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HomeMy WebLinkAbout05-02-14 (2) 1505610143 REV-1500 EX(02-11) CSJ�_ Pennsylvania PA Department of Revenue OFFICIAL USE ONLY Code Year File Number Bureau of Individual Taxes ee vr =.a*.eorasver+oe County PO BOx.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 13 13a3 ENTER DECEDENT INFORMATION BELOW 11 29 2013 03 22 1921 Decedent's Last Name Suffix Decedent's First Name BOYER MI MAUDE R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 1243-82) ❑ 4. Limited Estate I—I 4a Future Interest Compromise El LI (date of death after 12-12-82) 5. Federal Estate Tax Return Required LJ 6. Decedent Died Testate 7 Decedent MaintainetlaLiving Trust (Attach Copy or wup ❑ (Attach Copy of Trusty -- 8. Total Number of Safe Deposit Boxes ❑ 9. Litigation Proceeds Received ❑ 1o. Spousal Povertyv Credit(Date of Death between 12-31-91 and 1-1-95) ❑ 11.Election to lax 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 F CHRISTOPHER SPINA ESQ 412 281 3550 N O REGIS' R@F WILLS SE ONL`j 03 a O First Line of Address !'n �J 1002 FIFTH AVENUE r — rn tv nM i>- GO 77 7J O Second Line of Address ' ;' C> O O G7 CD L 7T n C> O C � � n City or Post Office SKE FILE"? M State ZIP Code PITTSBURGH PA 15219 Correspondent's e-mail address: fCSeinaespinalawpc 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 tru co ct and complete.Declaration of preparer other than the personal representative rs based on all infor�dh preparer has any knowledge. SIGN OF PERSON RESPONSIBLE FOR FILING RETURN DATE �XT2 Karen L Boyer A-/ ADDRESS 1001 Connor Road SIGNJyRE EPA ER OTHER REPRESENTATIVE DATE F. Christopher Spina Esq. a2 / ADDRESS 1002 Fifth Avenue, itt burgh, PA 1505610143 Side 1 1505610143 1505610243 REV-1500 EX peceacm's Name: Boyer, Maude R RECAPITULATION - 1. Real Estate(Schedule A). .................... 1. 2. Stocks and Bonds(Schedule 6). .. ........� 2. 235, 447 . 49 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. 45 , 868 . 60 6. Jointly Owned Property(Schedule F) ❑ Separate Billinq Requested............ 6. T Inter-Vivos Transfers&Miscellaneous on-Probate Property (Schedule G) Separate Billinq Requested......:..... 7, 8, Total Gross Assets (total Lines 1 through 7)............_..........._..__................_..... 8. 281 , 316. 09 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 29 , 466. 88 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)........ ................... 10. 530 . 02 11. Total Deductions(total Lines 9 and 10)............................................................... 17. 29, 996 . 90 12. Net Value of Estate(Line 8 minus Line 11)... . 12. 251 , 319. 19 13. Charitable and Governmental Bequests/Sec 9713 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. 251 , 319. 19 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES -- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable atlinealrateX .045 251 , 319 . 19 16. 11 , 309 . 36 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE.......... .....................................................................................I................ 19. 11 , 309. 36 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 Fite Plumber 21-13 Decedent's Complete Address: DECEDENT'S NAME Boyer, Maude R STREETADDRESS 770 South Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits; I. Tax Due(Page 2,Line 19) (1) 19,309.36 2. Credits/Payments A. Prior Payments 10,000.00 B. Discount 526.32 Total Credits(A +B) (2) 10,526.32 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 783,04 Make_Check PaVabie to: REGISTER QF 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;..... ........... .................... ❑ It. retain the right to designate who shat(use the property transferred or its income;.............. ............ ...... xi c. retain a reversionary interest;or......................................................._...................................................... .� d. receive the promise for life of either payments,benefits or care?...... .............. x 2. If death occurred after Dec. 12, 1962, did decedent transfer property within one year of death without receiving adequate consideration?........................................................L,...........................................I............. ❑t- FXJ 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... 0 (_� 4. Did decedent own an individual retirement account,annuity,or other nori-probate property which � contains a beneficiary designation?..........._....._..._.........._................_...._.......__......................................... ❑ Lzl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(1)). 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 The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent 172 P.S.§9116(a)(1.2)), • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 172 P.S.§9116(a)(1)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 17 P.S.§9116(a)(1,3)J. 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-1503 EXt(6-98) SCHEDULEB STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER. Boyer, Maude R 21-13 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 1 Edward Jones Mutual Fund Account#XXXX0113 60,799.52 2 591568108 35 shares of Metlife Inc -Com 52.42 1,834.70 3 744320102 37 shares of Prudential Financial Inc -Cohn 89.3 3.304.10 3.304.10 4 186 shares of The Frog, Switch &Manufacturing Company- 845 Common Stock Certificate No. 1110 157,170.00 5 Anchor Financial Group -Bonds Acct. No.XXXX8476 12,339.17 TOTAL(Also enter on Line 2, Recapitulation) 235,447.49 (If more space is needed adtlitional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. - Form PA-1500 Schedule B(Rev.6-98) a��-1508 EX,(11-1o) SCHEDULE E DEPARTMENT OF REVENUE pennsyNani CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Boyer, Maude R (FILE NUMBER 21-13 Indude the proceetls of litigation and the date the proceetls were received by the estate. All Property jointly-owned with the right of survivorship must be disclosed th schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Edward Jones Account No. XXXX0113 OF DEATH 9.981.20 2 Anchor Financial Group-Brokerage Money Market Acct. No.XXXX8476 21,514.33 3 Cetera Advisors, LLC -Balance on account 89.75 4 M&T Bank-Cash in bank 3.000.00 5 M&T Bank 31.17 6 Coins Inc. d.b.a. Treasure Hunt-Value of Coins 495.46 .7 Household Furniture and Furnishings and personal effects 2,500.00 8 AARP -Refund of Premium 236.25 9 Aflac- Refund 47.54 10 State Farm Fire and Casualty Company-Refund 52.90 11 Westminister Cemetery-Prepaid funeral 7,920.00 TOTAL(Also enter on Line 5, Recapitulation) 45,868.60 (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) RSV-1511 EXe(40-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF Boyer, Maude R FILE NUMBER 21-13 ITEM Decedent's debts must be reported on Schedule 1. NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s)attached 4,386.08 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions - Name of Personal Representative(s) Karen L Boyer street Address 1001 Connor Road City Pittsburgh State PA Zio 15234 Year(s)Commission Paid 7,000.00 2. Attorneys Fees Spina Law Associates, P.C. 17,000.00 1 Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees See continuation schedule(s) attached 438.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedules) attached 642.30 TOTAL(Also enter on line 9, Recapitulation) 29,466.88 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 Boyer, Maude R FILE NUMBER 21-13 ITEM NUMBER DESCRIPTION AMOUNT Funeral�m 1 Hoffman-Roth -Funeral 1.691.08 2 Mark D. Heintzelman Funeral &Cremation Services-Balance due 370.00 3 Mark D. Heintzelman Funeral Home-Funeral and cremation services 2,325.00 H-A 4,386.08 Probate Fees 4 Department of Court Records-Transfer fees to Cumberland County 25.00 5 Register of Wills Cumberland County-Probate 123.50 6 Register of Wills Cumberland County -Additional Probate Fee 290.00 H-B4 438.50 Administrative Costs 7 Cumberland Law Journal--Advertising 75.00 8 Karen L. Boyer-Reimbursement of coin appraisal 75.00 9 Register of Wills Cumberland County-Filing Receipt 5.00 10 Spina Law Associates, P.C.-Costs 424.20 11 The Sentinel -Advertising 63.10 H-67 642.30 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX«(12-08) SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF Boyer, Maude R (FILE NUMBER 21-13 Report debts incorred by the decedent prior to death that remained unpa cl id at the date of death,inudin ITEM 9 nnreimbursed medical expenses. NUMBER DESCRIPTION VALUE AT DATE 1 Alert Pharmacy-Medical expense not covered by decedent's health insurance OF DEATH 21.39 2 Chapel Pointe at Carlisle-Ambulance Membership 231.88 3 Cumberland Goodwill Fire Rescue EMS-Ambulance 83.85 4 First Church of the Brethren -Pledge made by decedent 192.90 TOTAL(Also enter on Line 10, Recapitulation) 530.02 Copyright(c)2008 form software only The(if more j,Gre is Group, Inced,additional pages of the same size) Form PA-1500 Schedule I(Rev. 12-08) TIFY 1513 EX.(07-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT BENEFICIARIES ESTATE OF _L_� Bo er, Maude R FILE NUMBER 21-13 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY DECEDENT J TAXABLE DISTRIBUTIONS [include outright spousal Do of L'M (Words) ($$$) distributions,and transfers under Sec.9116 a 1.2 1 Evelyn R Boyer 48 Summerfield Drive Daughter-in-Law Frog Swith Mfg. Carlisle, PA 17015 shares of stock itemized in Will, 2 26%of residue Karen L Boyer 1001 Connor Road Granddau 9 hter 8%share of Pittsburgh, PA 15234 residue 3 Madison E George 666 Monmouth Road Great- 2%of residue Wrightstown, NJ 08562 granddaughter 4 Amanda M George 666 Monmouth Road Great- 2% of residue Wrightstown, NJ 08562 granddaughter 5 Casie L Bruin 652 Jones Lane Great- 2%of residue Cynthiana, KY 41031 granddaughter See continuation schedule attached Continuation Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as a no Fate.Total II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AWELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Maude R Boyer 11/29/2013 203-10-7275 Item Name and Address of Person(s) Number Receiving Property Share of Estate Amount of Estate Relationship (Words) ($$$) 6 Kimberly J George Granddau hter 666 Manmouth Road g 8%of residue Wrightstown, NJ 08562 7 Andrew W Mason 1426 E. Queen Street Great-grandson 2%of residue Annville, PA 17003 , 8 Benjamin D Mason 1426 E. Queen Street Great-grandson 2%of residue Annville, PA 17003 9 Kelly A Mason 1426 E. Queen Street Granddaughter 8%of residue Annville, PA 17003 10 Ryan K Mason 1426 E. Queen Street Great-grandson 2%of residue Annville, PA 17003 11 Stephen A Zavislak 7448 Palermo Avenue Great-grandson 2%of residue Las Vegas, NV 89147 12 Joyce A Zavislak 7448 Palermo Avenue Daughter Frog Swith Mfg. shares Las Vegas, NV 89147 of stock itemized in will, 26%of residue 13 Steffi A Zavislak 7448 Palermo Avenue Great-granddaughter , 2%of residue Las Vegas, NV 89147 14 Thomas A Zavislak 7448 Palermo Avenue Grandson 8%of residue Las Vegas, NV 89147 1 Informational Dopy SCHEDULE Y_19/A Do Not File' Inheritance Tax Paid @ 5% Discount ESTATE OF Bo er, Maude R (FILE NUMBER 21-13 ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Register of Wills,Agent-Prepayment of inheritance tax OF DEATH 10,000.00 TOTAL(Also enter on Line 10, Recapitulation) 10,000.00 Copyright(c)2002 form software only The ILackner pGroup Group, additional pages o!the same size)) i LAST WILL AND TESTAMENT OF M. RUTH BOYER I , M. RUTH BOYER, of One Alliance Drive, Chapel Pointe, Apartment 302 , Carlisle, Cumberland County, Pennsylvania 17013 , o make, publish and declare this to be my Last Will and Testament , hereby revoking any and all Wills and Codicils at any time heretofore matte by me . FIRST: I direct that my just debts, funeral expenses and all estate and inheritance taxes imposed upon my gross estate, including any property not forming a part of my testamentary estate, be paid from my estate as soon as may be convenient after y death. SECOND: I direct that specified items of my tangible personal property be distributed in accordance with the provisions of a signed'memorandum which may be found with my Will or other valuable papers . In the event the memorandum is not found and in the absence of an agreement by my heirs for distribution of my personal tangible property in accordance with the terms of this Will , I direct my Executrix, herein named, to sell such property and add the proceeds to my general estate . THIRD: I give and bequeath all of my shares of stock in the Frog Switch Manufacturing Company, in equal shares, to my daughter, JOYCE A. ZAVISLAK, currently residing at 7448 Palermo Avenue, Las Vegas, Nevada 89147, and my daughter--in-law, EVELYN R. BOYER, currently residing at 48 Summer Field Drive, Carlisle, Cumberland County, Pennsylvania 17015, or, in the event of either of their deaths, to the survivor of them. If both my daughter, JOYCE A. ZAVISLAK, and my daughter-in-law, EVELYN R. BOYER, predecease me, then this gift shall lapse and become part Of my residuary estate. FOURTH: All the residue of my estate, real and personal , and wherever situate, I give, devise and bequeath as follows : A. Twenty-six percent (26%) share to my daughter, JOYCE A. ZAVISLAK, or, in the event of her death, in equal shares to her issue surviving; B. Twenty-six percent (260) share to my daughter-in- laces, EVELYN R. BOYER, or, in the event: of her death, in equal shares to her issue surviving; C. Eight percent (8°s) share to my granddaughter, KAREN L. BOYER, currently residing at 1001 Connor Road, Pittsburgh, Allegheny County, Pennsylvania 15234 , or, in the event of her death, in equal shares to my grandchildren, KIMBERLY J. GEORGE and KELLY ANNE MASON; D. Eight percent (80) share to my granddaughter, KIMBERLY J. GEORGE, currently residing at 666 Monmouth Road, Wrightstown, New Jersey 08562 , -2- or, in the event of her death, in equal shares to her issue surviving; E. Eight percent (8%) share to my granddaughter, KELLY ANNE MASON, currently residing at 1426 East Queen Street, Annville, Pennsylvania 17003 , or, in the event of her death, in equal shares to her issue surviving; F. Eight percent (8%) share to my grandson, THOMAS A. ZAVISLAK, II, currently residing at 7448 Palermo Avenue, Las Vegas, Nevada 89147, or, in the event of his death, in equal shares to his issue surviving; G. Two percent (2%) share to my great granddaughter, CASIE L. GEORGE, currently residing at 666 Monmouth Road, Wrightstown, New Jersey 08562, or, in the event of her death, to my granddaughter, KIMBERLY J. GEORGE; H. Two percent (2%) share to my great granddaughter, AMANDA MARIE GEORGE, currently residing at 666 Monmouth Road, Wrightstown, New Jersey 08562 , or, in the event of her death, to my granddaughter, KIMBERLY J. GEORGE; 1 • Two percent (2%) share to my great granddaughter, MADISON E. GEORGE, currently residing at 666 Monmouth Road, Wrightstown, New Jersey 08562 , -3- or, in the event of her death, to my granddaughter, KIMBERLY J. GEORGE; J Two percent (2°s) share to my great grandson, RYAN K. MASON, currently residing at 7.426 East Queen Street, Annville, Pennsylvania 17003 , or, in the event of his death, to my granddaughter, KELLY ANNE MASON; K. Two percent (2a) share to my great grandson, BENJAMIN D. MASON currently residing at 1426 East Queen Street, Annville, Pennsylvania 17003 , or, in the event of his death, to my granddaughter, KELLY ANNE MASON; L. Two percent (20) share to my great grandson, ANDREW W. MASON currently residing at 147.6 East Queen Street, Annville, Pennsylvania 17003 , or, in the event of his death, to my granddaughter, KELLY ANNE MASON; M. Two percent (2s) share to my great granddaughter, STEFFI A. ZAVISLAK, currently residing at 7448 Palermo Avenue, Las Vegas, Nevada 89147, or, in the event of her death, to my grandson, THOMAS A. ZAVISLAK, II; and N. Two percent (2%) share to my great grandson, STEPHEN ANTHONY ZAVISLAK, currently residing at -4- /448 Palermo Avenue, Las Vegas, Nevada 841.47, or, in the event of his death, to my grandson, THOMAS A. ZAVISLAK, II . FIFTH: I nominate, constitute and appoint my granddaughter, KAREN L. BOYER, Trustee for any beneficiary under the age of twenty-one (21) years receiving any sums of money by reason of my death. In the event my granddaughter, KAREN L. DYER, is unable to serve for any reason, then I appoint my granddaughter, KELLY ANNE MASON, Trustee in her stead. I give to said Trustee the power to sell any and all my property, real or personal , at public or private sale, and to distribute my estate in cash or in kind or partly in cash or partly in kind. Further, my Trustee shall have the power to invest and reinvest the trust corpus and income . Further, my Trustee shall have the power to distribute the trust corpus and income for the maintenance, support and education of any minor beneficiary. When each beneficiary reaches the age of twenty-one (23.) years, his or her share shall be determined and distributed to him or her free and clear of any trust . SIXTH: I nominate, constitute and appoint my granddaughter, KAREN L. BOYER, Executrix of this, my Last Will and Testament . In the event my granddaughter, KAREN L. BOYER, is unable to serve for any reason, then I appoint my granddaughter, KELLY ANNE MASON, Executrix in her stead. -5- SEVENTH: I direct that no fiduciary appointed hereunder shall be required to post any bond or surety thereon in any jurisdiction by reason of their appointment . EIGHTH: I direct my Executrix, herein named, to appoint F. CHRISTOPHER SPINA, ESQUIRE, Attorney for my Estate . IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of —' 2008 . (SEAL) M. RUTH BOYER �`� SIGNED, SEALED, PUBLISHED AND DECLARED by M. RUTH BOYER, the Testatrix above named, as and for her Will in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses hereto. residing at A i or Lk - �� .Jesiding at ACKNOWLEDGMENT OF TESTATRIX COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF I, M. RUTH BOYER, Testatrix, whose name is attached or foregoing signed to the according instrument, having been duly qualified to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the Purposes therein expressed. M. RUTH BOYER Sworn or affirmed to and acknowledged before me, by M. RUTH BOYER, the Testatrix, this _Z _ day of 2008 . 'Notary/ Pu is Amy AFFIDAVIT OF WITNESSES We, /- my J 13 witnesses whose names are signed d L'�theJ atta hed� or instrument, being duly -rc-' the y q alified according to law, foregoing that we were present and saw the Testatrix sign Band execute the instrument as her Last Will and Testament; that she signed willingly it and that she executed as her free and voluntary act for the Purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and influence . under no constraint. or undue - Subscribed and sworn to before this me b (� ) -P f:ar�: �h�l l � I:�n . 4. ��� of , Y i—Yy�ln ` I- .... I' day v (.>Y I � a cam_ and zoos . OtaT`�` Pu is �l / COMMON WEALTH OF PENNSYLVANIA NO'(ARIAL SEAL SUZANNE M. BELDEN, NOTARY PUBLIC -7- CARLISLE BOROUGH, CUMBERLAND COUNTY MY COMMISSION EXPIRES MAY 10, 2008 Coins Inc d.b,a.Treasure Hunt 1680 Washington Road Pittsburgh, PA 15241 invoice Jeannette Dodd Date: 12/06/2013 Invoice No.: 11007 Due Date- 01/05/2014 Salesperson: SOUTH HILLS Bill To: KAREN BOYER 412-835-1359 qty Ds,,ip Unit Price Total 1 1 1914$5 BLUE SEAL C5752734 1A - ----- --- -- 1 1935C$1 SILVER CERT M44304845E $35.00 $35.00 1 1928G$2 RED SEAL D9259421 1A $1.15 $1.15 1 1928G$2 RED SEAL E05580584A $2,25 $2.25 1 1953C$2 RED SEAL A78960268A $2.95 $2.95 1 1963$2 RED SEAL AM 72152A $2.10 $2.10 1 1 1963$2 RED SEAL A02438123A $2-50 $2-50 1 1963$2 RED SEAL A02101638A $2. ,5 $2.25 1 1953A$2 RED SEAL A59390081A $3.0R $3.00 1 1953A$2 RED SEACA47330477A $2-50 $2.50 I 1963A$2 RED SEALA17545715A $2.75 $2:I.l I 1963A$2 RED SEALA1 59886 $2.5 J1 �M $2, 1 1953$5 RED SEAL 619203818 $3.60 1 $3,00 1 1963$5 RED SEAL A27159569 $5.50 1 1963$5 RED SEALA34625291A $5.50 $5.50 1 1963$5 RED SEAL A47314622A $s�� $5-50 I ()ORIGAMI SWAN $5.5d $5.50 1 1904 LIBERTY NICKEL $1.00 $1.00 1 1912 LIBERTY NICKEL s0.2q $025 1 1903 LIBERTY NICKEL $0.25 $0.25 3 1937 BUFFALO NICKEL $0.25' $0.25 3 1935 BUFFALO NICKEL $0.15 $0A5 1 1936 BUFFALO NICKEL $0.t5 $0.45 1 1926 BUFFALO NICKEL PARTIAL DATF $0.15 $0.15 1 11923 BUFFALO NICKEL PARTIAL DATE $0.07t $0-07 1929 BUFFALO NICKEL PARTIAL DATE $0.07 1927 BUFFALO NICKEL PARTIAL DATE $0.07 $007 1925 BUFFALO NICKEL PARTIAL DATE $0.67 $0.07 25 BUFFALO NICKEL.NO DATE $ao f $0.07 1 1942 JEFFERSON NICKEL $0.05, $1.25 :! 1 1956 JEFFERSON NICKEL $Q'05,1 $0.05 1 1859 INDIAN CENT s0.45 $0.05 8 1905,1889,1907.1905,1890,2-DATELCSS,1902 $6.00 $6.00 $2-00 Invoice#11007,Page 1 I. . . .. .. _.P Qty Descri tion ._ .._. _ ice __._. Total 1 1901 INDIAN CENT CLIPPED PLEDCHET n'$0.2 1 1858 FLYING EAGLE CENT HO 0 $2.00 8 WHEAT CENTS (1943X4, 1956,'1943-DX2,DAMAGED) , I - $0.25 8 BARBER DIME ALL WORN - $0.03 $0.16 (1901,1914-D,1913,1911,1910,1911,1910,1901) $1.20 $9.60 5 BARBER QUARTERS ALL WORN(1912,NO DATE,1912,1915-DX2) $3.(d $15.00 1 WASHINGTON QUARTER 1954-D 7 KENNEDY HALVES FACE VALUE 1974 AND UP THEY $3.00 $3.00 CONTAIN NO SILVER $0.50 $3.50 1 1954-D FRANKLIN HALF 4 BARBER HALVES(1915-D,1902,1899,1915-S) $6'0 I $6.00 2 1952 WASH-CARVER COMMEMORATIVE HALF $6.40 $24.00 DOLLARS $9 do$ 18.00 1 1833 BUST HALF DOLLAR 1 1925 10C EAST AFRICA $43"04 $43.00 1 WORN BELGIUM SILVER COIN $0.6 $0.50 1 MGM GAMING TOKEN $6.0u0 $6.00 3 1963 CARLISLE CIVIL WAR CENTENNIAL TOKENS ill BRONZE 1 1882-0 1S MORGAN DOLLAR 1 1921 MORGAN DOLLAR $40.00 $40.00 1 1921-S MORGAN DOLLAR $19"O��J{{ $19.00 1 1886 MORGAN DOLLAR $19.0 $19.00 1 1885 MORGAN DOLLAR $23'00 $23.00 1 1885 MORGAN DOLLAR $20.00 $20.00 1 1885 MORGAN DOLLAR/AU/TONED $200 $20.00 1 1891 MORGAN DOLLAR $23.00 $23.00 1 1889 MORGAN DOLLAR $20"00 $20.00 1 1879-S MORGAN DOLLAR $23.00 $23.00 1 1924 PEACE DOLLAR $20.0,0 1 $20.00 1 1922-D PEACE DOLLAR $19'00 $19.00 1 1976 IKE DOLLAR $20.00 $20.00 1 1972 IKE DOLLAR $1.00I $1.00 $1.0;i $1.00 Total Am .. .._-_.. /�/6 113 -- --� - Subtot I $495.46 II t $495.46 Balance Due $495.46 Please contact us for more information about payment options. Thank you for your business. !' Invoice#11007, Page 2