HomeMy WebLinkAbout07-29-14 � 1505611185
REV-1500 EX�°z-,,,�F'>
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Tvices INHERITANCE TAX RETURN 21 13 0 6 6 5
PO BOX 280601
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
03302013 05291919
Decedent's Last Name Suffix DecedenYs First Name M I
MATTSON WALTER E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - RE�ISTER �F iIVILLS
FILL IN APPROPRIATE BOXES 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(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ ��• 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
KEVIN M • RICHARDS 717-274—� :=_ -,�,
-7-; -r,
=r ;
REGISTER $USE O� ;
� . . i�°"' J
F\J
�G � -
First Line of Address CJ�a� -
C-7 C�� 'D �_:
937 WILLOW STREET U�-,, �'� - ��
Second Line of Address t � � � �
� {,,,7 '"�C
PO BOX 1140 � �
City or Post Office State ZIP Code DATE FILED
LEBANON PA 17042
correspondenrse-mai�address: RICHARDSa�HENRYBEAVER • COM
Under penalties of perjury, I dec{are tnat 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 FILWG RETURN DATE� "����
GREGORY D MATTSON � vC
ADDRESS
2579 COVE CIRCLE ATLANTA, GA 30319
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1 �
� 15 0 5 61118 5 � oMasa�s.000 15 0 5 61118 5 � �
�
� 1505611285
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedenesName: MATTSON WALTER E
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 11 D,0 0 0 • 0 0
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 S 7�5 9 6 • 0 0
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. 0 • 0�
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. � • �0
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 3,9 61 • ��
6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g. 0 • ��
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . 7. 2 O 2,111 • ��
8. Total Gross Assefs(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , g 3 7 3,6 6 8 • ��
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 3�,8 4 4 • �0
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �p. 4�7 8 7 • ��
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 3 5,6 31 •��
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2. 3 3$�0 3 7 • �0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3. Q • Q Q
14. Net Value Subject to Tax(Line 12 minus Line 13) , , , , , , , , , , , , , , , �4. 3 3 8�Q 3 7 • Q 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 • �� 15. � • 0�
16. Amount of Line 14 taxable
at�inea�ratex.o� 338,037 • 00 �s. 15,212 -00
17. Amount of Line 14 taxable
at sibling rate X.12 D • 0 0 i�. 0 • 0�
18. Amount of Line 14 taxable
at collateral rate X.15 � • 0� 18. 0 • 0 0
19. TAXDUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. I,5�212 • 00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT X❑
Side 2
� 1505611285 1505611285 �
OM4648 3.000
REV-1500 EX(FI) Page 3 File Number
Decedent's Com lete Address: 21 13 0 6 6 5
DECEDENTS NAME
MATTSON ALTER
STREET ADDRESS
CITY STATE ZI P
CAMP H L PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,�ine 19) (�) 15,212 • 0 0
2. Credits/Payments
A. Prior Payments 17,0 0 0 • 0 0
B. Discount 8 01 • 0 0
Total Credits(A+B� �2� 17,8 01 • 0 0
3. Interest
(3) � • 0�
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2,Line 20 to request a refund. (4) 2 i 5 8 9 •��
5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) � • �0
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . � �
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . : � �
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . � �
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . � ❑
4. Did decedent own an individual retirement account,annuity, or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after 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 decedenYs linea�beneficiaries is 4.5 percent,except as noted in[72 P.S.g9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent [72 P.S.g9116(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.
OM4671 2.000
REV-1502EX+(�Z_�2) SCHEDULE A
pennsylvania
DEPPRTMENTOF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Walter E. Mattson 21 13 0665
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 joinUyowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2921 Cumberland Boulevard, Camp Hill, Cumberland Co. , PA
(Sale price-see attached copy of HUD Settlement
Statement) 110,000
TOTAL (Also enter on Line 1,Recapitulation.) $ 110,000
zwasss s.000 If more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(&12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERffANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Walter E Mattson 21 13 0665
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIP110N OF DEATH
1. 767.069399 Shares
Verizon @ $49.15 per share 37,701
2 163 Shares
Boeing Corp. @ $85.85 per share 13,994
3 103.421654 Shares
DuPont C� $49.16 per share 5,084
4 204.855066 Shares
Frontier Communications Cm $3.99 per share 817
TOTAL (Also enter on Line 2,Recapitulation) $ 57,596
zwasss s.000 If more space is needed,insert additional sheets of the same size
REV-1508 EX+(0&12)
pennsylvania SCHEDULE E
DEPPRTMENTOF REVENUE CASH, BANK DEPOSITS 8� MISC.
ESIDENTDECEDENTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
walter E. Mattson 21 13 0665
Include the proceeds of litigation and the dffie the proceeds were received by the estate.
All ro ert 'ointl owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2004 Volvo 540, appraised value 3,264
2 Refund of prepaid real estate taxes for 2921 Cumberland
Blvd. , Camp Hill, PA (see attached HUD Settlement
Statement) 697
TOTAL(Also enter on line 5,Recapitulation) $ 3,961
2w4sAD 2.00o If more space is needed,use additional sheets of paper of the same size.
_ _
_ _
REV-1510EX+(08-09) SCHEDULE G
pennsylvania
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Walter E. Mattson 21 13 0665
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY EXCLUSION TAXABLE
ITEM INCLLOETFENoMEOFTI-ETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S
NUMBE TFEDATEOFTRMISFFR.ATfP�HACAPV OF TFf DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF PPPLICABLE VALUE
�• PSECU Account #0159 made Joint
with son, Grgory D. Mattson
within one year of death on
10/16/12 55,801 100.0000 0 55,801
2 Charles Schwab Investment
Account #1088-3859, TOD to son,
Gregory D. Mattson 145,082 100.0000 0 145,082
3 Citizen's Bank Checking Account
#0922 made joint with son,
Gregory D. Mattson within one
year of death on 10/16/12 1,228 100.0000 0 1,228
TOTA�(Also enter on line 7,Recapitulation)$ 202,111
If more space is needed,use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 EX+,o&,3, SCHEDULE H
pennsylvania
DEPPRTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Walter E Mattson 21 13 0665
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
� Funeral luncheon 288
2 Myers-Harner Funeral Home 8,621
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 7,500
3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 384
5. AccountantFees:
6. Tax Return Preparer Fees:
7.
1 Misc. reserve 500
2 USAA, homeowners insurance 950
3 Borough of Camp Hill, sewer 661
Total from continuation schedules . . . . . . . . . 11,940
TOTAL(Also enter on Line 9,Recapitulation) $ 30,844
swasa,c z.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Walter E. Mattson 21 13 0665
Schedule H Part 7 (Page 2)
4 PA American Water 236
5 PP&L 485
6 Penn Waste 166
7 Verizon 583
8 Camp Hill School Tax 39
9 Postage 32
10 Capital City Oil 773
11 Register of Wills, filing fees 20
12 Register of Wills, Short Certificates 15
13 FedEx charges 132
14 Closing costs for 2921 Cumberland Blvd. , Camp Hill,
PA (see attached HUD Settlement Statement) 8,255
15 Diane Nepier, 2014 Real Estate Taxes 1,204
Total (Carry forward to main schedule) 11,940
REV-1512EX+�,2_,2, SCHEDULE I
pennsylvania
DEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Walter E. Mattson 21 13 0665
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
�• Capital One credit account 593
2 West Shore EMS 644
3 American Home Patient 37
4 VA, return benefit 2�9�3
5 Andre Blaustein Kill & McCarthy, legal fees 540
TOTAL(Also enter on Line 10,Recapitulation) $ 4,7 87
zwasAH z.000 If more space is needed,insert additional sheets of the same size.
REV-1513EX+(01-10) SCHEDULE J
pennsylvania
DEPARIMENT OF REVENUE BEN EFI C IARI ES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Walter E. Mattson 21 13 0665
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS(InGude outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
�, Gregory Mattson
2579 Cove Circle
Atlanta, GA 30319
Charles Schwab Investment Account
#1088-3859, TOD to son, Gregory D.
Mattson (see attached schedule of
valuation)
Inventory Value: 145,082
Citizen's Bank Checking Account
#0922 made joint with son, Gregory
D. Mattson within one year of death
on 10/16/12
Inventory Value: 1,228
PSECU Account #0159 made Joint with
son, Grgory D. Mattson within one
year of death on 10/16/12
Inventory Value: 55,801
ENTER DOLLAR AMOUM'S FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NOf�TAXABLE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0
If more space is needed,use additional sheets of paper of the same size.
9W46AI 2.000
Estate of: Walter E. Mattson 21 13 0665
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
1
One Half of Residue: 67,963 Son 270,074
2 Eugene C. Mattson
600 Charles Street
Mechanicsburg, PA 17055
One Half of Residue: 67,963 Son 67,963
� D
LAST WILL AND TESTANIEN'T
OF
WALTER EUGENE MATTSON
I,Waiter Eugene Mattsan the Testatar,presea�fly residing in Cumberland County,Pennsylvania,being
of sound and dispc�sing mind and memory,do make,puiblish and declare rhis to be my last Will and Testament,
hereby revoking any and all Wills and Codicils made by me previously.
1.
EXPLAINATION OF TERM.S
(a) The term "Testator" shall refer to both male and female gender, furthermore,throughout this Will,
wherever the contex requires or permiits, gend�s shall be interehangeable and the singular number shall be
deemed to include the plural and vise versa.
(b) The terrn"Devise"shall refer to distribution of real property,personal property,or both,as the context
requires ar pennits,furthermare,the terms"Devisee" and Beneficiary"shall be interchangeable where the context
requires of permits.
• (c)The term"my spouse"shall refer to the person to whom I am married at the time I execute this document
provided that I shall n�ot be deemed to have a spouse if at the time of my death I am nat married to that spouse by
reason of divarce. The term"my children" shall incliude all of my children, whether born before or after the
executioai af this document,and the terms"cluld",children", and"issue"shall such child,children, andlar issue
in gestation at the rime of my death who are born alive within ten(10)months of my death. For the purpose of
this Will,an adopted child sha11 be treated in all respects as if a natural child� issure of the adopting pazents,
regardless of whe�er such child is adopted before ot after the execution of this wll. The term"my stepchildren"
shall refea only to the children of the person to whom I am married at the time I execute this document,which
children are not my children, pravided that it shall not include such children if at the time of my death I am not
married to that spouse by reason of divorce ar am leagally separated from that spouse.
(d)The term"Executar"shall refer to the Execut�,F.�cec�mix,or Co-Executars,as the case may be of my
estate or to any successor or alternate thereto,provided,however,ffiat in the case of my estate of Co-Executors,
if one of the persons named has died,the surviving named person ar persons shall act as the sole Executar
Ccrostance Veronica Mattson shall serve as said Executtor of my estate. In the event that said Exe,cutoir is unable
or unwilling to serve in such capacity or dies while serving in such capacity, I appoint Gregory David Mattson
as my altemate Executor. In the event that said alternate Executor is unable or unwilling to serve in such capacity
or dies while s�ving in such capacity,I appoint Eugene Charles Mattson as my altemate Executar.
Page 1
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__ ._ _ _ _ ___ _
_
11.
DEBT,ADMISTRATION EXPENSE,AND TAXES
I direct my Executor,as soan as practicable after my death,to pay from my residuay estate
or otherwise satisfy for the purposes of Pennsylvania law,any debts of mine that are not barred
by any applicale statute of limitation.. I also direct ihe Execut�to pay from my residuary estaie
my funeral�xpenses, the expenses of administering my estate,and any estate, inheritance,or
other death t�es attributable to property passing under thisWill or ouiside of thisWill(including
specifically the proceeds of any life insurance policies on my life),eaccept the Executor shall make
such clai.m as is permitted by law for any death taxes attributable to property over which I have a
power of appoiniment or to the inctusion of qualified terrninable interest property in my estate.
111
POWERS OF ADNIINISTRATION
(a)In addition and without limitation upon any powers granted by thius�11 or by law,the
Executor,and any successar,shall have the following powers which shall be exercisable in the
Executor's discretion and in such manner as the Executor may deem equitable and just without
order of or report to any court:
(1}To lease,sell,exchange,or otherwise dispose of any property awned by me at my death
or acquired by the Executor after my death, at public or private sale,as the Executor deems best,
and to make any election permitted by tax laws.
(2)To invest any monies or other properties in my estate in su�ch stacks,bonds,notes, real
estate, certificates of deposit, impravements there�, or to make any other invest�nents the
Executor deems best.
(3)To use real estate brokers,accountants,and attorneys to asist in the administration of my
estate,at the discretion of my Executor,and to reasonably compensate them for their services.
(4)To value the property in my estate for ihe purpose of malcing distributions and to distribute
my estate in cash or in kind and in divided or undivided interests
(.5)To renew,extend,or modify any note,mortgage,deed of hnast,or other indebtedness and
to borrow money with or without security
(6)Furthermore, I gant to my Executor all of my powers set forth in Pennsylvania Laws
as amended to the date of execurion of this wll.
('n The povv�er to determine whether items should be charged�credited to income ar principal
` appcxtioned betv�en income and principal. The Executor shall exercise the Executor's
eti� i�such manner as the Executar may reasonably deem equitable and just under all �
th�circumstances and regardless of whether such items are charged or credited to or apportioned
between income and principal as provided in the Pennsylvania. Qfficial Code.
Page-2-
1
(b If I have directed my Executor to distribute any portion of my
tangible personal property by a separate written instrument, it is my
desire that such property be distributed as so directed, but without
imposing any legal obligation on my Executor.
(c)Any successor or alternate Executor shall have all of the rights,
powers privileges, and immunities of the oriqinally named Executor.
No Executor shall be required to make or file any inventory, appraisal,
return, or account, or report to any court, or be required to post bond,
unless otherwise required to do so not withstanding this provision. No
successor or alternate Executor or other fiduciaries shall be required to
inquire into or audit the acts of any predecessor or to make claim against
any predecessor or his or her estate.
(d) A corporate Executor may receive compensation for its services in
accordance with its published schedule of fees in effect at the time the
services under this Will are rendered. An individual Executor may receive
that compensation for his or her services which is allowed by law at the
time the services under this will are rendered.
(e) If it becomes necessary for a representative of my estate to
qualify in any jurisd�ction other than the state of Pennsylvania in which
my Executor shall be unable or unwilling to qualify as Executor,then my
Executor shall have the right to appoint an individual or corporate
representative of my estate in such jurisdiction. Any such representative
is authorized and requested to appoint my domicillary Executor as agent
to handle the details of the administration of my estate in such other
jurisdiction. Any such representative is requested to complete the
administration of my estate in such other jurisdiction as soon as possible
and to transfer any property received in sueh administration to my
domicilliary Executor.
IV,
SIMULTANEOUS DEATH
If any Beneficiary or Devisee under this Will does no� survive me by
thirty(30)days from the date of my death,it shall be presumed for purposes
of any distribution to or for the benefit of such. Beneficiary or Devisee
that such Beneficiary or devisee predeceased me.
V,
EFFECT OF BIRTH OR ADOPTION O�' CHILD
This Will is made in contemplation of the birth or adoption of
chi].dren or additional children and shall not be revoked by any such event
or events.
VI,
I devise all of the rest, residue, and remainder of my estate� real
and personal, or mixed, wheresoever located, as follows: �
Page -3-
1
I hereby devise the remainder of my estate to the Trustees then
acting under the Family Trust executed by me immediately prior to my
execution of this Will,as the same may be amended prior to my death,to
be held, managed, and distributed under the terms of such trust as of
the date of my death. In the event that this devise of my residuary
estate to the Family Trust is for any reason ineffective,I devise such
property to the Executor, acting as Trustee, to be held, managed, and
distributed pursuant to the terms of the Family Trust, the terms of
which are hereby expressly incorporated by reference.
Provided,however, if at the time of my death I am survived by my
spouse and the Trustee then acting under said Trust disclaims any part
or all of this Devise, any part of such Devise so disclaimed shall be
distributed to my spouse free of trust
Page-4-
1. Walter Eugene Mattson, the T tator, sign my name and affix my seal
to this instrument this �� day of , °,�, and do hereby declare
,�.--
and publish this instrume as my Las il an Testament and that I sign it
willingly (or direct another to sign r me)that I execute it as my free and
voluntary act for the purposes therein expressed, and that I am fourteen(14)
years or older, of sound mind, and under no constraint or undue influence. .
,��7��� (S EAL)
Eugen Mattson, Testator
We. ��i' z T 14y �,;_ L�/h andc-�-c.S��(��"� � �-f A n� �R-f; �� �C, ,
the witnesses,sign�o names to this instrument on the date above written,and
do hereby declare that the Testator signed,sealed, declared,and published this
instrument as his (her) last Will and Testament and that he(she) signed it
willingly (or willingly directed another in his (her)presence and hearing to
sign for him(her) and that each of us, at his (her) request and in the presence
and hearing of the Testator and in the presence and hearing of each other
hereby signs this Will as witness to the Testator's signing, and �o the best
of our knowledge the Testator is fourteen (1�) years of age or older, of sound
mind and under no constraint or undue influence.
Witness Signature �`�^r��
Witness Signature � ���"G`^������
/���
Page -5-
��1 ' ' .
�
AFFIDAVIT
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Before me, the un ersigned authority,on this day personally appeared Walter Eugene Mattson,
1�6 � . G' and c��l� �- ��I�J/Si�?�ICC� ,
l�own to e to be the Testator and the wimesses, respectively, whose names are subscribed to
the annexed ar foregoing instrument in their respective capacities,and,all of said persons being by me
duly sworn,Walter Eugene Mattson,Testator,declared to me and to the said witnesses in my presence
that said instrument is his(her) I.ast�11 and Testament and that he(she) had willingly made and
executed it as his(her)free act and deed for the purposes therein expressed. The wimesses,each on his
oath,stated to me in the pres�ce and hearing of the Testator that the Testatar had declared to them
that the ins-trument is his(her)Last Will and Testament and that he(she)executed same as such and
wanted each of them to sign it as a witnress, and upon his(her) oath each witness stated that he
(she)did sign that same as witness in the presence of the Testator and at his(her)request,that he(she)
was at the time fourteen (14) years of age or over and was of sound mind, and that each of said
wi�essess was then at least fwrteen(14)years of age.
' ��l��dT�
Walter Eugene ,Testator
dSJ� Q_
Witness •
T
t4^'�-y` v
1L[1CSS
Sworn to and subscribed before me by Walter Eugene Mattson, the Testator and sworn to and
subscribed before me by. ,y� n�
G(��2—��'Gl��✓E///�� , ��%�7� i�6��'�',4 and
C�t�`.��'�i� �- /`� ✓I/�`�3�JC/� , wimesses,
this��day of '—" ��
Notary Public
(3EAL) �, . �v�uv'�AZTH O�°PE�a(LVANIA
NOTARIAL SEAL
MyCommi ���'�:--�.,.-.-.�� - - -- ^ublic
Camp Nil! Boro, Cumberland County
PAy ��mmission Expires June 6, 20U9
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Portfolio Statement
As of 03/31/2013
Mattson,Walter Eugene TOD Acct#: 10883859
Portfolio Allocation
Cash and Money Funds:2.9°/
Intemational Equity:3.8°/
Large Cap Equity:33°/
Mid Cap Equity:3.1°/
Small Cap Equity: 1.0%
U.S.Fixed Income:45.9°/
�
Specialty Funds:34.1%
[ntemational Fixed Income:6.0%
Actual Initial
Cash Unit Cost Current Current Unrealized Net Trade
WeiQht Descriation Ouantitv Invested Cost Basis Price Value Cain(Loss) I( RR) Date
Cash and Money Funds
2.9% Schwab Money Market Fu 4,139.57 4,139.57
International Equity
3.8% First Eagle Sogen 239.773 4,700.00 20.47 4,908.07 22.84 5,476.42 568.35 17.9% OS/21/2012
Large Cap Equity
2.6% Longleaf Partners Fund 127349 2,601.21 28.12 3,581.54 29.46 3,751.70 170.16 16.5°/a l2/30/2003
0.7°/a Oakmark Select Fund 29.993 602.88 22.98 689.24 33.30 998.77 309.53 �5.2°/a l0/02/2009
33°/a 3,204.09 4,270.78 4,750.47 479.69
Mid Cap Equity
0.2°/a Aston/Fairpointe Mid Cap 5.894 100.39 15.40 90.77 3836 226.09 13532 92.2% 12/29/2008
2.9% Gabelli Enterprise Merg 362.128 3,451.08 9.53 3,451.08 11.75 4,255.00 803.92 21.8% 06/07/2010
3.1% 3,551.47 3,541.85 4,48L09 939.24
�.,,all Cap Equity
1.0% De(afield Fund 42.987 912.84 23.56 1,012.93 32.97 1,417.28 404.35 88.4% 12/22/2008
Specialty Funds
4.6°/a Eaton Vance Global Macr 673.032 6,400.00 10.38 6,988.47 9.89 6,656.29 (332.18) 5.9°/a 06/07/2010
14.7% Forward Longshort Credit 2,368.996 14,962.02 7.48 17,712.13 8.98 21,273.58 3,561.45 69.8% 03/26/2008
0.2% Leuthold Asset 25.418 195.21 7.31 185.74 10.65 270.70 84.96 50.0% 04/09/2009
3.4% Leuthold Core[nvestment 278.665 3,152.88 I6.00 4,458.17 17.76 4,949.09 490.92 80.8% 06/10/2005
Page 2
Portfolio Statement
As oY 03/3l/2013
son,Walter Eu�ene TOD Acct#: 10883859
Actual Initial
Cash Unit Cost Current Current Unrealized Net Trade
Weiaht Description Ouantitv Invested Cost Basis Price Value Gain(Lossl I( RR) Date
Specialty Funds
3.1% MergerFund 281.032 3,483.50 15.06 4,232.29 15.87 4,459.98 227.69 383% 12/16/2003
8.2% Mutualhedge Frontier 1,238.147 12,245.27 1030 12,749.69 9.64 I 1,935.74 (813.95) -2.5% 10/22/2010
34.1°/a 40,438.88 46,326.49 49,54538 3,218.89
International Fixed Income
6.0% Pimco Foreign Bond Fund 797.024 7,615.00 10.65 8,487.65 10.90 8,687.56 19991 34.6% 10/02/2009
U.S.Fixed Income
12.1% Angel OakMulti Strategy 1,417.283 16,585.00 11.75 16,654.87 12.35 17,503.45 848.58 8.2% 08/29/2012
11.7% Eaton Vance National Mu 1,657.844 12,450.00 9.03 14,976.61 10.24 16,97632 1,999.71 49.6% 09/22/2008
3.0% Loomis Sayles Bond Fund 287.121 2,437.22 10.44 2,998.95 15.23 4,372.85 1,373.90 95.2% 04/09/2009
7.6% Mainstay[ndexed Bond Fd 978.421 10,639.27 11.58 11,334.93 I 1.25 11,007.24 (327.69) 5.7% 09/16/20l 1
11.5% Pimco Total Return Fund 1,487.909 10,986.76 10.65 15,852.40 11.24 16,724.10 871.70 84.9% 12/16/2003
45.9% 53,098.25 61,817.76 66,583.96 4,766.20
100.0% 113,520.53 134,505.10 145,081.73 10,576.63
We recommend you compare this statement rtiidt tlie statement yo��receive from your custodian.
6/6/2014 1:58:01 PM
• A. $ett�g�pgnt Statg�pgnt U.S.Department of Housing OMB Approval No.2502-0265
" and Urban Development
8.Type of Loan
6.File Number. 7.Loan Number: 8.Mortgage insurence Case Number:
1.❑FHA 2.❑FmHA 3.�Conv.Unins. 20740857
4.❑VA 5.�Conv.Ins. ❑O[her
C.Note: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.
items marked"(POC)"were paid outside the closing;they are shown here for infortnational purposes and are not included
in the tota�s.
D.Name&Address David L.Schultz,PO Box 903,Camp Hili,PA 17011
of Borrower:
E.Name&Address The Estate of Walter E.Mattson,AIK/A Walter Eugene Mattson,A/K/A Walter E.Macijewski,2579 Cove Circle,Atlanta,GA 30319
of Sei�er:
F.Name 8 Address Members ist Federal Credit Union,5000 Louise Drive,Mechanicsburg,PA 17055
of Lender:
G.Property Location: Property Address
2921 Cumberland BNd.Camp Hiil,Pennsylvania 17011
H.Settlement Agent: Great Road Settlement Services,LLC,6 S.17th Street,Camp Hill,PA 1701 t,(717)731-1040
Place of Settlement: 6 S.17th Street,Camp Hill,PA 17011
I.Settlement Date: 6/6/2014 Proretion Date: 6/6/2014 Disbursement Date: 6/6/2014
,�"?" .�i:�SU �.fX��Y�� f31758GL�0�3L _t.,s..�t�"��E?>c.�'7�v3i�a.�.. ,�t.-,,,,��!:Y.+Q1��I�k��B�I�'r9�j817$dC�S1F�'�. � �;<'�e�...e�.y�.t �.
t� .+�:F.0
'IdO. ,'G'r`ox,+�,mot�` fraei��3bFr�,ar�+,'s?; ��'��r`,;�.','s�`a`^�°���,��_� ��s �o'IitiERlaaio.$Cller<<.�..�ti.�,x'��„�K� �-� e,..
707. Contractsalesprice �$110,000.00401. Contraetsales�price $110,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) $2,830.00 403.
104. 404.
1 O5. 405.
A2jasfinenb7ailtejifsPaid�:salferh�advaiiee ,' � -, � .��t p stdtentsfo?�temlj°�T4bYs�1lerMadvaiice. � . �
106. Cityttown taxes 408. Cityltown taxes
107. County taxes 6/612014 to 12131l2014 $686.37 407. County taxes 6l6l2014 to 12I3112014 $686.37
108. Assessments 408. Assessments
109. 409.
110. Sewer 616l2014 to 6/30/2014 570.85 410. Sewer 6I6/2014 to 6130l2014 $70.85
711. 411.
712. 412.
120. Gross Amount Due from Borrower 5113,527.22 420. Gross Amount Due to Seller =110,697.22
2os�.:-�liuo4�MSP�1i7�f�o�'�i�F6iiilfoE60�i'oN�96 '=-$ �. . . �=a _��,� �'` �o�k;�.Re+#iia��s �amwn"coiie:tas'a�i�r;� � .�# �'. ,
,
201. Deposlt or eamest money SS,OOa.00 501. 6ecess deposit(see instructions)
202. Principal amo�nt of new loan(s) SB8,0o0.00 502. Settlement charges to seller(line 1400) gB,255.00
203. Existing loan(s)taken subjed to 503. Existing loan(s)taken subject to
2�4• 504. Payolf of first mortgaga loan
205. 505. Payoff of second mortgage loan
206. Spg.
207. 5p7.
Z� 508.
209. 509.
..:,c .-,-,_ . _ . - -e..w. . .
„} ,.-.
l,itlJusfmant4tar,Items±M{�iate��_seiler _x,:�� . ���.�-.,."` as•�`�...�.- strrilarHe#o_r `•�nP�d saRe�`�`z''�;:�,;.<"""'�;,�;e .`;s:'`
_.� ,
210. Cit/towntaxes ... �. ,�.�.�.
Y 510. Cityttown taxes �
211. County taxes 511. Counry taxes
212. Assessments 512. Assessments
213. 513.
274. 514.
215. 515.
216. 516.
217. 517.
218. 51 B.
219. 519.
220. ToW I Paid by/for Borrower 593,000.00 520. Total Reducdon Amount Due Seller =8,255.00
3Cf0 'C�'st�dt3e�e''fr97R�t��rrower" ,,,°��i,-:�Az x:.:���"'�,. E , --�- � �_;y 1 S
� . � �, .<Cdsh.30R�erkRW.4Y5n1`. 411�rr .._�^- a..<��;f „�` ,:c�,. ,
301. Gross amaunt due trom borrower(line 120) 5173,527.22 601. Gross amount due to seller(line 420) 5110,fi97.22
302. Less amounts paid by/for borrower(line 220) (593,000.00)602. Less reductions in amount due seller(line 520) ($8,255.00)
303. Cash �From OToBorrower E20,527.22603. Cash �ToOFromSelter 5702,442.22
SUBSTITUTE FORM 1099 SELLER STATEMENT- The infortnation wntained in Blocks E,G,H and I anA on line 401(or, if line 401 is asterisked,lines 403 and 404),4D8,407
and 40&412(applicable part of buyefs real esWte tex reportable to the IRS)is important tax in}ortnation and is beinp lumished to the Intemal Revenue Service.If you ere
required to file a retum,a neglipence penalty or other sencbon will be imposed on you if this item is required to be reported and the IRS determines that it has not been reportetl.
SELLER INSTRUCTION- If Nis real estate was your principal residence,file form 2119,Sale or Facchange of Principal Resitlence,for eny pain,with your inwme tex return;
for other trensactions,complete the applicable parts of form 4797,Fortn 6252 andlor Schedule D(FOrm 1040),
You are required to provide the Settlement Agent with your coneet taxpayer identification number.
If you do not provide the Settlement Agent with your wrrect taxpayer identification number,you may be subject to civil or criminal penalties.
THE ESTATE OF WALTER E.MATTSON,AlKIA WALTER EUGENE MATTSON,
AIWA WALTER E.MACIJEWSKI
Gregory Mattson Exec
Exewtor
. -- __ _ _ _
6/6I2Q14 1:58:07 PM File Number:20140857
� , 4:SCttleme'rit Charge5= fx�`� �a � � � k ��z r e
. _ , _ ..__ v...... ,...< ... . ._ r.: , . ,._ �, �, .�,. . ... .x- : .. . ,.... , ,. ,
• 700. Total Sales/Brokers Commission based on price$110,000.00=$6,995.00 Paid From Paid From
Division of commission(line 700)as follows: Borrower's Seller's
701. $3,300.00+$395.00 to ReMax Really Associates,Inc. Funds at Funds at
702. $3,300.00 to Strauh 8 Assxiates Real Estate Group,Inc. Settlement Settlement
703. Commission paid at settlement$6,995.00 $6,995.00
704.
800 ,liems PayaEle La Coh�iedttqrtwitl�Loar�' _,; k
. ., ,.. _ _. .��. ,. _. .. . .�..- : . ,..., � .- .
. . , :. . . ; ...�. _. -......,.<.. � . :�,.._ . ..:.
801. Loan origination fee
802. Loan discount
803. Appraisal fee to Members 1 st Federal Credit Union POCB 5550.00
804. Credit report
805. Lender's inspection fee
806. Mortgage insurance application fee
807. AssumptiOn fee
808. Loan Proccessing Fee to Members tst Federal Credit Union $250.00
809. Fbod Cert to Members tst Federal Credit Union $72.00
810. Tax Trex lo Membars 1st Federal Cretlit Union � $90.00
811.
812.
813.
$0�<lfem8'ReqtllCgd by Lentle�to Be P�t7;pS A�ya�ce;,;z -x`` F, .i .-,�Y-� $��.n.t� ' , e ,.t'' s ''"
t
..
901. Interest from
902. Mortgage insurance premium for
903. Hazard insurance premium for
904.
905.
-.. »:
i0(f0„R@4#rveaDepoaited,wftft-LendeE �:,�` �'" .:x :.^•r�- , �v,�._ t .,. s .�. �,�. .M�
, �. =�� s°�:}w...t.,
_ ,. . ... ...,,. . .�... . ,:-: .;. . , .: -:.: , e. ,. .
1001. Hazard insuranca
1002. Mortgage insurence
1003. Ciry property taxes
1004. County property taxes
1005. Annual assessments
1006.
1007.
1008.
1009.
��OQ,'�a�h8r��s:. _ ° .v y .? ,:- �� 4�:-a� ,x. ,,,�:
�- :_ .., ti:.
_. ..�„ � . _. . . , -_ � -.s. _
.
= A.. , „., ,.. . .' ,_, _„ .
. .
* . ,3�> � .- . "
. , . .. , .,. . ._.,. , _ P. < ..._ :. . . ._ __.
1101. Settiement or closing fee � ��
1102. A6strad or title search
1103. TiGe examination
1104. Title insurence binder
1105. Document preparation
1108. Notary faes
1107. Attorney's fees to
InGudes ebove item numbers: �
1708. TiUe Insurance to Greal Road Settlement Services,LLC 51.150.00
Includes above item numbers:
1109. Lendefs coverege 588,000.00
t�to. ownerscovarage a»o,000.00 $sso.00
1111. Erecortling Fee to Great Road Settlement Services,LLC � E10.00
1112. Deed Preparetion to ReMax Realty Associales,Inc. $150.00
1113. Tax Cert to Great Road Settlement Services,LLC $70.00
�U�'�'p`VEtiGnen ~� „" �` --
-.t._ �_. ��BCWf�(Q$$RdT�9n5�9F,»�.'IYiR�YB` ,'�� s.c..7,�.�-,_.,.�: �t ,.....;'�s'.sii`� §'S�7�.� s �,rf�+�v� k�s�x S
. . . . ..:- _ �. ..:-. . ... �_ .,. ...::.-., ..�...,... .......>:�
12Q1. Recording fees:Deed 555.50;MaAgage 589.50 5145.00
1202. Cirylcounrytax/stamps:Deed51,t00.00 51,100.00
7203. Statetax/stamps:Dead$1,100.00 $1,100.00
1204. UPI Cert to Re�rder of Deetls 520.00
1205.
1206.
a30b,` fbl�et-3e[tf�Qt§nt Cha�gga ?�� ''�a �" f ^ +`�;�,� r�, _ 1 r
1307. Survey
1302. Pest inspection to Archer Pest Contrd
553.00
1303. 2nd quarter sewer to Camp Hill Borough POCS$165_0
1304. 2014 Countyftownship W�c on 5/8I2014 to Diane Neiper POCB 51,204.4
1305.
1306.
7 307.
1400. ToW I Settlement Charges(enter on lines 103,Seetion J and 502,Section K) 52,830.00 58,255.00
Items marked"POC were paid outside the closing by:Bortower(POCB),Lentler(POCI),Mortgape Broker(POCM),Other(POCO),Real EsWte Agent(POCR),of Seller(POCS).
6/6/2014 1:58:01 PM File Number:20740857
CERTIFICATION:
f have wrefuliy reviewed the HUD-1 Setflement Statement antl 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 Vansacfion.I/urther certiy that 1 have received a copy of HU0.1 Sattlement Statement.The Settlement Agent dces not warrant or
represenl Ifie accurecy of information provided by any party,includinp information concerning POC items and information supplied by the lendar,it any,In this Vansedion
appearing on this HUD-t Settlement Statement and the parties hold hartnless the Settlement Agent as to any inaccuracies in such matters.
��� THE ESTATE OF WALTER E.MATTSON,A!K/A WALTER EUGENE MATTSON,
David L.Schul� ( \ NKlA W LTE E.MACIJE SKI
\J ��-�`�t�,��-��' P_e.a� f�n .�v�
Gregory Mattson Exec
Executor
To the best of my,knowledge,the HU0.1 Settlement Statement which I have preparetl is a true and accurate account of the funds which were received and have 6een or will be
disburseQ by.fhe undersigned as part of the settlement of this transaction.
/ Gls��v ( /�,u_ (v ZD/'�
JeFnes A.Miller,Esq.:� Date
WARNING: It is a.erime to knowingly make false sfstements to the United States on this or any other similar form.Penalties upon wnviction can include a fine antl
imprisonmen�o�details see:Title 18:U.S.Code Settion 1001 and Sedion 1010.
�
�
Henry&Beaver«P
ATTORNEYS AT LAW
Charles V.Henry,III 937 Willow Street R.Hart Beaver
Frederick S.Wolf P.O.Box u4o Retired
Thomas P.Harlan Lebanon,PA i�o42-u4o
Wiley P.Parker* www.henrybeaver.com Phone(�i�)2�4-3644,Eact.i2i
John H.Whitmoyer Fax(�i�)274-6�82
Christopher J.Coyle richards@henrybeaver.com
Kevin M.Richards
Marc A.Hess *Certified in Civil Trial Advocacy by the
Amy B.Leonard National Board of Trial Advocacy
Roberta J.Gantea
Heather A.Eggert
July 28, 2014
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
i'^�5
Carlisle, PA 17013 � �' �,
�� c_._ �`�i '��
:�
t7D"t! .. � ��? ,-.
Re: Estate of Walter E Mattson ���. �"' �_
No. 2012-00665 `r<=` �`'' `�`` ,-�`
-�zv,_ `.° ; , �-
�r-� � _ :�:;
Dear Ladies: �� _ ,'
_ `� �+,,, r v ,-�
Please find enclosed two (2) original PA Inheritance Tax Returns and an or�'ginal and b�e `� -�
(1) copy of an Inventory and Appraisement for the above-referenced estate. Please file the ��
enclosed documents upon receipt, place your time-stamp upon the copies of the cover page and
the Inventory and return them to me in the enclosed, self-addressed stamped envelope. If you
have any questions, feel free to contact me.
Very truly yours,
(�- �.
KEVIN M. CHARDS
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