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12-10-13 (2)
1505610143 REV-1500 EX(t3t•i8) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County code Year File Number Bureau of Individual Taxes oEN ATMENTOFaEVENUE PO 60x.280601 INHERITANCE TAX RETURN 21 13 0351 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number I Date of Death Date of Birth 03 16 2013 08 271924 Decedent's,Last'Name Suffix Decedent's First Name MI SAUERWINE GRACE M (if Applicable)Enter:Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1, Original Return 2, Supplemental Return 3, Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate F 4a Future Interest Compromise 5, Federal Estate Fax Return Required (date of death after 12-12-82) 0 6 Decedent Died Testate 7. �gO°gdoM oNne rust)a Living Trust g- Total Number of Safe Deposit Boxes (Attach Copy of Will) 9. Litigation Proceeds Received 10.b8=.,I I l 3i tai a diti{Da�S�f Death r� 11 Election to tax under Sec.9113(A) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nulnher DIANE G RADCLIFF (71'P 737 11100;� n r REGIS -n �R:'kVLLScME O%N;,, 4o D r F--.+ M f`f'l First line of address > C � 3448 TRINDLE ROAD okra Second line of address CJ -rt ►--� "� "l7 Ln G!9 City or post Office State ZIP Code DATE FILED CAMP HILL PA 17011 Correspondent's e-mail address: dianeradcliff(W_corrlcast.net 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,correc d complete.Declaration of preparer other than the personal representative is based on alf information of which preparer has any knowledge. SIGNATU F P SON RESPONSIBLE F FIL ETURN DATE Patricia A Hess ADDIR124S 1704 Fairmont Drive Mechanicsburg, PA 17055 TURE OF PREPARE R RESENTATIVE DATE Diane G RAdcliff _/2i L7 /-7 QDR 8 Tr' )e Road, Camp,Hi11, PA Side 1 1505610143 1505610143 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 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. Signature#2 _, Name Joseph M Hess Address1 1704 Fairmont Drive Address2 City, State,Zip 17055 Date 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Sauerwine, Grace M RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 203 ,203 . 71 2. Stocks and Bonds(Schedule B)............................................................................. 2. 2 , 391 . 88 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. 68 , 647 . 23 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous N Probate Property (Schedule G) Separate Billing Requested............ 7. 266, 879. 73 8, Total Gross Assets(total Lines 1 through 7)........................................................ 8. 541 , 122 . 55 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 43,334 . 40 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 4 , 557 . 24 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 47 , 891 . 64 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 493 ,230 . 91 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 493 ,230 . 91 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 493 ,230 . 91 16. 22 , 195 . 39 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 22 , 195 . 39 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ 4 Side 2 1505610243 1505610243 REV-1510 EX Page 3 File Number 21-13-0351 Decedent's Complete Address: DECEDENT'S NAME Sauerwine, Grace M STREET ADDRESS 2037 Liberty Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 22,195.39 2. Credits/Payments A. Prior Payments 21,806.56 B. Discount 1,109.77 Total Credits(A +B) (2) 22,916.33 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 720.94 Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "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;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which containsa 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 172 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(01-10) SCHEDULE A Pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 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 coov of the settlement sheet if the orODertv has been sold Include a coov of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate-Sale-2037 Liberty Drive 203,203.71 Mechanicsburg, PA 17055 Net Proceeds-See Settlement Sheet TOTAL(Also enter on Line 1, Recapitulation) 203,203.71 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1503 EX+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 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 65 shares of Met Life Stock 36.7981538 2,391.88 TOTAL(Also enter on Line 2, Recapitulation) 2,391.88 (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 EX+(11.10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 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 Benefits Payment 256.13 2 Benefits Payment 344.45 3 Cumberland County Veteran Allotment 100.00 4 M&T Bank-Savings Account 2,003.22 5 M&T Bank-Checking Account 12,033.23 6 Transamerica Life Insurance Annuity-Cashed in prior to DOD; deposited after DOD 47,708.12 7 Automobile-2001 Buick LeSabre 3,000.00 8 Personal Property-Sale 100.00 9 Personal Property-Sale 350.00 10 Personal Property-Sale 350.00 11 Personal Property-Sale 315.00 12 Personal Property-Sale 455.00 13 Personal Property-Sale 400.00 14 Personal Property-Sale 200.00 15 Personal Property-Sale 500.00 16 Comcast-Refund 108.44 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 5, Recapitulation) 68,647.23 (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-1508 EX+ill.10) SCHEDULE E U pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17 Donegal Insurance-Refund 135.00 18 Donegal Insurance-Refund 14.00 19 PA Department of Revenue 250.00 20 Verizon 24.64 TOTAL(Also enter on Line 5, Recapitulation) 68,647.23 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 m pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. A COPY OF THE DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Mass Mutual Annuity 214,941.36 214,941.36 2 Transamerica Life Insurance Annuity 51,938.37 51,938.37 TOTAL(Also enter on Line 7, Recapitulation) 266,879.73 (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 TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Sauerwine, Grace M 21-13-0351 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 9,425.34 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Patricia A Hess Joseph M. Hess Street Address 1704 Fairmont Drive City Mechanicsburg State PA zio 17055 Year(s)Commission Paid 2014 25,000.00 2. Attorney's Fees Diane G Radcliff 2,292.50 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 433.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 6,183.06 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 43,334.40 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 Sauerwine, Grace M 21-13-0351 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Garden Bouquet-Funeral Flowers 234.26 2 Musselman Funeral Home-Obituary and Death Certificates 202.00 3 Musselman Funeral Home 7,995.00 4 Patricia Hess-Funeral Luncheon 249.08 5 Rolling Green Cemetery-Grave Marker Upgrade 395.00 6 Trinity Evangelical Lutheran Church-Funeral-Luncheon 200.00 7 Trinity Evangelical Lutheran Church-Funeral -Pastoral Fee 150.00 H-A 9,425.34 Other Administrative Costs 8 AAA-Vehicle Transfer 96.00 9 Betty Slagel -Caregiver fee 200.00 10 Camp Hill Forest Products-Mulch for Home in preparation of sale 91.16 11 Commonwealth of Pennsylvania-Title Transfer Fee-Automobile 58.50 12 Hess Garage-Auto inspection and maintenance 49.26 13 Hess Garage-Maintenance of Vehicle 365.73 14 PPL-Electric 43.94 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 Sauerwine, Grace M 21-13-0351 ITEM NUMBER DESCRIPTION AMOUNT 15 PPL 34.39 16 Reserve for additional tax,attorneys fees and tax preparation 5,000.00 17 UGI 74.47 18 UGI 30.31 19 UGI 6.58 20 United Water 11.32 21 United Water 17.41 22 United Water-Final Bill 4.53 23 Verizon 49.71 24 Verizon 49.75 H-B7 6,183.06 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-7572 EX+(12-08) SCHEDULE 1 Pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF F21-13-0351 ILE NUMBER Sauerwine, Grace M Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Betty Slagel (Care Giver Fee #2391) 500.00 2 Camp Hill Emergency Physicians 33.31 3 Camp Hill Emergency Physicians 28.31 4 Comcast 76.37 5 County/Twp. Real Estate Tax(#2386) 839.31 6 Holy Spirit Hospital 11.62 7 Holy Spirit Hospital 774.38 8 Holy Spirit Hospital 92.84 9 Holy Spirit Hospital 13.92 10 Internists of Central PA 304.66 11 Internists of Central PA 74.84 12 M&T Bank Visa(#2390) 381.49 13 M&T Visa 165.46 14 Pennsylvania Gastroenterology Consultants 110.73 15 Pennsylvania Gastroenterology Consultants 11.87 16 Pennsylvania Gastroenterology Consultants 33.27 17 Pinnacle Health Cardiovascular Institute 26.46 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10, Recapitulation) 4,557.24 (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-1512 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 Sauerwine, Grace M 21-13-0351 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 PPL-Electric Bill 87.24 19 Quantium Imaging 2.53 20 Quantium Imaging 23.15 21 Souder Tax Service(2012 Tax Preparation#2377) 120.00 22 U.S.Treasury(1st qtr estimated tax#2387) 430.00 23 UGI 98.38 24 United Water 29.45 25 Upper Allen Township -Sewer Bill 112.00 26 Verizon 51.26 27 Waste Management 39.03 28 West Shore Anesthesia Associates 30.36 29 Winding Hills Master Association(Monthly Fee#2378) 55.00 TOTAL(Also enter on Line 10, Recapitulation) 4,557.24 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 Sauerwine, Grace M 21-13-0351 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Patricia A Hess Daughter One-Third 1704 Fairmont Drive Residuary Estate Mechanicsburg, PA 17055 3 William C Sauerwine Son 80%of one-third 107 Hogestown Road of residuary Mechanicsburg, PA 17050 estate 4 Benjamin Sauerwine Grandson 10%of one-third 769 Hayes Street,#309 of residuary Seattle,WA 98109 estate 5 Grant Sauerwine Grandson 10%of one-third 107 Hogestown Road of residuary Mechanicsburg, PA 17050 estate 6 Richard H Sauerwine Son One-Third 1066 Locust Grove Road Residuary Estate Middletown, PA 17057 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 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) P p GRACE M. SAUERWINE • File No. 1-10-We Pre ared September 27, 2012 xx ^fie LAST WILL AND TESTAMENT of GRACE M. SAUERWINE BE IT REMEMBERED,that I,GRACE M.SAUERWINE,of 2037 Liberty Drive,Mechanicsburg,PA 17055,being of sound mind,memory and understanding,do make,publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me, at anytime heretofore made. ARTICLE 01. BACKGROUND INFORMATION: The following is background information pertaining to myself and my family: (A) I was born on August 27, 1924. (B) The last four(4)digits of my social security number are"1017'. (C) I am a widow. (D) I have three(3)children, to wit: (1) Richard H.Sauerwine(YOB: 1948), 1066 Locust Grove Road, Middletown, PA 17057; (2) William C.Sauerwine(YOB: 1952), 107 Hogestown Road, Mechanicsburg, PA 17050; (3) Patricia A. Hess (YOB: 1956), 1704 Fairmont Drive, Mechanicsburg, PA 17055. ARTICLE 02. DEFINITIONS AND MISCELLANEOUS TERMS: The following definitions and miscellaneous terms shall apply to this my Last Will and Testament: (A) My Child or My Children: The term (my "Child" or "my Children" includes the children referenced in Article 01 above. (B) Issue: The terms "issue" as used in my Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to,who are in being at the time they must be ascertained in Order to give effect to the reference to them. (C) Per Stirpes: The term "per stirpes" as used in my Will means that whenever a distribution is to be made to the issue or descendants of any person,the property to be distributed shall be divided into as many shares as there are(1)living children of the person, and (2)deceased children, who left descendants who are living, of the person. Each living child, if any, shall take one share and the share of each deceased child shall be divided amongst his then living descendants in the same manner. (D) Per Capita: The term "per capita" as used in my Will means that whenever a distribution is to be made to a person, the property to be distributed to that person shall be distributed only if that person survives me. If that person has not survived me, the distribution to that person shall lapse and be deemed void. "GMACE M. SAUL- WINE 1 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 (E) Personal Representative: The term"Personal Representative"as used in my Will means the Executor or Executrix of my Estate, or any other title of like import which is used to describe such a fiduciary. (F) Residuary Estate:The term "Residuary Estate"as used in my Will means all the rest, residue and remainder of my Estate remaining after payment of all of my last debts,funeral expenses,taxes and administration expenses,and any other expense, or expenditure required to be made as the result of my death and after distribution of the Tangible Personal Property and any special bequests specifically set forth herein. (G) Survive:The term"survive me",or any derivative thereof,as used in my Will means that any person or organization herein named or referred to shall be deemed to have survived me only if such person or organization shall survive me for a period of at least sixty (60) days. Any person or organization named or referred to herein who shall not survive me by a period of sixty (60) days shall be deemed to have died before I do and shall have failed to survive me. (H) Gender and Number: Where appropriate to the context, pronouns or other terms expressed in one number or gender shall be deemed to include the other number or gender, as the case may be. (1) Percentages: Where a gift, bequest or devise is expressed as a percentage in the following Articles, it refers to the percentage of that portion of my gross estate available for distribution unless a contrary intention appears in the Article. (J) Priori : Priority for distribution of the gifts and bequests herein made shall follow the Article number with the lower numbered Article taking priority over any Article appearing subsequently unless a contrary intention appears in the Article. (K) Encumbrance: When encumbered property has been specifically devised or bequeathed, it shall pass under the terms and conditions of this Will subject to said encumbrances, provided however, that any installment payments, current or past due, on either principal or interest on such encumbrances may be paid by my Personal Representative in his/her sole discretion. (L) Partial Invalidity: If any provision of this Will shall be declared inoperative or in violation of any rule of law,such invalidity shall not affect the remaining provisions of this Will and they shall remain in full force and effect. ARTICLE 03. BURIAL AND FUNERAL INSTRUCTIONS: I direct that all my funeral and burial arrangements shall be made by my Personal Representative as my Personal Representative in his/her in her sole discretion deems appropriate. To that end I have provided my Personal Representative with a form entitled "Burial Request Form" in which I have outlined my wishes regarding my funeral and burial, including the direction that I be buried in my burial plot located in the Rolling Green Cemetery, Camp Hill, PA. ARTICLE 04. DEBTS AND FUNERAL EXPENSES: I direct that all my just debts and funeral expenses appropriate to my station in life and custom of living be paid as soon after my demise as may be convenient. For purposes of this Paragraph the term "funeral expenses"expenses shall include, but not be limited to, expenses for the funeral,flowers and meal for family and friends. ARTICLE 05. ADMINISTRATION EXPENSES: I direct that all of the expenses of the administration of my Estate including, but not limited to, probate and other Court fees and reasonable commission for my Personal Representative and any attorney retained by my Personal RACE M. SAUERWINE 2 GRACE M. SAUERWINE • File No. 1-10-W •-Prepared September 27, 2012 a Representative, be paid as such expenses are incurred and as soon after my demise as may be convenient. ARTICLE 06. PAYMENT OF TAXES: I direct my Personal Representative to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or any person receiving the transfer of any property passing hereunder or otherwise passing by reason of my demise,may be subject and to charge such taxes against my Residuary Estate, it being my intention that none of the aforesaid taxes, either federal or state, or any property required to be included in-my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ARTICLE 07. TANGIBLE PERSONAL PROPERTY: I give and bequeath all tangible personal property owned by me at my death and all insurance policies on such property as follows: (A) Memorandum: To those individuals who survive me and who are designated on a list, memorandum,or Bequest of Personal Property form signed by me which refers to my Will or is found with a copy thereof, I give and bequeath the item or items of tangible personal property listed beside his/her name. (B) Remainder Distribution: (1) The balance of my tangible personal property (including any items to be distributed under this Article,the bequest of which has lapsed)shall become part of my Residuary Estate and distributed to the beneficiaries and in the proportions herein provided. (2) My Personal Representative shall have the right to dispose of said remaining items of personalty, either in kind or in cash as a result of liquidation thereof as my Personal Representative, in my Personal Representative's sole discretion, deems appropriate under the circumstances. (3) Any item to be distributed in kind to a residuary beneficiary shall be distributed to that residuary beneficiary upon payment of the fair and reasonable value for that item of property to be and as established by my Personal Representative in my Personal Representative's sole discretion. (4) My Personal Representative may, but shall not be required to, delay the liquidation and/or distribution of said balance of my tangible personal property until the sale of my home, so that the furnishing of that home with said property will enhance the sale thereof, if my Personal Representative in his/her sole discretion deems such a delay to be appropriate under the circumstances. (C) Safekeeping: If any beneficiary of any item of tangible personal property aforesaid has not yet attained the age of twenty-one(21)at the time of my death, I direct that my Personal Representative, hereinafter named, to hold said items in safekeeping for that beneficiary and to deliver the same to that beneficiary upon he or she reaching age twenty-one(21), or at such earlier age if my Personal Representative deems the beneficiary to be of appropriate age and maturity to receive said items of personalty. For these purposes my Personal Representative shall be entitled to use or set aside from my Estate sufficient funds to provide for that safekeeping. ARTICLE 08. SPECIAL BEQUESTS: I give and bequeath the death benefits payable from my ITT Retirees Life insurance Policy having a current death benefits of$10,000.00 and payable to GRACE M. SAtJERWINE 3 GRACE M. SAUERWINE File No. 1-10-W • Prepared September 27, 2012 my Estate as follows: (A) Fifty percent (50%) of the said death benefits, but in no event any more than five percent(5%)of the value of my net distributable estate, I give and bequeath to my sister, Betty Jane Slagel, of 490 Mt. Vernon Drive, Pittsburgh, PA 15223, provided she survives me. (B) Fifty percent (50%) of the said death benefits, but in no event any more than five percent(5%)of the value of my net distributable estate, I give and bequeath to my sister, Althea Mae Kessler, of 116 E. Littlewood Street, Pittsburgh, PA 15223, provided she survives me. (C) To the extent the said death benefits exceed ten percent(10%)of the value of my net distributable estate,said excess shall be made part of my Residuary Estate,and shall be distributed to the beneficiaries thereof as set forth in Article 09 below. ARTICLE 09. RESIDUARY ESTATE: I give,devise and bequeath my Residuary Estate as follows: (A) I give, devise and bequeath one-third (1/3) of my Residuary Estate to my Child, Richard H.Sauerwine,provided he survives me. If my Child, Richard H.Sauerwine, fails to survive me, his share of my Residuary Estate shall lapse and instead I give, devise and bequeath that one third (1/3) of my Residuary Estate to Richard H. Sauerwine's spouse and natural born children,Phyllis Sauerwine,Shawn Sauerwine and Amanda Hess,or such of them who survive me,share and share alike, in equal shares per capita. The foregoing notwithstanding, Richard H. Sauerwine's spouse Phyllis Sauerwine, shall be entitled to the foregoing share of my Residuary Estate provided.and upon the conditions that: (1) Phyllis Sauerwine survives me. (2) Phyllis Sauerwine and Richard H. Sauerwine were not separated or divorced on the date of death of Phyllis Sauerwine; AND, (3) There was no divorce action pending between Phyllis Sauerwine and Richard H. Sauerwine on the date of death of Richard H. Sauerwine. In the event all three of the above referenced conditions have not been met,then the distribution to Phyllis Sauerwine shall lapse, in which event I then give, devise and bequest that share of my residuary estate to my grandchildren, Shawn Sauerwine and Amanda Hess, or either of them who survive me, share and share alike, in equal shares per capita. (B) I give, devise and bequeath one-third (1/3) of my Residuary Estate to my Child, Patricia A. Hess, provided she survives me. If my Child, Patricia A. Hess, fails to survive me, her share of my Residuary Estate shall lapse and instead I give, devise and bequeath that one third(1/3)of my Residuary Estate to Patricia A.Hess'spouse and natural born children, Joseph M. Hess, LaShae Willits,Austin Hess and Olivia Hess, or such of them who survive me, share and share alike, in equal shares per capita. The foregoing notwithstanding, Patricia A. Hess'spouse, Joseph M. Hess, shall be entitled to the foregoing share of my Residuary Estate provided and upon the conditions that: (1) Joseph M. Hess survives me. (2) Joseph M. Hess and Patricia A. Hess were not separated or divorced on the GRACE M. SAUEfRWINE 4 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 date of death of Patricia A. Hess; AND, (3) There was no divorce action pending between Joseph M. Hess and Patricia A. Hess on the date of death of Patricia A. Hess. In the event all three of the above referenced conditions have not been met,then the distribution to Joseph M. Hess shall lapse, in which event I then give, devise and bequest that share of my residuary estate to my grandchildren,LaShae Willits,Austin Hess and Olivia Hess, or such of them who survive me, share and share alike, in equal shares per capita. (C) In the event my son,William C.Sauerwine should survive me,I then give,devise and bequeath one-third (1/3) of my Residuary Estate in the proportions and to the persons and in the proportions as follows: (1) 1 give,devise and bequeath eighty percent(80%)of the one-third(1/3)share of my Residuary Estate to my Child, William C. Sauerwine, provided he survives me. (2) 1 give,devise and bequeath ten percent(10%)of my Residuary Estate to my grandchild, Benjamin Sauerwine, provided he survives me. In the event my grandchild, Benjamin Sauerwine, fails to survive me, the distribution to Benjamin Sauerwine shall lapse in which event I then give, devise and bequest said ten percent(10%)share to my grandchild, Grant Sauerwine. (3) 1 give, devise and bequeath ten percent(10%)of my Residuary Estate to my grandchild, Grant Sauerwine, provided he survives me. In the event my grandchild, Grant Sauerwine, fails to survive me, the distribution to Grant Sauerwine shall lapse in which event I then give,devise and bequest said ten percent(10%) share to my grandchild, Benjamin Sauerwine. (D) In the event my son,William C.Sauerwine should fail to survive me,the distributions set forth in paragraph (C) (1)through (3)shall terminate and lapse, in which event, I instead give, devise and bequeath one-third (1/3) of my Residuary Estate in the proportions and to the persons who survive me as follows: (1) 1 give, devise and bequeath forty percent(40%)of the one-third (1/3)share of my Residuary Estate to my grandchild, Benjamin Sauerwine, provided he survives me. In the event my grandchild,Benjamin Sauerwine,fails to survive me, the distribution to Benjamin Sauerwine shall lapse in which event I then give,devise and bequest said forty percent(40%) of the one-third (1/3)share of my Residuary Estate to my grandchild, Grant Sauerwine. (2) 1 give,devise and bequeath forty percent(40%)of the one-third (1/3)share of my Residuary Estate to my grandchild,Grant Sauerwine,provided he survives me. In the event my grandchild, Grant Sauerwine, fails to survive me, the distribution to Grant Sauerwine shall lapse in which event I then give,devise and bequest said forty percent (40%) of the one-third (1/3) share of my Residuary Estate to my grandchild, Benjamin Sauerwine. (3) 1 give,devise and bequeath twenty percent(20%)of the one-third(1/3)share of my Residuary Estate to Laurie Sauerwine provided and upon the conditions that: (a) Laurie Sauerwine survives me. GRACE M. SAUE WINE 5 GRACE M. SAUERWINE • File No. 1-10-W*'Prepared September 27, 2012 (b) Laurie Sauerwine and William C. Sauerwine were not separated or divorced on the date of death of William C. Sauerwine; AND, (c) There was no divorce action pending between Laurie Sauerwine and William C. Sauerwine on the date of death of William C. Sauerwine. In.the event all three of the above referenced conditions have not been met, then the distribution to Laurie Sauerwine shall lapse, in which event I then give,devise and bequest said twenty percent(20%)of the one-third(1/3)share to my grandchildren, Benjamin Sauerwine and Grant Sauerwine, or either of them who survive me, in equal shares per capita. (E) The provisions of subparagraph (C) and (D) of this Article 09 are made for the express purpose of assuring that a share of my Residuary Estate is given to my biological grandchildren, Benjamin Sauerwine and Grant Sauerwine. ARTICLE 10. PERSONAL REPRESENTATIVE: The following shall apply to the my Personal Representative: (A) Appointment of Personal Representative: I hereby appoint the following as my Personal Representative: (1) Personal Representative: I appoint Patricia A. Hess and Joseph M. Hess, or the survivor of them as my Co-Personal Representatives. (2) 1"Alternate Personal Representative: In the event both Patricia A. Hess and Joseph M. Hess should predecease me,fail to survive me,fail to qualify, cease to act, or renounce the appointment as my Co-Personal Representatives or die prior to the completion of the administration of my estate, I then appoint Richard H. Sauerwine as my Personal Representative. (3) 2nd Alternate Personal Representative: In the event Patricia A. Hess, Joseph M. Hess and Richard H.Sauerwine should all should predecease me, fail to survive me,fail to qualify,cease to act,or renounce the appointment as my Personal Representatives or die prior to the completion of the administration of my estate, I then appoint William C. Sauerwine as my Personal Representative. (B) Fee for Personal Representative: I direct that the commission or fee to be paid to Patricia A. Hess and Joseph M. Hess, or the survivor of them as my Personal Representative for the administration of my Estate shall be at the rate of five percent (5%)of the value of the probate assets in my Estate,which fee shall be based on the value of the probate Estate assets as reported on the Pennsylvania Inheritance Tax Return, but in no event any less than the amount of$25,000.00. This minimum amount is based upon my desire to compensate Patricia A. Hess and Joseph M. Hess for their many years of faithful service to me both personally, and in the administration of my needs, affairs and Estate. For any person other than Patricia A. Hess and Joseph M. Hess who is appointed and/or acting as my Personal Representative, the commission or fee to be paid to that person shall be limited to three percent(3%)of the value of the probate assets in my Estate,which fee shall be based on the value of the Estate probate assets as reported on the Pennsylvania Inheritance Tax Return. i GRACE M. SA ERWINE 6 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 ARTICLE 11. POWERS OF PERSONAL REPRESENTATIVE: In addition to the powers conferred by law or under previous provisions of my Will, my Personal Representative shall have the following powers: (A) General Powers: In general,to exercise all powers in the management of the my Estate which any individual could exercise in his or her own right, upon such terms and conditions as it may reasonably deem best,and to do all acts which it may deem reasonably necessary or proper to carry out the purposes of the administration of my Estate. (B) Administration Powers: (1) Property and Debt Transactions: To engage in transactions involving the assets and debts of my Estate including but not limited to the following: real estate;tangible personal property;stocks,bonds and other securities and the exercise of any options arising out of those investments;banking and financial matters; insurance; and retirement plans; (2) Safe Deposit Boxes: To enter safe deposit boxes; (3) Claims and Litigation: To pursue claims and litigation; and to compromise claims without court approval and without the consent of any beneficiary; (4) Allocation: To determine what shall be fairly and equitably charged or credited to income and what to principal; (5) Agents: To appoint or substitute one or more Agent or Agents under my Personal Representative, to carry out any of the general of specific powers hereby granted; (6) Payment of Cost and Expenses: To pay all costs, taxes, expenses and charges in connection with the administration of my Estate including, but not limited to, my last debts and all funeral expenses. (C) Property and Debts: (1) Receipt of Property: To receive property belonging to my Estate including, but not limited to the receipt of the proceeds of any insurance policy which names my Estate as a beneficiary;and to execute all necessary receipts and releases to such persons of entities adding property to my Estate; (2) Disclaim Property: To disclaim any interest in property; (3) Retention of Form of Property: To retain in the form received any property or undivided interests in property donated to, or otherwise acquired as a part of my Estate; (4) Investments: To retain any investments I may have at my death when deemed advisable to my Estate to do so; and to vary investments, when deemed desirable, then to invest in such bonds, stocks, notes, real estate mortgages, or other securities, or in such property, real or personal, as deemed wise, without being restricted to so-called "legal investments" and without regard to diversification and without being limited by any statute or rule of law concerning investments by fiduciaries; GRACE M. SAUEMINE 7 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 (5) Sale of Assets: To sell either at public or private sale any real or personal property and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title with special warranty, free and clear of all liens and encumbrances and without obligation or liability to the purchaser(s) to see to the application of the purchase money or to make inquiry to the validity of the sale or sales; and to make, execute, acknowledge and deliver any and all deeds, assignments, options,or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Personal Representative in my Will or otherwise; (6) Division: To hold and retain the principal of my Estate undivided until actual division shall become necessary in order to make distributions; to hold, manage, invest, and account for the several shares or parts thereof by appropriate entries on my Personal Representative's books of account; and to allocate to each share or part of share its proportionate part of all receipts and expenses; (7) Cash: To keep, at any time and from time to time, all or any portion of my Estate in cash and uninvested for such period or periods of time as it may deem advisable,without liability for any loss in income by reason thereof; (8) Division and Distribution: In Order to effectuate a division of the principal of my Estate or for any other purpose,including final distribution,my Personal Representative is authorized to make such divisions or distributions of the personalty and realty in kind or by way of liquidation thereof in whole or in part as my Personal Representative may deem appropriate under the circumstances and without regard to the income tax basis of any specific property allocated to any beneficiary. If a distribution or division is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. When dividing fractional interests in property among several beneficiaries to allocate entire interests in some property to one beneficiary and entire interests in other property in another beneficiary or beneficiaries. (D) Estate and Testamentary: (1) Testamentary Elections: To make testamentary elections; (2) Elective Share: To claim an elective share of the estate of any deceased spouse I may have; (3) Marital Rights: To deal with or waive marital election rights; (4) Spousal Refusal: To assign rights to support to comply with the "spousal refusal"option of medicaid, if any. (E) Taxes: (1) Tax Matters and Returns: To pursue and handle tax matters and to prepare, execute and file on behalf of my Estate any and all income tax declarations and returns, and any other tax returns and reports (including, but not limited to, protests, claims, elections, consents, closing agreements, waivers of statutes of limitations and extensions),and to represent My Estate before the Internal Revenue Service of Treasury Department and any state or local taxing GRACE M. SAUERWINE 8 GRACE M. SAUERWINE • File No. 1-10-W• Prepared September 27, 2012 authority with respect to any claim or proceeding having to do with tax liabilities, federal, state or local,for any and all tax years; (2) Joinder in Returns: To join with any spouse I may have in the filing of any federal income tax return for any year for which I have not filed such return prior to my death, and to consent to the treatment of any gifts made by my spouse as being made one-half by me for gift tax purposes notwithstanding the fact that such action may result in additional liabilities for my Estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated between my Estate and my spouse and my spouse's estate, or all to any of them, in such manner as my Personal Representative and my said spouse may agree; (3) Generation Skipping Taxes: To elect to allocate any portion or all the generation-skipping transfer exemption provided for in Code section 2631 or under similar future legislation to any portion or all of any trusts or bequests in the my Will or any other transfer which I am the transferor for purposes of the generation-skipping tax; (4) Other: To otherwise take any action or make any election which would minimize the taxes owed as a result of my death whether_owed by my Estate or otherwise. ARTICLE 12. APPOINTMENT OF GUARDIAN OF MINOR'S PROPERTY: The following shall apply to the appointment of my Guardian of Minor's Property: (A) Property Guardian: I appoint Patricia A. Hess and Joseph M. Hess, or the survivor of them, as my Co-Guardians of Minor's Property. (B) 1St Alternate Property Guardian: In the event both Patricia A. Hess and Joseph M. Hess should die, fail to qualify, cease to act, or renounce the appointment as my Guardian of Minor's Property, I then appoint Richard H. Sauerwine as my Guardian of Minor's Property. (C) 2"d Alternate Property Guardian: In the event both Patricia A. Hess , Joseph M. Hess and Richard H.Sauerwine should all predecease me,die,fail to qualify,cease to act, or renounce the appointment as my Guardian of Minor's Property, I then appoint William C. Sauerwine as my Guardian of Minor's Property. ARTICLE 13. NO BONDING REQUIREMENT: I direct that my Personal Representative(s), or successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ARTICLE 14. EXCLUSION: It is not my intention to make provision in my Will for any relative or any other person not expressly provided for herein. If any such person has not been expressly mentioned herein, he or she has been omitted by me intentionally and with full knowledge of his or her relationship and existence, and not by any oversight or neglect. ARTICLE 15. WILL CONTEST: In the event that any person, including a devisee, legatee or beneficiary under my Will shall either directly or indirectly seek to establish or assert any claim to my Estate,or any part thereof, not authorized by my Will,or seek to impair, invalidate,or set aside the provisions of my Will, or to have any of the trust provisions or estate distributions limited, declared void or diminished or to defeat or change any of the dispositive scheme of my Will,or shall endeavor to secure or take any part of my estate in any manner other than through or under my Will,I hereby give,devise and bequeath to such person or persons the sum of Ten Dollars($10.00) /lctl�`��/. GRACE M. SAUERWINE 9 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 and no more in lieu of any other share or interest in my estate. Provided further that nothing in this Article contained shall prevent any beneficiary hereunder from bringing an action against any fiduciary hereunder, for an accounting, nor from enforcing any statutory share to which the beneficiary may be entitled. IN WITNESS WHEREOF,I have hereunto set my hand and seal this day of 2012. WITNESS: 'j SEAL} C GRACE M. SAUERWINE 10 GRACE M. SAUERWINE • File No. 1-10-W • Prepared September 27, 2012 e � ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND We, Grace M. Sauerwine, Diane G. Radcliff, Esquire, and Kelly S. Quinn, 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 the Testatrix's Last Will and Testament and that the Testatrix had signed willingly (or willingly directed another to sign for the Testatrix, and that the Testatrix executed it as the Testatrix's 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 witnesses and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. /L {SEAL} GRACE M. SAUERWI Testatrix 4 NES Sworn to and subscribed to before me this.A**61-'day of 2012. ,,,,��//� ��. ...� NOTARY PUBLIC My Commission Expires: COMMONVVEALl}t OF PENN YLVANIA Noland SON Deborah L.Donley,Notary PubNc Camp HW am,0umb&W"4 Court) up 11 amhD,(36)d-Bmac43062 A dCn-Ot SlatC rBt US.I)EperbTwtdFbisrgaidUtzDevelcV,ts fl Type d Lan CIVIBApprowd Na 2902-C265 FIN4L 1. ❑Fi4 2 ❑R*A 3 ❑CtrN.lhirs. 6 File Nrrba 7.Lan NiTber aNblgagelraratoe Case NiTber 4 ❑VA 5 Doorv.Iris 13496= CNote roerra rratO®d'%QQTv pa abider Hradoarg VW dr ha for iriarrr�arpupmes and ere not indtrm n We taxis Titlt SaWaTert&/S1rn WiYNN3 H isaairebiar Aiwyrnlreralva alaDa.. tOHs U,IOedl-tlmmHisarery dhaenilararnr,3rdtiesipar aarudimc,indudB8fteand Fvdetoii TWJBUSGUda�mlOD,mdgmon,o,a RirtedO6 d113at 13391C D.NMECFBafUAER Jew M Mlers E NMECFSRLER The Estated Owe M Sa wWne 20337 UbmW DhA Nfacttai RN 17M F.NoWECFLEMER ADCFEM G F43UUYPCD;ES& 2037UbertyDM Mad abug FA 17055 ttwAflenTomishD Ft SEnLBVENTAG31TT.- 0016MI Bairn ll-b. eadGnoupSdect Pro RAY=CFgTiLBuBTT: 4075MvWSVest CarTpHII,PA17011 I.SErnBVBVTD4TE O6rOYM3 Jl SUMARY cF B STRA%EAcncm K SUVNPWCFS616ZSTRANSALTKW 100.CROSSANC WDLEFFE MBCRFUNR 400.GROSSAKXWDLE70SH1Ht 101. CLTt W sales pice 21 000.00 401. Cxwd sales pice 21 000.00 102 Pama- 1 pmpaty 402 Paswd pmperty 103 Sysanat bbmcver ine 672-00 403 103. 105 405 'AcksftTarftfor*b9.s aicitwsellerinaijarce AclusbTertsfigr6a. oddlovsellerinaloerce 106 ONADm tom;;." 405 atiolmn tam 107. Ofi100113to12r M 48453 407 ta)es 06/03113b1213M13 48453 108 Avis << O6I00113bOMI3 1948D"408':P miss O6rM3bO6130T13 19180 109. ScBInaHMl'J O6r03113b0fi1JOr13 3446 4C6.' 93mrAlV1'J 16103113606r30r'13 3446 110. HONdies J'- 3 1692 414 I► cLesNWJ 06I03i113bO6T30H3 16.92 111. 411. 112 ,._..., 412 1MCFCMA CUWDLEFi 71 4M GF4SAMxURDLEMSa"R.' 21%74M71 2MANQM MDBYCRCNEEFOLFCFBQ3PB2 SMFEx=CNSlNMCWCF70SSMR 211. DwoMcr nuey 501. E,CSS9 seeirt rbCrs 212 RndPd aMul drxwlmm 52 fo ler ine1 1537.00 270. B:sti s tdQEn atieg b 503. BOS.IiM I IMN WlMakgg b SA. Paa dAra Loan 2)fz gJ5 207. 507 378 506. 29. 503. AclusbTaft for*bens Lrv3dd bi sells Acbjdnwftfcr i0errs tvpdd bisdier 214 OtAmn tail 51a atvybAn tam 211. 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WVWN3 rTtSACFACTOMONN3-YKNVCFASESTAlEhMNMIOTFE lMriDl S9Uarat3s9aYatvJ*hl Fare peQUe'isetrm"au+de saxutdUts t UTEDSMIMCNTHSCRAWSA-ARFfW FEMALI 5LFC IOOIN4CTXDN twvobm lhaeraeeticrwirsa Vw rdstote .r wMMseaa art CANRI ILEARWA IVDM14SCMr13Jr.FORCETA SSMTMJ=la USCXT'Ft 'itCN1001MDSH.RICN101Q N TTLO.34rAC$If �7E PLEASE SEE REVERSE SIDE FOR IMPORTANT DISCLOSURES AND INSTRUCTIONS 2013 Tax Form 1099-6 / MetLife Policyholder Trust Sales Advice El Cifrrected(If checked) Copy B-For Recipient Account Number 0061377972 Form 1099-B-Proceeds from Broker and Barter Exchange Transactions 2013 Recipient's ID No.ending in ••6309 Payers Federal ID No. 43-1912740 This is important tax information and Is being furnished to the Internal Revenue Service. If you are required to file a return,a negligence OMB No. 1545.0715 penalty or other sanction may be imposed on you N this income is taxable and the IRS determines that it has not been reported. Department of the Treasury•Internal Revenue Service PATRICIA HESS Recipient &JOSEPH M HESS EX EST GRACE M SAUERWINE 1704 FAIRMONT DRIVE MECHANICSBURG PA 17055 to Date of Sale td Stock or 1e Quantity Stocks, FEDERAL INCOME Check if or Exchange other symbol sold bonds.etc.(S) TAX WITHHELD(�) Noncoveredl Payer's Details Securi 12 Apr 2013 MET 65.000000 2.391.88 0.00 ® COMPUTERSHARE SHAREOWNER SVCS 13 1141 Stalell5l State tax P.O.BOX 43006 PROVIDENCE RI Description State .identification .. vv;thheld.($)-�-- — —-- ----._._._._. 02940-3006 65.000000 shares sold @ 36.80 METLIFE INC NOTE:The Payer will report the amount in column 2a to the IRS.The difference between the reportable proceeds in column 2a and the net proceeds you received represents withholding lazes and nonstandard service fees or charges you may have paid. Form 1099-B (Keep for your records) Trade Date: 12 Apr 2013 Settlement Date: 17 Apr 2013 Cost Basis Method: FIFO .Opening Shares/Units Price er Gross Amount Taxes Net Amount Closin USD) Balance Sold I Share/Unit(USD)I of Sate(USD)I Withheld( I of Sale(USD)I Balance 65.000000 65.000000 36.798100 2,391.88 0.00 2,391.88 0.000000 YOUR ACCOUNT HAS BEEN CLOSED AND YOU ARE NO LONGER ELIGIBLE TO PARTICIPATE IN THE PURCHASE AND SALE PROGRAM. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. ® 1 L G L T M E T L + GOICD70008 OWRA us.IrI.c.4dy.sel.il_4391A012%/(")250/i ,NAF-J NG;WA&TPLE SAFETY FEATURES,THE FACE OF THIS CHECK HAS A BLUE BAC1tGROU!,D AHO FLUORESCEM INN(HOLD UNDER BLACKLICHT TO Y'£i;j.REFER TO SECUMTY£;:DORSHf,EYT SACKEF.FOR TRUE Y,'ATFRPARKAISDADDITIOt:AL FEATURES. Meftife The Bank of New York Mellon 60.160 Pittsburgh,Pennsylvania 433 PLEASE DEPOSIT THIS CHECK PROMPTLY. IMPORTANT TAX RETURN DOCUMENT.ATTACHED METL. Pay to PATRICIA HE5S Check Number:0000040272 JOSEPH M HESS EX EST GRACE M SAUERWINE 1704-FAIRMONT DRIVE 17 Apr 2013 MECHANICSBURG PA 17055 $****2,391.88**** The sum of . $."`TWO THOUSAND.THREE HUNDRED NINETY-ONE DOLLARS AND EIGHTY-EIGHT. Computershare eovmer Services uC . CENTS US FUNDS ONLY` Authorized Paying A t Computershare Shareowner Services LLC 480 Washington Blvd,Jersey City,NJ 07310 , s +iy r.(n..Dot&on asca Authorized Signatures? Ito 00000Le 0 2 ? 211■ 40 4 3 30 1 60 W: 13 G-1 L9 3 2111 MM&TBank STATEMENT PERIOD':: PAGE MAR.02-APR.01,2013 3 OF 3 GRACE M SAUERWINE THE SOLUTION YOU'VE BEEN LOOKING FOR - THE M&T HOME EQUITY LOAN YOUR HOME'S EQUITY CAN BE THE SMART WAY TO MANAGE EXPENSES. AN M&T HOME EQUITY LOAN OFFERS YOU AN AFFORDABLE RATE AND A DEPENDABLE MONTHLY PAYMENT. CONSOLIDATE HIGH-RATE BILLS, MAKE HOME IMPROVEMENTS, OR COVER LARGE EXPENSES LIKE TUITION OR A DOWN PAYMENT ON A SECOND CAR. CALL TODAY FOR RATES AND TO APPLY: 800-557-0535. ALL LOANS SUBJECT TO CREDIT AND PROPERTY APPROVAL. EQUAL HOUSING LENDER. MEMBER FDIC. NMLS #381076 ACCOUNT:::::: GRACE M SAUERWINE RELATIONSHIP SAVINGS »Tr:Tr >>s ACCOUNT NO. 15004220421420 WEST SHORE PLAZA INTEREST EARNED FOR STATEMENT PERIOD 0.09 ACCOUNT SUMMARY 13RGINNINGi:. DEPpSiTS & WITHDRAWALS*:&.::,OTHER,:; Cx#RRFNT . » &NDING ;BALANCE;:: . > O'T'IiER ADDITIOi1S`': SUBTRACTTbNS.. . INTEREST-PAT:D . ;:BAIAI�fcE NO. AMOUNT NO. AMOUNT 14,003.22 0 0.00 3 14,003.32 0.10 0.00 ACCOUNT ACTIVITY POSTING :DEPOSITS INTEREST W/DRAWALS & 0 ER DAI7iY .. DATED TR NSACTZON:DfiSCRIPTION`<. .. . & OTHER:ADDSTSONS SUBTRACTION5ii BAf,A3fCE 03-02-13 BEGINNING BALANCE $14,003.22 03-11-13 In Branch Transfer/Withdrawal 2,000.00 12,003.22 03-13-13 In Branch Transfer/Withdrawal 10,000.00 2,003.22 03-28-13 INTEREST PAYMENT 0.10 03-28-13 CLOSEOUT 2,003.32 0.00 ENDING BALANCE $0.00 ANNUAL PERCENTAGE YIELD EARNED = 0.01 $ ** END OF STATEMENT ** Q M&TBank S......MEI3T:PEF�IOI?:;:: PAGE MAR.02-APR.01,2013 2 OF 3 GRACE M SAUERWINE ACCOUNT ACTIVITY POSTING » ... 09P..SI s4l . ERESI CHSCKS:::& O YISR A?1ILy DATE TRANSACTION DESC122PT20N .. .. : OTFTER ADDITIONS SU&TR2ICTLOITS<. . BALADTCE 03-14-13 DEPOSIT 12.03 03-14-13 CHECK NUMBER 2385 1,495.00 03-14-13 CHECK NUMBER 2383 8.33 12,111.23 03-15-13 CHECK NUMBER 2389 78.00 12,033.23 03-18-13 TA LIFE INS -ATY PREMIUM 47,708.12 03-18-13 CHECK NUMBER 2391 500.00 03-18-13 CHECK NUMBER 2390 381.49 03-18-13 CHECK NUMBER 2378 55.00 58,804.86 03-19-13 CHECK NUMBER 2377 120.00 58,684.86 03-20-13 CHECK NUMBER 2388 7,995.00 03-20-13 CHECK NUMBER 2387 430.00 50,259.86 03-27-13 CHECK NUMBER 2386 839.31 49,420.55 03-29-13 BENEFIT PAYMENTS DEPOSIT 256.13 03-29-13 In Branch Transfer/Withdrawal 15,000.00 03-29-13 In Branch Transfer/Withdrawal 33,920.55 756.13 04-01-13 BENEFIT PAYMENTS DEPOSIT 344.45 04-01-13 INTEREST PAYMENT 0.18 1,100.76 ENDING BALANCE $1,100.76 C NECK$ PAI17<:SUMMARY..... - 2366 03-04-13 23.40 2367 03-04-13 20.08 2368 03-04-13 70.39 2372* 03-08-13 167.50 2374* 03-12-13 130.73 2376* 03-13-13 112.68 2377 03-19-13 120.00 2378 03-18-13 55.00 2380* 03-12-13 100.00 2381 03-11-13 200.00 2382 03-12-13 68.14 2383 03-14-13 8.33 2385* 03-14-13 1,495.00 2386 03-27-13 839.31 2387 03-20-13 430.00 2388 03-20-13 7,995.00 2389 03-15-13 78.00 2390 03-18-13 381.49 2391 03-18-13 500.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 Administrative Office: 4333 Edgewood Road NE Cedar Rapids,IA 52499 03/13/2013 GRACE M SAUERWINE 2037 LIBERTY DR MECHANICSBURG PA 17055 Re: Annuity Number(s) 02CBT062171 Dear Valued Policyholder: Our office has received your request concerning the above listed tax deferred annuity. This letter is to inform you that we have processed your distribution request and forwarded the funds according to your instructions. Following is information regarding any deductions taken from and the taxable amount of the distribution. Gross distribution: $56,127.20 Less policy penalty: $0.00 Less Federal Income Tax Withheld: $8,419.08 Less State Income Tax Withheld: 0.00 Admin fee: 0.00 Rider fee: 0.00 Premium tax: 10.00 Net EFT amount: 47,708.12 Taxable amount: 156,127.20 If any portion of this distribution is taxable, it will be reported to the IRS, and to you, on Form 1099-R. If you own multiple deferred non-qualified annuities purchased within the same year, this distribution may be subject to regulations concerning serial annuities. If you are under age 59 1/2, the taxable amount may be subject to a federal tax penalty. Please be advised that the distribution of policy values may affect the guaranteed elements, non-guaranteed elements, face amount and surrender value of the policy from which the values are disbursed. State regulations require insurers to monitor unreported replacements of existing annuity contracts and life insurance policies held by our company. If this distribution isz- intended to be used to purchase a new annuity contract or life insurance policy with our company, please contact us at the number below. We recommend you seek the advice of your tax consultant concerning the proper reporting of this distribution. Unless we have been notified of a community or marital property interest in this policy, we will rely on our good faith belief that no such interest exists. The policyowner agrees to indemnify and hold the Company harmless from the consequences of accepting this transaction. Our Company is a member of the Insurance Marketplace Standards Association (IMSA), an organization committed to high ethical market place standards in the sale and service of individual life insurance and annuities. We appreciate your business. If you have additional questions concerning this annuity, please contact our office or your personal representative. Sincerely, Distribution Services Disbursements 1-800-553-5957 34719 11/08 28/05/2013 2001 Buick LeSabre Custom Sedan 4D used Car Prices-KelleyBlue Book ZIP CODE-17011 1 Sign in for Sign up) Horne car values p cars for sale car reviews R kbb top picks C research tOOLS f,tg99REW VE 'SiO000 Popular at KBB.com A 0 fmn ZIP C de L - The 40 mpg Cass of 2013 We don't tell you what your budget is. adverdzTrt t vahy ads? Home> Car Values> Buick>LeSabre>2001 >Style > Options>C.ondition > Buick LeSabre 2001 �ciO Custom Sedan 4D 2001 Buick LeSabre _ E 2000 200E 2002 Style: Custom Sedan 4D r' Mkeage:138,000 Change edit options change stye pstcirtg photos specs Id7b expert review! consumer rev ews ratings compare used Car Prices See Trade-WSel V.-ties Make the Move_Get Your Score Suggested Retail Private Party G Excellent �_ f $3,206 a Find Deals Near You Seetocal deals � 639 s Very Good average Good Free VIN Check (opt Enter VIN o onal Go v No VIN? o prbm!$2,831 &eft&.wt r by ads Fair - $2,281 Verify Condition 2 Get yours now k 9 Y�'RELrTc3IG R LEARN Know Your Credit Score. MOFIE Search Cars for Sale Recently Viewed Lars y 'My Saved Cars Save car i { adverftmwt why ads? [ Buick Le Sabre Up to 100 Mile: away from ZIP PED Buyers Resources search� —I What can I afford? caloAte your nun"Payrrent ("'—"' I want extended vehicle protection I wnnw.kbb.cm*dcklesabre!2001-buiclNesabre(custom-sedan-4d/?conditort=f air&%ehicleid=38248 intent=bWLised&pricetype=private•party 1/3 Massachusetts Mutual Life Insurance Company and affiliates Springfield MAO]111-0001 www,massmuttnl com MassMutucrd ■_ FINANCIAL GROUP" April 12, 2013 ***M156*** PATRICIA A HESS 1704 FAIRMONT DR MECHANICSBURG PA 17055 Dear Ms. Hess: Re: Contract No(s). ODY15262588; Annuitant- Grace M Sauerwine; 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: April 12, 2013 Valuation Date: April 9, 2013 Total of Proceeds: $71,611.31 Contract Interest* $35.81 Total Amount Payable $71,647.12 *Interest calculated at 3% from the valuation date to April 15, 2013. If you have any questions,please contact your claim examiner Judith Tyburski at (800) 767-1000 ext. 21389 or contact me directly at ext. 22606. Sincerely, Rad W, Laura Ritchie Operation Support Analyst USIG Policyholders Services and Claims Enclosure: 1 cc: Molly Musselman ©2013 Massachusetts Mutual Life Insurance Company,Springfield,MA 01111-0001.All rights reserved.www.massmutual coin.,MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company(MassMutual)and its affiliated companies and sales representatives. Massachusetts Mutual Life Insurance Company and affiliates Springfield MA Ol 111-0001 w w.massmutual.com rMassMutw NANCIAL GROUP April 12, 2013 ***M 156*** RICHARD H SAUERWINE 1066 LOCUST GROVE RD MIDDLETOWN PA 17057 Dear Mr. Sauerwine: Re: Contract No(s). ODY15262588; Annuitant-Grace M Sauerwine; 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: April 12,2013 Valuation Date: April 9, 2013 Total of Proceeds: $71,611.31 Contract Interest* $35.81 Total Amount Payable $71,647.12 *Interest calculated at 3% from the valuation date to April 15,2013. If you have any questions,please contact your claim examiner Judith Tyburski at(800) 767-1000 ext. 21389 or contact me directly at ext. 22606. Sincerely, .L"14 Laura Ritchie Operation Support Analyst USIG Policyholders Services and Claims Enclosure: 1 cc: Molly Musselman ®2013 Massachusetts Mutual L i f e Insurance Company,Springfield,MA 011 I 1-0001.All rights reserved.%-A w.massmutual.com.MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company(MassMutual)and its affiliated companies and sales representatives. Massachusetts Mutual Life Insurance Company and affiliates „ Springfield MA 0111 I-0001 ww«•.massmutual.com ManovsMutual I_ FINANCIAL GROUP” April 12, 2013 `M 156"'x* WILLIAM C SAUERWINE 107 HOGESTOWN RD MECHANICSBURG PA 17050 Dear Mr. Sauerwine: Re: Contract No(s). ODY15262588; Annuitant- Grace M Sauerwine; 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: April 12, 2013 Valuation Date: April 9, 2013 Total of Proceeds: $71,611.31 Contract Interest* $35.81 Total Amount Payable $71,647.12 *Interest calculated at 3% from the valuation date to April 15, 2013. If you have any questions,please contact your claim examiner Judith Tyburski at(800) 767-1000 ext. 21389 or contact me directly at ext. 22606. Sincerely, .Lla�svza �' Laura Ritchie Operation Support Analyst USIG Policyholders Services and Claims Enclosure: 1 cc: Molly Musselman 0 2013 Massachusetts Mutual Life Insurance Company,Springfield;MA 01111-0001.All rights reserved.www.massinutual.com,MassM.utual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company(MassMutual)and its affiliated companies and sales representatives. DATE: 04/12/2013 RE- TRANSAMERICA LIFE INSURANCE COMPANY Deferred Annuity Number: 02CBT062199 Tax Qualif ication: UALIFIED Annuitant Name: SRACE M SAUERWINE Policyowner(s): Payee Name: PATRICIA A HESS Please accept our company's sincere condolences on your recent loss. Your request for a distribution from your tax deferred annuity has been processed. Your check is attached. Following is information regarding any deductions taken from and the taxable amount of this distribution. Gross distribution: 17, 659.05 Less Federal Income Tax Withheld: .00 Less State Income Tax Withheld: .00 Less delivery fee: .00 Net check amount 17,659-05 Taxable amount 17,659.05 if any portion of this distribution is taxable, this distribution will be reported to the IRS and to you on a Form 1099—R. Please be advised that the release of policy values may affect the guaranteed elements, non—guaranteed elements, face amount or surrender value of the policy from which the values are released. For your information, state regulations require insurers to monitor unreported replacements of existing annuity contracts and life insurance policies by our company. If this distribution is intended to be used to purchase a new annuity contract or life insurance policy with our company, please contact us at the number below. We recommend you seek the advice of your tax consultant concerning the proper reporting of this distribution. Unless we have been notified of a community or marital property interest in this policy, we will rely on our good faith belief that no such interest exists; the policyowner agrees to indemnify and hold the Company harmless from the consequences of accepting this transaction If you have any questions please contact your local representative, or the Annuity Distribution Service Team at 1-800-553-5957. 65178 12/09 CHECK NO. DATE VENDOR NO. PAYEE NAME CHECK AMOUNT 15647176 04/12/2013 AAlP097292 PATRICIA A HESS 17,659.05 RE 04/1212013 TRANSAMERICA LIFE INSURANCE COMPANY Deferred Annuity -Number: 02CBT062199 Tax Qualification: SUALIFIED Annuitant Name: RACE M SAUERWINE Policyowner(s): Payee Name: RICHARD H SAUERWINE Please.accept our company's sincere:condolences on your recent loss. Your request for a distribution.from your tax deferred annuity as been processed._ Your .check is-attached: Following is information, regarding any,>deductions:taken„from and the 'taxable amount of this distribution. Gross distribution: .17,13 9.6 6 Less Federal..Income Tex, Withheld: b0 . Less State !h Ta ome x. Withheld: Less delivery fee: 00 Net check amount.-- 17,139.6 6 Taxable amount' 17;23.9.66, If any portion of: this distribution is taxable, this distribution.will-be reported to the IRS and to you on a Form 1099-R Please be advised that- the release of policy values may affect the.,guaranteed elements, non-guaranteed elements, face amount or surrender value of the policy,from which the values are released. For. your information,.state,regulations.require insurers to monitor:unreported replacements of existing "annuity contracts and life insurance policies. b' our-comp any:.If this distribution is intended to be .used.;to .purchase a� new annuity contract or:•_life insurance:policy with our .company; please contact us at the number,below.. We recommend you•seek the advice of, your,,tax•consultant..concerning the proper reporting of this.distribution Unless we have-been notified of -a'community or ,marital property. interest in this . .policy, we will rely-on our good faith belief that.no such interest'exists, the policyowner agrees .to indemnify and.hol.d the'Company'harmless from the consequences of accepting this transacfion If you have =any gUestions please contact your Iocef:representative, or:"the Annuity Distribution Service.Team at 1--804-553-5957. 66175 12109 CHECK IVO DATE VENDOR NO. PAYEE •NAME:” CHECK AMOUNT 15647173 04%12/2013 -AA:TPO972e9 racffA p.D,t sAVaxwnm 17,:239:65 i DATE: 04/12/2013 RE: TRANSAMERICA LIFE INSURANCE COMPANY Deferred Annuity Number: 02CBT062199 Tax Qualification: UALIFIED Annuitant Name: RACE M SAUERWINE Policyownerls): Payee Name: WILLIAM C SAUERWINE Please accept our company's sincere condolences on your recent loss. Your request for a distribution from your tax deferred annuity has been processed. Your check is attached. Following is information regarding any deductions taken from and the taxable amount of this distribution. Gross distribution: 17, 139.67 Less Federal Income Tax Withheld: .00 Less State Income Tax Withheld: .00 Less delivery fee: Net check amount 17, 139.67 Taxable amount 17 , 139.67 If any portion of this distribution is taxable, this distribution will be reported to the IRS and to you on a Form 1099-R. Please be advised that the release of policy values may affect the guaranteed elements, non-guaranteed elements, face amount or surrender value of the policy from which the values are released. For your information, state regulations require insurers to monitor unreported replacements of existing annuity contracts and life insurance policies by our company. If this distribution is intender to be used to purchase a new annuity contract or life insurance policy with our company, please contact us at the number below. We recommend you seek the advice of your tax consultant concerning the proper reporting of this distribution. Unless we have been notified of a community or marital property interest in this policy, we will rely on our good faith belief that no such interest exists; the policyowner agrees to indemnify and hold the Company harmless from the consequences of accepting this transactior If you have any questions please contact your local representative, or the Annuity Distribution Service Team at 1-500-553-5957. 65178 12/1 CHECK NO. DATE VENDOR NO. PAYEE NAME CHECK AMOUr 15647174 04/12/2013 AAIP097290 WILLIAM C SAUERWINE Musselman Funeral Home and Cremation Services 324 Hummel Avenue Lemoyne, PA 17043 Tel: 717-763-7440 Fax: 717-730-9798 Brian C. Musselman, Supervisor Clifford D. Forester Sr. Funeral Director Thursday,March 21,2013 Patricia Hess 1704 Fairmont Drive Mechanicsburg,PA 17055 Dear Patricia, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for: GRACE M. SAUERWINE PROFESSIONAL SERVICES $Included Embalming $Included Other Preparation of Body $Included Traditional funeral Package A $5795.00 Total Funeral Service Selected TOTAL PROFESSIONAL SERVICES $5,795.00 Use of Facilities&Staff for Visitation $Included Use of Equipment&Staff for Church Memorial Service $Included Use of Staff&Equipment for Graveside Service $Included Transfer of Remains to Funeral Home $Included Hearse/Funeral Coach $Included Service/Utility Vehicle $Included OTHER MERCHANDISE SELECTED Casket: Pearl Rose $1,750.00 Pre Paid Rolling Green Acknowledgement Cards $Included Register Book Pink Rose $Included Memorial Folders Pink Rose $Included TOTAL OTHER MERCHANDISE SELECTED $1,750.00 CASH ADVANCES Grave Opening/Closing Charge $Prepaid Certified Copies of Death Certificate $30.00 Clergy Honorarium $ 100.00 Newspaper Notice Patriot News $422.00 Organist $100.00 CASH ADVANCE TOTAL $652.00 LESS: Credits granted $7,995.00 Payment Ck 2388 $7,995.00 TOTAL OF SERVICES $202.00 BALANCE DUE $202.00 i If there are any questions or concerns that remain unanswered,please call me. ! Sincerely, Service Corporation International PRINT SINGLE CASH RECEIPT Date 4/16/2013 Page 1 of 1 Batch#: 97777005 Batch date: 4/16/2013 #of Trans: 1 Batch Amt $395.00 Location: 0624-Rolling Green Cemetery Cash Receipt date: 4/16/2013 9:04:00 AM Address: 1811 Carlisle Road Cash Receipt#: 062414108492 Camp Hill PA 17011 Cash Receipt Amt: 395.00 Payment Check Payer. Ref#: Type: 062440000015 Hess,Patricia A 395.00 Total: 395.00 Trans ID - COP To Pastor Dave Schreffler From Patti Hess Re Grace M. Sauerwine Estate Donations Date April 9, 2013 Enclosed you will find three (3) checks as listed below: Check #505 Trinity Evangelical Lutheran Church $1,000.00 This special donation to the church was made at the request of Mom before she passed as an expression of her gratitude in feeling accepted and embraced by the church. Check#506 Trinity Evangelical Lutheran Church $ 200.00 This donation is toward the staff help during the funeral luncheon and can be used as part of a discretionary fund such as for those who cannot afford costs for similar luncheons, etc. What an outstanding group to have helped that day, with special thanks to Laurie Ellis. Check#507 Pastor Dave Schreffler $ 150.00 This is a special check Mom wanted to give to you personally for your kind spiritual support given to her in the church, the hospital, and her home during her last days. Our family cannot begin to thank you and your church enough for helping us all through this very difficult time. You and the congregation's kindnesses are most appreciated. A special thanks to Linton ("Bones") & Bev Saurman for their efforts in displaying Mom's banners the day of the funeral. She can certainly rest in peace knowing that the banners have a good home. Blessings.