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HomeMy WebLinkAbout06-26-14 (2) REV-1500 EX (02-11)(FI) 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 260601 INHERITANCE TAX RETURN 2 1 1 4 0 1 7 6 _ Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 2 0 7 2 0 1 4 0 8 1 3 1 9 2 2 Decedent's Last Name Suffix Decedent's First Name MI H 0 F F M A N R U T H L (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 n 1.Original Return 2.Supplemental Return 3.Remainder Return(Date of Death Prior to 12-13.82) ❑ 4.Limited Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate 7.Decedent Maintained a Living Trust 1 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) 9. Litigation Proceeds Received E] 10.Spousal Poverty Credit(Date of Death 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 TO: Name Daytime Telephone Number W I L L I A M A D U N C A N 7 1 7 2 4 9 0 7 8 0 REGISIgROF WILLS SIE ONOYI Z C —(} �! C 7 First Line of Address 70 r T* ) n r\) ;,} ?s c) 1 I R V I N E R O W > Cn r) Second Line of Address O 1V r LE r— City or Post Office State ZIP Code` DATE FI D CJ7 C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: bill(OD_dUncanhartmarllaw.00111 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. SI �A/A,A✓^,n/(�y N ILINNGREETU N DATE A DRESSS 524 HILTON AV,N,ir DOVER PA 17315 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE A DR^S ESS 2220 LONGS GAP ROAD CARLISLE PA 17013 NA A PLEASE USE ORIGINAL FORM ONLY 1 I E -KM,-CARLISLE, PA 188 01 L Side1 1505610140 1505610140 J 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: RUTH L - HOFFMAN RECAPITULATION 1. Real Estate(Schedule A 1, 1 2 0 0 0 0 , 0 0 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 7 3 7 7 4 9 ' 9 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 8 5 7 7 4 9 , 9 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 6 9 2 8 2 . 6 5 10. Debts of Decedent, Mortgage Liabilities, and Liens Schedule I 10. 7 4 9 0 . 7 2 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7 6 7 7 3 . 3 7 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 7 8 0 9 7 6 . 6 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 1 0 0 0 0 . 0 0 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 7 7 0 9 7 6 . 6 0 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .o_ 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate x.12 7 7 0 4 7 . 6 0 17. 9 2 4 5 . 7 1 18. Amount of Line 14 taxable at collateral rate X.15 6 9 3 9 2 9 . 0 0 18. 1 0 4 0 8 9 . 3 5 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 3 3 3 5 . 0 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 Ex(FI) Page 3 File Number Decedent's Complete Address: 21 14 0176 DECEDENTS NAME RUTH L. HOFFMAN STREET ADDRESS 389 STONE CHURCH ROAD CITY STATE ZIP CARLISLE I PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 113,335.06 2. Credits/Payments A.Prior Payments 90,000.00 B.Discount 4,736.70 Total Credits(A+B) (2) 94,736.70 3. Interest (3) 4. If Line 2 is greater than Une 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Une 1 +Une 3 is greater than Une 2,enter the difference.This is the TAX DUE. (5) 18,598.36 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 ...................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income ............................... El X c. retain a reversionary interest ..................................................................................................... ❑ 0 d, receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... El ❑X 3. Did decedent own an'in trust for or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X 4. Did decedent own an individual retirement account,annuity or other non-probate property,which 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 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 Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in(72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 Ex*(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RUTH L. HOFFMAN 21 14 0176 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 decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 389 STONE CHURCH ROAD 120,000.00 CARLISLE, PA 17013 [SEE ATTACHED HUD SHEET] TOTAL(Also enter on Line 1,Recapitulation.) E 120 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: RUTH L. HOFFMAN 21 14 0176 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 1. CASH 797.58 2. MUTUAL OF OMAHA INSURANCE COMPANY CHECK 899.64 3. ADAMS ELECTRIC COOPERATIVE CHECK 46.60 4. M&T BANK CHECKING ACCOUNT#9843934184 18,544.69 [SEE DOD LETTER ATTACHED] 5. 2008 TOYOTA RAW- FAIR CONDITION 10,200.00 6. CASH 23.00 7. CASH 6.33 8. THE SENTINEL REFUND 44.64 9. MUTUAL OF OMAHA CHECK 807.18 10. MEMBERS FIRST ACCOUNT#796-00 1,557.91 [SEE DOD LETTER ATTACHED] 11. MEMBERS FIRST ACCOUNT#796-04 2,000.03 [SEE DOD LETTER ATTACHED] 12. MEMBERS FIRST ACCOUNT#796-11 8,862.24 [SEE DOD LETTER ATTACHED] 13. MEMBERS FIRST ACCOUNT#796-05 20,312.77 [SEE DOD LETTER ATTACHED] 14, MEMBERS FIRST ACCOUNT#796-40 10,466.56 [SEE DOD LETTER ATTACHED] 15. MEMBERS FIRST ACCOUNT#796-44 23,334.83 [SEE DOD LETTER ATTACHED] 16. MEMBERS FIRST ACCOUNT#796-46 52,167.44 [SEE DOD LETTER ATTACHED] TOTAL(Also enter on Line 5,Recapitulation) $ 737 749.97 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent RUTH L. HOFFMAN 21 14 0176 Decedent's Name Page 1 File Number Schedule E-Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. AMERIPRISE SECURITY ACCOUNT#385515929133 6,933.35 [SEE DEPT. OF REVENUE LETTER ATTACHED] 18. AMERIPRISE SECURITY ACCOUNT#0930067409779004 229,990.06 [SEE DEPT. OF REVENUE LETTER ATTACHED] 19. PROCEEDS SALE OF PERSONAL PROPERTY 1,042.00 20. PROCEEDS MUTUAL OF OMAHA INSURANCE 346,682.58 [SEE DOD LETTER ATTACHED] 21. PROCEEDS SALE OF PERSONAL PROPERTY 185.00 22. PROCEEDS SALE OF PERSONAL PROPERTY 503.00 23. COUNTY TAXES PRORATED 5/29/14-12/31/14 199.23 [SEE ATTACHED HUD SHEET] 24. SCHOOL TAX PRORATED 5/29/14-6/30/14 143.31 [SEE ATTACHED HUD SHEET] 25. SERIES HH SAVINGS BOND D4282460HH 500.00 [SEE ATTACHED] 26. SERIES HH SAVINGS BOND D4394474HH 500.00 [SEE ATTACHED] 27. SERIES HH SAVINGS BOND D4282459HH 500.00 [SEE ATTACHED] 28. SERIES HH SAVINGS BOND D4282458HH 500.00 [SEE ATTACHED] 29. SERIES HH SUBTOTAL SCHEDULE 587,678.53 REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RUTH L. HOFFMAN 21 14 0176 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. HOFFMAN ROTH FUNERAL HOME 5,864.04 2. FUNERAL LUNCHEON & EXPENSES 383.97 3. OSIRIS -GRAVE MARKER LETTERING 210.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: WILLIAM A. DUNCAN — 1 Irvine Row, Carlisle, PA Name(s)of Personal Representative(s) JOANN SMELTZER&BONNIE WAGGONER - BY 3 17013 29,482.49 Street Address 1524 HILTON AVE &2220 LONGS GAP ROAD City DOVER & CARLISLE State PA&PA ZIP 17315 Years)Commission Paid: 2. Attorney Fees: DUNCAN & HARTMAN, PC 29,482.49 3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 583.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. CUMBERLAND LAW JOURNAL- LEGAL NOTICE 75.00 B. THE SENTINEL- LEGAL AD 201.16 9. HELD IN RESERVE 3,000.00 TOTAL(Also enter on Line 9,Recapitulation) $ 69 282.65 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX,(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER RUTH L. HOFFMAN 21 14 0176 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. WASTE MANAGEMENT 83.43 2. CENTURYLINK 126.00 3. JARUSEWSKI OVERHEAD DOOR SERVICE INC. - GARAGE DOOR REPAIR 65.00 4. CARLISLE PETROLEUM INC 641.16 5. BANKAMERICARD 124.20 6. CARLISLE PETROLEUM INC. 641.16 7. WASTE MANAGEMENT 83.43 8. CENTURYLINK 126.00 9. PAMELA BURKHOLDER -TAX COLLECTOR 336.66 10. JOANN SMELTZER - MILEAGE REIMBURSEMENT 338.80 11. NEW LOCKS FOR HOUSE 76.22 12. BONNIE WAGGONER- MILEAGE REIMBURSEMENT 130.35 13. ADAMS ELECTRIC COOPERATIVE - ELECTRIC BILLING 118.00 14. BANKAMERICARD 26.50 15. GALBRAITH'S ACCOUNTING &TAX SERVICES -2013 INCOME TAXES 190.00 TOTAL(Also enter on Line 10,Recapitulation) $ 7,490.72 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent RUTH L. HOFFMAN 21 14 0176 Decedent's Name Page 3 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. U.S. TREASURY-2013 INCOME TAX DUE 494.00 17. CARLISLE PETROLEUM INC. 479.48 18. JOANN SMELTZER- MILEAGE REIMBURSEMENT 191.40 19. DELUXE CHECKS 15.74 20. ADAMS ELECTRIC COOPERATIVE 132.29 21. BONNIE WAGGONER-MILEAGE REIMBURSEMENT 82.50 22. CUMBERLAND GOODWILL EMS 672.87 23. CARLISLE PETROLEUM INC. 131.59 24. SETTLEMENT CHARGES -SALE OF 389 STONE CHURCH ROAD, CARLISLE, PA 1,200.00 [SEE ATTACHED HUD SHEET] 25. ADAMS ELECTRIC COOP. INC. 121.63 26. BONNIE WAGGONER - MILEAGE REIMBURSEMENT 233.75 27. JOANN SMELTZER- MILEAGE REIMBURSEMENT 327.80 28. YARD MOWED 120.00 29. CENTURYLINK 5.86 30. BONNIE WAGGONER - MILEAGE REIMBURSEMENT 137.50 SUBTOTAL SCHEDULE 4,346.41 Continuation of REV-1500 Inheritance Tax Return Resident Decedent RUTH L. HOFFMAN 21 14 0176 Decedent's Name Page 4 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 31. JOANN SMELTZER - MILEAGE REIMBURSEMENT 37.40 32. SUBTOTAL SCHEDULE 37.40 GRAND TOTAL SCHEDULE $ 7,490.72 REV-1513 E%+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RUTH L. HOFFMAN 21 14 0176 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include outr 6 a h(spousal distributions and transfers under Sec.91 1.2).) 1. SHARON YOUNG Collateral 107 OPOSSUM ROAD 500.00 CARLISLE, PA 17013 2. THOMAS M. SHOEMAKER Sibling 10 YORWICK ROAD 10% NET CARLISLE, PA 17013 3. JOANN SMELTZER Collateral 1524 HILTON AVENUE 33 COLLATERAL DOVER, PA 17315 HEIRS SHARE 90% NET 4. BONNIE WAGGONER 2220 LONGS GAP ROAD CARLISLE, PA 17013 SEE ATTACHED LIST OF NIECES & NEPHEWS COLLATERAL SEE ATTACHED LIST OF GRAND NIECES & GRAND NEPHEWS COLLATERAL ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. [[. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. WAGGONERS UNITED METHODIST CHURCH 5,000.00 1271 LONGS GAP ROAD CARLISLE, PA 17013 2. FRIENDS OF POSSUM LAKE CONSERVATORY 5,000.00 1205 EASY ROAD CARLISLE, PA 17015 TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 10 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 90 000.00 Discount: 4,736.70 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 through 2014 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: Page 2 Nieces & Nephews: Linda Gorkes 1361 Worthington Court Amber, PA 19002-1562 Thomas Shoemaker, Jr. 10 Yorwick Road Carlisle, PA 17013 Tammy Shoemaker 405 Longs Gap Road Carlisle, PA 17013 Gary Balmer 3817 Durham Road Harrisburg, PA 17110 JoAnn Shoemaker 30 Yorwick Road Carlisle, PA 17013 Diane Shoemaker 30 Yorwick Road Carlisle, PA 17013 Debra Hiddemen 205 Lincoln Street, Apt. # Duncannon, PA 17020 Charles E. Shoemaker, Jr. P.O. Box 66 Duncannon, PA 17020 Barbara Rourke 1585 Ferguson Valley Road McVeytown, PA 17051 Page 3 Grand Nieces & Nephews: TOTAL = 22 Michelle Monismith 2210 Longs Gap Road Carlisle, PA 17013 Heather Kuhn 188 Cold Springs Road Carlisle, PA 17015 Melissa Coldren 2100 Enola Road Carlisle, PA 17013 Jeremy Connors 709 Modern Ice Drive San Jose, CA 95112 David Hiddemen 205 Lincoln Street, Apt. # Duncannon, PA 17020 Russell Hiddemen 910 North High Street Duncannon, PA 17020 Chandra Shoemaker P.O. Box 66 Duncannon, PA 17020 Charles E. Shoemaker III 1060 Valley Road Marysville, PA 17053 Robert Keck, Jr. 1585 Ferguson Valley Road Mc Veytown, PA 17051 Shaun McClintock 507 Mifflin Street Huntington, PA 16652 Jessie Fry 2152 Ritner Highway Carlisle, PA 17015 Page 4 Ashley Ackerman 238 Lynbrook Road Springfield, PA 19004 Tammy Whitebread 1524 Hilton Avenue Dover, PA 17315 Jodi Swartz 1299 Yarmouth Lane New Cumberland, PA 17070 Caleb Lamason 405 Longs Gap Road Carlisle, PA 17013 Zachery Lamason 445B Longs Gap Road Carlisle, PA 17013 Minors: Madison Gorkes Age 14 1361 Worthington Court Amber, PA 19002 Meressa Gorkes Age 14 1361 Worthington Court Amber, PA 19002 Nicholas Gorkes Age 14 1361 Worthington Court Amber, PA 19002 Callie Hinderliter Age 7 76 Partridge Circle Carlisle, PA 17013 Dakota Book Age 17 9396 Laurel Hollow Road Three Springs, PA 17264 Hunter Book Age 17 9396 Laurel Hollow Road Three Springs, PA 17264 LAST WILL TESTAMENT I, RUTH L. HOFFMAN, of P.O. Box 10, Plainfield, 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 revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred in Westminister Cemetery between my father and my dear friend, William B. Hall, THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath the following: A. UNTO my friend, SHARON YOUNG, Five Hundred Dollars ($500.00) in cash; B. UNTO FUTURE FUND WAGGONERS UNITED METHODIST CHURCH, the sum of Five Thousand Dollars ($5,000.00); and C. UNTO POSSUM LAKE CONSERVANCY, the sum of Five Thousand Dollars ($5,000.00) for improvements to Lake and Dam. FIFTH. I give, devise and bequeath the residue and remainder of my estate of whatever nature, be it real,personal or mixed, and wherever situate as follows: A. Ten Percent (10%) share unto my brother, THOMAS M. SHOEMAKER. If he fails to survive me, then his Ten Percent (10%) share shall go to his wife, PAULINE SHOEMAKER. If both shall predecease me, then this bequest shall lapse and be added in equal portions to the bequest for benefit of my nieces and nephews and benefit for certain of my grand nieces and grand nephews, except for the children and grandchildren and descendants of GARY BALMER, who shall all be excluded ; B. Ten Percent (10%) share unto my sister, S. HELEN BALMER. If she fails to survive me, then this bequest shall lapse and be added in equal portions to the bequest for benefit of my nieces and nephews and benefit for certain of my grand nieces and grand nephews, except for the children and grandchildren and descendants of GARY BALMER, who shall all be excluded ; C. Forty Percent (40%) share shall pass to certain of my living nieces and nephews in equal shares at the time of my death; and D. Forty Percent (40%) share shall pass to certain of my living grandnieces and grand nephews, except for the children and grandchildren and descendants of GARY BALMER, who shall all be excluded, in equal shares at the time of my death. SIXTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SEVENTH I hereby nominate, constitute and appoint JOANN SMELTZER, BONNIE WAGNER and my personal attorney, WILLIAM A. DUNCAN as Co-Executors of this my Last Will and Testament. I hereby relieve my Executors from the necessity of posting security in connection with their duties, as such, in any jurisdiction in which they may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executors, in their absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. EIGHTH. If any of the beneficiaries of this, my Last Will and Testament, shall be under the age of Twenty-Five (25) years at the time of my death, then any portion of my estate in which they share shall be held in a separate trust for them with JOANN SMELTZER, BONNIE WAGNER and my personal attorney, WILLIAM A. DUNCAN or attorney from his Firm, as Trustees. The trusteeship shall end when the child attains the age of Twenty-five (25) years. The Trustees shall provide for the care, maintenance and education of said beneficiary and shall from time to time use either principal or income from the inheritance to provide for these needs. If a beneficiary of the Trust dies prior to attaining the age of Twenty-Five (25) years, the Trust shall terminate and all such funds in that deceased beneficiary's Trust shall be paid over to the beneficiary's sister or brother and if no sister or brother survives, then the beneficiary's legal heir. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, cons'sting of two typewritten pages this t YrN day of 2011. V RUTH L. HOFF AN Signed, scaled published and declared by the above named Testatrix RUTH L. HOFFMAN as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. C4 w /VM MA-0�4 COMMONWEALTH OFPENNSYLYANL4 : SS. COUNTY OF CUMBERLAND I, RUTH L. HOFFMAN , Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Nela ..s w RUTH L. HOFFMAP Sworn or affirmed to and acknowledged before me, by RUTH L. HOFFMAN this 1 �`� day of M AY 2011. Notary Public ORE OFp NNSYLVgNr s�s.rrom,r a„a�mheAarq rae Match 115 COMMONWEALTH OF PENNSYL VANIA :SS. COUNTY OF CUMBERLAND y We, W� II �AVVt A �7t�G>7c,aYl and - wly L, ✓�(�lNll'i?6Y L� the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw RUTH L. HOFFMAN sign and execute the instrument as her Last Will; that she signed willingly 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 will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by W A, t "✓I zA ✓l and ICaLy Lr , witnesses, this 10M day of Mal 2011. Notary Publi MIEOF PENNSVLVgNIAL SEAL S,Notary pudic umbeAaM County irae Merck 15,2015 REV-485 EX(05-04) 48500041046 SAFE DEPOSIT BOXINVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number 02/07/2014 21 14 0176 Decedent's Last Name Suffix First Name MI HOFFMAN RUTH L. ©ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE: 389 Stone Chur_h Road Carlisle PA 17013 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME' WILLIAM A. DUNCAN, ESQ. STREET ADDRESS: CITY: STATE: ZIP CODE: I IRVINE ROW CARLISLE PA 17013 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: WILLIAM A. DUNCAN, ESQ. EXECUTOR & ATTORNEY STREETADDRESS: CITY. STATE: ZIP CODE: I IRVINE ROW CARLISLE PA 17013 b. NAME: _ RELATIONSHIP: STREETADORESS: CITY: STATE: ZIP CODE: C. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: M&T BANK STREETADDRESS v CITY: STATE: ZIP CODE: 1 WEST HIGH STREET CARLISLE PA 17013 NAME OF PERSON MAKING LAST ENTRY DATE ANO TIME OF LAST ENTRY RUTH L. 14OFFMAN DATE OF CONTRACT TO RENT BOX NUMBER OF BOX i TITLE UNDER WHICH BOX IS REQUESTED 11/28/1947 141 RUTH L. HOFFMAN NAME AND ADDRESS OF PERSONIS)HAVING ACCESS TO BOX a. NAME- L. HOFFMAN b. NAME: STREET ADDRESS: STREET ADDRESS: 389 STONE CHURCH ROAD _ CITY: CARLISLE STATEA ZIR.CO'P CITY: STATE: ZIP CODE: NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY 1/tJ 13 JOAN CROWL TELLER WAS A WILL W THE BOX7 ❑ YES M NO if yes, a. Date of will: b. Name and address of personal representative,if named in the will NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: C. Name and address of attorney,if any NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: 48500041046 48500041046 J REV-465 EX SAFE DEPOSIT BOX INVENTORY Page 2of 2 INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,Certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government:Number of items,date of issue,face value, names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch, and balance. (6) Jewelry,Coins,Stamps, Manuscripts,etc:List and describe as fully as possible. (T) Deeds, Mortgages,Current Insurance Policies or other evidences of indebtedness:List and describe as fully as possible. (8) All other contents. (g) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT 280501 HARRISBURG,PA 17128,0601 ITEM NO ITEM DESCRIPTION 01-.-D MiG 0( 0 CL C Viti�C� C) J , L--OT o _ o �- I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT A O COMPL E J;qHIj BBST OF MY KNOWLEDGE AND BELIEF, SAFE OSIT OX INI/ENTIORr. SIGNATURE SIGNATU E t Q � PRIM NAME r PRINT NAME AND CHECK APPROPRIATE BOX BELOW: WILLIAM A. DUNCAN. ES Q. PRINT TITLE DATE CHECK APPROPRIATE BOX; ATTORNEY 03/12/14 Q Exea4p n j []Atlm a alartl ) Eslata Rapresentatrva �Joint owner or safe depaall box NOTE:Attach additional 8'/:"x 11"sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Sodal Security numbers in connection with adnunlster ng state tax taws.The Department uses he Soad Severity number to identify he decedent and personal representatives of the estate.The Color ormeaih may also use the information in exchange of tax information agreements with Federal and local lazing authorities.The state law prohibds the Commonwealth's personnel from disclosing confidential tax information exce t for official purposes. S Ininu,p ^- �ctu (HUD-1)Statement H ''^•a• ( OMB Approval No.2502-0 B.T as of Loan 1.0 FHA 2.0 RHS 3.0 Con,.Unins 6.File Number. 7.Loan Number: 4.0 VA 5.0 Conv.Ins re19-63 8.Mortgage Insurance Case Number: C.Note:This form w re Paid O to give you o statement of actual settlement casts.Amounts paid to and by the settlement agent are shown.Items marked "(p.o.c.)'were paid oufsitle the closing;they are shown here for informational purposes and are not included in fhe totals. D.Name 8 Address of Borrower: J. Michael Adler E.Name$Address of Seller: 337 Lincoln Street Es Gate of Ruth L. Hoffman F.Name$gdtlress of LendeC Carlisle, PA 17013 389 Stone Church Road Metro Hank Carlisle, PA 17015 3801 Paxton Street G.Property Location: Harrisburg, PA 17111 389 Stone Church Road H.Settlement Agent: Lower Frankfort! Twp Duncan 5 Hartman, p.C. TIN: Carlisle, PA 17015 1 Irvine Row Parcel: 14-05-0923-014, Carlisle, PA 17013 Phone: (717) 249-7780 Place of Settlement County: Cumberland l 1"ine Row L Settlement Date: 5/29 Carlisle, PA 17013 /2014 J.Summary of Borrower's Transaction 100.Gross Amount Due From Borrower Funding Date: 5/29/2019 K.Summary of Transaction 101.Contract sales price 400.Gross Amount Due To Sell er 102.Personal property 120,000.00 401.Contract sales price 103.Settlement charges to borrower(line 1400) 402.Personal property 120,000.0, 104. 4,212.00 403. 105. 404 Adjustments for Items paid by seller in advance 405. 106.City/town taxes: Adjustments for Items paid by seller In ativance to 406.City/town faxes: 107 CoumytaxeS:5/29/2014-12/31/2019 to to 199.23 407.County taxes:5/29/2019 108.Assessments: fO -12/31/2019 199.23 to 408.Assessments: 109. to 110.School Tax 5/29/2014-6/30/2014 409. 111, 143.31 410,School Tax 5/29/2014-6/30/2014 112 411. 143.31 412 120.Gross Amount Due From Borrower 200.Amounts Paid By Or In Behalf Of Borrower 129,559.59 420.Gross Amount Due To Seller 201.Deposit or earnest money 500.Reductlo-1 In Amount pue To 120,342.54 ?02.Principal amount of new I'in(s) 1,000.00 501.Excess deposit(see instructions)Seller !03.Existing loans)taken subject to 90,000.00 502.Settlement charges to seller(line 1400) 04. 503.Existing loans)taken subject to 1,200.00 504.Payoff of first mortgage loan 75. 16 505.Payoff Of second mortgage loan 7' 506, 8' 507. 3' 50& lustments for Items unpaid by salter 509. �.City/town taxes: Adjustments for items un to 510.City/town taxes: Paid by seller County taxes: to 0 511.County faxes: Assessments: to fo 512.Assessments: to 513. 514. 515. 516. 517. 518. list Paid By/For Borrower 519. mh At Settlement Fram/To Borrower 91,000.00 520.Total One Amount due from bonower(line 120) Reduction Amount Due Seller 600.Cash At Settlement TO/From Seller 1,200.00 ss amounts paid by/for borrower(line 220) 129.559.59 601.Gross amount tlue to 91,000.00 602.Less reductions in amount due seller 520) sh ®From 120,392.59 ❑To B¢mower Im 33,554.59 1,200.00 Seller Reporting Burden far this collection of information Is estimated at 35 minutes per responOse for collectln may not collect this information, and you are not re11 data.T 59 tiallty,is assured,this disclosure is mantlato required to complete this for put rocess. ry.This Is designed to provide the m, unless if Sla la g.reviewing,and reporting the number This 011 Eas Parties to a RESPA covered transaction with pMformation during No y Soft.Previous editions are obsolete. Page 1 of 3 g the HUD-1 L.Settlement Charges File Number:re14-63 Loan Number: 700.Total Real Estate Broker Fees Division of Commission line 700 as follows: Paid From Paid From 701.$ to Borrowers Seller's 702.$ to Funds at Funds at 703.Commission paid at settlement Settlement Settlement 704. 800.Items Pa able In Connection With Loan 801.Our origination charge 802.Your credit or char e( oints)for the so eci0c Interest rate chosen 5 (from GFE#1) 603.Your adjusted origination charges from GFE#2) 804.Appraisal fee to from GFE A) 805.Credit report to (from GFE#3) 806.Tax service to (from GFE#3) 807.Flood certification to Metro Bank (from GFE#3 BOB.Commitment fee to Metro Bank from GFE#3 7.00 809.Document re fee to Metro BAnk from GFE*3 900.00 810. from GFE#3 3]5.00 811. 900.Items Re ufired B Lender To Be Paid In Advance 901.Daily interest charges from 5/29/2014 to 6/1/2014 @ 5 /day 902.Mortgage insurance premium far 0 months to (from GFE#10) 903.Homeowners insurance for 0 ears to (from GFE#3) 904. from GFE#11 905. 1000.Reserves Deposited With Lender 1001.Initial -2-sit for our escrow account 1002.Homeowners insurance months @ from GFE#9 $ 1003.Mortgage Insurance per mo months @ per mo 1004.Property taxes $ months @ per mo $ 1005.School taxes months@ per mo 7006. $ 1 or mo $ 007.A Aggregate Aduslment nths 1100.Title Char as 50.00 1101.Title services and lenders title insumnce 1102.Settlement or closing fee (from GFE#4) 1,377.00 1103.Owners title insurance Old Republic Title Co. 1104.Lentlers title insurance Old Republic Title Co. from GFE#5) 155.00 1105.Lender's title policy limit $845.00 1106.Owner's title policy limit $90,000.00 707.Agent's portion of the total insurance premium $120,000.00 108.Underwriters portion of the total Insurance remium $1,020.00 709.Bnd. 100, 300, 8.1, ARM to Old Republic Title$COmpany 110.Closing Protection Letter to Old Republic Title Company $200.00 111.TOtal from addendum $75.00 200.Government Recordin and Tra nsfer Char es $257.00 201.Government recording charges Recorder of Deeds '.02.Deetl 56].00 M-rtgage$63.00 from GFE#7 198.00 '03.Transfer taxes Release$ '04.City/County tax/stamps:Deed$ (from GFE#8 1,200.00 05.State tax/stam s:Deed 51,200.00 Mortgage$1,200.DO 06.Assi Mortgage$ gnment of Rents 1,200.00 07. $96.00 D0.Additional Settlement Char es 5 ]1.Required services that you can shop for )2. (from GFE#6 13. Iq. to 5. 6. 7. 9. ].Total Settlement Char es limint,0n lines 103,Section J and 502,Section K 4,212.00 1,200.00 rve carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement Of all race pt and sements made on m7 ccount r by me in this transaction.I further certify that I have receivetl a copy of the HUD-1 Settlement Statement. tichael Adler Buyer/Borrower Est gfth� Hoffpla � �J 9 Seller Buyer/Borrower said in accord ith this state nt. IUD-7 Settlement Statement which I have Prepared is a true and accurate account of this ransacdon. I have caused or will cause the fund,to be Seller ' an s Nortma p,C. 5/29/2014 Settlement Agent Date ING:It isa came to knowln I maketalsesf laments to the United States on this oran other similar farm. Penalflesu ommnWdlonoanlncludeafneorim dsonment. -2011 Easy Sok.Previous editions are bsalete. Page 2 of 3 HUD-1 �4'pm a°rigp Yo(jGoodjF.allfi?Eet("sle,GF (anLrHUO"jjCh`a"'es -ftft?D=' Charges That Cannot increase HUD-1 Line Number Our origination charge #804 0.00 0.00 Your credit or charge(points)for the specific rate chosen #802 0.00 P.00 Your adjusted origination charges #803 0.00 0.00 Transfer tares #1203 0.00 1,200,06 jb ju osY,gig Ir1 6t'h1KC4niT4rlimliasa a roTha0 j0Y _ [G' "iF it E_#i('mal'e Government recording charges #1201 0.00 149.PO Flood Certification #807 0.00 Commitment fee #808 0.00 900.00 Document prep fee 11809 0.00 375.40 vR 1 Tofat. 0.00 1,480.00 ncreas"ejb'et aari�CiP.'.and:HUD;y"Cie ' � 1,aB0.00 (CR;3 Bs1T)iatiCanjQh�an =n^£�i: ... . ?_Good I"a"I(hifE_cFil., at4'd2lfUg2j Initial deposit for your esuow accountm #1001 __0.00 0.00 Daily Interest charges #901 _ 0.00 0.00 Homeowner's Insurance IX903 0.00 O.tl0 Owner's two insurance #1403 0.00 155.00 .oan Terms Your Initial loan amount Is 5 Your loan term Is Years Your Initial Interest rate is % Your initial monthly amount owed for principal.Interest,and E Includes any mortgage Insumnca Is ❑Principal ❑Interest ❑Mortgage insurance Can your unrest rate tisol r 0 No.❑Yes,it can rise to a maximum of %.The that change will be on and can change again every after .Every change date,your Interest rate can Increase or decrease by %.Over the lire of the loan,your Interest rate is guaranteed to never be ksymrthan %crbigherthan %. Sven If you make payments an time,can your loan balance dse7 0 No.❑Yes,it can rise to a maximum of$ , Sven If you make payments on tine,can your monthly ONO,O Yes,the first irmaso can be ae and the monthly amount Amount owed for principal,Interest,and mortgage insurance rise? owed can rise to$ . The maximum it can ever rise to Is 5 . toes your loan have a prepayment penally? 0 No.❑Yes,your maximum prepayment penalty is S . roes your loan have a balloon payment? 0 No.O Yes,you have a balloon payment of S due in years on War monthly amount owed Including escrow account payments $1 You do not have a monthly esuuw payment for items,such as property taxes and homeowner's Insurance.You must pay these Rem directly yourself. ❑You how an additional monthly#straw payment of$ that reaufls in a total Initial monthly amount owed of$ .This Includes principal,interest,any mortgage insurance and any items chocked better. ❑Property taxes ❑Homeowners insolence ❑Flood insurance ❑ ❑ 1 ❑ s:If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your(ender. 9-2011 Easy Soft.Previous editions are obsolete. Page 3 of 3 HUD-4 ADDENDUM PAGE for HUD-1 Name and Address of Additional Sorrowegs) Name antl Atltlress of Adtlitional Sellers) 1100.Title Charges(Addendum) 1112.NOtary to Cash 1113.OVernight/email/wire to Duncan s Hartman $15.00 0.00 1114.Attorney fees to Duncan s Hartman 567.00 0.00 Total 5175.00 0.00 5257.00 0.00 CERTIFICATION:I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I received a copy of the HUD-1 Settlement Statement. 1-2011 Easy Soft Previous editions are obsolete. Addendum Page HUD-1 St MEMBERS Vt FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 796-00 Date Account Established 03/14/1951 Principal Balance at Date of Death $1,557.88 Accrued Interest to Date of Death $0.03 Total Principal and Accrued Interest $1,557.91 Name of Joint Owner None LIFE SAVINGS ACCOUNT: Account Number/Suffix 796-04" Date Account Established 02/01/2001 Principal Balance at Date of Death $2,000.00 Accrued Interest to Date of Death $0.03 Total Principal and Accrued Interest $2,000.03 Name of Joint Owner None 'Rollover from 796-00 on 02/01/2001. CHECKING ACCOUNT: Account Number/Suffix 796-11 Date Account Established 12/31/1979 Principal Balance at Date of Death $8,862.24 Accrued Interest to Date of Death $0.07 Total Principal and Accrued Interest $8,862.24 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 796-05 Date Account Established 10/01/1985 Principal Balance at Date of Death $20,312.44 Accrued Interest to Date of Death $.33 Total Principal and Accrued Interest $20,312.77 Name of Joint Owner None MEMBERS 1ST FEDERAL CREDIT UNION ✓'Gere Anderson Lending Insurance Support Specialist March 19, 2014 Estate of: RUTH L. HOFFMAN Date of Death: 02/07/2014 Social Security Number: 184-12-4542 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • www.memberslst.org St MEMBERS I" FEDERALCREDrr UNION CERTIFICATE OF DEPOSIT: Account Number/Suffix 796-00" Date Account Established 01/31/2013 1 Principal Balance at Date of Death $10,464.84 Accrued Interest to Date of Death $1.72 Total Principal and Accrued Interest $10,466.56 Name of Joint Owner None "Rollover from CD 796-52 opened 10/27/2011. CERTIFICATE OF DEPOSIT: Account Number/Suffix 796.44"• Date Account Established 09/20/2011 Principal Balance at Date of Death $23,331.57 Accrued Interest to Date of Death $3.26 Total Principal and Accrued Interest $23,334.83 Name of Joint Owner None "Rollover From CD 796-53 opened 11/17/2011. CERTIFICATE OF DEPOSIT: Account Number/Suffix 786-46•"" Date Account Established 10/01/2013 Principal Balance at Date of Death $52,155.95 Accrued Interest to Date of Death $11.49 Total Principal and Accrued Interest $52,167.44 Name of Joint Owner None """Rollover from CD 796-45 opened 11/01/2012. MEMBERS 1S' FEDERAL CREDIT UNION Gere Anderson Lending Insurance Support Specialist March 19, 2014 Estate of: RUTH L. HOFFMAN Date of Death: 02/07/2014 Social Security Number: 184-12-4542 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 • wwwmemberslstorg p M&Tsank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 March 6,2014 Duncan & Hartman,P.C. Attorneys at Law One Irvine Row Carlisle,PA 17013 Re: Estate of Ruth L. Hoffman Social Security: Date of Death: February 7, 2014 Dear Sir or Madam: Per your inquiry on February 28, 2014, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 9843934184 Ownership(Names of) Ruth L.Hoffman Joanne Smekzer(POA) Opening Date 0212712007 Balance on Date of Death $ 18,544.63 Accrued Interest $ .06 ...._....-------. '----------------- Total $18,544.69 2. Type ofAccount Safe Deposit Box Box Number/Location 141 1High Street Carlisle Ownership(Names ofJ Ruth L.Hoffman Opening Date 0210711992 pennsylvania DEPARTMENT OF REVENUE BUREAU OF WAFIDUAI TAXES March 20, 2014 Ameriprise Financial 25 South 35th Street Camp Hill, Pa 17011 Re: Estate of: Ruth L Hoffman Social Security Number: File Number: 2114-0176 Dear Sirs: The Department Issues this waiver for the following security held in beneficiary format by the decedent. The security will be subject to Pennsylvania inheritance tax. The Department will not Issue an information notice to the transferee of the potential Pennsylvanian Inheritance tax due for this asset as the estate representative has informed the Department that the asset(s) will be reported on the REV-1500 filed by the estate representative. A copy of this waiver is to be used by you to notify the transfer agent that the reporting requirements of Section 6411 of the Probate Estates and Fiduciaries Code (Title 20, Chapter 64, Pennsylvania Consolidated Statutes), have been satisfied, Name of Company: Ameriprise AFG Type of Account: Security Account ID Number(s) 385515929133 0930067409779004 Account Balance(s): $6,933.35 $229,990.06 Sincerely, Am Heimbach Inheritance Tax Division Department of Revenue I PO 80x 2.806011 Harrisburg, PA 17128 1717.787.1794 1 www.revenue.state.pa.us /y........... 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