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HomeMy WebLinkAbout09-25-14 (2) J 1505610143 REV-1500 EX(02-11) _ OFFICIAL USE ONLY Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEV10.iMENTOF HEVEHVE PO BOx.280601 INHERITANCE TAX RETURN 21 14 0139 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206 32 4834 02 07 2014 09 21 1941 Decedent's Last Name Suffix Decedent's First Name MI KENNEDY JUAN (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 1-1 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-B2) 4. Limited Estate 4a.Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate 7 Decetlent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of W II) (Attach Copy of Trust) P 9. Litigation Proceeds Received 10.peeWeen P12 31151 aodt{Da�',Death 11.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number HUBERT X GILROY (717) 243 3341 REGISTER OF WILLS USE ONLY ru (7 _o First Line of Address C O s ry m 10 EAST HIGH STREET Co n �' o rri n Second Line of Address A i N - p Cn 1T7 C.1'I ;'I RT Cn DATE FILED, City or Post Office State ZIP Code CARLISLE PA 17013 z ca = c> -+ r m ct - F--� cn o v �l Correspondent's e-mail address: hgilroyComartsonlaw.com Under penalties of perjury,I declare that I have examined this return,includinC accompanying schedules and statements,and to the best of my knowledge and belief, i s true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. AT RE OF PER§VN ONSIBLE FOR FILING RETURN gATE L��CG Pamela R. Knowlton ADDRESS 11k7 CenteWil oad wville PA 17241 NA 0 RE HERT A EPRESENTATIVE DATE am��X Hubert X. Gilroy Q a aQ/L` AD RESS 10 East High Street, arlisle, PA Side 1 L 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oe.denra Name: Kennedy, Juan 206 32 4834 RECAPITULATION 1. Real Estate(ScheduleA)....................................................................................... 1. 98, 067 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 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. 51 , 732 . 88 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property (Schedule G) a Separate Billing Requested............ 7, 66, 785 . 27 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 216, 585 . 15 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 23 ,265 . 3 8 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3 , 437 . 12 11, Total Deductions(total Lines 9 and 10)................................................................ 11. 26, 702 . 50 12. Net Value of Estate(Line 8 minus Line 11)............................. . .. . 12. 189, 882 . 65 . . . ...................... 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)....................... 189, 882 . 65 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 at lineal rate X .045 189, 882 . 65 16. 8 , 544 . 72 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 8 , 544 . 72 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 J i REV-1500 EX Page 3 File Number 21-14-0139 Decedent's Complete Address: DECEDENT'S NAME Kennedy,Juan STREET ADDRESS ----��ii--ii--- 38 Mill Street CITY STATE ZIP Mount Holly Springs PA 17065 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 8,544.72 2. Credits/Payments A. Prior Payments 7,000.00 B. Discount 368.42 Total Credits(A +B) (2) 7,368.42 3. Interest (3) 4. If tine 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) 1,176,30 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 transferredt............................._................................................ b. retain the right to designate who shall use the property transferred or its income:..__............................ a. retain a reversionary interest;or.............................................................................................................. x d. receive the promise for life of either payments,benefits or care?............................................................ x 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?..... ❑ Qx 4. Did decedent own an individual retirement account,annuity,or other non-probate property which r� contains a beneficiary designation?.................................................................................................................. x u IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. aG, 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 an 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)]. 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)(11)1. • 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 172 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 P.S.§9116(a)(I.3)1. 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. Rer,4502 EX.101.10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kennedy,Juan 21-14-0139 All real pro perty owned solely or as a tenant In common must be reported at fair market value.Fair market value is doflned as the price at which Pro Ay would be exnnanged between a willing buyer end a willing carer,neither being compared to buy or sell,both having reasonable knowledge of the relevant racts. Real property that is jointly owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the dead showing docedant's Interest if owned as tangs in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residence-Real Estate located at 38 Mill Street, W. Holly Springs Borough,Cumberland 98,067.00 County,PA, known as Tax Parcel No.23-31-2187-045,being described in Deed Book B, Volume 28, Page 488,and being conveyed to Juan Kennedy and Suzanne M. Kennedy, his wife. Suzanne M. Kennedy died on July 10,2010, leaving title solely vested in Juan Kennedy Valuation is per assessed value$101,100.00 x 0.97 common level ratio,see attached. TOTAL{Also enter on Line 1, Recapitulation} 98,067.00 lif more space is needed,additional pages of the some size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1508 EX.(I140) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kennedy,Juan 21-14-4139 Include the proceeds of litigation and the date the procadds were received by the estate. All property Jointlyovmedwith the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Devin M. Kennedy-Proceeds from the sale of 2007 Dodge Ram truck($20,000)and 2004 30,000.00 Keystone Montana camper($10,000) 2 M&T Bank Pre-death Checking Account#50897306-Date of death value 19,587.08 3 1989 Ford Bronco-scrap value 100.00 4 Miscellaneous household goods and personal property 1,000.00 5 Brethren Mutual Insurance Company-Homeowner's insurance refund 174.00 6 Comcast-Refund 100,48 7 United States Treasury-Tax refund, 1040A 2013 736.00 8 Verizon Wireless-Refund 35.32 TOTAL(Also enter on Line 5, Recapitulation) 51,732.88 (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) Ray-1510 EX.(e8-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kennedy,Juan 21-14-0139 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. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DEWS EXCLUSION TAXABLE NUMBER THE DATE OF TERAANTRANSFEREE CH A COPY OF THE DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Transamerica Life Insurance Company Annuity No. 66,785.27 66,785.27 02CBT090810-Named beneficiaries:Jason Lee Kennedy (son) 113 share,Tony Allen Kennedy (son) 113 share,and Davin Matthew Kennedy(son) 1/3 share TOTAL(Also enter on Line 7, Recapitulation) 66,785.27 (If 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-0511 EX.(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kennedy,Juan 21-14-0139 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 435.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Pamela R. Knowlton Street Address 1167 Centerville Road City Newville State PA Zio 17241 Year(s)Commission Paid 9,497.55 2. Attorney's Fees Martson Law Offices 9,745.56 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 358.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,228.77 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 23,265.38 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 Kennedy,Juan 21-14-0139 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Mt. Holly Church of God Life Ministry-Meal following memorial service 250.00 2 Pamela R.Knowlton-Reimbursement for purchase of Animoto,Inc.software to make 35.00 music/video played at memorial service. 3 Pastor Dick Reese-Ministerial services 150.00 H-A 435.00 Other Administrative Costs 4 Barbara J. Boise,Tax Collector-Real estate taxes, pending sale of real estate 460.71 5 Barbara J.Boise,Tax Collector-Real estate taxes,pending sale of real estate 1.151.25 6 Borough of Mt. Holly Springs-Water/sewer/trash,pending sale of real estate 231.39 7 Borough of Mt.Holly Springs-Water/sewer/trash, pending sale of real estate 197.19 & Deed copy-Copy fees 0.15 9 Landex-Title search 0.24 10 Legal advertising-The Sentinel 201.16 11 Legal advertising-Cumberland Law Journal 75.00 12 M&T Bank, Deluxe Checks-Checks ordered for Estate checking account(qty=50) 15.74 13 MetEd-Electricity bill,pending sale of real estate 114.15 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kennedy,Juan 21-14-0139 ITEM NUMBER DESCRIPTION AMOUNT 14 MetEd-Electricity bill,pending sale of real estate 54.22 15 MetEd-Electricity bill,pending sale of real estate 12.55 16 MetEd-Electricity bill,pending sale of real estate 7.69 17 Pamela R. Knowlton -Reimbursement for purchase of homeowner's insurance for 707.00 decedent's residence H-B7 3,225.77 Copyright(c)2002 form software oniy The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6.98) RevA512 EX.(1248) SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kennedy,Juan 21-14-4139 Report debts Incurred by the decedent peer to death that remained unpaid at the date of death,Including unreimbumed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Byram Healthcare-Test strips and lancets,account payable 67.19 2 In Your Home Care-Invoices C9047 and C9112,account payable 2,532.00 3 Jennifer Kennedy-In home healthcare services 600.00 4 Jennifer Kennedy-Reimbursement of purchase of household items(i.e.toilet paper, paper 100.00 towels,laundry detergent) 5 MetEd-Electricity bill,account payable for residence 70.25 6 MetEd-Electricity bill,account payable for rental garage 1136 7 Verizon Wireless -Account payable 54.30 TOTAL(Also enter on Line 10,Recapitulation) 3,437.12 (If more space is needed,additional pages of the some 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 Kenned ,Juan 21-14-0139 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Wards) ($$$} Do Not List Trusise(S)I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)1 1 Davin Matthew Kennedy Son Schedule G Item 42,777.98 8 Young Drive 1 and One sixth 17015 of residue 2 Jason Lee Kennedy Son Schedule G Item 42,777.99 1705 Petersburg Road 1 and One sixth Boiling Springs, PA 17007 of residue 3 Kevin Glenn Kennedy Son One sixth of 20,516.23 2534 Larkwood Lane residue Knoxville,TN 37921 4 Tony Allen Kennedy Son Schedule G Item 42,777.99 81 S. High Street 1 and One sixth Newville, PA 17241 of residue 5 Pamela R.Knowlton Daughter One sixth of 20,516.23 1167 Centerville Road residue Newville, PA 17241 See continuation schedule attached Continuation 20,516.23 Total 189,88215 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as approp riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Juan Kennedy 02/07/2014 206-32-4834 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Kelly Anne Richwine Daughter One sixth of residue 20,516.23 28 Prickly Pear Drive Carlisle, PA 17013 Total 20.516.23 1 Will of Juan Kennedy Part 1. Personal Information 1,Juan Kennedy, a resident of the State of Pennsylvania. Mount Holly Springs Borough,— declare that this is my will Part 2.Revocation of Previous Wills CO I revoke all wills and codicils that I have previously made. Part 3. Children I have the following children now living: Jason Lee Kennedy, Tony Allen Kennedy, Devin Matthew Kennedy, Kevin Glenn Kennedy, Pamela R. Knowlton and Kelly Ann Richwine. Part 4.Grandchildren I have the following grandchildren now living: Tyler Snuffer, Matthew Kennedy and Sara Kennedy. Part 5. Disposition of Property A beneficiary must survive me for at least 45 days to receive property under this will. As used in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. If I leave property to be shin4by two or more beneficiaries, and any of them does not survive me, I leave his or her sure to the others equally unless this will provides otherwise. My entire estate is all property I own at my death that is subject to this will. I leave my entire estate to my children Jason Lee Kennedy,Tony Allen Kennedy,Devin Matthew Kennedy, Kevin Glenn Kennedy,Pamela R. Knowlton and Kelly Ann Richwine in equal shares. If Tony Allen Kennedy does not survive me, I leave his share of my entire estate to Tyler Snouffer. If Devin Matthew Kennedy does not survive me, I leave his share of my entire estate to Matthew Kennedy and Sara Kennedy in equal shares. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or debt. Page I of 4 initials: t),k' 71V- 1, / - Date: Will of Juan Kennedy Part 6. Executor I name Pamela R. Knowlton to serve as my executor. If Pamela R. Knowlton is unwilling or unable to serve as executor, I name Kelly Ann Richwine to serve as executor. No executor shall be required to post bond. Part 7. Executor's Powers I direct my executor to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including tiling a petition in the appropriate court for the independent administration of my estate. I grant to my executor the following powers,to be exercised as she deems to be in the best interests of my estate: 1. To retain property without liability for loss or depreciation. 2. To dispose of property by public or private sale, or exchange, or otherwise, and receive and administer the proceeds as a part of my estate. 3. To vote stock; to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities; and to exercise all other rights and privileges of a person owning similar property. 4. To lease any real property in my estate. 5. To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal with and settle claims in favor of or against my estate. 6. To continue or participate in any business which is a part of my estate, and to incorporate, dissolve or otherwise change the form of organization of the business. These powers, authority and discretion are intended to he in addition to the powers, authority and discretion vested in her by operation of law by virtue of her office, and may be exercised as often as is deemed necessary or advisable, without application to or approval by any court. Part 8. Payment of Debts Except for liens and encumbrances placed on property as security for the repayment of a loan or debt, I direct that all debts and expenses owed by my estate be paid in the manner Page 2 of J 4 Initials: J-1 , S L , 6' Date: ` / l0 Will of Juan Kennedy provided for by the laws of Pennsylvania. Part 9, Payment of Taxes I direct that all estate and inheritance taxes assessed against property in my estate or against my beneficiaries be paid out of all the property in my taxable estate,on a pro-rata basis. Part 10. No-Contest Provision If any beneficiary under this will contests this will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this will is revoked and shall be disposed of as if that contesting beneficiary had not survived me. Part 11. Severability If a court invalidates any provision of this will,that shall not affect other provisions that can be given effect without the invalid provision. Signature I, Juan Kennedy, the testator, sign my name to this document,this J 6'4 day of Dee eenb4r , 20/ o at AWV;/Ie Po, . I declare that I sign and execute this document as my last will, that I sign it willingly and that I execute it as my free and voluntary act. I declare that I am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. Signature: Qe�Witnesses We, the witnesses, sign our names to this document,and declare that the testator willingly signed and executed this document as the testator's last will. In the presence of the testator, and in the presence of each other, we sign this will as witnesses to the testator's signing. //1/ //// //// llll f �J C \�\ Page 3 of 4 Initials: I 'n' �' �' J' Date:\F� C �TV Will of Juan Kennedy To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is of sound mind and is under no constraint or undue influence. We declare under penalty of perjury that the foregoing is true and correct, this day of� ��� at First Witness Sign your name: ALI kk-cw Print your name: w a l� L � Address: O 7�� l ,I'Vl I City, State: WV�I Second Witness Sign your name: Print your name: Address: �'qz City, State: Page4of4Initials: �• � y / I� U ' Date:` �S Affidavit ACKNOWLEDGMENT Commonwealth of Pennsylvania County of.- .(�M 4VI j L jw 4 k1A the testator whose name is signed to the attached or foregoing instrumen"havi been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Testator: Officer: y NOTARIAL SEAL SHIRLEY A KENNEDY Notary Public - PENN TWP.,CUMBERLAND COUNTY My Commission Expires Jul 18,2013 Affidavit—Page 1 of 2 . . V M P Affidavit AFFIDAVIT Commonwealth of Pennsylvania County of: We, and �[ the witnesses whose names are signed to the attached or foregoing instrument,having been duly qualified according to law,do depose and say that we were present and saw the testator sign and execute the instrument as his/her Last Will; that the testator signed willingly and executed it as his/her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the Crest of our knowledge the testator was at that time 18 or more years of age,of sound mind and under no constraint or undue influence. Sworn to or affirmed qnd subscribed It efo er'mnenfby �n,' I �',{ and ��i [K 1 Vt o I�tOE'it' J witnesses, this. _day of �. Witness: Witness: Z4a-'Z� Officer: NOTARIAL SEAL SHIRLEY A KENNEDY Notary Public PENN TWP.• CUMBERLAND COUNTY My Commission Expires Jul 18, 2073 Affidavit—Page 2 of 2 Property Dapper Cumberland County, PA J 41, J x *7 X11 .. ,&EX 38 HILL YY" I r + d f g [ _• { 5 •g Square reet: 134d ;t < , clean&clean stat= P d w :tt+ .#r. „}�`� �d y fludding Assessed Value 83100 Total Assessed Value 101100 r/ Sale Price$:21500 jj ate Date:Mon Sep 25 1978 ... Copyright 2011 Esri. All rights reserved.•Mon Feb 10 2014 05:38:32 PM. 38 MILL STREET PIN: 23-31-2187-045 Deedbook: 0028B-00488 Owner: KENNEDY, JUAN & SUZANNE M Land Use Code: 101 Property Type: R Acreage: 0.29 Square Feet: 1344 Taxable Status: T Clean & Green Status: Land Assessed Value $: 18000 Building Assessed Value $: 83100 Total Assessed Value $: 101100 Sale Price $: 21500 Sale Date: Mon Sep 25 1978 08:00:00 PM Year Built: 1900 Municipality: MT HOLLY SPRINGS BORO Height in Stories: 2 Type of Dwelling: DETACH Primary Exterior: Wood Basement Percentage: 50 Air Conditioning: NO Total Rooms: 7 Bedrooms: 3 Full Bath: 1 Half Bath: q tom'_-'� �C4'tc"`�rt✓t�t %a ; e �4 E" lIIaT—Wwnm1 Wtl,llwR ranM1 W d lfOl. RCC,04fD�C DM•OrgCE 4F THE Aeffir DUN BE RI MD COUNT /� Sv 26 3 so PM 18 MADE THE e7�� day of /�/ '� in the year of cur Lord one thousand nine hundred seventy-eigKt (1978) BETWEEN RUSSELL D. STARNER and SUE A. STARNER, his wife, of Mt. Holly Springs, Cumberland County, Pennsylvania, hereinafter called i K ,I Grantors , and JUAN KENNEDY and SUZANNE M. KENNEDY, his wife, of Mt. Holly Springs, Cumberland County, Pennsylvania, hereinafter called .. .- Grantees WITNESSETH,that in consideration of TWENTY-ONE THOUSAND FIVE HUNDRED and 00/100---------------------------------------($21,500.00) Dollars, in hand paid,the receipt whereof is hereby acknowledged,the said grantors do hereby grant and convey to the said grantees, their heirs and assigns: I ALL that certain lot of ground with improvements thereon erected situate in the Borough of Mount Holly Springs, Cumberland County, Pennsylvania, bounded and described as follows: BEGINNING at the Southwest intersection of Mill and Fairfield Streets; thence in a Southwesterly direction along Mill Street 60 feet to a point on a public alley; thence along said public alley in a Southeasterly direction 183.7 feet to a point on lands now or formerly of Clark Harry; thence along lands of said Clark Harry in a Northeasterly direction 92 feet to a point on the Western side ; of Fairfield Street; thence in a Northwest direction along Fairfield Street 180 feet to a point, the place of BEGINNING. i IT BEING Lot No. 1 of Plan of Lots known as Warner Plan of Lots j recorded in Plan Book 4, Page 23, and being improved with a one- . story block dwelling house. SUBJECT to restrictions as set forth in the deed from Clarence T. ' Dorsey and wife to Richard E. Duttera,. dated June 7, 1968, and recorded in the Cumberland County Recorder's Office in Deed Book "U", Volume 22, Page 549. BEING the same premises which Theodore A. Tichy and Annie Lee Tichy, his wife, by deed dated April 13, 1973, and recorded in the office aforesaid in Deed Book "C", Volume 25., Page 382, granted and conveyed unto Russell D. Starner and Sue A. Starner, grantors herein. tarsveh'd . Cumb. .. .. School Dl,#. Comb. Co. PR. Co.,C Pe. j1 Rol ELI.TmAn L. R..I Ebb Tun.i.r T.. D.b ............ A^1. Ii G^k Co.NO.C.L A,#./TJ MO.GI.A.L .3 BOOK 28 MCE 488 I AND the said grantors hereby covenant and agree that they 1 will warrant generally the property hereby conveyed. COMMONWEAI➢1 OF RFNNSYLPAtJba = DUARIMENi OF REVENUE _ c GiALNP xg" i]FNSFFR SFY16'70 ��1 ux Ce.iust IN WITNESS WHEREOF, said grantors have hereunto set their hands and seals the day and year first above written. Witness: �� _ � _ �� (SEAL) �F-,- Russ--errD�'tarn,tT�'.er � Ue A. to a �—(S ) COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) On this, the .V I&r day of / u 1978, before me, the undersigned officer, personally appeared Russell D. Starner and Sue A. Starner, known to me or satisfactorily proven to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes ,; therein contained. ., In witness whereof. I hereunto set my hand and official<s, xs,'... x, ry covr�sissoa omats oer.m+sit Ul7 ,� ` o : :."c4,' N.S I hereby certify that the precise residence and complete post office address of the within Grantees is 38 Mill Street, Mt. Holly Springs, PA 17065. 1978 or Grantees :C 28 PACE 489 i s ���1� © M&TBank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-502-4349 F ax (302)934-2955 February 26,2014 Martson Law Offices 10 East High Street Carlisle, PA 17013 Re: Estate of Juan Kennedy Social Security: 206-32-4834 Date of Death: February 7, 2014 Dear Sir or Madam: Per your inquiry on February 21, 2014, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 50897306 Ownership(Names ofi Juan Kennedy p 3 D ZO I y — M 4T LO rl Fj`2 M fro Suzanne M Kennedy Pamela RKnowlton j FRYr7EL-A w'Ab A PtiW Du�NLa2 y4++o12Ve% N°T r} JoihT Opening Date 0812811975 Balance on Date of Death $ 19,587.08 Accrued Interest $ .00 Total $19,587.08 S Jt 2l G For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the Spring Garden at 717-240.1525. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valarie Mercer Records Management sdr TRlNS NE TC d 4333 Edgwoo d Road NY. ® LIFE INSURANCE COMPANY Cedar Rapids,1A 52499 www.transamcdcaannuitics.com February 14, 2014 RE: Annuity Number(s) 02CET090810 Dear Claimant: We have received notification of the death of Juan Kennedy. We extend our sincere condolences to you for your loss. The information in this letter is being provided to assist you in submitting death claim paperwork. Our records reflect the following information regarding this annuity: Annuitant: Juan Kennedy Owner: Juan Kennedy Claimant: �eE Annuity value: $66,705..27 as of 02-07-2014 G" Annuity type: Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting an option. General Information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as Systematic Payouts and Automatic Payments have been stopped. an AEGON company