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Home My WebLink About09-10-14 J 1505610143 REV-15Q0 EX�o2_,,, � OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFREVENUE Po aox.2soso� INHERITANCE TAX RETURN 21 13 1340 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 14 2013 05 05 1918 DecedenYs Last Name Suffix DecedenYs First Name MI KIMPEL LILLIAN M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return � 2. Supplementai Return � 3. Remainder Return(Date of Death Prior to 12-13-82) � 4. Limited Estate � 4a.Future Inlerest Compromise � 5. Federai Estate Tax Return Required (date of death after 12-12-82) � 6 Decedent Died Testate � �� AttacheCt�Maiof Trust a Living Trust �- 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) PY ) 9. Litigation Proceeds Received 10.Spousai PovertY Credit(Date of Death 11,Election to tax under Sec.9113(A) ❑ ❑ between 12-31�91 and T-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 JERRY A WEIGLE ESQUIRE 717 532 73� - C� �' �� REGIS�E�F WILL�ISE�L�j � `O C„� ^-L7 �!) � First Line of Address � � �-- F.-�+ � t"rt 126 EAST KING STREET � �" �� O `� � `"'" �.? .� � Second Line of Address � `�_a �� :a 3 � -�t "? `" _,_. ru 4-; �-=, '--' r- rn DA�E FILEi� � City or Post Office State ZIP Code � -r� SHIPPENSBURG PA 17257 �Y � Correspondent's e-mail address: jweiale�weiqleassociates.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE OF PERSON R P NSIBLE FOR FILING RETURN DATE , Aithea K. Miller -�- 1 AD ESS 9555 Gro ont Boulevard La Mesa A 91941 SIGNATURE PR A R OT THAN REPRESEN ATIVE E ry A.Weigle Esquire �� `� ADDRESS 126 East King Street, Shippensburg, A L Side 1 � 1505610143 1505610143 �� 1505610243 REV-1500 EX DecedenYs Social Security Number Decedent'sName: K11'Tlp@I� Lilllatl M. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. Z 1 O ,217 . 60 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. 287 , 935 . 74 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 21 , 031 . 17 7. Inter-Vivos Transfers&Miscellaneous -Probate Property (Schedule G) Separate Billing Requested............ 7, 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 519, 184 . 51 9. Funerai Expenses and Administrative Costs(Schedule H).................................... 9. 16� 7 0 9 . 5 4 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 10 , 155 . 02 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 2 C, 8 64 . 5 6 12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 4 92 , 319 . 95 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. 4 92 ,319. 95 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable 492 ,319 . 95 �s. 22 � 154 . 40 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . �0 17. � . �� 18. Amount of Line 14 taxable at collateral rate X.15 0 . �� 18. � . �� 19. TAX DUE................................................................................................................ 19. 22 , 154 . 4� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 15�5610243 15�5610243 � REV-1500 EX Page 3 File Number 21-13-1340 Decedent's Complete Address: DECEDENT'S NAME Kimpel, Lillian M. STREET ADDRESS Forest Park Health Center 700 Walnut Bottom Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 22,154.40 2. Credits/Payments A. Prior Payments 21,000.00 B. Discount 1,105.26 Total Credits(A +B) (2) 22,105.26 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4� Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 49.�4 Make Check Payable to REGISTER OF WILLS, AGENT 3 �, �� ,,� ; � �; � � � � .... '�. ...,.�..:�� „s�,,a..� .�.,. ....s..�..a�rr„�,�, .�-_,.��y,.,,..... .:,�... _.,.,�.. ..u......� �✓i,u.,.�«u:��..,.,.,.�,,,.�a� ....�.�..�,a,x..... ........�. .� <�_.�.��,rce�.�....�a�,w�.W .f�..�. ;a,�,,� 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:.................................. ❑ 0 c. retain a reversionary interest;or............................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care?............................................................ ❑ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ 0 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains a beneficiary designation?.................................................................................................................. X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ;; � � " ; � � � .,,,.,, ,,,,,..,,, �_�,�' .,,�..x..,,. � .�G,e, �_. .», . ?�..�... w�,...�.;w;sx w,.,�,,�..� .....�°�a .,..,�.., a...,_.. ....W, ,,. '�� m�..,� �.,, .....,„ For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)j. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disciosure of assets and filing a tax return are still applicable even if the survivi�g spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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-1503 EX+(6-98) b SCHEDULE B y"�.. -� STOCKS � BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimpel, Lillian M. 21-13-1340 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 U. S.Savings Bonds 210,217.60 TOTAL(Also enter on Line 2, Recapitulation) 210,217.60 (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 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimpel, Lillian M. 21-13-1340 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 U.S.Treasury-2013 federal income tax refund 2,265.00 2 U.S.Treasury-2012 federal income tax refund 2,217.00 3 Citizens Bank Checking Account 92242 30,628.70 Accrued interest on Item 3 through date af death 0.46 4 Citizens Bank Checking Account 93869 4,296.47 Accrued interest on Item 4 through date of death 0.03 5 Orrstown Bank Certificate of Deposit 33006 29,347.65 Accrued interest on Item 5 through date of death 1.57 6 Orrstown Bank Certificate of Deposit 33202 62,385.50 Accrued interest on Item 6 through date of death 20.34 7 Orrstown Bank Certificate of Deposit 34548 92,029.09 Accrued interest on Item 7 through date of death 33.53 8 Orrstown Bank Certificate of Deposit 37148 27,859.32 Accrued interest on Item 8 through date of death 38.41 9 Orrstown Bank Certificate of Deposit 44345 10,107.49 Accrued interest on Item 9 through date of death 5.54 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 5, Recapitulation) 287,935.74 (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-1508 EX+(11•10) SCHEDULE E pennsylvania CASH BANK DEPOSITS DEPARTMENT OF REVENUE � � � MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Kim el, Lillian M. 21 13 1340 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 10 Orrstown Bank Money Market Account 812846 26,698.32 Accrued interest on Item 10 through date of death 1.32 TOTAL(Also enter on Line 5, Recapitulation) 287,935.74 Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IFILE NUMBER Kimpel, Lillian M. 21-13-1340 If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Althea K. Miller 9555 Grossmont Boulevard Daughter La Mesa, CA 91941 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH %OF VALUE OF NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE DECD�S DECEDENT'S INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST 1 A 08/11/2009 Orrstown Bank Checking Account -jointiy 37,436.59 50.000% 18,718.30 owned with Althea K.Miller,daughter A 08/11/2009 Accrued income on Item 1 through date of 0.21 50.000% 0.11 death 2 A 08/11/2009 Orrstown Bank Savings Account 02372- 4,625.34 50.000% 2,312.67 jointly owned with Althea K. Miller,daughter A 08/11/2009 Accrued income on Item 2 through date of 0.17 50.000% 0.09 death TOTAL(Also enter on Line 6, Recapitulation) 21,031.17 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) REV-1511 EX+(�0-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE F U N E RAL EXP E NS ES AN D INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimpel, Lillian M. 21-13-1340 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees Weigle&Associates, P.C. 15,000.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Ziq Relationshio of Claimant to Decedent 4. Probate Fees 388.50 See continuation schedule(s)attached 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,321.04 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 16,709.54 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 Kimpel, Lillian M. 21 13 1340 ITEM NUMBER DESCRIPTION AMOUNT Probate Fees 1 Register of Wills, Cumberland County-Letters Testamentary and Short Certificates 388.50 H-B4 388.50 Other Administrative Costs 2 Althea K. Miller, Executrix-travel expenses to Pennsylvania for estate matters including air g4g,gg fare,motel fee,and rental car 3 Citizens Bank-replacement of safe deposit box key 25.00 4 Cumberland Law Journal-advertising Letters Testamentary 75.00 5 Linda K. Klein -notary fee 20.00 6 Register of Wills,Cumberland Counry-prepayment of cost of filing PA Inheritance Tax 15.00 Retu rn 7 Register of Wills, Cumberland County-two Short Certificates 10.00 8 Register of Wills, Cumberland County-filing Family Settlement Agreement 100.00 9 The Carlisle Sentinel -advertising Letters Testamentary 201.16 10 Weigle&Associates, P.C.-reimbursement for postage,xerox copies,and long distance 25.00 telephone calls H-B7 1,321.04 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+��Z-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT DEPARTMENT OF REVENUE � INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF IFILE NUMBER Kimpel, Lillian M. 21-13-1340 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 Guardian LTC Pharmacy 36.22 2 Guardian LTC Pharmacy 36.22 3 Orrstown Bank Checking Account -checks clearing after date of death, including Forest 10,082.58 Park Nursing Home($10,066.00);and miscellaneous check for$16.58 TOTAL(Also enter on Line 10, Recapitulation) 10,155.02 (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) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimpel, Lillian M. 21-13-1340 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) �$$$� Do Not List Trustee s I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Aithea K. Miller Daughter 100% 492,319.95 9555 Grossmont Boulevard La Mesa,CA 91941 TOta I 492,319.95 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) �-�,,.�-� �,,,--,�--- _ __ T ._._, ,....m_.._ . .--_.. _ _ . __.,_ � � �AST�ILL A1�D 7'ES?'��1��` i - I� j,jj„�,�A�T 1V�. j�VIPEL, presently residi�� at Episcopal Home 206 � Burd Stree Room ?A, Shippenss�urg Borough, Cumb�-land Cou�ty, 17257 being of sou�d mim� � , en -Y � me�ory aud disposition, do hereby make, �ublish and decl�re this my Last�V'ill and `Testame��, ; hereby r�evo�ing and making�oid all�TViI]�s by me at any time�ere�afore made_ � i FIRST. I order and direct the pay�ent of all my Iegally enf��ceabl� debts and �une��xpenses as soon as may be canvenient af�e�my decease. ; � � ua1 a-�d m�ed, P SECOND. I ��e, devi� and bequea�h ail any �ate, re�,, P'ers� absolutel _ whatsoever and vaheresoever si�ate, to my beloved dan�ter,AI.T$�A I��!'IILLE�t y In the evemt�haf my beloved daugh�er,�I.TH��K�'�.LER p�decease,ine I fhe��ive,deu�se and be�ueath my said es�e to �xiy �andcla��ter, �LIZASETH A. �1�LER on a per stirpes dishibut�on basis_ � s d TI�tD. I nominate, constitute and appoint ffiy dau�fer, AI.'��EA I� ��LLER to be the Execu�rix of�is m�Last�'ill and`Testament In the event that she be unable to fiidfill the d�ies o�f�xecutrix, I t�en no�inate, constitute a�d ap�oint ffiy son in-law, ST�P$��T L. MiI,LE�2�o be t�e Executor of this my�.ast VV�ill and Tesfament FOUR`T`H. I direct that ffiy pe��nal representaiives shall not be requia-�d to aiv�bond � , for#he faithful performance of t�eir duties ia any j�risdiction I� WITNESS WHEREOF, I, L�.LIAI'� �1'I. I�VIP�L, have hereunto set my hand and � seal to this my Last Will anci T'estament, w-ritten on one (1) page, the first page si�ed for id.egtific�tion only,this � day of _ 2010. '� - � I � i � 1 i��-�v' ,�, ��.rin�s�� ' �SEA�} � •' ,r ''� ,� i � i' WEtGLE F ASSOCIATES, PC. - ATTORN'tY5 ATi LAW - 4Z6 EAST FCI[�8 S�REET - SHSPQEFVSSURG, pA 3 7 25 7-13 97 �� _..._.. . �.F.,.. �, . „ ,,: - � � �.�.,��. .. ...,.. _.,.._.__....._ _._—_,,,,.._. �� . ,>, .", �,�� ._ - �_. � �� „ � , �r�, r��.,,t ,� .. , s , .Y�h��fi`��.'a °i � � � d#�Y �, L�'�d '�$; T1�is instr�ment was by the'I'estatrix, o��he date hereo� si�ed,Published and dec�ared by her�o be her Last WiLI and Te��ament, m o�presence, who at her reque�t and in the presence of eac�i other,we believEng her to be of so�d and disposing�d and nae�ory,hav�hereunto s�bscrib�d our names as witness�_ � �-._ � .�€ �` - � / ' �` f ' /'�� ' '„ � �%GG tL � � ,��i :.-� � C��VI�1�I3�1�4TE�I,`I`H�F PENI�SYL,VL�I'�IIA : : SS CO[�NTY O�' CUVIBERLAND = I, LIIrLIAN �.VI_HI�1PEL, the perso�.�hose name is sig�ed to�e fore;oin�insCrument,l�aving bae� duly qualified aecording to la�v, do hereby ackno�led�e that I si�ed. and ex�zted the in�nent as my Lassfi Will;that I sa�ed it willinglY; and ihat I signed it as my free and voluntary act for the purposes therein expressed_ � � �� rn-�zr,�� .�� ` LILLI�M.I�117PEI. S��or±�or affirmed to'and acknowledged before me by LILLIAN l�Z.KIlVVIPEI.,th` Testatifriic, ;; this'�Q day of p 2010. � r 1� . EGlr[MDt'lW��lT'ii 8P�'ENF1S. 11Hi+� _ . NOTAA�A�SEAL 9erry A.NYsigie.tdotary Put�f6t �at Ship�anstrurg.Cun+bertst��un_ "�y(ySommissian Expi�es Ocio�lt.�7•�� W�IGLE Sc ASSOC➢ATES. P.C_ —A'TTORIVEYS AT LAW — 926 �AAST KING STR��[' — SHIPPENSB�RG, PA 17257—t397 ._., .�.. . .__ _..... ..��,..�..,... :,,,,..,E..r •h� � _._._,..,... ___. .....,- . . . , . .._ .._ .__.. . . ,,, ,-�,., .-�.:.,. .:,._..... .. ._..,:.._ . _,..,-.. .,.._.. .. _,__... . , .. . . . :, . . ,,. � < �. ,. . . . . t 6 � ,` ,� . � � �' ��+,�,,�z� ��14�,��"t �'� . . � � - >i�3£_. 3,.srl�, x ,d�h��.A a t`. ��w �.k,e`hn;3`39ii.W�+,roai��.��°'d.�.r�d.`:° ; ° r � : �� . . _._. __ _ - _ -� - ��,m„r�.,.�„,,.�- �"-"""'* - x 3^`' t ,, r � �4 �dk�1�. �.,e` �+''a• �� L, � � ��+.��E. � ��,� t„ �� CC3MMON�iEALTH�F P��INSYLVA�I� : SS COUl�'I`Y OF CL�MBERL��]D = ; : '` � '� , > � { f� � ��1'"� We T•.�'�� c t� �}�� , �� jj, �� ,the�itnesses whose narn�ss are si�ed to�e ' and ,�cx�,�.� � foregoing insf�e��, beang duly quaiified a�cording ta �aw, do dep�se aud say tha� we were pr�nt and sa�v LII.LI��T �YI. �VIPEL, the Testatrix, sign and execute the insfinzment as h�r - �t�ill- thak sfie si ed wi�lingly and� she executed it a�her��e anc�volun�j act for�e La� , � - - puFposes therein expaessed; that each of� in the hearing a�ad sight of the "Testatrix, signed the � � W-�1 as witueesses; as�.ci fihat#o the b�c�f our kno�led�e the Testatrix was at ihe�ime eighteen{18) a � � or more years of a��and of so�d naind and unc�er n�cons�aint or undue i�fluence. ; � � = - � � � ��j � .� � s � //f� � 1 �f: . JJ ✓ � ��.. � � � ,li�f / �L'!�;'� / � 1!� '�f � . A � S�om or affirmeci to and�scn�ed.before me 5 � s by � � � �� ' � � � , � � � 4 r v v J �a ��r�,�w 1 �� '�aiesses,this ��tN' day of �010. ° � f N . - � �- -- � � �CQ�}lIAONYItEARTF[�F�PEAFHSY�VAMIA " trf#�TAA(AL S�AL Jlrry A.Weig�B,t+iotarj►Pab�ic �t af St►"ri►AsnsF�ur�;;C�nDtr�snd CQUn_ �onu_r�e.�oa fxprtts�li�t 47,-2Qa i*J�EIGIT F ASSOCLFITES. P.C. — ATrORNEYS AT E—AW — i26 EASi" KI'NG STRE�' — SHIPPEAVSBURG. PA t7257—i397 _ . . { 5 l . - � e � i `t�� a �,�,° � �n��'2= � 48500�41�46 REV-485 EX(05-04) SAFE DEPOSiT . BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number Suffix First Name MI Kimpel Lillian M �ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE: Forest Park Nursin Home 700 Walnut Bottom Road Carlisle PA 17013 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX "AME: Althea K. Miller and Jerry A. Weigle STREET ADDRESS: CITY: STATE: ZIP CODE: c/o 126 East King Street Shi ensbur PA 17257 � NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: Jerry A. Weigle, Esquire Attorney for the Estate STREET ADDRESS: CITY: STATE: ZIP CODE: 126 East King Street Shippensburg PA 17257 b. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZIPCODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: Citizens Bank STREET ADDRESS: CITY: STATE: ZIP CODE: 153 West Orange Street Shippensburg PA 17257 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY Jerr A. Wei le Es uire 5-28-14 10:05 a.m. DATE OF CONTRACT TO RENT BOX • NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REQUESTED Unknown 1411 Lillian M. Kim el NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX a. NAME: b. NAME: Lillian M. Kimpel STREET ADDRESS: STREET ADDRESS: 700 Walnut Bottom Road CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: Carlisle PA 17013 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY Jerry A. Weigle, Esquire - Attorney for the Estate WAS A WILL IN THE BOX1 ❑ YES � 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: Jerry A. Weigle, Esquire WEZGLE & ASSOCIATES, P.C. STREET ADDRESS: CITY: STATE: ZIP CODE: 126 East King Street Shippensburg PA 17257 � 48500047,046 485��04],046 � Lillian M. Kimpel - 21-13-1340 REV-485EX �7f�'►�G VGr"�.JJI 1 �V/� �IV��I�i 1 �� i Page 2 of-2 iNSTRUCTIONS (7) 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. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness:List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM lTEM DESCRI?TION NO. BOX WAS EMPTY I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PR�NT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW: Jerry A. Weigle, Esquire PRINT TITLE DATE CHECK APPROPRIATE BOX: Attorney for Estate �Executor(trix) �Administrator(trix) 5-28-14 �Estate Representative �Joint owner of safe deposil boz 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 Social Security numbers in connection with administering state tax laws.The Deparfinent uses the Social Security number to identify ihe decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax infortnation agreements with Federal and local taxing authoriiies.The state law prohibits the Commonwealth's personnel from disclosing confdeniial tax information except for official purposes. Calculate the Value of Your Paper Savings Bond(s) Page 1 of 2 �. ,:;' ��` �� _'_ � __ "=c�.' . _ . ..a._..�U__..�_Jniue u,Yctrr Paper Savir:<:s E.�n<f�} �� t�� '�a6€�� c�f'�aur Paper Sav6nas �onc�(s� 'St`:t?Tkti45C�*L5C3ridU CFS.LC�BLATLIP ...—.��, �..�ZRSEfUCYl07}6"- _...- i Value as of: � i.,. .,._,_.._....__.--, .._.�____ " , .t. t L ..tF� :n:��„�;t��;! I�J�(,J�� .j 12:01i EUPDATF.: , : ' ; � :....__..._................__.,_.m..1 �.....�._.� ; ' �I.l.r.;� � _ � ,. ' h{slya __...._ _._._._.__ ....... i Series; Denominatfcn: Bontl Serial Number. Issue Date: :..................... � ............................... ,..._...._.._........_..... .. . ,.._...._..__...._� ... P ES DCSCCI LFOSI _. ;iE Bonds v! i200.__......�!' �-...._�_f p ��- NI Not Issued � � ;�,��r,f��--�-�r �! NE Not eligible for payment NaW"f't1 SAVE Yaiti2 SMVEiVTUlCY ��., PS Inclutles 3 month ' .............._................._._............................_..........................................._..__.._._._..__..._. ' interest penalry : ...._.._...................._._......................_........_._...._._.............._................._. : : C�icut�tcrs Etesc�its for Redemption Date 12J2013 Ma Matured and not eamin� ; interest �:«al� � `` h;i _....................................................................................i '€'csta!Price 3btal va�lue Totai Znterest YTD interest $z8,200.00 $ZiQ,2ll.60 5172,011.60 $2,596.52 €?onds:1-3ft af 38 :;�rkz�t# Serres �. Denx�rrt �: Isyue NexY - final Ss�ue �� intcrest : Znterest '. Value � Nate--. . �� Qute ��. Acauui '� MaYUrity �. Rrice Ratc � ft440"I�170E E 5200- �2!1973' 02/2003' � . $150.00�. $88912' : $1.039.12'. �?A �. ..c"p'dE R44�771P.3E' E �. $200��.' 02l19731 02/20U3��. $150.OD: $889.12.: .. $1�039.12: t;� ; ...-h•p'd6 R44073819E E 5"L00��. L"!!1973�: 03/2�03�I $150.U0: $889.12'.. 51.039.12' Mr -: ..,-�•;;v� R4407AR34E E y200� 03/1973�� 03/2003� $150.06-�� $8&9.12� � 51�039.12� f F �� .., •,^,,;E R44�078857E' E � gz00�.. D4!1973[ � 04/2003: $150.00-�. $889.12� '. 51,039A2�- t q ., ,,^,.,r R44�7A869E E g200�r 04/1973��. 04/2003��. $150.00-: y889.12'�. . 51,039.12'� h,. �+;�..,E R44�7P859E� E � g200��. OS/1973 �5/2003: $150.00��: $889.12'�. '. 51,039.12�, Pl �� acp�pVe I<4407d888E E � 5200: �5/1973: �5/2003-: $150.00�� $889.12,' � 51�W9.Y2��. �l =.,;�vE R440�OII40E. E $200� 06/1973- � 06/20�3�� $150.0�� $891.6�- �� 51,041.60�� P �� ,..O�:E R44U£)0825E [ �� $200�. 06/19731 U6/2D03-: $150.00: $091.60.: � ;1,041.60; M . .,=.�p::E R44U60ni5E [ $200'�. 06{1973'� OG/20�3'�. $ISOA��: $891.6D�� . ;1,041.60��, � � :�:�^�yF PllU3GEfi9�3E�� E '� $1,000_ 07%1974, 07/2D04t $750.00: $4,450.80'> ' $5,200.80'�. h:f, . R�.�i•iE M7fi30fifi834E��. E 53,000'�: 67/1974t 07/20041 $750.ODi $4,450.80t �� 55,200.80��. h:A � �.�a;�yp M]D366fiP,35E E $],000� 07/1974� - �7/7004� $75f1.(10> $4,450.80> �� 5,200.80� h.A � �t�:+;?vE Pt]03066E3uE� E 51,(1D0' 07/1974'. . 07i2004'. $750.00:: $4,qi0.8��. �. 55.200.80��. t+,g . ar.'�pvp M10306bE3SE. E g1,000'� �7,:1974: D7120�4' $750.00[ $4,45�.60-. 55,20Q.80: t A. . ri=_'�ovE M103065u37E�. E �. 51,OOG�. 07,%1974'� � 07/2004' $750.00�: $4,45D.80: �� ;5,200.80�. N7A . rr-s�ns�r Id10306G8:2E. E � S1,UODI 0711974< 07/2004; $75U.OD1 $4,45�.80: I �5,200.SOI I� ��. ��_�`:?-✓E �-0103Q6G631E�� E 51,000; �7!1974�� 07/2004�-� $750.00�� $4,450.SD�. � $5,200.80� t� -- �_.;?L�C M10A931336E E $1,U00�> 09/1975: D3/20U5: $750.00-�: $4,576.00i. . 55,326A�I +�F ,,. G„� � M104931335E�� E 51,000: 09/19751 09/200SI $750.00< $4,5�6.00.;. '. 55,326.00: t M ,,..;7uf M104931334E E $1,U00��. 09/1975 09/2005��. $750A�: $4,576A�! : $5,326.00'. t M �, ;.�spdE j M10A931333E' E ! 51,000: 0911975 09/2005' $750.OQI $4,576.00( I 55,326.00' f A ; ,:r�pVE M202646�7P1E E � $1,000�� 08/1976� 08/2006�� $750.00� $4,702.8��. - 55,452.80: t k -�� .-;�,:� F M204519188E'. E � $1,000�. il/197Z: 11/2D07i $750.00[ y4,373.W' '� 55,123,60'� P .�.�:•t j M204519186E E �� $1,000'�. 11l1977i 11/2007'I� g750.OP' �4,373.60�-'� . _ � 55�123.60�. �A : �.'vvE M20E522443E'� E $5,000�.. OS/1978: " OS/2008: $750.00`. $3,516.80: '�. ;4,266.80! P __^%:,:�e P720ti522444E� E $1,000�� OS/1976�- � QS/2008�� $750.OQ��- $3,516.6D� . $4,266.80: P � ._a�'v:�C ' M?07607335E� E $],000.. 01/1979�: . OSj2009-- $750.00��. $3,581.20- ;4�331.20'� M1�" ��. REvi:+� 3 M207607314E� L .. 51,000�. �1/1979'. O1/2009:' $750.00`. $3,581.20t . ;4,331.201 P �EM�V[ M209'309097E [ � $1,D00� Ofi/1979- _ 06/20U9� $750.Otr: ;3,633.6D-� ¢4,383.60- Kr �� 2::uJVe M209909096E F $1,000� 06/1979� D6/20091 $750.00: $3,633.601 �� 54,353.60��. � : �t�t�OVE Pt'09409[195E��. E � $1,000�, 06/1979' . 06i2009-' $750.��:� $3.G33.G0�. �. �4.383.60: hA �, a:tr�ve C47688573EE. EE �. 51D0- 04(1983+ 04,%2013�� $SD.00: $180.64: � . . j230.64! t A :'. 2_u:�VE X65944EE� EE . S10,OD0�,. OS(1983�.. OSr2013:: $5,000.00'.: $18,064.OD'; '. ;23,D64.00'. �A . 2Er:•de X65945EE� E[ "alU,UUO�� Q5,%1903- OSR013�� $S,OOO.OD' $18,�64.00'. �. ;23,064.00'. t A ' .�.^c,ti X1790E3EE EE 510;000; 04(1965�: 04(2014:: D4/20151 $5,000.00: y16,732.00. 4,OD% 521,732.00. - .�.0•dF X1750$ZEE EE a10,OD0�. 04,%19851: 04/2014i ��i/2015:: $5,000.00` $16,732.00' 4.00°:c'. 521,732.00I �� ;;dE YIE�ts?:L2 ':A:�:::,..!'I:'r..^::�TF?i:.0:s::dl:• :°Sui�v�eu ..........._..........................._............................................_.............. .�How would you rete this tool? `:.t excellen! i �}Good :�I'air �� PDC� ;Yi},l�R{].�i' - http://www.treasurydirect.govBC/SBCPrice 4/16/2014 o�STO�N B� A Tradiiion of Excellence December 23, 2013 Weigle&Associates,P.C. 126 E Ki.ng St Shippensburg,Pa 17257 Fax: 532-5289 Re: Estate of Lillian M. Kimpel Social Secvrity Number 183-07-8357 ' Date of death 12/14/13 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNT WITH ORRSTOWN BANK: CHECKlNG ACCOUNT Account No.- 812846 Account Type- Money Market Account Title- Lillian M Kimpel Date Opened- 1/6/86 Joint Account(name/date}- No Balance- $26,698.32 Account Interest $132 CHECKING ACCOUNT Account No.- 102002531 Account Type- 50+Interest Checking Account Title- Lillian M Kimpel/Alfihea K Miller Date Opened- 8/11/09 Joint Account(name/date)- Yes Lillian M Kimpel/Althea K Miller 8/11/09 8��- $37,436.59 Account Interest- $0.21 2695 Philadelphia Avenue •Chambersburg, PA 17201 SAVINGSACCOUN7' Account No.- 702002372 Account Type- Statement Savings Account Title- Lillian M Kimpel/Althea K Miller Date Opened- 8/I 1/09 Joint Account(name/date)- Yes Lillian M Kimpel/Althea K Miller 8/11/09 Ba.lance- $4,625.34 Account Interest- $0.17 TIME DEPOSIT Account No.- 4000033006 Account Type- 36-41 Month Growth Account Title- Lillian M Kimpel Date Opened- 5/11/09 Joint Account(name/date)- No B��- $29,347.65 Account Interest- $1.57 TIME DEPOSIT Account No.- 4000033202 Account Type- 30-35 Month Growth Account Title- Lillian M Kimpel Date Opened- 5/29/09 Joint Account(name/date)- No Baiance- $62,385.50 Account Interest- $20.34 TIME DEPOSIT Account No.- 4000034548 Account Type- 30-35 Month Growth Account Title- Lillian M K_impel Date Opened- 8/25/19 Joint Account(name/date}- No Balance- $92,029.09 Account Interest- $33.53 TIME DEPOSIT Account No.- 4000037148 Account Type- 60-119 Month Growth Account Title- Lillian M Kimpel Date Opened- 3/3I/10 Joint Account(name/date)- No Balance- $27,859.32 Account Interest- $38.41 TIME DEPOSIT Account No.- 4000044345 Account Type- 24-29 Month Growth Account Title- Lillian M Kimpel Date Opened- 7/19/12 Joint Account(name/date)- No Bal��- $10,107.49 Account Interest- $5.54 Best Regards, K.im Moy Deposit Processing Clerk �. � � ` ��' . �� _ -��" � � One Citizens Drive ROP112 Riverside, RI 02915 January 17, 2014 Weigle&Associates, P.C. Attorneys At Law 126 East King Street Shippensburg PA 17257-1397 Estate o£ LILLIAN M KIMPEL Date of Death: Dec 14, 2013 SSN: 183-07-8357 Dear Sir/Madam: In accordance with your request,the attached information sheet has been provided in the above decedent's name as of his/her date of death. For Installment Loans or Line of Credit accounts,contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 Sincerely, - !��'�,,��-;�- n �� r � ; ; �� i .��,�.C (,,.0 Kristen L. Petrucci I Decedent Account Processing REF#: 624771 �. " ' � � � �' � ' �� Account Number 6100792242 Account Title LILLIAN M KIMPEL Date Opened 12/31/1982 Account Type Checking Princi al Balance as of DOD $30628.70 Interest from Last Posting to DOD $ .46 Account Balance as of DOD $30629.16 YTD Interest to DOD $61.21 � � � �� : � � � � .. Account Number 6100793869 Account Title LILLIAN M KIMPEL Date Opened 3/29/1980 Account Type Checking � Princi al Balance as of DOD $4296.47 Interest from Last Posting to DOD $ .03 Account Balance as of DOD $4296.50 YTD Interest to DOD $ .88