HomeMy WebLinkAbout05-20-14 .. � ,� , .,� �..� �,..�„� .� ,: �.��.��� rt. �.�-.,�,.� ��-_� � . :
� 1505610143
REV-1500 Ex�oz-��� `�' OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEYARTMENTOFREVENUE
Po sox.zsoso� INHERITANCE TAX RETURN 21 13 1289
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
10 23 2013 02 18 1920
DecedenYs Last Name Suffix DecedenYs First Name MI
THOMAS PEARL E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate � 4a. Future Interest Compromise � 5. Federal Estate Tax Return Required
❑ (date of death after 12-12-82)
� 6 Decedent Died Testate � �• qnachB�Gopy�of T�ust)a Living Trusl 1 8. Total Number of Safe Deposit Boxes
(Atlach Copy of Will)
� 9. Litigation Proceeds Received � 10.Spousal PovenY Credit(Date�f Death � 11.Election to tax under Sec.9113(A)
between 12-31-yt and 1-1-95 (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIO��IiOULD BE DIRECTED TO:
Name Daytimt�.�elephone,,,�Number
JERRY R DUFFIE � (72�) �"'�6� 4540
c� � � �,, a
-.,°: ��
r r�p _r rf�EGI�ER 0�-��,1Mlti7LS USE ONLY
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First Line of Address ` �.� ' " �:•a ��'
, � • , , -�
3 01 L iCfi�L�i S 1 ~� � �'� � _��
C.� C� ��1 � ., 7
Second Line of Address �� �"'" ~ r� rn
_ � N �-- Q
CI�
PO BOX 1 O 9 %=' --�pATE FI ED
City or Post Office State ZIP Code
LEMOYNE PA 170430109
CorrespondenYs e-mail address:
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 RESPONSIBLE FOR FILING RETURN DAT
� � . �� �� Barry E McCord �
ADDRESS
403 West Cedar Str Palm ra PA 17078
SIGN OF P E HE THAN REPRESENTATIVE D TE
JERRY R. DUFFIE � � t
DORE
01 MARKET ST., LEMOYNE, PA
� Side 1 �
1505610143 1505610143
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
�eoade�r5 Name: THOMAS, Pearl E
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 1 O O , 0 0 0 . 0 0
2. Stocks and Bonds(Schedule B)............................................................................. 2. 2 , 907 . 3�
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. 52 , 6$8 . 17
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous�n;Probate Property
(Schedule G) U Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 155, 595 . 47
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 11 , 62 8 . 6 9
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 14 , 113 . 4 9
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 25 , 742 . 1$
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. Z Z 9, 8 5 3 . 2 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13. 17 , 3 7 7 . 4 7
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 112 , 4 75 . 82
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 � . 0�
(a)(1.2)X.00 15.
16. Amount of Line 14 taxable 0 . 00 16. 0 . 00
at lineal rate X .045
17. Amount of Line 14 taxable 0 . 0 0
at sibling rate X.12 � . �0 17.
18. Amount of Line 14 taxable 16 8 71 . 3 7
at collateral rate X.15 11.2 , 4 75 . 82 18. r
19. TAX DUE................................................................................................................ 19. 16� 8 71 . 3 7
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 21-13-1289
Decedent's Complete Address:
DECEDENT'S NAME
THOMAS, Pearl E
STREET ADDRESS
824 Lisburn Road
Apartment 223
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 16,871.37
2. Credits/Payments
A. Prior Payments 14,500.00
B. Discount 763.16
Total Credits(A +B) (2) 15,263.16
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) �,s�$.2�
Make Check Pa able to REGISTER OF WILLS AGENT
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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:............................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ �
c. retain a reversionary interest;or.................................................................. ............................................
. x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ �
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑
receiving adequate consideration?.................................................................................................................... x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ Ox
4. Did decedent own an individual retirement account, annuity,or other non-probate property which ❑ ❑
containsa beneficiary designation?.................................................................................................................. X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS�S YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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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 appiicable 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 sibiings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
All real propeRy owned solely or as a tenant in common must ba reported at fair markat value.Fair market value is defined as the price at which property would be
exchanged betwean a wdling buyer and a willing seller,neither bemg compelled to buy or sell,both having reasonable knowledge of the relevant facts
Real propeRy that is jointly-ownad with right of survivorship mustbe disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the dead showing decedenNs interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 1932 Chatham Drive,Camp Hill,Cumberland County,PA-Real Estate 100,000.00
sold on December 23,2013. Contracted Sales Price. A copy of the HUD-1 Settlement Sheet
is attached.
TOTAL(Also enter on Line 1, Recapitulation) 100,000.00
(If more space is needed,additionat pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10)
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Rev-1503 EX+(6•98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
All property jointlyownedwith right of survivorahip must bedisclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
� 59156R108 60 shares of Metlife -Valued using EstatVal Valuation. A 48.4550 2,907.30
copy is attached to Return
TOTAL(Also enter on Line 2, Recapitulation) 2,907.30
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98)
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Rev-1508 EX+�11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8� MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
Include the proceeds of liligation and the dale the proceeds were received by lhe estate.
All property jointly-ownedwith the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M8�T Bank Christmas Club Account 500.04
2 PNC Bank Individual Checking Account No.5004045399-Date of Death Letter from PNC 13,612.43
Bank for 4 Accounts is attached
3 PNC Bank Individual Savings Account No.5001143727 2,891.19
4 PNC Bank Individual Savings Account No.5114143758 29,664.45
5 PNC Bank Individual Savings Account No. 5130153358 502.28
6 Sovereign Bank Individual Checking Account 1,169.71
7 Real Estate located at 1932 Chatham Drive, Camp Hill,Cumberland County,PA- 625.61
Reimbursement to Estate for County and School Taxes Paid. A copy of the HUD-1
Settlement Sheet is attached
8 The Woods at Cedar Run-Reimbursement of Account 1,182.46
9 U.S.Treasury-2013 Federal Individual Income Tax Refund 2,540.00
TOTAL(Also enter on Line 5, Recapitulation) 52,688.17
(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)
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REV-1511 EX+��0�08)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENTDEC D NTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N MBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 2,500.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2, Attorney's Fees JOHNSON, DUFFIE, STEWART&WEIDNER 5,500.00
3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zi�
Relationship of Claimant to Decedent
4. Probate Fees 363.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees 105.00
7. Other Administrative Costs 3,160.19
See continuation schedule�s) attached
TOTAL(Also enter on line 9, Recapitulation) 11,628.69
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
THOMAS, Pearl E 21-13-1289
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex e�nses
1 Headstone-Estimated Costs for Headstone and Engraving 2,500.00
H-A 2,500.00
Other Administrative Costs
2 Costs/Expenses at Probate 23.16
3 Don Miller, Contractor-Contractor Charges for Repairs to Real Estate 2,650.00
4 Reserves: Additional Miscellaneous Estate Expenses 250.00
5 The Cumberland Law Journal-Notice of Estate Administration 75.00
6 The Patriot News Co. -Notice of Estate Administration 162.03
H-B7 3,160.19
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
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Rev-1512EX+�12-OS) gCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
Report debts incuned by the dacedent prior to death that ramained unpaid at the date of death,including unrefmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Water Company 125.30
2 Checks clearing after date of Death 42.37
3 PA Department of Revenue-2013 Pennsylvania State Individual Income Tax 931.00
4 Pinnacle Health 29.84
5 PP&L Utilities 46.73
6 Quantum Imaging 66.52
7 Real Estate located at 1932 Chatham Drive,Camp Hill,Cumberland County, PA-Settlement 12,634.47
Charges. A copy of the HUD-1 Settlement Sheet is Attached
8 UGI 237.26
TOTAL(Also enter on Line 10, Recapitulation) 14,113.49
(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)
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REV-1511 EX+�01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THOMAS, Pearl E 21-13-1289
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (N/ords) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Donna Hoke Niece $5,000.00
840 S. 14th Avenue Specific Bequest
Lebanon, PA 17042
2 Tracy Weaver Lutz Niece $5,000.00
3574 Jug Factory Road Specific Bequest
Greer,SC 29651
3 Barry E McCord Nephew Remaining
403 W.Cedar Street Residue of
Palmyra, PA 17078 Estate
4 Terry Peterson Niece $5,000.00
240 Conkey Street Specific Bequest
Burlington,WI 53105-1806
Total
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
1 Grace Evangelical Lutheran Church 11,584.98
2 The Humane Society of Harrisburg Area 5,792.49
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 17,377.47
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
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ESTA TE OF PEARL E. THOMAS
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Pearl E. Thomas signed and dated
June 7, 2012
EXHIBIT B Receipt of Inheritance Tax Prepayment postmarked January 17,
2014
EXHIBIT C HUD-1 Settlement Sheet for Sale of Real Estate located at 1932
Chatham Drive, Camp Hill, PA
EXHIBIT D EstateVal Valuation for Metlife Shares
EXHIBIT E Date of Death Letter from PNC for Decedent's Estate Account and
Checking Account
:622949
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Last Will and Testament
OF
PEARL E. THOMAS
I, PEARL E. THOMAS, of Lower Alien Township, Cumberland County, Pennsylvania,
declare this to be my last will and revoke any will previously made by me.
I.
I direct that all my legal debts and funeral expenses, including my gravemarker and all
expenses of my last illness, shall be paid from my residuary estate as soon as practicabte after
my decease as a part of the expense of the administration of my estate.
II.
I bequeath my household goods and personal effects and other tangible personalty of a
like nature (not including cash or securities), together with any existing insurance thereon, except
for my automobile and the personal property bequeathed pursuant to Paragraph III, to my
nephew, BARRY E. McCORD. Should my nephew, BARRY E. McCORD, predecease me, I
direct that such tangible personalty be liquidated and be added to and distributed as part of my
residuary estate.
III.
I bequeath my automobile, together with any existing insurance thereon, and the yellow
chair(with the heart shapec! back)to LOWER ALLEN VFW POST 7530.
IV.
I devise and bequeath the residue of my estate of every nature and wherever situate, as
follows: �
A. Ten (10%) percent thereof or Ten Thousand ($10,000.00) Dollars, whichever is
greater, to the Endowment Committee of GRACE EVANGELICAL LUTHERAN
CHURCH to be invested by said Endowment Committee and the income therefrom
ExH�a�r A
-- --- -------- -- -- �
- - -
to be distributed to the Congregational Council of GRACE EVANGELICAL
LUTHERAN CHURCH annually to be used for general church purposes.
B. Five (5%) percent thereof or Five Thousand ($5,000.00) Dollars (whichever is
greater) to The Humane Society of Harrisburg Area to be used for general
purposes.
C. The sum of Five Thousand ($5,000.00) Dollars to my niece, TERRY PETERSON.
Should my niece, TERRY PETERSON, predecease me, then I bequeath said sum
to her then living issue, per stirpes, and in default of said issue, said bequest shall
lapse.
D. The sum of Five Thousand ($5,000.00) Dollars to my niece, DONNA HOKE.
Should my niece, DONNA HOKE, predecease me, then I bequeath said sum to
her then living issue, per stirpes, and in default of said issue, said bequest shall
lapse.
E. The sum of Five Thousand ($5,000.00) Dollars to my niece, TRACY WEAVER.
Should my niece, TRACY WEAVER, predecease me, then I bequeath said sum to
her then living issue, per stirpes, and in default of said issue, said bequest shall
lapse. '
F. The balance thereof to my nephew, BARRY E. McCORD. Should my nephew,
BARRY E. McCORD, predecease me then I devise and bequeath the balance of
my residuary estate to his then living issue, per stirpes.
V.
Should any person entitled to a share ofi my esfate not attained the age of twenty-five (25)
at the time of distribution to him or her, I devise and bequeath the share of each such person to
MID PEIdN BANK, of Harrisburg, Pennsylvania, IN SEPARATE TRUST, to hold, manage, invest
and reinvest the shares so received and the accumulation of income thereon, and to use and
apply the income and principal, or so much thereof as, in Trustee's sole and absolute discretion,
may be necessary and appropriate for such person's support and education (including trade
school and college education, both graduate and undergraduate) without regard to his or her
parent's ability to provide for such support and education and to make payments for these
-2-
. : . ,_,.�,� � � �..3. �.� �.�. �.-��, � . . � ,��.>,��,� �,.�.. .. � ... �.� f, � __ �, _,
purposes, without further responsibility, to such person or such person's parent or to any person
taking care of such person. Any income not so used or applied shall be accumulated and added
to and thereafter be treated as part of the principal. When each such person shall attain the age
of twenty-five (25), his or her Separate Trust shall terminate and the principal and any
accumulated and undistributed income shall be distributed to him or her absolutely. If said person
dies before attaining the age of twenty-five (25), the Separate Trust shall terminate and the then
remaining principal and any accumulated and undistributed income shall be distributed to said
person's then living issue, per stirpes. In default of said issue, the share shall be distributed to
said person's personal representative.
VI.
I direct that the interest of the beneficiaries hereunder shall not be subject to anticipation
or voluntary or involuntary alienation.
VI1.
I direct that all taxes that may be assessed in consequence of my death of whatever
nature and by whatever jurisdiction imposed shall be paid from my residuary estate as a part of
the expense of the administration of my estate.
VI11.
I appoint my nephew, BARRY E. McCORD, Executor of this, my last Will. Should my
nephew, BARRY E. McCORD, fail to qualify or cease to act as Executor, then I appoint MID
PENN BANK, Harrisburg, Pennsylvania, Executor of this, my last Will.
IX.
I direct that my Executor or his successor shall not be required to post bond for the faithful
performance of their duties in any jurisdiction. .
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ���� day of
���_, 2012.
�.e-��►..Q. �,.�.,�GfiruRO (SEAL)
PEARL E. THOMAS
-3-
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Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, 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.
�.e. ' �..�t�
, �
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
. ss:
COUNTY OF CUMBERLAND •
I, PEARL E. THOMAS, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according 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.
�..�e�,�.�,�
PEARL E. THOMAS
Sworn or affirmed to and acknowledged before me, by PEARL E. THOMAS, the Testatrix,
this�day of ��P , 2012.
N ry Public
�pN1MONWEALTH OF PENNSYLVAIIIA
NOTtaRIAL SEAL
Gail J.Mahoney,Notary Public
Lemoyne Borough,Cumberland County
� My commission expires Febtuary 19,2014
-4-
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� ` � � ,
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
. ss:
COUNTY OF CUMBERLAND .
We, L-1✓l�t`J�(.�tP� and �t,t.�Q.�l � . �-Ec-4��I , the
witnesses whose names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the Testatrix sign and execute the .
foregoing instrument as her Last Will and Testament; that she signed willingly and that she�
executed it as her free and votuntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our
knowledge, the Testatrix was that time at least 18 years of age, of sound mind and under no
constraint or undue influence.
4 �...�-�L�
� �
v
�
Sworn or affirmed to and subscribed to before me by �—� '1-�-Q-a- � � '�� and
�t,(���,rn I/�1. , '�°_�L'�, witnesses, this 77M day of �CC�-�? , 2012.
�
Not " Public
:498271
WMMONWEALTH OF PENNSYLVANIA
NOT1�,RiAL SRAT"
Gail J.Mahoney,Notary Public
Lemoyne Borough,Cumberland County
My commission expires Febniary 19,2014
-5-
REV-1162 EX�11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 018670
CEDAR CLIFF ABSTRACT AGENCY
414 BRIDGE STREET
NEW CUMBERLAND, PA 17070
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
_""___ fold ""__'_"
101 � S 14,500.00
ESTATE INFORMATION: ssrv: 209-22-o6ss I
FILE NUMBER: 21 1 3-1 289 �
DECEDENT NAME: THOMAS PEARL E I
DATE OF PAYMENT: 01/21/2014 �
POSTMARK DATE: 01/17/2014 (
CoUNTY: CUMBERLAND I
DATE OF DEATH: 10/23/2013 �
�
TOTAL AMOUNT PAID: $14,500.00
REMARKS: RECEIPT TO ATTY.
CHECK# 35573
INITIALS: CJ
sEA� RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
TAXPAYER
ExHis►r 8
,.� `,
i r ' OMB Approval No.2502-0265
�:,,�^��j�.��; A. Settlement Statement (HUD-1)
. . _. .. . ,.. _ _ . .__ .. _ .
: .- . .. . - - � � - -
1.Q FHA 2.Q RH$ 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
32493KUNKEL 7700413275 446-1971045-203
4.Q VA 5.❑ nv.Ins.
C.Note:This form' fumished to give you a statement of actual settiement costs.Amounts paid to and by the settlement agents are shown Items marked
"(p.o.c'were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
Vicki L Kunkel Estate of Pearl E.Thomas MoRgage Network,Inc.
313 Walnut St.(Rearj,Boiling Springs,Pa 17001 1932 Chatham Drive,Camp Hill,Pa 17011 300 Rosewood Drive,�anvers,MA 01923
G.Property Location H.Settiement Agent: I.Settlement Date:12/23/2013
1932 Chatham Drive Cedar Cliff AbsVact Agency,lnc. Disbursement Date:12J23/2013
Camp Hill,PA 17011 414 Bridge Street,New Cumbedand,PA 17070
Lower Allen Township
Telephone:717-774-7435 Fax:717-774-3869
Place of Settlement: TitleExpress
414 Bridge Street,New Cumberland,PA 17070 Printed 1 2/2 312 0 1 3 at 2:43 pm
by CLT
- �
_.._
100. Gross Amount Due from Borrower ' 400. Gross Amount Due to Seller
101. Contrad sales price 100,000.00 401. Contract sales price 100,000.00
102. Personai ro e 402. Personal ro e
103. Settlement charges to borrower(line 1400) 6,707.57 403.
104. 404.
1D5. 405.
Ad'ustments for items aid b seller in advance Ad'us6nents for items aid b seller in advance
106. Cityltown taxes to 406. Cityltown taxes to
107. County taxes 12/23/2013 to 12/31/2013 1424 407. County taxes 12f23/2013 to 12I3112013 1424
108. School Taxes 12/23I2013 to O6I3012014 601.08 4D8. School Taxes 12123/2013 to 06/3012014 601.08
109. 409.
110. 410.
111. 4th qtr sewerRrash prl 1212312013 to 12/31Y1013 1029 411. 4th qtr sewerlVash prl 12I2312013 to 12I31f2013 1029
112. 412.
�20• Gross Amount Due from Borrower 107,333.18 420. Gross Amount Due to Seller 100,625.61
,
200. Amounts Paid b or in Behalf of Bortower 500. Reductions In Amount Due W Seller
201. �eposit or eamest money 1,000.00 501. Excess deposit(see instructions)
202. Principal amount of new ioan(s) 98,188.00 502. Settlement charges to seller(line 1400) 7,634.47
203. E�cistin loa s taken sub'ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of first mort e loan
205. 505. Pa oH of second mort a e loan
206. Escrow reserves paid by Seller 70729 506. Escrow reserves paid by Seller 70729
207. Credit by Seller 4,292.71 507. Credit by Seller 4,292.71
208. 5D8.
209. 509.
Ad'ustments for items un aid 6 selier Ad'ustments for items un aid b seller
210. Cityltown taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School Taxes to 512. Schooi Taxes to
213. 513.
214. 514. Inheritance tax escrow 18,000.00
215. 515.
216. 516.
217. 517.
2i8. 518.
219. 519.
220. Total Paid b Ifor Borcower 104,188.00 520. Total Reduction Amount Due Seller 30,634.47
__. . .
300. Cash at Settlement fromlto Borrower 600. Cash at Settlement to/from Seller
301. Gross amount due from borrower(line 120) 107,333.18 gp�. Gross amount due to seller(line 420) 100,625.61
302. Less amounts paid by/for borrower(line 220) 104,188.00 602. Less reductions in amount due seller(line 520) 30,634.47
303. Cash ❑X From ❑ To Borrower 3,145.18 603. Cash XQ To ❑ From Seller 69,991.14
c e n8 n r s ca on o m orm o¢e ma rtun es par response orco e ,re evnnB.a po fg e a is aeanry may no rn e is m ortne on,a you ere n requir mmp e
iNZfam�unlessq6spayseamaNyvalitlOMBmnbdnumEer.NomMOeMieltly¢asswaG;IM1isEiatlasureisman0mory.Thislstlesipnetlbprovitle��epaNesloaRESPAmveretivaasadionwiNmfomia4onEUnnpNa
setllemeN pmcess
See attached addendum for additional information EXHIBIT C
Previous editions are obsolete Page 1 of 4
�.,���,.,�,.,,�,� � .,W. >�,,� � ����. ,�,�
;�0. Total Real Estate Broker Fees $5,700.00 Paid From Paid From
Divisionofcommission Iine700 asfollows: Bof�oWeF's SellBr'S
701• $2,850.00 to BrownstoneRealEstate Funds at' Funds at
��2• $2,850.00 to ReMaxlstAdvantage Settiement Setklement
703. Commission paid at settlement 5,700.00
704. Broker fee to Re/Max 1 st Advantage 350.00
705. Broker fee to Brownstone Reai Estale 195.00
800. Bems Pa able in Connection with Loan
601. Our origination charge (Includes Origination Point 0.000%or$0.00) $895.00 (from GFE#1)
802. Your credit or charge(points)for the specific interest rate chosen $-1,000.00 (from GFE#2)
803. Your adjusted origina6on charges (from GFE A) -105.00
604. Appraisal fee to A�rtnative Certified A raisers (from GFE#3) 485.00
805. Credit report to Birchwood Credit 5ervices,Inc. (from GFE#3) 90.00
806. Tax service to from GFE#3
807. Flood certification to LP5 Natinai Flood (from GFE#3) 10.00
808. FNMA LQI Update to Birchwood Credit Seivices,Inc. (from GFE#3) 25.00
_
900. Items R uired b Lender to be Paid in Advance
901. Daily interest charges ftom from 121'13/2013 to 01/01I2D14 @$11.43001day (from GFE#10) 102.87
902. Mortgage insurance premium for months to HUD (from GFE#3) 1,688.75
903. Homeowner's insurance for 1 ears to Nationwide Insurance {from GFE#11) 836.96
904, months to from GFE#11
1000.Reserves De osited with Lender
1001. IniGal deposit for your escrow account (from GFE#9) 70729
1002.Homeowners insurance 3 months $ 69.75/monih $20925
1003.Mortgageinsurance months $ 107.741month $
1004. Pro rt taxes months $ Imonth
1005.Counry taxes 1� months $ 54.131month $595.43
1006.School Ta�ces 7 months $ 96.731month $677•11
1007.Aggregate AdjusUnent $-774.50
1100.Ti�e Cha es
1101.TiBe services and lender's title insurance from GFE#4 ��2�•�
1102. Settlement or closing fee to �
1703.Owner's title insurance from GFE#5 5��
1104.Lender's title insurance $1,119.50
1105.Lenders title policy limit$98,188.00 Lender's Policy
]106.Owner's title policy limit$100,000.00 Owner's Policy
1107.AgenPs portion of the total iitle insurance premium $903.D0
to Cedar Cliff AbsVact A enc,Inc.
1108.Underwriters pation of the total title insurance premium $222.00
to Commonwealth Land Title Insurance Com an
1109.
1200.Govemment Recordin and Transfer Cha es
1201.Govemment recording charges $ (from GFE#7) 144.00
�n12• Deed$67.00 Mort a e$77.00 Release$
1203.Transfer taxes $ (from GFE#8) 1,000.00
1204. CitylCounty tax/stamps Deed$1,000.00 Mort a e$
1205.State Taxlstamps Deed$1,000.00 Mort a e$ 1,000.00
1206. Deed$ Mort a e$
1300.Additlonal Settlement Char es
1301.Required services that you ran shop for (from GFE#6)
1302. to
1303. to
1304.2013 County ta�ces to Bonnie K.Miller' $649.53 P.O.C.S`
1305.2013 School taxes to Bonnie K.Miiler* $1,160.81 P.O.C.S`
1306.Tax cert fee to Stone Lafaver&Shekletski 10.00
1307.4th qtr sewedtrash+penaity to Lower Ailen Townshi 129•4�
1308. 1st qtr sewedUash-2014 to LowerAllen Townshi ��•��
1309.HomeWarranty toAHS 600.00
.�� , . • � • � . . ► - . 6,707.57 7,634.47
'Paid outside of clasing by(e)o�rower,(S)eller,(L)ender,(I)nvestor,Bro(i�er.'*Credit by lender shown on page t."'Credit by seller shown on page 1.
See attached addendum for additional information
Previous editions are obsolete Page 2 of 4 HUD-1
_. ,, _ ,, . � . .�,�.� ��,,,� �....��.� ��� ,. . .� �.�,��, ..
Com"ari§odof Good F.atth EsGmat.e GF. and HUD-1 Ghar es Good Faith Estimate MUD,1
`F:har es That Cannot Increase. HUD-7 Lme Number
Outorigination charge "# 801 ' 974.00 895.00
<Your credit a charge(points)for the specific inleregt rate chosen " # 802' -1,000.00 -1,000.00
Your adjusted originafion oharges` # 803 ' -26.00 -105.00
Transfertaxes 1203`':' 1,000.00 1,000.00
Char es rhat in Total Cannot Increase More Than 10�0: - Good Faith Estimate MUQ1 :
Govemmenfrecording charges ` ' :`. '. ' # �?�� 200.00 144.00
Appraisal fee , ' _, # 804 ' 485.00 485.00
Credit repnrt _ ; ' # 805 ": , 60.00 90.00
Fiood certification # 807 21.OD 10.00
"FNMA LQI Updale : #�8 ' 25.00 25.00
Modgage insurance premium ." #902' 1,68875 1,688J5
Title services and lender's tille insurance # 11fl1 900.00 1,244.50
Owner's title insurance , . ` ,:`' ', p.1103 400.00 5.50
3,779.75 3,692.75
. ,. . � $ -87.00 or -2.3017�0
Char es That Can Chan e Good Faith EsGmate HU�,1 '
Initial deposi!for your esaow acwunt ` # 1001 2,104.12 70729
Daily interesf charges ftom ' ' #90f :. . $11[:93QOLda 137.16 102.87
Homeowner's insurance ` ' ` ' # 903 550.00 836.96
, _:
# '
,: _. _#
Loan Terms
Your ini6al loan amount is $98,188.00
, __. .. ,
Your.loan term is 30.years
Your initial interest rate is 42500%a
Your initial monihly amouM owed for principal,interest,and any modgage $590.77 includes
insurance is . QX Principal
QX Interest
: QX Mortgage Insurance
Can youf interest rate rise?, QX No. ❑Yes,it can rise to a maximum of °k.The first change
will be on ! / and can change again every years after / / . Every
change date,your interest rate can increase or decrease by °h. Over fhe life of
the loan,your interest rate is guaranteed to never be lower than �o or higher
than °k.
Even'rf you make payments on time,can youtioan balance rise? QX No. ❑Yes,it can rise to a ma�cimum of$ .
Even:rf you make payments on time,ran your monthly amoupt owed fw ❑X No. ❑Yes,the first increase can be on / I and the monthly
prinapal,interest,and moAgage in&urance rise7: amount owed can rise to$ .
The maximum it can ever rise to is$ .
Does your loan have a prepayment penalty? Q No. ❑Yes,your maximum prepayment penalty is$ .
Does your loan have a.balloon payment? QX No. ❑Yes,you have a balloon payment of$ due in
years on / I .
Total monfMly amount owed including escrow accounY paymen{s ❑You do not have a monthly escrow payment for items,such as property taxes
and homeowner's insurance. You must pay these items directly yourself.
❑X You have an additional monthly escrow payment of$220.61
that results in a total initial monthly amount owed of$811.38. This includes principat,interest,any
modgage insurance and any items checked below:
❑X Property taxes Q Homeowner's insurance
�Flood insurance XQ School taxes
- ❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
See attached addendum for additional information
Previous editions are obsolete Page 3 of 4 HUD-1
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HUD CERTIFICATION OF BUYER AND SELLER
t�iaVe carefully reviewed the HUD-1 Settlement Statement and to the best of my knowiedge and belief,it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transactiort I further certify that I have received a copy of the HUD-1 Settiement Statement
//'��r Iz�-�5�2.f�e—�' /��02���3
Vicki L.Kunkei
ESTATE OF PEARL E.THOMAS
� � . �'Ld�°�l_
Barry E.McCo ,E�cecutor
The HUa1 Settlement Statem n which I have prepared is a We and accurate account of this transac[ion.I have caused or will cause the funds to be
disbursed in accordance with t i statement
� `/�/ '`��
SETTLEME AGE � DATE
WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS ORANY SIMIIAR FORM.PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
See attached addendum for additional information
Previous editions are obsolete Page 4 of 4 HUD-1
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Name of Borrower: Name of Seller: �ile Number
Vicki L.Kunkel Estate of Pearl E.Thomas 32493KUNKEL
TitleExpress
Prepared 72/23/2013 at 2:44 pm
No�e: This page is furnished to give you an itemization of the amounts shown on Lines n01,noa and Paid From Paid From'
1104 of the Setdement Statement (HUD-1). This page accompanies but is not a part of che Borrowers Seller's
settlement statemenc If a discrepancy exisu,the information shown on the Settlement Statement `FUIIC�S at . ' F1111fJS at
�HU�-�)applies. S21�IBI11211t Settlement
Amounts Included
1100..TiHe Gharges . i4 Lipe 11p1
, _ : .. - _
1101. Title services and lender's title insurance 1,244.50
a.ETF Fee $ 50.00
b.Fed-e�wire fee 40.00
c.Notary fee 35.00
$ 125.00
1102. Settlement or closing fee
1703. Owner's title insurance (policy) $ 5.50 5.50
7104. Lendets title insurance (policy) 894.50 $ 1,119.50
a.Endorsement 9D0 EPL-Residential 50.00
b.Closing Service Letter 75.00
c.ALTA Short Form Loan 100.00
(Total 1103+1104)
i 705. Lender's tltle policy limit$98,188.OD.
1906. Owner's title policy limil S��D,OU0.00::
1107;AgenPs poAion of ihe iota�GUe insurance premium :' $ 403.00
1108. Undervurite['s portan of the#gtal tide insurance prem. 222.00
• ` (Tota11107+1108).'
1109.
1110.
1111.
1112.
_ � .
�
, - 'Total, Borcowe� ; Borrower Seller
•:
1700:Title Char es with Pa ee . Char e :: POC or.Credit. : Line 7101 Paid
1101. Title services and lender's GUe insurance $
a.ETF Fee to Stone Lafaver&Shekletski 50.00 50.00
b.Fed�xlwire fee to Stone Lafaver&Shekletski 40.00 40.00
c. Notary fee to Cash 35.00 35.00
1104. Lender's tiUe insurance to Cedar Cliff Abstract Agency,Inc. 1,119.50 1,119.50
.,.:. $ 1,244.50 _ 1244.50
,, r.. „ ,�,a.� �.�.,,<�.�.: .�., �v .�.�,,�,�.�.�.v�. .�..�,.
Estate Valuation
Date of Death: 10/23/2013 Estate of: Estate of Pearl Thomas
Valuation Date: 10/23/2013 Account: 8215-1
Processing Date: OS/09/2019 Report Type: Date of Death
Number of Securities: 1
File ID: thomas
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 60 METLIFE INC (59156R108)
COM
New York Stock Exchange
10/23/2013 48.96000 97.95000 H/L
48.955000 2,907.30
Total value: 52,907.30
Total Accrual: $0.00
Total: $2,907.30
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or 4 �' ' '�
ExH�a�r D
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December 11,2013
Bany Edward McCord
403 W. Cedar St
Palmyra,PA 17078
RE: Name: Pearl E Thomas
SSN: 209-22-0696
DOD: 10/23/2013
Dear Mr. McCord:
In response to your request for Date of Death(DOD)balances for the customer noted above,our
records show the following:
Checking Account
Account#5004045399 Established: 03/21/2003
PEARI.E THOMAS
DOD balance: $ 13,612.42+0_Ol accrued interest
Savings Account
Account#5001143727 Esta.blished: 12/051997
PEARL E THOMAS
DOD balance: $2,891.18+0.01 accrued interest
Account#5114143758 Established: OS/15/2413
PEARL E THOMAS
DOD balance: $29,663.93 +0.52 accrued interest
Account#5130153358 Established: 04/OS/1990
PEARL E THOMAS
DOD balance: $ 502.28 +0.00 accrued interest
Please note that this office provides date of death balances for degosit accounts(IIZAs,CDs,Checking and
Savings}. We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
P�e ExH�e�r E
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�n,�������� ,�,f�:� OHNSON ���,�,��. � �7�����:�
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�TARIi C.DIiI FIF
JU}1N R.:V 1.1'UtiRI' OF COUNSEL
1bI1CHAEL J.CAS51v1' � I-IOt�Fl(:�,A.JUH,�SO,��
14�T�LISSA P.GIiLt:�'}' C. ROY WC:i(itiI:{i.�t�.
t�'nDt:D.1�.��i,ev 1914-2014
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May 19, 2014 � o � � �
e�a z7 � �? o
Register of Wills Office �� � r? —� l��a �'
Cumberland County Courthouse � �' r ^' _��s n
One Courthouse Square r�' �'� = � j' �`'
Carlisle, PA 17013 � � � � K�i �
� � � ��,� �
RE: Estate of Pearl E. Thomas - � � � �
Date of Death: October 23, 2013 � G� �r, o
Your File No. 21-13-1289 —� �
Our File No. 8215-1
Dear Register:
Enclosed for filing, please find the following:
1. 2 Original Pennsylvania lnheritance Tax Returns. There is inheritance tax due in the amount of
$1,608.21. Estate Check No. 108 is attached to the Return.
2. One(1)copy of Page 1 of the Inheritance Tax Return that we ask that you time-stamp and return to us.
3. Inventory.
4. One copy of the Inventory that we ask that you time-stamp and return to us.
Thank you for your assistance in this matter. Should you have any questions, or require any additional
information, please feel free to contact us.
Very truly yours,
HNSON, DUFFI , STEWART&WEIDNER
Dana Wieseman
Estate Administration Paralegal,
Enc.
c: Barry E. McCord, Executor
:622942
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