HomeMy WebLinkAbout06-26-14 (2) REV-1500 EX(02-it) T 1505610143
OFFICIAL USE ONLY
PA Deparmlenf of Revenue Pennsylvania
Bureau of Individual Taxes ��°^�.. � Yin' F�N�,n'r
PO BOX.280601 INHERITANCE TAX RETURN 21 13 1244
Harrisburg,PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
11 03 2013 08 18 1927
Decedenrs Last Name Suffix Decedent's First Name MI
GERRITY GEORGENE S
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Ml
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return 2. Supplemental Retum 3. Remainder Return(Date of Death
Prtr%to 12-13.82)
4.Limited Estate 4a.( dlntJ—eZ i2 i2 j 5. Federal Estate Tax Return Required
® 8, nl DDlleed7radate Ej T, s e nftgf LMn9Txun 0 8. Total Number of Safe Deposit Bass
El a.1.189adon Proceeds Received C3 10.bb S,I P,23t&M RA)"0-'n � 11.Election to tax under See 9113(A)
tAdanb Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
WX D SCHRACR III ESQ 717 432 9733
rr
n
s
REGI F'"F WILLScUSE ONUY
i7 B Z try
First Line of Address rn
r_ a f" rV i'tl IT
124 W HARRISBURG STREET „ C 7
Second Line of Address s"7
DATE
City or Post Office State 7JP Code �I-Ebr� r-
DILLSBURG 8A 170191258
s
COrrespondenrs e-mail address: Schracktaw@comcastnet
FUnder pene8iee of perjury i dactare Biaf i have a�mrein r t ��Ind.u"da�aac=nparryirg schetluias and atetemeMS.and b the beat my krxowiedge and barrel.
IB Wa,dbrtect and w te.Oedaratlon of persona represent0ve is based on all information of which prepamr has any knovdedge.
SHM OF PERSON RE ONSMEF FIINGRE RN DATE
U ` 2-t. � Patricia Gerrity G&3
ADDRESS
20 Latham P4rkway,Melrose Park PA 19027
SIGNATUR .P EP RER THAN REPRESENTATIVE DATE
Wm D SChmck III Esq.
ADD
124 W.Harrisburg Street,Dillsburg, PA 17018-1268
Side 1
,� 1505610143 1505610143 �,�
1 1505610243
-J REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 121, 116 . 51
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. 59, 676 . 75
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 23 ,235 . 78
7. Inter.Vivos Transfers&Miscellaneous Nt Probate Property
(Schedule G) a Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 204 , 029. 04
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 8 , 941 . 18
% Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 7 , 465 . 00
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 16,406 . 18
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 187 , 622 . 86
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 187 , 622 . 86
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 0 . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 187 , 622 . 86 16. 8,443 . 03
at lineal rate X .045
17. Amount of Line 14 taxable 0 . 00 17. 0 . 00
at sibling rate X.12
18. Amount of Line 14 taxable 0 . 00 18. 0 . 00
at collateral rate X.15
19. TAX DUE................................................................................................................ 19. 8 , 443 . 03
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243
REV-1500 EX Page 3 File Number 21-13-1244
Decedent's Complete Address:
DECEDENT'S NAME
Gerrity,Georgene S.
STREETADDRESS
506 Falcon Drive
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 8,443.03
2. Credits/Payments
A. Prior Payments 7,500.00
B. Discount 394.74
Total Credits(A +B) (2) 7,894.74
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 24 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 548.29
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "VIN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a, retain the use or income of the property transferred;....-.............____............................. ................... ❑ I[�x]t
b. retain the right to designate who shall use the property transferred or its income;..................................
c, retain a reversionary interest;or...............................................................................................................
d. receive the promise for life of either payments,benefits or care?,.,,,................... .............................
2. if death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑
receiving adequate consideration?............................_......................----...................____..........................
....
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
containsa beneficiary designation?....._.._............._....................................._................................................. ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONSIS 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.
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 O percent
172 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 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
[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-1603 EX+(8-88)
SCHEDULE B
STOCKS & BONDS
COMMONyrEALTHOFFENNSY VANIA
W $TANC£TMRETURN
R£SNT DECEDENT
ESTATE OF FILE NUMBER
Gerrity,Georgene S. 21-13-1244
All property joingyrownedwith right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Susquehanna Valley Investments-Account#NW7352441 44,856.77
2 Susquehanna Valley Investments-Account#1005406869 76,259:74
TOTAL(Also enter on Line 2,Recapitulation) 121,116.51
(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)
Rev-1508 FXa(11-00)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gerrity Georgene S. 21-13-1244
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property 1oPntlyowned with Me right of survivorehip must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Susquehanna Valley Investments-Account#000DA135437 5,254.47
2 Putnam Fiduciary Trustee Co-Trustee FBO Georgene S.Gerrity-Account#00551290742 54,422.28
TOTAL(Also enter on Line 5, Recapitulation) 59,676.75
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1509 FX-(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gerrity, Georgene S. 21-13-1244
If an Beset was made joint within one yearof the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Robert M. Lomison 506 Falcon Drive Friend
Carlisle, PA 17013-8777
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S DECEDENT'S INTEREST
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 11102/2007 2008 Nissan Sedan,VIN 12,258.65 50.000% 6,129.33
1 N4AL21 EXBN42791 8
2 A 11/17/2008 Orrstown Bank checking account#149000569 9,131.98 50.000% 4,565.99
3 A 12/0112008 Ormtown Bank checking account#149000587 9,080.17 50.000% 4,540.09
4 A 01/29/2007 Orrstown Bank checking account#40095986 16,000.73 50.000% 8,000.37
TOTAL(Also enter on Line 6, Recapitulation) 23,235.78
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10)
REV-1511 EXi(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gerrity, Georgene S. 21-13-1244
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 4,081.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attornev's Fees Wm. D. Schrack 111 Esq. 3,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 413.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 946.68
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 8,941.18
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
Gerrity, Georgene S. 21-13-1244
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Ronan Funeral Home 2,746.00
2 Ronan Funeral Home-vault for ashes 300.00
3 Rose Hill Cemetery -plaque for vault 200.00
4 Rose Hill Cemetery-plot for vault 835.00
H-A 4,061.00
Other Administrative Costs
5 Carlisle Sentinel-estate advertisement 157.68
6 Clerk of Orphans'Court-Release filing fee 5.00
7 Cumberland Law Journal-estate advertisement 75.00
8 Miscellaneous expenses during period of administration-postage,fax charges,telephone 15.00
etc.
9 Office Max-miscellaneous expenses 29.00
10 Register of Wills-Inheritance Tax Return filing fee 15.00
11 Reserve for future administrative expenses 650.00
H-B7 946.68
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-96)
Rev-1512 EX-(12-09)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT -
ESTATE OF FILE NUMBER
Gerrity, Georgene S. 21-13-1244
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unmimbumed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Griswold Home Health Aids-last illness while under care of Hospice 7,385.00
2 Pharmacy-last illness 80.00
TOTAL(Also enter on Line 10, Recapitulation) 7,465.00
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX.(01-10)
pennsyivania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gerrity, Georgene S. 21-13-1244
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON{S}RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Nal List TruwtWel I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1,2)]
Patricia Gerrity Child 1$7,622.86
20 Latham Parkway
Melrose Park, PA 16627
Total 187,622.86
Enter dollar amounts for distributions shown above on lines 15 through 16 on Rev 15 10 cover sheet,as approp r(ate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1600 Schedule J(Rev.01.16)
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Pill a �_ -estamid
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i
OF
GEORGENE S. GERRM
BE IT REMEMBERED,that 1,GEORGENE S.GERRITY,presently of 306 Falcon Dtivc. I
_ I
_
Wide, l,Llm 1)erlanHl L.UUn1,y, 1 enil5ji'v Full n, being Gf SO ui.(i i;:(n(l, tL'e:.lpr. !7?(l l!n(,lc rtil atvht7 C, do
nnakc,publish and declare Phis as and for my Last«/ill and 11mamcnt, hercb) i cvoking and Inakin,g
mrll and void anY :md all Wills and Testaments and writings in the nature, thereof by me at any lime
heretofore made.
ITEM 1: I direct that my hereinafter rimmed Executrix pay all lily just debts, my fnncral �
wgxrlses, and the expenses of be adtiru istration of my estate. 'With this direction, I authorize and
empower illy Lxecut ix to expend lot-illy funeral expenses:md interment such amounts as she nlav
i�
consider rnecess ry and proper, without re;trd to ally limit that may be prescribcd bj' a cote I of law. j
ITEM 2: I direct my Executrix to pay a.11 inhcril.urce, estate, succession, said lcgacv taxes of
whatsoever nature and ]dnd, to which my estate, or the transfer of any properly passing hereunder or
otherwise passing by reason of my demise, may be subject, and to charge such taxes a,gainsl nry
reciclua;v csl te. It is niy intention that none of the aforesaid taxes, eithea Icdcral or state, on any
properly required to be included in lily'-oss estate, tinder the provisions of ally stale or federal 1;m,
now in force or hereafter enacted, shrill be ptarated among the persons interested in my estate to
i I
i
whom such property is or may be transfetTCd or to whom any belief![accrues.
ITEM 3: In ]writing this Will,I understand that my Not insurance, amtuifics, IRlNs, "in mist
tot"bank accounts, and any other assets in whkh I may]lave designated a beneficiary, will pass to the �
i
beneficivry that I have named, and will not be controlled by the provisions of dds MIL l also
i
understand that:illy assets chat I OIvn iointly r dth another with the right of survivorship or presumed
i
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rights of survivorship (whetbcr the joint ownership was created be'lore or ter this Will was Iwrittcu)
w 11 pass to the surviving joint owner, and will not be controlled by the provisions of,Ibis \Will.
ITLM 1: All the rest, resicduc and remainder of my estate, of Nvhatsocvcr nature and
I
wheresoever situate, whether it he rc<d, 1xi-sonal or mixed, including propertY over which I have a
power ol"appointment, I drive, devise and bequcad, to my daughter, PATRICIA GERRITY.
ITEM 5: I nominate,constitute and appointmv daughter,PATRICIA GERRITY,to serve
as I':xecutrix of this m}- Last Will and Testament.
ITEM 6: I direct Ihaf my hercinbc(ore na.mcd Executrix shall not be rcgnircd t;i �•c bond
for the faithli,d perloruz urce of ber duties in this or m v jurisdiction.
IN WITNhSS WIILREOE, I have hereunto seL my hand and scat this dac of
------ (— —��c-- 2011.
GEORdENE S. GERRIT1
The precccling instrument,consistingof this and one(1)other typewl,ittcn page,was on the clay
and dale thcrcofsignecl,scaled,publislic d,and declared hp the Testatrix herein n:m ed,as and Ior her
Last Will and Testunent, in die presence oI us, who, at her request, in her prescuce and in the
presence of each other, have subscribed our names as witnesses hcrc(.o.
---
or--4' --�-- �.=---
l
� 1
Page 2
COMMONWEALTII OF PENNSYLVANIA
COUNTY OF YORK
SS.
\Wc,GEORGENE S.GERRITY,
/ ----- ------------
C
------------- fhcTest'atrix wid the Nvilncsscs,respcclivel}.
whose nurses arc signed to (lie attluhcd oi- Ioregoing instruincnt, being first drily sworn, do heiCI)v
daclare to the midcrsiglicd aulhovity that the TCS(atix sided andl CXmited the ins(rutnent as tierL.cst
\Will :uid Testament, and Il'fai she siglicd willingly, .md Ihat she CRCCIIte-d ills her Gcc mid vohinlary
act for the purposes tltercin expressed, and thatcach of the witnesses, in the prescncc and hearing' of
Chc Testator sipud (lie AWill as w tacsses, and that to the besC of their laioiwlcdgc, the"1'cslalrix lasts of
the time eighteen (18) years of age. or older, of sound mind, u-ld uiulci no constraint or undue
iuilucnce.
1
GEORGL"`NE S. �;ERRITY
i
SWORN TO AND SUBSCRIBED
BEFORE ME THISS //M DAY
OF 2011.
t
i
NOTAIV� PybLIC
COMMONWEALTH OF PtNNSYLVANIA
Notarial Seal
Janet S.Gore,Notary Public
Dillsburg Boro,York County
Ply Commission Expires Oct.25,2014
Member.Pennsylvania Association of Notaries
zo
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CERTIFICATE OF TITLE FOR A VEHICLE
�) 184
IFS
"-rjg092059999008690-001
f^f r F ( 653127.61601 LO l
1MAL21EXBN427918 2❑OBI NI SAN- _ - TITLE -^ H
1 - - s
c VEHICLE IDEMI CATION NWDEP EAR AKE OF VENMAC
VIP SDN 0 11102/07{ . 00003[(( 0 `
�.I BODY TYPE �I Our, " I SEAT CAP I PRION nTIE STATE I ODOIA.PROM.OATE ODDM MILEb- ODON STATUS `
11/02/07 I 11/02/07 "TITLE BRANDS
TE !�
3n DATE TRLED DA of IssuE I uNiAOEN ruE1GHr •• "cw+P .�'�•.� ccvm
1 P. IX
MaE AAL UIEACEEDEO
- 'YV..EGE B TMC NCCl4NIC.•L i-
t I-•rqT THE AY.(WL U0.LAOE
1 5 T"'Oh"a VEF`M AaECOO IE Eh t
TXELIFf RI NOCKA' E f`
JOINT OWNERSHIP WITH. RIGHT>zAF'SU R V I V O R S H IP .•EIEbp FnO ODpIE EP DbCLOSWE I + _
nnB BRArms
I! REGISTERED OVMEms) ./ I .NR M
' VewcLe � _
D•LOLLEr.ME Y LE 1
. RFyay.dn LrohTr n.SV^n�L'd"^�. f'? . F .art of COCA X11
, ROBERT M .LOi4I SON V. r f O.DRIDwn XoD.FOR NO11Ls
i GEORGENE GERRI-TY . H.AUBTV
WIC ALVENIG.E a?'
' 506 FALCON DR - eqE
_ P•IWAS A P0.1CC V•cHICLC
R.RECONSTRUCTED
CARLISLE PA 17013 1 FECETRCD
T.RECGfEr1E0 THEFT VEMELE j ;j
V• LOOD Cp:RAINS REISSUED VIN
F
_a Yf. LN'O A TAO
.F SEUN1O lJEN FAVOR OF:
I�FIRSi LIEN FAVOR OF:
1E5epBo- yb;fr:
.} n . sewvJ MINRIdR + EsIT RIIR FA IMW d Da.het nen,.tM Ilnl JJII".'y
WNntlM mVR rw�'eM
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eppop4b blm aM IFe.
F",T LIEN RELEASED DATD �-
i
SECOND LIEN RELEASED
DY DATE
.) AUT11ORIZEO REPPEBENTATIVE
4 MAILMG AODFiE55 BY AMHORIZED REPRESENTATIVE '
ROBERT fS LOMISON
GEORGENE GERRITY .
506 FALCON DR `
CARLISLE PA 17013
I r
ALLEN D BIEHLER
�. 4I ttmh ec M IH[d.11 d bw. Cm Imcul r.cptl!tl b ��.
"VV d TrNaRMeW.o rLRkCI Irv:Dro ARm(N a¢nOe^Y Sttl<Inrp Of Tnn•RnLtaNnn 4 1
"_•�� ' w19si d dr.eAe.Elucx. '- :•
It d coyurchasor
-' II1e0 IXs"Jo hB hnn your spo is lsleltl antl Yo wdM the title lO
cu D AND SWORN nents With Right of SurvvorshiO•(OR death of orle
OF,To w
v owner.Iile goes Io o sUW Fe,)CHECK HERE 0.OIherMSP.Me
iO BEFORE Mm title
Lvnl DB tssuDtl es•fens ITS n Common')On tlR vm
elh o1 one Odr,inIe18St of
deceased owner goes IO hiJRler hDlrs w Oat
nle).
IF NO U[N.CHCCNO Ib TN4 AN ELTR(1F YES.FIN REQUIRED) YES Q NOD
W 1St LIENH0.DER FINANGAL"If- T1ON NUTAOEP: Ii FffF``;
j``} N IST LIENIWLOEP NNlE5f -
II
STREET
.Q CRY STATE ZIP
�� f.
N ~ rcA'.
IF NO ZND LIEN,CHECK O is THIS AN E4i(IF YES.FIN flE0NREO1 YES❑NOO
'MW"4°e 2ND UENNOLDEP FINANCIAL INSTITUTION NUMER:
_
CrJ 2ND UEHIIOLDEP NAME -
r
O�STOWN
BANK
A Tradition of Excellence
November 25, 2013
Law Office of Wm. D. 3chrack III
124 West Hru-risburg St
Dillsburg, Pa 17019
Fax: 717-432-1053
Re: Estate of Georgene S. Gerrity
Social Security Number
Date of death 11/4/2013
IT IS HEREBY CERTIFIED THAT THE, ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKING ACCOUNT /
Account No.- 40095986 V
Account Type- 50+Interest Checking
Account Title- Georgene S Gerrity/Robert M Lomison
Date Opened- 9/14/06
Joint Account (name/date)- Yes Georgene S Gerrity/Robert M Lomison 1/29/07
Balance- $16000.73
Account Interest- $ 0.55
CHECKING 11CCOUNT
Account No.- 149000569
Account Type- 50+Interest Checking
Account Title- Robert M Lomison/Georgene S Gerrity
Date Opened- 11/17/08
Joint Account(nanic/date)- Yes Robert M Loinison/Georgene S Gerrity 11/17/08
Balance- $9131.98
Account Interest- $ 0.02
2695 Philadelphia AVCOUe • Chambersburg, PA 17201
CHECKING ACCOUNT
Account No.- 149000587 %
Account Type- 50+Interest Checking
Account Title- Robert M Lomison/Georgene S Gerrity
Date Opened- 12/01/08
Joint Account(name/date)- Yes Robert M Lonuson/Georgene S Gerrity 12/01/08
Balance- $9080.17
Account Interest- $ 0.02
A L PURPOSE CLUB ACCOUNT
Account 5000000695
Account Type- All Purpose Club Account
Account Title- Georgene S Gerrity
Date Opened- 10/12/06
Joint Account(name/date)- o
Balance- $0
Account Interest- $ 0.00
Best Regards,
Kimberly Moyer
Deposit Processing Clerk
111.27,''211.? 14:38 1570`1374'3261 SUSQUEHANNA VAL INV
PAGE 01/05
Holdings by Investor
Mrs Georgele S Gerrity Joseph Parry Combined Aocoont Par olle
595 Falcon Di Ive Susquehanna Valley Investments Dale: 11104/2013
Carlisle.PA 17013 One Susquehanna Valley Mall Drive Creetsd:11127/Z013
Suite G1
Selinsgrove,PA 17870
570-374-4589
Georgene S Gerrity
Acct Ndme:GEORGENE S GERRITY 506 FALCON DR CARLISLE PA 17013 -
Acct NO:000DA135437 Acct Type:General
Rep.No:5H13335
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A,1,41ANZ LIFE 147,!39 ]0: 2 a : 149'158:
:: ;tfOWIVALENTS a + ',�
FRANKLIN INCOME SECURITIE5 EOUITY ALLIANZ LIFE- 5B 54 4 3 76d 82:
Account Total $5.254.47
Acct Name=GEORGENE S GERRITY 506 FALCON DR CARLISLE,PA 17013
Acct No:1005406869 Acct Type:General
Rep.No:1880866
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JNUMELLON CAPITAL.10X10 EQUITY .IACkSON 14&314 11: 0 17110l
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JNUMFLON CAF`17AL OIL&OAS EtlUIYY JAK�CiN I 9903 3B 4 ' B59 tt3',
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JNUl MANAGED MODERATE GRI EQUITY JAGKSbN 293Q,48 176 '52,332,791
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Accountlota
I. $76.259.74
Acct Name:GEORGENE S GERRITY TOD DTD 09/2312013 506 FALCON DRIVE CARLISLE PA 17013-8777
Acct No NW7352441 Acct Type Transfer n Death(9ldlvldual)
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4 111,1
OPPENHEiMER SENIOR FLOATING :'tltlSAX FIXED INCOME, OI?PNHEIMER 381954 8: 9 30367
RATE FUND FUNDS
Accounllbtab $44,856.77
Incomplete 1f presented without accompanying dlsciosul'e pages pja� 1 o13
111.27 '2013 14: 32 15703749251
SUSQUEHANNA VAL INV F'F; E L-1�JIJF
Holdings by Investor
Mrs Gecrgene 5 Gerrity Joseph Perry Combined Account Por olip
508 Falcon Drive Susquehanna valls Investments
Carlisle,PA 17013 One Susquehanna Valley Mall Drive Date: 11/04!7013
Reafed;11127!2013
Suite G1
Selinegrove.PA 17870
570-.374-4509
Acct Name:PUTNAM FIDUCIARY TRUST GO TTEE F130 GEORGENE S GERRITY IRA PLAN 506 FALCO DR CARLISLE
PA 17013-8777 ---- ------______
AcetNo:00551290742 Acet7yp®:Putnam IRA
Rep No J65
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BWTNAM-G4OBAl WTILITIES FVNp? PUTBX EQWITYit R4t"�dVAryry11r + M188743 0 1M1 g,' r Fp A2E 28!
...Account Tolal• $51422.28 G
InvostorTotal: $100,793.26
Inrpmplete if presented without accompanying disdosum pages Page 2 of 3