpezzi Funeral Home 818.15
H-A 2,497.86
Probate Fees
5 Carlisle Sentinel legal advertisements 170.00
6 Cumberland County taw Journal 75.00
7 Register of Wills additional probate fee 50.00
8 Register of Wills fee to file releases 45.00
9 Register of Wills probate fee 353.50
10 Register of Wills short certificates 25.00
H-64 718.50
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
Peet, Theresa Ann 21-13-0029
Report debts incurred by the decedent prior to death that remained unpaid at me date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Allstate Insurance condo insurance 62.21
2 AT&T 51.62
3 AT&T 108.32
4 Bank checks expense 14.25
5 Baron and Associates appraisal 350.00
6 Barry Tolby appraisal 210.00
7 Capitol One Credit Card 39.26
8 Cindy Fenton auction fee for personal property 277.00
9 Comcast 113.56
10 County and Township real estate taxes 409.64
11 Discover Credit Card 642.30
12 Discover Credit Card 469.86
13 Emerald Auction Co. fee for selling real estate 4.500.00
1
14 Hampden Township sewer and trash bill 155.05
15 Hampden Township sewer and trash bill 155.05
16 Hampden Township sewer and trash collection 155.05
17 Lowe's carpet cleaning supplies 45.56
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 10, Recapitulation) 13,460.69
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Foml PA-1500 Schedule I(Rev. 12-08)
ftvA512 EX.(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 MedStar insurance payment 173.15
19 PA American Water Co. 22.39
20 PA American Water Co. 14.21
21 PA American Water Co. 16.09
22 PA American Water Co. 15.15
23 PA American Water Co. 30.48
24 PA American Water Co. 16.46
25 PA American Water Co. 14.31
26 PA state income tax 33.00
27 Pamela Reitenbach, Inc. appraisal 375.00
28 PP&L 98.08
29 PP&L 56.57
30 PPBL 60.98
3'r PP&L 26.13
32 PP&L 21.81
33 PP&L - 20.67
34 PP&L 22.32
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-08) -
Rev-1512 EX+(12-05)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Peet, Theresa Ann 21-13-0029
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
35 PP&L 20.68
36 Real estate settlement expenses 3.281.90
37 Smart Clean carpet cleaning 410.00
38 Stephen's Crossing Homeowners fee 450.00
39 Stephen's Crossing Homeowners fee 300.00
40 Stephen's Crossing Homeowners fee 125.00
41 Turbo Tax 95.38
TOTAL(Also enter on Line 10, Recapitulation) 13,460.69
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
Peet,Theresa Ann 21-13-0029
NUMBER NAME AND ADDRESS OF DECEDENT RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
Do Not List Trtrstee s
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Amy Kupres Bruce Niece personal items
8810 Teresa Ann Court and 117 of
Alexandria,VA 22308 residue
2 Krista Kupres Buckley Niece personal items
400 Riggs Avenue and 117 of
Severna Park, MD 21146 residue
3 Joseph M Gohn Nephew personal items
586 Old York Road and 1/7 of
--Etters, PA 17319 - residue
4 Joan K Gohn Sister personal items
6381 Stephens Crosing
Mechanicsburg, PA 17050
5 Lois J Gohn Niece persona[items
47 Keefer Way
Mechanicsburg, PA 17055
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
- S.CHARITABLE AND-GOVERNMENTAL-DISTRIBUTIONS
TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Theresa Ann Peet 1210912012 207-30-6319
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Lonny L Gohn Jr Nephew personal items and 117
823 Laudermilch Road of residue
Hummelstown, PA 17036
7 Nicholas J Gohn Grand Nephew personal items and 117
47 Keefer Way of residue
Mechanicsburg, PA 17055
-8 Zachary R-Gohn - ..Grand Nephew personal items and 117
47 Keefer Way of residue
Mechanicsburg, PA 17055
9 John M Kupres Jr Brother personal items and 1/7
539 North West Street of residue
York, PA 17404
1
LAST WILL AND `I['IES'ICAM]ENT
OF
THERESA ANN P EIET
I, THERESA ANN PEET, of the Township of Hampden, County of Cumberland,
Commonwealth of Pennsylvania, declare this to be my Last Will and revoke any Will or Codicil
previously made by me.
ITEM 1: Upon my demise, I direct my body be interred in next to my late parents in a
burial plot I own in Conewago Chapel Cemetery,Basilica of the Sacred Heart of Jesus, 30 Basilica Drive,
Hanover, Pennsylvania.
ITEM 2: I direct that all my funeral expenses be paid as soon as practical after my death.
ITEM 3: I direct that all taxes, penalties and interest that may be assessed on property
U j passing under this Will, of whatever nature and by whatever jurisdiction imposed, shall be paid from my
`6 w
z residuary estate as part of the expense of administration of my estate, without apportionment. Any such
Q taxes,penalties and interest imposed on other property passing as a result of my death, but passing outside
W�W
of my probate estate shall be apportioned among and allocated to the beneficiaries of such property and
IT,
shall be paid by each such beneficiary and in no event shall the taxes, penalties and interest owed on
property passing outside of my probate estate be paid from the residue of my probate estate.
Page 1 of 8
ITEM 4: I give, devise and bequeath all the contents of my home and all personal items to
my family members listed below:
A. JOAN K. GOHN of 6381 Stephens Crossing, Mechanicsburg, Pennsylvania,per
capita;
B. LOIS J. GOHN of 47 Keffer Way, Mechanicsburg,Pennsylvania,per capita;
C. JOHN M.KUPRES, JR. of 539 N. West Street,York, Pennsylvania,per capita;
D. LONNY L. GOHN, JR. of 823 Laudermilch Road,Hummelstown, Pennsylvania,
per capita;
E. JOSEPH M. GOHN of 586 Old York Road, Etters,Pennsylvania,per capita;
F. KRISTA KUPRES BUCKLEY of 400 Riggs Avenue, Severna Park, Maryland,
per capita;
G. AMY KUPRES BRUCE of 8810 Teresa Ann Court, Alexandra, Virginia, per
capita;
H. ZACHARY R. GOHN of 47 Keffer Way, Mechanicsburg, Pennsylvania, per
W capita; and
t I. NICHOLAS J. GOHN of 47 Keffer Way, Mechanicsburg, Pennsylvania, per
z
d capita.
d
W If there are items remaining after my family members have concluded their selections, I direct
\ � these remaining items be sold and the proceeds become part of my residual estate.
ITEM 5: I direct my real estate at 6363 Stephens Crossing, Mechanicsburg, Cumberland
County, Pennsylvania, which I own,be sold and the proceeds become part of my residual estate.
Page 2 of 9
ITEM 6: I give, devise and bequeath all the rest, remainder and residue of my estate of
every nature and wherever situate, together with all insurance thereon, in equal shares, among the
following provided that that named beneficiary survives my death by thirty(30) days:
A. To my brother, JOHN M. KUPRES, JR. of 539 N. West Street, York,
Pennsylvania;
B. To. .my nephew, LONNY L. GOHN, JR. of 823 Laudermilch Road,
Hummelstown,Pennsylvania;
C. To my nephew, JOSEPH M. GOHN of 586 Old York Road, Etters,
Pennsylvania;
D. To my niece, KRISTA KUPRES BUCK-LEY of 400 Riggs Avenue, Severna
Park,Maryland;
E. To,my niece, AMY KUPRES BRUCE of 8810 Teresa Ann Court, Alexandra,
Virginia;
F. To my great nephew, ZACHARY R. GOHN of 47 Keffer Way, Mechanicsburg,
w
n Pennsylvania; and
G. To my great nephew, NICHOLAS J. GOHN of 47 Keffer Way, Mechanicsburg,
d
Pennsylvania.
Should any named beneficiary of this ITEM 6 predecease me or fail to survive my death by thirty
(30) days, then I direct that deceased beneficiary's share be divided equally among the remaining living
beneficiaries in this ITEM6.
Page 3 of 9
ITEM 7: My Co-executors shall have the following powers in addition to those given by
law to be exercised by them in their absolute discretion, which powers shall be applicable to all property
held by them, effective without the order of any court and until the actual distribution of all such property:
a. To retain any investments at discretion including stock of any corporate fiduciary
hereunder or of a holding company controlling it;
b. To invest and reinvest in the co-executors' discretion as permitted under Act 28 of 1999,
as amended, the 'Trudent Investor Act," with the specific right to invest in stocks, bonds and real estate,
including non-income producing residential real estate for the occupancy of any present income
beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds,
including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated
corporation or a holding company controlling it, as my co-executors deem appropriate;
C. To sell,to grant options for the sale of, or otherwise convert any real or personal property
or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such
terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments
and transfers thereof without liability of any purchaser to see to the application of the purchase money;
d. To borrow money and to secure the repayment thereof by mortgage of real or personal
F property, pledge of investments or otherwise, without liability on the part of the lenders to see to the
�T W
w application thereof;
e. To compromise claims by or against my estate or any trust created hereunder;
d
f. To allocate and distribute different kinds or disproportionate shares of property or
hundivided interests in property among beneficiaries or trusts,in cash or in kind, or partly in each;
g. To register investments in the name of a nominee or to hold the same unregistered in such
form that they will pass by delivery;
Page 4 of 9
h. To join in any recapitalization, merger, reorganization or voting trust plan affecting
investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and
generally to exercise all rights of security holders;
i. To manage, operate,repair,alter or improve real estate or other property, and to lease real
estate and other property upon such terms and for such period as my co-executors deem advisable even
for more than five(5)years and beyond the duration of any trust;
j. To-deduct administration expenses upon either the federal estate tax return or fiduciary
income tax return with or without adjustment as between principal and income, as my corporate or
disinterested co-executors shall determine;
k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian
and investment advisor,and other agents and to compensate them from principal or income or both,as my
executors shall determine, such compensation to be a reduction of the compensation of my co-executors;
1. To associate with them at any time, in their absolute discretion and of their choice, a
corporate fiduciary which shall have the same powers as my co-executors, such designation by my co-
w executors and acceptance by a corporate fiduciary to be in writing;
w
o,
m. To combine; without prior court approval, any trust herein with any other trust with
substantially similar provisions, although such other trust may have been created by separate instruments
U
and by different persons, and, if necessary to protect different future interests, to value the assets at the
time of such combination and to record the proportionate interest of each separate trust in the combined
fund; provided however, that no such combination shall be permitted if the effect of such combination
would be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or
more of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable;
Page 5 of 9
or(3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the
generation-skipping tax;
n. To exercise any stock options which they may receive; to borrow such funds from any
source as my co-executors may deem necessary for the exercise of such options; and to pledge assets as
my co-executors deem appropriate for this purpose;
o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a
breach of trust, account to any court (and failure to account alone shall not be considered such a breach);
nor shall trustee be required to obtain the order or approval of any court in the exercise of any power or
decision granted hereunder;
P. To allocate any generation-skipping transfer tax exemption from the federal generation-
Skipping transfer tax to any property to which I am deemed the transferor under the provisions of Section
2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred under
my will and any property not in my probate estate and any property transferred by me during life as to
which no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios
applicable to such transfers to be zero;
q. To disclaim any interest in property without court approval; and
F�
zW r. To do all other acts and things necessary or appropriate in the management,
z administration and distribution of my estate or trust.
ITEM 8: In the event any legatee or devisee named in this will dies under such
cG
circumstances that there is not sufficient evidence to determine absolutely whether such legatee or devisee
h
survived me, I direct such legatee or devisee shall be presumed to have predeceased me and devise and
bequeath the gift in favor of that legatee or devisee to such persons and in such manner and in such
Proportions as set forth in this will for distribution if the legatee or devisee predeceased me.
Page 6 of 9
ITEM 9: Until distributed, no gift or beneficial interest shall be subject to anticipation or
voluntary or involuntary alienation.
ITEM 10: I appoint my nephews, LONNY L. GOHN, JR. of 823 Laudemilch Road,
Hummelstown,Pennsylvania and JOSEPH M. GOHN of 586 Old York Road,Etters, Pennsylvania as Co-
Executors of this,my Last Will.
ITEM 11: I direct that my personal representatives shall not be required to give bond for the
faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this day of g6 1/, 2011.
THERESA ANN PEET
Signed, sealed,published and declared by the above-named Testatrix as and for her Last Will and
Testament in our presence, who, at her request, in her presence and in the presence of each other, have
hereunto subscribed our names as attesting witnesses. /
residing at�3�ill��cf i' �K%<�/'a / w�f
( 618� w,
y -�c r';sS�h�.rresiding at NC w
7I5'S
Page 7 of 9
i;.
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )ss:
We, THERESA ANN PEET, �
� ���� and
the Testatrix and the witnesses respectively, 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 purpose 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 or her knowledge, the Testatrix was at the time eighteen (18)years of older, of sound mind
and under no constraint or undue influence.
THERESA A/NN PEET
tness
` W ess
Subscribed, sworn and acknowledged before me f J �j
��F1/"�, � by
THERESA ANN PEET, the Testatrix, and " subscribed and sworn to before me by
fs'/ra .La ri:�rrs f
A, and and / �S�- � r the witnesses, this
3 day of r it 2011.
1
Notary Public SEAL)
COMMONWEALTH OF PENNS VIVANIA
i. NOigRIAL SEAL
Henry F. Coyne, Notary Pu-
blic
Page 8 Of 8 Hampden Tawnship,Cumberland Couni
MY Commiseie.,c...:.__ T
A01M Approved MO ND 2502-a2e5
A. us.UJP�wlmen oP a osvero>mIse B. TYPE OF LOAN
SETTLEMENT STATEMENT 1,: FHA 2, FMHA ,},EICONV.UNITS.
Abstract Land Associates,Inc. - 4, ❑vA 5.❑CONV.INS,
3912 Market Street 6. ESCROW FILE NUMBER: 7. LOAN NUMBER:
01316148-001 MAW
Camp Hill,PA 17011 8. MORTGAGE INSURANCE OASE NUMBER:
(717)763-1450
FINAL
C.NOTE: Thisform Isfurn ishedtOgNeyouastatementofactualsett lenient Coals. Amountspaidtoaadby the settlementagentareshown.
Items marked"Po CJ"were paid outside the Closing,they are shown here for info mselonal purposes and are not included in the totals.
D. NAME OF BORROWER: Jane Hafer Best
ADDRESS OF BORROWER:
E, NAME OF SELLER: Estate of Theresa Ann Peel
ADDRESS OF SELLER:
E NAOE OF LENDER:
ADDRESS OF LENDER:
(T PROPERTY LOCATION: 6363 Stephens Crossing
Mechanicsburg,PA-17050
Cumberland County 10-09-1604-213-U-A2
Unit A-2,of Stephen's Court
H BE BEFILEMENT AGENT: Abstract Land Associates, Inc.
PL6CE OF SETTLEMENT: 3912 Market Street,Camp Hill,PA 17011
1, SEPTLEMENTDATE: 7/19/2013 PRORATION DATE 7/1912013 DISBURSEMENT DATE: 7/191201°.
d SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100.-GROSSAMOUNi DUEFROMBORRMM: '00, GROSS AMOUNT DUE TO SELLER:.
101. `Contract Sales Price 150,000.00 401, Contract Sales Price 150,000.00
102, L Personal Properly 402. Personal Properly
103, Settlement charges to Borrower(line 1400) 3,117.00 403.
too. „ _ 404.
105. .. 405,
ADJUSTMENTS FOR ITEMS PAIL BY SELLER IN ADVANCE: - ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. Clrw Town Taxes 406. Cit frown Taxes
107. County Taxes 07119!13 to 12131113 189,05 407. County Taxes 07119113 to 12131/13 189.05
108. Assessments 408. Assessments
109, School lane 0'x/19113 to 06130114 1,39334 409. School laze 07119113 to 05130114 7 393.34
110. Sewerfrrash 07119/13 to 09130113 124.04 410. SewerfPrash 07/19113 to 09/30/13 "`124.4
111. July HOA DU 07/19113 to 07131113 49.32 411. July HOA DU 07119113 to 07131113 4932
112. 412.
113, 413.
114. 414.
115. 415
120, GROSS AMOUNT DUE FROM BORROWER: 154,872]5 420. GROSS AMOUNT DUE TO SELLER: 151755]5
200.AMOUNTS PAID BY OR IN BEHALF OF BORROWERi'` 500. REOUCTIONSINPMOUNTOUETO SELLER:
201. 5Pdncfpal earnest money 10,000,00 501, Excess deposit(see instructions)
202. mount of new loan(s) 502 Settlement charges to Seller(line 1400) 3,281 90 203. ans)taken'subject to 503 EeWiug loan(s)taken sWjed to 204. 504, Payoffof0rsl mortgage loan 205. : 505 Payoff of second mortgage loan 206. - Los
207. 507.208. " - 508,
z09, SIts,
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210, Cilyfiown Taxes „ 510. Cit Crown Taxes
211. County Taxes 511. County Taxes
212. Assessments 512. Assessments
513
214. - 514.
215. 515. -
216. 516.
217. 517.
218. - 516. _
219. 579.
220. TOTAL PAID BYIFOR BORROWER: 1'0,000.D0 52G TOTAL REDUCTIONS IN AMOUNT DUE SELLER: 3,281.90
300. CASHATSETTLEMENT-,FROMfTOBORROWFR: - 600. CASHATSETTLEMENT TOGROMSELLER:
301.'!Gross amount due from Borrower(line 120) 154,872.75 601. Gross amount tlue to Seller(line 4201 151,755 75
302 L t paid bylf B (line 220) 10 000.06 602. Less reduction in amount due Seller(line 520) 3,28190
303 CASH( Zi FROM) ( 11 TO)BORROWER' 144672.75 503. CASH(k] FROM) I® TO)SELLER: 146,473.85
Exhibit to Schedule A
TT EMENTCHARGE OWF NUMB - 013 001 AW
900, TOTAL S4 LESIBROKER'B COMMISSION: - P.O.C.
BASED ON PRICES 150,000.00 @ %= PAID FROM PAID FROM
BORROWERS FUNDS SELLER'S
DIVISION OF COMMISSION(LINE 700)AS FOLLOWS: ATSETTLEMENT FUNDSAT
701. $ to SETTLEMENT
702. $ to
703. Commission paid at settlement
704.
8110.-ITEMS PAYABLE IN CONNECTION WT H LOAN: - "P.o.e.
801. Loan Origination Fee
802. Loan Discount Fee
803. Appraisal Fee
804. Credit Report
805, Lenders Inspection Fee
806. mortgage Insurance Application Fee
807. Assumption Fee
808.
809.
810.
811.
930.ITEMS REQUIRED BY LENDER LOSE PAID IN ADVANCE: - P.O.C.
901.: Inlerma From le @$/day. % (days)
902.- Mortgage Insurance Premium for Month(.)to
903.. Hazard Insurance Premium for Yeasts)to
9D4.
905. -
1000.REBERYES DEPOSITED WITH LENDER _
1001, Hazard Insurance month,Q 4 pbrui
1002. Mortgage Insurance months @b per monm
1IS3 City Properly Taxes months @3 per monm
1004. County.Property Taxes months Q$ 34.85 per month
1 D05 Annual Assessments months @$ per month
1006, months @$ par monm
1007. months @$ per month
1008, months @$ per month
1100.,TITLE CHARGES: - P.O.C. -
110E Settlement or closing fee
1102 Abstract or title search
III The examination
1104: Title insurance binder
1105, Document preparation
1106 Notary fees to Settlement Olfcer - 10.00 ` 2200
1107" Attorney's Fees
Ilndutles above items numbers
: )
1108 Title Insurance to Abstract Land Associates,Inc. 1.15000
lincwdes above items numbers; )
1109. Lenders coverage $
1110. Owner's coverage $ 150,000.00
1111. Overnight Fee to Abstract Land Associates,Inc. 15.00
1112. Tax Cerl to Abstract Land Associates,Inc. 1001)
1113
12W:GOVERNMENT RECORDING AND TRANSFER CHARGES: - P.O.C.".
1201, Recording Fees: Deed$ 67.00 Mod,age$ Release$ 67.00
1202' City/County City/County lost[amps Deed$ 1,500.00 Molt age$ 1,500_00
1203. Slate laxlsern s Deed$ 1,500.00 Mod a e$ 1,600,00
1204.
1205
1300. ADDBIONALSETTLEMENTCHARGES: - P.O.C. "
1301` Survey ,
1302- Pest Inspection
1303 SawerRrash 711113-9130113 to Hampden Twp.Sewer A Wholly 155.05
1304. July HOA Dues to Stephens Crossing 125.00
1305. August HOA Dues to Stephens Grossing HOA 125.00
1306' Initiation Fee to Stephens Crossing HOA- 25000
1307. 2013114 School taxes to Michael Langan 1,469.85
1400: TOTAL SETTLEMENTgHARGES(Enter on line 103,Section J-and-Iine5026eclion K) 3,117,00 3x281.90
I have.parefully had ewes the HU0.1 SeWemenl5tatement antl to the bell of mY knowledge and belief,it is a true and sadists butt men/of all receipts and dlsbur annish s made oh mY
account or by me In thi l ansacion. I further certify that l have received a coW of the HUDA Settlement Strome I.
E ale ores In e -
1`/ti
Jane Hafer BeM ,l Lanny L. n F e 1,I
Borrowers Joseph M. ohq E ecutor `-slims
The HNI11 Settlement Statement which I have prepared is a true and accurate account of this tmnsadelf I hake mused or sell cause the funds lobe disbursed in accordance v;llh this
slalemenL _ 1
SsWemenl ABent - I�' f I' _Date
Abstract Land Associates,Inc.
WARNING. 11Is a crimeto lmowngly make false statements to 0e United States on Nis many slotlarfmm.Penalties upon marshiness Include sure and imprimnment For Eelails
see: Title 18 U.S.Code Section 1001 and Se pion 1010. "
St
MEMBERS V
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 306512-00
D-ate Account Established 05/22/2007
Principal Balance at Date of Death $16.93
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $16.93
Interest Earned from 01/01/2012—1 i/30/2012 $.00
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/Suffix 306512-11
D-ate Account Established 05/22/2007
Principal Balance at Date of Death $6,425.83
Accrued Interest to Date of Death $.14
Total Principal and Accrued Interest $6,425.97
Interest Earned from 01101/2012—11/30/2012 $4.24
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 306512-05
D-ate Account Established 05/22/2007
Principal Balance at Date of Death $43,830.75
Accrued Interest to Date of Death $3.84
Total Principal and Accrued Interest $43,834.59
Interest Earned from 01101/2012—11/30/2012 $143.06
Name of Joint Owner None
EMBERS REDIT UNION
Danielle A. Kline
Lending Insurance Support Specialist
February 5,2013
Exhibit to Schedule E
Estate of:THERESA ANN PEET
Date of Death: 1210912012
Social Security Number: 207-30-6319
5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • v7wwmembers1st.org
S
,etropolitan Life Insurance Company @,
.P.O.Box 10342 -
Des Moines IA50306-0342
July 8, 2013
ESTATE OF THERESA A PEET Copy to:
823 LAUDERMILCH RD METLIFE FINANCIAL
HUMMELSTOWN PA 17036 SHANNON SHUPP
101 ERFORD RD STE 200
CAMP HILL PA 17011
RE: METROPOLITAN LIFE INSURANCE COMPANY CONTRACT 550296488
DECEASED THERESA ANN PEET
Dear Executors:
We processed a lump-sum distribution-representing the proceeds payable to you under the above-referenced
annuity.We are sending a check in the amount of$25,941.68 to you under separate cover.
The taxable portion of your proceeds is$28,824.09. Due to your request for withholding,$2,882.41 was
withheld for federal taxes. An IRS Form 1099-R will be mailed to you by January 31,2014.
The Internal Revenue Service requires we furnish the date of death value for Individual Retirement
Annuities(1RAj on which a death claim has been filed in case this value is needed for income tax
purposes. 1n most cases, the executortadministrator of the decedent's estate will not need the date of
death fair market value for income tax purposes. The date of death valuation will only be necessary for
income tax purposes if one or more of the decedent's IRAs contain nondeductible contributions and, in
addition, the decedent received an IRA distribution in the year of death.
This is to inform you that the value of the IRA contract as of the date of death, December 9, 2012, was
$28,843.39.
If you have any questions, please contact your representative or call our Customer Service Center at
800-638-7732(Client Lihe)Monday-through Friday between 9:00 a.m.and 6:00 p.m., ET.
Sincerely,
Crystal Barr, FLMI, ACS
Sr. Annuity Representative-Post Issue Processing
MetLife Annuity Operations and Services
Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the
annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address,
phone number,date of birth,and social security or tax identification number. Changes may be submitted to the address provided
above,by calling our Customer Service Center at the phone number provided above,or by contacting your Representative.
Exhibit to Schedule E
' - rage i ui e
F F'
Metropolitan Life Insurance Company Preference Plus Select B Class
P.O. Box 10342 Overnight Address: Quarterly Statement
Des Moines,IA 50306-0342 4700 Westown Parkway,Suite 200 October 01, 2012- December 31, 2012
O 1 (800) 638-7732 West Des Moines,IA 50266-0266
www.metlife.com
Advisor Name(s):
'SHANNON SHUPP
(717)724-9700
THERESA A PEET
_ 6363 STEPHENS CROSSING
° MECHANICSBURG PA 17050-2347
general Contrat:t 1n#or'
matfon,
-x..... ,-_.e ✓_.s ,a.,_._n :....._ -,_ .-.E._._ at,.��4,,,..m.2".� . ,._� ,� w_o.°"u .__._a:.«.�.u:._ .t'.,�. a., ,. rr..... .{,s,`_,�...,at. ..
Contract Number ' --- — 1 550190665 Total Purchase Payments Since Issue -
Issue Date - -:02!06/2006 - . ` ' $149,762.85 -
Account Type(Tax Market) - Non-Qualified Total Withdrawals Since Issue
Owner(s) EET $14,645.36
Annuitant(s) THERESA A PEET
luarterly�ACCOUnt�tlnln1af17 j 7 ` x a ' � # 5 !' t- uyr t i
October 01, 2012 Opening Account Value 11) $163,067.73 =
Purchase Payments $0.00
Gross Withdrawals - $0.00 ` ' -
�Gain or(Loss) 10/01/2012- 12/3112012 121 _ $392.97
.December 31, 2012 Account Value .131 $163,460.70 -
0
0
� I h
enefltsbV6N1eW
eath Benefit Features
aath Benefit Value m $163,460.70
ecerrat er'8�K'2012 a'fu-6-Alioca#ions
and Name �- -• - #of Umtst4) Fund Balance Allocation%
nerican Funds Global Small Capitalization Fund 292.45 $8,325.82 5.6% Percentages may not equal 100%as they
3ckRock Bond Income Portfolio(Class B) 266.51 $16,329.70 10.0% are rounded to the nearest percent-
ackRock Large Cap Value Portfolio(Class B) 1,923.48 $24,399.45 150% 10.0%
3ckRock Legacy Large Cap Growth Portfolio(8) 751.85 $24,668.60 15.0%
rd Abbett Bond Debenture Portfolio(Class B) 302.15 $8,244.54 5.0% 30.0% ;
MCO Total Return Portfolio(Class B) 893.39 $16,332.22 10.0% � ':•' -
astern Asset Management U.S.Government Port(B) 2,589.95 $48,767.35 - 30.0% 10.0% m- 5.0% 15.0%
°stem Asset Mgmt Strategic Bond Opportunities 546.32 $16,393.02 10.0%
Exhibit to Schedule G
ty
uarterly"Financial Transai tton 5tammary ;
.,T.._
ansaction Date 1331 Transaction Description 1361 Transaction Amount
1/06/2012 Automatic Rebalancing Transfer _ $1,304.66
414197--Q121P-073-1613