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Home My WebLink About02-24-14 (2) � 1505610143 REV-1500 Ex�o2-�i> ,�; OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEVARTMENTOFREVENUE Po eoxzsoso� INHERITANCE TAX RETURN 21 13 0751 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 05 23 2013 07 25 1927 DecedenYs Last Name Suffix DecedenYs First Name M� SCHARDIN HELEN L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x 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. Pe�m ii�nd2r 3e82)(Date of Death 4. Limited Estate � qa,Future Interest Compromise � 5. Federal Estate Tax Return Required ❑ (date of death after 12-12-82) � 6 Decedent Died Testate � �� (Atta dh Copy�of Trust)a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) � 9. Litigation Proceeds Received � �0�betweenP2 31�J1 a dit�(Da95�f Death � ��.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number AMY M MOYA 717 652 7323 c` � REGISTF�II�,WILLS U3E ONI�1(�i r� First Line of Address 1 — '�'". ` t i 5011 LOCUST LANE — '� - __._ ; Second Line of Address , c: 1 -, �'',.'1 _._ �t .'��r� r�rf �__f� ' DATE FILEDil - City or Post Office State ZIP Code HARRISBURG PA 17109 CorrespondenYs e-maii address: Amv Ledererlaw com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPON�IBLE FOR FILING RETURN �DAjE ��,_ „�,�� f ��.;��1 Barbara S. Dawson ��'��"'�_�l� ADDRESS 3805 Pamav Drive, Mechanicsburq, PA 17050 SIGNA URE OF P �R THER THAN REPRESENTATIVE DATE Amy M. Moya ,� ,? ' " ADDRE S 5011 Locust Lane, Harrisburg, PA 17109 � Side 1 � 150561�143 1505610143 � 1505610243 REV-1500 EX DecedenYs Social Security Number DecedenYsName: SCIIarCIIII� Helen L. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 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. 2 ,542 . 84 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 24 , 57 9. 68 7. Inter-Vivos Transfers&Miscellaneous f�q Probate Property (Schedule G) �J Separate Billing Requested............ 7. 7 , 046. 63 g. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 34 , 169. 15 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 11 , 8 64 . 7 7 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 12 7 . 3� 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 11, 992 . 07 12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 2 2 , 17 7 . 0 8 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. 2 2 , 17 7 . �$ TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �5 O . 0 0 (a)(1.2)X.00 16. Amount of Line 14 taxable 22 � 177 . 08 �s. 997 • 97 at lineal rate X .045 17. Amount of Line 14 taxable 0 . 00 17. 0 . 00 at sibling rate X.12 18. Amount of Line 14 taxable 0 . 0� at collateral rate X.15 0 . 0 0 18. 19. TAX DUE................................................................................................................ 19. 997 . 97 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21-13-0751 Decedent's Complete Address: DECEDENT'S NAME Schardin, Helen L. STREET ADDRESS 801 North Hanover Street C��, STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 997.97 2. Credits/Payments A. Prior Payments 950.00 B. Discount 49.90 Total Credits(A +B) (2) 999.90 3. Interest �3� 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 1.93 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. �� ;," d, � .. ��r ,p. , �.. 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 ❑ ❑ receivingadequate consideration?.................................................................................................................. . 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ Ox 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. , �,; � ; ,,, , y : ,; , ,.,,,... ,. :' . , . , ,. : ,. n;: �, 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 chiid 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 decedenYs 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 decedenYs 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. Rev1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE p E RSO NAL P ROPE RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 Include the proceeds of litigation and the date lhe proceeds were received by the estate. All property jointly-ownedwith the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash on hand 123.63 2 Check from Church of God(nursing home refund) 2,136.37 3 Check from Delta Dental(refund of dental service-copy of check not available) 32.84 4 Miscellaneous personal property 250.00 TOTAL(Also enter on Line 5,Recapitulation) 2,542.84 (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-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Barbara S. Dawson 3805 Pamay Drive Daughter Mechanicsburg, PA 17050 g, Marianne S. DeSoto 2101 Patty Lane Daughter Vienna,VA 22182 C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S DECE ENT S NTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE �NTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 05/11/2005 Savings Account No.235793-00,held at 76.58 50.000% 38.29 Members 1st Federal Credit Union,titled to Helen L.Schardin and Barbara S. Dawson ($0.01 accrued interest) 2 A 05/11/2005 Checking Account No.235793-11, held at 4,037.92 50.000% 2,018.96 Members 1st Federal Credit Union,titled to Helen L.Schardin and Barbara S. Dawson ($0.12 accrued interest) 3 A 05/11/2005 Certificate of Deposit No.235793-40,held at 1,152.55 50.000% 576.28 Members 1st Federal Credit Union,titled to Helen L.Schardin and Barbara S. Dawson ($0.21 accrued interest)(opened 9/12/2006 by transfer of funds from Joint Account 235793 -11) 4 A 03/12/2007 Certificate of Deposit No.235793-42,held at 1,142.52 50.000% 571.26 Members 1st Federal Credit Union,titled to Helen L.Schardin and Barbara S. Dawson ($0.24 accrued interest) 5 A� 01/15/1992 Savings Account No.0050373109,held at 12,108.54 33.333% 4,036.18 Navy Federal Credit Union,titled to Helen L. Schardin, Barbara S. Dawson,and Marianne S. DeSoto Total of Continuation Schedule ee attached page TOTAL(Also enter on Line 6, Recapitulation) 24,579.68 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-7509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G. JOINTLY OWNED PROPERTY DESCRIPTION OF PROPERTY a LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT /o OF DATE OF DEATH ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECD�S DECED NT'S WTEREST NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST 6 A�Q 05/18/2005 Checking Account No.7003093031, held at 14,326.03 33.333% 4,775.34 Navy Federal Credit Union,titled to Helen L. Schardin, Barbara S. Dawson,and Marianne S. DeSoto 7 A�� 07/2005 Certificate of Deposit No.68000113738801, 11,800.90 33.333% 3,933.63 held at Navy Federal Credit Union,titled to Helen L.Schardin,Barbara S. Dawson,and Marianne S. DeSoto 8 A� 07/2005 Certificate of Deposit No.68000113738802, 9,275.06 33.333% 3,091.69 held at Navy Federal Credit Union,titled to Helen L.Schardin, Barbara S. Dawson, and Marianne S. DeSoto 9 A� 07/2005 Certificate of Deposit No.68000113738803, 16,614.16 33.333% 5,538.05 held at Navy Federal Credit Union,titled to Helen L.Schardin, Barbara S. Dawson,and Marianne S. DeSoto TOTAL(Also enter on Line 6, Recapitulation) 24,579.68 Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-7510 EX+(08A9) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 This schedule must be completed and filed rf 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.SATTACH A COPY OF TIHE DE�ED FOR REAL ESTATE. VALUE OF ASSET �NTEREST (�F APPLICABLE) VALUE 1 Prepaid funeral Contract with PNC Trust 1,582.59 100.000% 1,582.59 2 Prepaid funeral contract with NGL Insurance Co. 5,464.04 100.000% 5,464.04 TOTAL(Also enter on Line 7, Recapitulation) 7,046.63 (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) gCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MBER q, FUNERAL EXPENSES: See continuation schedule(s)attached 9,634.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Ziq Year(s)Commission Paid 2. Attorney's Fees Law Offices of Susan E. Lederer(estimate) 2,000.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 123.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 107.27 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 11,864.77 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 Schardin, Helen L. 21-13-0751 NUMBER DESCRIPTION AMOUNT Funeral Ex eq nses 1 Myers Buhrig Funeral Home 9,634.00 H-A 9,634.00 Other Administrative Costs 2 Harland Clarke(new checks) 22.96 3 FedEx and UPS 84.31 H-67 107.27 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-05) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 Report debts incurred by the decedent prior to death that remained unpaid atthe date of death,including unreimbursedmedical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alert Pharmacy(prescription bill) 113.13 2 Navy Federal Credit Union Visa(credit card final payment) 14.17 TOTAL(Also enter on Line 10,Recapitulation) 127.30 (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-1573 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Schardin, Helen L. 21-13-0751 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) o Not 'st T stee TAXABLE DISTRIBUTIONS [include outright spousal I. distributions,and transfers under Sec.9116 a 1.2 1 Barbara S. Dawson Daughter 25%of residual 12,690.92 3805 Pamay Drive estate; 1/2 of F1- Mechanicsburg, PA 17050 F4; 1/3 of F5-F9 2 Marianne S.DeSoto Daughter 25%of residual 9,486.16 2101 Patty Lane estate; 1/3 of F5- Vienna,VA 22182 F9 3 Patrick Schardin Son 25%of residual 601 Iris Street estate Altamonte Springs, FL 32714 4 Stephen Lee Schardin Son 25%of residual 24 Gavin Circle estate Andover, MA 01810 Total 22,177.08 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) ,( �� LAST WILL AND T�STAMENT OF HEL�N LUCILL� (GARRISON) SCHARDIN I, HELEN LUCILLB (GARRISON) SCHARDIN, a legal resident of the State '• of Virginia, being of sound and disposing mind and memory, do make, publish, and declare this to be my Last Will and Teatament, and hereby • revoke all other Wills and Codicils heretofore made by me. " FIRST: It is my will that all my just debts and funeral expenses � �: be fully paid. SECOND: I give, devise, and bequeath to my husband, ROY KENNARD . : SCHARDIN, JR., if he survives me £or a period of thirty (30) days, all of the property which I possess at the time of my death or to which I '.. may be entitled, real, personal and mlxed, and of avery kind whatsoever ' and wheresoever situated, absolutely and without restriction, lrnowing that he wi11 make adequate provision for the welfare and education of such children as may be born.of my marriage to the said ROY KENNARD SCHARDIN, JR. ox legally adopted by me during the continuance of such marriage. THYRD: In the event that my husband does not survive me for a period of thirty (30) days, I give, devise, and bequeath, absolutely and �' without restriction, all of the property which I possess at the time of my death or to which I may be entitled, real, personal and mixed, and of eveYy kind whatsoever and wheresoever situated, to my children, STEPHEN ; � LEE SCHARDIN of Manlius, New York, BARBARA JEAN (SCHARDIN) DAWSON of Chantilly, Virginia, PATRICK SCHARDIN of Alexandzia, Virginia, and MARIANNE (5CHARDIN) De50T0 of Alexandria, Virginia, and any children hereinafter born of this marriage or legally adopted by me duri.ng the : continuance of such marriage, equally, share and share alike, �er stirpes. • FOURTH: I nominate, constituCe, and appoint my husband as executor of Chis, my Last Will and Testament, and, as substitute executor, I nominate, constituCe and appoint my btother-in-law, CHARLES DAHL MARLER of Lancaster, California. I appoint both to serve without bond to the extent that any such requiremenC can be legally waived. FiFTH: My executor and subsCitute execuCor, hereinbefore named, sha11 have the power to buy and sell property of my estate, at public or private sale, for cash or credit, and otheiwi.se to invest and reinvast the funds in their hands, to loan or borrow money, to compromise claims against my estate, to convey, assign, encumber, pledge, mortgage, and . lease property of my estate, and deal generally with my propa=ty in the same manner and to Che same effect as Z could if I wera living, without � court order. ` IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed i ; my signature this c3/�"day of �i�J?�N1- , 1911� ' � `�/��..� ' .,.�,f_ ' : f ; ' The fozegoing instrument�was on the day of the date thereof, signed, :� • sealed, published, and declared by HEL�N LUCILLE (GARRISON) SCHARDIN, as : - and for her Last Will and TestamenC, in Che presence of us, the undeYSigned; who at her request and in her sight and presence, and in the sight and . presence of each other, have hereunto subscribed our names as witnesses, � ' and we hereby certify that at the time of execution hereof, we believe • the said testatrix to be of sound and disposing mind and memory. . �.y 'f�. - T'.ti- i'-� . , . �V•(�.1. .� , Yt�� Y y*Y,�� - 4�� u. . � . ��1 ��`�:h 'S .,"�,��5� �Y�C'.• 1 . . � �' � S l5 :Y��4`._ t3'�;"i r . . . � M1��'S 4 y:�:�1f . „>>.. . . +k•.x'. . __ �� r � �i .. .. �� k�ii� �� - � �' _,..� ��,�/�-1 . , � � � �� ADDRESS `' �� , r7 � : . �.G-�. -�/.. . v t - , /J r 1 � �ADDRES S / '��; �L, / a� ci.tC� . � l��^l� ��"% � �(' �c�i�� ADDRES5�� 7! dl �.O�.G�d.Y/U/��e�,�'�tw/ G/l✓ STATE OF COUNTY OF : W . -�ui ..c'✓.Fi�tiv , i .us�• . / and "j *� + the Ce5tatrix and the wit esses, respect vely, whose nam are signed to the attached or foregoing instrument, being firat duly sworn, do he=eby declare to tihe undexsigned authority that the testatrix signed and execuCed the instrument as her last will and that she had signed willingly . or directed another to sign for her, and that she executed 3t as her • free and voluntary sct for the purposes therein expresaed; and that each of the witnasses, in the pr2sence and hearing of the teatatr3x, signed the wil7. as witness and L-hat to the best of her lmowledge the testatrix, was at �hat time 18 or more years of age, of sound mind and under no , constraint or undue 9.nfluence. , � �_. ,� .d�.�..�- ��': T�STATRIX , (.GZ��• �, ITNESS . �� ` ',f-�- I'TNES� C �y} � ,� l/.�/.i //,,�i��•L.fC�'�L��i wzTNESs J :L�tn�ri'��/�• � Subs ibed, sworn to and acknowledged befoxe me � t� � ? `""' the st�txiicc, and�subscribed and swoxn bafox , � �u.rt- � a�„ .. .u�.�v , 19 �. ,! wit ss , this' day of � ' .. V }° �i e - � N A1tY PUBLIC Q �!� � i 1. My ommission expiYes� p`�' �� ; t ,� . � '. ; ; . ; 's ' 4 11 � . .. ,� '..�^'�^V 'r�'.tf {F�', ,�y„a � �+`�v��;�'��'. F�F �t�� , ' :;! r�...,� . • �;;`,�4 . ±rn.�.,�.,�"•,•_..,.�. . '��r . � . . �k-m... FIRST CODICIL TO LAS7 WILL AND TESTAMENT OF HELEN L. SCHARD,JL1 I, HELEN L. SCHARD{N,make this first Codicil to my Last Will and Testament dated May 31, 1979; 1. I hereby revoke Paragraph 4 of my said Last Will and Testament and substitute therefor a new Paragraph 4 which shall read as foilows: "4) I nominate, constitute and appoint my husband as Personal Representative of this my Last Wili and Testament and as Successor Personal Representative, I nominate,constitue and appoint my daughter, BARBARA JEAN SCHARDIN DAWSON,of Centreville,Virginia. I appoint both to serve without bond to the extent that any such requirement can be legally waived" In all other respects I confirm and republish my will dated May 31, 1979. IN WITNESS WHEREOF, I have signed this First Codicil,consisting of two pages,this page and the affidavit affixed to the end of this Codicil included on the a�'�day of , 1995. �� ,��.-� ` cs�,�� HELEN L. SCHARDIN We certif�,�that the above instrument was on the date thereof signed and declared by HELEN L. SCHARDIN, as a First codicil to Last Will and Testament dated May 31, 1979, in our presence and that we, in her presence and in the presence of each other, have signed our names as witnesses thereto, believing HELE�N,�t. SCHARD�F,to b�sound mind at the time of signing. .�~ �:.c.��f.-�/ � ' 2 OT� �� Residing at S� �� , Florida �� esiding at , Florida �esiding at , Florida STATE OF FLORIDA COUNTY OF MANATEE We,the undersigned, being the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, and having been sworn, do hereby declare to the undersigned officer that the Testatrix in the presence of witnesses signed the instrument as a First Codicil to her will,that she signed willingly and that each of the witnesses, in the presence of the Testatrix and in the presence of each other, signed the First Codicil as a witness. y��,+u � ��. ✓ ` � HELEN L. SCHARDIN �_ ` __ ,� I � �:�- _J�--�. WITNESS WITNESS � ,�,�,�.,' WITNE Subscribed and sworn to before me by HELEN L.SCHARDIN, and by each of the above witnesses on L,�.,,�:,�� , 1995, all of who are personally known to me and did no produce identification. OFFICIAI,NOTARY SEAL I,INDA ANN FARFr1,L � NO7'ARY I'UBLIC STA'I'E OF FLORIDA ��5� C,�� f,� C A CCh1MI5510N NO.CC315?�5 �• MY COMM155fON EXP. llNE 4,,s�n Linda Ann Farrell, Notary Public Lit�D� ANN F/aRRELL ` � ��6Si �� SE��.i. 1� �`,3{�+ +'1�$.�3 d .: .: ��' .'; y : 3 l4-7 � s,� •a .._...._. ' . �,.�...,;E��"`"`� uT , _. ,:: �,. .�: _ - , fI, y � '__' '."._—".'__'-_'__ _�__'^. '_ � J.�-'�'V?.ST�1�cti.L �� { i � i ; ' f ' � � ; � ��:-, ; .,—_ i ' � � , � � � � i � � o = ' � � tn" Zc� � a I � � ° ; � � � � I� o _m = �' ; � �. , o � o ° Q � m °, ; `- o � �- cnooa: `-° D � � ii p ; sv -p � c� o ao o ; � p � �. A� � O -" V � Q ; � O � cnn � � � -' _ ; `- O � �� 0 � W � � i � r � � � � � m :.� � ` r. � m -o <' �, � ; _ m y � o � � ; � ; 1 � � ; � I o Q . � c :. � _ � � - , _ � 0 �� ; � w t • � ° � � : r � � W �. p: c i , r {, � f r.l � ✓• j ' c a � � . r, ., � � W ' � Q� i ; - � � g •• 1 � " L1l � � , i 1 o . jt O � � . . . . y .. . ; � p� < � � . � � ' � � ! 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I ' � W '� � � �, ' : �" "i � N F � ; < �� '�' � p !: �'` � ; < , < I ` �1 W �_ � i ` i � � , � - ; : ; �� ,... , i {'.— �, Securih features inciuded.Defails on back--- � st `-;i.�;_ � i -� . =><- ,.�:,,,� �,,,.�,,_Y 1 f;�, � MEMBERS 15t FEDERAL CREDIT UNION I REGULAR SAVINGS ACCOUNT• Account Number/Suffix 235793-00 Date Account Established 09/24l2003 Principal Balance at Date of Death $76.57 Accrued Interest to Date of Death $,p� Total Principal and Accrued Interest $76.58 Name of Joint Owner Barbara S.Dawson Date Joint Ownership Establlshed 05i11/2005 L CHECKING ACCOUNT: Account Number/Suffix 235793-11 Date Account Established 09/24/2003 Principal Balance at Date of Death $4,037.80 Accrued Interest to Date of Death $,�2 Total Principal and Accrued Interest $4,037.92 Name of Joint Owner Barbara S.Dawson Date Joint Ownership Established 05/11/2005 j CERTIFICATE OF DEPOSIT: Account NumbedSuffix 235793-40 `1 235793-�i2 Date Account Established 09/12/2006" 03/12/2007 Principal Balance at Date of Death $1,152.34 $1,142.28 Accrued Interest to Date of Death $.21 $,Zq Total Principal and Accrued Interest $1,152.55 $1,142.52 Name of Joint Owner Barbara S.Dawson Barbara S.Dawson Date Joint Ownership Established 05/11/2005 03/12/2007 'Opened by transfer of funds from 235793-11. � M MB RS 1ST FEDERAL EDIT �..��_��' ��..�..� nielle A.Kline Lending Insurance Support Specialist 06/25/2013 Estate of: HELEN SCHARDIN Date of Death:05123/2013 Social Security Number: 307-28-8851 5000 Louise Dri�Te • P..O. Boa 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • �;�vw.memberslst.org �� BURE4U OF INDIVIDUAL TAXES Penns Iv � et111S lvania Po a z8o6o1 y ania inheritance Tax � p y '" ReISeURG PA 17128-0601 IllfOflllatlOfl NOtIC@ � DEPARTMENT OF REVENUE And Taxpayer Response RE�.1543 E=oo�czec con-i2� FILE NO.21 ACN 13130645 DATE 06-25-2013 Type of Account Estate of HELEN SCHARDIN Savings SSN 307-28-8851 Checking Date of Death 05-23-2013 Trust BARBARA S DAWSON County CUMBERLAND Certificate 3805 PAMAY DR MECHANICSBURG PA 17050-7675 MEMBERS isr Fcu provided the department with the information below indicating fhat at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.235793 Remit Payment and Forms ta: Date Established 09-24-2003 REGISTER OF WILLS . Account Balance $4,037.92 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $2,018.96 Tax Rate X 0.045 Potential Tax Due $90.85 NOTE*: If tax payments are made within three months of the With 5%Discount ax x 0.95 decedenYs date of death,deduct a 5 percent discount on the tax (T ) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed fo Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct,no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Se�ect correct tax rate at right,and complete Part � �2% I am a sibling of the deceased. 3 on reverse.) [� 15% All other relationships (including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed[o Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. � � BUREAU OF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � ennS lvania � "� Po z8o6o� v p y '� ISBUR6 PA 17128-0601 Information Notice � DEPARTMENT OF REVENUE And Taxpayer Response - "`"-154"°°"xE``°'_'Z' FILE NO.21 ACN 13130646 DATE 06-25-2013 Type of Account Estate of HELEN SCHARDIN Savings SSN 307-28-8851 . Checking Date of Death 05-23-2013 Trust BARBARA S DAWSON County CUMBERLAND X Certificate 3805 PAMAY DR MECHANICSBURG PA 17050-7675 MEMBERS i sr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.235793 Remit Payment and Forms to: Date Established 09-24-2003 REGISTER OF WILLS Account Balance $1,152.55 y COURTHOUSE SGIUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $576.28 Tax Rate X 0.045 Potential Tax Due �2g,93 NOTE*: If tax payments are made within three months of the With 5%Discount Tax x 0.95 decedenYs date of death,deduct a 5 percent discount on the tax � ) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART $te 1 : Please check the a 1 p ppropriate boxes below. A �No tax is due. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B �The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. _ Proceed to Step 2 on reverse. Do not check any other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.) of the deceased. (Select correct tax rate at right,and complete Part � �2��, I am a sibling of the deceased. 3 on reverse.) [] 15% All other relationships(including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Sfep 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. . �'� pByU�X 2806011VIDUAL TAXES Pennsylvania lnheritance Tax - � PennSyLVat11a /HARRISBURG PA n�za-o6o� . Information Notice ; DEPARTMENT OF REVENUE �� -- ' REV•15<3 EX DeeEXEG f0e-12) And Taxpayer Response FILE NO.21 ACN 13130647 DATE 06-25-2013 Type of Account Estate of HELEN SCHARDIN Savings SSN 307-28-8851 Checking Date of Death 05-23-2013 Trust BARBARA S DAWSON County CUMBERLAND X Certificate 3805 PAMAY DR MECHANICSBUR6 PA 17050-7675 MEMBERS isr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No.235793 Date Established 03-�2-2007 REGISTER OF WILLS Account Balance $1,142.52 1 COURTHOUSE SGIUARE Percent Taxable X 50 CARLISLE PA 17073 Amount Subject to Tax $571.26 Tax Rate X 0.045 Potential Tax Due $25,7� NOTE": If tax payments are made within three months of the decedent s date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct, no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any ofher boxes. � ❑The tax rate is incorreCt. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part � 12% I am a sibling of the deceased. 3 on reverse.) � 15% All other relationships(including none). p �Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. �(��.t,:��..Ln � l ��-,.,-�� `� _ % r11AVY • FEDERAL� Credit Union In reply refer to: 161t93o 18 June 2013 Mrs. Barbara S. Da��vson 3805 Pamay Dr _ Mechanicsburg, PA 17050-7675 Dear Mrs. Dawson: Un behall�of Navy �ederal's staff and membership, I wish to extend our heartfelt sympathy to ��ou and your family on the loss of your mother, Helen L. Schardin. We have completed setticment of her accounts and I hope that the followin� information is of assistance to you. On 23 May, your mother's savings and checkinb accounts refleeted balances � � �� ui'$12,l� 08.5� and $1�,326.03, respectively. Dividends credited to the savings since that date iiici•eased the ba1�111CC [0 `�12,I I I.S2 1S 0� E) TLlll�. Tl'a11SaCt10I1S OIl tlle CI1c;C�111` �CI;OLIIlt 5111�� that date resulted in a balance of$64,037.U2 as of� 11 Jtme. :�s the desi��natcd joint owners o1'ihe accoucits, you and }'our sis;er, Marianne S. Dc S�to, �ti; cntitled to the iunds. 'l�l:e savings balance has been tiansferred to the checking account. As requested, your nlother's checl:ing account was retitled in your name under your access numb�r oii 12 June; your sister rcmains the joint owner of ihis account. At the be�inning of 2U14, t�vo 1RS 1099 forms ��vill be generated; one will be issued in your moiher's name for 2013 dividends carned prior to the account bein�retitled and thc oth�r will be in your name for dividends earned on the account for the remainder ofthe ycar. -- Your mother also maintained certificates with Navy I�ederal. Un 23 May, her certiiicates h��c? the ,;.......� ,_..,.. ....:v�:l':� i.lii:�:.:,..�.�. Account Nurnber 13alaiice "� �xxxx��xxx��:01 $11,800.90 �. xxxxxxaxx�xx02 � 9,275.Uci , xxxxxx�axa:cx03 $16,614.16 �� "I'he certificates were rcdeemed without penalty and tl�e proceeds were transferred tc� thc r�titled checkin� account. On 23 May, your mother's Visa account had a balance of$122.56. The balance wa5 liqui��ated b}� a transrer fi•om her checkin� account on 6 June. The Visa account has been canceled. PO Box 3000 Merrifield VA 22119-3000 Access Number 1611930 Page 2 of 2 Your mother's accounts are now closed and the tinal statements will be forwarcled to your address at a later date. If you have any questions or need additional assistance, please do not hesitate to call me toll-fi-ee at 1-800-5�3-3323, extension 70817. You may also reach me by fax at 1-703-�SS-796�. Sincerely, Kiona Holley LL:11 �vz/o5/zVia wso ia: 51 sax �002/005 NAVy Feder$1 Cr�dit Union' NFCU Gram DYN(Mo,De�Y�� 02/Q6114 Accrss N0. 1611930 SavTnps I�bo. Oear Law Oiflce of Suasn [.Lede�r Thfs NFCU Gram is used instead of a typed letter so that we may expedite the settlement of Hetsn L Schar�ln ____ , 's Navy Federal account{�y, ❑ Please complete,sign,and return the foliowing: ❑ Estate ACCOUnt Saving�/Che<king Applieation(N�CU 406) ❑ Other ❑ The following documentt5)are required to continue ti�e process of closing the acmunt{s�: � ❑ Death Certificate ❑ DD9300/Casualty Report ❑ Estate�Executor)Papers � Affldavit O Court Document�ltetters of Admiri�tion � Other ❑ We are returning the for your records. ❑ ❑ � The U.S.'IYeasury/ � ha�have submitted a Notice of Retlamation in the amount af$ for--.—_. ._ � ❑ The full amount has been withdrawn from the account and will be returned ta t1-�e agency, � ❑ Tltere are InSUffiCient funds in the account t0 s�tisfy tlle ReClBmation.Pfease corrtad our otfite at the number listed below. ❑ A copy of the notice is enclosed. � Goed aftemoon.The check�ng account 7003093031 was apened on 05/18/2005 and savings account 0050373108 was opened an 01115/1982.The last statament printad Qut for�ccounts have b�en pravlded as well for Intereat and dlvldends purposes. Should you have any questions, please cal)the 0¢tedent Account5 Settlement Section 3t 1-800-883-33Z3,or loeally in metro Washington DC at 703-Z55-7363,weekdays 8:Oa am to 6:04 pm,Eastern 7ime.You may elso wntact us by f�ax at 703-255-7963 or by mail�t PO Box 30flZ,Merrifield,VA 22116. Ms I{qlley ext 7Q817_ Navy Federal[redit Union The Law Offlce of Susan E Lederer Altn:Jacky Mlndeck, Paralagal Fax#717-B52-7340 O 2011 Navy fetloral NFCU PC 3�9(J-1 t} S e�,�.�.�4 �:, (��.� i..� , -:` , !�i� ers _ : ,�..1 .uhra ._ y g Funeral:Hom� ,, Crerrtatory.„� June 2,2013 Barbara Dawson 3805 Pamay Drive Mechanicsburg,PA 17050 Dear Barbara: Thank you for allowing us the privilege of serving you and your family. We know that financial statements can be confusing, so below is a summary of your account. Statement of Goods& Services $ 10,974.00 Less: Contract Addendums (175.00) ' Less: Discounts from Funeral Home (1,165.00) ( Less: Estimated Payment from PNC Trust (1,582.59) 1, Less: Estimated Payment from NGL Insurance Co. (5,464.04) Your Balance Due b June 24,2013 $2,587.37 - We have enclosed a complete invoice for your records. Please call us at any time that we may be of service. With Warm Regards, ' � � � �� ..,��,� �/�J��''� �-'��f..�� C��,�C. -� /3� - jr��-, C-� i�-t Michelle L. Buhrig Treasurer �o'Z� ��S 7 3� Enclosure Walkii:g wit/r Tlrose in Grief Robert°'Bob"L.Buhrig,Jr.,F�,suPcrviso�•William"Bill"L.Christopher,FD Phone: t�i�i 766.3421 • Fax: �n��795J291 • 37 East Main Street • Mechanicsburg,PA 17055 • www.Myers-Buhrie.com • Directors(a.Myers-Buhrig.com iii} . �{,I{I/ f'�.{fi-- yyy��///�� I I�( It »';T"� �Pf El� � {�. .. � .....\ 4 �ti� . 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