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Home My WebLink About03-05-14 ��. _ ., � 1505610105 REV-1500EX�°z-"„F" � OFFICIAL USE ONLY PA Department of Revenue PennsyNania Bureau of Individual Taxes "`"p��`�� r Counry Code Year File Number PO BOX 28o6oi � INHERITANCE TAX RETURN n' ' � �,!,,� I Harrisburg PA 1�iz8-o6oi RESIDENT DECEDENT li y'e�-� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 08/18/2013 03/18/1926 DecedenYs Last Name Suffix DecedenYs First Name MI Calkins Dorothea L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI None 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 O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4.Limited Estate O 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousat Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Hiram B. Calkins III (717)697-4360 REGISTER OF WILLS USE ONLY � � .c— x First Line of Address Q = �? EXECUTOR �'{--, �' ��> Z--..: %� C,t � SecondLineofAddress ��.` � �'° �'� �3'`'i ��V'r:.. �'1 + C_'� 2151 Canterbury Dr. Oc';,, , ,,,a �,, City or Post Office State ZIP Code �ED Mechanicsburg PA 17055 �t� ;-=3 `��" � �i � CorrespondenYs e-mail address: hbC8lklnS@COmC2St.f16t 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 co lete.Declaration of prepar er than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR ON RESPONSIB O IL RN DATE �;�1J'T3 � 3 � ADDRESS �' 2151 nterbury Dr., Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 � �;.� . • � 15056102�5 REV-1500 EX(FI) DecedenYs Social Security Number oecedent's Name: Dorothea L. Calkfis RECAPITULATION 1. Real Estate(Schedule A). ...... .. .. ... .. .. ... .. .. .. ... ............... 1. H3,000.00 2. Stocks and Bonds(Schedule B) ........... ..... .. .. ... ............... . 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .... . 3. 0.0� 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.�� 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 73,221.70 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.�0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)........................... .. 8. 156,221.70 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 6,867.34 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)........ ... .... 10. 9,133.25 11. Total Deductions(total Lines 9 and 10).................... .... .. ... .. .. 11. 16,000.59 12. Net Value of Estate(Line S minus Line 11) .......... .................... 12. 140,221.11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ........... ............. 14. 140,221.11 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 140,221.11 16. 6,309.94 17. Amount of Line 14 taxable at sibling rate X.12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X.15 1g. �.�� 19. TAX DUE .... ..................................... ................ 19. 6,309.94 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (� $Ide 2 � 1505610205 150561�205 � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Dorothea L. Calkins __ _ _ _ _ _ _ STREETADDRESS C/O Church of God Home (resident from 1/1/2013 until death on 8/18/2013) . _ __ _ _ __ _ _ . __._. 801 N. Hanover St. CITY STATE I ZIP Carlisle PA ' 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,309.94 2. CreditslPayments A.Prior Payments __ 10,300.00 _--- - B.Discount 0.00 Total Credits(A+g) (p� 10,300.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 3,990.06 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ � c. retain a reversionary interest.............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after Juiy 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 tlates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the suroiving 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 disciosure 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 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. :,� � REV-1502 EX+ (12-12) � pennsylvania SCHEDULE A . DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Dorothea L. Calkins All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• TOWNHOUSE: 239 W.Willow St.,Carlisle PAr�176f� ' ��,�� ,� 83,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 83,000.00 If more space is needed,use additional sheets of paper of the same size. :�� . REV-i5o8 EX+(o8-iz) " �� : pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Dorothea L. Calkins Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �. CASH(Acct#163790:Members 1st FCU,5000 Louise Dr.,Mechanicsburg,PA 17055) Checking;(inclutles interest income 811113 thru 8118113) 9,646.57 Savings;aka"Money Management" (includes interest 811113 thru 8118/13 50,452.48 2. Refund from Church of God Home,801 N. Hanover St.,Cartisle, PA 17013 (breakdown below) 12,011.17 Security Deposit paid 6114113: 31 days @$2701day =$8370.00 RoomlBoardlCare 811911 3-813111 3: 13 days @$2701day =$3510.00 Refund Partial Day 8118113(day of death) _ $131.17 3. Misc Clothing(est) 400.00 4, Refund of Homeowner's Insurance:Liberty Mutual Grp,PO Box 52102,Phoenix,AZ 85702 95.00 ($173.63 paid by Estate Check#0053 on 9112113 prior to sale of 239 W.Willow St.$173.63 included as a debt on Schedule I.Refunded premium from sale on 1216113 thru end on term.) 5. Pro-rated refund of Property Tax on 239 W.Willow St.(see settlement sheets attached) 616.48 School Tax refund = $580.38 County Tax refuntl = $36.10 TOTAL(Also enter on Line 5, Recapitulation) $ 73,221.70 If more space is needed,use additional sheets of paper of the same size. ��.,�,�.�,�.�,�.: ��, .��-..� ...�.�,,.�,�,4�.,,<-�,�,��..._ .�_,..� :.. �� , . REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothea L. Calkins DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i' Balance of furneral expenses(after pre-paid amount of$11,100) 257.00 Ewing Brothers Funeral Home Inc 630 South Hanover St. Carlisle,PA 17013 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s)_ ___ __ _ _ _ Street Address _ City State ZIP _ Year(s)Commission Paid: _ _ 0.00 2. Attorney Fees: 0.00 3, Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.) Claimant Street Address City State_ ZIP Relationship of Claimant to Decedent _ _ 4. Probate Fees: 368.50 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 �• Settlement Expenses:Sale of 239 W.Willow St. ,Carlisle, PA 17013 Real Estate Sales Commission 4,980.00 Real Estate Broker Fee 225.00 Attorney Fee($150.00)&Notary Fee($5.00) 155.00 Real Estate Transfer Tax 830.00 WaterlSewer Bill(to Carlisle,PA for 4th Qtr 2013 thru 12/6/13) 51.84 TOTAL(Also enter on Line 9, Recapitulation) � 6,867.34 ,.� • REV-1512 EX+ (12-12) "�'�i�� pennsylvania SCHEDULE I �� DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothea L. Calkins 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• Medication(Bal.Due to:Alert Pharmacy Service Inc.,219 N.Baltimore St.,Mt Holly Sprgs,PA 17065) 192.48 2. Nutritional Suppliments for 8/1113 thru 8/18113(Bal.Due to:Church of God Home,801 N.Hanover St., 32.40 Carlisle, PA 17013) 3. Electric Bill for 239 W.Willow St,Carlisle PA 17013(PPL Electric Utilities,2 N.Nineth St., 14.33 Allentown, PA 18101-1179)Check#1059 issued 8112113,prior to death,&cleared 8/19113 4. Expenses/Maint of 239 W.Willow St.Carlisle PA from 8118/13(death)thru salelsettlement on 12/6/13 Natural Gas,4 months:(UG�Utilities,PO Box 13009, Reading,PA 19612-3009) 43.00 Electric,4 months:(PPL) 43.77 Water&Sewer,3rd Qtr 2013,paid by estate 10121113:(Borough of Carlisle,PA) 72.90 Homeowners Ins for 239 W.Willow for balance of policy term paid by estate 9112113 (Liberty 173.63 Mutual Ins Grp, PO Box 52102 Phoeniz,AZ 85072) NOTE: $95 of this paymt refunded after sale of property.That$95 is reFlected as an estate asset on Schedule E. 5. Nursing Home Bill:Room/Board/Care for 8/1/13 thru 831/13 PLUS July 2013 Suppliesllncidentals; 8,560.74 (Church of God Home,801 N.Hanover St.,Carlisle PA 17013) RoomlBoardlCare: 31 Days C�$270/Day = $8370.00 July Suppliesllncidentals = $190.74 NOTE: Paid via decedenCs Members 1 st Acct#163790 Check#1060 issued 8/12/13 prior to death.Check cleared 8/19113 after death.C.o.G.Home issued a refund to Estate for"un-used"balance and refund is reFlected as an Estate asset on Schedule E. TOTAL(Also enter on Line 10, Recapitulation) $ 9,133.25 If more space is needed,insert additional sheets of the same size. � � � REV-1513 EX+ (01-10) �,�i pennsylvania SCHEDULE � � DEPARTMENT OF REVENUE INHERIfANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Dorothea L. Calkins RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• Hiram B.Calkins III Son 1/3 2151 Canterbury Dr. Mechanicsburg,PA 17055 2. DebraA.Bressler Daughter 1/3 223 Faith Circle Carlisle,PA 17013 3. Linda C.Powers Daughter 1/3 639 West First St. Boiling Springs,PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1• N/A 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: i. N/A 0.00 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # 0.00 If more space is needed,use additional sheets of paper of the same size. �� N xr �^r ��+ `+ys^ " x ^�E -s s-,. ."�' "'� ��, r T ""t'rt.' t`�,°5`"`r'�.�z' �.._ . � � '+ F ��sti z� : � �f�' �. �Sr. ;-.s �, e r�g �' � j� l,� h `�"" a�"��'��"�` � Fe'�a; 4 � � � � � ,_��.� �,�.��;'� �._..,�_._ ,. ?"�'� w:� ..�� r' _ _ . . . . _ � '�_ .. . .. -- �l�e►'. � LAST WILL AND TESTAMENT OF DOROTHEA L.CALKINS I,DOROTHEA L. CALKINS,of 239 West Willow Street in the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding,do hereby make,publish and declare this as and for my Last Will and Testament hereby revoldng and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor or Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so, including all inheritance and estate and death tazes:�hich may be payabie on accoant af rny death:egardless of whether the assets upon which such taxes aze based are included in my probate estate. 2. All of the rest,residue and remainder of my estate,real,personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my husband, Hiram B. Calldns,Jr.,his heirs and assigns,to the exclusion of my children,bom and unborn,provided my said husband,Hiram B.Calkins,Jr.,shall survive me by a period of ninety(90)days. 3. Should my said husband,Hiram B.Calkins,Jr.,predecease me or fail to survive me by the aforesaid pefiod of ninety (90) days, then in such event all of the rest, residue and remainder of my estate,real,personal and mixed,and wheresoever the same may be situate,I give,devise and bequeath to such of my following named three(3)children as shall survive me by a period of ninety(90)days,their heirs and assigns,in equal shares,but should any of them fail to so survive me then the amount provided for such child shali lapse and be added to the shares of my other children so surviving. My three(3)childten aze Hiram B.Calltins,III,Debra A.Bressler,and Linda C.Powers. 4. I hereby nominate,constitute and apnoint my said husband,Hiram B.Calldns,Jr.,as : Executor of this my Last Will and Testament,but should he predecease me or fail to qualify or ; � cease serving as such,then in such event I nominate,constitute and appoint my three(3)children, or any of them,as altemate or successor Executors,my three children being Hiram B. Calkins, d III, Debra A. Bressler, and Linda C. Powers. I further direct that neither of them shall be 1 required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other j�isdiction. ' IN WITNESS WHEREOF,I have hereunto set my hand and seal to this my Last Will � and Testament written on one(1)page,this 6th day of January, 1993. ,' ' � �.e�-2eL��l2/.s� 6 , L"�L�1.�7.��SEAL) : Dorothea L.Calkins ' Signed, sealed, published and declazed by DOROTI�A L. CALKINS, the Testatrix above-named,as and for her Last Will and Testament,in our presence,who,in her presence,at her request,and in the presence of each other,have hereunto subscribed our names as attesting wimesses. {2�C-t.�,.�� , � ,�- . :� fl.-��H OF �0\-��rP�CR�BI�� t� ITtiESS(ESj �. � EGI�TER OF `tiILLS j-��==��;� �.°�- COi.JNTY, PE�`�;SYLV�.NIA -�, , . , . Estate of ��1� ,�1�,� °^� �-� �<� l (`^�i� '>-=' ,Deceased �L..r: � �r '.� �• it.,�.�, i and � (each)being duly qualified according to la�v, depose(s) and say(s) that she/he/they was/were well- ,- �. , acqliainted with W��'�� `�-y-� �-_ .- - �%°•a` � ; � �z `�� and am/are familiar with the handwriting and signature of the decedent, and that the signature of ; ;c;;',;�'�^,`��--- �� - `-��-'%'��°-� to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ._�i�:r��i�-� �.. ' -�;� '��f°_� is in his/her own proper handwriting. - --- _�—d ��t ��``r�—' v��...��---__� , t � � (Si;acuw�el (Signnrure) � ` �.,:;� L.i`1 � S � `\i�'. _''=ti:u: �`�L.T� v� (Srreet Address) (Street Address) ��p,,,,J� � ��1-� �f.iL�' � t �f � '� 3 (C�ty.State.Zip) (Ciry.Stnte,ZipJ j Execctted irc Register's Offiee Sworn to or affirmed and subscribed �'" 1��i before me this �'�� '� day o f ! '� �.,�1 e �� C��1'J (�� -` `\_ � c" �_ r� _ i��,�L Deputy zor R�egister of�1'ill l\ i,, . Form RW'•04 �ev. 10.13.O( �.�.� `�� _��I�� OF SL�ESC'��I'�G �S�'IT�ESS(ESj RcGISTER OF �VILLS ��_a��=��,�1n� �; COINTY, PE�'S�"LVA�L� Estate of�c�;�`f-��.�� ' �'� �� J�f� ,Deceased 3 � _� �, a 1 '`;' \ � ��...��-� C '.:�r i`,. `$',y .�•--� (Pr�rs�Name/sJ I � (each) a subscribing witness to the� Wlll ❑ Codicil(s)presented herewith, (each)being duly qualified according to law, depose(s) and say s that ..� �1�� was/were present and saw the above �/Testatrix sign the same and that �.�" ��}�° signed the same and that �-�J he l-�C signed as a witness at the request of the ��:/-�estatrix in her/�q presence and in the presence of each other. ; ,- ,,�. J -/-��`..��ii, °.n .'6��i � t�- ` �c:�_�'-- ��.�� . (Si nature) � , ��;?1>S!w1 i�� p�� `�, (SignattrreJ 7� i�,.l` ayy ,� �L � . � t�fJ''C`14i�� '�� (Sfree!Address) (S[reel AddressJ l� i e ,�;r� L��,i't'(��t;.,,. !"t%E,., � � '.i ''�, (Gty,Stale,Zip) d (Ciry,Srare,2ip) Execc�ted in Register's Office Execc�ted out of Register's O,ffcce Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed hefore me this day before rne this ��c::�a'' of , ! day , of r;4.; �; �_��" �;,� � � � .� r _, -j � �.� �t; �'.f` ,,:( ..�.._. ,� 'd%5'_�'\r��i,�%-`' i ;'-`� Depu,; fO-Feg'�;ero`�,�`.<is �o: :�' � P.��:ic _ � ?�1�� C:o^��r.is�ior E?:p;re�: iSgr.a,u;e a,�d Seai of'.�o:ary or o;;zr e-�:.�z';azi��e;;[o adTinis;e:oxths. Sho«dzte p`expi:a:ion ei;•io:a�'s Commissior.) NOTE: To be talcen by Gificer authorized co administer oaths. Plezse have present thz original or copy cf' �SiGi�5�4�,1`�4P�5F°�WWi��it�w1 Norn�uti�t Fornt RW-OJ rev. 10.13.Q6 N08ER1GFREY,Mol�tf�h� BoNtgh of<�tG�le�CtenDerlend�1rnnMplM AAy Comrniasnn E�irea.kv�e{�0l1 _� RENUl�tCIATION REGISTER OF WILLS ��Gz��7Z�ti!z.� COUNTY, PENNSYLVANIA Estate of F%,YJA��" �-- �-��/ti�� ,Deceased I ��,¢ � , ��€�<SC�=� , in my capacity/relationship as (Print Name) 7J�G,��y� of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to /-f/��Z�4 � c ��O��ii,�S � �-- 7� �� ' � �� 1� i�!I-�` ;;' _ ! Fir' i% ' �� /�i��//' -= J ,% ,r� � ;i ;`�'i > ' f.;-i ,�t,�'i �: , ,G, r�`r(��/ �.,_.__:,� :�— (Date) � ? (Signature) '/ �Z� �-�i%� �`ii�C'L� _ (Street Address) i �.�` `L-/�5�� i.� ,� d /�5 � (Ciry,S[ate.Zip) Executed in Register's Office Executed out of Re;ister's Of�ce Sworn to or affirmed and subscribed Before the undersia ed personally appeared the before me this day party executing this renunciation and certified of , that he or she executed the renunciation for the purposes stated within an this�_day of��:�; ,,, :�'r,�� ._— t ..`��Yx1� ` // i ! ..✓ � ,.�� `^-�� `-- �� r�%.�� ;� ✓� r�� '..=�'_�� Deputy for Register of Wills Notary Public My Commission Expires: (Signature and Sea!of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) �y,�{�p�Y1.VANtA NOTARiAL SEAL '1R18HA A L�SS.tl�ty R� ��P51 Form RIV-06 rev.10.13.06 ,. �. , r � ,,.�-..� ,,� . RENUlaTCIATION REGISTER OF WILLS ��'I��Lr9�t�i COUNTY, PENNSYLVANIA Estate of �'��i�� L - C��Z�S ,Deceased I�— L'��=v� L ° �Cti�G72s , in my capacity/relationship as (Print Name) ��T�'Z of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to t�✓i.��( �- ��i�v�s" �` � I I r ' a �� :.4..�G'-_- � `_�-�;� ��:� I 3 �' G ��u��'� � j.-�- (Date) (SignatuYe) �3�� .��s�r �T (Street Address) 1��C-%ic,�C c��',ii��-S� ` r� %�c�C, � (Ciry,State,Zip) Executed in Register's Office .8xecuted oui of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of , that he or she executed the renunciation for the purposes stated within on this 1:'�-�- day of �,��a t i��:' �C: I � , ��,� � ;� �: . ,� F 7'_,T�� !v�`..� , Deputy for Register of Wills Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ct�Mavw�tni oF PeNnrsY�vavra Notartdl Seal Dawn M.Zmuda,Plntary Pu�lic Mampden Twp,,Cumberland County Form RW-06 rev. 10.I j.06 �Y�Ommisston ExP�res]uly 21,2015 MEMBER,PENNSYLVANIA AS$pC[q7i0N OF NOTARIES �.� � .�,�-.�� -_ �-- � �.,� � �� .,,...,��.p,.,z,�. �. , _ . . � , �, — REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA �� , �� ARr, No. 2013- 00942 PA No. 2�- 13- 0942 Estate Of: DOROTHEA L CALK/NS (First,Middle,Lastl a/k/a: DOROTHEA L KEMPER La te Of: CUMBER AND�OUNTY Deceased Soci al Securi ty No: WHEREAS, on the 5th day of September 2013 an instrument dated January 6th 1993 was admitted to probate as the last will of DOROTHEA L CALKINS (Fi�sL Middle,LasU a/k/a DOROTHEA L KEMPER late of CARL/SLEBOROUGH, CUMBERLAND County, who died on the 18th day of August 2013 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certi fy tha t I have thi s day gran ted Le t ters TESTAMENTARY to: HIRAM B CALKINS lll who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fu11y appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 5th day of September 20�3. �� c, ,�C`, _,�',��;/'C�:``Z� } ,"� ,/�/ t,/'1.'�- Register of r ls i r�`� �-� �t,, � t�''. �'l�'� �f ! � (/, jLc: �... �,�-`�i eputy ,�. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) , : ,. _� , .. � �,.�- .,� , .�,s ..� �,� . :��,,�.:w,�. .��.�.-,�.- -�,-,�. .,��,.��.,��.��. . � .�_ � � RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 9/05/2013 Cumberland County - Register Of Wills Receipt Time : 08 :29 : 28 One Courthouse Sc(uare Receipt No. : 1075454 Carlisle, PA 17613 CALKINS DOROTHEA L Estate File No. : 2013-00942 Paid By Remarks : HMwRAM B CALKINS III _______ _________________ Receipt Distribution ------ ------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENER.AL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION _ _______10_00 CUMBERLAND COUNTY GENERAL FUN Check# 6480 $368 . 50 Total Received. . . . . . . . . $368 . 50 .._, . a ,.,_ .N.., ,,x._ .�. M--�. .� . .,:.. �-�--.�..en= . , ._ � _ . .,.4. :� . . .. .- ... .. . ... .. .,,.�,.-Ya. Register of Wills Cumberland County 1 Court House Square Carlisle, PA 17013 Subj: REV-1500 Inheritance Tax Return, Estate of Dorothea L. Calkins The following narrative provides background/explanatory information regarding the subject tax return and associated attachments. 1. For several years and through the end of calendar 2013, Members 1 St FCU issued their monthly account statements as of the 24th of each month even though earned interest was credited on the final day of each month. Accordingly, the enclosed August statement for Acct# 163790 is as of 8/24/13 (6 days after Death). Also attached, please find the closing statement for Acct# 163790 and the initial monthly statement for of Estate of Dorothea L. Calkins, Acct# 523327 covering the date that account was opened on 9/6/13 and through 9/24/13. For the purposes of Cash on Hand at death on Schedule E, I have used the balances provided by Members 1 St FCU on the PA REV-1543 EX forms signed and enclosed with these documents. 2. The Church of God Home established a monthly billing anniversary date of the 12th of each month. I assume this date was selected as my mother's 100 day Medicare Nursing Home coverage ended on 4/12/13. The Home bills for supplies/incidentals in a-rears. Therefore, the attached bill for August was issued circa 8/12/13 covering daily care charges for 8/1- 8/31/13 and July 2013 supplies/incidentals. A separate bill (attached) was issued to the Estate covering supplies/incidentals ($32.40) for the 8/1-8/18/13 period and this bill also references the $12,01 L 17 refund to the Estate (issued separately from the billing). The Home refunded the 1 month security deposit and pro- rated care costs for the balance of August 2013 as noted on the applicable REV-1500 schedules. Mother entered the Home on 1/1/13 after hospitalization for a broken hip, shoulder and rib after a fall on 12/8/12. 3. My mother suffered a small stroke in October 2007. After hospitalization and several months of rehab, she was never able to return to her townhouse/home at 239 W. Willow St, Carlisle, PA. However, she was unwilling to sell to the property even though she had directed the dispersal and/or disposal of her furnishings and belongings during 2008-09. The property remained vacant and empty until it was sold by the Estate on � 12/6/13. As it was vacant and unused, the attached electric bills reflect monthly minimum charges and the natural gas bills reflect minimal heating. Carlisle Borough water and sewer charges are flat quarterly rates. 4. At settlement on the sale of 239 W. Willow St, Carlisle, PA the Title Company involved required an Inheritance Tax pre-payment of$10,300.00 to insure conveyance of clear title. This is reflected in the attached settlement papers and a copy of the receipts issued by your office are attached.. 5. Prior to death, circa July 2013, a pre-paid funeral account was established with Ewing Brothers Funeral Home, Carlisle, PA in the amount of $11,000.00 and a credit of$100 (Cumberland County widow of a WWII vet) was also applied. Actual/final funeral costs were $11, 357 and the Estate was billed/paid the $257 balance due as reflected on the attached schedule(s). This bill is included as an attachment. 6. For reasons unknown, the Law Offices of Frey and Tiley never notorized my mother's Will when it was executed in January, 1993. Accordingly, Oaths of Subscribing/Non-Subscribing Witness(es) from the attorneys were required by your office when the Will was presented in August 2013. Copies of these oaths have been attached for your convenience. The Will designates both of my sisters as potential Executrix(s) in addition to myself. They both declined the appointment via the Letters of Renunciation, attached with the Will. 7. I have included copies of bills and others documentation related to expenses/deductions taken and cash infusions into the Estate Very Truly Yours, ? , �� iram B. Calkins III Executor, Estate of Dorothea L. Calkins 2151 Canterbury Dr. Mechanicsburg, PA 17055 . .. . .. . .. . . . .... ,:..... ,::: ... . . .._._ ... . :_. ... . _,.. . . "_,".. ._._.. .. ... . fortn HUD-1(3186)ref Handbook 4305.2 Previo.�editions are ibsolete q:��settlement Statement U.S.Department of Housing and Urban Development B.T e of Loan OMB A roval No.2502-0265 1. pFHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number 4. pVA 5. ❑Conv.lns. 2013-521CLINE is orm is umis e o 9ive you a s a emen o a ua se emen cos s. moun s pai o an y e se emen agen are s �+�. TitleExpress Settlement System C.NOte: Items marked"(p.o.c.)"were paid outside the closing;they are shown here for infortnation purposes and are not included in the totals. WARNING:It is a crime to knowingly make false statements to the United States on this or any other similar form.Penalties upon conviction can include a fine and imprisonment.For details see:Title 18 U.S.Code Section 1001 and Section 1010. D.NAME OF BORROWER: P.Terry Cline ADDRESS: 2128 Walnut Bottom Road Carlisle PA 17015 E.NAME OF SELLER: Estate of Dorothea L.Calkins ADDRESS: 239 W.Willow Street Carlisle Penns Ivania 17013 F.NAME OF LENDER: ADDRESS: G.PROPERTY ADDRESS: 239 W.Willow Street,Carlisle,PA 17013 Carlisle Borou h H.SETTLEMENT AGENT: Baric Scherer LLC,Telephone:717-249•6873 Fax:717-249-5755 PLACE OF SETTLEMENT: 19 West South Street Carlisle PA 17013 I.SETTLEMENT DATE: 1210612013 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 83 000.00 401. Contract sales rice 83 000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement char es to borrower line 1400 1 903.50 403. 104. 404. 105. 405. Ad�ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 106. Cit Itown taxes 406. Cit /town taxes 107. Count taxes 12106113 to 12131113 36.10 407. Count taxes 12106113 to 12131113 36.10 108. School Tax 12106113 to 06130114 580.38 408. School Tax 12106113 to 06130114 580.38 109. 409. 110. 410. 111. 411. 112. 412. 120.GROSS AMOUNT DUE FROM BORROWER 85 519.98 420.GROSS AMOUNT DUE TO SELLER 83 616.48 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 10 000.00 501. Excess De osit see instructions 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 16 541.84 203. Existin loan s taken sub'ect to 503. Existin loa�s taken sub'ect to 204. 504. Pa off of First Mort a e Loan 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 210. Cit Itown taxes 510. Cit Itown taxes 211. Count taxes 511. Count taxes 212. School Tax 512. School Tax 213. 513. 214. 514. 215. 515. 216. 516. 217 517. 218. 518. 219. 519. 220.TOTAL PAID BYIFOR BORROWER 10 000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 16 541.84 300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER g3 616.48 301. Gross amount due from borrower line 120 85 519.98 601. Gross amount due to seller line 420 302. Less amounts aid b Ifor borrower line 220 10 000.00 602. Less reduction amount due seller line 520 16 541.84 303.CASH FROM BORROWER 75 519.98 603.CASH TO SELLER 67 074.64 s�. l _ _ x e �.. _ , . ,..:- � . _.. .. .._. . rorm nuu-i�aiem�reT nan0000K va�o.t Previous editions are�bsolete PAGE 2 - - -- �1.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number.2013-52ICLINE SETTLEMENT STATEMENT TitleEx ress setUement S stem L. SETTLEMENT CHARGES Pa,io FROM PAIO FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice$83 000.00 6.000=4 980.00 BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. $ " 2 490.00 to ERA-NRT LLC SETTLEMENT SETTLEMENT 702, g 2 490.00 to Prudential Homesale Services Grou 703. Commission aid at Settlement 4 980.00 704. Transaction Fee to ERA-NRT LLC 195.00 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori inatiorr Fee % 802. Loan Discount % 803. A raisal Fee 804, Credit Re ort 805. Lender's Ins ection Fee 806. Mort a e A lication Fee 807. Assum tion Fee 808. 809. 810. 811. 900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to $ Ida 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000.RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. $ Imo 1002. Mort a e Insurance mo. Imo 1003. Cit Pro ert Tax mo. $ Imo 1004. Count Pro rt Ta�c mo. $ Imo 1005. School Tax mo. $ /mo 1009. A re ate Anal sis Ad'ustment 0.00 0.00 1100.TITLE CHARGES 1101. Settlement or closin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 150.00 1105. Document Pre aration to Baric Scherer LLC 1106. Nota Fees to Cash 5.00 5.00 1107. Attorne 's fees includes above items No: 1108. Title Insurance to Baric Scherer LLC 806.50 includes above items Na 1109. Lender's Polic 1110. Owner's Polic 83 000.00 -806.50 111 L 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed$67.00 �Mort a e$ •Release$ 67.00 1202. Cit ICount tax/stam s Deed$830.00 •Mort a e$ 830.00 1203. State Taxlstam s Deed$830.00 �Mort a e$ 830.00 1204. 1205. 1300.ADDITIONAL SETTLEMENT CHARGES 1301. Final WaterlSewer Acct 01064 to Carlisle Borou h 51.84 1302. Inheritance Tax Escrow to Re ister of Wills A ent 10 300.00 1303. Broker Fee to Prudential Homesale Services Grou 225.00 1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1903.50 16 541.84 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurete statemenl of all receipts and disbursements made on my account or by me in this trans�Ction.I�her certif ha have received a copy of the HUD-1 Settlement Statement / � � � �1. ,U �<- �� erry m ° r GG" saeo o a ins WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Seltlement Statemen hich I have prepared is a true and accurate account of this UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION Vansaction. I have caused or w' use the funds to be disbursed in accordance with this statement. CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18: J � U.S.CODE SECTION 1001 AND SECTION 1010. � ' "7 (_ I I SETTLEMENT AGENT: DATE: L Y1 1\ ,, �„� ,..�., F�. �. �, m� . -�, ��_ � _ ..�, S l� Send Inquires to: Stat@I71@Clt of Accounts 5000 Loulse Drive PO Box 40 Mechanicsburg,PA 17055 Jul 25, 2013 thru Aug 24, 2013 www.membersl st.org Main Switchboard: (800)283-2328 EZ Call: p17)697-4372 or(S00)283-4372 Account Number: 163790 � TDD: (717)697-5312 or(800)283-2328 e�A.5312 MEMBERS 1St TeleBraneh: (800)237-7288 Balances at a Glance: FEDERALCREDIT UNION Checking: 1 ,071 .37 9228 i Av 0.360 18455-9228 Savings: 5.53 � ��Ill��l��lll�i�ll��i�llllilll�l��i�iiili�ii�llll��iil��l,i�� Certificates: 0.00 DOROTHEA L CALKINS Loans: 0.00 ,,, HIRAM B CALKINS Ifl Money Management: 50,446.04 � C/O HIRAM B CALKINS III `� 2151 CANTERBURY DR Swipe 5 YTD Reward: 0.00 " MECHANICSBURG PA 17055 � Page: 1 of 2 � Your current Member Loyalty Rewards level is Titanium. Please read the enclosed insert regarding upcoming statement changes. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Ju/25 Ba/ance Forward 13,226.56 Jul 25 Check 001053 Tracer 0000218995 72.9Q- 13,153.66 Jul 31 Deposit Dividend 0.050% 0.29 13,153.95 Annua/ Pe�entage Y"ie/d Eamed 0.05U� from 07/0>/2013 through 07/31/20>3 Based on Average Daily Ba/ance of 6,729.04 Aug 01 Deposit by Check 266.23 13,420.18 Aug 01 Check 001054 Tracer 0000301858 11,000.04- 2,420.18 Aug 02 Deposit ACH XXSOC SEC 1,140.00 3,560.18 ID: 9031736042 CO: XXSOC SEC Aug 05 Check 001055 Tracer 0000303252 8.51- 3,551.67 Aug 09 Check 001056 Tracer 0000221304 321.30- 3,230.37 _._�;�-�2-- _ L3e�o�it-hh��rs 1st Onl�nR Transfer From She�e �04 7,500.(�? 10;730.37 Aug 13 Check 001058 Tracer 0021773242 60.55- 10,669.82 Processed Check - LibertyMutuallns TYPE: INSPayment ID: 9200608012 Aug 15 Check 001057 Tracer 0000210590 i{�t:'� . S 1,023.38- 9,646.44 Aug 19 Check 001060 Tracer 0000260426 — G�Ji�C{� c•� r a� �`r,�c{ � <,t .-�i.r�� 8,560.74- �,' 1,085.70 Aug 20 Check 001059 Tracer 0000259516 -� rPL � 14.33- � 1,071.37 Aug 24 Ending Ba/ance �1`'� � ��t�'�� 1,071.37 CHECK SUMMARY ✓ �''/- ,-��`°�"F Check # Amount Date Check # ;f,�t-»¢ Amount Date 001053 72.90 Jul 25 001057 1,023.38 Aug 15 001054 11,000.00 Aug 01 001058 60.55 Aug 13 001055 8.51 Aug 05 001059 14.33 Aug 20 001056 321.30 Aug 09 001060 8,560.74 Aug 19 8 Checks C/eared for 2>,Gl�i 1.71 --- Continued on following page --- �' S�; Send Inquires to: Main Switchboard: (800)283-2328 5000 Louise Drive EZ CaIL• (717)697-4372 or(800)283-4372 Jul 25, 2013 thru Aug 24, 2013 ;.�� . � Po eoX ao TDD: (717)697-5312 or(800)2832328 ext.5312 16456-93Y8 Account Number. 163790 Mechanicsburg,PA 17055 MEIv1BERS 1° TeleBranch: (800)237-7288 Page: 2 of 2 � �RM�� www.memberslst.org SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction Descri tion Additions Subtractions Balance ✓u/25 Ba/ance Forward 5.53 r Aug 24 Ending Ba/ance 5.53 N N 0005 - MONEY MANAGEMENT � " Date Transaction Descri tion Additions Subtractions Balance ° Ju/25 Ba/ance Forward 57,931.34 fi Jul 31 Deposit Dividend Tiered Rate 14.70 57,9�� Annua/ Pe�centage Yield Earned 0.250� from 07/0>/20>3 through 07/3>/20>3 Aug 12 Withdrawal Members 1st Online Transfer To Share 00 7,500.00- 50,446.04 Aug 24 Ending Balance 50,446.04 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.00 0005 MONEY MANAGEMENT 173.32 0011 CHECKING ��29 Total Year To Date Dividends Paid 199.45 NOTE: Total includes closed shares Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a resutt, we need to be able to verify your ident�ty immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and unders�anding. . � Statement of Accounts �� Send Inquires to: 5000 Louise Drive PO Box 40 `"�- � "`•` Mechanicsburg,PA 17055 Aug 25, 2013 thru Sep 24, 2013 �� www.memberelst.org � �� ' Main Switehboard: (800)283-2328 �"`� �-` ��' EZ CaIL• (717)697-4372 or(800)283-4372 Account Number: 163790 �` TDD: (717)697-.5312 or(800)283-2328 e�.5312 y��;_ � TeleBranch: (800)237-7288 MEMBERS 1St Baiances at a Glance: Checking: 0.00 FEDERALCREDIT UNION Savings: 0.00 12475 1 AV 0.360 24949-12475 � ��II��II��I��I��I�I��II��I��I��I�I��I��I�II�� Certificates: 0.00 �� DOROTHEA L CALKINS Loans: 0.00 N HIRAM B CALKINS III Money Management: 0.00 C/O HIRAM B CALKINS III Swipe 5 YTD Reward: 0.00 `° 2151 CANTERBURY DR � MECHANICSBURG PA 17055 Page: 1 Of 2 � Your aggregate balance as of September 1st is $51,534.39. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. Please read the enclosed insert regarding upcoming statement changes. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Descri tion Additions Subtractions Balance Aug 25 Ba/ance Forwa�d 1,071.37 Aug 31 Deposit Dividend 0.050% 0.17 1,071.54 Annua/ Pe�centage Yie/d Earned 0.05U�from 08/01/2013 fhrough 08/3>/20>3 Based on Average Daily Ba/ance of 3,922.47 Sep 06 Withdrawal Transfer To Share 0000 1,071.54- 0.00 CHECK/NG C/osed "'This is the fina/ sfafement p�esenting info�mation on this product"' ��I�S� "' P/ease �etain fhis 6na/ statement for tax reporting purposes "' /�G'T g�,,,� SAVINGS ACCOUNTS OOuO -R.F�+ULHR 5,�.+��t�c:,� Date Transaction Descri tion Additions Subtractions Balance �. � .s Aug 25 Ba/ance Forward Sep 06 Deposit Transfer From Share 0011 1,071.54 1,0�'/?-OT�� Sep 06 Deposit Transfer From Share 0005 50,459.05 51,536.12 Sep 06 Withdrawal 51,536.12- 0.00 REGULAR SAVINGS C/osed � .� t� ""This is the fina/ sfatement p�esenfing information on fhis product"" � "* P/ease �etain this fina/ sfatement fo� taY reporfrng pu�poses "' �,� ,�'��J�� 0005 -MONEY MANAGEMENT Date Transaction Descri tion Additions Subtractions Balance Aug 25 Ba/ance Forward 50,446.04 Aug 31 Deposit Dividend Tiered Rate 11.28 50,457.32 Annua/ Percentage Yie/d Eamed 0.250�from 08/0>/20>3 through 08/3>/2013 Sep 06 Deposit Dividend 1.73 50,459.05 Annua/ Percentage Yie/d Eamed 0.250�from 09/01/2093 fhrough 09/05/2013 Sep 06 Withdrawal Transfer To Share 0000 50,459.05- 0.00 �� sA�d�n�6�� --- Continued on following page --- �� r Mechanicsburg,PA 17055 Sep 06, 2013 thru Sep 24, 2013 www.membersl st.org Main Switchboard: (800)283-2328 .�-_: ' � EZ CaIL• (717)697-4372 or(800)283-4372 Account Number: 523327 TDD: (717)697-5312 or(800)283-2328 e�.5312 ' � TeleBranch: (800)237-7288 MEMBERS 1St Balances at a Glance: FEDERALCREDITUNION Checking: 63, �52.88 14015 i Av 0.360 2eoz9-i4ois Savings: 5.00 � „I��III��1�1��1��1��1��11��1�11��111��11�11�� Certificates: 0.00 �� DOROTHEA L CALKINS ESTATE Loans: 0.00 N� C/O HIRAM B CALKINS III Money Management: 0.00 2151 CANTERBURY DRIVE SWI e 5 YTD Reward: 0.00 `°�� MECHANICSBURG PA 17055 p Page: 1 of 2 x Please read the enclosed insert regarding upcoming statement changes. CHECKING ACCOUNTS ��.c �,��3�� 0011 -CHECKING Date Transaction Descri tion � Additions Subtractions Balance Sep � Ba/ance Forrvard 0.00 Sep 06 Deposit 51,531.12 �� $ 51- 51,522.61 Sep 10 Check 000051 Tracer 0000282549 �.' Sep 10 Check 000052 Tracer 0000250906 ,�' �[.� /Qt�'�� - ---�192.48- 51,330.13 Sep 17 Check 000053 Tracer 0024351834 ,/ ,�� °"�173.63- 51,156.50 Processed Check - LibertyMutuallns �<< TYPE: INSPayment ID: 9200608012 Sep 19 Check 000054 Tracer 0000322597 � 14.79- 51,141.71 ,�—`:'}Se 23 De osit b Check � ra � '/ 12,011.17 �ry 63,152.88 P P Y C��= P� i�� ,�t� — Sep 24 Ending Ba/ance �`L � /' 63,152.88 �� ,Br� CHECK SUMMARY C:�eck � fi��c;;r�: uaia Check # Amount Date 000051 8.51 Sep 10 000053 173.63 Sep 17 000052 192.48 Sep 10 000054 14.79 Sep 19 4 Checks C/ea�ed fo� 389.4> SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Sep O16 Ba/ance Forwa�d 0.00 Sep 06 Deposit 5.00 5.00 Sep 24 Ending Ba/ance 5.00 YTD SUMMARIES � TOTAL DIVIDENDS PAID �" �� 1r�� 0000 REGULAR SAVINGS 0.00 {v�- d --- Continued on following page --- .,;-,� � �� o�� o 00000000000000000000000000 m oo � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� m O NNN � �-+ �+►-� F-+ ►-+ ►r�+ 000000p 0000000 �+ � p �+ NOO �IA WN►-+ OOO �DOOOO �IO� Vi �AAW NNNN �+ �I D N cn � �� `�� .� m �p � N N N N N N N N N N N N N N N N N N N N N N N N N N N m Z � m O O O O O O O O O O O O O O O O O O O C O O O O O O O F�+ I--� 1�+ Y�+ Mr N+ H+I� I� r� 1� H+ N•+ M-+ H+ 1--� 1-+ ►�+ F�+ Mr F+ H+ Fr Y�+ ►�+ Mr N+ Z W -ZI W W W W W W W W W W W W W W W W W W W W W W W W W W W D � z r � �x� 7dx�7 � � � � 7d7d � 7d7c7c7d � � � � �oy7� b � � C/1 A� Q„ �. �'to te te re t� p., � t� tfl t9 efl t� to �' tfl te G. � "'j � � b� Q� (A CA CA Vi VJ 'C/� CA � Vi V1 V1 V1 Q� Vi CA 'Q� V1 'C m �• � a � v�"", � C C � C C � v��,i C C �' � C C C � C G � v�""�, vR C � � � � 'C7 r7 n! i"! n"1 ►! � "! n't �"! ►! �! �'S 'CS �! ►! � � i�' � � 1Q ".� C �+ � O A A A A A � A A � A A n r! 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M > > 9 > D > 9 a a D rtl 7C T� r A T !" 2' -C -G { { .� { .G � •C z a r �� C7 � rf'f333333333m� Z � � n rts 7C M m m m m m m m m m m E y n � � a z zrzzzzz � zzza > a < � '� � 47 D -i -i 1 -� -� -i -� 1 -1 r-� ('f r 1 � y ; z a c° m N � � � � � � � � � � o z a n N r Z m O 1 1 -� -I 1 1 -i 1 -I m 2 N -1 _ > -1 N222SSSSSSS3 t�l z :� aasaaana �-i O 3 � c� irtZZZZZZZZZC m rrs x m o m s� R 7C x 7s S 7� F 7s 3 � � n � 00 « �[ � �G �G « � � � si-+ � 000000ao �-+ � -i �iCCCCCCCCC '9 y m T � T � i Z i � � Z �� m � � N N �+ O � \ z �C� -i � i Z � mlr�-. . � N � � W m �z m -+ I o �°n m H .T�. Z � < Z ti � � I C � � � � o � � �' o � � tv � m A � � c'm7 0 ,n V � � Y o � � \ G � f'' I ° r r m � o * m = p W W N O * f'f p�p n n Oa I � � * D p� 7C p. 2 T N OD N�O F+ C � N 3 ~ �-�I ~ 7�0 V � �O p F i O� O Fr �D W �0 �+1 Q� T Q+ T T 0� O+ �►1 N a W C 17� N IJI W o O o O o 0 o R• N 3 . I� O O O O+ VI lil V1 li1 VI Uf lJf U1 O C - � o oe W ViFt7fFVfi� lntno 2 t� c� c� t� � � t� nt� r� � a � � a a � � � a z A � O m � � oo rn O 7C N 7� N Z � O �. r I � � 0o m � �^ �I w ' L�—� .�-.w "-s--� �..,..:.r., .. .,�..�_:.._.�+ ..-nr.-,�. _ i.c�..cs--_:--s._=='sa+%�#`—'.eur-a.:, x. ., w,-�er. ...� ... .... . ... .. ... .. -. .... ... ... .. ,__ .. � r � �. eral Home Inc. �� Ewing Brothers Fun , , �!�� 630 South Hanover Street �'� 1' Carlisle, PA 17013 �� (717)243-2421 ` �� 1 . � q August 26, 2013 1� � � 1—° � Hir�atn B. Call<ins (� �, �� 2151 Canterbury Drive ��' Mechanicsburg, PA 17055 �4 ''s The Funeral Service for porothea L. Calkins We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN tTGMIZ�D STATEMENT OF THE SERVICGS,FACILITIES,AUTOMO'I'IVEi GQIJIPMENT. AND MER�HANDISL-'"I'I-IAT YOU SELECTED WHEi�ViAKIivi�THE FUNERAL ARRANGEMENTS. Professional Services Basic Services of PA L.F.D. 1,300.00 Bathing and Embalming 895.00 Other Preparation of Deceased 295.00 Basic Use of Facility 250.00 Documentation Prep/Recording 325.00 FD/Staff for Interment Service 125.00 Total Pi-ofessional Services 3,190.00 Gquipment Transfer Deceased to Funeral Home 295.00 Hearse Usage 295.00 Utility Vehicle 135.00 -------------------'�2�.�Sa---- Total �quipment Merchandise Magnolia Poplar Casket 3,150.00 American ChiefOBC 1,695.00 Memorial Folders 85.00 -----------------�;�3�:6�1---- Total Merchandise Selected AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Cemetery Charges/Grave Open&Close 1,906.00 The Sentinel Obituary 175.60 Clergy Honorarium 200.00 Death Certificates 30.00 Flowers 159.00 -----------------2;4�a:b0----- Total Cash Advances SAL�S TAX 0.00 /'�� ' � ��q�0� SUB-TOTAL 11,31�.60 l � INITIAL PAYMENT/DISCOUNT/CREDITS 11,100.00 � '.��o� , (.U/*S �Gt�..-1., G�% TOTAL AMOUNT DUE 215.60 �C�f � ��-�_il `�/. Y° �" '�G i il� /.�l.c,� = ,,2..S .. C �✓ � - �� The unpaid balance over 30 days is subjected to a 1 %service charge per month- 12°io per annum. �.—.— �e ,--—_—_.— .—_— — —___. _—_—_—— —_—_ _ — ------ __ — _ ; _—_ ! 0 W �� I O O O O O O O O O O O O O O O O O O O � O O O O O p O � � '_O OD 00 0� OJ 00 00 00 W 00 00 W 00 00 00 OD OD 00 07 OD 00 00 Q] OD OD 00 OD 0� D N �I ' I � �� ^. �� ' '� ~ y N t-+ I-� N N o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0�� ; r • I I � O 00 W N F-' W �l U7 Ul Ui U1 U1 Ul Ui Ul UI Ui U7 Ui U1 U1 U1 Ul V1 Ut F-' I-' C� I�� w W:� ' \ \ \\ \ �\ \\ \\\ \ \\ \\ \ \\\ \\ \ \ \ \� = O �I � 1-� 1--� I-� F-� f-' N 1-' t-+ !-� V-+ .I-� F-� F-� F-+ F-� F-+ 1-� I--� f-� I--� F-' t-� I-� F-� I-+ t-+ t-�l H �. D S1� , i W W W W W W W W W W W W W W W W W W W W W W W W W W W C � ;17 3 � � �' H , D �' ! 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D � O Q � l0 � � O l0 � • ~ � � * � � � * � �� ""°F �' 1-� p E � � 3i i�� >; � .r ,�.�� .��,.,,.�;.�,�.�.� � � ��.�.�,..=�.�..�� .- �.��, y� � . ._ � . ._�.,.� .�. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.28060� HARRISBURG,PA 1 7 7 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018496 BARIC SCHERER 19 WEST SOUTH STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER '_____" told _______"_ 101 � S 10,300.00 ESTATE INFORMATION: SSN: 2os-�2-�4s2 � FILE NUMBER: 2113-0942 � �ECE�ErvT rvannE: CALKINS DOROTHEA L � DATE OF PAYMENT: 12/06/2013 � POSTMARK DATE: 1 2/06/201 3 � CouNTV: CUMBERLAND � DATE OF DEATH: 08/1 8/201 3 � � TOTAL AMOUNT PAID: 510,300.00 REMARKS: CHECK# 01941 1 INITIALS: DMB SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ' � BUREAU OF INDIYIDUAL TAXES Pennsylvania lnheritance Tax � pennsylvania Po BOX 280601 DEPARTMENT OFREVENUE HARRISBUR6 PA 17128-0601 Information Notice . , , � REV-1543 E%DocEXEt<OB-12) And Taxpayer Response FILE NO.21 —/?j-��- ACN 13145514 DATE 08-28-2013 Type of Account Estate of DOROTHEA L CALKINS Savings SSN 209-12-7482 X Checking Date of Death 08-18-2013 Trust H I RAM B CAL K I NS I I i County CUMBERLAND Certificate 2151 CANTERBURY DR MECHANICSBUR6 PA 17055-5769 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. 163790 Date Established 11-03-2006 REGISTER OF WILLS Account Balance $9,646.57 1 COURTHOUSE S(1UARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $4,823.29 Tax Rate X 0.045 Potential Tax Due $217.05 NOTE*: If tax payments are made within three months of the decedenYs 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. 1 A �No tax is due. 1 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 Potentia/T�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. C �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. Comp/ete 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. • BUREAU oF INDIVIDUAL TAXES Penns Ivania lnheritance Tax � pennsylvania PO BOX 280601 y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE REV-1543 E%UocE%EL (OB•12) And Taxpayer Response �� FILE NO.21 '��3��-ir��- ACN 13145513 `� � DATE 08-28-2013 Type of Account Estate of DOROTHEA L CALKINS Savings SSN 209-12-7482 Checking Date of Death 08-18-2013 Trust H I RAM B CAL K I NS I I I County CUMBERLAND Certificate 2151 CANTERBURY DR MECHANICSBUR6 PA 17055-5769 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.163790 Date Established 06-28-2000 REGISTER OF WILLS Account Balance $50,452.48 1 COURTHOUSE SGIUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $25,226.24 Tax Rate X 0.045 Potential Tax Due $1,135.18 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 tau due will become delinquent nine months after the date of death. PART St@p 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 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 other boxes. C �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. Comp/ete 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.