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HomeMy WebLinkAbout09-24-14 (2) J 1505610143 REV-1500 Ex�°z_,,, � PA De artment of Revenue OFFICIAL USE ONLY p pennsylvania o��cY code Year File Number Bureau of Individual Taxes ��TMEMOFREVEMIE PO Box.2soso� INHERITANCE TAX RETURN 21 14 0120 Marrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172 24 9103 O1 29 2014 08 28 1929 DecedenYs Last Name Suffix DecedenYs First Name MI BROUDE DORIS J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� Spouse's Social Securiry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X❑ 1. Original Retum � p. Supplemental Return � 3 Remainder Return(Date of Death Priorto 12-13-82) � 4. Limited Est2te � q� Future Interest Compromise (date of death after 12-12-82) ❑ 5. Federal Estate Tax Return Required (r1 6 Decedent Died Testate �1 Decedent Maint ined a Livin Trust '^' (Anach Copy of wi��) �J � (Anach Copy of�T'rust) 9 8. Total Number of Safe Deposit Boxes � g. Litigation Proceeds Received � 10.��en P2 3i�1 e tl���Da95�f Death C �� Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRE$PONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L BANGS 717 730 7310 ry REGIST�({18 WILLS 05�E Ol�i' CO � � c�.-7 First Line of Address � � c� "v ��,,� � 429 SOUTIi 18TH STREET � x° ''' � ���i r�i '-,,, t::� Second Line of Address .�.� , �-� � `� �� City or Post Office fl�pTE FIL� p�- � State ZIP Code o CAi� HILI� PA 17011 o L" -� CorrespondenYs e-maii address: mikebangs@verizon.net ' Under penalties of perjury,i deClare that I have examined this retum,inGuding accompanyi.ng schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Dedaratio�of preparer other than the personal representatrve is based on all information of which preparer has any knowledge. SIGNAT E OF PERSON RESPONSIBLE FOR F ING RETURN DATE �� ��►.c.�'L James C. Buck �3 � ADDR 2487 Cope Drive, Mechanicsbura, PA 17055 SIG TUR�Of PREPARER OTHER TH EPRESENTATIVE D TE ' Michael L. Bangs o�� � ADORESS 429 South 18th Street, Camp Hill, PA 17011 Side 1 � 1505610143 1505610143 � � � 1505610243 REV-1500 EX DecedenYs Social Security Number o8�a��rSNeme: Broude, Doris J. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 87 , 994 . 98 2. Stocks and Bonds(Schedule B)............................................................................. 2. 2 , 111 . 95 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. 2 3 4 , 8�-0 . 5 6 6. Jointly Owned Property(Schedule F) L! SE;parate Billing Requested............ 6. 2 , 457 . 20 7. Inter-Vivos Transfers 8�Miscellaneous IyQn,-Prc�bate Property (Schedule G) �J Separate Billing Requested............ 7. 6, 616. O 1 8. Total Gross Assets(total Lines 1 through 7).. ..................................................... 8. 333, 990 . 70 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 21 , 6 90 . 4 9 10. Debts of Decedent,Mortgage Liabilities and Lisns(Schedule I)............................ 10. S 41 . 71 11. Total Deductions(total Lines 9 and 10)................................................................ ��. 22 , 532 . 20 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 311 , 458 . 50 �3. Charitable and Governmental Bequests/Sec 9'I 13 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. 311 , 458 . 50 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �5 0 . 0 0 (a)(1.2)X.00 16. Amount of Line 14 taxable �6 0 . Q Q at lineal rate X .045 17. Amount of Line 14 taxable 2 g 2 2 9 , ']5 at sibling rate X.12 2 3 5 ,2 4 7 . 8 8 ��. � 1 S. Amount of Line 14 taxable 7(,210 . 62 18. 11 , 431 . 5 9 at coliateral rate X.15 19. TAXDUE................................................................................................................ 19. 39, 661 . 34 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21-14-0120 Decedent's Complete Address: DECEDENT'S NAME Broude, Doris J. STREET ADDRESS 216 Cumberland Drive CITY � STATE �Z� IP Camp Hill PA i 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 39,661.34 2. Credits/Payments A. Prior Payments 38,OOO.qO B. Discount 1,983.Q7 Total Credits(A +B) (2) 39,983.07 3. Interest �3� —__ q. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 321.73 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) 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 r– a. retain the use or income of the prope;rty transferred:............. ...... ......:....:.............................................. I`; �x, c. retain ah evehs onary nte est!oo shall use the property transferred or its income:....:............................. � � d. receive the promise for life of edher payments,benefds or care?............................................................ ' u 2. If death occurred after Dec. 12, 1982, clid decedent transfer property within one year of death without J receiving adequate consideration?.................................................................................................................... !—i � 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ z 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ,—, . � u� conta�ns a beneficiary designation?.................................................................................................................. � IF THE ANSWER TO ANY OF THE ABOVE(�UESTIONS 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 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 lransfer 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 Juty 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["?2 P.S.§9116(a)(1.2)j. . 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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Section 9102,as an individual wh��has at least one parent in common with the decedent,whether by blood or adoption. Rav-�so2 ex+�o�-�o� SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE � INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 All roal property owned soleiy or as e 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 willinQ seller,neither being compelled to buy or sell,both having reasonable knowledge o�the relevant fads. Real property that is�oindyowned with right of survivorahip must be disclosed on schedule F. Attach a copy of the settlsment sheat ii the,property has been sold Include a copy of the deed showing decedenYa interest if owned aa tena�t in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate-216 Cumberland Drive, Lower Allen Township,Cumberland County.Tax Parcel 87,994.98 No. 13-23-0555-044;sold 5/30N4(see HUD attached). Estate received proceeds of 574,795.73; 513,199.25 is being held pending approval of the Pennsylvania inheritance tax retum. TOTAL(Also enter on Line 1, Recapitulation) 87,994.98 (It more space is needed,additionai pages of the same size) Copyright(c)2010 form software only The lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10) Rev1503 EX�(B•98) SCHEDULE B STOCKS & BONDS COMMONYVEALTH OF PENNSVIVANIA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 All property jointlyowned with right oi survivorahip must ba diaclosed on Schedula F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 43 shares of MetLife-Trust Interests 49.115 2,111.95 TOTAL(Also enter on Line 2, Recapitulation) 2,111.95 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software oniy The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Rav1508 EX+(11-70) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENVE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 Include the proceeds of litigation and the date the proceeds were received by the astate. All property jointlyovmed with tha right oT aunivorship muat ba disclosed on achedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Automobile-2004 Chevrolet automobile(see Bill of Sale) 4,000.00 2 Members 1st Federal Credit Union-Regular savings 1,685.48 3 Members 1st Federal Credit Union -Investment savings account 14,158.95 4 Members 1st Federal Credit Union -Certificate of Deposit 14381-40 10,000.00 5 Members 1st Federal Credit Union-Certificate of Deposit 14381-41 5,000.00 6 Members 1st Federal Credit Union-Certificate of Deposit 14381-45 5,0.00.00 7 Met Life-Trust interests dividend 11.83 8 PNC Bank-Interest Checking 11,316.50 9 PNC Bank-CD 31100313615 18,000.00 10 PNC Bank-CD 31800312903 2,000.00 11 Refund-US Treasury Refund 2013 income taxes 890.00 12 Refund from Ohio Casualty-Homeowners insurance 88.00 13 Refund from PA American Water Co. 9.68 14 Refund from PPB�L Electric-dupticate payment 24.32 15 Refund from Progressive Insurance-(automobile insurance) 610.00 16 Refund from ServiceMaster 294.41 Total vf Continuation Schedule See attached page TOTAL(Also enter on Line 5, Recapitulation) 234,810.56 (if more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1S00 Schedule E(Rev. 11-10) Rev-1508 EX+(71-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, � MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17 Refund from United Health Care Services 208.30 18 Refund from Verizon 179.94 19 Revenue Rebate 250.00 20 Riverview Bank-Account 101026330 19,426.67 21 Riverview Bank-Account 101126930 1,766.77 22 Riverview Bank-Account 100997930 1,000.00 23 Thrivent Financial for Lutherans-distribution 1/28/14 183.19 24 Symetra Life Insurance Company-Modified Single Premium Annuity; benefciary is the 138,706.52 estate TOTAL(Also enter on Line 5, Recapitulation) 234,810.56 Copyright(c)2010 fortn 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 FILE NUMBER Broude, Doris J. 21-14-0120 If an esset was mado Joint within one year oi the decedenYa date ot death,It muat ba reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Patricia Buck 2487 Cope Drive Sister-in-Law Mechanicsburg, PA 17055 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM �ETfER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FOR JOIN MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATfACH OEED FOR VALUE OF ASSE INTEREST DECEDENTS INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 01/OS/2014 PNC Bank-Savings Account 2,457.20 100.000% 2,457.20 TOTAL(Also enter on Line 6, Recapitulation) 2,457.20 (If more space is needed,additionai pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-1610 EX+(OS-p9) SCHEDULE G pennsyivania lNTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 This schedule must be wmpleted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S �c�usioN TAXABLE NUMBER THE DATE OF TRANSFER.SATTACIiTA COPY OF THE DEEO OR REAL EsTATE. VALUE OF ASSET INTEREST (IF ARPLICABLE) VALUE 1 Thrivent Financial for Lutherans -Annuity Account 6,616.01 100.000% 0.00 6,616.01 B4550044. Original beneficiary was Richard Buck, Decedent's other brother,who predeceased Decedent. James C. Buck then became beneficiary of annuity. TOTAL(Also enter on Line 7, Recapitulation) 6,616.01 pf more space is needed,additional pages of the same size) ' Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+�10-09) SCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q, FUNERAL EXPENSES: See continuation schedule(s) attached 274.40 B. ADMINISTRATIVE COSTS: 1. Personai Representative's Commissions Name of Personal Representative(s) James C. Buck Street Address 2487 Cope Drive City Mechanicsburg _ scace PA zio 17055 Year(s)Commission Paid 10,000.00 2, Attomev's Fees Michael L. Bangs 10,000.00 3, Famiiy Exemption: (If decedent's address is not the same as claimanYs,attach explanation) Claimant Street Address �;ty State Z�4 Relationshio of Claimant to Decedent 4. Probate Fees 363.50 5. AccountanYs Fees 500.00 6. Tax Return Preparer's Fees 7, Other Administrative Costs 552.59 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 21,690.49 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHE�ULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 ITEM AMOUNT NUMBER DESCRIPTION Funeral Exuenses 1 Fackler Wiedeman Funeral Home-advertisement and organist ��8•72 2 James C.Buck-reimbursement for funeral lunch 165.68 H-A 274.40 Other A�ministrative Gosts 3 Cumberland Law Journal-estate advertisement 75.00 4 DeSantis 8 Son, LLC-repairs to house 250.00 5 James C. Buck-reimbursement for payment of preparation of 2013 income tax returns 125.00 6 The Patriot News-estate advertisement 102.59 H-B7 552.59 Copyright(c)2002 form software only The Lackner Group Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIA�BILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Broude, Doris J. 21-14-0120 Report debb incurred by the decedent prtor to death that remained unpaid at the date of death,tncluding unreimburmed medical expensea. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bonnie Miller,Tax Collector-2014 county/township real estate tax 530.81 2 Lower Allen Township-sewer/refuse 122.70 3 PA American Water Co. -5/6/14 to 5l22/14 3.30 4 PA Department of Revenue -Income tax due on 2013 income tax return 7.00 5 PP�L Electric-1/23/14 to 2/24/14 66.63 6 PP&L Electric-2/24/14 to 3/24N4 34.06 7 PP8�L Electric-3/24/14 to 4/24/14 24.32 8 PPB�L Etectric-final bill 42.99 9 UGI-final bill 9.90 TOTAL(Also enter on Line 10, Recapitulation) 841.71 (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 Broude, Doris J. 21-14-0120 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT (Words) ($$$) I� TAXABLE DISTRIBUTIONS [inciude outright spousal distributions,and transfers under Sec.9116 a 1.2 James C.and Patricia A. Buck Brother 75%of residue 2487 Cope Drive Mechanicsburg, PA 17055 Amy Ortega Fortney Niece 25%of residue 7880 Valley View Avenue Harrisburg, PA 17112 Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II• A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL OISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form soflware only The lackner Group,inc. Form PA-1500 Schedule J(Rev.01-10) =MlNt4 � *o OMB Approval No.2502-0265 s`!��*m� � ,= A. Settlement Statement (HUD-1) "�y o.��sc� B.�Type of Loan 1•�FHA 2.0 RhIS 3.❑Conv.Unins. 6. Fae Number: 7. Loan Number: 8. Mortgage insurance Case Number: 4.Q VA 5.Q Conv Ins. C�,l+BFAN1.14-023 6001032 446-2086094-703 C. Note: This/wm is furnished to gi�e you a statement ol adual settkmenf oosts. Amounts paid to and by the settlement agent are shown. Itoms marked•(p.o.c.)'ware paid outside the dosng;they are shown here for�lormationaf purposes and a�e no!induded rn lhe tota/s. D. Name and Address of Borrower: E. Name andAddress of$eller: F. Name and Address of Lender: Abigaa l.Smdh and Estate of Ooris Jean Broude Meritlian Bank Tyb�R.HOCkCnbC�ry 216 Cumberland Drdre 920 Germantown Road,Suite t02 23 8812've AvEnue Camp Hill,PA 17011 Plymouth Meeting,PA 19462 Car6sle,PA 77013 G. Properly Locatbn: H. Settlement Agent: 1. Settlement Date: 216 Cumberland Drive GUARANTEEDABSTRACT SERVICES.INC. Camp Hi�PA 77011 3813 MARKET STREET May 29,20�a CUMBERLAND County,Pennsytwania CAMP HILL PA 17011 Ph. (717)724-8758 Place of Settlement: GUARANTEEOABSTRACT SERVICES,INC. 3813 MARKET ST,CAMP HILL PA 17011 J. Summary of Borrowers transaction K. Summary of Sellels transaction 100. GrossAmount Due from Borrower: 400. GrossAmount Due to Seuer: 101. ConUad sales rioe 95,000.00 401. Contrad sales rice 95,000.00 �OZ• Perso^a� 402. Personal ro 103. Settlement Char es to 8orrower Line 1400 6,765.02 403. 104. 404. ��� 405. Ad'ustmenb for items aid b Seller in advance Ad'usiments for items aid b Seller in advance 106. COUNTYITOWNSHIP 05/29/14 to 01/01/15 321.70 406. COUNTYITOWNSHIP 05I29J14 to 01/01/15 321.70 107. CITY TAX to 407. CITY TAX io 108. SCHOOITAX OS/29l14 to 07/01/14 83.79 408. SCHOOLTAX 0529/14 to 07/01/14 83.79 109. Seuver Fees 05/29/14 to 07l01/14 25.38 409.Sewer Fees 0529/14 to 07/01/14 25.38 110. Rafuse Fees 05/29/14 to 07/Ot/1a 19.11 410. Refuse Fees 05/29/14 to 07/011�a 1g.11 171. 4N. 112. 412. 120. Groas Amount Due from Borrower 102,215.00 420. Gross Amount Due to Seiler 95,449.98 200. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller. 201. or earnest mone 1,000.00 501. Excess see instructions 202. P' ' I amount of new ban s 93,279.00 502. Setflement char es to Se1er �ine 1 a00 20,654.25 203. ' ban s taken su ' to . 503. ' loan s taken w ' to 204. Redeve ment Author' Grant 5,000.00 504. PayoH F'vst Mortgage 205. LenderCredd•UnderdisdosedAPR Fees 65.86 505. Second Mort e 206. 506. 207. $07. De 'd'sb.as roceeds 208. 508. 209. 509. Ad ustments for items un aid b Seller Ad ustments for items un aid b Seller 210. COUNTYfiW1MSHIP to 510. COUNTYlTOWMSHIP lo 217. CITY TAX to 511. CITY TAX to 212. SCHOOL TAX to 512. SCHOOL TAX lo 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 278. 518. 219. 519. 220. Totai Paid b/for Bortower 99,344.86 520. Total Reduction Amount Due Seller 20,654.25 300. Cash at Settkment fromlto Borrowar 6p0. Cash at settlement to/from Seller 301. Grou amount due from Bwrower fine 120 102,215.00 60�. Gross amount due to Se1er 6ne 420 95,449.98 302. Less amouM id lFor Borrower(Gne 220) ( 99,344.86 602. Less redudions due Se1er(fne 520) ( 20,654.2 303. Cash Q From � To Bortower 2,870.14 603. Cash Xa To � From Seller 74,795.73 •PrWWiE�ddah9A'ema.�f9)au�(81.�wr(U.aetir The undersipned hereby a e reca a pleted capy of this statement&any attachments r rred to herein Borrower Seder �{,�r � Ab'ai mdh state oi Doris Jean Br p � . 9dce iT�Pupq RyvYry drtlnlor Ws mll�edma(irbm�im It M6maW y ffi mir4w qr rwpmu Aor colNpinp,rMwJrp�rW rpohnp tMOY THS aprcy my roc cdlect Ina Ir/am�tlon ano ra se nol rpub D compM h�i iarm�ViM�M 6lQayt�d�MY vJW 0►6 Ca6tl NnDK.Noar110liYNly 17 tlW�411is 6�tlav�ii rt�ttl11PY.Ttii q EWQW b RohW Qe P�a b s RES�Car�0 o-�riHCtlm WCi i�iarm�da+Qrirpllr NItlOmMt °�"�� HUD-1 Page t of 3 (HOCKENBERRY PFDMOCKENBERRY122) L Settiement Cha s 700.Tohl sal Estate Broker Fees S 5,700.Op P�F� P��� Di�isa�ol ownmispon(6ie 700)es/o/bws.• Borrowars Seners 707.S 6 000.00 to Than son Wood Real Estate Funds at Fuqs at N :L'ne 701 In Ad nt of 3 .00 For Add�ional Commission Setuement Setc�emenc ��• to Thom n�Wood Real Estate 703.Comm' 'n aid at enl 6 000.00 704. 705. Deed Prep to Bangs Law OfFice,LLC 706.Add�ional Commission to Thom son Wood Real Estate 3p0.00 800.Itoms able in Connaction with Loan 801. r or ination char e S 550.00 from GFE#1 802.Your aedB or�arge(points)for the spedFic interest rate chosen $ (from GFE#2) 803.Your ad'usted or' ination char es (rom GFE#A 550.00 804. ra'sal fee to ALS from GFE#3 575.00 805.Credd R rt to Credit Plus from GFE#3 55.72 ��T��^'� �a from GFE#3 807.Flood cartifi�ation to Core L ic from GFE#3 13.50 �� from GFE#3 �• (rom GFE#3 810. from GFE#3 811• (from GFE#3) 800.ttems R uired b Lender to Be Paid io Advanee 901.Da nlerest char es from OS/29/14 to 06/01/14 3 E10.860000/da from GFE#10 32.58 902.Mo insurance remium for months to HUD from GFE#3 1,6pa.3t 903.Homeownefs insurance for 1.0 ears to Allstate from GFE#1� 315.25 �• from GFE#11 �� (from GFE#�1) 1000.Reserves D osited with Lender 1001.In4ial deposrt for your esaow account (from GFE#9) 911.16 1002.Homeowner's�surance 3.00� months (� S 26.28 per month $ 78.84 1 iiwrance months $ 102.34 r month S 1004.Pr taxes � 1,068.12 COUNTY TAX 4.000 months E 44.24 month CITY TAX months S r month SCHOOI TAX 12.000 months S 75.93 r month 1005. S COUNTY/fOWNSHiP months S r rtwnih SCHOOL TAX months S r month 1006. months S r month $ 1007. months 5 r month $ 1008. S 1009.AGGREGATE AD,IUSTMENT 5 •255.80 1100.Tftk Chatgas 1101. Tib servitas and IerWers tdle insurence from GFE#4 1,2 .00 1102. Settle�rient or ' fee $ 1103. Owrror's t�le inwranee to FIRST AMERICAN TITLE INS.CO. from GFE#5 5.5Q 1704, s titk insurence to FIRST AMERICAN TITLE INS.CO. S t 017.00 11 . Lenders tib fmd S 93 279.00 1106. Owner's tiGe Sm1 S 95.000.00 1707. rdon f the total tRle insurance emium to GUAR�W7EED ABSTRACT SERVICES I 5 869.12 1108. UnderwrRers rtion of the total titie insurance remium to FIRST AMERICAN TITLE INS.C0. 5 153.38 1108. N Fee to GUARANTEED ABSTRACT SERVICES,INCS 10.00 1110. Reimbursement for Tax Cert to GUARANTEED ABSTFL4CT SERVICES,INCS 10.00 1111. $ 1112. b 1113. S 1200.Govemment Reco►ding and Tnnsfer Chatges 1201.Governrtietft reoord' cha to RECORDER OF OEEDS from GFE it 218.00 1202. 67.00 Mort e $ 87.00 Relaases Olher $ 84.00 1203.Tr t�aes to RECOR�ER OF DEEDS from GFE#8 9 .00 1204.C /Coun tax/stam s S 950.00 S 9�.� 1205.State tax/stam s S 950.00 5 1206.Release Fee to Redevebpment Authority 32.00 1207. 1300.AddiNonal SetUement Charges 1301.R uied servioes that u an sho for from GFE#6 1302. Home Warran ro F"vstAmerican Home B rs ProteGion $ #10401440501 a85.00 1303. Inhen'tanceTaxEscrow to GuaranteedAbstred S 13,199.25 1304. S ' 1305. f 1�00.ToW Settlement Charpes(enter on lines 103,Section J and 502,Section K) , 6 .0 •Ptl0 a1Y4 d tlaWp q Emawr(W.�MNr(Sl.NMVW.aYirbpnty(n �. BJ�P��4P�P�aftiit4lmKlh�pMmp�cMicW�Cp�rK�ipdawnpaqCW/atWp�2bJlfvi�happ� 1 i f(� GU TEED CT SERVICES,INC.,SettlementAgent Certified to be a true copy. Page 2 of 3 HUD•1 (HOCICENBERR Y.PF DMOCKENBERRY/21) Comparison of Gootl Fafth Estimate(GFE7 and HUD•1 Charges Good Faith Estimate HUD-1 Cha es That Cannot Inerease HUD-1 Line Number Our orghation charge # 801 550.00 550.00 Your edjusted orgination charges # 803 550.00 550.00 Tranafer laxes #1203 950.00 950.00 Charges That in Total Cannot Increase More than 10°/. Good Faith Estimate HUD-1 Go�ernmentrecording charges #1201 240.00 218.00 Apptei581�ee # gpq 450.00 575.00 ClBdkfepOrt # 805 40.00 55.72 Flood cert�ication # 807 13.50 13.50 Mort e Insurance Premium # 902 1,604.31 1,60a.31 To t a I 2,347.81 2,466.53 Inaease between GFE and HUD-1 Charges S 118.72 or' S.06°/ Chargea That Can Change Good Faith Estimate HUD-1 In�ialdapositforyourescrow aocount #i001 1,606.04 911.16 Daiy interest tharges # g01 $ 10.860000Iday 2t72 32.58 Homeowner's insurence # 903 480.00 ' 315.25 T�k servioes and knder's tdb inwrance i���p� 1,1 a2.00 1,202.00 Owner'stille inwrence to FIRSTAMERICAN TITIE INS.CO. #�103 5.50 5.50 Loan Terms Your inkial loan amount is g g3,27g,pp Yourloan term is 30.00 years , YouriniGalinterest rate is 4.2500% Your initial monthly amount owed for principal,interest and S 56122 indudes any moRgage insurance is Q p��ppal Q INerest Q Mortgage Insurance Can your Interest rate rise7 �X No � Yes,A can rise to a maximum of °�. The fvst change w�l be on and can change again every�months after Every change date,your interest rate can inuea$e or deaease by °h. Over the�fe of ihe ban,your interest rate js guaranteed to naver be bwer than %or hgher than %. Even if you make payments on time,can your loan balance rise7 QX No � Yes,A an rise to a mabmum of S Even N you maks paymenta on time,wn your monthly QX No � Yes,the fvst inaease pn be on apd the monthy amount owed for principat,interest,and mortga8e insurence rise? amount owed can rise to S The ma�cinum d pn ever rise to is 5 Does your loan have a prepayment penalty7 QX No � Yes,your ma�anum prepayment penalry is b Doea your loan have a balloon payment? �X No � Yes,you have a balbon payment ot 5� due in_years on ' ToWI monthly amount owed including escrow acwunt payments ❑ You do not have a monthy esuan payment for Aems,sa�ch as property taxes and homeowner's insurance. You must pay these demS dvectly yourself. QX You have an addabnai monlhy esaow payment of 5748.a5 that resuqs in a totel inifial monthly amount ow6d of 5707.67. ThiS indud4s prindpal,interest,any mortgage insurance and any @ems checked bebw: QX Property taxe5 QX Homeowner S in5ur8nce � Fbod nsurance QX School Tax ❑ � Note: If you Fwve any questbns about the Settlement Charges and Loan Terms fsted on this form,please contad your lender. Page 3 of 3 ', HUD-t (HOCKENBERRY.PFDIHOCKENBERRY20) HUD-1 Attachment Borrower(s):Abigail L. Smith and Tylor R. Selle�s): Estate of Doris Jean Broude Hockenberry 23 Belaire Avenue 216 Cumberland Drive Carlisle, PA 17013 Camp Hill, PA 17011 Lender:Meridian Bank SetUementAgent:GUARANTEEDABSTRACT SERVICES, INC. (717)724-8758 Place of Settiement:GUARANTEED ABSTRACT SERVICES, INC. 3813 MARKET ST, CAMP HILL PA 17011 Settlement Date:May 29, 2014 Property�ocation:216 Cumberland Drive Camp Hill, PA 17011 CUMBERLAND County, Pennsylvania Additional Adjustments For items Paid By Selier In Advance(Borrower Debit) DesCription Amount From/Throuqh Prorated Amount Sewer Fees 70.00 05/29/14 through06/30/14 25.38 Total Line 109/409 25.38 Refuse Fees 52.70 05/29J14 through 06/30/14 19.11 Total Line 110/410 19.11 Adjusted Origination Charge Details O�igination Charge Origination Fee 550.00 to Meridian Bank Total $ 550.00 Origination CrediUCharge(points)for the specific interest rate chosen Tota I 5 Adjusted Origination Charges $ 550.00 Reserves Deposited with Lender Homeowner's Insurance 78�84 3.000 at 26.28 per month 176.96 COUNTY TAX 4.000 at 44.24 per month SCHOOLTAX 911 16 12.000 at 75.93 per month AGGREGATE ADJUSTMENT -255.80 Tota I $ 911.16 Title Services and Lender's Title Insurance Details BORROWER SELLER CPlto FrstAmericanTitle In 75.00 to FirstAmerican Title insurance Company Emaii Document Retrieval 50.00 to GUARANTEEDABSTRACT SERVICES, INC. Notary Fee 20.00 to GUARANTEEDABSTRACT SERVICES, INC. Overnight Fee/Package 25.00 to GUARANTEEDABSTRACT SERVICES, INC. WARNING: it ia a crime to knowingly make false statements to the United States on this or any similar fortn. Penaltfes upon convictlon can include a fine and imprisonment. For details see: Tttle 18 U.S.Code Sectlon 1001 and Seetion 1010. (HOCKENBERRY.PFD/HOCKENBERRYl18) HUD-1 Attachment- Corrtinued Incoming Wire Fee 15.00 to GUARANTEED ABSTRACT SERVICES, INC. Lender's title insurance 1,0�7.00 to FIRSTAMERICANTITLE INS. C0. Totai $ 1,202.00 $ 0.00 Owner's Title insurance BORROWER SELLER Owner's Policy Premium 5.50 to FIRST AMERICAN TITLE INS. C0. Totai $ 5.50 $ O.UO Lender's Title Insurance BORROWER SEILER 'faes also shown abova in Title Services and Lendefs Title Insurance Details Lender's Policy Premium 867.00 to FIRST AMERICAN T ITLE INS. CO. Lender's Endorsement Charges 150.00 Endorsement Endorsement Charge END 100 50.00 END 300 50.00 END 900 50.00 Total $ 1,017.00 $ 0.00 WARNING: It is a erime to knowingly make false statements to the United States on this or any similar fortn. Penalties upon conviction can include a tine and imprisonment. For detaiis see: Title 18 U.S.Code Section 1001 and Seetion 1010. (HOCKENBERRY PF D/HOCKENBERRYl18) �Thrivent Financial for Lutherans� 4321 N. Ballard Road,Appleton,WI 54919-0001 Thrivent.com •800-THRIVENT(800-847-4836) February 21, 2014 Bangs Law Office Attn: Michael Bangs 429 South 18th St Camp Hill PA 17011 Subject: Doris Jean Broude- CIF No: 514021149 Dear Attorney Bangs; Thank you for norifying Thrivent Financial for Lutherans of Doris Jean Broude's death. Please accept our condolences. As requested, the date of death value for contract B4550044 is $6,616.01. However, James Buck is not a beneficiary. Our Financial Advice Center, whose telephone number is 888-834-7434, will contact the beneficiary to assist with the completion of claim papers and answer any questions. If you have any quesrions, please call us at 800-847-4836, ask for death claims. Sincerely, � Holly Kolpack Claims Examiner Claims Operarions MFSS Service Operations hk cc: F A Center 0383 00001 Doris Jean Broude, deceased,514021149; Symetra Life Insura�ce Company Retirement Division 777 108th A�enue NE,Suite 1200 S Y M E T R A Be��e��e,`NA 98004-5135 Moiling Address PO Box 305156 RETIREh�ENT� BENEFITS LIfE Noshville,TN 37230•5156 April 8, 2014 Pno�e 1-800-796-3872 TTY/TDD 1-800-833-6388 www.symetro com Estate of Doris Broude C/o Michael Bangs, Attorney-at-Law 429 South 18`h Street Camp Hill, PA 17011 RE: Symetra Life Insurance Company Annuity V000050791 for poris Broude Dear Mr. Bangs: Per your request, the date of death value on the above mentioned annuity is as follows: Date of Death Value January 29, 2014 �138,914.84 We appreciate the opportunity to serve our customers. Our service center is located in Bellevue, Washington. If you have any questions or would like help finding an agent or advisor in your area, please contact us at 1-800-SYMETRA or 1-$00-796-3872. Select option 2 for Retirement Services, followed by option 3 for the Individual Retirement Plans unit. To reach me directly, please press 9 followed by my extension 65041. Our customer service representatives are available from 6:00 a.m. to 4:30 p.m. Pacific Time, Monday through Friday. Sincerely, � ��- Everett Fowler Claims Examiner Retirement Services Symetra Life Insurance Company � .,:� \�� �,����,.' � BILL OF SALE I, JAMES C. BUCK, Executor of the Estate of Doris J. Broude, do hereby sell a 2004 Chevrolet automobile, Vehicle Identification Number (VIN) 1 G 1 JF52F947298667, to /� ��`�a,-/.� � /�,���.;� � � `��li'����r- , for the sum of _ f7/c � Tl�c�-s n5-r�-� �i��,($_ ��iO<� �rZ ) Dollars. ' Date: aZ�)�%L/ ���'i.�c�C`-�� �.�--�-Cr� ��'�� , JAP(�IES C. BUCK . _. . , _ .,, ,., , ,.� ,,,.,�� roo. t IbU h'. 1 ���.� Ma�7, 20I4 Michael L Bangs Attomey At T.,aw 429 Sauth 1 S�St Camp T�'ill,pA 17011 RE: Daris Jea�n$roude SSN: 172-24�9103 . D0Y7:01-29-2014 Dear Mr_Bangs: In response to yawr request�pz�Daie of Deatb(DQD}balances for the customez-notsd above,our records show the following: Ce�te of Dep�it A,CCOtmt#311(?0313615 �stablished= 05-08-2007 D4RIS JF,AN BROUDE nt?T7 balance: S18,Oai?.40+Q.g4�cru�d i�rest Account#31800312903 �stabli�ed: OS-21-2007 DQRIS 7EAN BRO'UDE 1�OY7 balance: $2,OOO.UO+Q.03 accrued i�tere5t � Checkin�Accot��►t . Ac�cou.�t#51.44U075C>5 Established: OZ-01-1978 . DO�S JEAN BROTJDE DOD balance: �11,316.50+0.07�crued interest Savings Accoant Account# 511 bQ59832 Establi,sb,ed: O l-08-2414 DORIS JE.AN BR�LJ�E PATRICIA A BUCK DOD balance: $2,45720+O.Q1 a�ccrued i�erest � Page 1 of 2 . .. _. , , _ _,,.,. , �.� ,,,.,,� �vo. t ioU f'. L please note that this office provides�e of death balsnces for deposit sccots�ts(IRAs,CDs,Checla[ng a�d Savings). We do�,t process anp fi,�ncial t�ranaactio,�s ar provicie stateu�ent�s. Yf you�aeed sssi�tance vviih any oft�ese it�s,piease call 1-888-PNC BA,N�(1-888-762-2265)or stog by�o�local pNC Bank t�ench affece. Sincerely, N'ational Financial Senrices Center PNC Banti,N.A. Membe�r FAIC This message rs intended fa�the use of the individual or entity to which it is addressed cmd may corrtairz irformaiion that fsprivilegec� confiderrtial and exemptfrom disclosure unaier applieable law. If the read'er of t�is message Ys riot the intended recipient ar the em,ployee or agent responsible for deliverimg this message ta the intended recipierit,you are hereby not�fied t)urt arry drsseminativr� distribution or copyirng of rhis comrnunicativns is strictly prohihired. If you�Zave�eceived this co»ununication in error,pleczse natrfy me irt�nediatety by reply or by teleplione at 844-762-1775 and immeciialely destroy this fir�ced docu�nent. l�age 2 of Z RIVERVI EW BAN K AUD ITS OPERATING DIVISIOVS 200 Front Street,PO Box B,Marysville,PA 17053 www.riverviewbankpa.com 3/3/201 Bangs Law Office LLC RE: Doris J Broude 429 South 18th Street DOD: 1/29/2014 Camp Hill PA 17011 Account Number(s) 100997930 101026330 101126930 Type of Account CD CD CD Date Opened October 17, 1990 January 8, 1991 January 8, 1992 Principal Balance at date of death $1,000.00 $19,426.67 $1,766.77 Interest Rate 0.3990% 03490% 0.4000% Accrued Interest not disbursed as of date of death $1.15 $4.09 $0.43 Maturity Date Primary Owner of Account Doris.J.Broude Doris J Broude I7oris J Broude Name of Joint Owner(s),if any - ' Beneficiary,if any Date Joint Ownership was Established --_ _____ __ -- - -- --- - - - _ -- - _-— - - ---- � If within 1 yeaz of death of Decedent could prior Account Be traced into a prior Joint Account in existence over 1 year prior to death of Decedent N/A Safe Deposit Box(s)and Location By: Steven M Williams Halifax Bank Marysville Bank � 300 Market Street � 200 Front Street PO Box A . � PO Bo�B Halifax,PA 17032 arVSVille : Marysville,PA 17053 HR�l,�X BQJtIc www.marysvillebankpa.com www.halifaxban kpa.com St � MEMBERS 1� FEDERAL CREDTT UN[ON REGULAR SAVINGS ACCOUNT: Account Number/Suffix 14381-00 Date Account Established 02/22/1973 Principal Balance at Date of Death $1,685.48 Accrued Interest to Date of Death �0.19 Total Principal and Accrued Interest $1,685.67 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 14381-05 Date Account Established 02/05/1993 -- Principal Balance at Date of Death $14,158.95 Accrued Interest to Date of Death �1.63 Total Principal and Accrue�+ Interest $14,160.58 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 14381-40 Date Account Established 12/20/2003 Principai Balance at Date of Death $10,000.00 Accrued interest to Date of Death $3.84 Total Principal and Accrued Interest $10,003.84 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 14381-41 Date Account Established 07/10/2004 Principal Balance at Date of Death $5,000.00 Accrued Interest to Date of Death $1.34 Total Principal and Accrued Interest $5,001.34 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 14381-45 Date Account Established 10/11/2004 Principal Balance at Date of Death $5,000.00 Accrued interest to Date of Death $1.34 Totai Principai a�d Accrued Interest $5,001.34 Name of Joint Owner None MEMBERS 1ST FEDERAL CREDIT UNION �./,.Ct1.OGt� Tessa L Klugh Lending Insurance Support Specialist February 28, 2014 Estate of: DORIS J BROUDE Date of Death: 01/29/2014 Social Security Number: 172-24-9103 5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwwmemberslst.org /�y�� � `:lib« .� �i���� I, DORIS J. BROUDE, of 216 Cumberland Drive, Camp Hill, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of mv last illness. and any and all taxes and assessments imposed by any governmental bod�� as a result of mv death, whether on propem� passing under this will or otherwzse. shall be paid from my residuary• estate as soon as practicable after m�� death as a part of the expense of the administration of my estate. ITEM II. I gi��e and bequeath all of my household goods> automobiles,jewelry, and all other articles of household and personal use. equipment and ornament. together with all insurance thereon and relating thereto. as follo��s: A. Tw�ent�-five (2�%) Percent to AMY ORTEGA FORTNEY provided she survives my death by thirty (30) days. Should she predecease me or not survive my death by thirty days, then her share shall be divided evenly among her issue per stirpes who �� survive my death by thirty (30) days. B. Seventy-five (75%) Percent to JAMES C. BUCK and PATRICIA A. BUCK, or the survivor of them, who survive my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate as follows: �� L � 1 _ _ _ A. Twent�-Ti�e (?�%) Percent to .<�,'�IY ORTEGA FORT?vEY provided she survives my death by thirty (30) days. Should she predecease me or not survive my death by thirty days, then her share shall be divided evenly among her issue per stirpes who survive my death by thirty (30) days. B. Seventy-five (7�%) Percent to JAMES C. BUCK and PATRICIA A. BUCK, or the survivor of them. who survive my death by thirty (30) days. ITEM IV. A11 of the interests of the beneficiaries hereunder shall not be subject to anticipation or to ��olunt.ary or involuntary alienation nor shall ti�ey be subject to an�° execution or attachment. ITE':1�1 �'. I appoint m� brother JAMES C. BUCK executor of this m}� last �zll. Should m�� brott�er predecease me or other��ise fail to qualif�� or cease to ser��e as e�ecutor of this my last �ili. I appoint m� sister-in-la« PATRICIA A. BL�CK e�ecutn� of this my last w711. ITE'�i �'I. In addition to the other powers and authorities granted to m� personal representati�es b� Penns�l�ania law and by the other terms and pr���isions of this will. I hereby give to m�� perso�ial representati��es the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; __ to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or ,{ .t� 2 �1 �� - - .,., diversification: to sell at public or prit-ate sale, to exchange_ ar to lease for an� period of time. any real or personal property and to give options for sales, exchanges. or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREDF, I have hereunto set my hand this � � day of �� `,�_� . 2011. % � �(; �- - , T_Y \ -r--_ --{.{�_ DORIS J. BROUDE,/ 3 The preceding instrument, consistin� oi this and THREE other n-peuritten pages. each identified by the signature of the testatrix was on the date thereof signed, published, and declared by DORIS 1. BROUDE, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ; > � � � ' � � ' % L.i..�:l � ,•��,C.�fG' 4 COMMO?�71�EAL.TH O� PE`v�SY1.Vt+�.�.'lA ) ( SS: COliNTY OF CL'MBERLAtiD ) The undersigned. being the testatrix whose name is signed to the attached or foregoing instrument, having been dul� qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. � � _ ���- G-",�� ,y"< <" DORIS J. BRO Swocrn or affumed to and a+cknow{edged before me by the � � natned above th ic�� da of , 2fl 11. �,�y�� � o „ , t/ ��,u s�u � VwnQ�r IC.StnvD.Notsrr Pu�ic otan PubliC' l.e..r AM�.Towwsf�io.ce*�w.�+..e co.«. ' C.ow�Mbn Eaqrss Ma�r 1 2Q13 COMMONWEALTH OF PENNSYLVAN�Q�-��....-�.---��-:_..•-....• .- --- �:: `. _.� ( SS: COUti^TY O�CU�iBERLA:�iD ) p �� ---, � �� r� � �" � d�l� the w`E. ! '' ,�. �'c : ; `z�C f' ;-- and ' �►itnesse�whose names ar+e signed to the aikached or foregoing insuument� being duly quaiified according to law.do depose and sav that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingiy and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testavix signed the will as witnesses: and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. f�.� ���� �� � � _. � , , � � � � ��=� C �? �..�- � Sworn or a�rmed an acknowledged bef�re � t ' day of , �011. ; �I 1 i 'J � -+� ` � otary Public � 01AMONWlALTM Of �ENNS�lYAM1A NO�AR�A1 SEAL W�nOy K.Stroub, Notary Public Low�r Atl�n Township,Cumbert�nd CountY IAY Commi�sla�fzpire:MaY 10.201 b 5